Search results for: treatment plan
7634 E-Resource Management: Digital Environment for a Library System
Authors: Vikram Munjal, Harpreet Munjal
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A few years ago we could hardly think of Libraries' strategic plan that includes the bold and amazing prediction of a mostly digital environment for a library system. However, sheer hard work by the engineers, academicians, and librarians made it feasible. However, it requires huge expenditure and now a day‘s spending for electronic resources (e-resources) have been growing much more rapidly than have the materials budgets of which such resources are usually a part. And many libraries are spending a huge amount on e-resources. Libraries today are in the midst of a profound shift toward reliance on e-resources, and this reliance seems to have deepened in recent years as libraries have shed paper journal subscriptions to help pay for online access. This has been exercised only to cater user behavior and attitudes that seem to be changing even more quickly in this dynamic scenario.Keywords: radio frequency identification, management, scanning, barcodes, checkout and tags
Procedia PDF Downloads 4047633 Neuroprotective Effects of Rosmarinic Acid in the MPTP Mouse Model of Parkinson's Disease
Authors: Huamin Xu, Wenting Jia, Hong Jiang, Junxia Xie
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Rosmarinic acid (RA) is a natural acid that is found in a variety of herbs, such as rosemary and has multiple biological activities such as antioxidative, anti-inflammatory and antiviral activities. In this study, we investigated the neuroprotective effects of RA on dopaminergic system in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) induced mouse model of Parkinson’s disease (PD). The mice received oral administration of RA before MPTP injection. Results showed that the tyrosine hydroxylase expression in SN reduced and the levels of dopamine and its metabolites in the striatum decreased in MPTP intoxicated PD mice. Pretreatment with RA significantly inhibited these changes. Further studies demonstrated that MPTP treatment increased the iron content, which was counteracted by pre-treatment with RA. In addition, RA could restore the decrease of superoxide dismutase (SOD) induced by MPTP. This study provides evidence that RA could suppress MPTP-induced degeneration of the nigrostriatal dopaminergic system by regulating iron content and the expression of SOD. Thus, RA might be clinically evaluated for the prevention of neurodegenerative diseases.Keywords: rosmarinic acid, Parkinson's disease, MPTP, dopaminergic system
Procedia PDF Downloads 2067632 CRISPR Technology: A Tool in the Potential Cure for COVID-19 Virus
Authors: Chijindu Okpalaoka, Charles Chinedu Onuselogu
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COVID-19, humanity's coronavirus disease caused by SARS-CoV-2, was first detected in late 2019 in Wuhan, China. COVID-19 lacked an established conventional pharmaceutical therapy, and as a result, the outbreak quickly became an epidemic affecting the entire World. Only a qPCR assay is reliable for diagnosing COVID-19. Clustered, regularly interspaced short palindromic repeats (CRISPR) technology is being researched for speedy and specific identification of COVID-19, among other therapeutic techniques. Apart from its therapeutic capabilities, the CRISPR technique is being evaluated to develop antiviral therapies; nevertheless, no CRISPR-based medication has been approved for human use to date. Prophylactic antiviral CRISPR in living being cells, a Cas 13-based approach against coronavirus, has been developed. While this method can be evolved into a treatment approach, it may face substantial obstacles in human clinical trials for licensure. This study discussed the potential applications of CRISPR-based techniques for developing a speedy and accurate feasible treatment alternative for the COVID-19 virus.Keywords: COVID-19, CRISPR technique, Cas13, SARS-CoV-2, prophylactic antiviral
Procedia PDF Downloads 1307631 Dairy Wastewater Treatment by Electrochemical and Catalytic Method
Authors: Basanti Ekka, Talis Juhna
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Dairy industrial effluents originated by the typical processing activities are composed of various organic and inorganic constituents, and these include proteins, fats, inorganic salts, antibiotics, detergents, sanitizers, pathogenic viruses, bacteria, etc. These contaminants are harmful to not only human beings but also aquatic flora and fauna. Because consisting of large classes of contaminants, the specific targeted removal methods available in the literature are not viable solutions on the industrial scale. Therefore, in this on-going research, a series of coagulation, electrochemical, and catalytic methods will be employed. The bulk coagulation and electrochemical methods can wash off most of the contaminants, but some of the harmful chemicals may slip in; therefore, specific catalysts designed and synthesized will be employed for the removal of targeted chemicals. In the context of Latvian dairy industries, presently, work is under progress on the characterization of dairy effluents by total organic carbon (TOC), Inductively Coupled Plasma Mass Spectrometry (ICP-MS)/ Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES), High-Performance Liquid Chromatography (HPLC), Gas Chromatography-Mass Spectrometry (GC-MS), and Mass Spectrometry. After careful evaluation of the dairy effluents, a cost-effective natural coagulant will be employed prior to advanced electrochemical technology such as electrocoagulation and electro-oxidation as a secondary treatment process. Finally, graphene oxide (GO) based hybrid materials will be used for post-treatment of dairy wastewater as graphene oxide has been widely applied in various fields such as environmental remediation and energy production due to the presence of various oxygen-containing groups. Modified GO will be used as a catalyst for the removal of remaining contaminants after the electrochemical process.Keywords: catalysis, dairy wastewater, electrochemical method, graphene oxide
Procedia PDF Downloads 1447630 Data Mining Spatial: Unsupervised Classification of Geographic Data
Authors: Chahrazed Zouaoui
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In recent years, the volume of geospatial information is increasing due to the evolution of communication technologies and information, this information is presented often by geographic information systems (GIS) and stored on of spatial databases (BDS). The classical data mining revealed a weakness in knowledge extraction at these enormous amounts of data due to the particularity of these spatial entities, which are characterized by the interdependence between them (1st law of geography). This gave rise to spatial data mining. Spatial data mining is a process of analyzing geographic data, which allows the extraction of knowledge and spatial relationships from geospatial data, including methods of this process we distinguish the monothematic and thematic, geo- Clustering is one of the main tasks of spatial data mining, which is registered in the part of the monothematic method. It includes geo-spatial entities similar in the same class and it affects more dissimilar to the different classes. In other words, maximize intra-class similarity and minimize inter similarity classes. Taking account of the particularity of geo-spatial data. Two approaches to geo-clustering exist, the dynamic processing of data involves applying algorithms designed for the direct treatment of spatial data, and the approach based on the spatial data pre-processing, which consists of applying clustering algorithms classic pre-processed data (by integration of spatial relationships). This approach (based on pre-treatment) is quite complex in different cases, so the search for approximate solutions involves the use of approximation algorithms, including the algorithms we are interested in dedicated approaches (clustering methods for partitioning and methods for density) and approaching bees (biomimetic approach), our study is proposed to design very significant to this problem, using different algorithms for automatically detecting geo-spatial neighborhood in order to implement the method of geo- clustering by pre-treatment, and the application of the bees algorithm to this problem for the first time in the field of geo-spatial.Keywords: mining, GIS, geo-clustering, neighborhood
