Search results for: elevated creatinine clearance level
Commenced in January 2007
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Edition: International
Paper Count: 13422

Search results for: elevated creatinine clearance level

13182 Efficiency of Microbial Metabolites on Quality Milk Production in Nili Ravi Breed of Buffalos

Authors: Sajjad Ur Rahman, Muhammad Tahir, Mukarram Bashir, Jawad, Aoun Muhammad, Muhammad Zohaib, Hannan Khan, Seemal Javaid, Mariam Azam

Abstract:

The efficiency of natural metabolites obtained from partially fermented soya hulls and wheat bran using Saccharomyces cerevisiae (DL-22 S/N) ensures a potential impact on the total milk yield and quality of milk production. On attaining a moderate number of Saccharomyces cerevisiae cells around 1×10⁹ CFU/ml, the concentrate was further elevated under in-vivo conditions to study the quality of milk production in lactating buffalo. Ten lactating buffalos of the Nili Ravi breed having the same physical factors were given 12 gm of microbial metabolites daily, along with the palleted feed having 22 % proteins. Another group of 10 lactating animals with the same characteristics was maintained without metabolites. The body score, overall health, incidence of mastitis, milk fat, milk proteins, ash and solid not fat (SNF) were elevated on a weekly basis up to thirty days of trial. It was recorded that the average total increase in quality milk production was 0.9 liter/h/d, whereas SNF in the milk was enhanced to 0.71, and fats were decreased to 0.09 %. Moreover, during all periods of the trial, the overall non-specific immunity of buffalo was increased, as indicated by less than 0.2 % of mastitis incidence compared to 1.8% in the untreated buffalos.

Keywords: natural metabolites, quality milk, milk yield, microorganisms, fermentation, nonspecific immunity, better performing animals

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13181 Cooking Attributes of Rice Stored under Varying Temperature and Moisture Regimes

Authors: Lakshmi E. Jayachandran, Manepally Rajkumar, Pavuluri Srinivasa Rao

Abstract:

The objective of this research was to study the changes in eating quality of rice during storage under varying temperature and moisture regimes. Paddy (IR-36) with high amylose content (27%) was stored at a temperature range between 10 to 40°C and moisture content from 9 to 18% (d.b.) for 6 months. Drastic changes in color and parameters representing cooking qualities, cooked rice texture, and surface morphology occurred after 4 months of storage, especially at elevated temperature conditions. Head rice yield was stable throughout the storage except at extreme conditions of temperature and moisture content. Yellowing of rice was prominent at combinations of high temperature and moisture content, both of which had a synergistic effect on the b* values of rice. The cooking time, length expansion ratio and volume expansion ratio of all the rice samples increased with prolonged storage. The texture parameter, primarily, the hardness, cohesiveness, and adhesiveness of cooked rice samples were higher following storage at elevated temperature. Surface morphology was also significantly affected in stored rice as compared to fresh rice. Storage of rice at 10°C with a grain moisture content of 10% for 2 months gave cooked rice samples with good palatability and minimal cooking time. The temperature was found to be the most prominent storage parameter for rough rice, followed by moisture content and storage duration, influencing the quality of rice.

Keywords: rice, cooking quality, storage, surface morphology

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13180 Epidemiology of Low Back Pain among Nurses Working in Public Hospitals of Addis Ababa, Ethiopia

Authors: Mengestie Mulugeta Belay, Serebe Abay Gebrie, Biruk Lambbiso Wamisho, Amare Worku

Abstract:

Background: Low back pain (LBP) related to nursing profession, is a very common public health problem throughout the world. Various risk factors have been implicated in the etiology and LBP is assumed to be of multi-factorial origin as individual, work-related and psychosocial factors can contribute to its development. Objectives: To determine the prevalence and to identify risk factors of LBP among nurses working in Addis Ababa City Public Hospitals, Ethiopia, in the year 2015. Settings: Addis Ababa University, Black-Lion (‘Tikur Anbessa’) Hospital-BLH, is the country’s highest tertiary level referral and teaching Hospital. The three departments in connection with this study: Radiology, Pathology and Orthopedics, run undergraduate and residency programs and receive referred patients from all over the country. Methods: A cross-sectional study with internal comparison was conducted throughout the period October-December, 2015. Sample was chosen by simple random sampling technique by taken the lists of nurses from human resource departments as a sampling frame. A well-structured, pre-tested and self-administered questionnaire was used to collect quantifiable information. The questionnaire included socio-demographic, back pain features, consequences of back pain, work-related and psychosocial factors. The collected data was entered into EpiInfo version 3.5.4 and was analyzed by SPSS. A probability level of 0.05 or less and 95% confidence level was used to indicate statistical significance. Ethical clearance was obtained from all respected administrative bodies, Hospitals and study participants. Results: The study included 395 nurses and gave a response rate of 91.9%. The mean age was 30.6 (±8.4) years. Majority of the respondents were female (285, 72.2%). Nearly half of the participants (n=181, 45.8% (95% CI (40.8%- 50.6%))) were complained low back pain. There was statistical significant association between low back pain and working shift, physical activities at work; sleep disturbance and felt little pleasure by doing things. Conclusion: A high prevalence of low back pain was found among nurses working in Addis Ababa Public Hospitals. Recognition and preventive measures like providing resting periods should be taken to reduce the risk of low back pain in nurses working in Public hospitals.

