Search results for: association rule

Authors: Jiaqian Yin, Ruoling Chen, David Churchill, Huijuan Zou, Peipei Guo, Chunmei Liang, Xiaoqing Peng, Zhikang Zhang, Weiju Zhou, Yunxia Cao

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Purpose: This study aimed to explore the interaction of male and female age on implantation failure from in vitro fertilisation (IVF)/ intracytoplasmic sperm injection (ICSI) treatments in couples following their first cycles using the Anhui Maternal-Child Health Study (AMCHS). Methods: The AMCHS recruited 2042 infertile couples who were physically fit for in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatment at the Reproductive Centre of the First Affiliated Hospital of Anhui Medical University between May 2017 to April 2021. This prospective cohort study analysed the data from 1910 cohort couples for the current paper data analysis. The multivariate logistic regression model was used to identify the effect of male and female age on implantation failure after controlling for confounding factors. Male age and female age were examined as continuous and categorical (male age: 20-<25, 25-<30, 30-<35, 35-<40, ≥40; female age: 20-<25, 25-<30, 30-<35, 35-<40, ≥40) predictors. Results: Logistic regression indicated that advanced maternal age was associated with increased implantation failure (P<0.001). There was evidence of an interaction between maternal age (30-<35 and ≥ 35) and paternal age (≥35) on implantation failure. (p<0.05). Only when the male was ≥35 years of increased maternal age was associated with the risk of implantation failure. Conclusion: In conclusion, there was an additive effect on implantation failure with advanced parental age. The impact of advanced maternal age was only seen in the older paternal age group. The delay of childbearing in both men and women will be a serious public issue that may contribute to a higher risk of implantation failure in patients needing assisted reproductive technology (ART).

Keywords: parental age, infertility, cohort study, IVF

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Authors: Okafor Joan, Nwodo Uchechukwu

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Klebsiella pneumoniae (K. pneumoniae) is a significant pathogen responsible for opportunistic and nosocomial infection. One of the most significant antibiotic resistance mechanisms in K. pneumoniae isolates is efflux pumps. Our current study identified efflux genes (AcrAB, OqxAB, MacAB, and TolC) and regulatory genes (RamR and RarA) in multidrug-resistant (MDR) K. pneumoniae isolated from hospital effluents and investigated their relationship with antibiotic resistance. The sum of 145 K. pneumoniae isolates was established by PCR and screened for antibiotic susceptibility. PCR detected efflux pump genes, and their link with antibiotic resistance was statistically examined. However, 120 (83%) of the confirmed isolated were multidrug-resistant, with the largest percentage of resistance to ampicillin (88.3%) and the weakest rate of resistance to imipenem (5.5%). Resistance to the other antibiotics ranged from 11% to 76.6%. Molecular distribution tests show that AcrA, AcrB, MacA, oqxB oqxA, TolC, MacB were detected in 96.7%, 85%, 76.7%, 70.8%, 55.8%, 39.1%, and 29.1% respectively. However, 14.3% of the isolates harboured all seven genes screened. Efflux pump system AcrAB (83.2%) was the most commonly detected in K. pneumonia isolated across all the antibiotics class-tested. In addition, the frequencies of RamR and RarA were 46.2% and 31.4%, respectively. AcrAB and OqxAB efflux pump genes were significantly associated with fluoroquinolone, beta-lactam, carbapenem, and tetracycline resistance (p<0.05). The high rate of efflux genes in this study demonstrated that this resistance mechanism is the dominant way in K. pneumoniae isolates. Appropriate treatment must be used to reduce and tackle the burden of resistant Klebsiella pneumonia in hospital wastewater effluents.

Keywords: Klebsiella pneumonia, efflux pumps, regulatory genes, multidrug-resistant, hospital, PCR

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Authors: Rithika Sriram, Kiran M. Bhojwani

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Introduction : Tuberculosis of the head and neck has proved to be a diagnostic challenge for otorhinolarynologists around the world. These lesions are often misdiagnosed as cancer. So in order to contribute to a better understanding of these lesions, we have conducted our study among patients affected by TB in the head and neck region with the objective of assessing the various manifestations, presentations, diagnostic techniques, risk factors such as smoking and alcohol consumption, coexisting illnesses and treatment modalities. Materials and Methods: This was a retrospective study conducted over a three year period (2012-2014) in 2 hospitals affliated to Kasturba Medical College in Mangalore, South India. A semi structured proforma was used to capture information from the medical records pertaining to the various objectives of the study such as clinical features and history of smoking. Data was analysed using SPSS version 16.0 and results obtained were depicted as percentages. Chi square test was used to find association between the variables and p<0.05 was considered statistically significant. Results: 104 patients were found to have TB of the head and neck and among them,the most common manifestation was found to be Tubercular Lymphadenitis (86.53%), followed by laryngeal TB (4.8%), submandibular gland TB (3.8%), deep neck space abscess(3.8%) and adenotonsillar TB. FNAC was found to be the gold standard for the diagnosis of TB disease of the lymph node.26% of the patients had coexisting HIV infection and 16.3% of the patients had associated pulmonary TB. More than 20% of the patients were smokers. Most patients were treated using ATT. Conclusion: Tuberculosis affecting regions of head and neck is no longer uncommon. Sufficient knowledge and appropriate diagnostic means is required while dealing with these lesions and must be included in the differential diagnosis of pathological lesions of head and neck.

Keywords: FNAC, Mangalore, smoking, tuberculosis

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Authors: Muhammad Adeel Arshad, Faiz-Ul Hassan, Yanfen Cheng

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According to FAO, enteric methane (CH4) production is about 44% of all greenhouse gas emissions from the livestock sector. Ruminants produce CH4 as a result of fermentation of feed in the rumen especially from roughages which yield more CH4 per unit of biomass ingested as compared to concentrates. Efficient ruminal fermentation is not possible without abating CO2 and CH4. Methane abatement strategies are required to curb the predicted rise in emissions associated with greater ruminant production in future to meet ever increasing animal protein requirements. Ecology of ruminal methanogenesis and avenues for its mitigation can be identified through various genomic and transcriptomic techniques. Programs such as Hungate1000 and the Global Rumen Census have been launched to enhance our understanding about global ruminal microbial communities. Through Hungate1000 project, a comprehensive reference set of rumen microbial genome sequences has been developed from cultivated rumen bacteria and methanogenic archaea along with representative rumen anaerobic fungi and ciliate protozoa cultures. But still many species of rumen microbes are underrepresented especially uncultivable microbes. Lack of sequence information specific to the rumen's microbial community has inhibited efforts to use genomic data to identify specific set of species and their target genes involved in methanogenesis. Metagenomic and metatranscriptomic study of entire microbial rumen populations offer new perspectives to understand interaction of methanogens with other rumen microbes and their potential association with total gas and methane production. Deep understanding of methanogenic pathway will help to devise potentially effective strategies to abate methane production while increasing feed efficiency in ruminants.

