Search results for: diagnostic biomarker
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1240

Search results for: diagnostic biomarker

1000 A Literature Review of Precision Agriculture: Applications of Diagnostic Diseases in Corn, Potato, and Rice Based on Artificial Intelligence

Authors: Carolina Zambrana, Grover Zurita

Abstract:

The food loss production that occurs in deficient agricultural production is one of the major problems worldwide. This puts the population's food security and the efficiency of farming investments at risk. It is to be expected that this food security will be achieved with the own and efficient production of each country. It will have an impact on the well-being of its population and, thus, also on food sovereignty. The production losses in quantity and quality occur due to the lack of efficient detection of diseases at an early stage. It is very difficult to solve the agriculture efficiency using traditional methods since it takes a long time to be carried out due to detection imprecision of the main diseases, especially when the production areas are extensive. Therefore, the main objective of this research study is to perform a systematic literature review, of the latest five years, of Precision Agriculture (PA) to be able to understand the state of the art of the set of new technologies, procedures, and optimization processes with Artificial Intelligence (AI). This study will focus on Corns, Potatoes, and Rice diagnostic diseases. The extensive literature review will be performed on Elsevier, Scopus, and IEEE databases. In addition, this research will focus on advanced digital imaging processing and the development of software and hardware for PA. The convolution neural network will be handling special attention due to its outstanding diagnostic results. Moreover, the studied data will be incorporated with artificial intelligence algorithms for the automatic diagnosis of crop quality. Finally, precision agriculture with technology applied to the agricultural sector allows the land to be exploited efficiently. This system requires sensors, drones, data acquisition cards, and global positioning systems. This research seeks to merge different areas of science, control engineering, electronics, digital image processing, and artificial intelligence for the development, in the near future, of a low-cost image measurement system that allows the optimization of crops with AI.

Keywords: precision agriculture, convolutional neural network, deep learning, artificial intelligence

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999 Diagnostics of Subclinical Mastitis in Dairy Cows

Authors: G. Tanbayeva, Z. Myrzabekov, O. Tagayev, B. Barakhov, M. Tokayeva

Abstract:

Mastitis is widely spread among dairy cows bringing large economic damage resulting in decreased milk yield, deterioration of the milk quality, gastrointestinal tract disorders among young animals, culling of breeding stock, and expenses for sick animal treatment. Up-to-date and accurate diagnostics of subclinical (latent) mastitis in dairy cows has huge practical and economical significance. The aim of the research was to develop a new optimal alternative rapid method for the diagnosis of subclinical mastitis in cows. The study was performed in the laboratory of the Hygiene and Sanitation of Kazakh National Agrarian University. The first stage was to evaluate the different percentages of “Promastit” preparation. It showed that the best diagnostics capacity had 10% dilution. The second stage was to compare “Promastit” with some of the domestic and foreign analogues “Somatic-Test” (Denmark), “MastTest” (Russia), “Mastidin” (Ukraine), “Diagmast” (Kazakhstan). The observation was carried out on 520 dairy cows with subclinical mastitis on farms of Almaty region of Kazakhstan. The effectiveness was checked by milk sedimentation test. Our research tends to show that the diagnostic test "Promastitis" revealed subclinical mastitis in 193 out of 520 lactating cows (37.1% of those examined). At the same time, in the case of using other diagnostic tests, the given index was as follows: 35.5% (mastidin), 34.4% (masttest-AF), 33.8% (somatic-test Ecotest), 30.7% (diagmast).

Keywords: dairy cows, diagnostics, subclinical mastitis, test Promastit

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998 Rare Case of Pyoderma Gangrenosum of the Upper Limb

Authors: Karissa A. Graham

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Pyoderma gangrenosum (PG) is a prototypic autoinflammatory neutrophilic dermatosis that is a rare disorder. It presents a diagnostic challenge owing to its variable presentation, clinical overlap with other conditions, it is often associated with other systemic conditions, and there is no definitive histological or laboratory characteristic. The Delphai consensus for PG includes the presence of at least one ulcer on the anterior lower limb. Systemic corticosteroids and immunosuppressive therapies are the mainstay treatment for PG. We describe a case report of delayed diagnosis of ulcerative pyoderma gangrenosum in a 44-year-old male on his forearm. The patient presented with an infected ulcer on his right forearm that had been present for over three years. The patient was a Type 2 Diabetic with no personal or family history of inflammatory bowel disease or other autoimmune diseases. The patient was initially investigated for malignancy, but biopsies returned as chronic inflammatory tissue with neutrophilic infiltrate and no malignancy. The patient was commenced on systemic prednisone for the treatment of pyoderma gangrenosum. The diagnosis of ulcerative PG poses a challenge given the vast differential diagnosis for a cutaneous ulcer (i.e., malignant, vascular, autoimmune, trauma, infective, etc.). Diagnostic accuracy is important given that the treatment for PG with steroids does not go without risks and indeed may be contraindicated in other potential causes of the ulcer. Indeed, more common and more sinister causes of ulcers should be investigated first, as death from PG is quite rare.

Keywords: dermatological diagnosis, dermatosis, pyoderma gangrenosum, rare presentation

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997 High-Resolution ECG Automated Analysis and Diagnosis

Authors: Ayad Dalloo, Sulaf Dalloo

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Electrocardiogram (ECG) recording is prone to complications, on analysis by physicians, due to noise and artifacts, thus creating ambiguity leading to possible error of diagnosis. Such drawbacks may be overcome with the advent of high resolution Methods, such as Discrete Wavelet Analysis and Digital Signal Processing (DSP) techniques. This ECG signal analysis is implemented in three stages: ECG preprocessing, features extraction and classification with the aim of realizing high resolution ECG diagnosis and improved detection of abnormal conditions in the heart. The preprocessing stage involves removing spurious artifacts (noise), due to such factors as muscle contraction, motion, respiration, etc. ECG features are extracted by applying DSP and suggested sloping method techniques. These measured features represent peak amplitude values and intervals of P, Q, R, S, R’, and T waves on ECG, and other features such as ST elevation, QRS width, heart rate, electrical axis, QR and QT intervals. The classification is preformed using these extracted features and the criteria for cardiovascular diseases. The ECG diagnostic system is successfully applied to 12-lead ECG recordings for 12 cases. The system is provided with information to enable it diagnoses 15 different diseases. Physician’s and computer’s diagnoses are compared with 90% agreement, with respect to physician diagnosis, and the time taken for diagnosis is 2 seconds. All of these operations are programmed in Matlab environment.