Keywords: low back pain, risk factors, nurses, public hospitals

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13179 The Relationship between Body Positioning and Badminton Smash Quality

Authors: Gongbing Shan, Shiming Li, Zhao Zhang, Bingjun Wan

Abstract:

Badminton originated in ancient civilizations in Europe and Asia more than 2000 years ago. Presently, it is played almost everywhere with estimated 220 million people playing badminton regularly, ranging from professionals to recreational players; and it is the second most played sport in the world after soccer. In Asia, the popularity of badminton and involvement of people surpass soccer. Unfortunately, scientific researches on badminton skills are hardly proportional to badminton’s popularity. A search of literature has shown that the literature body of biomechanical investigations is relatively small. One of the dominant skills in badminton is the forehand overhead smash, which consists of 1/5 attacks during games. Empirical evidences show that one has to adjust the body position in relation to the coming shuttlecock to produce a powerful and accurate smash. Therefore, positioning is a fundamental aspect influencing smash quality. A search of literature has shown that there is a dearth/lack of study on this fundamental aspect. The goals of this study were to determine the influence of positioning and training experience on smash quality in order to discover information that could help learn/acquire the skill. Using a 10-camera, 3D motion capture system (VICON MX, 200 frames/s) and 15-segment, full-body biomechanical model, 14 skilled and 15 novice players were measured and analyzed. Results have revealed that the body positioning has direct influence on the quality of a smash, especially on shuttlecock release angle and clearance height (passing over the net) of offensive players. The results also suggest that, for training a proper positioning, one could conduct a self-selected comfort position towards a statically hanged shuttlecock and then step one foot back – a practical reference marker for learning. This perceptional marker could be applied in guiding the learning and training of beginners. As one gains experience through repetitive training, improved limbs’ coordination would increase smash quality further. The researchers hope that the findings will benefit practitioners for developing effective training programs for beginners.

Keywords: 3D motion analysis, biomechanical modeling, shuttlecock release speed, shuttlecock release angle, clearance height

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13178 Numerical Simulation on Deformation Behaviour of Additively Manufactured AlSi10Mg Alloy

Authors: Racholsan Raj Nirmal, B. S. V. Patnaik, R. Jayaganthan

Abstract:

The deformation behaviour of additively manufactured AlSi10Mg alloy under low strains, high strain rates and elevated temperature conditions is essential to analyse and predict its response against dynamic loading such as impact and thermomechanical fatigue. The constitutive relation of Johnson-Cook is used to capture the strain rate sensitivity and thermal softening effect in AlSi10Mg alloy. Johnson-Cook failure model is widely used for exploring damage mechanics and predicting the fracture in many materials. In this present work, Johnson-Cook material and damage model parameters for additively manufactured AlSi10Mg alloy have been determined numerically from four types of uniaxial tensile test. Three different uniaxial tensile tests with dynamic strain rates (0.1, 1, 10, 50, and 100 s-1) and elevated temperature tensile test with three different temperature conditions (450 K, 500 K and 550 K) were performed on 3D printed AlSi10Mg alloy in ABAQUS/Explicit. Hexahedral elements are used to discretize tensile specimens and fracture energy value of 43.6 kN/m was used for damage initiation. Levenberg Marquardt optimization method was used for the evaluation of Johnson-Cook model parameters. It was observed that additively manufactured AlSi10Mg alloy has shown relatively higher strain rate sensitivity and lower thermal stability as compared to the other Al alloys.