Keywords: Genome sequences, Hungate1000, methanogens, ruminal fermentation

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Authors: Chuan Yang, Jing Bie, Zhong Wang, Panagiotis Psimoulis

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Contemporary studies investigating the association between the spatial configuration of the urban network and economic activities at the street level were mostly conducted within space syntax conceptual framework. These findings supported the theory of 'movement economy' and demonstrated the impact of street configuration on the distribution of pedestrian movement and land-use shaping, especially retail activities. However, the effects varied between different urban contexts. In this paper, the relationship between economic activity distribution and the urban configurational characters was examined at the segment level. In the study area, three kinds of neighbourhood types, urban, suburban, and rural neighbourhood, were included. And among all neighbourhoods, three kinds of urban network form, 'tree-like', grid, and organic pattern, were recognised. To investigate the nested effects of urban configuration measured by space syntax approach and urban context, multilevel zero-inflated negative binomial (ZINB) regression models were constructed. Additionally, considering the spatial autocorrelation, spatial lag was also concluded in the model as an independent variable. The random effect ZINB model shows superiority over the ZINB model or multilevel linear (ML) model in the explanation of economic activities pattern shaping over the urban environment. And after adjusting for the neighbourhood type and network form effects, connectivity and syntax centrality significantly affect economic activities clustering. The comparison between accumulative and new established economic activities illustrated the different preferences for economic activity location choice.

Keywords: space syntax, economic activities, multilevel model, Chinese city

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Authors: Ginés Hernández-Cánovas, Mª Camino Ramón-Llorens, Johanna Koëter-Kant

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This paper uses a survey data-set of 837 Spanish SMEs to analyze the association between borrower discouragement and prior firm´s strategic decisions, while controlling for firm and owner characteristics. While existing literature has neglected factors limiting the demand for resources by an overreliance on arguments which attempt to explain the existence of discouraged borrowers solely in terms of lack of access to supply of credit. The objective of this paper is to show that factors limiting the demand for resources and, therefore, reducing the availability of funds, can be traced back to the firm manager´s decision. Our hypothesis is that managers that undertake strategic decisions seeking growth or improvement in their business performance participate more in the banking market than those showing contentment with their current business situation. Our results shows that SMEs that undertake an active role in research and development activities and that achieve improvements in the operating performance of their business are less likely to be discouraged from applying for a loan. Who needs credit and who applies for credit is important for firms, prospective lenders and policymakers interested in the financial health of these firms. Credit constrained firms are less likely to invest in R&D and to introduce new products, possibly harming long-term economic growth. Knowing how important borrower discouragement is in Europe, is important for judging the priority which should be attached to government policies aimed at reducing its effects. For example, policy makers could encourage the transparency about credit eligibility and conditions in order to reduce discouragement.

Keywords: discouragement, financial constraints, SMEs financing

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Authors: Yohannes Bisa Biramo

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This study examined the meditational role of surface acting and deep acting on the relationship between calling orientation and work engagement of teachers in secondary schools of Wolaita Zone, Wolaita, Ethiopia. A predictive non-experimental correlational design was performed among 300 secondary school teachers. Stratified random sampling followed by a systematic random sampling technique was used as the basis for selecting samples from the target population. To analyze the data, Structural Equation Modeling (SEM) was used to test the association between the independent variables and the dependent variables. Furthermore, the goodness of fit of the study variables was tested using SEM to see and explain the path influence of the independent variable on the dependent variable. Confirmatory factor analysis (CFA) was conducted to test the validity of the scales in the study and to assess the measurement model fit indices. The analysis result revealed that calling was significantly and positively correlated with surface acting, deep acting and work engagement. Similarly, surface acting was significantly and positively correlated with deep acting and work engagement. And also, deep acting was significantly and positively correlated with work engagement. With respect to mediation analysis, the result revealed that surface acting mediated the relationship between calling and work engagement and also deep acting mediated the relationship between calling and work engagement. Besides, by using the model of the present study, the school leaders and practitioners can identify a core area to be considered in recruiting and letting teachers teach, in giving induction training for newly employed teachers and in performance appraisal.

Keywords: calling, surface acting, deep acting, work engagement, mediation, teachers

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Authors: Yuexin Liu, Gordon B. Mills, Russell R. Broaddus, John N. Weinstein

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The lethality of endometrioid endometrial cancer (EEC) is primarily attributable to the high-stage diseases. However, there are no available biomarkers that predict EEC patient staging at the time of diagnosis. We aim to develop a predictive scheme to help in this regards. Using reverse-phase protein array expression profiles for 210 EEC cases from The Cancer Genome Atlas (TCGA), we constructed a Protein Scoring of EEC Staging (PSES) scheme for surgical stage prediction. We validated and evaluated its diagnostic potential in an independent cohort of 184 EEC cases obtained at MD Anderson Cancer Center (MDACC) using receiver operating characteristic curve analyses. Kaplan-Meier survival analysis was used to examine the association of PSES score with patient outcome, and Ingenuity pathway analysis was used to identify relevant signaling pathways. Two-sided statistical tests were used. PSES robustly distinguished high- from low-stage tumors in the TCGA cohort (area under the ROC curve [AUC]=0.74; 95% confidence interval [CI], 0.68 to 0.82) and in the validation cohort (AUC=0.67; 95% CI, 0.58 to 0.76). Even among grade 1 or 2 tumors, PSES was significantly higher in high- than in low-stage tumors in both the TCGA (P = 0.005) and MDACC (P = 0.006) cohorts. Patients with positive PSES score had significantly shorter progression-free survival than those with negative PSES in the TCGA (hazard ratio [HR], 2.033; 95% CI, 1.031 to 3.809; P = 0.04) and validation (HR, 3.306; 95% CI, 1.836 to 9.436; P = 0.0007) cohorts. The ErbB signaling pathway was most significantly enriched in the PSES proteins and downregulated in high-stage tumors. PSES may provide clinically useful prediction of high-risk tumors and offer new insights into tumor biology in EEC.

