Search results for: normal stirrups

Authors: T. Rakhi, Thrivikram Shenoy

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Esophageal atresia is a disorder of maldevelopment of esophagus with or without a connection to the trachea. Radiological reviews are needed in consultation with the pediatric surgeon and neonatologist and we report a rare case of esophageal atresia associated with atrial septal defect-patent ductus arteriosus complex. A 2-day old female baby born at term, weighing 3.010kg, admitted to the Neonatal Intensive Care Unit with respiratory distress and excessive oral secretions. On examination, continuous murmur and cyanosis were seen. Esophageal atresia was suspected, after a failed attempt to pass a nasogastric tube. Chest radiograph showed coiling of the nasogastric tube and absent gas shadow in the abdomen. Echocardiography confirmed Patent Ductus Arteriosus with Atrial Septal Defect not in failure and was diagnosed with esophageal atresia with suspected fistula posted for surgical repair. After preliminary management with oxygenation, suctioning in prone position and antibiotics, investigations revealed Hb 17gms serum biochemistry, coagulation profile and C-Reactive Protein Test normal. The baby was premedicated with 5mcg of fentanyl and 100 mcg of midazolam and a rapid awake laryngoscopy was done to rule out difficult airway followed by induction with o2 air, sevo and atracurium 2 mg. Placement of a 3.5 tube was uneventful at first attempt and after confirming bilateral air entry positioned in the lateral position for Right thoracotomy. A pulse oximeter, Echocardiogram, Non-invasive Blood Pressure, temperature and a precordial stethoscope in left axilla were essential monitors. During thoracotomy, both the ends of the esophagus and the fistula could not be located after thorough search suggesting an on table finding of type A esophageal atresia. The baby was repositioned for gastrostomy, and cervical esophagostomy ventilated overnight and extubated uneventful. Absent gas shadow was overlooked and the purpose of this presentation is to create an awareness between the neonatologist, pediatric surgeons and anesthesiologist regarding variation of typing of Tracheoesophageal fistula pre and intraoperatively. A need for imaging modalities warranted for a definitive diagnosis in the presence of a gasless stomach.

Keywords: anesthetic, atrial septal defects, esophageal atresia, patent ductus arteriosus, perioperative, chest x-ray

Procedia PDF Downloads 179

Authors: Mawong R., Bussracumpakorn C.

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Millions of young people around the world have been affected by COVID-19 to their psychological and social effects. Millennials’ stresses have been shaped by a few global issues, including climate change, political instability, and financial crisis. In particular, the spread of COVID-19 has become laying psychological and socioeconomic scars on them. When end-of-life planning turns into more widely discussed, the stigma and taboos around this issue are greatly lessened. End-of-life planning is defined as a future life plan, such as financial, legacy, funeral, and memorial planning. This plan would help millennials to discover the value and meaning of life. This study explores the attitudes of Thai Millennials toward end-of-life planning as a new normal awareness of life in order to initiate an innovative service concept to fit with their value and meaning. The study conducts an in-depth interview with 12 potential participants who have awareness or action on the plan. The framework of the customer journey map is used to analyze the responses to examine trigger points, barriers, beliefs, and expectations. The findings pointed to a service concept that is suggested for a new end-of-life planning service that is suited to Thai Millennials in 4 different groups, which are 1. Social -Conscious as a socially aware who to donate time and riches to make the world and society a better place, their end-of-life planning value is inspired by the social impact of giving something or some action that they will be able to do after life or during life which provides a variety of choice based on their preference to give to society, 2. Life Fulfillment who make a life goal for themselves and attempt to achieve it before the time comes to their value will be to inspire life value with a customized plan and provide guidance to suggest, 3. Prevention of the After-Death Effect who want to plan to avoid the effects of their death as patriarch, head of the family, and anchor of someone, so they want to have a plan that brings confidence and feel relief while they are still alive and they want to find some reliable service that they can leave the death will or asset, and 4. No Guilty Planning who plan for when they wish to be worry-free as a self-responsible they want to have the plan which is easy to understand and easy to access. The overall finding of the study is to understand the new service concept of end-of-life planning which to improve knowledge of significant life worth rather than death planning, encouraging people to reassess their lives in a positive way, leading to higher self-esteem and intrinsic motivation for this generation in this time of global crisis.

Keywords: design management, end-of-life planning, millennial generation, service design solution

Procedia PDF Downloads 187

Authors: Hyeuk Ju Ko, Eui Ju Lee

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Many electronic devices are powered by various rechargeable batteries such as lithium-ion today, but occasionally the batteries undergo thermal runaway and cause fire, explosion, and other hazards. If a battery fire should occur in an electronic device of vehicle and aircraft cabin, it is important to quickly extinguish the fire and cool the batteries to minimize safety risks. Attempts to minimize these risks have been carried out by many researchers but the number of study on the successful extinguishment is limited. Because most rechargeable batteries are operated on the ion state with electron during charge and discharge of electricity, and the reaction of this electrolyte has a big difference with normal combustion. Here, we focused on the effect of ions on reaction stability and pollutant emissions during combustion process. The other importance for understanding ionized fuel combustion could be found in high efficient and environment-friendly combustion technologies, which are used to be operated an extreme condition and hence results in unintended flame instability such as extinction and oscillation. The use of electromagnetic energy and non-equilibrium plasma is one of the way to solve the problems, but the application has been still limited because of lack of excited ion effects in the combustion process. Therefore, the understanding of ion role during combustion might be promised to the energy safety society including the battery safety. In this study, the effects of an ionized fuel on the flame stability and pollutant emissions were experimentally investigated in the hydrocarbon jet diffusion flames. The burner used in this experiment consisted of 7.5 mm diameter tube for fuel and the gaseous fuels were ionized with the ionizer (SUNJE, SPN-11). Methane (99.9% purity) and propane (commercial grade) were used as a fuel and open ambient air was used as an oxidizer. As the performance of ionizer used in the experiment was evaluated at first, ion densities of both propane and methane increased linearly with volume flow rate but the ion density of propane is slightly higher than that of methane. The results show that the overall flame stability and shape such as flame length has no significant difference even in the higher ion concentration. However, the fuel ionization affects to the pollutant emissions such as NOx and soot. NOx and CO emissions measured in post flame region decreased with increasing fuel ionization, especially at high fuel velocity, i.e. high ion density. TGA analysis and morphology of soot by TEM indicates that the fuel ionization makes soot to be matured.

Keywords: battery fires, ionization, jet flames, stability, NOx and soot

Procedia PDF Downloads 186

Authors: Martina Santobuono, Wing Sze Chan, Elettra D'Amico, Henriette Selck

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Chemicals in modern society are fundamental in many different aspects of daily human life. We use a wide range of substances, including polychlorinated compounds, pesticides, plasticizers, and pharmaceuticals, to name a few. These compounds are excessively produced, and this has led to their introduction to the environment and food resources. Municipal and industrial effluents, landfills, and agricultural runoffs are a few examples of sources of chemical pollution. Many of these compounds, such as pharmaceuticals, have been proven to mimic or alter the performance of the hormone system, thus disrupting its normal function and altering the behavior and reproductive capability of non-target organisms. Antidepressants are pharmaceuticals commonly detected in the environment, usually in the range of ng L⁻¹ and µg L⁻¹. Since they are designed to have a biological effect at low concentrations, they might pose a risk to the native species, especially if exposure lasts for long periods. Hydrophobic antidepressants, like the selective serotonin reuptake inhibitor (SSRI) Sertraline, can sorb to the particles in the water column and eventually accumulate in the sediment compartment. Thus, deposit-feeding organisms may be at particular risk of exposure. The polychaete Capitella teleta is widespread in estuarine organically enriched sediments, being a key deposit-feeder involved in geochemistry processes happening in sediments. Since antidepressants are neurotoxic chemicals and endocrine disruptors, the aim of this work was to test if sediment-associated Sertraline impacts burrowing- and feeding behavior as well as reproduction capability in Capitella teleta in a chronic exposure set-up, which could better mimic what happens in the environment. 7 days old juveniles were selected and exposed to different concentrations of Sertraline for an entire generation until the mature stage was reached. This work was able to show that some concentrations of Sertraline altered growth and the time of first reproduction in Capitella teleta juveniles, potentially disrupting the population’s capability of survival. Acknowledgments: This Ph.D. position is part of the CHRONIC project “Chronic exposure scenarios driving environmental risks of Chemicals”, which is an Innovative Training Network (ITN) funded by the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie Actions (MSCA).