Keywords: ABAQUS, additive manufacturing, AlSi10Mg, Johnson-Cook model

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13177 Siderophore Receptor Protein from Klebsiella pneumoniae as a Promising Immunogen for Serotype-Independent Therapeutic Lead Development

Authors: Sweta Pandey, Samridhi Dhyani, Susmita Chaudhuri

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Klebsiella pneumoniae causes a wide range of infections, including urinary tract infections, sepsis, bacteremia, pneumonia, and liver abscesses. The emergence of multi-drug resistance in this bacterium led to a major setback for clinical management. WHO also endorsed a need for finding alternative therapy to antibiotics for the treatment of these infections. Development of vaccines and passive antibody therapy has been proven as a potent alternative to antibiotics in the case of MDR, XDR, and PDR Klebsiella infections. Siderophore receptors have been demonstrated to be overexpressed for the internalization of iron siderophore complexes during infections in most Gram-negative bacteria. For the present study, immune response to siderophore receptors to establish this protein as a potential immunogen for the development of therapeutic leads was explored. Clinical strains of Klebsiella pneumoniae were grown in iron-deficient conditions, and the iron-regulated outer membrane proteins were extracted and characterized through mass spectrometry for specific identification. The gene for identified protein was cloned in pET- 28a vector and expressed in E. coli. The native protein and the recombinant protein were isolated and purified and used as antigens for the generation of immune response in BALB/c mice. The native protein of Klebsiella pneumoniae grown in iron-deficient conditions was identified as FepA (Ferrienterobactin receptor) and other siderophore receptors. This 80 kDa protein generated an immune response in BALB/c mice. The antiserum from mice after subsequent booster doses was collected and showed binding with FepA protein in western blot and phagocytic uptake of the K. pneumoniae in the presence antiserum from immunized mice also observed from the animal studies after bacterial challenge post immunisation in mice have shown bacterial clearance. The antiserum from mice showed binding and clearance of the Klebsiella pneumoniae bacteria in vitro and in vivo. These antigens used for generating an active immune response in mice can further be used for therapeutic monoclonal antibody development against Klebsiella pneumoniae infections.

Keywords: antiserum, FepA, Klebsiella pneumoniae, multi drug resistance, siderophore receptor

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13176 Characterization of the Immune Response of Inactivated RVF Vaccine: A Comparative Study in Sheep and Goats as Experimental Model

Authors: Ahmed Zaghawa

Abstract:

Rift Valley Fever is an economically specific disease of the health and arboviral disease that affects many types of animals, causing significant economic losses in livestock, and it is transmitted to humans and has public health issues. The vaccine program is the backbone for the control of this disease. The goal of this study was to apply a new approach to evaluate the inactivated RVF vaccine developed in Egypt. In this study, the RVF vaccine was evaluated in young puppies and compared with sheep; the findings showed that young puppies were susceptible to infection with the inhibitory RVF virus and had a strong response of antibodies with two doses of the RVF vaccine within the two-week interval. The neutralization indices began to appear to the protective level on the 7th day at 1.35 and steadily elevated at 14,21 and 28 days to 1.35, 1.43, and 1.20, respectively, in comparison to the control group. While in sheep, the neutralization indices began to appear to the protective level on the 7th day at 1.10 and remain strongly at high titer at 14, 21, and 28 days with NI values 1.20, 1.50, and 1.50, respectively. The new approach for comparing the immune response in puppies and sheep via SNT indicated the high response in both species was evident as well as the neutralization indices values in young puppies at different periods after RVF vaccination reported the value of 1.08±0.03, 1.23±0.04, 1.30±0.03, and 1.45±0.02 after 7, 14, 21, and 28 days post-vaccination respectively. On the other side, a nearly similar immune response was noticed in sheep with NI values of 1.15±0.02, 1.27±0.02, 1.42±0.05, and 1.55±0.03 at 7, 14, 21, and 28 days post-vaccination, respectively. In conclusion, young puppies are similar to sheep in developing antibodies after vaccination with the RVF vaccine and can replace sheep for evaluating the efficacy of the RVF vaccine. Further studies are mandatory to assess more recent methods for evaluating inhibition of the RVF vaccine.

Keywords: immune response, puppies, RVF, sheep, vaccine

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13175 A Systematic Review of Street-Level Policy Entrepreneurship Strategies in Different Political Contexts

Authors: Hui Wang, Huan Zhang

Abstract:

This study uses systematic review and qualitative comparative analysis methods to comprehensively inquire about the recent street-level policy entrepreneurship research, to identify the characteristics and lessons we can learn from 20 years of street-level policy entrepreneurship literature, and the relations between political contexts and street-level policy entrepreneurs’ strategies. Using data from a systematic review of street-level policy entrepreneurship literature, we identify the sub-components of different political contexts and core strategies of street-level policy entrepreneurs and estimate the configurational relations between different political settings and street-level policy entrepreneurs’ strategies. Our results show that street-level policy entrepreneurs display social acuity, define the problem, and build team strategies when policy or political streams dominate. Street-level policy entrepreneurs will use lead-by-example strategies when both policy and political streams dominate. Furthermore, street-level policy entrepreneurs will use bureaucratic strategies, even if no stream dominates in the political context.