Procedia PDF Downloads 3757629 Serum Sickness-Like Reaction to D-Mannose Supplement
Authors: Emma Plante, Charles Ekwunwa, Diego Illanes
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Introduction: Serum Sickness-Like Reaction (SSLR) is an inflammatory immune response characterized by a rash, polyarthralgias, and fever. SSLR usually occurs in response to a new medication (most commonly antibiotics, anticonvulsants, or antiinflammatory agents) and is believed to involve the formation of drug-specific immune complexes. Here we present a case of a 16-year-old female patient who developed an SSLR in response to the D-mannose-containing over-the-counter supplement, Uqora, used to promote bladder health. Methodology: The methodology for this study included a thorough literature search for other cases of SSLR associated with D-Mannose containing products. Data collection was performed through a review of the patient’s medical record, including history, physical examination, relevant laboratory results, and treatment plan. Findings: A 16-year-old female with a history of overactive bladder and anemia presented with a diffuse urticarial rash, headaches, joint pain, and swelling for three days. Her medications included oral contraceptive pills, iron, mirabegron, UQora, and a probiotic. Physical examination revealed a diffuse urticarial rash, and her musculoskeletal exam revealed swelling and tenderness in her wrists. Her CBC, basic metabolic panel, liver function panel, lyme titers, and urinalysis were all within normal limits. The patient was referred to an allergist, who diagnosed her with SSLR. All medications were discontinued, and she was treated with a 7-day course of prednisone and cetirizine. Her symptoms resolved, and her medications were slowly resumed sequentially over several months. However, UQora triggered a recurrence of her symptoms, and it was identified as the culprit medication. Consequently, UQora was permanently discontinued, and the patient has remained symptom-free. Conclusion: This case report describes the first documented case of SSLR caused by UQora (active ingredient D-mannose). D-Mannose is a monosaccharide found in many plants and fruits, and it is commonly used to prevent urinary tract infections. While the clinical features and timeline, in this case, were typical of SSLR, UQora as the trigger was highly unusual. Clinicians should be aware of the diverse triggers of SSLR and the importance of prompt identification and management to enhance patient safety. It is possible D-mannose was not the trigger, and further research is necessary to better understand the potential therapeutic applications of D-mannose, as well as the potential risks and interactions.Keywords: serum sickness-like reaction, d-mannose, hypersensitivity reaction, urticaria
Procedia PDF Downloads 947628 Effect of Various Tillage Systems on Soil Compaction
Authors: Sushil Kumar, Mukesh Jain, Vijaya Rani, Vinod Kumar
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The prime importance of tillage is that it prepares the land where the seed easily germinate and later the plant can well establish. Using different types of equipments driven manually or by powered, machines make the soil suitable to place the seeds into the desirable depth. Moreover, tillage loosens the compacted layers. Heavy equipment and tillage implements can cause damage to the soil structure. Effect of various tillage methods on soil compaction was studied in Rabi season of 2013-14 at village Ladwa, Hisar, Haryana (India). The experiments studied the effect of six tillage treatments i.e. no tillage or zero tillage (T1), tillage with rotavator (T2), disc harrow (T3), rotavator + sub soiler (T4), disc harrow + sub soiler (T5) and power harrow (T6) on soil compaction. Soil compaction was measured before tillage and after sowing at 0, 30, 60 and 90 days after sowing. No change in soil resistance was recorded before and after no tillage treatment. Maximum soil resistance was found in zero tillage followed by disc harrow up to 150 mm soil depth. Minimum soil resistance was found in rotavator immediately after the tillage treatment. However, the soil resistance approached the same level as it had been before the tillage after the soil strata where the implement cannot reach.Keywords: tillage, no tillage, rotavator, subsoiler, compaction
Procedia PDF Downloads 3187627 Design, Molecular Modeling, Synthesize, and Biological Evaluation of Some Dual Inhibitors of Soluble Epoxide Hydrolase (sEH) and Cyclooxygenase 2 (COX-2)
Authors: Elham Rezaee, Sayyed Abbas Tabatabai
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Dual inhibition of COX-2 and sEH enzymes represents one of the distinct pharmaceutical approaches for the treatment of inflammation, pain, cancers, and other diseases. The discovery of these inhibitors for treatment is a great deal of attention because of some advantages such as increased efficacy, a promising safety profile, ease of formulation, and better target engagement. In this research, based on the structure-activity relationship of COX-2 and sEH inhibitors, some amide derivatives with oxadiazole and dihydropyrimidinone rings against sEH and COX-2 enzymes were developed. The designed compounds showed high affinity to the active site of both enzymes in docking studies and were synthesized in good yield and characterized by IR, Mass, 1HNMR, and 13CNMR. All of the novel compounds exhibited considerable in-vitro sEH and COX-2 inhibitory activities in comparison with 12-(3-Adamantan-1-yl-ureido)- dodecanoic acid and celecoxib (a potent urea-based sEH inhibitor and selective nonsteroidal anti-inflammatory drug, respectively). Ethyl 6-methyl-4-(4-(4-(methylsulfonyl)benzamido)phenyl)-2-oxo-1,2,3,4-tetrahydropyrimidine-5-carboxylate was found to be the most selective COX-2 inhibitor (COX-2/COX-1 ratio: 683) with IC50 value of 2.1 nM targeting sEH enzyme.Keywords: COX-2, dual inhibitors, sEH, synthesis
Procedia PDF Downloads 527626 Characterization of Domestic Sewage Mixed with Baker's Yeast Factory Effluent of Beja Wastewater Treatment Plant by Respirometry
Authors: Fezzani Boubaker
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In this work, a comprehensive study of respirometric method was performed to assess the biodegradable COD fractions of domestic sewage mixed with baker’s yeast factory effluent treated by wastewater treatment plant (WWTP) of Beja. Three respirometric runs were performed in a closed tank reactor to characterize this mixed raw effluent. Respirometric result indicated that the readily biodegradable fraction (SS) was in range of 6-22%, the slowly biodegradable fraction (Xs) was in range of 33-42%, heterotrophic biomass (XH) was in range of 9-40% and the inert fractions: XI and SI were in range of 2-40% and 6-12% respectively which were high due to the presence of baker’s yeast factory effluent compared to domestic effluent alone. The fractions of the total nitrogen showed that SNO fraction is between 6 and 9% of TKN, the fraction of nitrogen ammonia SNH was ranging from 5 to 68%. The organic fraction divided into two compartments SND (11-85%) and XND (5-20%) the inert particulate nitrogen fraction XNI was between 0.4 and 1% and the inert soluble fraction of nitrogen SNI was ranged from 0.4 to 3%.Keywords: wastewater characterization, COD fractions, respirometry, domestic sewage
Procedia PDF Downloads 4847625 Treatment of Papillary Thyroid Carcinoma Metastasis to the Sternum: A Case Report
Authors: Geliashvili T. M., Tyulyandina A. S., Valiev A. K., Kononets P. V., Kharatishvili T. K., Salkov A. G., Pronin A. I., Gadzhieva E. H., Parnas A. V., Ilyakov V. S.
