Search results for: surgical wound infection
297 Implementing a Structured, yet Flexible Tool for Critical Information Handover
Authors: Racheli Magnezi, Inbal Gazit, Michal Rassin, Joseph Barr, Orna Tal
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An effective process for transmitting patient critical information is essential for patient safety and for improving communication among healthcare staff. Previous studies have discussed handover tools such as SBAR (Situation, Background, Assessment, Recommendation) or SOFI (Short Observational Framework for Inspection). Yet, these formats lack flexibility, and require special training. In addition, nurses and physicians have different procedures for handing over information. The objectives of this study were to establish a universal, structured tool for handover, for both physicians and nurses, based on parameters that were defined as ‘important’ and ‘appropriate’ by the medical team, and to implement this tool in various hospital departments, with flexibility for each ward. A questionnaire, based on established procedures and on the literature, was developed to assess attitudes towards the most important information for effective handover between shifts (Cronbach's alpha 0.78). It was distributed to 150 senior physicians and nurses in 62 departments. Among senior medical staff, 12 physicians and 66 nurses responded to the questionnaire (52% response rate). Based on the responses, a handover form suitable for all hospital departments was designed and implemented. Important information for all staff included: Patient demographics (full name and age); Health information (diagnosis or patient complaint, changes in hemodynamic status, new medical treatment or equipment required); and Social Information (suspicion of violence, mental or behavioral changes, and guardianship). Additional information relevant to each unit included treatment provided, laboratory or imaging required, and change in scheduled surgery in surgical departments. ICU required information on background illnesses, Pediatrics required information on diet and food provided and Obstetrics required the number of days after cesarean section. Based on the model described, a flexible tool was developed that enables handover of both common and unique information. In addition, it includes general logistic information that must be transmitted to the next shift, such as planned disruptions in service or operations, staff training, etc. Development of a simple, clear, comprehensive, universal, yet flexible tool designed for all medical staff for transmitting critical information between shifts was challenging. Physicians and nurses found it useful and it was widely implemented. Ongoing research is needed to examine the efficiency of this tool, and whether the enthusiasm that accompanied its initial use is maintained.Keywords: handover, nurses, hospital, critical information
Procedia PDF Downloads 240296 Investigation Two Polymorphism of hTERT Gene (Rs 2736098 and Rs 2736100) and miR- 146a rs2910164 Polymorphism in Cervical Cancer
Authors: Hossein Rassi, Alaheh Gholami Roud-Majany, Zahra Razavi, Massoud Hoshmand
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Cervical cancer is multi step disease that is thought to result from an interaction between genetic background and environmental factors. Human papillomavirus (HPV) infection is the leading risk factor for cervical intraepithelial neoplasia (CIN)and cervical cancer. In other hand, some of hTERT and miRNA polymorphism may plays an important role in carcinogenesis. This study attempts to clarify the relation of hTERT genotypes and miR-146a genotypes in cervical cancer. Forty two archival samples with cervical lesion retired from Khatam hospital and 40 sample from healthy persons used as control group. A simple and rapid method was used to detect the simultaneous amplification of the HPV consensus L1 region and HPV-16,-18, -11, -31, 33 and -35 along with the b-globin gene as an internal control. We use Multiplex PCR for detection of hTERT and miR-146a rs2910164 genotypes in our lab. Finally, data analysis was performed using the 7 version of the Epi Info(TM) 2012 software and test chi-square(x2) for trend. Cervix lesions were collected from 42 patients with Squamous metaplasia, cervical intraepithelial neoplasia, and cervical carcinoma. Successful DNA extraction was assessed by PCR amplification of b-actin gene (99bp). According to the results, hTERT ( rs 2736098) GG genotype and miR-146a rs2910164 CC genotype was significantly associated with increased risk of cervical cancer in the study population. In this study, we detected 13 HPV 18 from 42 cervical cancer. The connection between several SNP polymorphism and human virus papilloma in rare researches were seen. The reason of these differences in researches' findings can result in different kinds of races and geographic situations and also differences in life grooves in every region. The present study provided preliminary evidence that a p53 GG genotype and miR-146a rs2910164 CC genotype may effect cervical cancer risk in the study population, interacting synergistically with HPV 18 genotype. Our results demonstrate that the testing of hTERT rs 2736098 genotypes and miR-146a rs2910164 genotypes in combination with HPV18 can serve as major risk factors in the early identification of cervical cancers. Furthermore, the results indicate the possibility of primary prevention of cervical cancer by vaccination against HPV18 in Iran.Keywords: polymorphism of hTERT gene, miR-146a rs2910164 polymorphism, cervical cancer, virus
Procedia PDF Downloads 311295 Let-7 Mirnas Regulate Inflammatory Cytokine Production in Bovine Endometrial Cells after Lipopolysaccharide Challenge by Targeting TNFα
Authors: S. Ibrahim, D. Salilew-Wondim, M. Hoelker, C. Looft, E. Tholen, C. Grosse-Brinkhaus, K. Schellander, C. Neuhoff, D. Tesfaye
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Bovine endometrial cells appear to have a key role in innate immune defense of the female genital tract. A better understanding of molecular changes in microRNAs (miRNAs) and their target genes expression may identify reliable prognostic indicators for cows that will resolve inflammation and resume cyclicity. In the current study, we hypothesized that let-7 miRNAs family has a primary role in the innate immune defence of the endometrium tissue against bacterial infection, which is partly achieved via regulating mRNA stability of pro-inflammatory cytokines at the post-transcriptional level. Therefore, we conducted two experiments. In the first experiment, primary bovine endometrial cells were challenged with clinical (3.0 μg/ml) and sub-clinical (0.5 μg/ml) doses of lipopolysaccharide (LPS) for 24h. In the 2nd experiment, we have investigated the potential role of let-7 miRNAs (let-7a and let-7f) using gain and loss of function approaches. Additionally, tumor necrosis factor alpha (TNFα), transforming growth factor beta 1 induced transcript 1 (TGFB1I1) and serum deprivation response (SDPR) genes were validated using reporter assay. Here we addressed for the first time that let-7 miRNAs have a precise role in bovine endometrium, where LPS dysregulated let-7 miRNAs family expression was associated with an increased pro-inflammatory cytokine level by directly/indirectly targeting the TNFα, interleukin 6 (IL6), nuclear factor kappa-light-chain enhancer of activated B cells (NFκB), TGFβ1I1 and SDPR genes. To our knowledge, this is the first study showing that TNFα, TGFβ1I1 and SDPR were identified and validated as novel let-7 miRNAs targets and could have a distinct role in inflammatory immune response of LPS challenged bovine endometrial cells. Our data represent a new finding by which uterine homeostasis is maintained through functional regulation of let-7a by down-regulation of pro-inflammatory cytokines expression (TNFα and IL6) at the mRNA and protein levels. These findings suggest that LPS serves as a negative regulator of let-7 miRNAs expression and provides a mechanism for the persistent pro-inflammatory phenotype, which is a hallmark of bovine subclinical endometritis.Keywords: bovine endometrial cells, let-7, lipopolysaccharide, pro-inflammatory cytokines
Procedia PDF Downloads 370294 Digitial Communication – The Future of Chronic Disease Management Is Healthcare Apps
Authors: Kirstin Griffin
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During a period of increased anxiety and stress, communication became the essential tool to help the public stay informed and feel prepared during the Covid-19 pandemic. However, certain groups of patients were not feeling as reassured. The news and media blasted the message that patients with diabetes were “high-risk" in regards to contracting the Covid-19 infection. Routine clinics were being cancelled, GP practices were closing their doors, and patients with type 1 diabetes were understandably scared. The influx of calls to diabetes specialists nurses from concerned patients highlighted the need for better and more specialised information. An Application specifically for patients with type 1 diabetes was created to deliver this information, and it proved to be the essential communication tool that was desperately needed. The Application for patients with type 1 diabetes aimed to deliver specialist information to patients in regards to their diagnosis, management, and ongoing follow-up commitments. The Application gives practical advice on multiple areas of diabetes management, including sick-day rules and diabetic emergencies, as well as up-to-date information on technology, including setting up Libre devices and downloading glucose meters to facilitate attending virtual clinics. Delivery of this information in an easy-to-understand and comprehensive way is intended to improve patient engagement with diabetes services and ultimately empower patients in the control of their own disease. The application also offers a messaging service to allow the diabetes team to send out alerts to patient groups on specific issues, such as changes to clinics, or respond to recent news updates regarding Covid-19. The App was launched in NHS Fife in June 2020 and has amassed 800 active users so far. There is growing engagement with the App since its launch, with over 1000 user interactions in the last month alone. Feedback shows that 100% of users like the App and have found it useful in the management of their diabetes. The App has proven to be an essential tool in communication with one of the most vulnerable groups during the Covid-19 pandemic, and its ongoing development will continue to increase patient engagement and improve glycaemic control for patients with type 1 diabetes. The future of chronic disease management should involve digital solutions such as apps to further empower patients in their healthcare.Keywords: diabetes, endocrinology, digital healthcare, medical apps