Keywords: ECG diagnostic system, QRS detection, ECG baseline removal, cardiovascular diseases

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996 Characteristics of Patients Undergoing Subclavian Artery Revascularization in Latvia: A Retrospective Analysis

Authors: Majid Shahbazi

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Subclavian artery stenosis (SAS) is a common vascular disease that can cause a range of symptoms, from arm fatigue and weakness to ischemic stroke. Revascularization procedures, such as percutaneous transluminal angioplasty and stenting, are widely used to treat SAS and improve blood flow to the affected arm. However, the optimal management of patients with SAS is still unclear, and further research is needed to evaluate the safety and efficacy of different treatment options. This study aims to investigate the characteristics of patients with SAS who underwent revascularization procedures in Latvia (Specifically RAKUS). The research part of this paper aims to describe and analyze the demographics, comorbidities, diagnostic methods, types of revascularization procedures, and antiaggregant therapy used. The goal of this study is to provide insights into the current clinical practice in Latvia and help future treatment decision-makers. To achieve this aim, a retrospective study of 76 patients with SAS who underwent revascularization procedures was performed. After statistical analysis of the data, the study provided insights into the characteristics and management of patients with SAS in Latvia, highlighting the most observed comorbidities in these patients, the preferred diagnostic methods, and the most performed procedures. These findings can inform clinical decision-making and may have implications for the management of patients with subclavian artery stenosis in Latvia.

Keywords: subclavian artery stenosis, revascularization, characteristics of patients, comorbidities, retrospective analysis

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995 Innovative Biomonitoring in Port Ecosystem: Lessons and Perspectives from the QUAMPO Project

Authors: Benedicte Madon, Marion Pillet, Justine Castrec, Quentin Fonatine, Pierre Lejeune, Michel Marengo, Helene Thomas

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Biodiversity in port ecosystems faces many anthropic pressures from port activities. The maritime industry and port areas have been under scrutiny regarding their environmental impacts. In the port value chain, port managers need to implement actions to fulfil environmental certifications and European Directive requirements. This paper seeks to highlight the lessons learned and opportunities through the QUAMPO project to move towards port biodiversity restoration in Corsica using innovative biomonitoring in the goal of obtaining green certification.

Keywords: biomonitoring, port, water quality, invertebrate, corsica, biomarker, trace elements, HAP, PCB, certification

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994 Correlation Test of Psychomotor Vigilance Test Fatigue Scores on Sleep Quality at Home in Oil and Gas Tanker Driver: A Diagnostic Study

Authors: Pandega Gama Mahardika, Muhammad Rifki Al Iksan, Datuk Fachrul Razy

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Oil And Gas Tanker Driver is a high-risk jobdesc. drivers drive with sleep circadian rhythm disturbances. Therefore, FAMOUS (Fatigue Management Online Ultimate System) conducted a diagnostic test on the effectiveness and accuracy of the Psychomotor vigilance test (PVT) in the field to capture the fatigue level of Oil And Gas Tanker Driver. Fatigue examination with the PVP method for 3 minutes using the Pertamina FAMOUS system (Fatigue Management Online Ultimate System). The research sample was Oil And Gas Tanker Driver Elnusa petrofin drivers as many as 2205 people. PVT is categorical data that states a driver has a low or high fatigue level. The quality of sleep at home was recorded by filling in a score of 1 = not well, 2 = not well, 3 = well, per person. A total of 1852 (84%) driver had a low fatigue level, while 353 (16%) driver had a high fatigue level. Poor sleep quality was experienced by 68 (79%) driver who had a high fatigue level. Oil And Gas Tanker Driver who slept soundly at home as many as 1804 (87%) had a low fatigue level. The correlation coefficient of sleep quality home and fatigue level is significant because it shows a probability value of 0.00 (p <5%). Fatigue level can be diagnosed through examining sleep quality, using FAMOUS Program for occupational medicine, particularly in the oil and gas sector.

Keywords: psychomotor vigilance test, fatigue, sleep, oil and gas tanker driver drivers, pertamina FAMOUS

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993 Potential Impacts of Maternal Nutrition and Selection for Residual Feed Intake on Metabolism and Fertility Parameters in Angus Bulls

Authors: Aidin Foroutan, David S. Wishart, Leluo L. Guan, Carolyn Fitzsimmons

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Maximizing efficiency and growth potential of beef cattle requires not only genetic selection (i.e. residual feed intake (RFI)) but also adequate nutrition throughout all stages of growth and development. Nutrient restriction during gestation has been shown to negatively affect post-natal growth and development as well as fertility of the offspring. This, when combined with RFI may affect progeny traits. This study aims to investigate the impact of selection for divergent genetic potential for RFI and maternal nutrition during early- to mid-gestation, on bull calf traits such as fertility and muscle development using multiple ‘omics’ approaches. Comparisons were made between High-diet vs. Low-diet and between High-RFI vs. Low-RFI animals. An epigenetics experiment on semen samples identified 891 biomarkers associated with growth and development. A gene expression study on Longissimus thoracis muscle, semimembranosus muscle, liver, and testis identified 4 genes associated with muscle development and immunity of which Myocyte enhancer factor 2A [MEF2A; induces myogenesis and control muscle differentiation] was the only differentially expressed gene identified in all four tissues. An initial metabolomics experiment on serum samples using nuclear magnetic resonance (NMR) identified 4 metabolite biomarkers related to energy and protein metabolism. Once all the biomarkers are identified, bioinformatics approaches will be used to create a database covering all the ‘omics’ data collected from this project. This database will be broadened by adding other information obtained from relevant literature reviews. Association analyses with these data sets will be performed to reveal key biological pathways affected by RFI and maternal nutrition. Through these association studies between the genome and metabolome, it is expected that candidate biomarker genes and metabolites for feed efficiency, fertility, and/or muscle development are identified. If these gene/metabolite biomarkers are validated in a larger animal population, they could potentially be used in breeding programs to select superior animals. It is also expected that this work will lead to the development of an online tool that could be used to predict future traits of interest in an animal given its measurable ‘omics’ traits.