Keywords: endometrial carcinoma, protein, protein scoring of EEC staging (PSES), stage

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Authors: Francesco Pisano

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Islam has been an important topic in Turkey’s institutional identity. Since the dawn of the Turkish Republic, at the end of the First World War, the new Turkish leadership was urged to deal with the religious heritage of the Sultanate. Mustafa Kemal Ataturk, Turkey’s first President, led the country in a process of internal change, substantially modifying not merely the democratic stance of it, but also the way politics was addressing the Muslim faith. Islam was banned from the public sector of the society and was drastically marginalized to the mere private sphere of citizens’ lives. Headscarves were banned from institutional buildings together with any other religious practice, while the country was proceeding down a path of secularism and Westernization. This issue is demonstrated by the fact that even a new elected Prime Minister, Recep Tayyip Erdoğan, was initially barred from taking the institutional position, because of allegations that he had read a religious text while campaigning. Over the years, thanks to this initial internal shift, Turkey has often been seen by Western partners as one of the few countries that had managed to find a perfect balance between a democratic stance and an Islamic inherent nature. In the early 2000s, this led many academics to believe that Ankara could eventually have become the next European capital. Since then, the internal and external landscape of Turkey has drastically changed. Today, religion has returned to be an important point of reference for Turkish politics, considering also the failure of the European negotiations and the always more unstable external environment of the country. This paper wants to address this issue, looking at the important role religion has covered in the Turkish society and the way it has been politicized since the early years of the Republic. It will evolve from a more theoretical debate on secularism and the path of political westernization of Turkey under Ataturk’s rule to a more practical analysis of today’s situation, passing through the failure of Ankara’s accession into the EU and the current tense political relation with its traditional NATO allies. The final objective of this research, therefore, is not to offer a meticulous opinion on Turkey’s current international stance. This issue will be left entirely to the personal consideration of the reader. Rather, it will supplement the existing literature with a comprehensive and more structured analysis on the role Islam has played on Turkish politics since the early 1920s up until the political domestic revolution of the early 2000s, after the first electoral win of the Justice and Development Party (AKP).

Keywords: democracy, Islam, Mustafa Kemal Atatürk, Recep Tayyip Erdoğan, Turkey

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Authors: R. Janyaphadungpong, A. Pimkhaokham

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This prospective clinical study determined the insertion torque (IT) value and monitored the changes in implant stability quotient (ISQ) values during the 12 weeks healing period from implant placement without bone graft (control group) and with bone graft using the guided bone regeneration (GBR) technique (study group). The relationship between the IT and ISQ values of the implants was also assessed. The control and study groups each consisted of 6 patients with 8 implants per group. The ASTRA TECH Implant System™ EV 4.2 mm in diameter was placed in the posterior mandibular region. In the control group, implants were placed in bone without bone graft, whereas in the study group implants were placed simultaneously with the GBR technique at favorable bone defect. IT (Ncm) of each implant was recorded when fully inserted. ISQ values were obtained from the Osstell® ISQ at the time of implant placement, and at 2, 4, 8, and 12 weeks. No difference in IT was found between groups (P = 0.320). The ISQ values in the control group were significantly higher than in the study group at the time of implant placement and at 4 weeks. There was no significant association between IT and ISQ values either at baseline or after the 12 weeks. At 12 weeks of healing, the control and study groups displayed different trends. Mean ISQ values for the control group decreased over the first 2 weeks and then started to increase. ISQ value increases were statistically significant at 8 weeks and later, whereas mean ISQ values in the study group decreased over the first 4 weeks and then started to increase, with statistical significance after 12 weeks. At 12 weeks, all implants achieved osseointegration with mean ISQ values over the threshold value (ISQ>70). These results indicated that implants, in which guided bone regeneration technique was performed during implant placement for treating favorable bone defects, were as predictable as implants placed without bone graft. However, loading in implants placed with the GBR technique for correcting favorable bone defects should be performed after 12 weeks of healing to ensure implant stability and osseointegration.

Keywords: dental implant, favorable bone defect, guided bone regeneration technique, implant stability

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Authors: Carol Howells, Edwin Parks

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This paper explores the existing and evolving constitutional arrangements within the United Kingdom and within the wider international context of the EU. It considers the nature of an ‘English’ constitution and internal colonialism that underpins it. The debates over the UK’s exit from the EU have been many however the constitutional position of the devolved nations (Scotland, Northern Ireland and Wales) is little understood or explored. Their constitutional position has been touched upon in academic debate (but not widely) and is only now beginning to receive attention. The paper considers the constitutional role of the legislatures within the UK; the UK Parliament Bill for exiting the European Union and provides a commentary on the Brexit process in relation to constitutional arrangements within the UK and EU. Questions arise over the constitutional framework and, whether, having delegated competencies, the UK Parliament can now legislate in relation to delegated competencies without the consent. The Scottish Parliament and Welsh Assembly are a permanent and a fixed feature of the UK’s constitution, but their position is set within the traditional concept of the ‘English’ constitution. The current situation is opaque and complex and raises significant constitutional questions. In relation to exit from the EU two of the nations did not vote in favour of Brexit and the third is in receipt of an inequitable funding settlement. Questions arise as to whether the work of modernising the UK’s constitution over the past twenty years in recognising the Nations and governments within those nations is now being unpicked and whether the piecemeal and unequal process of devolution and new constitutional arrangements hold weight. Questions of democratic legitimacy arise throughout. An advisory referendum (where no definition of the EU was provided) in which two of the four nations voted to leave the EU and two voted to remain has led the UK Government negotiating a wholesale exit from the EU based on ‘English’ constitutional law principles. Previous constitutional referendums in relation to devolution within the UK have been treated differently. Within the EU questions are being raised in relation to the focus on member states. The goals of the EU mention member countries and its purpose is seen as being to promote greater social, political and economic harmony among the nations of Europe. The emphasis on member states is proving challenging and has led flawed processes. Scrutiny of legislative proposals, historical developments, and social commentary reveal distinct national identities within the UK. Analysis of the debate, legislation and case law surrounding the exiting process from the EU reveal a muddled picture of a constitution in crisis and significant challenges to principles underpinning the rule of law. Suggestions are made for future reforms and a move towards new constitutional arrangements beyond the current ‘English’ constitution.