Keywords: policy entrepreneurs, qualitative comparative analysis, street-level bureaucracy, systematic review

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13174 Chronic Exposure of Mercury on Amino Acid Level in Freshwater Fish Clarias batrachus (Linn.)

Authors: Mary Josephine Rani

Abstract:

Virtually all metals are toxic to aquatic organisms because of the devastating effect of these metals on humans; heavy metals are one of the most toxic forms of aquatic pollution. Metal concentrations in aquatic organisms appear to be of several magnitudes higher than concentrations present in the ecosystem. Mercury is one of the most toxic heavy metals in the environment. The principal sources of contamination in wastewater are chloralkali plants, battery factories, mercury switches, and medical wastes. Elevated levels of mercury in aquatic organisms specially fish represent both an ecological and human concern. Amino acid levels were estimated in five tissues (gills, liver, kidney, brain and muscle) of Clariasbatrachus after 28 days of chronic exposure to mercury. Free amino acids serve as precursor for energy production under stress and for the synthesis of required proteins to face the metal challenge.

Keywords: amino acids, fish, mercury, toxicity

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13173 Measurement of Susceptibility Users Using Email Phishing Attack

Authors: Cindy Sahera, Sarwono Sutikno

Abstract:

Rapid technological developments also have negative impacts, namely the increasing criminal cases based on technology or cybercrime. One technique that can be used to conduct cybercrime attacks are phishing email. The issue is whether the user is aware that email can be misused by others so that it can harm the user's own? This research was conducted to measure the susceptibility of selected targets against email abuse. The objectives of this research are measurement of targets’ susceptibility and find vulnerability in email recipient. There are three steps being taken in this research, (1) the information gathering phase, (2) the design phase, and (3) the execution phase. The first step includes the collection of the information necessary to carry out an attack on a target. The next step is to make the design of an attack against a target. The last step is to send phishing emails to the target. The levels of susceptibility are three: level 1, level 2 and level 3. Level 1 indicates a low level of targets’ susceptibility, level 2 indicates the intermediate level of targets’ susceptibility, and level 3 indicates a high level of targets’ susceptibility. The results showed that users who are on level 1 and level 2 more that level 3, which means the user is not too careless. However, it does not mean the user to be safe. There are still vulnerabilities that may occur, such as automatic location detection when opening emails and automatic downloaded malware as user clicks a link in the email.

Keywords: cybercrime, email phishing, susceptibility, vulnerability

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13172 Antidiabetic and Antioxidant Potential of Aqueous Extract of Jasminum humile Leaves in Nicotinamide/Streptozotocin induced Type-2 Diabetes Mellitus (T2DM) Rat

Authors: Parminder Nain, Jaspreet kaur, Vipin Saini, Sunil Sharma

Abstract:

Jasminum humile commonly known as yellow Jasmine or Pili chameli, is a medicinal plant used in Ayurveda for treating various diseases, one of which is diabetes mellitus. The current study aimed to establish the antidiabetic and antioxidant properties of aqueous extract of Jasminum humile leaves (AEJHL) in nicotinamide/streptozotocin induced type 2 diabetic rats. Phytochemical screening, HPLC analysis, and acute toxicity study of AEJHL were carried out. Male albino wistar rats (n=42) were divided into seven equal groups. Rats with moderate diabetes having hyperglycemia (blood glucose 250-400 mg/dl) were taken for the experiment. Various concentrations of aqueous extract of Jasminum humile leaves (50, 100, 200 and 300 mg/kg, p.o.), and glibenclamide (1mg/kg, p.o.) were orally administered to diabetic rats for 45 days. The effect of AEJHL on blood glucose, plasma insulin and biochemical parameters such as hemoglobin, total protein, serum creatinine, serum urea, alkaline phosphate, Glutamic-oxalacetic transaminase (SGOT) and glutamic-pyruvic transaminase (SGPT), as well as total cholesterol, triglycerides, and high-density lipoprotein (HDL) were also studied. The antioxidant effect of AEJHL was determined by analyzing hepatic and renal antioxidant markers, like superoxide dismutase (SOD), catalase (CAT), reduced Glutathione (GSH), Glutathione peroxidase (GPx), and lipid peroxidation (LPO) in diabetic rats. After 45-days oral administration of aqueous extract of Jasminum humile leaves significantly (p<0.05) reduced blood sugar and increase plasma insulin level and also reverse all above biochemical parameters and antioxidant enzyme level at dose dependent manner. These findings provide in vivo evidence that the aqueous extract of Jasminum humile leaves possess significant antidiabetic and antioxidant potential in nicotinamide/streptozotocin-induced type-2 diabetes mellitus in rats.