Procedia PDF Downloads 78293 Expression of Human Papillomavirus Type 18 L1 Virus-Like Particles in Methylotropic Yeast, Pichia Pastoris
Authors: Hossein Rassi, Marjan Moradi Fard, Samaneh Niko
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Human papillomavirus type 16 and 18 are closely associated with the development of human cervical carcinoma, which is one of the most common causes of cancer death in women worldwide. At present, HPV type 18 accounts for about 34 % of all HPV infections in Iran and the most promising vaccine against HPV infection is based on the L1 major capsid protein. The L1 protein of HPV18 has the capacity to self-assemble into capsomers or virus-like particles (VLPs) that are non-infectious, highly immunogenic and allowing their use in vaccine production. The methylotrophic yeast Pichia pastoris is an efficient and inexpensive expression system used to produce high levels of heterologous proteins. In this study we expressed HPV18 L1 VLPs in P. pastoris. The gene encoding the major capsid protein L1 of the high-risk HPV type 18 was isolated from Iranian patient by PCR and inserted into pTG19-T vector to obtain the recombinant expression vector pTG19-HPV18-L1. Then, the pTG19-HPV18-L1 was transformed into E. coli strain DH5α and the recombinant protein HPV18 L1 was expressed under IPTG induction in soluble form. The HPV18 L1 gene was excised from recombinant plasmid with XhoI and EcoRI enzymes and ligated into the yeast expression vector pPICZα linearized with the same enzymes, and transformed into P. pastoris. Induction and expression of HPV18 L1 protein was demonstrated by BMGY/BMMY and RT PCR. The parameters for induced cultivation for strain in P. pastoris KM71 with HPV16L1 were investigated in shaking flask cultures. After induced cultivation BMMY (pH 7.0) medium supplemented with methanol to a final concentration of 1.0% every 24 h at 37 degrees C for 96 h, the recombinant produced 78.6 mg/L of L1 protein. This work offers the possibility for the production of prophylactic vaccine for cervical carcinoma by P. pastoris for HPV-18 L1 gene. The VLP-based HPV vaccines can prevent persistent HPV18 infections and cervical cancer in Iran. The HPV-18 L1 gene was expressed successfully in E.coli, which provides necessary basis for preparing HPV-18 L1 vaccine in human. Also, HPV type 6 L1 proteins expressed in Pichia pastoris will facilitate the HPV vaccine development and structure-function study.Keywords: Pichia pastoris, L1 virus-like particles, human papillomavirus type 18, biotechnology
Procedia PDF Downloads 400292 Emergency Multidisciplinary Continuing Care Case Management
Authors: Mekroud Amel
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Emergency departments are known for the workload, the variety of pathologies and the difficulties in their management with the continuous influx of patients The role of our service in the management of patients with two or three mild to moderate organ failures, involving several disciplines at the same time, as well as the effect of this management on the skills and efficiency of our team has been demonstrated Borderline cases between two or three or even more disciplines, with instability of a vital function, which have been successfully managed in the emergency room, the therapeutic procedures adopted, the consequences on the quality and level of care delivered by our team, as well as that the logistical consequences, and the pedagogical consequences are demonstrated. The consequences found are Positive on the emergency teams, in rare situations are negative Regarding clinical situations, it is the entanglement of hemodynamic distress with right, left or global participation, tamponade, low flow with acute pulmonary edema, and/or state of shock With respiratory distress with more or less profound hypoxemia, with haematosis disorder related to a bacterial or viral lung infection, pleurisy, pneumothorax, bronchoconstrictive crisis. With neurological disorders such as recent stroke, comatose state, or others With metabolic disorders such as hyperkalaemia renal insufficiency severe ionic disorders with accidents with anti vitamin K With or without septate effusion of one or more serous membranes with or without tamponade It’s a Retrospective, monocentric, descriptive study Period 05.01.2022 to 10.31.2022 the purpose of our work: Search for a statistically significant link between the type of moderate to severe pathology managed in the emergency room whose problems are multivisceral on the efficiency of the healthcare team and its level of care and optional care offered for patients Statistical Test used: Chi2 test to prove the significant link between the resolution of serious multidisciplinary cases in the emergency room and the effectiveness of the team in the management of complicated cases Search for a statistically significant link : The management of the most difficult clinical cases for organ specialties has given general practitioner emergency teams a great perspective and has been able to improve their efficiency in the face of emergencies receivedKeywords: emergency care teams, management of patients with dysfunction of more than one organ, learning curve, quality of care
Procedia PDF Downloads 73291 Genomic Characterisation of Equine Sarcoid-derived Bovine Papillomavirus Type 1 and 2 Using Nanopore-Based Sequencing
Authors: Lien Gysens, Bert Vanmechelen, Maarten Haspeslagh, Piet Maes, Ann Martens
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Bovine papillomavirus (BPV) types 1 and 2 play a central role in the etiology of the most common neoplasm in horses, the equine sarcoid. The unknown mechanism behind the unique variety in a clinical presentation on the one hand and the host-dependent clinical outcome of BPV-1 infection, on the other hand, indicate the involvement of additional factors. Earlier studies have reported the potential functional significance of intratypic sequence variants, along with the existence of sarcoid-sourced BPV variants. Therefore, intratypic sequence variation seems to be an important emerging viral factor. This study aimed to give a broad insight in sarcoid-sourced BPV variation and explore its potential association with disease presentation. In order to do this, a nanopore sequencing approach was successfully optimized for screening a wide spectrum of clinical samples. Specimens of each tumour were initially screened for BPV-1/-2 by quantitative real-time PCR. A custom-designed primer set was used on BPV-positive samples to amplify the complete viral genome in two multiplex PCR reactions, resulting in a set of overlapping amplicons. For phylogenetic analysis, separate alignments were made of all available complete genome sequences for BPV-1/-2. The resulting alignments were used to infer Bayesian phylogenetic trees. We found substantial genetic variation among sarcoid-derived BPV-1, although this variation could not be linked to disease severity. Several of the BPV-1 genomes had multiple major deletions. Remarkably, the majority of the cluster within the region coding for late viral genes. Together with the extensiveness (up to 603 nucleotides) of the described deletions, this suggests an altered function of L1/L2 in disease pathogenesis. By generating a significant amount of complete-length BPV genomes, we succeeded in introducing next-generation sequencing into veterinary research focusing on the equine sarcoid, thus facilitating the first report of both nanopore-based sequencing of complete sarcoid-sourced BPV-1/-2 and the simultaneous nanopore sequencing of multiple complete genomes originating from a single clinical sample.Keywords: Bovine papillomavirus, equine sarcoid, horse, nanopore sequencing, phylogenetic analysis
Procedia PDF Downloads 172290 Sensorless Machine Parameter-Free Control of Doubly Fed Reluctance Wind Turbine Generator
Authors: Mohammad R. Aghakashkooli, Milutin G. Jovanovic
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The brushless doubly-fed reluctance generator (BDFRG) is an emerging, medium-speed alternative to a conventional wound rotor slip-ring doubly-fed induction generator (DFIG) in wind energy conversion systems (WECS). It can provide competitive overall performance and similar low failure rates of a typically 30% rated back-to-back power electronics converter in 2:1 speed ranges but with the following important reliability and cost advantages over DFIG: the maintenance-free operation afforded by its brushless structure, 50% synchronous speed with the same number of rotor poles (allowing the use of a more compact, and more efficient two-stage gearbox instead of a vulnerable three-stage one), and superior grid integration properties including simpler protection for the low voltage ride through compliance of the fractional converter due to the comparatively higher leakage inductances and lower fault currents. Vector controlled pulse-width-modulated converters generally feature a much lower total harmonic distortion relative to hysteresis counterparts with variable switching rates and as such have been a predominant choice for BDFRG (and DFIG) wind turbines. Eliminating a shaft position sensor, which is often required for control implementation in this case, would be desirable to address the associated reliability issues. This fact has largely motivated the recent growing research of sensorless methods and developments of various rotor position and/or speed estimation techniques for this purpose. The main limitation of all the observer-based control approaches for grid-connected wind power applications of the BDFRG reported in the open literature is the requirement for pre-commissioning procedures and prior knowledge of the machine inductances, which are usually difficult to accurately identify by off-line testing. A model reference adaptive system (MRAS) based sensor-less vector control scheme to be presented will overcome this shortcoming. The true machine parameter independence of the proposed field-oriented algorithm, offering robust, inherently decoupled real and reactive power control of the grid-connected winding, is achieved by on-line estimation of the inductance ratio, the underlying rotor angular velocity and position MRAS observer being reliant upon. Such an observer configuration will be more practical to implement and clearly preferable to the existing machine parameter dependent solutions, and especially bearing in mind that with very little modifications it can be adapted for commercial DFIGs with immediately obvious further industrial benefits and prospects of this work. The excellent encoder-less controller performance with maximum power point tracking in the base speed region will be demonstrated by realistic simulation studies using large-scale BDFRG design data and verified by experimental results on a small laboratory prototype of the WECS emulation facility.Keywords: brushless doubly fed reluctance generator, model reference adaptive system, sensorless vector control, wind energy conversion