Keywords: English, constitution, parliament, devolved

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Authors: Ashna Sinha, Surendra Varma

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The Asian elephant is predominantly found in South Asian and Southeast Asian countries. They are intrinsically associated with the religions, religious and cultural practices and festivals of these regions. Amazingly, these magnificent animals are also mentioned in the texts and are found sculpted on the walls of places of religious significance even in the Middle Eastern countries, and evidently, they have been mentioned in all the major religions. The elephants are intrigued and associated with the cultural and religious practices of Asians for thousands of years. While some of the practices and festivals in certain geographical regions are going on for years; some regions and religions have gone through a cultural shift and cultural adaptation, and have incorporated the participation of these divine beings. The symbolism of elephants is used for preaching and giving philosophical lessons through stories and painted art, across different religions through varying literary and visual artworks. The animals carved on the ancient and present day temples can easily be found in South and South East Asian countries, signifying the importance of the animal in a given religion which the temples are associated with. Though not sculpted but captive elephants are easily found on the premises of the places of worship to give a blessing to the people or to give a tour to show their own connotation with the religion. They are also used for carrying out processions in varying religious and cultural activities, and are considered to be of immense value as they add an extra glamour and publicize the wealth and weightiness of that distinct religion or culture. Our critical review of elephant’s association with religions and their practices show, although they give a higher degree of value and respects to this animal, the practices do not match with their biological design, but profoundly compromise their welfare and conservation. It is time to follow the values the animal enjoy and use the same for their conservation and welfare.

Keywords: conservation, elephant, religion, welfare

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Authors: Sara Przetocka, Krzysztof Żak, Grzegorz Dubin, Tadeusz Holak

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Toll-like receptors (TLRs) play central role in the innate immune response and inflammation by recognizing pathogen-associated molecular patterns (PAMPs). A fundamental basis of TLR signalling is dependent upon the recruitment and association of adaptor molecules that contain the structurally conserved Toll/interleukin-1 receptor (TIR) domain. MyD88 (myeloid differentiation primary response gene 88) is the universal adaptor for TLRs and cooperates with Mal (MyD88 adapter-like protein, also known as TIRAP) in TLR4 response which is predominantly used in inflammation, host defence and carcinogenesis. Up to date two possible models of MyD88, Mal and TLR4 interactions have been proposed. The aim of our studies is to confirm or abolish presented models and accomplish the full structural characterisation of TIR domains interaction. Using molecular cloning methods we obtained several construct of MyD88 and Mal TIR domain with GST or 6xHis tag. Gel filtration method as well as pull-down analysis confirmed that recombinant TIR domains from MyD88 and Mal are binding in complexes. To examine whether obtained complexes are homo- or heterodimers we carried out cross-linking reaction of TIR domains with BS3 compound combined with mass spectrometry. To investigate which amino acid residues are involved in this interaction the NMR titration experiments were performed. 15N MyD88-TIR solution was complemented with non-labelled Mal-TIR. The results undoubtedly indicate that MyD88-TIR interact with Mal-TIR. Moreover 2D spectra demonstrated that simultaneously Mal-TIR self-dimerization occurs which is necessary to create proper scaffold for Mal-TIR and MyD88-TIR interaction. Final step of this study will be crystallization of MyD88 and Mal TIR domains complex. This crystal structure and characterisation of its interface will have an impact in understanding the TLR signalling pathway and possibly will be used in development of new anti-cancer treatment.

Keywords: cancer, MyD88, TIR domains, Toll-like receptors

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Authors: Md. Fazlul Karim, Ashik Sharfaraz, Aysha Ferdoushi

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Background: Computational medicinal chemistry approaches are used for designing and identifying new drug-like molecules, predicting properties and pharmacological activities, and optimizing lead compounds in drug development. SIRT7, a nicotinamide adenine dinucleotide (NAD+)-dependent deacylase which regulates aging, is an emerging target for cancer therapy with mounting evidence that SIRT7 downregulation plays important roles in reversing cancer phenotypes and suppressing tumor growth. Activation or altered expression of SIRT7 is associated with the progression and invasion of various cancers, including liver, breast, gastric, prostate, and non-small cell lung cancer. Objectives: The goal of this work was to identify potent and selective bioactive candidate inhibitors of SIRT7 by in silico screening of small molecule compounds obtained from Nigella sativa (N. sativa). Methods: SIRT7 structure was retrieved from The Research Collaboratory for Structural Bioinformatics Protein Data Bank (RCSB PDB), and its active site was identified using CASTp and metaPocket. Molecular docking simulation was performed with PyRx 0.8 virtual screening software. Drug-likeness properties were tested using SwissADME and pkCSM. In silico toxicity was evaluated by Osiris Property Explorer. Bioactivity was predicted by Molinspiration software. Antitumor activity was screened for Prediction of Activity Spectra for Substances (PASS) using Way2Drug web server. Molecular dynamics (MD) simulation was carried out by Desmond v3.6 package. Results: A total of 159 bioactive compounds from the N. Sativa were screened against the SIRT7 enzyme. Five bioactive compounds: chrysin (CID:5281607), pinocembrin (CID:68071), nigellidine (CID:136828302), nigellicine (CID:11402337), and epicatechin (CID:72276) were identified as potent SIRT7 anti-cancer candidates after docking score evaluation and applying Lipinski's Rule of Five. Finally, MD simulation identified Chrysin as the top SIRT7 anti-cancer candidate molecule. Conclusion: Chrysin, which shows a potential inhibitory effect against SIRT7, can act as a possible anti-cancer drug candidate. This inhibitor warrants further evaluation to check its pharmacokinetics and pharmacodynamics properties both in vitro and in vivo.

Keywords: SIRT7, antitumor, molecular docking, molecular dynamics simulation

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Authors: Madhuka G. P. D. Udantha, Gihan V. Dias, Surangika Ranathunga

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Today Websites contain very interesting applications. But there are only few methodologies to analyze User navigations through the Websites and formulating if the Website is put to correct use. The web logs are only used if some major attack or malfunctioning occurs. Web Logs contain lot interesting dealings on users in the system. Analyzing web logs has become a challenge due to the huge log volume. Finding interesting patterns is not as easy as it is due to size, distribution and importance of minor details of each log. Web logs contain very important data of user and site which are not been put to good use. Retrieving interesting information from logs gives an idea of what the users need, group users according to their various needs and improve site to build an effective and efficient site. The model we built is able to detect attacks or malfunctioning of the system and anomaly detection. Logs will be more complex as volume of traffic and the size and complexity of web site grows. Unsupervised techniques are used in this solution which is fully automated. Expert knowledge is only used in validation. In our approach first clean and purify the logs to bring them to a common platform with a standard format and structure. After cleaning module web session builder is executed. It outputs two files, Web Sessions file and Indexed URLs file. The Indexed URLs file contains the list of URLs accessed and their indices. Web Sessions file lists down the indices of each web session. Then DBSCAN and EM Algorithms are used iteratively and recursively to get the best clustering results of the web sessions. Using homogeneity, completeness, V-measure, intra and inter cluster distance and silhouette coefficient as parameters these algorithms self-evaluate themselves to input better parametric values to run the algorithms. If a cluster is found to be too large then micro-clustering is used. Using Cluster Signature Module the clusters are annotated with a unique signature called finger-print. In this module each cluster is fed to Associative Rule Learning Module. If it outputs confidence and support as value 1 for an access sequence it would be a potential signature for the cluster. Then the access sequence occurrences are checked in other clusters. If it is found to be unique for the cluster considered then the cluster is annotated with the signature. These signatures are used in anomaly detection, prevent cyber attacks, real-time dashboards that visualize users, accessing web pages, predict actions of users and various other applications in Finance, University Websites, News and Media Websites etc.