Keywords: antidepressants, Capitella teleta, chronic exposure, endocrine disruption, sublethal endpoints, neurotoxicity

Procedia PDF Downloads 95

Authors: Hamsa T. Tayeb, Mohammad A. Arafah, Dana M. Bakheet, Duaa M. Khalaf, Agnieszka Tarnoska, Nduna Dzimiri

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Background: CYP2D6 is a member of the cytochrome P450 mixed-function oxidase system. The enzyme is responsible for the metabolism and elimination of approximately 25% of clinically used drugs, especially in breast cancer and psychiatric therapy. Different phenotypes have been described displaying alleles that lead to a complete loss of enzyme activity, reduced function (poor metabolizers – PM), hyperfunctionality (ultrarapid metabolizers–UM) and therefore drug intoxication or loss of drug effect. The prevalence of these variants may vary among different ethnic groups. Furthermore, the xTAG system has been developed to categorized all patients into different groups based on their CYP2D6 substrate metabolization. Aim of the study: To determine the prevalence of the different CYP2D6 variants in our population, and to evaluate their clinical relevance in personalized medicine. Methodology: We used the Luminex xMAP genotyping system to sequence 305 Saudi individuals visiting the Blood Bank of our Institution and determine which polymorphisms of CYP2D6 gene are prevalent in our region. Results: xTAG genotyping showed that 36.72% (112 out of 305 individuals) carried the CYP2D6_*2. Out of the 112 individuals with the *2 SNP, 6.23% had multiple copies of *2 SNP (19 individuals out of 305 individuals), resulting in an UM phenotype. About 33.44% carried the CYP2D6_*41, which leads to decreased activity of the CYP2D6 enzyme. 19.67% had the wild-type alleles and thus had normal enzyme function. Furthermore, 15.74% carried the CYP2D6_*4, which is the most common nonfunctional form of the CYP2D6 enzyme worldwide. 6.56% carried the CYP2D6_*17, resulting in decreased enzyme activity. Approximately 5.73% carried the CYP2D6_*10, consequently decreasing the enzyme activity, resulting in a PM phenotype. 2.30% carried the CYP2D6_*29, leading to decreased metabolic activity of the enzyme, and 2.30% carried the CYP2D6_*35, resulting in an UM phenotype, 1.64% had a whole-gene deletion CYP2D6_*5, thus resulting in the loss of CYP2D6 enzyme production, 0.66% carried the CYP2D6_*6 variant. One individual carried the CYP2D6_*3(B), producing an inactive form of the enzyme, which leads to decrease of enzyme activity, resulting in a PM phenotype. Finally, one individual carried the CYP2D6_*9, which decreases the enzyme activity. Conclusions: Our study demonstrates that different CYP2D6 variants are highly prevalent in ethnic Saudi Arabs. This finding sets a basis for informed genotyping for these variants in personalized medicine. The study also suggests that xTAG is an appropriate procedure for genotyping the CYP2D6 variants in personalized medicine.

Keywords: CYP2D6, hormonal breast cancer, pharmacogenetics, polymorphism, psychiatric treatment, Saudi population

Procedia PDF Downloads 572

Authors: Azin Zargham, Gholamreza Rouhi, Allahyar Geramy

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One of the most prevalent types of alveolar bone loss is horizontal bone loss (HBL) in which the bone height around teeth is reduced homogenously. In the presence of HBL the magnitudes of forces during orthodontic treatment should be altered according to the degree of HBL, in a way that without further bone loss, desired tooth movement can be obtained. In order to investigate the appropriate orthodontic force system in the presence of HBL, a three-dimensional numerical model capable of the simulation of orthodontic tooth movement was developed. The main goal of this research was to evaluate the effect of different degrees of HBL on a long-term orthodontic tooth movement. Moreover, the effect of different force magnitudes on orthodontic tooth movement in the presence of HBL was studied. Five three-dimensional finite element models of a maxillary lateral incisor with 0 mm, 1.5 mm, 3 mm, 4.5 mm and 6 mm of HBL were constructed. The long-term orthodontic tooth tipping movements were attained during a 4-weeks period in an iterative process through the external remodeling of the alveolar bone based on strains in periodontal ligament as the bone remodeling mechanical stimulus. To obtain long-term orthodontic tooth movement in each iteration, first the strains in periodontal ligament under a 1-N tipping force were calculated using finite element analysis. Then, bone remodeling and the subsequent tooth movement were computed in a post-processing software using a custom written program. Incisal edge, cervical, and apical area displacement in the models with different alveolar bone heights (0, 1.5, 3, 4.5, 6 mm bone loss) in response to a 1-N tipping force were calculated. Maximum tooth displacement was found to be 2.65 mm at the top of the crown of the model with a 6 mm bone loss. Minimum tooth displacement was 0.45 mm at the cervical level of the model with a normal bone support. Tooth tipping degrees of models in response to different tipping force magnitudes were also calculated for models with different degrees of HBL. Degrees of tipping tooth movement increased as force level was increased. This increase was more prominent in the models with smaller degrees of HBL. By using finite element method and bone remodeling theories, this study indicated that in the presence of HBL, under the same load, long-term orthodontic tooth movement will increase. The simulation also revealed that even though tooth movement increases with increasing the force, this increase was only prominent in the models with smaller degrees of HBL, and tooth models with greater degrees of HBL will be less affected by the magnitude of an orthodontic force. Based on our results, the applied force magnitude must be reduced in proportion of degree of HBL.

Keywords: bone remodeling, finite element method, horizontal bone loss, orthodontic tooth movement.

Procedia PDF Downloads 342

Authors: İlhami Karahanoglu, Oguz Ceylan

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As its well-known definitions; systemic risk refers to whole economic system down-turn movement even collapse together in very severe cases. In fact, it points out the contagion effects of the defaults. Such a risk is can be depicted with the famous Chinese game of falling domino stones. During and after the Bear & Sterns and Lehman Brothers cases, it was well understood that there is a very strong effect of systemic risk in financial services sector. In this study, we concentrate on the existence of systemic risk in Turkish Banking Sector based upon the Halkbank Case during the end month of 2013; there was a political turmoil in Turkey in which the close relatives of the upper politicians were involved in illegal trading activities. In that operation, the CEO of Halkbank was also arrested and in investigation, Halkbank was considered as part of such illegal actions. That operation had an impact on Halkbanks stock value. The Halkbank stock value during that time interval decreased remarkably, the distributional profile of stock return changed and became more volatile as well as more skewed. In this study, the daily returns of 5 leading banks in Turkish banking sector were used to obtain 48 return distributions (for each month, 90-days-back stock value returns are used) of 5 banks for the period 12/2011-12/2013 (pre operation period) and 12/2013-12/2015 (post operation period). When those distributions are compared with timely manner, interestingly; the distribution of the 5 other leading banks in Turkey, public or private, had also distribution profiles which was different from the past 2011-2013 period just like Halkbank. Those 5 big banks, whose stock values are monitored with sub index in Istanbul stock exchange (BIST) as BN10, had more skewed distribution just following the Halkbank stock return movement during the post operation period, with lover mean value and as well higher volatility. In addition, the correlation between the stock value return distributions of the leading banks after Halkbank case, where the returns are more skewed to the left, increased (which is measured in monthly base before and after the operation). The dependence between those banks was stronger under the case where the stock values were falling compared with the normal market condition. Such distributional effect of stock returns between the leading banks in Turkey, which is valid for down sub-market (financial/banking sector) condition, can be evaluated as an evidence for the existence of contagious effect and systemic risk.

Keywords: financial risk, systemic risk, banking sector, return distribution, dependency structure

Procedia PDF Downloads 296

Authors: Christine Y. Yeh, Brian D. Piening, Sarah M. Totten, Kimberly Kukurba, Wenyu Zhou, Kevin P. F. Contrepois, Gucci J. Gu, Sharon Pitteri, Michael Snyder

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Three million deaths worldwide are attributed to obesity. However, the biomolecular mechanisms that describe the link between adiposity and subsequent disease states are poorly understood. Insulin resistance characterizes approximately half of obese individuals and is a major cause of obesity-mediated diseases such as Type II diabetes, hypertension and other cardiovascular diseases. This study makes use of longitudinal quantitative and high-throughput multi-omics (genomics, epigenomics, transcriptomics, glycoproteomics etc.) methodologies on blood samples to develop multigenic and multi-analyte signatures associated with weight gain and insulin resistance. Participants of this study underwent a 30-day period of weight gain via excessive caloric intake followed by a 60-day period of restricted dieting and return to baseline weight. Blood samples were taken at three different time points per patient: baseline, peak-weight and post weight loss. Patients were characterized as either insulin resistant (IR) or insulin sensitive (IS) before having their samples processed via longitudinal multi-omic technologies. This comparative study revealed a wealth of biomolecular changes associated with weight gain after using methods in machine learning, clustering, network analysis etc. Pathways of interest included those involved in lipid remodeling, acute inflammatory response and glucose metabolism. Some of these biomolecules returned to baseline levels as the patient returned to normal weight whilst some remained elevated. IR patients exhibited key differences in inflammatory response regulation in comparison to IS patients at all time points. These signatures suggest differential metabolism and inflammatory pathways between IR and IS patients. Biomolecular differences associated with weight gain and insulin resistance were identified on various levels: in gene expression, epigenetic change, transcriptional regulation and glycosylation. This study was not only able to contribute to new biology that could be of use in preventing or predicting obesity-mediated diseases, but also matured novel biomedical informatics technologies to produce and process data on many comprehensive omics levels.