Keywords: antidiabetic, antioxidant, jasminum humile, nicotinamide/streptozotocin, type-2 diabetic

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13171 Snails and Fish as Pollution Biomarkers in Lake Manzala and Laboratory B: Lake Manzala Fish

Authors: Hanaa M. M. El-Khayat, Hanan S. Gaber, Hoda Abdel-Hamid, Kadria M. A. Mahmoud, Hoda M. A. Abu Taleb

Abstract:

This work aimed to examine Oreochromis niloticus fish from Lake Manzala in Port Said, Dakahlya and Damietta governorates, Egypt, as a bio-indicator for the lake water pollution through recording alterations in their hematological, physiological, and histopathological parameters. All fish samples showed a significant increase in levels of alkaline phosphatase (ALP), creatinine and glutathione-S-transferase (GST); only Dakahlya samples showed a significant increase (p<0.01) in aspartate aminotransferase (AST) level and most Dakahlya and Damietta samples showed reversed albumin and globulin ratio and a significant increase in γ-glutamyltransferase (GGT) level. Port-Said and Damietta samples showed a significant decrease of hemoglobin (Hb) while Dakahlya samples showed a significant decrease in white blood cell (WBC) count. Histopathological investigation for different fish organs showed that Port-Said and Dakahlya samples were more altered than Damietta. The muscle and gill followed by intestine were the most affected organs. The muscle sections showed severe edema, neoplasia, necrotic change, fat vacuoles and splitting of muscle fiber. The gill sections showed dilated blood vessels of the filaments, curling of gill lamellae, severe hyperplasia, edema and blood vessels congestion of filaments. The intestine sections revealed degeneration, atrophy, dilation in blood vessels and necrotic changes in sub-mucosa and mucosa with edema in between. The recorded significant alterations, in most of the physiological and histological parameters in O. niloticus samples from Lake Manzala, were alarming for water pollution impacts on lake fish community, which constitutes the main diet and the main source of income for the people inhabiting these areas, and were threatening their public health and economy. Also, results evaluate the use of O. niloticus fish as important bio-indicator for their habitat stressors.

Keywords: Lake Manzala, Oreochromis niloticus fish, water pollution, physiological, hematological and histopathological parameters

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13170 Severe Post Operative Gas Gangrene of the Liver: Off-Label Treatment by Percutaneous Radiofrequency Ablation

Authors: Luciano Tarantino

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Gas gangrene is a rare, severe infection with a very high mortality rate caused by Clostridium species. The infection causes a non-suppurative localized producing gas lesion from which harmful toxins that impair the inflammatory response cause vessel damage and multiple organ failure. Gas gangrene of the liver is very rare and develops suddenly, often as a complication of abdominal surgery and liver transplantation. The present paper deals with a case of gas gangrene of the liver that occurred after percutaneous MW ablation of hepatocellular carcinoma, resulting in progressive liver necrosis and multi-organ failure in spite of specific antibiotics administration. The patient was successfully treated with percutaneous Radiofrequency ablation. Case report: Female, 76 years old, Child A class cirrhosis, treated with synchronous insertion of 3 MW antennae for large HCC (5.5 cm) in the VIII segment. 24 hours after treatment, the patient was asymptomatic and left the hospital . 2 days later, she complained of fever, weakness, abdominal swelling, and pain. Abdominal US detected a 2.3 cm in size gas-containing area, eccentric within the large (7 cm) ablated area. The patient was promptly hospitalized with the diagnosis of anaerobic liver abscess and started antibiotic therapy with Imipenem/cilastatine+metronidazole+teicoplanine. On the fourth day, the patient was moved to the ICU because of dyspnea, congestive heart failure, atrial fibrillation, right pleural effusion, ascites, and renal failure. Blood tests demonstrated severe leukopenia and neutropenia, anemia, increased creatinine and blood nitrogen, high-level FDP, and high INR. Blood cultures were negative. At US, unenhanced CT, and CEUS, a progressive enlargement of the infected liver lesion was observed. Percutaneous drainage was attempted, but only drops of non-suppurative brownish material could be obtained. Pleural and peritoneal drainages gave serosanguineous muddy fluid. The Surgeon and the Anesthesiologist excluded any indication of surgical resection because of the high perioperative mortality risk. Therefore, we asked for the informed consent of the patient and her relatives to treat the gangrenous liver lesion by percutaneous Ablation. Under conscious sedation, percutaneous RFA of GG was performed by double insertion of 3 cool-tip needles (Covidien LDT, USA ) into the infected area. The procedure was well tolerated by the patient. A dramatic improvement in the patient's condition was observed in the subsequent 24 hours and thereafter. Fever and dyspnea disappeared. Normalization of blood tests, including creatinine, was observed within 4 days. Heart performance improved, 10 days after the RFA the patient left the hospital and was followed-up with weekly as an outpatient for 2 months and every two months thereafter. At 18 months follow-up, the patient is well compensated (Child-Pugh class B7), without any peritoneal or pleural effusion and without any HCC recurrence at imaging (US every 3 months, CT every 6 months). Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients non-responder to antibiotics and when surgery and liver transplantation are not feasible. A fast and early indication is needed in case of rapid worsening of patient's conditions.