Procedia PDF Downloads 55289 Family Planning and HIV Integration: A One-stop Shop Model at Spilhaus Clinic, Harare Zimbabwe
Authors: Mercy Marimirofa, Farai Machinga, Alfred Zvoushe, Tsitsidzaishe Musvosvi
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The Government of Zimbabwe embarked on integrating family planning with Sexually Transmitted Infection (STI) and Human Immunodeficiency Virus (HIV) services in May 2020 with support from the World Health Organization (WHO). There was high HIV prevalence, incidence rates and STI infections among women attending FP clinics. Spilhaus is a specialized center of excellence clinic which offers a range of sexual reproductive health services. HIV services were limited to testing only, and clients were referred to other facilities for further management. Integration of services requires that all the services be available at one point so that clients will access them during their visit to the facility. Objectives: The study was conducted to assess the impact the one-stop-shop model has made in accessing integrated Family Planning services and sexual reproductive health services compared to the supermarket approach. It also assessed the relationship family planning services have with other sexual reproductive health services. Methods: A secondary data analysis was conducted at Spilhaus clinic in Harare using family planning registers and HIV services registers comparing years 2019 and 2021. A 2 sample t-test was used to determine the difference in clients accessing the services under the two models. A Spearman’s rank correlation was used to determine if accessing family planning services has a relationship with other sexual reproductive health services. Results: In 2019, 7,548 clients visited the Spilhaus clinic compared to 8,265 during the period January to December 2021. The median age for all clients accessing services was 32 years. An increase of 69% in the number of services accessed was recorded from 2019 to 2021. More services were accessed in 2021. There was no difference in the number of clients accessing family planning services cervical cancer, and HIV services. A difference was found in the number of clients who were offered STI screening services. There was also a relationship between accessing family planning services and STI screening services (ρ = 0.729, p-value=0.006). Conclusion: Programming towards SRH services was a great achievement, the use of an integrated approach proved to be cost-effective as it minimised the required resources for separate programs. Clients accessed important health needs at once. The integration of these services provided an opportunity to offer comprehensive information which addressed an individual’s sexual reproductive health needs.Keywords: intergration, one stop shop, family planning, reproductive health
Procedia PDF Downloads 55288 The Investigation of Endogenous Intoxication and Lipid Peroxidation in Patients with Giardiasis Before and After Treatment
Authors: R. H. Begaydarova, B. Zh. Kultanov, B. T. Esilbaeva, G. E. Nasakaeva, Y. Yukhnevich, G. K. Alshynbekova, A. E. Dyusembaeva
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Background: The level of middle molecules of peptides (MMP) allows to evaluate the severity and prognosis of the disease and is a criterion for the effectiveness of the treatment. The detection the products of lipidperoxidation cascade, such as conjugated dienes, malondialdehyde in biological material, has an important role in the development of pathogenesis, the diagnosis and prognosis in different parasitic diseases. Purpose of the study was to evaluate the state of endogenous intoxication and indicators of lipid peroxidation in patients with giardiasis before and after treatment. Materials and methods: Endogenous intoxication was evaluated in patients with giardiasis in the level of middle molecules of peptides (MMP) in the blood. The amount of MMP and products of lipid peroxidation were determined in the blood of 198 patients with giardiasis, 129 of them were women (65%), 69 were men (35%). The MMP level was detected for comparison in the blood of 84 healthy volunteers. The lipid peroxidation were determined in 40 healthy men and women without giardiasis and history of chronic diseases. Data were processed by conventional methods of variation statistics, we calculated the arithmetic mean (M) and standard dispersion (m). t-test (t) was used to assess differences. Results: The level of MMP in the blood was significantly higher in patients with giardiasis in comparison with group of healthy men and women. MMP concentration in the blood of women with Giardia was 2.5 times greater than that of the comparison groups of women. The level of MMP exceeds more than 6 times in men with giardiasis. The decrease in the intensity of endogenous intoxication was two weeks after antigiardia therapy, both men and women. According to the study, a statistically significant increase in the level of all the studied parameters lipid peroxidation cascade was observed in the blood of men with giardiasis, with the exception of the total primary production (NGN). The treatment of giardiasis helped to stabilize the level of almost all metabolites of lipid peroxidation cascade. The exception was level of malondialdehyde, it was significantly elevated to compare with the control group and after treatment. Conclusion: Thus, the MMP level was significantly higher in blood of patients with giardiasis than in comparison group. This is evidence of severe endogenous intoxication caused by giardia infection. The accumulation of primary and secondary products of lipid peroxidation was observed in the blood of men and women. These processes tend to be more active in men than in women. Antigiardiasis therapy contributed to the normalization of almost all the studied indicators of lipid peroxidation in the blood of participants, except the level malondialdehyde in the blood of men.Keywords: enzymes of antioxidant protection, giardiasis, blood, treatment
Procedia PDF Downloads 231287 Molecular Diagnosis of a Virus Associated with Red Tip Disease and Its Detection by Non Destructive Sensor in Pineapple (Ananas comosus)
Authors: A. K. Faizah, G. Vadamalai, S. K. Balasundram, W. L. Lim
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Pineapple (Ananas comosus) is a common crop in tropical and subtropical areas of the world. Malaysia once ranked as one of the top 3 pineapple producers in the world in the 60's and early 70's, after Hawaii and Brazil. Moreover, government’s recognition of the pineapple crop as one of priority commodities to be developed for the domestics and international markets in the National Agriculture Policy. However, pineapple industry in Malaysia still faces numerous challenges, one of which is the management of disease and pest. Red tip disease on pineapple was first recognized about 20 years ago in a commercial pineapple stand located in Simpang Renggam, Johor, Peninsular Malaysia. Since its discovery, there has been no confirmation on its causal agent of this disease. The epidemiology of red tip disease is still not fully understood. Nevertheless, the disease symptoms and the spread within the field seem to point toward viral infection. Bioassay test on nucleic acid extracted from the red tip-affected pineapple was done on Nicotiana tabacum cv. Coker by rubbing the extracted sap. Localised lesions were observed 3 weeks after inoculation. Negative staining of the fresh inoculated Nicotiana tabacum cv. Coker showed the presence of membrane-bound spherical particles with an average diameter of 94.25nm under transmission electron microscope. The shape and size of the particles were similar to tospovirus. SDS-PAGE analysis of partial purified virions from inoculated N. tabacum produced a strong and a faint protein bands with molecular mass of approximately 29 kDa and 55 kDa. Partial purified virions of symptomatic pineapple leaves from field showed bands with molecular mass of approximately 29 kDa, 39 kDa and 55kDa. These bands may indicate the nucleocapsid protein identity of tospovirus. Furthermore, a handheld sensor, Greenseeker, was used to detect red tip symptoms on pineapple non-destructively based on spectral reflectance, measured as Normalized Difference Vegetation Index (NDVI). Red tip severity was estimated and correlated with NDVI. Linear regression models were calibrated and tested developed in order to estimate red tip disease severity based on NDVI. Results showed a strong positive relationship between red tip disease severity and NDVI (r= 0.84).Keywords: pineapple, diagnosis, virus, NDVI
Procedia PDF Downloads 785286 A Web-Based Systems Immunology Toolkit Allowing the Visualization and Comparative Analysis of Publically Available Collective Data to Decipher Immune Regulation in Early Life
Authors: Mahbuba Rahman, Sabri Boughorbel, Scott Presnell, Charlie Quinn, Darawan Rinchai, Damien Chaussabel, Nico Marr