Keywords: insulin resistance, multi-omics, next generation sequencing, proteogenomics, type ii diabetes

Procedia PDF Downloads 429

Authors: Jihane Bouabid

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The urgency to transition towards sustainable energy sources has revealed itself imperative. Today, in the 21st Century, the intellectual society have imposed technological advancements and improvements, and anticipates expeditious outcomes as an integral component of its relentless pursuit of an elevated standard of living. As a part of empowering human development, driving economic growth and meeting social needs, the access to energy services has become a necessity. As a part of these improvements, we are introducing the project "Mywindturbine" - an interactive web user interface for design and analysis in the field of wind energy, with a particular adherence to the IEC (International Electrotechnical Commission) standard 61400-2 "Wind turbines – Part 2: Design requirements for small wind turbines". Wind turbines play a pivotal role in Morocco's renewable energy strategy, leveraging the nation's abundant wind resources. The IEC 61400-2 standard ensures the safety and design integrity of small wind turbines deployed in Morocco, providing guidelines for performance and safety protocols. The conformity with this standard ensures turbine reliability, facilitates standards alignment, and accelerates the integration of wind energy into Morocco's energy landscape. The aim of the GUI (Graphical User Interface) for engineers and professionals from the field of wind energy systems who would like to design a small wind turbine system following the safety requirements of the international standards IEC 61400-2. The interface provides an easy way to analyze the structure of the turbine machine under normal and extreme load conditions based on the specific inputs provided by the user. The platform introduces an overview to sustainability and renewable energy, with a focus on wind turbines. It features a cross-examination of the input parameters provided from the user for the SLM (Simple Load Model) of small wind turbines, and results in an analysis according to the IEC 61400-2 standard. The analysis of the simple load model encompasses calculations for fatigue loads on blades and rotor shaft, yaw error load on blades, etc. for the small wind turbine performance. Through its structured framework and adherence to the IEC standard, "Mywindturbine" aims to empower professionals, engineers, and intellectuals with the knowledge and tools necessary to contribute towards a sustainable energy future.

Keywords: small wind turbine, IEC 61400-2 standard, user interface., simple load model

Procedia PDF Downloads 63

Authors: Rashid Azeem

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Introduction: Eosinophilia, which can be categorized as mild, moderate, and severe form on the basis of increasing eosinophil counts, might be responsible for a wide range of cardiac manifestations, varying from a simple myocarditis to a severe state like endomyocardial fibrosis. Eosinophils are involved in the pathogenesis of a variety of cardiovascular disorder like Loffler endocarditis, eosinophilic granulomatosis with polyangitis (EGPH), and hyper eosinophilic (HES). Among them HES carries and incidence rate b/w 48% and 75% and is the main causes of cardiac motility and mobility due to eosinophilia involvement. Aims and objectives: The aim of this study is to determine the frequency of eosinophilia in cardiac patients and to ascertain the evidence of endomyocardial diseases in eosinophilic patients in a cardiology institution Material and Methods: This cross sectional analytical study was conducted in hematology Department of Peshawar institute of Cardiology after approval from hospital ethical and research committee. All 70 patients were subjected to detailed history and clinical examination. Investigation like CBC, Chest X-ray, ECG, Echo, Angiography findings were used to monitor patient’s clinical status. Data is analyzed using SPSS version 25 and MS Excel. Results: Out of 70 patients in our study, a total of 66 patients(94 %) shows evidence of cardiac manifestations. In our study, we have observed a number of abnormal ECG patterns in cardiac patients presenting with eosinophilia, like T wave changes, loss of R wave, sinus bradycardia with LVH strain, and ST wave abnormality. abnormal echocardiographic findings were observed in our patients, like valvular abnormalities (in 45.7%), RWMA abnormalities (in 2.8%), isolated ventricular dysfunction (in 21.4%), and in 10% patients, normal echocardiography. We further noted abnormal coronary angiography findings in cardiac patients with eosinophilia ranging from single vessel to multi vessel occlusions. Conclusions: Eosinophils are involved in the pathogenesis of a variety of cardiovascular disorders which can be detected by various diagnostic means, and the severity of the disease increases with time and with increasing eosinophil count ranging from simple myocarditis to a fatal condition like endomyocardial fibrosis. Thus, increased eosinophilic count as a laboratory parameter in cardiac patients may be a sign of endomyocardial damage which will further help cardiologist to intervene more aggressively then routine approach to a cardiac patient.

Keywords: eosinophilia, endomyocardial fibrosis, cardiac, hypereosinophilic syndrome

Procedia PDF Downloads 65

Authors: Chang Liu, Nuria Fiol, Isabel Villaescusa, Jordi Poch

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Over the last decades, biosorption has been an alternative to costly wastewaters treatment for metal removal. Most of the literature on metal biosorption was devoted to studying of single metal ions but nowadays studies on multi-components biosorption are booming. Hexavalent chromium is usually found in mixtures with divalent metal ions in industries wastewaters. However, studies on the simultaneous removal of Cr(VI) and divalent metals are hardly found and the cooperative or competitive mechanism governing each metal ions sorption is still unclear. In this work, simultaneous sorption of Cr(VI) and Cu(II) from their binary mixtures by using sweet potato vine (SPV) was investigated. Sweet potato is one of the four major grain crops in China. Each year about 2000 tons of SPV are generated as by-products. SPV could be a low-cost biosorbent for metal ions due to its rich in cellulose and lignin. In this work, the sorption of Cr(VI) and Cu(II) from their binary mixtures solutions was studied by using SPV sorbent. Equilibrium studies were carried out in binary mixtures in which Cr(VI) and Cu(II) concentration was both varied between 0.1 mM and 0.3 mM, Cr(VI) and Cu(II) single solutions were also prepared as comparison. All the experiments were performed at pH 3±0.05 under 30±2°C for 7 days to make sure sorption achieved equilibrium. Results showed that (i) chromium was partially (10.93%-42.04%) eliminated under studied conditions through reduction and sorption of hexavalent and trivalent forms. The presence of Cu(II) exerts a synergistic effect on the overall sorption process in all the cases of the 0.1-0.3 mM binary mixtures concentration range. (ii) Cr(VI) removal by SPV is favoured by the presence of Cu(II) in solution, because more protons needed for Cr(VI) reduction are available due to Cu(II)-proton competition; however sorption of the formed Cr(III) is unfavoured as a result of the competition between Cr(III) and Cu(II) for protons and sorbent active sites. (iii) Copper was partially (9.26%-13.91%) sorbed onto SPV under studied conditions. The presence of Cr(VI) in binary mixtures also exerts a synergistic effect on the Cu(II) removal in all the cases of the 0.1-0.3 mM binary mixtures concentration range. The results of the present work indicate that sweet potato vine can be successfully employed for the simultaneously removal of Cr(VI) and Cu(II) in binary mixtures, taking advantage of the synergistic effect provoked by one of the metal ion to each other, even though the acquisition of higher removal yields has to be further investigated. Acknowledgements—This work has been financially supported by Ministry of Human Resources and Social Security of PRC (Anhui15), Education Department of Anhui Province (KJ2016A270) and Anhui Normal University (2015rcpy33, 2014bsqdjj53).