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Aim/Introduction: Metastasis (Mts) to the sternum, while extremely rare in differentiated thyroid cancer (DTC) (1), requires a personalized, multidisciplinary treatment approach. In aggressively growing Mts to the sternum, which rapidly become unresectable, a comprehensive therapeutic and diagnostic approach is particularly important. Materials and methods: We present a clinical case of solitary Mts to the sternum as first manifestation of a papillary thyroid microcarcinoma in a 55-year-old man. Results: 18F-FDG PET/CT after thyroidectomy confirmed the solitary Mts to the sternum with extremely high FDG uptake (SUVmax=71,1), which predicted its radioiodine-refractory (RIR). Due to close attachment to the mediastinum and rapid growth, Mts was considered unresectable. During the next three months, the patient received targeted therapy with the tyrosine kinase inhibitor (TKI) Lenvatinib 24 mg per day. 1st course of radioiodine therapy (RIT) 6 GBq was also performed, the results of which confirmed the RIR of the tumor process. As a result of systemic therapy (targeted therapy combined with RIT and suppressive hormone therapy with L-thyroxine), there was a significant biochemical response (decrease of serum thyroglobulin level from 50,000 ng/ml to 550 ng/ml) and a partial response with decrease of tumor size (from 80x69x123 mm to 65x50x112 mm) and decrease of FDG accumulation (SUVmax from 71.1 to 63). All of this made possible to perform surgical treatment of Mts - sternal extirpation with its replacement by an individual titanium implant. At the control examination, the stimulated thyroglobulin level was only 134 ng/ml, and PET/CT revealed postoperative areas of 18F-FDG metabolism in the removed sternal Mts. Also, 18F-FDG PET/CT in the early (metabolic) stage revealed two new bone Mts (in the area of L3 SUVmax=17,32 and right iliac bone SUVmax=13,73), which, as well as the removed sternal Mts, appeared to be RIRs at the 2nd course of RIT 6 GBq. Subsequently, on 02.2022, external beam radiation therapy (EBRT) was performed on the newly identified oligometastatic bone foci. At present, the patient is under dynamic monitoring and in the process of suppressive hormone therapy with L-thyroxine. Conclusion: Thus, only due to the early prescription of targeted TKI therapy was it possible to perform surgical resection of Mts to the sternum, thereby improve the patient's quality of life and preserve the possibility of radical treatment in case of oligometastatic disease progression.Keywords: differentiated thyroid cancer, metastasis to the sternum, radioiodine therapy, radioiodine-refractory cancer, targeted therapy, lenvatinib
Procedia PDF Downloads 1057624 Clinical Prediction Rules for Using Open Kinetic Chain Exercise in Treatment of Knee Osteoarthritis
Authors: Mohamed Aly, Aliaa Rehan Youssef, Emad Sawerees, Mounir Guirgis
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Relevance: Osteoarthritis (OA) is the most common degenerative disease seen in all populations. It causes disability and substantial socioeconomic burden. Evidence supports that exercise are the most effective conservative treatment for patients with OA. Therapists experience and clinical judgment play major role in exercise prescription and scientific evidence for this regard is lacking. The development of clinical prediction rules to identify patients who are most likely benefit from exercise may help solving this dilemma. Purpose: This study investigated whether body mass index and functional ability at baseline can predict patients’ response to a selected exercise program. Approach: Fifty-six patients, aged 35 to 65 years, completed an exercise program consisting of open kinetic chain strengthening and passive stretching exercises. The program was given for 3 sessions per week, 45 minutes per session, for 6 weeks Evaluation: At baseline and post treatment, pain severity was assessed using the numerical pain rating scale, whereas functional ability was being assessed by step test (ST), time up and go test (TUG) and 50 feet time walk test (50 FTW). After completing the program, global rate of change (GROC) score of greater than 4 was used to categorize patients as successful and non-successful. Thirty-eight patients (68%) had successful response to the intervention. Logistic regression showed that BMI and 50 FTW test were the only significant predictors. Based on the results, patients with BMI less than 34.71 kg/m2 and 50 FTW test less than 25.64 sec are 68% to 89% more likely to benefit from the exercise program. Conclusions: Clinicians should consider the described strengthening and flexibility exercise program for patents with BMI less than 34.7 Kg/m2 and 50 FTW faster than 25.6 seconds. The validity of these predictors should be investigated for other exercise.Keywords: clinical prediction rule, knee osteoarthritis, physical therapy exercises, validity
Procedia PDF Downloads 4237623 Characteristics of Domestic Sewage in Small Urban Communities
Authors: Shohreh Azizi, Memory Tekere, Wag Nel
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An evaluation of the characteristics of wastewater generated from small communities was carried out in relation to decentralized approach for domestic sewage treatment plant and design of biological nutrient removal system. The study included the survey of the waste from various individual communities such as a hotel, a residential complex, an office premise, and an educational institute. The results indicate that the concentration of organic pollutant in wastewater from the residential complex is higher than the waste from all the other communities with COD 664 mg/l, BOD 370.2 mg/l and TSS 248.8 mg/l. And the waste water from office premise indicates low organic load with COD428 mg/l, BOD 232mg/l and TSS 157mg/l. The wastewater from residential complex was studied under activated sludge process to evaluate this technology for decentralized wastewater treatment. The Activated sludge process was operated at different 12to 4 hrs hydraulic retention times and the optimum 6 hrs HRT was selected, therefore the average reduction of COD (85.92%) and BOD (91.28 %) was achieved. The issue of sludge recycling, maintenance of biomass concentration and high HRT reactor (10 L) volume are making the system non-practical for smaller communities.Keywords: wastewater, small communities, activated sludge process, decentralized system
Procedia PDF Downloads 3577622 Water Management Scheme: Panacea to Development Using Nigeria’s University of Ibadan Water Supply Scheme as a Case Study
Authors: Sunday Olufemi Adesogan
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The supply of potable water at least is a very important index in national development. Water tariffs depend on the treatment cost which carries the highest percentage of the total operation cost in any water supply scheme. In order to keep water tariffs as low as possible, treatment costs have to be minimized. The University of Ibadan, Nigeria, water supply scheme consists of a treatment plant with three distribution stations (Amina way, Kurumi and Lander) and two raw water supply sources (Awba dam and Eleyele dam). An operational study of the scheme was carried out to ascertain the efficiency of the supply of potable water on the campus to justify the need for water supply schemes in tertiary institutions. The study involved regular collection, processing and analysis of periodic operational data. Data collected include supply reading (water production on daily basis) and consumers metered reading for a period of 22 months (October 2013 - July 2015), and also collected, were the operating hours of both plants and human beings. Applying the required mathematical equations, total loss was determined for the distribution system, which was translated into monetary terms. Adequacies of the operational functions were also determined. The study revealed that water supply scheme is justified in tertiary institutions. It was also found that approximately 10.7 million Nigerian naira (Keywords: development, panacea, supply, water