Keywords: biomarker, maternal nutrition, omics, residual feed intake

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992 Bacterial Profiling and Development of Molecular Diagnostic Assays for Detection of Bacterial Pathogens Associated with Bovine mastitis

Authors: Aqeela Ashraf, Muhammad Imran, Tahir Yaqub, Muhammad Tayyab, Yung Fu Chang

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For the identification of bovine mastitic pathogen, an economical, rapid and sensitive molecular diagnostic assay is developed by PCR multiplexing of gene and pathogenic species specific DNA sequences. The multiplex PCR assay is developed for detecting nine important bacterial pathogens causing mastitis Worldwide. The bacterial species selected for this study are Streptococcus agalactiae, Streptococcus dysagalactiae, Streptococcus uberis, Staphylococcus aureus, Escherichia coli, Staphylococcus haemolyticus, Staphylococcus chromogenes Mycoplasma bovis and Staphylococcus epidermidis. A single reaction assay was developed and validated by 27 reference strains and further tested on 276 bacterial strains obtained from culturing mastitic milk. The multiplex PCR assay developed here is further evaluated by applying directly on genomic DNA isolated from 200 mastitic milk samples. It is compared with bacterial culturing method and proved to be more sensitive, rapid, economical and can specifically identify 9 bacterial pathogens in a single reaction. It has detected the pathogens in few culture negative mastitic samples. Recognition of disease is the foundation of disease control and prevention. This assay can be very helpful for maintaining the udder health and milk monitoring.

Keywords: multiplex PCR, bacteria, mastitis, milk

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991 Comparative Diagnostic Performance of Diffusion-Weighted Imaging Combined With Microcalcifications on Mammography for Discriminating Malignant From Benign Bi-rads 4 Lesions With the Kaiser Score

Authors: Wangxu Xia

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BACKGROUND BI-RADS 4 lesions raise the possibility of malignancy that warrant further clinical and radiologic work-up. This study aimed to evaluate the predictive performance of diffusion-weighted imaging(DWI) and microcalcifications on mammography for predicting malignancy of BI-RADS 4 lesions. In addition, the predictive performance of DWI combined with microcalcifications was alsocompared with the Kaiser score. METHODS During January 2021 and June 2023, 144 patients with 178 BI-RADS 4 lesions underwent conventional MRI, DWI, and mammography were included. The lesions were dichotomized intobenign or malignant according to the pathological results from core needle biopsy or surgical mastectomy. DWI was performed with a b value of 0 and 800s/mm2 and analyzed using theapparent diffusion coefficient, and a Kaiser score > 4 was considered to suggest malignancy. Thediagnostic performances for various diagnostic tests were evaluated with the receiver-operatingcharacteristic (ROC) curve. RESULTS The area under the curve (AUC) for DWI was significantly higher than that of the of mammography (0.86 vs 0.71, P<0.001), but was comparable with that of the Kaiser score (0.86 vs 0.84, P=0.58). However, the AUC for DWI combined with mammography was significantly highthan that of the Kaiser score (0.93 vs 0.84, P=0.007). The sensitivity for discriminating malignant from benign BI-RADS 4 lesions was highest at 89% for Kaiser score, but the highest specificity of 83% can be achieved with DWI combined with mammography. CONCLUSION DWI combined with microcalcifications on mammography could discriminate malignant BI-RADS4 lesions from benign ones with a high AUC and specificity. However, Kaiser score had a better sensitivity for discrimination.

Keywords: MRI, DWI, mammography, breast disease

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990 Hypersensitivity Reactions Following Intravenous Administration of Contrast Medium

Authors: Joanna Cydejko, Paulina Mika

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Hypersensitivity reactions are side effects of medications that resemble an allergic reaction. Anaphylaxis is a generalized, severe allergic reaction of the body caused by exposure to a specific agent at a dose tolerated by a healthy body. The most common causes of anaphylaxis are food (about 70%), Hymenoptera venoms (22%), and medications (7%), despite detailed diagnostics in 1% of people, the cause of the anaphylactic reaction was not indicated. Contrast media are anaphylactic agents of unknown mechanism. Hypersensitivity reactions can occur with both immunological and non-immunological mechanisms. Symptoms of anaphylaxis occur within a few seconds to several minutes after exposure to the allergen. Contrast agents are chemical compounds that make it possible to visualize or improve the visibility of anatomical structures. In the diagnosis of computed tomography, the preparations currently used are derivatives of the triiodide benzene ring. Pharmacokinetic and pharmacodynamic properties, i.e., their osmolality, viscosity, low chemotoxicity and high hydrophilicity, have an impact on better tolerance of the substance by the patient's body. In MRI diagnostics, macrocyclic gadolinium contrast agents are administered during examinations. The aim of this study is to present the results of the number and severity of anaphylactic reactions that occurred in patients in all age groups undergoing diagnostic imaging with intravenous administration of contrast agents. In non-ionic iodine CT and in macrocyclic gadolinium MRI. A retrospective assessment of the number of adverse reactions after contrast administration was carried out on the basis of data from the Department of Radiology of the University Clinical Center in Gdańsk, and it was assessed whether their different physicochemical properties had an impact on the incidence of acute complications. Adverse reactions are divided according to the severity of the patient's condition and the diagnostic method used in a given patient. Complications following the administration of a contrast medium in the form of acute anaphylaxis accounted for less than 0.5% of all diagnostic procedures performed with the use of a contrast agent. In the analysis period from January to December 2022, 34,053 CT scans and 15,279 MRI examinations with the use of contrast medium were performed. The total number of acute complications was 21, of which 17 were complications of iodine-based contrast agents and 5 of gadolinium preparations. The introduction of state-of-the-art contrast formulations was an important step toward improving the safety and tolerability of contrast agents used in imaging. Currently, contrast agents administered to patients are considered to be one of the best-tolerated preparations used in medicine. However, like any drug, they can be responsible for the occurrence of adverse reactions resulting from their toxic effects. The increase in the number of imaging tests performed with the use of contrast agents has a direct impact on the number of adverse events associated with their administration. However, despite the low risk of anaphylaxis, this risk should not be marginalized. The growing threat associated with the mass performance of radiological procedures with the use of contrast agents forces the knowledge of the rules of conduct in the event of symptoms of hypersensitivity to these preparations.

Keywords: anaphylactic, contrast medium, diagnostic, medical imagine

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989 Quantitative Analysis of Carcinoembryonic Antigen (CEA) Using Micromechanical Piezoresistive Cantilever

Authors: Meisam Omidi, M. Mirijalili, Mohammadmehdi Choolaei, Z. Sharifi, F. Haghiralsadat, F. Yazdian

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In this work, we have used arrays of micromechanical piezoresistive cantilever with different geometries to detect carcinoembryonic antigen (CEA), which is known as an important biomarker associated with various cancers such as the colorectal, lung, breast, pancreatic, and bladder cancer. The sensing principle is based on the surface stress changes induced by antigen–antibody interaction on the microcantilevers surfaces. Different concentrations of CEA in a human serum albumin (HSA) solution were detected as a function of the deflection of the beams. According to the experiments, it was revealed that microcantilevers have surface stress sensitivities in the order of 8 (mJ/m). This matter allows them to detect CEA concentrations as low as 3 ng/mL or 18 pM. This indicates the fact that the self-sensing microcantilever approach is beneficial for pathological tests.