Keywords: sweet potato vine, chromium reduction, divalent metal, synergistic sorption

Procedia PDF Downloads 169

Authors: Walid Al-Qerem, Ruba Zumot

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Background: The rise of obesity among children and adolescents remains a primary challenge for healthcare providers globally and in the Middle East. The aim of the present study is to determine the prevalence of obesity among 5-20 years old Jordanians based on CDC criteria. Method: A total of 5722 Jordanians (37% males; 63% females) aged 5-20 years data were retrieved from the Jordanian Ministry of Health electronic database (Hakeem). As per the CDC selection criteria, the chosen data pertains exclusively to healthy Jordanian children and adolescents who are medically sound, not suffering from health conditions, and not undergoing any treatments that could hinder normal growth patterns, such as severe infection, chronic kidney disease (CKD), Down’s syndrome, attention deficit hyperactivity disorder, cancer, heart disease, lung disease, cystic fibrosis, Crohn’s disease, type 1 diabetes, hormonal disturbances, any stress-related conditions, hormonal therapy such as corticosteroids, Growth hormones (GHS) or gonadotropin-releasing hormone agonists, insulin, and amphetamines or any other stimulants. In addition, participants with missing or invalid data values for anthropometric measurements were excluded from the study. Weight for age and body mass index for age were analyzed comparatively for Jordanian children and adolescents against the international growth standards. The Z-score for each record was computed based on CDC equations. As per CDC classifications, BMI for age percentiles, values ≥85th and < 95th are classified as overweight, and value at ≥ 95th is classified as obesity. Results: The average age of the evaluated sample was 12.33 ±4.39 years (10.79 ±3.39 for males and 13.23 ± 4.66 for females). The mean weight for males and females were 33.16±14.17 Kg and 133.54±17.17 cm for males, 43.86 ±18.82 Kg, and 142.19±18.35 for females, while for BMI the mean was for boys and girls 17.81±3.88 and 20.52±5.03 respectively. The results indicated that based on CDC criteria, 8.9% of males were classified as children/adolescents with overweight, and 9.7% were classified as children/adolescents with obesity, while in females, 17.8% were classified as children/adolescents with overweight and 10.2% were classified as children/adolescents with obesity. Discussion: The high prevalence of obesity reported in the present study emphasizes the importance of applying different strategies to prevent childhood obesity, including encouraging physical activity, promoting healthier food options, and behavioral changes. Conclusion: The results presented in this study indicated the high prevalence of overweight/obesity among Jordanian adolescents and children, which must be tagged by healthcare planners and providers.

Keywords: CDC, obesity, childhood, Jordan

Procedia PDF Downloads 57

Authors: Orkide Donma, Mustafa M. Donma

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Morbid obesity is a health threatening condition particularly in children. Generally, it leads to the development of metabolic syndrome (MetS) characterized by central obesity, elevated fasting blood glucose (FBG), triglyceride (TRG), blood pressure values and suppressed high density lipoprotein cholesterol (HDL-C) levels. However, some ambiguities exist during the diagnosis of MetS in children below 10 years of age. Therefore, clinicians are in the need of some surrogate markers for the laboratory assessment of pediatric MetS. In this study, the aim is to develop an index, which will be more helpful during the evaluation of further risks detected in morbid obese (MO) children. A total of 235 children with normal body mass index (N-BMI), with varying degrees of obesity; overweight (OW), obese (OB), MO as well as MetS participated in this study. The study was approved by the Institutional Ethical Committee. Informed consent forms were obtained from the parents of the children. Obesity states of the children were classified using BMI percentiles adjusted for age and sex. For the purpose, tabulated data prepared by WHO were used. MetS criteria were defined. Systolic and diastolic blood pressure values were measured. Parameters related to glucose and lipid metabolisms were determined. FBG, insulin (INS), HDL-C, TRG concentrations were determined. Diagnostic Obesity Notation Model Assessment Laboratory (DONMA_LAB) Index [ln TRG/HDL-C*INS] was introduced. Commonly used insulin resistance (IR) indices such as Homeostatic Model Assessment for IR (HOMA-IR) as well as ratios such as TRG/HDL-C, TRG/HDL-C*INS, HDL-C/TRG*INS, TRG/HDL-C*INS/FBG, log, and ln versions of these ratios were calculated. Results were interpreted using statistical package program (SPSS Version 16.0) for Windows. The data were evaluated using appropriate statistical tests. The degree for statistical significance was defined as 0.05. 35 N, 20 OW, 47 OB, 97 MO children and 36 with MetS were investigated. Mean ± SD values of TRG/HDL-C were 1.27 ± 0.69, 1.86 ± 1.08, 2.15 ± 1.22, 2.48 ± 2.35 and 4.61 ± 3.92 for N, OW, OB, MO and MetS children, respectively. Corresponding values for the DONMA_LAB index were 2.17 ± 1.07, 3.01 ± 0.94, 3.41 ± 0.93, 3.43 ± 1.08 and 4.32 ± 1.00. TRG/HDL-C ratio significantly differed between N and MetS groups. On the other hand, DONMA_LAB index exhibited statistically significant differences between N and all the other groups except the OW group. This index was capable of discriminating MO children from those with MetS. Statistically significant elevations were detected in MO children with MetS (p < 0.05). Multiple parameters are commonly used during the assessment of MetS. Upon evaluation of the values obtained for N, OW, OB, MO groups and for MO children with MetS, the [ln TRG/HDL-C*INS] value was unique in discriminating children with MetS.

Keywords: children, index, laboratory, metabolic syndrome, obesity

Procedia PDF Downloads 148

Authors: Neerja Bharti, Drishya P.

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Introduction: Thyroidectomies are extensive surgeries involving a significant degree of tissue handling and dissection and are associated with considerable postoperative pain. Regional anaesthesia techniques have immerged as possible inexpensive and safe alternatives to opioids in the management of pain after thyroidectomy. The front of the neck is innervated by branches from the cervical plexus, and hence, several approaches for superficial and deep cervical plexus block (CPB) have been described to provide postoperative analgesia after neck surgery. However, very few studies have explored the analgesic efficacy of intermediate CPB for thyroid surgery. In this study, we have evaluated the effects of ultrasound-guided bilateral intermediate CPB on perioperative opioid consumption in patients undergoing thyroidectomy under general anesthesia. Methods: In this prospective randomized controlled study, fifty ASA grade I-II adult patients undergoing thyroidectomy were randomly divided into two groups: the study group received ultrasound-guided bilateral intermediate CPB with 10 ml 0.5% ropivacaine on each side, while the control group received the same block with 10 ml normal saline on each side just after induction of anesthesia. Anesthesia was induced with propofol, fentanyl, and vecuronium and maintained with propofol infusion titrated to maintain the BIS between 40 and 60. During the postoperative period, rescue analgesia was provided with PCA fentanyl, and the pain scores, total fentanyl consumption, and incidence of nausea and vomiting during 24 hours were recorded, and overall patient satisfaction was assessed. Results: The groups were well-matched with respect to age, gender, BMI, and duration of surgery. The difference in intraoperative propofol and fentanyl consumption was not statistically significant between groups. However, the intraoperative haemodynamic parameters were better maintained in the study group than in the control group. The postoperative pain scores, as measured by VAS at rest and during movement, were lower, and the total fentanyl consumption during 24 hours was significantly less in the study group as compared to the control group. Patients in the study group reported better satisfaction scores than those in the control group. No adverse effects of ultrasound-guided intermediate CPB block were reported. Conclusion: We concluded that ultrasound-guided intermediate cervical plexus block is a safe and effective method for providing perioperative analgesia during thyroid surgery.

Keywords: thyroidectomy, cervical plexus block, pain relief, opioid consumption

Procedia PDF Downloads 97

Authors: William Luke Hamel

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Existing conceptions of urban flooding caused by tidal fluctuations and sea-level rise have been inadequately conceptualized by metrics of resilience and methods of flow modeling. While a great deal of research has been devoted to the effects of urbanization on pluvial flooding, the kind of tidal flooding experienced by locations like Hampton Roads, Virginia, has not been adequately conceptualized as being a result of human factors such as urbanization and gray infrastructure. Resilience from sea level rise and its associated flooding has been pioneered in the region with the 2015 Norfolk Resilience Plan from 100 Resilient Cities as well as the 2016 Norfolk Vision 2100 plan, which envisions different patterns of land use for the city. Urban resilience still conceptualizes the city as having the ability to maintain an equilibrium in the face of disruptions. This economic and social equilibrium relies on the Elizabeth River, narrowly conceptualized. Intentionally or accidentally, the river was made to be a piece of infrastructure. Its development was meant to serve the docks, shipyards, naval yards, and port infrastructure that gives the region so much of its economic life. Inasmuch as it functions to permit the movement of cargo; the raising and lowering of ships to be repaired, commissioned, or decommissioned; or the provisioning of military vessels, the river as infrastructure is functioning properly. The idea that the infrastructure is malfunctioning when high tides and sea-level rise create flooding is predicated on the idea that the infrastructure is truly a human creation and can be controlled. The natural flooding cycles of an urban river, combined with the action of climate change and sea-level rise, are only abnormal so much as they encroach on the development that first encroached on the river. The urban political ecology of water provides the ability to view the river as an infrastructural extension of urban networks while also calling for its emancipation from stationarity and human control. Understanding the river and city as a hydrosocial territory or as a socio-natural system liberates both actors from the duality of the natural and the social while repositioning river flooding as a normal part of coexistence on a floodplain. This paper argues for the adoption of an urban political ecology lens in the analysis and governance of urban rivers like the Elizabeth River as a departure from the equilibrium-seeking and stability metrics of urban resilience.