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Collections of large-scale datasets made available in public repositories can be used to identify and fill gaps in biomedical knowledge. But first, these data need to be made readily accessible to researchers for analysis and interpretation. Here a collection of transcriptome datasets was made available to investigate the functional programming of human hematopoietic cells in early life. Thirty two datasets were retrieved from the NCBI Gene Expression Omnibus (GEO) and loaded in a custom, interactive web application called the Gene Expression browser (GXB), designed for visualization and query of integrated large-scale data. Multiple sample groupings and gene rank lists were created based on the study design and variables in each dataset. Web links to customized graphical views can be generated by users and subsequently be used to graphically present data in manuscripts for publication. The GXB tool also enables browsing of a single gene across datasets, which can provide information on the role of a given molecule across biological systems. The dataset collection is available online. As a proof-of-principle, one of the datasets (GSE25087) was re-analyzed to identify genes that are differentially expressed by regulatory T cells in early life. Re-analysis of this dataset and a cross-study comparison using multiple other datasets in the above mentioned collection revealed that PMCH, a gene encoding a precursor of melanin-concentrating hormone (MCH), a cyclic neuropeptide, is highly expressed in a variety of other hematopoietic cell types, including neonatal erythroid cells as well as plasmacytoid dendritic cells upon viral infection. Our findings suggest an as yet unrecognized role of MCH in immune regulation, thereby highlighting the unique potential of the curated dataset collection and systems biology approach to generate new hypotheses which can be tested in future mechanistic studies.Keywords: early-life, GEO datasets, PMCH, interactive query, systems biology
Procedia PDF Downloads 288285 Transcriptional Response of Honey Bee to Differential Nutritional Status and Nosema Infection
Authors: Farida Azzouz-Olden, Arthur G. Hunt, Gloria Degrandi-Hoffman
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Bees are confronting several environmental challenges, including the intermingled effects of malnutrition and disease. Intuitively, pollen is the healthiest nutritional choice; however, commercial substitutes, such as BeePro and MegaBee, are widely used. Herein we examined how feeding natural and artificial diets shapes transcription in the abdomen of the honey bee, and how transcription shifts in combination with Nosema parasitism. Gene ontology enrichment revealed that, compared with poor diet (carbohydrates (C)), bees fed pollen (P > C), BeePro (B > C), and MegaBee (M > C) showed a broad upregulation of metabolic processes, especially lipids; however, pollen feeding promoted more functions and superior proteolysis. The superiority of the pollen diet was also evident through the remarkable overexpression of vitellogenin in bees fed pollen instead of MegaBee or BeePro. Upregulation of bioprocesses under carbohydrates feeding compared to pollen (C > P) provided a clear poor nutritional status, uncovering stark expression changes that were slight or absent relatively to BeePro (C > B) or MegaBee (C > M). Poor diet feeding (C > P) induced starvation response genes and hippo signaling pathway, while it repressed growth through different mechanisms. Carbohydrate feeding (C > P) also elicited ‘adult behavior’, and developmental processes suggesting transition to foraging. Finally, it altered the ‘circadian rhythm’, reflecting the role of this mechanism in the adaptation to nutritional stress in mammals. Nosema-infected bees fed pollen compared to carbohydrates (PN > CN) upheld certain bioprocesses of uninfected bees (P > C). Poor nutritional status was more apparent against pollen (CN > PN) than BeePro (CN > BN) or MegaBee (CN > MN). Nosema accentuated the effects of malnutrition since more starvation-response genes and stress response mechanisms were upregulated in CN > PN compared to C > P. The bioprocess ‘Macromolecular complex assembly’ was also enriched in CN > PN, and involved genes associated with human HIV and/or influenza, thus providing potential candidates for bee-Nosema interactions. Finally, the enzyme Duox emerged as essential for guts defense in bees, similarly to Drosophila. These results provide evidence of the superior nutritional status of bees fed pollen instead of artificial substitutes in terms of overall health, even in the presence of a pathogen.Keywords: honeybee, immunity, Nosema, nutrition, RNA-seq
Procedia PDF Downloads 143284 Investigating the Use of Seaweed Extracts as Biopesticides
Authors: Emma O’ Keeffe, Helen Hughes, Peter McLoughlin, Shiau Pin Tan, Nick McCarthy
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Biosecurity is emerging as one of the most important issues facing the agricultural and forestry community. This is as a result of increased invasion from new pests and diseases with the main protocol for dealing with these species being the use of synthetic pesticides. However, these chemicals have been shown to exhibit negative effects on the environment. Seaweeds represent a vast untapped resource of bio-molecules with a broad range of biological activities including pesticidal. This project investigated both the antifungal and antibacterial activity of seaweed species against two problematic root rot fungi, Armillaria mellea and Heterobasidion annosum and ten quarantine bacterial plant pathogens including Xanthomonas arboricola, Xanthomonas fragariae, and Erwinia amylovora. Four seaweed species were harvested from the South-East coast of Ireland including brown, red and green varieties. The powdered seaweeds were extracted using four different solvents by liquid extraction. The poisoned food technique was employed to establish the antifungal efficacy, and the standard disc diffusion assay was used to assess the antibacterial properties of the seaweed extracts. It was found that extracts of the green seaweed exhibited antifungal activity against H. annosum, with approximately 50% inhibition compared to the negative control. The protectant activities of the active extracts were evaluated on disks of Picea sitchensis, a plant species sensitive to infection from H. annosum and compared to the standard chemical control product urea. The crude extracts exhibited very similar activity to the 10% and 20% w/v concentrations of urea, demonstrating the ability of seaweed extracts to compete with commercially available products. Antibacterial activity was exhibited by a number of seaweed extracts with the red seaweed illustrating the strongest activity, with a zone of inhibition of 15.83 ± 0.41 mm exhibited against X. arboricola whilst the positive control (10 μg/disk of chloramphenicol) had a zone of 26.5 ± 0.71 mm. These results highlight the potential application of seaweed extracts in the forestry and agricultural industries for use as biopesticides. Further work is now required to identify the bioactive molecules that are responsible for this antifungal and antibacterial activity in the seaweed extracts, including toxicity studies to ensure the extracts are non-toxic to plants and humans.Keywords: antibacterial, antifungal, biopesticides, seaweeds
Procedia PDF Downloads 162283 Feasibility Study and Energy Conversion Evaluation of Agricultural Waste Gasification in the Pomelo Garden, Taiwan
Authors: Yi-Hao Pai, Wen-Feng Chen
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The planting area of Pomelo in Hualien, Taiwan amounts to thousands of hectares. Especially in the blooming season of Pomelo, it is an important producing area for Pomelo honey, and it is also a good test field for promoting the "Under-forest Economy". However, in the current Pomelo garden planting and management operations, the large amount of agricultural waste generated by the pruning of the branches causes environmental sanitation concerns, which can lead to the hiding of pests or the infection of the Pomelo tree, and indirectly increase the health risks of bees. Therefore, how to deal with the pruning of the branches and avoid open burning is a topic of social concern in recent years. In this research, afeasibility study evaluating energy conversion efficiency through agricultural waste gasification from the Pomelo garden, Taiwan, is demonstrated. we used a high-temperature gasifier to convert the pruning of the branches into syngas and biochar. In terms of syngas composition and calorific value assessment, we use the biogas monitoring system for analysis. Then, we used Raman spectroscopy and electron microscopy (EM) to diagnose the microstructure and surface morphology of biochar. The results indicate that the 1 ton of pruning of the branches can produce 1797.03m3 of syngas, corresponding to a calorific value of 9.1MJ/m3. The main components of the gas include CH4, H2, CO, and CO2, and the corresponding gas composition ratio is 16.8%, 7.1%, 13.7%, and 24.5%. Through the biomass syngas generator with a conversion efficiency of 30% for power generation, a total of 1,358kWh can be obtained per ton of pruning of the branches. In the research of biochar, its main characteristics in Raman spectroscopy are G bands and D bands. The first-order G and D bands are at 1580 and 1350 cm⁻¹, respectively. The G bands originates from the in-plane tangential stretching of the C−C bonds in the graphitic structure, and theD band corresponds to scattering from local defects or disorders present in carbon. The area ratio of D and G peaks (D/G) increases with the decrease of reaction temperature. The larger the D/G, the higher the defect concentration and the higher the porosity. This result is consistent with the microstructure displayed by SEM. The study is expected to be able to reuse agricultural waste and promote the development of agricultural and green energy circular economy.Keywords: agricultural waste, gasification, energy conversion, pomelo garden
Procedia PDF Downloads 134282 Identification and Molecular Profiling of A Family I Cystatin Homologue from Sebastes schlegeli Deciphering Its Putative Role in Host Immunity
Authors: Don Anushka Sandaruwan Elvitigala, P. D. S. U. Wickramasinghe, Jehee Lee