Keywords: anomaly detection, clustering, pattern recognition, web sessions

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Authors: Getnet Gedefaw, Fentanesh Endalew, Bitewush Azmeraw, Bethelhem Walelign, Eyob Shitie

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Introduction: The issue of menstrual hygiene is often overlooked and has not been sufficiently addressed in the fields of reproductive health in low and middle-income countries. Inadequate menstrual hygiene practices can increase the risk of various infectious and chronic obstetric and gynaecological complications for girls and adolescents. Hence, this study seeks to investigate the knowledge, attitudes, and practices related to menstrual hygiene, along with the factors influencing them, among high school students. Methods: A facility based cross-sectional study was conducted involving a total of 423 study subjects. A systematic random sampling technique was utilized. Data was entered and analyzed through Epi data 3.1 and SPSS 22, respectively. Both univariable and multivariable logistic regression models were employed. A p-value of less than 0.05 was considered statistically significant. Results: This study revealed that 365(89.2%), 200(48.9%) and 196(47.9%) of the study participants have good knowledge, good practice, and good attitudes about menstrual hygiene, respectively. Being higher grade students (grade 10) [AOR=3.96, 95% CI =2.0-7.8] and having good practice of menstrual hygiene (AOR=2.52, 95% CI= 1.26-5) had a positive association with menstrual hygiene knowledge. Whereas maternal education level (AOR=1.86, 95% CI=1.18-2.9) and being a grade 10 student (AOR=2.3, 95% CI=1.48-3.56) were associated factors for practising menstrual hygiene. Additionally, being higher grade students (AOR=1.9, 95% CI=1.2-2.8), age ≥18 years (AOR=1.67, 95% CI=1.09-2.55) were statistically and positively associated with the attitude of menstrual hygiene. Conclusion: The study findings indicated that the knowledge of the study participants regarding menstrual hygiene was high, while their attitudes and practices towards menstrual hygiene were low. It is suggested that raising awareness among reproductive health groups and educating their families and parents could potentially lead to a positive change in their poor practices and attitudes towards menstrual hygiene.

Keywords: menstrual hygiene, menstruation, students, reproductive health

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Authors: Jill Garner, Belinda Lange, Sheila Lennon, Maayken van den Berg

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Currently, there are approximately one billion people worldwide affected by a neurological condition. Many of whom are assessed and treated by a physiotherapist in a variety of settings. There is a lack of consensus in the literature related to what is clinically assessed by physiotherapists in people with neurological conditions. This study aimed to explore assessment in people with neurological conditions, including how health care setting, experience, and therapeutic approach, may influence neurological assessment. A national survey targeted Australian physiotherapists who assess adults with neurological conditions as part of their clinical practice. The survey consisted of 39 questions and was distributed to physiotherapists through the Australian Physiotherapy Association, and Chief Allied Health Officers across Australia and advertised on the National Neurological Physiotherapy Facebook page. In total, 395 respondents consented to the survey from all states within Australia. Most respondents were female (85.4%) with a mean (SD) age of 35.7 years. Respondents reported working clinically in acute, community, outpatients, and community settings. Stroke was the most assessed condition (58.0%). There is variability in domains assessed by Australian physiotherapists, with common inclusions of balance, muscle strength, gait, falls and safety, function, goal setting, range of movement, pain, coordination, activity tolerance, postural alignment and symmetry and upper limb. There is little evidence to support what physiotherapists assess in practice, in different settings, and in different states within Australia and not enough information to develop a decision tree regarding what is important for assessment in different settings. Further research is needed to explore this area and develop a consensus around best practices.

Keywords: physiotherapy, neurological, assessment, domains

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Authors: Matthew T. McCarthy, Sarah Janse, Natalie M. Pizzimenti, Anthony K. Savino, Brian Crosser, Sean C. Rose

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Concussion is diagnosed clinically using a comprehensive history and exam, supported by ancillary testing. Frequently, symptom checklists are used as part of the evaluation of concussion. Existing symptom scales are based on a subjective Likert scale, without relation of symptoms to clinical or functional impairment. This is a retrospective review of 133 patients under age 30 seen in an outpatient neurology practice within 30 days of a probable or definite concussion. Each patient completed 2 symptom checklists at the initial visit – the SCAT-3 symptom evaluation (22 symptoms, 0-6 scale) and a scale based on the degree of clinical impairment for each symptom (22 symptoms, 0-3 scale related to functional impact of the symptom). Final clearance date was determined by the treating physician. 60.9% of patients were male with mean age 15.7 years (SD 2.3). Mean time from concussion to first visit was 6.9 days (SD 6.2), and 101 patients had definite concussions (75.9%), while 32 were diagnosed as probable (24.1%). 94 patients had a known clearance date (70.7%) with mean clearance time of 20.6 days (SD 18.6) and median clearance time of 19 days (95% CI 16-21). Mean total symptom score was 27.2 (SD 22.9) on the SCAT-3 and 14.7 (SD 11.9) for the functional impairment scale. Pearson’s correlation between the two scales was 0.98 (p < 0.001). After adjusting for patient and injury characteristics, an equivalent increase in score on each scale was associated with longer time to clearance (SCAT-3 hazard ratio 0.885, 95%CI 0.835-0.938, p < 0.001; functional impairment scale hazard ratio 0.851, 95%CI 0.802-0.902, p < 0.001). A concussion symptom scale based on degree of functional impairment correlates strongly with the SCAT-3 scale and demonstrates a similar association with time to clearance. By assessing the degree of impact on clinical functioning, this symptom scale reflects a more intuitive approach to rating symptoms and can be used in the management of concussion.