Keywords: micromechanical biosensors, carcinoembryonic antigen (CEA), surface stress

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988 Soft Computing Approach for Diagnosis of Lassa Fever

Authors: Roseline Oghogho Osaseri, Osaseri E. I.

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Lassa fever is an epidemic hemorrhagic fever caused by the Lassa virus, an extremely virulent arena virus. This highly fatal disorder kills 10% to 50% of its victims, but those who survive its early stages usually recover and acquire immunity to secondary attacks. One of the major challenges in giving proper treatment is lack of fast and accurate diagnosis of the disease due to multiplicity of symptoms associated with the disease which could be similar to other clinical conditions and makes it difficult to diagnose early. This paper proposed an Adaptive Neuro Fuzzy Inference System (ANFIS) for the prediction of Lass Fever. In the design of the diagnostic system, four main attributes were considered as the input parameters and one output parameter for the system. The input parameters are Temperature on admission (TA), White Blood Count (WBC), Proteinuria (P) and Abdominal Pain (AP). Sixty-one percent of the datasets were used in training the system while fifty-nine used in testing. Experimental results from this study gave a reliable and accurate prediction of Lassa fever when compared with clinically confirmed cases. In this study, we have proposed Lassa fever diagnostic system to aid surgeons and medical healthcare practictionals in health care facilities who do not have ready access to Polymerase Chain Reaction (PCR) diagnosis to predict possible Lassa fever infection.

Keywords: anfis, lassa fever, medical diagnosis, soft computing

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987 Rapid Detection and Differentiation of Camel Pox, Contagious Ecthyma and Papilloma Viruses in Clinical Samples of Camels Using a Multiplex PCR

Authors: A. I. Khalafalla, K. A. Al-Busada, I. M. El-Sabagh

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Pox and pox-like diseases of camels are a group of exanthematous skin conditions that have become increasingly important economically. They may be caused by three distinct viruses: camelpox virus (CMPV), camel contagious ecthyma virus (CCEV) and camel papillomavirus (CAPV). These diseases are difficult to differentiate based on clinical presentation in disease outbreaks. Molecular methods such as PCR targeting species-specific genes have been developed and used to identify CMPV and CCEV, but not simultaneously in a single tube. Recently, multiplex PCR has gained reputation as a convenient diagnostic method with cost- and time–saving benefits. In the present communication, we describe the development, optimization and validation a multiplex PCR assays able to detect simultaneously the genome of the three viruses in one single test allowing for rapid and efficient molecular diagnosis. The assay was developed based on the evaluation and combination of published and new primer sets, and was applied to the detection of 110 tissue samples. The method showed high sensitivity, and the specificity was confirmed by PCR-product sequencing. In conclusion, this rapid, sensitive and specific assay is considered a useful method for identifying three important viruses in specimens from camels and as part of a molecular diagnostic regime.

Keywords: multiplex PCR, diagnosis, pox and pox-like diseases, camels

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986 A Diagnostic Comparative Analysis of on Simultaneous Localization and Mapping (SLAM) Models for Indoor and Outdoor Route Planning and Obstacle Avoidance

Authors: Seyed Esmail Seyedi Bariran, Khairul Salleh Mohamed Sahari

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In robotics literature, the simultaneous localization and mapping (SLAM) is commonly associated with a priori-posteriori problem. The autonomous vehicle needs a neutral map to spontaneously track its local position, i.e., “localization” while at the same time a precise path estimation of the environment state is required for effective route planning and obstacle avoidance. On the other hand, the environmental noise factors can significantly intensify the inherent uncertainties in using odometry information and measurements obtained from the robot’s exteroceptive sensor which in return directly affect the overall performance of the corresponding SLAM. Therefore, the current work is primarily dedicated to provide a diagnostic analysis of six SLAM algorithms including FastSLAM, L-SLAM, GraphSLAM, Grid SLAM and DP-SLAM. A SLAM simulated environment consisting of two sets of landmark locations and robot waypoints was set based on modified EKF and UKF in MATLAB using two separate maps for indoor and outdoor route planning subject to natural and artificial obstacles. The simulation results are expected to provide an unbiased platform to compare the estimation performances of the five SLAM models as well as on the reliability of each SLAM model for indoor and outdoor applications.

Keywords: route planning, obstacle, estimation performance, FastSLAM, L-SLAM, GraphSLAM, Grid SLAM, DP-SLAM

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985 Atmospheric Polycyclic Aromatic Hydrocarbons (PAHs) in Rural and Urban of Central Taiwan

Authors: Shih Yu Pan, Pao Chen Hung, Chuan Yao Lin, Charles C.-K. Chou, Yu Chi Lin, Kai Hsien Chi

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This study analyzed 16 atmospheric PAHs species which were controlled by USEPA and IARC. To measure the concentration of PAHs, four rural sampling sites and two urban sampling sites were selected in Central Taiwan during spring and summer. In central Taiwan, the rural sampling stations were located in the downstream of Da-An River, Da-Jang River, Wu River and Chuo-shui River. On the other hand, the urban sampling sites were located in Taichung district and close to the roadside. Ambient air samples of both vapor phase and particle phase of PAHs compounds were collected using high volume sampling trains (Analitica). The sampling media were polyurethane foam (PUF) with XAD2 and quartz fiber filters. Diagnostic ratio, Principal component analysis (PCA), Positive Matrix Factorization (PMF) models were used to evaluate the apportionment of PAHs in the atmosphere and speculate the relative contribution of various emission sources. Because of the high temperature and low wind speed, high PAHs concentration in the atmosphere was observed. The total PAHs concentration, especially in vapor phase, had significant change during summer. During the sampling periods the total PAHs concentration of atmospheric at four rural and two urban sampling sites in spring and summer were 3.70±0.40 ng/m3,3.40±0.63 ng/m3,5.22±1.24 ng/m3,7.23±0.37 ng/m3,7.46±2.36 ng/m3,6.21±0.55 ng/m3 ; 15.0± 0.14 ng/m3,18.8±8.05 ng/m3,20.2±8.58 ng/m3,16.1±3.75 ng/m3,29.8±10.4 ng/m3,35.3±11.8 ng/m3, respectively. In order to identify PAHs sources, we used diagnostic ratio to classify the emission sources. The potential sources were diesel combustion and gasoline combustion in spring and summer, respectively. According to the principal component analysis (PCA), the PC1 and PC2 had 23.8%, 20.4% variance and 21.3%, 17.1% variance in spring and summer, respectively. Especially high molecular weight PAHs (BaP, IND, BghiP, Flu, Phe, Flt, Pyr) were dominated in spring when low molecular weight PAHs (AcPy, Ant, Acp, Flu) because of the dominating high temperatures were dominated in the summer. Analysis by using PMF model found the sources of PAHs in spring were stationary sources (34%), vehicle emissions (24%), coal combustion (23%) and petrochemical fuel gas (19%), while in summer the emission sources were petrochemical fuel gas (34%), the natural environment of volatile organic compounds (29%), coal combustion (19%) and stationary sources (18%).