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Cystatins are a large superfamily of proteins which act as reversible inhibitors of cysteine proteases. Papain proteases and cysteine cathepsins are predominant substrates of cystatins. Cystatin superfamily can be further clustered into three groups as Stefins, Cystatins, and Kininogens. Among them, stefines are also known as family 1 cystatins which harbors cystatin Bs and cystatin As. In this study, a homologue of family one cystatins more close to cystatin Bs was identified from Korean black rockfish (Sebastes schlegeli) using a prior constructed cDNA (complementary deoxyribonucleic acid) database and designated as RfCyt1. The full-length cDNA of RfCyt1 consisted of 573 bp, with a coding region of 294 bp. It comprised a 5´-untranslated region (UTR) of 55 bp, and 3´-UTR of 263 bp. The coding sequence encodes a polypeptide consisting of 97 amino acids with a predicted molecular weight of 11kDa and theoretical isoelectric point of 6.3. The RfCyt1 shared homology with other teleosts and vertebrate species and consisted conserved features of cystatin family signature including single cystatin-like domain, cysteine protease inhibitory signature of pentapeptide (QXVXG) consensus sequence and N-terminal two conserved neighboring glycine (⁸GG⁹) residues. As expected, phylogenetic reconstruction developed using the neighbor-joining method showed that RfCyt1 is clustered with the cystatin family 1 members, in which more closely with its teleostan orthologues. An SYBR Green qPCR (quantitative polymerase chain reaction) assay was performed to quantify the RfCytB transcripts in different tissues in healthy and immune stimulated fish. RfCyt1 was ubiquitously expressed in all tissue types of healthy animals with gill and spleen being the highest. Temporal expression of RfCyt1 displayed significant up-regulation upon infection with Aeromonas salmonicida. Recombinantly expressed RfCyt1 showed concentration-dependent papain inhibitory activity. Collectively these findings evidence for detectable protease inhibitory and immunity relevant roles of RfCyt1 in Sebastes schlegeli.Keywords: Sebastes schlegeli, family 1 cystatin, immune stimulation, expressional modulation
Procedia PDF Downloads 126281 Exploring Penicillin Resistance in Gonococcal Penicillin Binding Protein-2: Molecular Docking and Ligand Interaction Analysis
Authors: Sinethemba Yakobi, Lindiwe Zuma, Ofentse Pooe
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Gonococcal infections present a notable public health issue, and the major approach for treatment involves using β-lactam antibiotics that specifically target penicillin-binding protein 2 (PBP2) in Neisseria gonorrhoeae. This study examines the influence of flavonoids, namely rutin, on the structural changes of PBP2 in both penicillin-resistant (FA6140) and penicillin-susceptible (FA19) strains. The research clarifies the structural effects of particular mutations, such as inserting an aspartate residue at position 345 (Asp-345a) in the PBP2 protein. The strain FA6140, which is resistant to penicillin, shows specific changes that lead to a decrease in penicillin binding. These mutations, namely P551S and F504L, significantly impact the pace at which acylation occurs and the stability of the strain under high temperatures. Molecular docking analyses investigate the antibacterial activities of rutin and other phytocompounds, emphasizing its exceptional binding affinity and potential as an inhibitor of PBP2. Quercetin and protocatechuic acid have encouraging antibacterial effectiveness, with quercetin displaying characteristics similar to those of drugs. Molecular dynamics simulations offer a detailed comprehension of the interactions between flavonoids and PBP2, highlighting rutin's exceptional antioxidant effects and strong affinity for the substrate binding site. The study's wider ramifications pertain to the pressing requirement for antiviral treatments in the context of the ongoing COVID-19 epidemic. Flavonoids have a strong affinity for binding to PBP2, indicating their potential as inhibitors to impair cell wall formation in N. gonorrhoeae. Ultimately, this study provides extensive knowledge on the interactions between proteins and ligands, the dynamics of the structure, and the ability of flavonoids to combat penicillin-resistant N. gonorrhoeae bacteria. The verified simulation outcomes establish a basis for creating potent inhibitors and medicinal therapies to combat infectious illnesses.Keywords: phytochemicals, penicillin-binding protein 2, gonococcal infection, ligand-protein interaction, binding energy, neisseria gonorrhoeae FA19, neisseria gonorrhoeae FA6140, flavonoids
Procedia PDF Downloads 58280 Assessment of Selected Marine Organisms from Malaysian Coastal Areas for Inhibitory Activity against the Chikungunya Virus
Authors: Yik Sin Chan, Nam Weng Sit, Fook Yee Chye, van Ofwegen Leen, de Voogd Nicole, Kong Soo Khoo
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Chikungunya fever is an arboviral disease transmitted by the Aedes mosquitoes. It has resulted in epidemics of the disease in tropical countries in the Indian Ocean and South East Asian regions. The recent spread of this disease to the temperate countries such as France and Italy, coupled with the absence of vaccines and effective antiviral drugs make chikungunya fever a worldwide health threat. This study aims to investigate the anti-chikungunya virus activity of selected marine organism samples collected from Malaysian coastal areas, including seaweeds (Caulerpa racemosa, Caulerpa sertularioides and Kappaphycus alvarezii), a soft coral (Lobophytum microlobulatum) and a sponge (Spheciospongia vagabunda). Following lyophilization (oven drying at 40C for K. alvarezii) and grinding to powder form, each sample was subjected to sequential solvent extraction using hexane, chloroform, ethyl acetate, ethanol, methanol and distilled water in order to extract bioactive compounds. The antiviral activity was evaluated using monkey kidney epithelial (Vero) cells infected with the virus (multiplicity of infection=1). The cell viability was determined by Neutral Red uptake assay. 70% of the 30 extracts showed weak inhibitory activity with cell viability ≤30%. Seven of the extracts exhibited moderate inhibitory activity (cell viability: 31%-69%). These were the chloroform, ethyl acetate, ethanol and methanol extracts of C. racemosa; chloroform and ethyl acetate extracts of L. microlobulatum; and the chloroform extract of C. sertularioides. Only the hexane and ethanol extracts of L. microlobulatum showed strong inhibitory activity against the virus, resulting in cell viabilities (mean±SD; n=3) of 73.3±2.6% and 79.2±0.9%, respectively. The corresponding mean 50% effective concentrations (EC50) for the extracts were 14.2±0.2 and 115.3±1.2 µg/mL, respectively. The ethanol extract of the soft coral L. microlobulatum appears to hold the most promise for further characterization of active principles as it possessed greater selectivity index (SI>5.6) compared to the hexane extract (SI=2.1).Keywords: antiviral, seaweed, sponge, soft coral, vero cell
Procedia PDF Downloads 276279 Molecular Farming: Plants Producing Vaccine and Diagnostic Reagent
Authors: Katerina H. Takova, Ivan N. Minkov, Gergana G. Zahmanova
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Molecular farming is the production of recombinant proteins in plants with the aim to use the protein as a purified product, crude extract or directly in the planta. Plants gain more attention as expression systems compared to other ones due to the cost effective production of pharmaceutically important proteins, appropriate post-translational modifications, assembly of complex proteins, absence of human pathogens to name a few. In addition, transient expression in plant leaves enables production of recombinant proteins within few weeks. Hepatitis E virus (HEV) is a causative agent of acute hepatitis. HEV causes epidemics in developing countries and is primarily transmitted through the fecal-oral route. Presently, all efforts for development of Hepatitis E vaccine are focused on the Open Read Frame 2 (ORF2) capsid protein as it contains epitopes that can induce neutralizing antibodies. For our purpose, we used the CMPV-based vector-pEAQ-HT for transient expression of HEV ORF2 in Nicotiana benthamina. Different molecular analysis (Western blot and ELISA) showed that HEV ORF2 capsid protein was expressed in plant tissue in high-yield up to 1g/kg of fresh leaf tissue. Electron microscopy showed that the capsid protein spontaneously assembled in low abundance virus-like particles (VLPs), which are highly immunogenic structures and suitable for vaccine development. The expressed protein was recognized by both human and swine HEV positive sera and can be used as a diagnostic reagent for the detection of HEV infection. Production of HEV capsid protein in plants is a promising technology for further HEV vaccine investigations. Here, we reported for a rapid high-yield transient expression of a recombinant protein in plants suitable for vaccine production as well as a diagnostic reagent. Acknowledgments -The authors’ research on HEV is supported with grants from the Project PlantaSYST under the Widening Program, H2020 as well as under the UK Biotechnological and Biological Sciences Research Council (BBSRC) Institute Strategic Programme Grant ‘Understanding and Exploiting Plant and Microbial Secondary Metabolism’ (BB/J004596/1). The authors want to thank Prof. George Lomonossoff (JIC, Norwich, UK) for his contribution.Keywords: hepatitis E virus, plant molecular farming, transient expression, vaccines
Procedia PDF Downloads 141278 A Program of Data Analysis on the Possible State of the Antibiotic Resistance in Bangladesh Environment in 2019
Authors: S. D. Kadir