Procedia PDF Downloads 2097621 Development of an Ecological Binder by Geopolymerization of Untreated Dredged Sediments
Authors: Lisa Monteiro, Jacqueline Saliba, Nadia Saiyouri, Humberto Y. Godoy
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Theevolution of the global environmental context incites companies to reduce their impact by reusing local materials and promoting circular economy. Dredged sediments represent a potential source of materials due to their large volume. Indeed, the dredging operations carried out in Gironde alone generated an annual volume of sediment of approximately 9 million m³. Moreover, on the eve of the evolution of laws concerning dredging practices, the recovery of sediments is necessary to create a viable economy for their management. This thesis work is oriented towards the development of an ecological binder from the fine fraction of untreated dredged sediments. In fact, their physico-chemical properties make them favorable for the synthesis of geopolymer, current competitor of cement, thanks to its lower carbon footprint and environmental impact. However, several obstacles must be overcome before implementing this new family of materials: the use of sediments without thermal or chemical treatment, the absence of a formulation approach, ignorance of the reactions produced, etc. During the first year of the thesis, a physico-chemical characterization of the sediments made it possible to validate their use as precursors forgeopolymerization according to three criteria: their fineness, their mineralogical composition, and the percentage of amorphous phase. Following these results, several formulations have been defined, taking into account the environmental impact. The sediments were activated with an alkaline solution of sodium hydroxide and sodium silicate. Two other formulations with cement and blast furnace slag have been defined for comparison. The results highlighted the possibility of forming geopolymers from untreated and still wet dredged sediments. The development of structural bonds through the formation of hydrated sodium aluminosilicate thus leads to higher strengths at 90 days (4.78 MPa) than a mixture with cement (0.75 MPa). A 30% gain in CO₂ emissions has also been obtained compared to cement. In order to reduce the uncertainties linked to the absence of a formulation approach, to optimize the number of experiments to be carried out in the laboratory, and to obtain an optimal formulation, an analysis by mixing plan was conducted in order to frame the responses according to the proportions of the constituents. Following the obtaining of an optimal binder, the work will focus on the study of the durability and the interspecific variability of the sediments on the mechanical properties by testing the binder developed with different sediments dredged from the Bordeaux estuary. , the Grand Port Maritime of Bayonne, La Rochelle, and the Bassinsd'Arcachon.Keywords: compressive strength, dredged sediments, ecological binder, geopolymers
Procedia PDF Downloads 1007620 Comparative Catalytic Activity of Some Ferrites for Phenol Degradation in Aqueous Solutions
Authors: Bayan Alqassem, Israa A. Othman, Mohammed Abu Haija, Fawzi Banat
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The treatment of wastewater from highly toxic pollutants is one of the most challenging issues for humanity. In this study, the advanced oxidation process (AOP) was employed to study the catalytic degradation of phenol using different ferrite catalysts which are CoFe₂O₄, CrFe₂O₄, CuFe₂O₄, MgFe₂O₄, MnFe₂O₄, NiFe₂O₄ and ZnFe₂O₄. The ferrite catalysts were prepared via sol-gel and co-precipitation methods. Different ferrite composites were also prepared either by varying the metal ratios or incorporating chemically reduced graphene oxide in the ferrite cluster. The effect of phosphoric acid treatment on the copper ferrite activity. All of the prepared catalysts were characterized using infrared spectroscopy (IR), X-ray diffraction (XRD) and scanning electron microscopy (SEM). The ferrites catalytic activities were tested towards phenol degradation using high performance liquid chromatography (HPLC). The experimental results showed that ferrites prepared through sol-gel route were more active than those of the co-precipitation method towards phenol degradation. In both cases, CuFe₂O₄ exhibited the highest degradation of phenol compared to the other ferrites. The photocatalytic properties of the ferrites were also investigated.Keywords: ferrite catalyst, ferrite composites, phenol degradation, photocatalysis
Procedia PDF Downloads 2187619 The Quality Improvement of Painting Assignments for Grade 4-6 Students by Using PDCA Cycle
Authors: Pawinee Sorawech
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The purpose of this study was to investigate the quality improvement of painting assignments for grade 4-6 students by using PDCA cycle. This study employed a qualitative technique. Suan Sunandha Rajabhat University and its demonstration school were selected as the area of study. An in-depth interview was utilized. The findings revealed that model of PDCA cycle was a proper model to increase the quality of painting assignments for grade 4-6 students. The six steps of improvement included: studying the PDCA model, setting up a plan, determining the scope of work, creating a strategy, developing a quality for painting assignment, and coming up with a handbook for a quality improvement of painting assignment.Keywords: quality, painting assignments, PDCA cycle, grade 4-6 students
Procedia PDF Downloads 4827618 The Analgesic Effect of Electroacupuncture in a Murine Fibromyalgia Model
Authors: Bernice Jeanne Lottering, Yi-Wen Lin
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Introduction: Chronic pain has a definitive lack of objective parameters in the measurement and treatment efficacy of diseases such as Fibromyalgia (FM). Persistent widespread pain and generalized tenderness are the characteristic symptoms affecting a large majority of the global population, particularly females. This disease has indicated a refractory tendency to conventional treatment ventures, largely resultant from a lack of etiological and pathogenic understanding of the disease development. Emerging evidence indicates that the central nervous system (CNS) plays a critical role in the amplification of pain signals and the neurotransmitters associated therewith. Various stimuli have been found to activate the channels existent on nociceptor terminals, thereby actuating nociceptive impulses along the pain pathways. The transient receptor potential vanalloid 1 (TRPV1) channel functions as a molecular integrator for numerous sensory inputs, such as nociception, and was explored in the current study. Current intervention approaches face a multitude challenges, ranging from effective therapeutic interventions to the limitation of pathognomonic criteria resultant from incomplete understanding and partial evidence on the mechanisms of action of FM. It remains unclear whether electroacupuncture (EA) plays an integral role in the functioning of the TRPV1 pathway, and whether or not it can reduce the chronic pain induced by FM. Aims: The aim of this study was to explore the mechanisms underlying the activation and modulation of the TRPV1 channel pathway in a cold stress model of FM applied to a murine model. Furthermore, the effect of EA in the treatment of mechanical and thermal pain, as expressed in FM was also to be investigated. Methods: 