Keywords: urban flooding, political ecology, Elizabeth river, Hampton roads

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Authors: E. Njuguna, S. Ilovi, P. Muiruri, K. Mutai, J. Kinuthia, P. Njoroge

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Introduction: Cervical cancer is the commonest cause of cancer-related morbidity and mortality among women in developing countries in Sub Saharan Africa. Screening for cervical cancer in all women regardless of HIV status is crucial for the early detection of cancer of the cervix when treatment is most effective in curing the disease. It is particularly more important to screen HIV infected women as they are more at risk of developing the disease and progressing faster once infected with HPV (Human Papilloma Virus). We aimed to determine the factors affecting the utilization of cervical cancer screenings among HIV infected women above 18 years of age at Kenyatta National Hospital (KNH) Comprehensive Care Center (CCC). Materials and Methods: A cross-sectional mixed quantitative and qualitative study involving randomly and purposefully selected HIV positive female respectively was conducted. Qualitative data collection involved 4 focus group discussions of eligible female participants while quantitative data were acquired by one to one interviewer administered structured questionnaires. The outcome variable was the utilization of cervical cancer screening. Data were entered into Access data base and analyzed using Stata version 11.1. Qualitative data were analyzed after coding for significant clauses and transcribing to determine themes arising. Results: We enrolled a total of 387 patients, mean age (IQ range) 40 years (36-44). Cervical cancer screening utilization was 46% despite a health care provider recommendation of 85%. The screening results were reported as normal in 72 of 81 (88.9%) and abnormal 7 of 81(8.6%) of the cases. Those who did not know their result were 2 of 81(2.5%). Patients were less likely to utilize the service with increasing number of years attending the clinic (OR 0.9, 95% CI 0.86-0.99, p-value 0.02), but more likely to utilize the service if recommendation by a staff was made (OR 10, 95% CI 4.2-23.9, p<0.001), and if cervical screening had been done before joining KNH CCC (OR 2.9, 95% CI 1.7-4.9, p < 0.001). Similarly, they were more likely to rate the services on cervical cancer screening as good (OR 5.0, 95% CI 1.7-3.4, p <0.001) and very good (OR 8.1, 95% CI 2.5-6.1, p<0.001) if they had utilized the service. The main barrier themes emerging from qualitative data included fear of screening due to excessive pain or bleeding, lack of proper communication on screening procedures and increased waiting time. Conclusions: Utilization of cervical cancer screening services was low despite health care recommendation. Patient socio-demographic characteristics did not influence whether or not they utilized the services, indicating the important role of the health care provider in the referral and provision of the service.

Keywords: cervical, cancer, HIV, women, comprehensive care center

Procedia PDF Downloads 275

Authors: S. Surapa Raju

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In Andhra Pradesh, the symptoms of climate variations in coastal villages can be observed from various studies. The Andhra Pradesh coast is known its frequent tropical cyclones and associated floods and tidal surges causing loss of life and property in the region. In the last decade alone, the state experienced 18 devastating storms causing huge loss to coastal people. The year 2007 was the fourth warmest year on record since 1901 and 2009 witnessed the heat wave conditions prevailing over the coastal Andhra Pradesh. With regarding to sea level rise (SLR), 43 percent of the coastal areas considered to be at high risk. The main objectives of the study are: to know the perceptions of fisher people on climate variations and to find out the awareness of the fisher people on climate variations and its effects at village and on fishing households. Altogether 150 households were chosen purposively for this study and collected information from the households based on semi-structured schedule. The present field-based study observed that most of the fisher people are experienced about the changes in climate variations in their villages. The first generation fisher people expressed that the at least 1/2km of sea erosion taken place from the last 20 years and most of them displaced. With regard to fishing activities, first generation fisher people revealed that 20 years back they were fishing in near-shore areas, but now availability of near shore is decreased at a large extent. The present study observed the lot of variations in growth of species in marine districts of Andhra Pradesh from the year 2005-2010. Some species like Silver pomfret, Sole (flat fish), Chriocentrus, Thrisocies, Stakes, Rays etc. are in decaling. The results of the study indicate that huge variation observed in growth rates of fish species. Small and traditional fishers have drastically effected in El NiNo years than the normal years as they have not own suitable equipment such as crafts and nets. The study discovered that many changes taken place in the fishing activities and they are: go for long distance for fishing which increases the cost of fishing operations; decrease in fish catches. Need to take up in-depth studies in the marine villages and tackle the situation by creating more awareness about the negative effects of climate variations among fishing households. Suitable fish craft technology is to be supplied and create more employment opportunities for the fishers in other than fishery.

Keywords: climate, Andhra Pradesh, El nino years, India

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Authors: R. K. Purohit

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Ionizing radiation induces cellular damage through direct ionization of DNA and other cellular targets and indirectly via reactive oxygen species which may include effects from epigenetic changes. So there is a need of hour is to search for an ideal radioprotector which could minimize the deleterious and damaging effects caused by ionizing radiation. Radioprotectors are agents which reduce the radiation effects on cell when applied prior to exposure of radiation. The aim of this study was to access the efficacy of Emblica officinalis in reducing radiation and lead induced changes in mice liver. For the present experiment, healthy male Swiss albino mice (6-8 weeks) were selected and maintained under standard conditions of temperature and light. Fruit extract of Emblica was fed orally at the dose of 0.01 ml/animal/day. The animal were divided into seven groups according to the treatment i.e. lead acetate solution as drinking water (group-II) or exposed to 3.5 or 7.0 Gy gamma radiation (group-III) or combined treatment of radiation and lead acetate (group-IV). The animals of experimental groups were administered Emblica extract seven days prior to radiation or lead acetate treatment (group V, VI and VII) respectively. The animals from all the groups were sacrificed by cervical dislocation at each post-treatment intervals of 1, 2, 4, 7, 14 and 28 days. After sacrificing the animals pieces of liver were taken out and some of them were kept at -20°C for different biochemical parameters. The histopathological changes included cytoplasmic degranulation, vacuolation, hyperaemia, pycnotic and crenated nuclei. The changes observed in the control groups were compared with the respective experimental groups. An increase in the value of total proteins, glycogen, acid phosphtase, alkaline phosphatase activity and RNA was observed up to day-14 in the non drug treated group and day 7 in the Emblica treated groups, thereafter value declined up to day-28 without reaching to normal. The value of cholesterol and DNA showed a decreasing trend up to day -14 in non drug treated groups and day-7 in drug treated groups, thereafter value elevated up to day-28. The biochemical parameters were observed in the form of increase or decrease in the values. The changes were found dose dependent. After combined treatment of radiation and lead acetate synergistic effect were observed. The liver of Emblica treated animals exhibited less severe damage as compared to non-drug treated animals at all the corresponding intervals. An early and fast recovery was also noticed in Emblica pretreated animals. Thus, it appears that Emblica is potent enough to check lead and radiation induced heptic lesion in Swiss albino mice.

Keywords: radiation, lead , emblica, mice, liver

Procedia PDF Downloads 322

Authors: Raymond Treacy, Paul Humphreys, Ronan McIvor, Trevor Cadden, Alan McKittrick

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This study employed event study methodology to examine the role of institutions, resources and dynamic capabilities in the relationship between the Environmental Management System ISO 14001 adoption and firm performance. Utilising financial data from 140 ISO 14001 certified firms and 320 non-certified firms, the results of the study suggested that the UK and Irish manufacturers were not implementing ISO 14001 solely to gain legitimacy. In contrast, the results demonstrated that firms were fully integrating the ISO 14001 standard within their operations as certified firms were able to improve both financial and operating performance when compared to non-certified firms. However, while there were significant and long lasting improvements for employee productivity, manufacturing cost efficiency, return on assets and sales turnover, the sample firms operating cycle and fixed asset efficiency displayed evidence of diminishing returns in the long-run, underlying the observation that no operating advantage based on incremental improvements can be everlasting. Hence, there is an argument for investing in dynamic capabilities which help renew and refresh the resource base and help the firm adapt to changing environments. Indeed, the results of the regression analysis suggest that dynamic capabilities for innovation acted as a moderator in the relationship between ISO 14001 certification and firm performance. This, in turn, will have a significant and symbiotic influence on sustainability practices within the participating organisations. The study not only provides new and original insights, but demonstrates pragmatically how firms can take advantage of environmental management systems as a moderator to significantly enhance firm performance. However, while it was shown that firm innovation aided both short term and long term ROA performance, adaptive market capabilities only aided firms in the short-term at the marketing strategy deployment stage. Finally, the results have important implications for firms operating in an economic recession as the results suggest that firms should scale back investment in R&D while operating in an economic downturn. Conversely, under normal trading conditions, consistent and long term investments in R&D was found to moderate the relationship between ISO 14001 certification and firm performance. Hence, the results of the study have important implications for academics and management alike.