Keywords: checklist, concussion, neurology, scale, sports, symptoms

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Authors: Zeynep İnan Ocak, Gülsün Tanyeli

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One of the most important architectural types of Islamic architecture is madrasah used as educational institutions, hospital or observatory. This type of buildings has one or two storeys, central open or closed courtyards, four iwans and students cells located among the iwans. The main characteristic of the designs featured in the portals. The Islamic art features and adornments are seen well on these buildings made of stone. The earliest examples date to late 12th century in Anatolia after the Battle of Manzikert. Under the Seljuks rule over the one thousand facilities were built in 12th and 13th centuries and there are one hundred thirty five madrasah in total list. But today no all of them are conserved only forty percent are remained. The Seljuks madrasah located in many Anatolian were registered as immovable cultural property in several times by Turkish Culture and Tourism Ministry. The first Turkish buildings inscribed on the World Heritage List are the Great Mosque and Hospital of Divriği in 1985. Also the nominated site named as Anatolian Seljuks Madrasah is in the tentative list of UNESCO World Heritage in 2014. The property is composed some of notable madrasah such as İnce Minareli Madrasah and Karatay Madrasah in Konya; Çifte Madrasah and Sahibiye Madrasah in Kayseri; Buruciye Madrasah, Çifte Minareli Madrasah and Gök Madrasah in Sivas; Çifte Minareli Madrasah and Yakutiye Madrasah in Erzurum; Cacabey Madrasah in Kirşehir. Certainly the advantage of tourism is important for conducting the preservation of heritage. It offers much kind of cultural heritage products by means of visiting monuments. In spite of advantage of tourism, it can be the negative effects of tourism on sites and places of cultural significance. While assisting and guiding the conservation works of madrasah, it should be get reference to international charters and other doctrinal texts about the relation between heritage and tourism. Thereby the monuments will be conserved in good condition promoting by tourism. It should be plan a project about the correlation of visitors and heritage to focus on theme of Seljuks architecture. This study aims to set out the principles about the conservation of madrasah as world heritage taking advantages of tourism. The madrasah as a heritage should be evaluated not only a monument but also cultural route. So the cultural route for madrasah is determined by means of a journey through space and time, how the heritage of the different Anatolian cities. Also the cultural route is created visiting both the madrasah and the other medieval structures. In this study, the route, the principles, relation of tourism are represented considering the conservation of Seljuks madrasah.

Keywords: architectural heritage, cultural routes, Seljuks madrasah, Anatolia

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Authors: Fazle Rabbi, Mashuda Khanom Tithi, Tasnim Mirza, Sanjida Rowshan Anannya, Ahmed Hossain

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Background: Low Back Pain (LBP) is one of the common health problems among the garment workers that causes workers absenteeism from the work. The purpose of the study is to identify the association between occupational factors and LBP among the female garment workers in Bangladesh. Materials and Methods: A cross-sectional study was conducted with 487 female garment workers from three compliant garment factories of Bangladesh. Face-to-face interview on four different LBP measures along with questions on socio-demographic, occupational, and physical factors were used to collect the data. Result: The prevalence rates for LBP lasts for at least one day during the last six months, chronic pain, intense pain, and seeking medical care for LBP were found 63.04%, 38.60%, 13.76%, and 18.89%, respectively among the female garments workers. The multivariate logistic regression analysis indicates that duration of employment (>5 years), regular weight bearing and extended weekly working hours (>48 hours) are positively associated with LBP. Besides, age, BMI, family income, marital status and number of children are also found positively associated with the LBP measures. Conclusion: The prevalence of LBP among female garment workers in Bangladesh is found high. The duration of employment (>5 years), regular weight bearing and extended weekly working hours (>48 hours) play a significant role in developing LBP among the female workers. Factories need to consider training programs on the appropriate technique of weight bearing. It is also important to conduct regular screening programs to identify LBP, especially with married, overweight/obese and older age group to reduce the occurrence of LBP.

Keywords: Bangladesh, garment workers, low back pain, occupational health

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Authors: Zerubabel Mihret

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Background: Work-related stress is a pattern of reactions to work demands unmatched by worker’s knowledge, skills, or abilities. Healthcare institutions are considered high-risk and intensive work areas for work-related stress. However, there is the nonexistence of clear and strong data about the magnitude of work-related stress on sanitation workers in hospitals in Ethiopia. The aim of this study was to determine the magnitude of work-related stress among sanitation workers in public hospitals during COVID-19 in Addis Ababa, Ethiopia. Methods: Institution-based cross-sectional study was conducted from October 2021 to February 2022 among 494 sanitation workers who were selected from 4 hospitals. HSE (Health and Safety Executive of UK) standard data collection tool was used, and an interviewer-administered questionnaire was used to collect the data using KOBO collect application. The collected data were cleaned and analyzed using SPSS version 20.0. Both binary and multivariable logistic regression analyses were done to identify important factors having an association with work-related stress. Variables with p-value ≤ 0.25 in the bivariate analysis were entered into the multivariable logistic regression model. A statistically significant level was declared at a p-value ≤ 0.05. Results: This study revealed that the magnitude of work-related stress among sanitation workers was 49.2% (95% CI 45-54). Significant proportions (72.7%) of sanitation workers were dissatisfied with their current job. Sex, age, experience, and chewing khat were significantly associated with work-related stress. Conclusion: Work-related stress is significantly high among sanitation workers. Sex, age, experience, and chewing khat were identified as factors associated with work-related stress. Intervention program focusing on the prevention and control of stress is desired by hospitals.

Keywords: work-related stress, sanitation workers, Likert scale, public hospitals, Ethiopia

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Authors: Betty Chiyangwa

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This paper explores the complexities surrounding second-generation Mozambican migrant youth’s identity and sense of belonging in post-apartheid South Africa, Bushbuckridge. Established in 1884, Bushbuckridge is one of the earliest districts to accommodate first-generation Mozambicans who migrated to South Africa in the 1970s. This is a single case study informed by data from 24 semi-structured interviews and narratives with migrant youth (18-34 years) born and raised in South Africa to Mozambican parent(s) living in Bushbuckridge. Drawing from Sen’s Capability and Crenshaw’s Intersectionality approaches, this paper contributes to the existing body of knowledge on South to South migration by demonstrating how the role of participants’ identity status influences their agency and capability. The subject of youth migrants is often under-researched in the context of migration in South African thus, their opinions and views have often been marginalized in sociology. Through exploring participants’ experiences, this paper reveals that lack of identity status was described to be a huge hindrance to participants to identify as South Africans and they explained that is a constant distortion of their sense of belonging. Un-documentation status restricts participants and threatens their mobility and hinders their agency to access human rights and perpetuates social inequalities as well as hampering future aspirations. This paper concludes there is a strong association between identity status and levels of social integration. The development of a multi-layered comprehensive model in enhancing participants’ identity is recommended. This model encourages a collaborative effort from multiple stakeholders in enhancing and harnessing migrant youth capabilities in host societies.