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Background: Antibiotics have always been at the centrum of the revolution of modern microbiology. Micro-organisms and its pathogenicity, resistant organisms, inappropriate or over usage of various types of antibiotic agents are fuelled multidrug-resistant pathogenic organisms. Our present time review report mainly focuses on the therapeutic condition of antibiotic resistance and the possible roots behind the development of antibiotic resistance in Bangladesh in 2019. Methodology: The systemic review has progressed through a series of research analyses on various manuscripts published on Google Scholar, PubMed, Research Gate, and collected relevant information from established popular healthcare and diagnostic center and its subdivisions all over Bangladesh. Our research analysis on the possible assurance of antibiotic resistance been ensured by the selective medical reports and on random assay on the extent of individual antibiotic in 2019. Results: 5 research articles, 50 medical report summary, and around 5 patients have been interviewed while going through the estimation process. We have prioritized research articles where the research analysis been performed by the appropriate use of the Kirby-Bauer method. Kirby-Bauer technique is preferred as it provides greater efficiency, ensures lower performance expenditure, and supplies greater convenience and simplification in the application. In most of the reviews, clinical and laboratory standards institute guidelines were strictly followed. Most of our reports indicate significant resistance shown by the Beta-lactam drugs. Specifically by the derivatives of Penicillin's, Cephalosporin's (rare use of the first generation Cephalosporin and overuse of the second and third generation of Cephalosporin and misuse of the fourth generation of Cephalosporin), which are responsible for almost 67 percent of the bacterial resistance. Moreover, approximately 20 percent of the resistance was due to the fact of drug pumping from the bacterial cell by tetracycline and sulphonamides and their derivatives. Conclusion: 90 percent of the approximate antibiotic resistance is due to the usage of relative and true broad-spectrum antibiotics. The environment has been created by the following circumstances where; the excessive usage of broad-spectrum antibiotics had led to a condition where the disruption of native bacteria and a series of anti-microbial resistance causing a disturbance of the surrounding environments in medium, leading to a state of super-infection.Keywords: antibiotics, antibiotic resistance, Kirby Bauer method, microbiology
Procedia PDF Downloads 117277 Evaluating the Efficacy of Tasquinimod in Covid-19
Authors: Raphael Udeh, Luis García De Guadiana Romualdo, Xenia Dolje-Gore
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Background: Quite disturbing is the huge public health impact of COVID-19: As at today [25th March 2021, the COVID-19 global burden shows over 123 million cases and over 2.7 million deaths worldwide. Rationale: Recent evidence shows calprotectin’s potential as a therapeutic target, stating that tasquinimod, from the Quinoline-3-Carboxamide family is capable of blocking the interaction between calprotectin and TLR4. Hence preventing the cytokine release syndrome, that heralds the functional exhaustion in COVID-19. Early preclinical studies showed that tasquinimod inhibit tumor growth and prevent angiogenesis/cytokine storm. Phase I – III clinical studies in prostate cancer showed it has a good safety profile with good radiologic progression free survival but no effect on overall survival. Rationale/hypothesis: Strategic endeavors have been amplified globally to assess new therapeutic interventions for COVID-19 management – thus the clinical and antiviral efficacy of tasquinimod in COVID-19 remains to be explored. Hence the primary objective of this trial will be to evaluate the efficacy of tasquinimod in the treatment of adult patients with severe COVID-19 infections. Therefore, I hypothesise that among adults with COVID19 infection, tasquinimod will reduce the severe respiratory distress associated with COVID-19 compared to placebo, over a 28-day study period. Method: The setting is in Europe. Design – a randomized, placebo-controlled, phase II double-blinded trial. Trial lasts for 28 days from randomization, Tasquinimod capsule given as 0.5mg daily 1st fortnight, then 1mg daily 2nd fortnight. I0 outcome - assessed using six-point ordinal scale alongside eight 20 outcomes. 125 participants to be enrolled, data collection at baseline and subsequent data points, and safety reporting monitored via serological profile. Significance: This work could potentially establish tasquinimod as an effective and safe therapeutic agent for COVID-19 by reducing the severe respiratory distress, related time to recovery, time on oxygen/admission. It will also drive future research – as in larger multi-centre RCT.Keywords: Calprotectin, COVID-19, Phase II Trial, Tasquinimod
Procedia PDF Downloads 183276 Review of Consecutive Patients Treated with a Combination of Vancomycin and Rifaximin for Diarrhea Predominant Irritable Bowel Syndrome (IBS-D)
Authors: Portia Murphy, Danica Vasic, Anoja W. Gunaratne, Encarnita Sitchon, Teresita Tugonon, Marou Ison, Antoinette Le Busque, Christelle Pagonis, Thomas J. Borody
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Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that affects an estimated 11% of the population globally with the most predominant symptoms being abdominal pain, bloating and altered bowel movements. All age groups suffer from IBS although the prevalence of IBS decreases for age groups over 50 years. Women are more likely to suffer from IBS than men. IBS can be categorized into 3 groups based on the type of altered bowel movement: diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C) and IBS with mixed bowel habit (IBS-M). The contribution of the gut microbiome to the etiology of IBS is becoming increasingly recognized with rising use of anti-microbial agents. Previous studies on vancomycin and rifaximin used as monotherapy or in combination have been conducted mainly on IBS-C and showed marked improvements in the symptoms. According to our knowledge, no studies reported using these two combinations of antibiotics for IBS-D. Here, we report a consecutive cohort of 18 patients treated with both vancomycin and rifaximin for IBS-D. These patients’ records were reviewed retrospectively. In this cohort, patients ages were between 24-74 years (mean 44 years) and 9 were female. Baseline all patients had diarrhea, 4 with mucus and one with blood. Patients reported other symptoms were abdominal pain (n=11) bloating (n=9), flatulence (n=7), fatigue (n=4) and nausea (n=3). Patients treatments were personalized according to their symptom severity and tolerability and were treated with combination of rifaximin (500 - 3000mg/d) and vancomycin (500mg - 1500mg/d) for an ongoing period. Follow-ups were conducted between 2-32 weeks’ time. Of all patients, 89% patients reported improvement of the symptoms, 1 reported no change and 1 patient’s symptoms got worse. The mechanism of action for both vancomycin and rifaximin involves the inhibition of bacterial cell wall and protein synthesis respectively. The role of these medications in improving the symptoms of this cohort suggests that IBS-D may be microbiome infection driven. In this cohort, similar patient presentations to Clostridium difficile, as well as symptom improvement with the use of rifaximin and particularly vancomycin, suggest that the infectious agent may be an unidentified Clostridium. These preliminary results offer an alternative etiology for IBS-D not previously considered and open the avenue for new research.Keywords: clostridium deficile, diarrhea predominant Irritable Bowel Syndrome, microbiome, vancomycin/rifaximin combination
Procedia PDF Downloads 120275 Assessment of Interior Environmental Quality and Airborne Infectious Risk in a Commuter Bus Cabin by Using Computational Fluid Dynamics with Computer Simulated Person
Authors: Yutaro Kyuma, Sung-Jun Yoo, Kazuhide Ito
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A commuter bus remains important as a means to network public transportation between railway stations and terminals within cities. In some cases, the boarding time becomes longer, and the boarding rate tends to be higher corresponding to the development of urban cities. The interior environmental quality, e.g. temperature and air quality, in a commuter bus is relatively heterogeneous and complex compared to that of an indoor environment in buildings due to several factors: solar radiative heat – which comes from large-area windows –, inadequate ventilation rate caused by high density of commuters, and metabolic heat generation from travelers themselves. In addition to this, under conditions where many passengers ride in the enclosed space, contact and airborne infectious risk have attracted considerable attention in terms of public health. From this point of view, it is essential to develop the prediction method for assessment of interior environmental quality and infection risk in commuter bus cabins. In this study, we developed a numerical commuter bus model integrated with computer simulated persons to reproduce realistic indoor environment conditions with high occupancy during commuting. Here, computer simulated persons were newly designed considering different types of geometries, e.g., standing position, seating position, and individual differences. Here we conducted coupled computational fluid dynamics (CFD) analysis with radiative heat transfer analysis under steady state condition. Distributions of heterogeneous air flow patterns, temperature, and moisture surrounding the human body under some different ventilation system were analyzed by using CFD technique, and skin surface temperature distributions were analyzed using thermoregulation model that integrated into computer simulated person. Through these analyses, we discussed the interior environmental quality in specific commuter bus cabins. Further, inhaled air quality of each passenger was also analyzed. This study may have possibility to design the ventilation system in bus for improving thermal comfort of occupants.Keywords: computational fluid dynamics, CFD, computer simulated person, CSP, contaminant, indoor environment, public health, ventilation
Procedia PDF Downloads 243274 Additional Pathological Findings Using MRI on Patients with First Time Traumatic Lateral Patella Dislocation: A Study of 150 Patients
Authors: Ophir Segal, Daniel Weltsch, Shay Tenenbaum, Ran Thein