Keywords: supply chain management, environmental management systems, quality management, sustainability, firm performance

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Authors: Sajee A. Gamage, Champa J. Wijesinghe, Patricia Burtner, Ananda R. Wickremasinghe

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Background: Teachers working in the context of special education have an enormous responsibility of enhancing performance skills of children in their classroom settings. Fine Motor Skills (FMS) are essential functional skills for children to gain independence in Activities of Daily Living. Children with Down Syndrome (DS) are predisposed to specific challenges due to deficits in FMS. This study is aimed to determine the teachers’ experience on improving FMS of children with DS in the context of special education of Southern Province, Sri Lanka. Methodology: A cross-sectional study was conducted among all consenting eligible teachers (n=147) working in the context of special education in government schools of Southern Province of Sri Lanka. A self-administered questionnaire was developed based on literature and expert opinion to assess teachers’ experience regarding deficits of FMS, limitations of classroom activity performance and barriers to improve FMS of children with DS. Results: Approximately 93% of the teachers were females with a mean age ( ± SD) of 43.1 ( ± 10.1) years. Thirty percent of the teachers had training in special educationand 83% had children with DS in their classrooms. Major deficits of FMS reported were deficits in grasping (n=116; 79%), in-hand manipulation (n=103; 70%) and bilateral hand use (n=99; 67.3%). Paperwork (n=70; 47.6%), painting (n=58; 39.5%), scissor work (n=50; 34.0%), pencil use for writing (n=45; 30.6%) and use of tools in the classroom (n=41; 27.9%) were identified as major classroom performance limitations of children with DS. Parental factors (n=67; 45.6%), disease specific characteristics (n=58; 39.5%) and classroom factors (n=36; 24.5%), were identified as major barriers to improve FMS in the classroom setting. Lack of resources and standard tools, social stigma and late school admission were also identified as barriers to FMS training. Eighty nine percent of the teachers informed that training fine motor activities in a special education classroom was more successful than work with normal classroom setting. Conclusion: Major areas of FMS deficits were grasping, in-hand manipulation and bilateral hand use; classroom performance limitations included paperwork, painting and scissor work of children with DS. Teachers recommended regular practice of fine motor activities according to individual need. Further research is required to design a culturally specific FMS assessment tool and intervention methods to improve FMS of children with DS in Sri Lanka.

Keywords: classroom activities, Down syndrome, experience, fine motor skills, special education, teachers

Procedia PDF Downloads 153

Authors: Nehir Nebioglu

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Chemotherapy is widely used for the treatment of cancer. Doxorubicin is an anti-cancer chemotherapy drug that is classified as an anthracycline antibiotic. Antitumor antibiotics consist of natural products produced by species of the soil fungus Streptomyces. These drugs act in multiple phases of the cell cycle and are known cell-cycle specific. Although DOX is a precious clinical antineoplastic agent, resistance is also a problem that limits its utility besides cardiotoxicity problem. The drug resistance of cancer cells results from multiple factors including individual variation, genetic heterogeneity within a tumor, and cellular evolution. The mechanism of resistance is thought to involve, in particular, ABCB1 (MDR1, Pgp) and ABCC1 (MRP1) as well as other transporters. Several studies on DOX-resistant cell lines have shown that resistance can be overcome by an inhibition of ABCB1, ABCC1, and ABCC2. This study attempts to understand the effects of different concentration levels of glucose treatment and starvation on the proliferation of Doxorubicin resistant cancer cells lines. To understand the effect of starvation, K562/Dox and K562 cell lines were treated with 0, 5 nM, 50 nM, 500 nM, 5 uM and 50 uM Dox concentrations in both starvation and normal medium conditions. In addition to this, to interpret the effect of glucose treatment, different concentrations (0, 1 mM, 5 mM, 25 mM) of glucose were applied to Dox-treated (with 0, 5 nM, 50 nM, 500 nM, 5 uM and 50 uM) K562/Dox and K652 cell lines. All results show significant decreasing in the cell count of K562/Dox, when cells were starved. However, while proliferation of K562/Dox lines decrease is associated with the increasingly applied Dox concentration, K562/Dox starved ones remain at the same proliferation level. Thus, the results imply that an amount of K562/Dox lines gain starvation resistance and remain resistant. Furthermore, for K562/Dox, there is no clear effect of glucose treatment in terms of cell proliferation. In the presence of a moderate level of glucose (5 mM), proliferation increases compared to other concentration of glucose for each different Dox application. On the other hand, a significant increase in cell proliferation in moderate level of glucose is only observed in 5 uM Dox concentration. The moderate concentration level of Dox can be examined in further studies. For the high amount of glucose (25 mM), cell proliferation levels are lower than moderate glucose application. The reason could be high amount of glucose may not be absorbable by cells. Also, in the presence of low amount of glucose, proliferation is decreasing in an orderly manner of increase in Dox concentration. This situation can be explained by the glucose depletion -Warburg effect- in the literature.

Keywords: drug resistance, cancer cells, chemotherapy, doxorubicin

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Authors: Yuri V. Bykov, V. A. Baturin

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Aim of the study: The aim of the study was to perform a comparative analysis of the levels of autoantibodies (AAB) to the S-100 protein as well as to the dopamine and NMDA receptors in children with type 1 diabetes mellitus (DM) in therapeutic remission. Materials and methods: Blood serum obtained from 42 children ages 4 to 17 years (20 boys and 22 girls) was analyzed. Twenty-one of these children had a diagnosis of type 1 DM and were in therapeutic remission (study group). The mean duration of disease in children with type 1 DM was 9.6±0.36 years. Children without DM were included in a group of "apparently healthy children" (21 children, comparison group). AAB to the S-100 protein, the dopamine, and NMDA receptors were measured by ELISA. The normal range of IgG AAB was specified as up to 10 µg/mL. In order to compare the central parameters of the groups, the following parametric and non-parametric methods were used: Student's t-test or Mann-Whitney U test. The level of significance for inter-group comparisons was set at p<0.05. Results: The mean levels of AAB to the S-100B protein were significantly higher (p=0.0045) in children with DM (16.84±1.54 µg/mL) when compared with "apparently healthy children" (2.09±0.05 µg/mL). The detected elevated levels of AAB to NMDA receptors may indicate that in children with type 1 DM, there is a change in the activity of the glutamatergic system, which in its turn suggests the presence of excitotoxicity. The mean levels of AAB to dopamine receptors were higher (p=0.0082) in patients comprising the study group than in the children of the comparison group (40.47±2.31 µg/mL and 3.91±0.09 µg/mL). The detected elevated levels of AAB to dopamine receptors suggest an altered activity of the dopaminergic system in children with DM. This can also be viewed as indirect evidence of altered activity of the brain's glutamatergic system. The mean levels of AAB to NMDA receptors were higher in patients with type 1 DM compared with the "apparently healthy children," at 13.16±2.07 µg/mL and 1.304±0.05 µg/mL, respectively (p=0.0021). The elevated mean levels of AAB to the S-100B protein may indicate damage to brain tissue in children with type 1 DM. A difference was also detected between the mean values of the measured AABs, and this difference depended on the duration of the disease: mean AAB values were significantly higher in patients whose disease had lasted more than five years. Conclusions: The elevated mean levels of AAB to the S-100B protein may indicate damage to brain tissue in the setting of excitotoxicity in children with type 1 DM. The discovered elevation of the levels of AAB to NMDA and dopamine receptors may indicate the activation of the glutamatergic and dopaminergic systems. The observed abnormalities indicate the presence of central nervous system damage in children with type 1 DM, with a tendency towards the elevation of the levels of the studied AABs with disease progression.

Keywords: autoantibodies, brain damage, children, diabetes mellitus

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Authors: A. Caicedo Padilla, J. Zambrano Nájera

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Cali, the capital of Valle del Cauca and the second city of Colombia, is located in the Cauca River Valley between the Western and Central Cordillera that is South West of the country. The topography of the city is mainly flat, but it is possibly to find mountains in the west. The city has increased urbanization during XX century, especially since 1958 when started a rapid growth due to migration of people from other parts of the region. Much of that population has settled in eastern of Cali, an area originally intended for cane cultivation and a zone of flood from Cauca River and its tributaries. Due to the unplanned migration, settling was inadequate and produced changes in natural dynamics of the basins, which has resulted in increases in runoff volumes, peak flows and flow velocities, that in turn increases flood risk. Sewerage networks capacity were not enough for this higher runoff volume, because in first term they were not adequately designed and built, causing its failure. This in turn generates increasingly recurrent floods generating considerable effects on the economy and development of normal activities in Cali. Thus, it becomes very important to know hydrological behavior of Urban Watersheds. This research aims to determine the impact of urbanization on hydrology of watersheds with very low slopes. The project aims to identify changes in natural drainage patterns caused by the changes made on landscape. From the identification of such modifications it will be defined the most critical areas due to recurring flood events in the city of Cali. Critical areas are defined as areas where the sewerage system does not work properly as surface runoff increases considerable with storm events, and floods are recurrent. The assessment will be done from the analysis of Geographic Information Systems (GIS) theme layers from CVC Environmental Institution of Regional Control in Valle del Cauca, hydrological data and disaster database developed by OSSO Corporation. Rainfall data from a network and historical stream flow data will be used for analysis of historical behavior and change of precipitation and hydrological response according to homogeneous zones characterized by EMCALI S.A. public utility enterprise of Cali in 1999.