Keywords: migrant youth, mozambique, second-generation, south africa

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Authors: Vagolu S. Krishna, Shan Zheng, Estharla M. Rekha, Luke W. Guddat, Dharmarajan Sriram

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Tuberculosis (TB) remains a major threat to human health. This due to the fact that current drug treatments are less than optimal as well as the rising occurrence of multi drug-resistant and extensively drug-resistant strains of the etiological agent, Mycobacterium tuberculosis (Mt). Given the wide-spread significance of this disease, we have undertaken a design and evaluation program to discover new anti-TB drug leads. Here, our attention is focused on ketol-acid reductoisomerase (KARI), the second enzyme in the branched-chain amino acid biosynthesis pathway. Importantly, this enzyme is present in bacteria but not in humans, making it an attractive proposition for drug discovery. In the present work, we used high-throughput virtual screening to identify seventeen potential inhibitors of KARI using the Birla Institute of Technology and Science in-house database. Compounds were selected based on high docking scores, which were assigned as the result of favourable interactions between the compound and the active site of KARI. The Ki values for two leads, compounds 14 and 16 are 3.71 and 3.06 µM, respectively for Mt KARI. To assess the mode of binding, 100 ns molecular dynamics simulations for these two compounds in association with Mt KARI were performed and showed that the complex was stable with an average RMSD of less than 2.5 Å for all atoms. Compound 16 showed an MIC of 2.06 ± 0.91 µM and a 1.9 fold logarithmic reduction in the growth of Mt in an infected macrophage model. The two compounds exhibited low toxicity against murine macrophage RAW 264.7 cell lines. Thus, both compounds are promising candidates for development as an anti-TB drug leads.

Keywords: ketol-acid reductoisomerase, macrophage, molecular docking and dynamics, tuberculosis

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Authors: M. De Filippo, J. S. Kuang

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In construction industry, reinforced concrete (RC) slabs represent fundamental elements of buildings and bridges. Different methods are available for analysing the structural behaviour of slabs. In the early ages of last century, the yield-line method has been proposed to attempt to solve such problem. Simple geometry problems could easily be solved by using traditional hand analyses which include plasticity theories. Nowadays, advanced finite element (FE) analyses have mainly found their way into applications of many engineering fields due to the wide range of geometries to which they can be applied. In such cases, the application of an elastic or a plastic constitutive model would completely change the approach of the analysis itself. Elastic methods are popular due to their easy applicability to automated computations. However, elastic analyses are limited since they do not consider any aspect of the material behaviour beyond its yield limit, which turns to be an essential aspect of RC structural performance. Furthermore, their applicability to non-linear analysis for modeling plastic behaviour gives very reliable results. Per contra, this type of analysis is computationally quite expensive, i.e. not well suited for solving daily engineering problems. In the past years, many researchers have worked on filling this gap between easy-to-implement elastic methods and computationally complex plastic analyses. This paper aims at proposing a numerical procedure, through which a pseudo-lower bound solution, not violating the yield criterion, is achieved. The advantages of moment distribution are taken into account, hence the increase in strength provided by plastic behaviour is considered. The lower bound solution is improved by detecting over-yielded moments, which are used to artificially rule the moment distribution among the rest of the non-yielded elements. The proposed technique obeys Nielsen’s yield criterion. The outcome of this analysis provides a simple, yet accurate, and non-time-consuming tool of predicting the lower-bound solution of the collapse load of RC slabs. By using this method, structural engineers can find the fracture patterns and ultimate load bearing capacity. The collapse triggering mechanism is found by detecting yield-lines. An application to the simple case of a square clamped slab is shown, and a good match was found with the exact values of collapse load.

Keywords: computational mechanics, lower bound method, reinforced concrete slabs, yield-line

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Authors: Nicolás Clavijo Buriticá, Laura Viviana Triana Sanchez

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This research develops a productive context associated with the aquaculture industry in northern Tolima-Colombia, specifically in the town of Lerida. Strategic aspects of chain of fish Production-Distribution, especially those related to supply network design of an association devoted to cultivating, farming, processing and marketing of fish are addressed. This research is addressed from a special approach of Supply Chain Management (SCM) which guides management objectives to the system sustainability; this approach is called Sustainable Supply Chain Management (SSCM). The network design of fish production-distribution system is obtained for the case study by two mathematical programming models that aims to maximize the economic benefits of the chain and minimize total supply chain costs, taking into account restrictions to protect the environment and its implications on system productivity. The results of the mathematical models validated in the productive situation of the partnership under study, called Asopiscinorte shows the variation in the number of open or closed locations in the supply network that determines the final network configuration. This proposed result generates for the case study an increase of 31.5% in the partial productivity of storage and processing, in addition to possible favorable long-term implications, such as attending an agile or not a consumer area, increase or not the level of sales in several areas, to meet in quantity, time and cost of work in progress and finished goods to various actors in the chain.

Keywords: Sustainable Supply Chain, mathematical programming, aquaculture industry, Supply Chain Design, Supply Chain Configuration

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Authors: Isomar Lima da Silva, Aristeu Jonatas Leite de Oliveira, Roberto Maia Augusto

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Biological isolation capsules are equipment commonly used in the control and prevention of infectious diseases in the hospital environment. This type of equipment, combined with pre-established medical protocols, contributes significantly to the containment of highly transmissible pathogens such as COVID-19. Due to its hermetic isolation, it allows more excellent patient safety, protecting companions and the health team. In this context, this work presents the development, testing, and validation of a medical capsule to treat patients affected by COVID-19. To this end, requirements such as low cost and easy handling were considered to meet the demand of people infected with the virus in remote locations in the Amazon region and/or where there are no ICU beds and mechanical ventilators for orotracheal intubation. Conceived and developed in a partnership between SAMEL Planos de Saúde and Instituto Conecthus, the device entitled "Vanessa Capsule" was designed to be used together with the NIV protocol (non-invasive ventilation), has an automatic exhaust system and filters performing the CO2 exchange, in addition to having BiPaps ventilatory support equipment (mechanical fans) in the Cabin Kit. The results show that the degree of effectiveness in protecting against infection by aerosols, with the protection cabin, is satisfactory, implying the consideration of the Vanessa capsule as an auxiliary method to be evaluated by the health team. It should also be noted that the medical observation of the evaluated patients found that the treatment against the COVID-19 virus started earlier with non-invasive mechanical ventilation reduces the patient's suffering and contributes positively to their recovery, in association with isolation through the Vanessa capsule.