Keywords: liver tumor ablation, interventional ultrasound, liver infection, gas gangrene, radiofrequency ablation

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13169 Can Bone Resorption Reduce with Nanocalcium Particles in Astronauts?

Authors: Ravi Teja Mandapaka, Prasanna Kumar Kukkamalla

Abstract:

Poor absorption of calcium, elevated levels in serum and loss of bone are major problems of astronauts during space travel. Supplementation of calcium could not reveal this problem. In normal condition only 33% of calcium is absorbed from dietary sources. In this paper effect of space environment on calcium metabolism was discussed. Many surprising study findings were found during literature survey. Clinical trials on ovariectomized mice showed that reduction of calcium particles to nano level make them more absorbable and bioavailable. Control of bone loss in astronauts in critical important In Fortification of milk with nana calcium particles showed reduces urinary pyridinoline, deoxypyridinoline levels. Dietary calcium and supplementation do not show much retention of calcium in zero gravity environment where absorption is limited. So, the fortification of foods with nano calcium particles seemed beneficial for astronauts during and after space travel in their speedy recovery.

Keywords: nano calcium, astronauts, fortification, supplementation

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13168 The Factors that Effect to User Satisfaction of Information System in Bangkok Hospital

Authors: Somchai Buaroong

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This research attempted to study information system success in dimensions of the user satisfaction level and to find the association between the independent factors of the user experiences, user knowledge, and user attitude. The study sample was selected using simple random sampling that comprised of 190 users who had used the Bangkok HIS. The data were reported from 165 questionnaires. The results found that the user satisfaction was at a moderate level, user satisfaction on the information quality and system quality was at a moderate level, while satisfaction on service quality was at a high level. The computer knowledge of the user was at a moderate level, and the user attitude was at a positive level. The participation of the user was at a low level and the participation in decision and in evaluation was at a low level; however participation in implementation and in benefit was at a moderate.

Keywords: information system success, hospital information system, user attitude, user satisfaction

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13167 Prognostic Value of C-Reactive Protein (CRP) in SARS-CoV-2 Infection: A Simplified Biomarker of COVID-19 Severity in Sub-Saharan Africa

Authors: Teklay Gebrecherkos, Mahmud Abdulkader, Tobias Rinke De Wit, Britta C. Urban, Feyissa Chala, Yazezew Kebede, Dawit Welday

Abstract:

Background: C-reactive protein (CRP) levels are a reliable surrogate for interleukin-6 bioactivity that plays a pivotal role in the pathogenesis of cytokine storm associated with severe COVID-19. There is a lack of data on the role of CRP as a determinant of COVID-19 severity status in the African context. Methods: We determined the longitudinal kinetics of CRP levels on 78 RT-PCR-confirmed COVID-19 patients (49 non-severe and 29 severe cases) and 50 PCR-negative controls. Results: COVID-19 patients had overall significantly elevated CRP at baseline when compared to PCR-negative controls [median 11.1 (IQR: 2.0-127.8) mg/L vs. 0.9 (IQR: 0.5-1.9) mg/L; p=0.0004)]. Moreover, severe COVID-19 patients had significantly higher median CRP levels than non-severe cases [166.1 (IQR: 48.6-332.5) mg/L vs. 2.4 (IQR: 1.2-7.6) mg/L; p<0.00001)]. In addition, persistently elevated levels of CRP were exhibited among those with comorbidities and higher age groups. Area under receiver operating characteristic curve (AUC) analysis of CRP levels distinguished PCR-confirmed COVID-19 patients from the ones with PCR-negative non-COVID-19 individuals, with an AUC value of 0.77 (95% CI: 0.68-0.84; p=0.001). Moreover, it clearly distinguished severe from non-severe COVID-19 patients, with an AUC value of 0.83 (95% CI: 0.73-0.91). After adjusting for age and the presence of comorbidities, CRP levels above 30 mg/L were significantly associated with an increased risk of developing severe COVID-19 (adjusted relative risk 3.99 (95%CI: 1.35-11.82; p=0.013). Conclusions: Determining CRP levels in COVID-19 patients in African settings may provide a simple, prompt, and inexpensive assessment of the severity status at baseline and monitoring of treatment outcomes.