Keywords: PAHs, source identification, diagnostic ratio, principal component analysis, positive matrix factorization

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984 Assessing the Structure of Non-Verbal Semantic Knowledge: The Evaluation and First Results of the Hungarian Semantic Association Test

Authors: Alinka Molnár-Tóth, Tímea Tánczos, Regina Barna, Katalin Jakab, Péter Klivényi

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Supported by neuroscientific findings, the so-called Hub-and-Spoke model of the human semantic system is based on two subcomponents of semantic cognition, namely the semantic control process and semantic representation. Our semantic knowledge is multimodal in nature, as the knowledge system stored in relation to a conception is extensive and broad, while different aspects of the conception may be relevant depending on the purpose. The motivation of our research is to develop a new diagnostic measurement procedure based on the preservation of semantic representation, which is appropriate to the specificities of the Hungarian language and which can be used to compare the non-verbal semantic knowledge of healthy and aphasic persons. The development of the test will broaden the Hungarian clinical diagnostic toolkit, which will allow for more specific therapy planning. The sample of healthy persons (n=480) was determined by the last census data for the representativeness of the sample. Based on the concept of the Pyramids and Palm Tree Test, and according to the characteristics of the Hungarian language, we have elaborated a test based on different types of semantic information, in which the subjects are presented with three pictures: they have to choose the one that best fits the target word above from the two lower options, based on the semantic relation defined. We have measured 5 types of semantic knowledge representations: associative relations, taxonomy, motional representations, concrete as well as abstract verbs. As the first step in our data analysis, we examined the normal distribution of our results, and since it was not normally distributed (p < 0.05), we used nonparametric statistics further into the analysis. Using descriptive statistics, we could determine the frequency of the correct and incorrect responses, and with this knowledge, we could later adjust and remove the items of questionable reliability. The reliability was tested using Cronbach’s α, and it can be safely said that all the results were in an acceptable range of reliability (α = 0.6-0.8). We then tested for the potential gender differences using the Mann Whitney-U test, however, we found no difference between the two (p < 0.05). Likewise, we didn’t see that the age had any effect on the results using one-way ANOVA (p < 0.05), however, the level of education did influence the results (p > 0.05). The relationships between the subtests were observed by the nonparametric Spearman’s rho correlation matrix, showing statistically significant correlation between the subtests (p > 0.05), signifying a linear relationship between the measured semantic functions. A margin of error of 5% was used in all cases. The research will contribute to the expansion of the clinical diagnostic toolkit and will be relevant for the individualised therapeutic design of treatment procedures. The use of a non-verbal test procedure will allow an early assessment of the most severe language conditions, which is a priority in the differential diagnosis. The measurement of reaction time is expected to advance prodrome research, as the tests can be easily conducted in the subclinical phase.

Keywords: communication disorders, diagnostic toolkit, neurorehabilitation, semantic knowlegde

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983 Routing Medical Images with Tabu Search and Simulated Annealing: A Study on Quality of Service

Authors: Mejía M. Paula, Ramírez L. Leonardo, Puerta A. Gabriel

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In telemedicine, the image repository service is important to increase the accuracy of diagnostic support of medical personnel. This study makes comparison between two routing algorithms regarding the quality of service (QoS), to be able to analyze the optimal performance at the time of loading and/or downloading of medical images. This study focused on comparing the performance of Tabu Search with other heuristic and metaheuristic algorithms that improve QoS in telemedicine services in Colombia. For this, Tabu Search and Simulated Annealing heuristic algorithms are chosen for their high usability in this type of applications; the QoS is measured taking into account the following metrics: Delay, Throughput, Jitter and Latency. In addition, routing tests were carried out on ten images in digital image and communication in medicine (DICOM) format of 40 MB. These tests were carried out for ten minutes with different traffic conditions, reaching a total of 25 tests, from a server of Universidad Militar Nueva Granada (UMNG) in Bogotá-Colombia to a remote user in Universidad de Santiago de Chile (USACH) - Chile. The results show that Tabu search presents a better QoS performance compared to Simulated Annealing, managing to optimize the routing of medical images, a basic requirement to offer diagnostic images services in telemedicine.

Keywords: medical image, QoS, simulated annealing, Tabu search, telemedicine

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982 Creation of a Clinical Tool for Diagnosis and Treatment of Skin Disease in HIV Positive Patients in Malawi

Authors: Alice Huffman, Joseph Hartland, Sam Gibbs

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Dermatology is often a neglected specialty in low-resource settings, despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV positive patients. African countries have the highest HIV infection rates and skin conditions are frequently misdiagnosed and mismanaged, because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV positive patients. A literature search within Embase, Medline and Google scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff a list of 15 skin conditions was included and a booklet created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff, alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.