18 C57BL/6 wild type and 6 TRPV1 knockout (KO) mice, aged 8-12 weeks, were exposed to an intermittent cold stress-induced fibromyalgia-like pain model, with or without EA treatment at ZusanLi ST36 (2Hz/20min) on day 3 to 5. Von Frey and Hargreaves behaviour tests were implemented in order to analyze the mechanical and thermal pain thresholds on day 0, 3 and 5 in control group (C), FM group (FM), FM mice with EA treated group (FM + EA) and FM in KO group. Results: An increase in mechanical and thermal hyperalgesia was observed in the FM, EA and KO groups when compared to the control group. This initial increase was reduced in the EA group, which directs focus at the treatment efficacy of EA in nociceptive sensitization, and the analgesic effect EA has attenuating FM associated pain. Discussion: An increase in the nociceptive sensitization was observed through higher withdrawal thresholds in the von Frey mechanical test and the Hargreaves thermal test. TRPV1 function in mice has been scientifically associated with these nociceptive conduits, and the increased behaviour test results suggest that TRPV1 upregulation is central to the FM induced hyperalgesia. This data was supported by the decrease in sensitivity observed in results of the TRPV1 KO group. Moreover, the treatment of EA showed a decrease in this FM induced nociceptive sensitization, suggesting TRPV1 upregulation and overexpression can be attenuated by EA at bilateral ST36. This evidence compellingly implies that the analgesic effect of EA is associated with TRPV1 downregulation.Keywords: fibromyalgia, electroacupuncture, TRPV1, nociception
Procedia PDF Downloads 1397617 High Pressure Processing of Jackfruit Bulbs: Effect on Color, Nutrient Profile and Enzyme Inactivation
Authors: Jyoti Kumari, Pavuluri Srinivasa Rao
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Jackfruit (ArtocarpusheterophyllusL.) is an underutilized yet highly nutritious fruit with unique flavour, known for its therapeutic and culinary properties. Fresh jackfruit bulb has a very short shelf life due to high moisture and sugar content leading to microbial and enzymatic browning, hindering its consumer acceptability and marketability. An attempt has been made for the preservation of the ripe jackfruit bulbs, by the application of high pressure (HP) over a range of 200-500 MPa at ambient temperature for dwell times ranging from 5 to 20 min. The physicochemical properties of jackfruit bulbs such as the pH, TSS, and titrable acidity were not affected by the pressurization process. The ripening index of the fruit bulb also decreased following HP treatment. While the ascorbic acid and antioxidant activity of jackfruit bulb were well retained by high pressure processing (HPP), the total phenols and carotenoids showed a slight increase. The HPP significantly affected the colour and textural properties of jackfruit bulb. High pressure processing was highly effective in reducing the browning index of jackfruit bulbs in comparison to untreated bulbs. The firmness of the bulbs improved upon the pressure treatment with longer dwelling time. The polyphenol oxidase has been identified as the most prominent oxidative enzyme in the jackfruit bulb. The enzymatic activity of polyphenol oxidase and peroxidase were significantly reduced by up to 40% following treatment at 400 MPa/15 min. HPP of jackfruit bulbs at ambient temperatures is shown to be highly beneficial in improving the shelf stability, retaining its nutrient profile, color, and appearance while ensuring the maximum inactivation of the spoilage enzymes.Keywords: antioxidant capacity, ascorbic acid, carotenoids, color, HPP-high pressure processing, jackfruit bulbs, polyphenol oxidase, peroxidase, total phenolic content
Procedia PDF Downloads 1747616 Developing Effective Strategies to Reduce Hiv, Aids and Sexually Transmitted Infections, Nakuru, Kenya
Authors: Brian Bacia, Esther Githaiga, Teresia Kabucho, Paul Moses Ndegwa, Lucy Gichohi
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Purpose: The aim of the study is to ensure an appropriate mix of evidence-based prevention strategies geared towards the reduction of new HIV infections and the incidence of Sexually transmitted Illnesses Background: In Nakuru County, more than 90% of all HIV-infected patients are adults and on a single-dose medication-one pill that contains a combination of several different HIV drugs. Nakuru town has been identified as the hardest hit by HIV/Aids in the County according to the latest statistics from the County Aids and STI group, with a prevalence rate of 5.7 percent attributed to the high population and an active urban center. Method: 2 key studies were carried out to provide evidence for the effectiveness of antiretroviral therapy (ART) when used optimally on preventing sexual transmission of HIV. Discussions based on an examination, assessments of successes in planning, program implementation, and ultimate impact of prevention and treatment were undertaken involving health managers, health workers, community health workers, and people living with HIV/AIDS between February -August 2021. Questionnaires were carried out by a trained duo on ethical procedures at 15 HIV treatment clinics targeting patients on ARVs and caregivers on ARV prevention and treatment of pediatric HIV infection. Findings: Levels of AIDS awareness are extremely high. Advances in HIV treatment have led to an enhanced understanding of the virus, improved care of patients, and control of the spread of drug-resistant HIV. There has been a tremendous increase in the number of people living with HIV having access to life-long antiretroviral drugs (ARV), mostly on generic medicines. Healthcare facilities providing treatment are stressed challenging the administration of the drugs, which require a clinical setting. Women find it difficult to take a daily pill which reduces the effectiveness of the medicine. ART adherence can be strengthened largely through the use of innovative digital technology. The case management approach is useful in resource-limited settings. The county has made tremendous progress in mother-to-child transmission reduction through enhanced early antenatal care (ANC) attendance and mapping of pregnant women Recommendations: Treatment reduces the risk of transmission to the child during pregnancy, labor, and delivery. Promote research of medicines through patients and community engagement. Reduce the risk of transmission through breastfeeding. Enhance testing strategies and strengthen health systems for sustainable HIV service delivery. Need exists for improved antenatal care and delivery by skilled birth attendants. Develop a comprehensive maternal reproductive health policy covering equitability, efficient and effective delivery of services. Put in place referral systems.Keywords: evidence-based prevention strategies, service delivery, human management, integrated approach
Procedia PDF Downloads 887615 Video-Based Psychoeducation for Caregivers of Persons with Schizophrenia
Authors: Jilu David
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Background: Schizophrenia is one of the most misunderstood mental illnesses across the globe. Lack of understanding about mental illnesses often delay treatment, severely affects the functionality of the person, and causes distress to the family. The study, Video-based Psychoeducation for Caregivers of Persons with Schizophrenia, consisted of developing a psychoeducational video about Schizophrenia, its symptoms, causes, treatment, and the importance of family support. Methodology: A quasi-experimental pre-post design was used to understand the feasibility of the study. Qualitative analysis strengthened the feasibility outcomes. Knowledge About Schizophrenia Interview was used to assess the level of knowledge of 10 participants, before and after the screening of the video. Results: Themes of usefulness, length, content, educational component, format of the intervention, and language emerged in the qualitative analysis. There was a statistically significant difference in the knowledge level of participants before and after the video screening. Conclusion: The statistical and qualitative analysis revealed that the video-based psychoeducation program was feasible and that it facilitated a general improvement in knowledge of the participants.Keywords: Schizophrenia, mental illness, psychoeducation, video-based psychoeducation, family support