Keywords: drainage systems, land cover changes, urban hydrology, urban planning

Procedia PDF Downloads 264

Authors: Subrat Kumar Bhattamisra, Vivian Lee Yean Yan, Chin Koh Lee, Chew Hui Kuean, Yun Khoon Liew, Mayuren Candasamy

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Geraniol, an acyclic monoterpenoid is the main active constituent in the essential oils of rose and palmorosa. Antioxidant, antibacterial, anticancer and antiulcer activity of geraniol was reported by many researchers. The present investigation was designed to study in vivo antiulcer and anti-Helicobacter pylori activity of geraniol. Antiulcer and anti-H. pylori activity of geraniol was evaluated on acetic acid plus H. pylori induced ulcer in rats. Acetic acid (0.03 mL) was injected to the sub-serosal layer of the stomach through laparotomy under anaesthesia. Orogastric inoculation of H. pylori (ATCC 43504) was done twice daily for 7 days. Geraniol (15 and 30 mg/kg), vehicle and standard drugs (Amoxicillin, 50 mg/kg; clarithromycin, 25 mg/kg & omeprazole, 20 mg/kg) was administered twice daily for 14 days. Antiulcer activity of geraniol was examined by the determination of gastric ulcer index, measuring the volume of gastric juice, pH and total acidity, myeloperoxidase activity and histopathological examination. Histopathological investigation for the presence of inflammation, white blood cell infiltration, edema, the mucosal damage was studied. The presence of H. pylori was detected by placing a biopsy sample from antral part of the stomach into rapid urease test. Ulcer index in H. pylori inoculated control group was 4.13 ± 0.85 and was significantly (P < 0.05) lowered in geraniol (30 mg/kg) and reference drug treated group. Geraniol increase the pH of the gastric juice (2.18 ± 0.13 in control vs. 4.14 ± 0.57 in geraniol 30mg/kg) and lower total acidity significantly (P < 0.01) in geraniol (15 & 30 mg/kg). Myeloperoxidase (MPO) activity was measured in stomach homogenate of all the groups. H. pylori control group has significant (P < 0.05) increase in MPO activity compared to normal control group. Geraniol (30 mg/kg) was showed significant (P < 0.05) and most effective among all the groups. Histopathological examination of rat stomach was scored and the total score for H. pylori control group was 8. After geraniol (30 mg/kg) and reference drug treatment, the histopathological score was significantly decreased and it was observed to be 3.5 and 2.0 respectively. Percentage inhibition of H. pylori infection in geraniol (30 mg/kg) and reference drug were found to be 40% and 50% respectively whereas, 100% infection in H. pylori control group was observed. Geraniol exhibited significant antiulcer and anti- H. pylori activity in the rats. Thus, geraniol has the potential for the further development as an effective medication in treating H. pylori associated ulcer.

Keywords: geraniol, helicobacter pylori atcc 43504, myeloperoxidase, ulcer

Procedia PDF Downloads 343

Authors: Susumu Fukita, Hiromi Kawasaki, Satoko Yamasaki, Kotomi Yamashita, Tomoko Iki

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The increase in the number of workers with mental health problems has become an issue. Many workers work in small- and medium-sized enterprises, which often support local employment and economy, especially in underpopulated mountainous areas. It is important for managers to take mental health measures for employees since there is no budget to hire health staff in small- and medium-sized enterprises. It is necessary to understand the manager's attitude toward the mental health of employees and to publicly support the manager in promoting mental health measures for employees. The purpose of this study was to study the awareness of managers of small- and medium-sized enterprises regarding the mental health of employees and to consider support for managers to take measures for the mental health of employees. Semi-structured interviews were conducted with six managers of small- and medium-sized enterprises in underpopulated mountainous areas in November 2019. Managers were asked about their awareness of the mental health of their employees. Qualitative descriptive analysis was used, and subcategories and categories were extracted. Four categories emerged. Regarding the mental health of employees, the managers acknowledged that if the appearance and behavior of the employees do not interfere with their lives, the manager judges that the employees’ mental health is normal. It was also found that the managers acknowledged that there is a comfortable working environment due to the characteristics of the underpopulated mountainous area. On the other hand, the managers acknowledged that employees are dissatisfied with salaries and management systems. In addition, it was found the manager acknowledged that some employees retire due to mental health problems. Although managers recognized that employees may be dissatisfied with salaries, they also recognized that there was a comfortable working environment due to the characteristics of the areas, with good interpersonal relationships. Economic challenges are difficult to solve in underpopulated mountainous areas. It is useful to consider measures that take advantage of the characteristics of the areas where it is easy to work because of good relations with each other, for example, to create a family-like workplace culture where managers and employees can engage in daily conversation. The managers judged that the employees were in good health if there was no interference with their lives. However, it is too late to take measures at the stage when it becomes an obstacle to life. Therefore, it is necessary to provide training for managers to learn observation techniques by which they quickly notice changes in the situation of employees and give appropriate responses; and to set up a contact point for managers to consult. Local governments should actively provide public support such as training for managers and establishing consultation desks to maintain valuable employment and local economics in underpopulated mountainous areas.

Keywords: employer, mental health, small- and medium- sized enterprises, underpopulated areas

Procedia PDF Downloads 144

Authors: Madeleine Cox

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Objective: Discussion of diagnosis and management options for myometrial ectopic pregnancy Case: A 30 yo G1P0 presented to the emergency department with vaginal bleeding for the last 4 days. She had a positive home urine pregnancy test, confirmed with a serum HCG. When she presented for an ultrasound, there was no intrauterine pregnancy, no evidence of adnexal pregnancy, however, the anterior myometrium of the uterus was noted to be markedly abnormal. When she presented to the emergency department of a busy tertiary hospital in Queensland, she had a small amount of vaginal bleeding, was anxious but well, observations normal. Repeat blood testes demonstrated a serum HCG of 9246 IU/L, haemoglobin of 143g/L. The patient had an interesting history of a right oophorectomy and open myomectomy in another country. A repeat ultrasound again showed an abnormality within the myometrium of the uterus, which was initially reported as concerning for an AVM, or potentially invasive gestational trophoblastic disease. An MRI was organised 2 days later, which demonstrated a intramural/subserosal irregularity in the right lateral body measuring 35x38x42mm with peripheral enhancement and central cystic components, favouring a myometrial ectopic most likely at the site of previous myomectomy. Alternative diagnosis of AVM, GTD were considered less likely. After discussion with the patient, IV methotrexate was administered as an in patient 4 days after her initial presentation to emergency. After this, her HCG fell to 1236 IU/L on day 6 post treatment. Weekly reviews showed stable ultrasound appearances with a steadily dropping HCG level. A repeat MRI was performed 3 weeks after methotrexate administration which confirmed involution of the myometrial ectopic, however, showed ongoing progression of vascularity surrounding the site. Despite resolution of HCG, the patient persisted to have ongoing bleeding associated with this and went to have uterine artery embolisation. Follow up ultrasound showed resolution of abnormal vascularity and negative HCG levels. Conclusion: Myometrial ectopic pregnancies are a rare occurrence and require a multidisciplinary approach to achieve timely management for these patients. This patient was in a very well resourced setting with excellent access to Interventional Radiology and specialist Radiologists who could work together with the Obstetrics, Gynaecology, and Maternal Fetal Medicine team to provide multiple options of management which preserved her fertility. This case has a very good outcome, with the patient being referred back to our service 12 months later with an early intrauterine pregnancy.