Keywords: dermatology, HIV, Malawi, skin disease

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981 Strategies of Drug Discovery in Insects

Authors: Alaaeddeen M. Seufi

Abstract:

Many have been published on therapeutic derivatives from living organisms including insects. In addition to traditional maggot therapy, more than 900 therapeutic products were isolated from insects. Most people look at insects as enemies and others believe that insects are friends. Many beneficial insects rather than Honey Bees, Silk Worms and Shellac insect could insure human-insect friendship. In addition, insects could be MicroFactories, Biosensors or Bioreactors. InsectFarm is an amazing example of the applied research that transfers insects from laboratory to market by Prof Mircea Ciuhrii and co-workers. They worked for 18 years to derive therapeutics from insects. Their research resulted in production of more than 30 commercial medications derived from insects (e.g. Imunomax, Noblesse, etc.). Two general approaches were followed to discover drugs from living organisms. Some laboratories preferred biochemical approach to purify components of the innate immune system of insects and insect metabolites as well. Then the purified components could be tested for many therapeutic trials. Other researchers preferred molecular approach based on proteomic studies. Components of the innate immune system of insects were then tested for their medical activities. Our Laboratory team preferred to induce insect immune system (using oral, topical and injection routes of administration), then a transcriptomic study was done to discover the induced genes and to identify specific biomarkers that can help in drug discovery. Biomarkers play an important role in medicine and in drug discovery and development as well. Optimum biomarker development and application will require a team approach because of the multifaceted nature of biomarker selection, validation, and application. This team uses several techniques such as pharmacoepidemiology, pharmacogenomics, and functional proteomics; bioanalytical development and validation; modeling and simulation to improve and refine drug development. Our Achievements included the discovery of four components of the innate immune system of Spodoptera littoralis and Musca domestica. These components were designated as SpliDef (defesin), SpliLec (lectin), SpliCec (cecropin) and MdAtt (attacin). SpliDef, SpliLec and MdAtt were confirmed as antimicrobial peptides, while SpliCec was additionally confirmed as anticancer peptide. Our current research is going on to achieve something in antioxidants and anticoagulants from insects. Our perspective is to achieve something in the mass production of prototypes of our products and to reach it to the commercial level. These achievements are the integrated contributions of everybody in our team staff.

Keywords: AMPs, insect, innate immunitty, therappeutics

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980 Using Audit Tools to Maintain Data Quality for ACC/NCDR PCI Registry Abstraction

Authors: Vikrum Malhotra, Manpreet Kaur, Ayesha Ghotto

Abstract:

Background: Cardiac registries such as ACC Percutaneous Coronary Intervention Registry require high quality data to be abstracted, including data elements such as nuclear cardiology, diagnostic coronary angiography, and PCI. Introduction: The audit tool created is used by data abstractors to provide data audits and assess the accuracy and inter-rater reliability of abstraction performed by the abstractors for a health system. This audit tool solution has been developed across 13 registries, including ACC/NCDR registries, PCI, STS, Get with the Guidelines. Methodology: The data audit tool was used to audit internal registry abstraction for all data elements, including stress test performed, type of stress test, data of stress test, results of stress test, risk/extent of ischemia, diagnostic catheterization detail, and PCI data elements for ACC/NCDR PCI registries. This is being used across 20 hospital systems internally and providing abstraction and audit services for them. Results: The data audit tool had inter-rater reliability and accuracy greater than 95% data accuracy and IRR score for the PCI registry in 50 PCI registry cases in 2021. Conclusion: The tool is being used internally for surgical societies and across hospital systems. The audit tool enables the abstractor to be assessed by an external abstractor and includes all of the data dictionary fields for each registry.

Keywords: abstraction, cardiac registry, cardiovascular registry, registry, data

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979 Molecular Farming: Plants Producing Vaccine and Diagnostic Reagent

Authors: Katerina H. Takova, Ivan N. Minkov, Gergana G. Zahmanova

Abstract:

Molecular farming is the production of recombinant proteins in plants with the aim to use the protein as a purified product, crude extract or directly in the planta. Plants gain more attention as expression systems compared to other ones due to the cost effective production of pharmaceutically important proteins, appropriate post-translational modifications, assembly of complex proteins, absence of human pathogens to name a few. In addition, transient expression in plant leaves enables production of recombinant proteins within few weeks. Hepatitis E virus (HEV) is a causative agent of acute hepatitis. HEV causes epidemics in developing countries and is primarily transmitted through the fecal-oral route. Presently, all efforts for development of Hepatitis E vaccine are focused on the Open Read Frame 2 (ORF2) capsid protein as it contains epitopes that can induce neutralizing antibodies. For our purpose, we used the CMPV-based vector-pEAQ-HT for transient expression of HEV ORF2 in Nicotiana benthamina. Different molecular analysis (Western blot and ELISA) showed that HEV ORF2 capsid protein was expressed in plant tissue in high-yield up to 1g/kg of fresh leaf tissue. Electron microscopy showed that the capsid protein spontaneously assembled in low abundance virus-like particles (VLPs), which are highly immunogenic structures and suitable for vaccine development. The expressed protein was recognized by both human and swine HEV positive sera and can be used as a diagnostic reagent for the detection of HEV infection. Production of HEV capsid protein in plants is a promising technology for further HEV vaccine investigations. Here, we reported for a rapid high-yield transient expression of a recombinant protein in plants suitable for vaccine production as well as a diagnostic reagent. Acknowledgments -The authors’ research on HEV is supported with grants from the Project PlantaSYST under the Widening Program, H2020 as well as under the UK Biotechnological and Biological Sciences Research Council (BBSRC) Institute Strategic Programme Grant ‘Understanding and Exploiting Plant and Microbial Secondary Metabolism’ (BB/J004596/1). The authors want to thank Prof. George Lomonossoff (JIC, Norwich, UK) for his contribution.

Keywords: hepatitis E virus, plant molecular farming, transient expression, vaccines

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978 Detecting Potential Biomarkers for Ulcerative Colitis Using Hybrid Feature Selection

Authors: Mustafa Alshawaqfeh, Bilal Wajidy, Echin Serpedin, Jan Suchodolski

Abstract:

Inflammatory Bowel disease (IBD) is a disease of the colon with characteristic inflammation. Clinically IBD is detected using laboratory tests (blood and stool), radiology tests (imaging using CT, MRI), capsule endoscopy and endoscopy. There are two variants of IBD referred to as Ulcerative Colitis (UC) and Crohn’s disease. This study employs a hybrid feature selection method that combines a correlation-based variable ranking approach with exhaustive search wrapper methods in order to find potential biomarkers for UC. The proposed biomarkers presented accurate discriminatory power thereby identifying themselves to be possible ingredients to UC therapeutics.