Procedia PDF Downloads 1317614 Clinical Study of the Prunus dulcis (Almond) Shell Extract on Tinea capitis Infection
Authors: Nasreen Thebo, W. Shaikh, A. J. Laghari, P. Nangni
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Prunus dulcis (Almond) shell extract is demonstrated for its biomedical applications. Shell extract prepared by soxhlet method and further characterized by UV-Visible spectrophotometer, atomic absorption spectrophotometer (AAS), FTIR, GC-MS techniques. In this study, the antifungal activity of almond shell extract was observed against clinically isolated pathogenic fungi by strip method. The antioxidant potential of crude shell extract of was evaluated by using DPPH (2-2-diphenyl-1-picryhydrazyl) and radical scavenging system. The possibility of short term therapy was only 20 days. The total antioxidant activity varied from 94.38 to 95.49% and total phenolic content was found as 4.455 mg/gm in almond shell extract. Finally the results provide a great therapeutic potential against Tinea capitis infection of scalp. Included in this study of shell extract that show scientific evidence for clinical efficacy, as well as found to be more useful in the treatment of dermatologic disorders and without any doubt it can be recommended to be Patent.Keywords: Tinea capitis, DPPH, FTIR, GC-MS therapeutic treatment
Procedia PDF Downloads 3797613 De-Pigmentary Effect of Ayurvedic Treatment on Hyper-Pigmentation of Skin Due to Chloroquine: A Case Report
Authors: Sunil Kumar, Rajesh Sharma
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Toxic epidermal necrolysis, pruritis, rashes, lichen planus like eruption, hyper pigmentation of skin are rare toxic effects of choloroquine used over a long time. Skin and mucus membrane hyper pigmentation is generally of a bluish black or grayish color and irreversible after discontinuation of the drug. According to Ayurveda, Dushivisha is the name given to any poisonous substance which is not fully endowed with the qualities of poison by nature (i.e. it acts as an impoverished or weak poison) and because of its mild potency, it remains in the body for many years causing various symptoms, one among them being discoloration of skin.The objective of this case report is to investigate the effect of Ayurvedic management of chloroquine induced hyper-pigmentation on the line of treatment of Dushivisha. Case Report: A 26-year-old female was suffering from hyper-pigmentation of the skin over the neck, forehead, temporo-mandibular joints, upper back and posterior aspect of both the arms since 8 years had history of taking Chloroquine came to Out Patient Department of National Institute of Ayurveda, Jaipur, India in Jan. 2015. The routine investigations (CBC, ESR, Eosinophil count) were within normal limits. Punch biopsy skin studied for histopathology under hematoxylin and eosin staining showed epidermis with hyper-pigmentation of the basal layer. In the papillary dermis as well as deep dermis there were scattered melanophages along with infiltration by mononuclear cells. There was no deposition of amyloid-like substances. These histopathological findings were suggestive of Chloroquine induced hyper-pigmentation. The case was treated on the line of treatment of Dushivisha and was given Vamana and Virechana (therapeutic emesis and purgation) every six months followed by Snehana karma (oleation therapy) with Panchatikta Ghrit and Swedana (sudation). Arogyavardhini Vati -1 g, Dushivishari Vati 500 mg, Mahamanjisthadi Quath 20 ml were given twelve hourly and Aragwadhadi Quath 25 ml at bed time orally. The patient started showing lightening of the pigments after six months and almost complete remission after 12 months of the treatment. Conclusion: This patient presented with the Dushivisha effect of Chloroquineandwas administered two relevant procedures from Panchakarma viz. Vamana and Virechana. Both Vamana and Virechanakarma here referred to Shodhana karma (purification procedures) eliminates accumulated toxins from the body. In this process, oleation dislodge the toxins from the tissues and sudation helps to bring them to the alimentary tract. The line of treatment did not target direct hypo pigmentary effects; rather aimed to eliminate the Dushivisha. This gave promising results in this condition.Keywords: Ayurveda, chloroquine, Dushivisha, hyper-pigmentation
Procedia PDF Downloads 2347612 Effect of Flour Concentration and Retrogradation Treatment on Physical Properties of Instant Sinlek Brown Rice
Authors: Supat Chaiyakul, Direk Sukkasem, Patnachapa Natthapanpaisith
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Sinlek rice flour beverage or instant product is a dietary supplement for dysphagia, or difficulty swallowing. It is also consumed by individuals who need to consume supplements to maintain their calorific needs. This product provides protein, fat, iron, and a high concentration of carbohydrate from rice flour. However, the application of native flour is limited due to its high viscosity. Starch modification by controlling starch retrogradation was used in this study. The research studies the effects of rice flour concentration and retrogradation treatment on the physical properties of instant Sinlek brown rice. The native rice flour, gelatinized rice flour, and flour gels retrograded under 4 °C for 3 and 7 days were investigated. From the statistical results, significant differences between native and retrograded flour were observed. The concentration of rice flour was the main factor influencing the swelling power, solubility, and pasting properties. With the increase in rice flour content from 10 to 15%, swelling power, peak viscosity, trough, and final viscosity decreased; but, solubility, pasting temperature, peak time, breakdown, and setback increased. The peak time, pasting temperature, peak viscosity, trough, and final viscosity decreased as the storage period increased from 3 to 7 days. The retrograded rice flour powders had lower pasting temperature, peak viscosity, breakdown, and final viscosity than the gelatinized and native flour powders. Reduction of starch viscosity by gelatinization and controlling starch retrogradation could allow for increased quantities of rice flour in instant rice beverages. Also, the treatment could increase the energy and nutrient densities of rice beverages without affecting the viscosity of this product.Keywords: instant rice, pasting properties, pregelatinization, retrogradation
Procedia PDF Downloads 2417611 Medical Decision-Making in Advanced Dementia from the Family Caregiver Perspective: A Qualitative Study
Authors: Elzbieta Sikorska-Simmons