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Purpose: Patients with lateral patellar dislocation (LPD) are not always referred to perform an MRI. This might be the case in first time LPD patients without surgical indications or in patients with recurrent LPD who had MRI in previous episodes. Unfortunately, in some cases, there are additional knee pathological findings, which include tearing of the collateral or cruciate ligaments and injury to the tendons or menisci. These findings might be overlooked during the physical examination or masked by nonspecific clinical findings like knee pain, effusion, or hemarthrosis. The prevalence of these findings, which can be revealed by MRI, is misreported in literature and is considered rare. In our practice, all patients with LPD are sent for MRI after LPD. Therefore, we have designed a retrospective comparative study to evaluate the prevalence of additional pathological findings in patients with acute traumatic LPD that had performed MRI, comparing different groups of patients according to age, sex, and Tibial Tuberosity-Trochlear Groove(TT-TG) distance. Methods: MRI of the knee in patients after traumatic LPD were evaluated for the presence of additional pathological findings such as injuries to ligaments: Anterior/Posterior cruciate ligament(ACL, PCL), Medial/Lateral collateral ligament(MCL, LCL), injuries to tendons(QUADICEPS, PATELLAR), menisci(Medial/Lateral meniscus(MM, LM)) and tibial plateau, by a fellowship-trained, senior musculoskeletal radiologist. A comparison between different groups of patients was performed according to age (age group < 25 years, age group > 25 years), sex (Male/Female group), and TT-TG distance (TT-TG<15 groups, TT-TG>15 groups). A descriptive and comparative statistical analysis was performed. Results: 150 patients were included in this study. All suffered from LPD between the years 2012-2017 (mean age 21.3( ± SD 8.9), 86 males). ACL, PCL, MCL, and LCL complete or partial tears were found in 17(11.3%), 3(2%), 22(14.6%), and 4(2.7%) of the patients, respectively. MM and LM tears were found in 10(6.7%) and 3(2%) of the patients, respectively. A higher prevalence of PCL injury, MM tear, and LM tear were found in the older age group compared to the younger group of patients (10.5% vs. 1.8%, 18.4% vs. 2.7%, and 7.9% vs. 0%, respectively, p<0.05). A higher prevalence of non-displaced MM tear and LCL injury was found in the male group compared to the female group (8.1% vs. 0% and 8.1% vs. 0% respectively, p<0.05). A higher prevalence of ACL injury was found in the normal TT-TG group compared to the pathologic TT-TG group (17.5% vs. 2.3%, p= 0.0184). Conclusions: Overall, 43 out of 150 (28.7%) of the patient's MRI’s were positive for additional pathological radiological findings. Interestingly, a higher prevalence of additional pathologies was found in the groups of patients with a lower risk for recurrent LPD, including males, patients older than 25, and patients with TT-TG lower than 15mm, and therefore might not be referred for an MRI scan. Thus, we recommend a strict physical examination, awareness to the high prevalence of additional pathological findings, and to consider performing an MRI in all patients after LPD.Keywords: additional findings, lateral patellar dislocation (LPD), MRI scan, traumatic patellar dislocation, cruciate ligaments injuries, menisci injuries, collateral ligaments injuries
Procedia PDF Downloads 134273 Differences in Patient Satisfaction Observed between Female Japanese Breast Cancer Patients Who Receive Breast-Conserving Surgery or Total Mastectomy
Authors: Keiko Yamauchi, Motoyuki Nakao, Yoko Ishihara
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The increase in the number of women with breast cancer in Japan has required hospitals to provide a higher quality of medicine so that patients are satisfied with the treatment they receive. However, patients’ satisfaction following breast cancer treatment has not been sufficiently studied. Hence, we investigated the factors influencing patient satisfaction following breast cancer treatment among Japanese women. These women underwent either breast-conserving surgery (BCS) (n = 380) or total mastectomy (TM) (n = 247). In March 2016, we conducted a cross-sectional internet survey of Japanese women with breast cancer in Japan. We assessed the following factors: socioeconomic status, cancer-related information, the role of medical decision-making, the degree of satisfaction regarding the treatments received, and the regret arising from the medical decision-making processes. We performed logistic regression analyses with the following dependent variables: extreme satisfaction with the treatments received, and regret regarding the medical decision-making process. For both types of surgery, the odds ratio (OR) of being extremely satisfied with the cancer treatment was significantly higher among patients who did not have any regrets compared to patients who had. Also, the OR tended to be higher among patients who chose to play a wanted role in the medical decision-making process, compared with patients who did not. In the BCS group, the OR of being extremely satisfied with the treatment was higher if, at diagnosis, the patient’s youngest child was older than 19 years, compared with patients with no children. The OR was also higher if patient considered the stage and characteristics of their cancer significant. The OR of being extremely satisfied with the treatments was lower among patients who were not employed on full-time basis, and among patients who considered the second medical opinions and medical expenses to be significant. These associations were not observed in the TM group. The OR of having regrets regarding the medical decision-making process was higher among patients who chose to play a role in the decision-making process as they preferred, and was also higher in patients who were employed on either a part-time or contractual basis. For both types of surgery, the OR was higher among patients who considered a second medical opinion to be significant. Regardless of surgical type, regret regarding the medical decision-making process decreases treatment satisfaction. Patients who received breast-conserving surgery were more likely to have regrets concerning the medical decision-making process if they could not play a role in the process as they preferred. In addition, factors associated with the satisfaction with treatment in BCS group but not TM group included the second medical opinion, medical expenses, employment status, and age of the youngest child at diagnosis.Keywords: medical decision making, breast-conserving surgery, total mastectomy, Japanese
Procedia PDF Downloads 142272 Comparison of Early Post-operative Outcomes of Cardiac Surgery Patients Who Have Had Blood Transfusion Based on Fixed Cut-off Point versus of Change in Percentage of Basic Hematocrit Levels
Authors: Khosro Barkhordari, Fateme Sadr, Mina Pashang
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Back ground: Blood transfusion is one of the major issues in cardiac surgery patients. Transfusing patients based on fixed cut-off points of hemoglobin is the current protocol in most institutions. The hemoglobin level of 7- 10 has been suggested for blood transfusion in cardiac surgery patients. We aimed to evaluate if blood transfusion based on change in percentage of hematocrit has different outcomes. Methods: In this retrospective cohort study, we investigated the early postoperative outcome of cardiac surgery patients who received blood transfusions at Tehran Heart Center Hospital, IRAN. We reviewed and analyzed the basic characteristics and clinical data of 700 patients who met our exclusion and inclusion criteria. The two groups of blood transfused patients were compared, those who have 30-50 percent decrease in basal hematocrit versus those with 10 -29 percent decrease. Results: This is ongoing study, and the results would be completed in two weeks after analysis of the date. Conclusion: Early analysis has shown no difference in early post-operative outcomes between the two groups, but final analysis will be completed in two weeks. 1-Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IRAN 2- Department of Research, Tehran Heart Center, Tehran, IRAN Quantitative variables were compared using the Student t-test or the Mann‐Whitney U test, as appropriate, while categorical variables were compared using the χ2 or the Fisher exact test, as required. Our intention was to compare the early postoperative outcomes between the two groups, which include 30 days mortality, Length of ICU stay, Length of hospital stay, Intubation time, Infection rate, acute kidney injury, and respiratory complications. The main goal was to find if transfusing blood based on changes in hematocrit from a basal level was better than to fixed cut-off point regarding early post-operative outcomes. This has not been studied enough and may need randomized control trials.Keywords: post-operative, cardiac surgery, outcomes, blood transfusion
Procedia PDF Downloads 77271 The Efficacy of Albendazole against Soil-Transmitted Helminths and the Impact of Mass Drug Administration of Albendazole and Ivermectin on Health Status
Authors: Mike Yaw Osei-Atweneboana, John Asiedu Larbi, Edward Jenner Tettevi
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Background: The lymphatic filariasis (LF) control programme has been on-going in Ghana since 2000. This community-wide approach involves the use of ivermectin (IVM) and albendazole (ALB). Soil-transmitted helminth (STH) infections control is augmented within this programme; however, in areas where LF is not prevalent, albendazole alone is administered to school children. The purpose of this study was therefore, to determine the efficacy of albendazole against soils transmitted helminths and the impact of mass drug administration of albendazole and ivermectin on the health status of children of school going age and pregnant women. Material/Methods: This was a twelve months longitudinal study. A total of 412 subjects including school children (between the ages of 2-17 years) and pregnant women were randomly selected from four endemic communities in Kpandai district of the Northern region. Coprological assessment for parasites was based on the Kato–Katz technique in both dry and rainy seasons at baseline, 21 days and 3 months post-treatment. Single-dose albendazole treatment was administered to all patients at baseline. Preserved samples are currently under molecular studies to identify possible single nucleotide polymorphism (SNP) within the beta tubulin gene which is associated with benzimidazole resistance. Results: Of all the parasites found (hookworm, Trichuris trichiura, Hymenolepis nana, and Taenia sp.); hookworm was the most prevalent. In the dry season, the overall STHs prevalence at pre-treatment was 29%, while 9% and 13% prevalence was recorded at 21 days, and three months after treatment respectively. However, in the rainy season, the overall STHs prevalence was 8%, while 4% and 12% was recorded at 21 days and three months respectively after ALB treatment. In general, ALB treatment resulted in an overall hookworm egg count reduction rate of 89% in the dry season and 93% in the rainy season, while the T. trichiura egg count reduction rate was 100% in both seasons. Conclusions: STH infections still remains a significant public health burden in Ghana. Hookworm infection seems to respond poorly or sub-optimally to ALB, raising concerns of possible emergence of resistance which may lead to a major setback for the control and elimination of STH infections, especially hookworm infections.Keywords: hookworm, sub-optimal response, albendazole, trichuriasis, soil-transmitted helminths