Keywords: CRP, COVID-19, SARS-CoV-2, biomarker

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13166 Oxidative Stress Related Alteration of Mitochondrial Dynamics in Cellular Models

Authors: Orsolya Horvath, Laszlo Deres, Krisztian Eros, Katalin Ordog, Tamas Habon, Balazs Sumegi, Kalman Toth, Robert Halmosi

Abstract:

Introduction: Oxidative stress induces an imbalance in mitochondrial fusion and fission processes, finally leading to cell death. The two antioxidant molecules, BGP-15 and L2286 have beneficial effects on mitochondrial functions and on cellular oxidative stress response. In this work, we studied the effects of these compounds on the processes of mitochondrial quality control. Methods: We used H9c2 cardiomyoblast and isolated neonatal rat cardiomyocytes (NRCM) for the experiments. The concentration of stressors and antioxidants was beforehand determined with MTT test. We applied 1-Methyl-3-nitro-1-nitrosoguanidine (MNNG) in 125 µM, 400 µM and 800 µM concentrations for 4 and 8 hours on H9c2 cells. H₂O₂ was applied in 150 µM and 300 µM concentration for 0.5 and 4 hours on both models. L2286 was administered in 10 µM, while BGP-15 in 50 µM doses. Cellular levels of the key proteins playing role in mitochondrial dynamics were measured in Western blot samples. For the analysis of mitochondrial network dynamics, we applied electron microscopy and immunocytochemistry. Results: Due to MNNG treatment the level of fusion proteins (OPA1, MFN2) decreased, while the level of fission protein DRP1 elevated markedly. The levels of fusion proteins OPA1 and MNF2 increased in the L2286 and BGP-15 treated groups. During the 8 hour treatment period, the level of DRP1 also increased in the treated cells (p < 0.05). In the H₂O₂ stressed cells, administration of L2286 increased the level of OPA1 in both H9c2 and NRCM models. MFN2 levels in isolated neonatal rat cardiomyocytes raised considerably due to BGP-15 treatment (p < 0.05). L2286 administration decreased the DRP1 level in H9c2 cells (p < 0.05). We observed that the H₂O₂-induced mitochondrial fragmentation could be decreased by L2286 treatment. Conclusion: Our results indicated that the PARP-inhibitor L2286 has beneficial effect on mitochondrial dynamics during oxidative stress scenario, and also in the case of directly induced DNA damage. We could make the similar conclusions in case of BGP-15 administration, which, via reducing ROS accumulation, propagates fusion processes, this way aids preserving cellular viability. Funding: GINOP-2.3.2-15-2016-00049; GINOP-2.3.2-15-2016-00048; GINOP-2.3.3-15-2016-00025; EFOP-3.6.1-16-2016-00004; ÚNKP-17-4-I-PTE-209

Keywords: H9c2, mitochondrial dynamics, neonatal rat cardiomyocytes, oxidative stress

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13165 Recombination Center Levels in Gold and Platinum Doped N-type Silicon for High-Speed Thyristor

Authors: Nam Chol Yu, GyongIl Chu, HoJong Ri

Abstract:

Using DLTS (Deep-level transient spectroscopy) measurement techniques, we determined the dominant recombination center levels (defects of both A and B) in gold and platinum doped n-type silicon. Also, the injection and temperature dependence of the Shockley-Read-Hall (SRH) carrier lifetime was studied under low-level injection and high-level injection. Here measurements show that the dominant level under low-level injection located at EC-0.25 eV (A) correlated to the Pt+G1 and the dominant level under high-level injection located at EC-0.54 eV (B) correlated to the Au+G4. Finally, A and B are the same dominant levels for controlling the lifetime in gold-platinum doped n-silicon.

Keywords: recombination center level, lifetime, carrier lifetime control, Gold, Platinum, Silicon

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13164 Anxieolytic Activity of Ethyl Acetate Extract of Flowers Nerium indicum

Authors: D. S. Mohale, A. V. Chandewar

Abstract:

Anxiety is defined as an exaggerated feeling of apprehension, uncertainty and fear. Nerium indicum is a well-known ornamental and medicinal plant belonging to the family Apocynaceae. A wide spectrum of biological activities has been reported with various constituents isolated from different parts of the plant. This study was conducted to investigate antianxiety activity of flower extract. Flowers were collected and dried in shade and coarsely powdered. Powdered mixture was extracted with ethyl acetate by maceration process. Extract of flowers obtained was subsequently dried in oven at 40-50 °C. This extract is then tested for antianxiety activity at low and high dose using Elevated Plus Maze and Light & dark Model. Rats shown increased open arm entries and time spent in open arm in elevated Plus maze with treatment low and high dose of extract of Nerium indicum flower as compared to their respective control groups. In Light & dark Model, light box entries and time spent in light box increased with treatment low and high dose of extract of Nerium indicum flower as compared to their respective control groups. From result it is concluded that Ethyl acetate extract of flower of Nerium indicum possess antianxiety activity at low and high dose.