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Advanced dementia is a progressive terminal brain disease that is accompanied by a syndrome of difficult to manage symptoms and complications that eventually lead to death. The management of advanced dementia poses major challenges to family caregivers who act as patient health care proxies in making medical treatment decisions. Little is known, however, about how they manage advanced dementia and how their treatment choices influence the quality of patient life. This prospective qualitative study examines the key medical treatment decisions that family caregivers make while managing advanced dementia. The term ‘family caregiver’ refers to a relative or a friend who is primarily responsible for managing patient’s medical care needs and legally authorized to give informed consent for medical treatments. Medical decision-making implies a process of choosing between treatment options in response to patient’s medical care needs (e.g., worsening comorbid conditions, pain, infections, acute medical events). Family caregivers engage in this process when they actively seek treatments or follow recommendations by healthcare professionals. Better understanding of medical decision-making from the family caregiver perspective is needed to design interventions that maximize the quality of patient life and limit inappropriate treatments. Data were collected in three waves of semi-structured interviews with 20 family caregivers for patients with advanced dementia. A purposive sample of 20 family caregivers was recruited from a senior care center in Central Florida. The qualitative personal interviews were conducted by the author in 4-5 months intervals. The ethical approval for the study was obtained prior to the data collection. Advanced dementia was operationalized as stage five or higher on the Global Deterioration Scale (GDS) (i.e., starting with the GDS score of five, patients are no longer able survive without assistance due to major cognitive and functional impairments). Information about patients’ GDS scores was obtained from the Center’s Medical Director, who had an in-depth knowledge of each patient’s health and medical treatment history. All interviews were audiotaped and transcribed verbatim. The qualitative data analysis was conducted to answer the following research questions: 1) what treatment decisions do family caregivers make while managing the symptoms of advanced dementia and 2) how do these treatment decisions influence the quality of patient life? To validate the results, the author asked each participating family caregiver if the summarized findings accurately captured his/her experiences. The identified medical decisions ranged from seeking specialist medical care to end-of-life care. The most common decisions were related to arranging medical appointments, medication management, seeking treatments for pain and other symptoms, nursing home placement, and accessing community-based healthcare services. The most challenging and consequential decisions were related to the management of acute complications, hospitalizations, and discontinuation of treatments. Decisions that had the greatest impact on the quality of patient life and survival were triggered by traumatic falls, worsening psychiatric symptoms, and aspiration pneumonia. The study findings have important implications for geriatric nurses in the context of patient/caregiver-centered dementia care. Innovative nursing approaches are needed to support family caregivers to effectively manage medical care needs of patients with advanced dementia.Keywords: advanced dementia, family caregiver, medical decision-making, symptom management
Procedia PDF Downloads 1217610 Intellectual Property Risk Assessment in Planning Market Entry to China
Authors: Qing Cao
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Generally speaking, China has a relatively high level of intellectual property (IP) infringement. Risk assessment is indispensable in the strategic planning process. To complement the current literature in international business, the paper sheds the light on how to assess IP risk for foreign companies in planning market entry to China. Evaluating internal and external IP environment, proposed in the paper, consists of external analysis, internal analysis and further internal analysis. Through position the company’s IP environment, the risk assessment approach enables the foreign companies to either build the corresponding IP strategies or abort the entry plan beforehand to minimize the IP risks.Keywords: intellectual property, IP environment, risk assessment
Procedia PDF Downloads 5607609 Assessment of Yield and Water Use Efficiency of Soybean under Deficit Irrigation
Authors: Meysam Abedinpour
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Water limitation is the main challenge for crop production in a semi-arid environment. Deficit irrigation is a strategy that allows a crop to sustain some degree of water deficit in order to reduce costs and potentially increase income. For this goal, a field experimental carried out at Asrieh fields of Gorgan city in the north of Iran, during summer season 2011. The treatments imposed were different irrigation water regimes (i.e. W1:70, W2:80, W3:90, and W4:100) percent of field capacity (FC). The results showed that there was Significant difference between the yield and (WUE) under different levels of irrigation, excepting of soil moisture content at field capacity (W4) and 90% of field capacity (W3) on yield and water use efficiency (WUE). The seasonal irrigation water applied were (i.e. 375, 338, 300, and 263 mm ha-1) under different irrigation water treatments (100, 90, 80, 80 and 70%) of FC, respectively. Grain yield productions under treatments were 4180, 3955, 3640, and 3355 (kg ha-1) respectively. Furthermore, the results showed that water use efficiency (WUE) at different treatments were 7.67, 7.79, 7.74, and 7.75 Kg mm ha-1 for (100, 90, 80, and 70) per cent of field capacity, therefore the 90 % of FC treatment (W3) is recommended for Soybean irrigation for water saving. Furthermore, the result showed that the treatment of 90 % of filed capacity (W3) seemed to be better adapted to product a high crop yield with acceptable yield coupling with water use efficiency in Golestan province.Keywords: deficit irrigation, water use efficiency, yield, soybean
Procedia PDF Downloads 4697608 Comparison of Bactec plus Blood Culture Media to BacT/Alert FAN plus Blood Culture Media for Identification of Bacterial Pathogens in Clinical Samples Containing Antibiotics
Authors: Recep Kesli, Huseyin Bilgin, Ela Tasdogan, Ercan Kurtipek
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Aim: The aim of this study was to compare resin based Bactec plus aerobic/anaerobic blood culture bottles (Becton Dickinson, MD, USA) and polymeric beads based BacT/Alert FA/FN plus blood culture bottles (bioMerieux, NC, USA) in terms of microorganisms recovery rates and time to detection (TTD) in the patients receiving antibiotic treatment. Method: Blood culture samples were taken from the patients who admitted to the intensive care unit and received antibiotic treatment. Forty milliliters of blood from patients were equally distributed into four types of bottles: Bactec Plus aerobic, Bactec Plus anaerobic, BacT/Alert FA Plus, BacT/Alert FN Plus. Bactec Plus and BacT/Alert Plus media were compared to culture recovery rates and TTD. Results: Blood culture samples were collected from 382 patients hospitalized in the intensive care unit and 245 patients who were diagnosed as having bloodstream infections were included in the study. A total of 1528 Bactec Plus aerobic, Bactec Plus anaerobic, BacT/Alert FA Plus, BacT/Alert FN Plus blood culture bottles analyzed and 176, 144, 154, 126 bacteria or fungi were isolated, respectively. Gram-negative and gram-positive bacteria were significantly more frequently isolated in the resin-based Bactec Plus bottles than in the polymeric beads based BacT/Alert Plus bottles. The Bactec Plus and BacT/Alert Plus media recovery rates were similar for fungi and anaerobic bacteria. The mean TTDs in the Bactec Plus bottles were shorter than those in the BacT/Alert Plus bottles regardless of the microorganisms. Conclusion: The results of this study showed that resin-containing media is a reliable and time-saving tool for patients who are receiving antibiotic treatment due to sepsis in the intensive care unit.Keywords: Bactec Plus, BacT/Alert Plus, blood culture, antibiotic