Procedia PDF Downloads 284270 A Systematic Review of Efficacy and Safety of Radiofrequency Ablation in Patients with Spinal Metastases
Authors: Pascale Brasseur, Binu Gurung, Nicholas Halfpenny, James Eaton
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Development of minimally invasive treatments in recent years provides a potential alternative to invasive surgical interventions which are of limited value to patients with spinal metastases due to short life expectancy. A systematic review was conducted to explore the efficacy and safety of radiofrequency ablation (RFA), a minimally invasive treatment in patients with spinal metastases. EMBASE, Medline and CENTRAL were searched from database inception to March 2017 for randomised controlled trials (RCTs) and non-randomised studies. Conference proceedings for ASCO and ESMO published in 2015 and 2016 were also searched. Fourteen studies were included: three prospective interventional studies, four prospective case series and seven retrospective case series. No RCTs or studies comparing RFA with another treatment were identified. RFA was followed by cement augmentation in all patients in seven studies and some patients (40-96%) in the remaining seven studies. Efficacy was assessed as pain relief in 13/14 studies with the use of a numerical rating scale (NRS) or a visual analogue scale (VAS) at various time points. Ten of the 13 studies reported a significant decrease in pain outcome, post-RFA compared to baseline. NRS scores improved significantly at 1 week (5.9 to 3.5, p < 0.0001; 8 to 4.3, p < 0.02 and 8 to 3.9, p < 0.0001) and this improvement was maintained at 1 month post-RFA compared to baseline (5.9 to 2.6, p < 0.0001; 8 to 2.9, p < 0.0003; 8 to 2.9, p < 0.0001). Similarly, VAS scores decreased significantly at 1 week (7.5 to 2.7, p=0.00005; 7.51 to 1.73, p < 0.0001; 7.82 to 2.82, p < 0.001) and this pattern was maintained at 1 month post-RFA compared to baseline (7.51 to 2.25, p < 0.0001; 7.82 to 3.3; p < 0.001). A significant pain relief was achieved regardless of whether patients had cement augmentation in two studies assessing the impact of RFA with or without cement augmentation on VAS pain scores. In these two studies, a significant decrease in pain scores was reported for patients receiving RFA alone and RFA+cement at 1 week (4.3 to 1.7. p=0.0004 and 6.6 to 1.7, p=0.003 respectively) and 15-36 months (7.9 to 4, p=0.008 and 7.6 to 3.5, p=0.005 respectively) after therapy. Few minor complications were reported and these included neural damage, radicular pain, vertebroplasty leakage and lower limb pain/numbness. In conclusion, the efficacy and safety of RFA were consistently positive between prospective and retrospective studies with reductions in pain and few procedural complications. However, the lack of control groups in the identified studies indicates the possibility of selection bias inherent in single arm studies. Controlled trials exploring efficacy and safety of RFA in patients with spinal metastases are warranted to provide robust evidence. The identified studies provide an initial foundation for such future trials.Keywords: pain relief, radiofrequency ablation, spinal metastases, systematic review
Procedia PDF Downloads 161269 A Comparison of qCON/qNOX to the Bispectral Index as Indices of Antinociception in Surgical Patients Undergoing General Anesthesia with Laryngeal Mask Airway
Authors: Roya Yumul, Ofelia Loani Elvir-Lazo, Sevan Komshian, Ruby Wang, Jun Tang
Abstract:
BACKGROUND: An objective means for monitoring the anti-nociceptive effects of perioperative medications has long been desired as a way to provide anesthesiologists information regarding a patient’s level of antinociception and preclude any untoward autonomic responses and reflexive muscular movements from painful stimuli intraoperatively. To this end, electroencephalogram (EEG) based tools including BIS and qCON were designed to provide information about the depth of sedation while qNOX was produced to inform on the degree of antinociception. The goal of this study was to compare the reliability of qCON/qNOX to BIS as specific indicators of response to nociceptive stimulation. METHODS: Sixty-two patients undergoing general anesthesia with LMA were included in this study. Institutional Review Board (IRB) approval was obtained, and informed consent was acquired prior to patient enrollment. Inclusion criteria included American Society of Anesthesiologists (ASA) class I-III, 18 to 80 years of age, and either gender. Exclusion criteria included the inability to consent. Withdrawal criteria included conversion to the endotracheal tube and EEG malfunction. BIS and qCON/qNOX electrodes were simultaneously placed on all patients prior to induction of anesthesia and were monitored throughout the case, along with other perioperative data, including patient response to noxious stimuli. All intraoperative decisions were made by the primary anesthesiologist without influence from qCON/qNOX. Student’s t-distribution, prediction probability (PK), and ANOVA were used to statistically compare the relative ability to detect nociceptive stimuli for each index. Twenty patients were included for the preliminary analysis. RESULTS: A comparison of overall intraoperative BIS, qCON and qNOX indices demonstrated no significant difference between the three measures (N=62, p> 0.05). Meanwhile, index values for qNOX (62±18) were significantly higher than those for BIS (46±14) and qCON (54±19) immediately preceding patient responses to nociceptive stimulation in a preliminary analysis (N=20, * p= 0.0408). Notably, certain hemodynamic measurements demonstrated a significant increase in response to painful stimuli (MAP increased from 74 ±13 mm Hg at baseline to 84 ± 18 mm Hg during noxious stimuli [p= 0.032] and HR from 76 ± 12 BPM at baseline to 80 ± 13 BPM during noxious stimuli [p=0.078] respectively). CONCLUSION: In this observational study, BIS and qCON/qNOX provided comparable information on patients’ level of sedation throughout the course of an anesthetic. Meanwhile, increases in qNOX values demonstrated a superior correlation to an imminent response to stimulation relative to all other indicesKeywords: antinociception, BIS, general anesthesia, LMA, qCON/qNOX
Procedia PDF Downloads 123268 Applying the Global Trigger Tool in German Hospitals: A Retrospective Study in Surgery and Neurosurgery
Authors: Mareen Brosterhaus, Antje Hammer, Steffen Kalina, Stefan Grau, Anjali A. Roeth, Hany Ashmawy, Thomas Gross, Marcel Binnebosel, Wolfram T. Knoefel, Tanja Manser
Abstract:
Background: The identification of critical incidents in hospitals is an essential component of improving patient safety. To date, various methods have been used to measure and characterize such critical incidents. These methods are often viewed by physicians and nurses as external quality assurance, and this creates obstacles to the reporting events and the implementation of recommendations in practice. One way to overcome this problem is to use tools that directly involve staff in measuring indicators of quality and safety of care in the department. One such instrument is the global trigger tool (GTT), which helps physicians and nurses identify adverse events by systematically reviewing randomly selected patient records. Based on so-called ‘triggers’ (warning signals), indications of adverse events can be given. While the tool is already used internationally, its implementation in German hospitals has been very limited. Objectives: This study aimed to assess the feasibility and potential of the global trigger tool for identifying adverse events in German hospitals. Methods: A total of 120 patient records were randomly selected from two surgical, and one neurosurgery, departments of three university hospitals in Germany over a period of two months per department between January and July, 2017. The records were reviewed using an adaptation of the German version of the Institute for Healthcare Improvement Global Trigger Tool to identify triggers and adverse event rates per 1000 patient days and per 100 admissions. The severity of adverse events was classified using the National Coordinating Council for Medication Error Reporting and Prevention. Results: A total of 53 adverse events were detected in the three departments. This corresponded to adverse event rates of 25.5-72.1 per 1000 patient-days and from 25.0 to 60.0 per 100 admissions across the three departments. 98.1% of identified adverse events were associated with non-permanent harm without (Category E–71.7%) or with (Category F–26.4%) the need for prolonged hospitalization. One adverse event (1.9%) was associated with potentially permanent harm to the patient. We also identified practical challenges in the implementation of the tool, such as the need for adaptation of the global trigger tool to the respective department. Conclusions: The global trigger tool is feasible and an effective instrument for quality measurement when adapted to the departmental specifics. Based on our experience, we recommend a continuous use of the tool thereby directly involving clinicians in quality improvement.Keywords: adverse events, global trigger tool, patient safety, record review
Procedia PDF Downloads 240