Keywords: ulcerative colitis, biomarker detection, feature selection, inflammatory bowel disease (IBD)

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977 Use of a New Multiplex Quantitative Polymerase Chain Reaction Based Assay for Simultaneous Detection of Neisseria Meningitidis, Escherichia Coli K1, Streptococcus agalactiae, and Streptococcus pneumoniae

Authors: Nastaran Hemmati, Farhad Nikkhahi, Amir Javadi, Sahar Eskandarion, Seyed Mahmuod Amin Marashi

Abstract:

Neisseria meningitidis, Escherichia coli K, Streptococcus agalactiae, and Streptococcus pneumoniae cause 90% of bacterial meningitis. Almost all infected people die or have irreversible neurological complications. Therefore, it is essential to have a diagnostic kit with the ability to quickly detect these fatal infections. The project involved 212 patients from whom cerebrospinal fluid samples were obtained. After total genome extraction and performing multiplex quantitative polymerase chain reaction (qPCR), the presence or absence of each infectious factor was determined by comparing with standard strains. The specificity, sensitivity, positive predictive value, and negative predictive value calculated were 100%, 92.9%, 50%, and 100%, respectively. So, due to the high specificity and sensitivity of the designed primers, they can be used instead of bacterial culture that takes at least 24 to 48 hours. The remarkable benefit of this method is associated with the speed (up to 3 hours) at which the procedure could be completed. It is also worth noting that this method can reduce the personnel unintentional errors which may occur in the laboratory. On the other hand, as this method simultaneously identifies four common factors that cause bacterial meningitis, it could be used as an auxiliary method diagnostic technique in laboratories particularly in cases of emergency medicine.

Keywords: cerebrospinal fluid, meningitis, quantitative polymerase chain reaction, simultaneous detection, diagnosis testing

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976 Loss of Control Eating as a Key Factor of the Psychological Symptomatology Related to Childhood Obesity

Authors: L. Beltran, S. Solano, T. Lacruz, M. Blanco, M. Rojo, M. Graell, A. R. Sepulveda

Abstract:

Introduction and Objective: Given the difficulties of assessing Binge Eating Disorder during childhood, episodes of Loss of Control (LOC) eating can be a key symptom. The objective is to know the prevalence of food psychopathology depending on the type of evaluation and find out which psychological characteristics differentiate overweight or obese children who present LOC from those who do not. Material and Methods: 170 children from 8 to 12 years of age with overweight or obesity (P > 85) were evaluated through the Primary Care Centers of Madrid. Sociodemographic data and psychological measures were collected through the Kiddie-Schedule for Affective Disorders & Schizophrenia, Present & Lifetime Version (K-SADS-PL) diagnostic interview and self-applied questionnaires: Children's eating attitudes (ChEAT), depressive symptomatology (CDI), anxiety (STAIC), general self-esteem (LAWSEQ), body self-esteem (BES), perceived teasing (POTS) and perfectionism (CAPS). Results: 15.2% of the sample exceeded the ChEAT cut-off point, presenting a risk of pathological eating; 5.88% presented an Eating Disorder through the diagnostic interview (2.35% Binge Eating disorder), and 33.53% had LOC episodes. No relationship was found between the presence of LOC and clinical diagnosis of eating disorders according to DSM-V; however, the group with LOC presented a higher risk of eating psychopathology using the ChEAT (p < .02). Significant differences were found in the group with LOC (p < .02): higher z-BMI, lower body self-esteem, greater anxious symptomatology, greater frequency of teasing towards weight, and greater effect of teasing both towards weight and competitions; compared to their peers without LOC. Conclusion: According to previous studies in samples with overweight children, in this Spanish sample of children with obesity, we found a prevalence of moderate eating disorder and a high presence of LOC episodes, which is related to both eating and general psychopathology. These findings confirm that the exclusion of LOC episodes as a diagnostic criterion can underestimate the presence of eating psychopathology during this developmental stage. According to these results, it is highly recommended to promote school context programs that approach LOC episodes in order to reduce associated symptoms. This study is included in a Project funded by the Ministry of Innovation and Science (PSI2011-23127).

Keywords: childhood obesity, eating psychopathology, loss-of-control eating, psychological symptomatology

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975 Role of Special Training Centers (STC) in Right to Education Act Challenges And Remedies

Authors: Anshu Radha Aggarwal

Abstract:

As per the Right to Education Act (RTE), 2009, every child in the age group of 6-14 years shall be admitted in a neighborhood school. All the Out of School Children identified have to be enrolled / mainstreamed in to age appropriate class and there-after be provided special training. This paper addresses issues emerging from provisions in the RTE Act that specifically refer to the enrolment of out-of school children into age appropriate classes and the requirement to provide special trainings that will enable this to take place. In the context of RTE Act, the Out-of-School Children are first enrolled in the formal school and then they are provided with Special Training through NRSTCs (Long Term / Short term basis). These centers are functioning in formal school campus itself. This paper specifies the role of special training centers (STC). It presents a re-envisioning of assessment that recognizes two principal functions of assessment, assessment for learning and assessment of learning, instead of the more familiar categories of formative, diagnostic, summative, and evaluative assessment. The use of these two functions of assessment highlights and emphasizes the role of special training centers (STC) to assess their level for giving them appropriate special training and to evaluate their improvement in learning level. Challenge of problem faced by teachers to do diagnostic assessment, including its place in the sequence of assessment procedures appropriate in identifying and addressing individual children’s learning difficulties are solved by special training centers (STC). It is important that assessment is used to identify children with learning difficulties at the earliest possible stage so that appropriate support and intervention can be put in place. So appropriate challenges with tools are presented here for their assessment at entry level and at completion level of primary children by special training centers (STC).

Keywords: right to education, assessment, challenges, out of school children

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974 Production of Recombinant VP2 Protein of Canine Parvovirus Type 2c Using Baculovirus Expression System

Authors: Jae Young Song, In-Ohk Ouh, Seyeon Park, Byeong Sul Kang, Soo Dong Cho, In-Soo Cho

Abstract:

Canine parvovirus (CPV) is a major pathogen of diarrhea disease in dogs. CPV type 2 has three of antigenic variants such as 2a, 2b, and 2c. CPV constructs a small non-enveloped, icosahedral capsid that contains single-stranded DNA. It has capsids that two largely overlapping virion proteins (VP), VP1 (82 kDa), and VP2 (65 kDa). Baculoviruses are insect pathogens that regulate insect populations in nature and are being successfully used to control insect pests. The proteins produced in the baculovirus-expression system are used for instance for functional studies, vaccine preparations, or diagnostics. The vaccines produced by baculovirus-expression system showed elicitation of antibodies. The recombinant baculovirus infected SF9 cells showed broken shape. The recombinant VP2 proteins from cell pellet or supernatant were confirmed by western blotting. The result showed that the recombinant VP2 protein bands were appeared at 65 kDa molecular weight in both cell pellet and supernatant of infected SF9 cell. These results indicated that the recombinant baculovirus infected SF9 cell express the recombinant VP2 protein successfully. In addition, the expressed recombinant VP2 protein is secreted from cell to supernatant. The baculovirus expression system can be used to produce the VP2 protein of CPV 2c. In addition, the secretion property of the expression of VP2 protein may decrease the cost of production, because it can be skipped the cell breaking step. The produced VP2 protein could be used for vaccine and the agent of diagnostic tests. This study provides the foundation of the production of CPV 2c vaccine and the diagnostic agent.