Procedia PDF Downloads 1467607 Impact of Heat Moisture Treatment on the Yield of Resistant Starch and Evaluation of Functional Properties of Modified Mung Bean (Vigna radiate) Starch
Authors: Sreejani Barua, P. P. Srivastav
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Formulation of new functional food products for diabetes patients and obsessed people is a challenge for food industries till date. Starch is a certainly happening, ecological, reasonable and profusely obtainable polysaccharide in plant material. In the present scenario, there is a great interest in modifying starch functional properties without destroying its granular structure using different modification techniques. Resistant starch (RS) contains almost zero calories and can control blood glucose level to prevent diabetes. The current study focused on modification of mung bean starch which is a good source of legumes carbohydrate for the production of functional food. Heat moisture treatment (HMT) of mung starch was conducted at moisture content of 10-30%, temperature of 80-120 °C and time of 8-24 h.The content of resistant starch after modification was significantly increased from native starches containing RS 7.6%. The design combinations of HMT had been completed through Central Composite Rotatable Design (CCRD). The effects of HMT process variables on the yield of resistant starch was studied through Rapid Surface Methodology (RSM). The highest increase of resistant starch was found up to 34.39% when treated the native starch with 30% m.c at 120 °C temperature for 24 h.The functional properties of both native and modified mung bean starches showed that there was a reduction in the swelling power and swelling volume of HMT starches. However, the solubility of the HMT starches was higher than that of untreated native starch and also observed change in structural (scanning electron microscopy), X-Ray diffraction (XRD) pattern, blue value and thermal (differential scanning calorimetry) properties. Therefore, replacing native mung bean starch with heat-moisture treated mung bean starch leads to the development of new products with higher resistant starch levels and functional properties.Keywords: Mung bean starch, heat moisture treatment, functional properties, resistant starch
Procedia PDF Downloads 2027606 Patient Perspectives on the Role of Orthopedic Nurse Practitioners: A Cross-Sectional Study
Authors: Merav Ben Natan, May Revach, Or Sade, Yaniv Yonay, Yaron Berkovich
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Background: The inclusion of nurse practitioners (NPs) specializing in orthopedics holds promise for enhancing the quality of care for orthopedic patients. Understanding patients’ perspectives on this role is crucial for evaluating the feasibility and acceptance of integrating NPs into orthopedic settings. This study aims to explore the receptiveness of orthopedic patients to treatment by orthopedic NPs and examines potential associations between patients’ willingness to engage with NPs, their familiarity with the NP role, perceptions of nursing, and satisfaction with orthopedic nursing care. Methods: This cross-sectional study involved patients admitted to an orthopedic department at a central Israeli hospital between January and February 2023. Data was collected using a validated questionnaire consisting of five sections, reviewed by content experts. Statistical analyses were conducted using SPSS and included descriptive statistics, independent samples t-tests, Pearson correlations, and linear regression. Results: Participants in the study showed a moderate willingness to receive treatment from orthopedic NPs, with more than two-thirds expressing strong openness. Patients were generally receptive to NPs performing various clinical tasks, though there was less enthusiasm for NPs’ involvement in medication management and preoperative evaluations. Positive attitudes towards nurses and familiarity with the NP role were significant predictors of patient receptiveness to NP treatment. Conclusion: Patient acceptance of orthopedic NPs varies across different aspects of care. While there is a general willingness to receive care from NPs, these nuanced preferences must be considered when implementing NPs in orthopedic settings. Awareness and positive perceptions of the NP role play crucial roles in shaping patients’ willingness to engage with NPs.Keywords: orthopedic nurse practitioners, patient receptiveness, perceptions of nursing, clinical tasks
Procedia PDF Downloads 287605 Drug Susceptibility and Genotypic Assessment of Mycobacterial Isolates from Pulmonary Tuberculosis Patients in North East Ethiopia
Authors: Minwuyelet Maru, Solomon Habtemariam, Endalamaw Gadissa, Abraham Aseffa
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Background: Tuberculosis is a major public health problem in Ethiopia. The burden of TB is aggravated by emergence and expansion of drug resistant tuberculosis and different lineages of Mycobacterium tuberculosis (M. tuberculosis) have been reported in many parts of the country. Describing strains of Mycobacterial isolates and drug susceptibility pattern is necessary. Method: Sputum samples were collected from smear positive pulmonary TB patients age >= 7 years between October 1, 2012 to September 30, 2013 and Mycobacterial strains isolated on Loweensten Jensen (LJ) media. Each strain was characterized by deletion typing and Spoligotyping. Drug sensitivity testing was determined with the indirect proportion method using Middle brook 7H10 media and association to determine possible risk factors to drug resistance was done. Result: A total of 144 smear positive pulmonary tuberculosis patients were enrolled. The age of participants ranged from 7 to 78 with mean age of 29.22 (±10.77) years. In this study 82.2% (n=97) of the isolates were sensitive to the four first line anti-tuberculosis drugs and resistance to any of the four drugs tested was 17.8% (n=21). A high frequency of any resistance was observed in isoniazid, 13.6%, (n=16) followed by streptomycin, 11.8% (n=14). No significant association of isoniazid resistance with HIV, sex and history of previous TB treatment was observed but there was significant association with age, high between 31-35 years of age (p=0.01). Majority, 89.9% (n=128) of participants were new cases and only 11.1% (n=16) had history of previous TB treatment. No MDR-TB from new cases and 2 MDRTB (13.3%) was isolated from re-treatment cases which was significantly associated with previous TB treatment (p<0.01). Thirty two different types of spoligotype patterns were identified and 74.1% were grouped in to 13 clusters. The dominant strains were SIT 25, 18.1% (n=21), SIT 53, 17.2% (n=20) and SIT 149, 8.6% (n=10). Lineage 4 is the predominant lineage followed by lineage 3 and lineage 7 comprising 65.5% (n=76), 28.4% (n=33) and 6% (n=7) respectively. Majority of strains from lineage 3 and 4 were SIT 25 (63.6%) and SIT 53 (26.3%) whereas SIT 343 was the dominant strain from lineage 7 (71.4%). Conclusion: Wide spread of lineage 3 and lineage 4 of the modern lineage and high number of strain cluster indicates high ongoing transmission. The high proportion resistance to any of the first line anti-tuberculosis drugs may be a potential source in the emergence of MDR-TB. Wide spread of SIT 25 and SIT 53 having a tendency of ease transmission and presence of higher resistance of isoniazid in working and mobile age group, 31-35 years of age may increase risk of drug resistant strains transmission.Keywords: tuberculosis, drug susceptibility, strain diversity, lineage, Ethiopia, spoligotyping
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