Keywords: ectopic, pregnancy, miscarriage, gynaecology

Procedia PDF Downloads 133

Authors: Maryam Hajibaba, Mohsen Soltanpour, Mehrnoosh Abbasian, S. Abbas Haghshenas

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This paper aims to evaluate the main role of mangroves forests on the unique hydrodynamic characteristics of the Khuran Strait (KS) in the Persian Gulf. Investigation of hydrodynamic conditions of KS is vital to predict and estimate sedimentation and erosion all over the protected areas north of Qeshm Island. KS (or Tang-e-Khuran) is located between Qeshm Island and the Iranian mother land and has a minimum width of approximately two kilometers. Hydrodynamics of the strait is dominated by strong tidal currents of up to 2 m/s. The bathymetry of the area is dynamic and complicated as 1) strong currents do exist in the area which lead to seemingly sand dune movements in the middle and southern parts of the strait, and 2) existence a vast area with mangrove coverage next to the narrowest part of the strait. This is why ordinary modeling schemes with normal mesh resolutions are not capable for high accuracy estimations of current fields in the KS. A comprehensive set of measurements were carried out with several components, to investigate the hydrodynamics and morpho-dynamics of the study area, including 1) vertical current profiling at six stations, 2) directional wave measurements at four stations, 3) water level measurements at six stations, 4) wind measurements at one station, and 5) sediment grab sampling at 100 locations. Additionally, a set of periodic hydrographic surveys was included in the program. The numerical simulation was carried out by using Delft3D – Flow Module. Model calibration was done by comparing water levels and depth averaged velocity of currents against available observational data. The results clearly indicate that observed data and simulations only fit together if a realistic perspective of the mangrove area is well captured by the model bathymetry data. Generating unstructured grid by using RGFGRID and QUICKIN, the flow model was driven with water level time-series at open boundaries. Adopting the available field data, the key role of mangrove area on the hydrodynamics of the study area can be studied. The results show that including the accurate geometry of the mangrove area and consideration of its sponge-like behavior are the key aspects through which a realistic current field can be simulated in the KS.

Keywords: Khuran Strait, Persian Gulf, tide, current, Delft3D

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Authors: Sultan Çağırıcı, Arsida Bajrami, Beyza Aslan, Hacı Ali Erdoğan, Nejla Sözer Topçular, Dilek Bozkurt, Vildan Yayla

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Objective: Corticobasal syndrome (CBS) is phenotypically characterized by asymmetric rigidity, apraxia, alien-limb phenomenon, cortical sensory loss, dystonia and myoclonus. The underlying pathologies consists of corticobasal degeneration (CBD), progressive supra nuclear palsy, Alzheimer's, Creutzfeldt-Jakob and frontotemporal degeneration. CBD is a degenerative disease with clinical symptoms related to the prominent involvement of cerebral cortex and basal ganglia. CBD is a pathological diagnosis and antemortem clinical diagnosis may change many times. In this paper, we described the clinical features and discussed a cases diagnosed with symmetric CBS because of its rarity. Case: Seventy-five-year-old woman presented with a three years history of difficulty in speaking and reading. Involuntary hand jerks and slowness of movement also had began in the last six months. In the neurological examination the patient was alert but not fully oriented. The speech was non-fluent, word finding difficulties were present. Bilateral limited upgaze, bradimimia, bilateral positive cogwheel' rigidity but prominent in the right side, postural tremor and negative myoclonus during action on the left side were detected. Receptive language was normal but expressive language and repetition were impaired. Acalculia, alexia, agraphia and apraxia were also present. CSF findings were unremarkable except for elevated protein level (75 mg/dL). MRI revealed bilateral symmetric cortical atrophy prominent in the frontoparietal region. PET showed hypometabolism in the left caudate nucleus. Conclusion: The increase of data related to neurodegenerative disorders associated with dementia, movement disorders and other findings results in an expanded range of diagnosis and transitions between clinical diagnosis. When considered the age of onset, clinical symptoms, imaging findings and prognosis of this patient, clinical diagnosis was CBS and pathologic diagnosis as probable CBD. Imaging of CBD usually consist of typical asymmetry between hemispheres. Still few cases with clinical appearance of CBD may show symmetrical cortical cerebral atrophy. It is presented this case who was diagnosed with CBD although we found symmetrical cortical cerebral atrophy in MRI.

Keywords: symmetric cortical atrophy, corticobasal degeneration, corticobasal syndrome

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Authors: Mike Wei, Nebu Koshy, Koen van Besien, Giorgio Inghirami, Steven M. Horwitz

Abstract:

T-cell prolymphocytic leukemia (T-PLL) is a rare hematologic disease characterized by a T-cell phenotype, rapid progression, and poor prognosis with median survival of less than a year. Alemtuzumab-based chemotherapy has increased the rate of complete remissions but these are often short-lived, and allogeneic transplant is considered the only curative therapy. In recent studies, JAK3 activating mutations have been identified in T-cell cancers, with T-PLL having the highest rate of JAK3 mutations (30 – 42%). As such, T-PLL is a model disease for evaluating the utility of JAK3 inhibitors. We present a case of a 64-year-old man with relapsed-refractory T-PLL. He was initially treated with alemtuzumab and obtained complete response and was consolidated with matched unrelated donor stem cell transplant. His disease stayed in remission for approximately 1.5 years before relapse, which was then treated with a clinical trial of romidepsin-lenalidomide (partial responses then progression at 6 months) and later alemtuzumab. Due to complications of myelosuppression and CMV reactivation, his treatment was interrupted leading to disease progression. The doubling time of lymphocyte count was approximately 20 days and over a span of 60 days the lymphocyte count rose from 8 x 109/L to 68 x 109/L. Exon sequencing showed a JAK3 mutation. The patient consented to and was treated with FDA-approved tofacitinib (initially 5 mg BID, increased to 10 mg BID after 15 days of treatment). An initial decrease in lymphocyte count was followed by progression. In vitro treatment of the patient’s cells showed modest effects of tofacitinib and ruxolitinib as single agents, in the range of doxorubicin, but synergy between the agents. After 40 days of treatment with tofacitinib and with a lymphocyte count of 150 x 109/L, ruxolitinib (5mg BID) was added. Over the 60 days since dual inhibition was started, the lymphocyte count has stabilized. The patient has remained completely asymptomatic during treatment with tofacitinib and ruxolitinib. Neutrophil count has remained normal. Platelet count and hemoglobin have however declined from ~50 x109/L to ~30 x109/L and from 11 g/dL to 8.1 g/dL respectively, since the introduction of ruxolitinib. The stabilization in lymphocyte count confirms the clinical activity of JAK inhibitors in T-PLL as suggested by the presence of JAK3 mutations and by in-vitro assays. It also suggests clinical synergy between ruxolitinib and tofacitinib in this setting. Prospective studies of JAK inhibitors in PLL patients with formal dose-finding studies are needed.

Keywords: tofacitinib, ruxolitinib, T-cell prolymphocytic leukemia, JAK3

Procedia PDF Downloads 311

Authors: Marcin Szlachetka, Rafal Sochaczewski, Lukasz Grabowski

Abstract:

This paper presents the results of the load simulations of main bearings in a two-stroke Diesel engine. A model of an engine lubrication system with connections of its main lubrication nodes, i.e., a connection of its main bearings in the engine block with the crankshaft, a connection of its crankpins with its connecting rod and a connection of its pin and its piston has been created for our calculations performed using the AVL EXCITE Designer. The analysis covers the loads given as a pressure distribution in a hydrodynamic oil film, a temperature distribution on the main bush surfaces for the specified radial clearance values as well as the impact of the force of gas on the minimum oil film thickness in the main bearings depending on crankshaft rotational speeds and temperatures of oil in the bearings. One of the main goals of the research has been to determine whether the minimum thickness of the oil film at which fluid friction occurs can be achieved for each value of crankshaft speed. Our model calculates different oil film parameters, i.e., its thickness, a pressure distribution there, the change in oil temperature. Additional enables an analysis of an oil temperature distribution on the surfaces of the bearing seats. It allows verifying the selected clearances in the bearings of the main engine under normal operation conditions and extremal ones that show a significant increase in temperature above the limit value. The research has been conducted for several engine crankshaft speeds ranging from 1000 rpm to 4000 rpm. The oil pressure in the bearings has ranged 2-5 bar according to engine speeds and the oil temperature has ranged 90-120 °C. The main bearing clearance has been adopted for the calculation and analysis as 0.025 mm. The oil classified as SAE 5W-30 has been used for the simulations. The paper discusses the selected research results referring to several specific operating points and different temperatures of the lubricating oil in the bearings. The received research results show that for the investigated main bearing bushes of the shaft, the results fall within the ranges of the limit values despite the increase in the oil temperature of the bearings reaching 120˚C. The fact that the bearings are loaded with the maximum pressure makes no excessive temperature rise on the bush surfaces. The oil temperature increases by 17˚C, reaching 137˚C at a speed of 4000 rpm. The minimum film thickness at which fluid friction occurs has been achieved for each of the operating points at each of the engine crankshaft speeds. Acknowledgement: This work has been realized in the cooperation with The Construction Office of WSK ‘PZL-KALISZ’ S.A.’ and is part of Grant Agreement No. POIR.01.02.00-00-0002/15 financed by the Polish National Centre for Research and Development.

Keywords: diesel engine, main bearings, opposing pistons, two-stroke

Procedia PDF Downloads 137