Keywords: baculovirus, canine parvovirus 2c, dog, Korea

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973 Accurate Mass Segmentation Using U-Net Deep Learning Architecture for Improved Cancer Detection

Authors: Ali Hamza

Abstract:

Accurate segmentation of breast ultrasound images is of paramount importance in enhancing the diagnostic capabilities of breast cancer detection. This study presents an approach utilizing the U-Net architecture for segmenting breast ultrasound images aimed at improving the accuracy and reliability of mass identification within the breast tissue. The proposed method encompasses a multi-stage process. Initially, preprocessing techniques are employed to refine image quality and diminish noise interference. Subsequently, the U-Net architecture, a deep learning convolutional neural network (CNN), is employed for pixel-wise segmentation of regions of interest corresponding to potential breast masses. The U-Net's distinctive architecture, characterized by a contracting and expansive pathway, enables accurate boundary delineation and detailed feature extraction. To evaluate the effectiveness of the proposed approach, an extensive dataset of breast ultrasound images is employed, encompassing diverse cases. Quantitative performance metrics such as the Dice coefficient, Jaccard index, sensitivity, specificity, and Hausdorff distance are employed to comprehensively assess the segmentation accuracy. Comparative analyses against traditional segmentation methods showcase the superiority of the U-Net architecture in capturing intricate details and accurately segmenting breast masses. The outcomes of this study emphasize the potential of the U-Net-based segmentation approach in bolstering breast ultrasound image analysis. The method's ability to reliably pinpoint mass boundaries holds promise for aiding radiologists in precise diagnosis and treatment planning. However, further validation and integration within clinical workflows are necessary to ascertain their practical clinical utility and facilitate seamless adoption by healthcare professionals. In conclusion, leveraging the U-Net architecture for breast ultrasound image segmentation showcases a robust framework that can significantly enhance diagnostic accuracy and advance the field of breast cancer detection. This approach represents a pivotal step towards empowering medical professionals with a more potent tool for early and accurate breast cancer diagnosis.

Keywords: mage segmentation, U-Net, deep learning, breast cancer detection, diagnostic accuracy, mass identification, convolutional neural network

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972 Bias Prevention in Automated Diagnosis of Melanoma: Augmentation of a Convolutional Neural Network Classifier

Authors: Kemka Ihemelandu, Chukwuemeka Ihemelandu

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Melanoma remains a public health crisis, with incidence rates increasing rapidly in the past decades. Improving diagnostic accuracy to decrease misdiagnosis using Artificial intelligence (AI) continues to be documented. Unfortunately, unintended racially biased outcomes, a product of lack of diversity in the dataset used, with a noted class imbalance favoring lighter vs. darker skin tone, have increasingly been recognized as a problem.Resulting in noted limitations of the accuracy of the Convolutional neural network (CNN)models. CNN models are prone to biased output due to biases in the dataset used to train them. Our aim in this study was the optimization of convolutional neural network algorithms to mitigate bias in the automated diagnosis of melanoma. We hypothesized that our proposed training algorithms based on a data augmentation method to optimize the diagnostic accuracy of a CNN classifier by generating new training samples from the original ones will reduce bias in the automated diagnosis of melanoma. We applied geometric transformation, including; rotations, translations, scale change, flipping, and shearing. Resulting in a CNN model that provided a modifiedinput data making for a model that could learn subtle racial features. Optimal selection of the momentum and batch hyperparameter increased our model accuracy. We show that our augmented model reduces bias while maintaining accuracy in the automated diagnosis of melanoma.

Keywords: bias, augmentation, melanoma, convolutional neural network

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971 A Rare Cause of Abdominal Pain Post Caesarean Section

Authors: Madeleine Cox

Abstract:

Objective: discussion of diagnosis of vernix caseosa peritonitis, recovery and subsequent caesarean seciton Case: 30 year old G4P1 presented in labour at 40 weeks, planning a vaginal birth afterprevious caesarean section. She underwent an emergency caesarean section due to concerns for fetal wellbeing on CTG. She was found to have a thin lower segment with a very small area of dehiscence centrally. The operation was uncomplicated, and she recovered and went home 2 days later. She then represented to the emergency department day 6 post partum feeling very unwell, with significant abdominal pain, tachycardia as well as urinary retention. Raised white cell count of 13.7 with neutrophils of 11.64, CRP of 153. An abdominal ultrasound was poorly tolerated by the patient and did not aide in the diagnosis. Chest and abdominal xray were normal. She underwent a CT chest and abdomen, which found a small volume of free fluid with no apparent collection. Given no obvious cause of her symptoms were found and the patient did not improve, she had a repeat CT 2 days later, which showed progression of free fluid. A diagnostic laparoscopy was performed with general surgeons, which reveled turbid fluid, an inflamed appendix which was removed. The patient improved remarkably post operatively. The histology showed periappendicitis with acute appendicitis with marked serosal inflammatory reaction to vernix caseosa. Following this, the patient went on to recover well. 4 years later, the patient was booked for an elective caesarean section, on entry into the abdomen, there were very minimal adhesions, and the surgery and her subsequent recovery was uncomplicated. Discussion: this case represents the diagnostic dilemma of a patient who presents unwell without a clear cause. In this circumstance, multiple modes of imaging did not aide in her diagnosis, and so she underwent diagnostic surgery. It is important to evaluate if a patient is or is not responding to the typical causes of post operative pain and adjust management accordingly. A multiteam approach can help to provide a diagnosis for these patients. Conclusion: Vernix caseosa peritonitis is a rare cause of acute abdomen post partum. There are few reports in the literature of the initial presentation and no reports on the possible effects on future pregnancies. This patient did not have any complications in her following pregnancy or delivery secondary to her diagnosis of vernix caseosa peritonitis. This may assist in counselling other women who have had this uncommon diagnosis.

Keywords: peritonitis, obstetrics, caesarean section, pain

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