Keywords: COVID-19, mechanical ventilators, medical capsule, non-invasive ventilation

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Authors: A. Sherif, H. Sabry, A. Elzafarany, M. Gadelhak, R. Arafa, M. Aly

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This paper addresses the design of hospital Intensive Care Unit windows for the achievement of visual comfort and energy savings. The aim was to identify the window size and shading system configurations that could fulfill daylighting adequacy, avoid glare and reduce energy consumption. The study focused on addressing the effect of utilizing different shading systems in association with a range of Window-to-Wall Ratios (WWR) in different orientations under the desert clear-sky of Cairo, Egypt. The results of this study demonstrated that solar penetration is a critical concern affecting the design of ICU windows in desert locations, as in Cairo, Egypt. Use of shading systems was found to be essential in providing acceptable daylight performance and energy saving. Careful positioning of the ICU window towards a proper orientation can dramatically improve performance. It was observed that ICU windows facing the north direction enjoyed the widest range of successful window configuration possibilities at different WWRs. ICU windows facing south enjoyed a reasonable number of configuration options as well. By contrast, the ICU windows facing the east orientation had a very limited number of options that provide acceptable performance. These require additional local shading measures at certain times due to glare incidence. Moreover, use of horizontal sun breakers and solar screens to protect the ICU windows proved to be more successful than the other alternatives in a wide range of Window to Wall Ratios. By contrast, the use of light shelves and vertical shading devices seemed questionable.

Keywords: daylighting, desert, energy efficiency, shading

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Authors: Jeroen Vinkx, Jan A. Delcour, Bart Goderis

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Complete aqueous dissolution of starch is notoriously difficult. A high-temperature autoclaving process is necessary, followed by cooling the solution below its boiling point. The cooled solution is inherently unstable over time. Gelation and retrogradation processes, along with aggregation-induced by undissolved starch remnants, result in starch precipitation. We recently observed the spontaneous gelatinization of native maize starch (MS) in aqueous sodium salicylate (NaSal) solutions at room temperature. A hydrotropic mode of solubilization is hypothesized. Differential scanning calorimetry (DSC) and polarized optical microscopy (POM) of starch dispersions in NaSal solution were used to demonstrate the room temperature gelatinization of MS at different concentrations of MS and NaSal. The DSC gelatinization peak shifts to lower temperatures, and the gelatinization enthalpy decreases with increasing NaSal concentration. POM images confirm the same trend through the disappearance of the ‘Maltese cross’ interference pattern of starch granules. The minimal NaSal concentration to induce complete room temperature dissolution of MS was found to be around 15-20 wt%. The MS content of the dispersion has little influence on the amount of NaSal needed to dissolve it. The effect of the NaSal solution on the MS molecular weight was checked with HPSEC. It is speculated that, because of its amphiphilic character, NaSal enhances the solubility of MS in water by association with the more hydrophobic MS moieties, much like urea, which has also been used to enhance starch dissolution in alkaline aqueous media. As such small molecules do not tend to form micelles in water, they are called hydrotropes rather than surfactants. A minimal hydrotrope concentration (MHC) is necessary for the hydrotropes to structure themselves in water, resulting in a higher solubility of MS. This is the case for the system MS/NaSal/H₂O. Further investigations into the putative hydrotropic dissolution mechanism are necessary.

Keywords: hydrotrope, dissolution, maize starch, sodium salicylate, gelatinization

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Authors: Melanie Macgregor-Ramiasa, Isabel Hopp, Patricia Murray, Krasimir Vasilev

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Stem cells based therapies are one of the greatest promises of new-age medicine due to their potential to help curing most dreaded conditions such as cancer, diabetes and even auto-immune disease. However, establishing suitable in vitro culture materials allowing to control the fate of stem cells remain a challenge. Amongst the factor influencing stem cell behavior, substrate chemistry and nanotopogaphy are particularly critical. In this work, we used plasma assisted surface modification methods to produce model substrates with tailored nanotopography and controlled chemistry. Three different sizes of gold nanoparticles were bound to amine rich plasma polymer layers to produce homogeneous and gradient surface nanotopographies. The outer chemistry of the substrate was kept constant for all substrates by depositing a thin layer of our patented biocompatible polyoxazoline plasma polymer on top of the nanofeatures. For the first time, protein adsorption and stem cell behaviour (mouse kidney stem cells and mesenchymal stem cells) were evaluated on nanorough plasma deposited polyoxazoline thin films. Compared to other nitrogen rich coatings, polyoxazoline plasma polymer supports the covalent binding of proteins. Moderate surface nanoroughness, in both size and density, triggers cell proliferation. In association with polyoxazoline coating, cell proliferation is further enhanced on nanorough substrates. Results are discussed in term of substrates wetting properties. These findings provide valuable insights on the mechanisms governing the interactions between stem cells and their growth support.

Keywords: nanotopography, stem cells, differentiation, plasma polymer, oxazoline, gold nanoparticles

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Authors: Mihai-Ionut Firescu, Mark A. P. Carson

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We present a case of inferior vena cava agenesis (IVCA) associated with bilateral deep venous thrombosis (DVT) in a patient with Beckwith-Wiedemann syndrome (BWS). In adult patients with BWS presenting with bilateral lower limb oedema, specific aetiological factors should be considered. These include cardiomyopathy and intraabdominal tumours. Congenital malformations of the IVC, through causing relative venous stasis, can lead to lower limb oedema either directly or indirectly by favouring lower limb venous thromboembolism; however, they are yet to be reported as an associated feature of BWS. Given its life-threatening potential, the prompt initiation of treatment for bilateral DVT is paramount. In BWS patients, however, this can prove more complicated. Due to overgrowth, the above-average birth weight can continue throughout childhood. In this case, the patient’s weight reached 170 kg, impacting on anticoagulation choice, as direct oral anticoagulants have a limited evidence base in patients with a body mass above 120 kg. Furthermore, the presence of IVCA leads to a long-term increased venous thrombosis risk. Therefore, patients with IVCA and bilateral DVT warrant specialist consideration and may benefit from multidisciplinary team management, with hematology and vascular surgery input. Conclusion: Here, we showcased a rare cause for bilateral lower limb oedema, respectively bilateral deep venous thrombosis complicating IVCA in a patient with Beckwith-Wiedemann syndrome. The importance of this case lies in its novelty, as the association between IVC agenesis and BWS has not yet been described. Furthermore, the treatment of DVT in such situations requires special consideration, taking into account the patient’s weight and the presence of a significant, predisposing vascular abnormality.

Keywords: Beckwith-Wiedemann syndrome, bilateral deep venous thrombosis, inferior vena cava agenesis, venous thromboembolism

Procedia PDF Downloads 235