Keywords: anxiety, anxieolytic, social isolation, nerium indicum, kaner

Procedia PDF Downloads 305
13163 In situ High Temperature Characterization of Diamond-Like Carbon Films

Authors: M. Rouhani, F. C. N. Hong, Y. R. Jeng

Abstract:

The tribological performance of DLC films is limited by graphitization at elevated temperatures. Despite of numerous studies on the thermal stability of DLC films, a comprehensive in-situ characterization at elevated temperature is still lacking. In this study, DLC films were deposited using filtered cathodic arc vacuum method. Thermal stability of the films was characterized in-situally using a synchronized technique integrating Raman spectroscopy and depth-sensing measurements. Tests were performed in a high temperature chamber coupled with feedback control to make it possible to study the temperature effects in the range of 21 – 450 ̊C. Co-located SPM and Raman microscopy maps at different temperature over a specific area on the surface of the film were prepared. The results show that the thermal stability of the DLC films depends on their sp3 content. Films with lower sp3 content endure graphitization during the temperature-course used in this study. The graphitization is accompanied with significant changes in surface roughness and Raman spectrum of the film. Surface roughness of the films start to change even before graphitization transformation could be detected using Raman spectroscopy. Depth-sensing tests (nanoindentation, nano-scratch and wear) endorse the surface roughness change seen before graphitization occurrence. This in-situ study showed that the surface of the films is more sensitive to temperature rise compared to the bulk. We presume the changes observed in films hardness, surface roughness and scratch resistance with temperature rise, before graphitization occurrence, is due to surface relaxation.

Keywords: DLC film, nanoindentation, Raman spectroscopy, thermal stability

Procedia PDF Downloads 191
13162 Hyaluronic Acid Binding to Link Domain of Stabilin-2 Receptor

Authors: Aleksandra Twarda, Dobrosława Krzemień, Grzegorz Dubin, Tad A. Holak

Abstract:

Stabilin-2 belongs to the group of scavenger receptors and plays a crucial role in clearance of more than 10 ligands from the bloodstream, including hyaluronic acid, products of degradation of extracellular matrix and metabolic products. The Link domain, a defining feature of stabilin-2, has a sequence similar to Link domains in other hyaluronic acid receptors, such as CD44 or TSG-6, and is responsible for most of ligands binding. Present knowledge of signal transduction by stabilin-2, as well as ligands’ recognition and binding mechanism, is limited. Until now, no experimental structures have been solved for any segments of stabilin-2. It has recently been demonstrated that the stabilin-2 knock-out or blocking of the receptor by an antibody effectively opposes cancer metastasis by elevating the level of circulating hyaluronic acid. Moreover, loss of expression of stabilin-2 in a peri-tumourous liver correlates with increased survival. Solving of the crystal structure of stabilin-2 and elucidation of the binding mechanism of hyaluronic acid could enable the precise characterization of the interactions in the binding site. These results may allow for designing specific small-molecule inhibitors of stabilin-2 that could be used in cancer therapy. To carry out screening for crystallization of stabilin-2, we cloned constructs of the Link domain of various lengths with or without surrounding domains. The folding properties of the constructs were checked by nuclear magnetic resonance (NMR). It is planned to show the binding of hyaluronic acid to the Link domain using several biochemical methods, i.a. NMR, isothermal titration calorimetry and fluorescence polarization assay.

Keywords: stabilin-2, Link domain, X-ray crystallography, NMR, hyaluronic acid, cancer

Procedia PDF Downloads 398
13161 A Systematic Review on the Effect of Climate Change on Rice Farming in Nepal

Authors: Tulsi Ram Bhusal

Abstract:

Global climate change is known to have a huge impact on agriculture due to changing in rainfall pattern and elevated air temperature that lead to drought and/or flooding. This systematic study has focused on agriculture in Nepal. The study has shown that the trend of current climatic change is affecting rice production, while the farmers with technological access have tried to adapt to the changing conditions at their level. There is insufficient intervention from the government side in terms of policies and schemes. The lack of sufficient funds is one of the significant reasons in terms of governance. The climatic trends and the way it is affecting the annual riceyieldinNepal has been discussed in this study thoroughly. This study has reviewed published studies and ferred important points regarding the Nepal’s status on rice production. Mainly due to the increasing graph of average temperature and other physical conditions needed for the proper cultivation of ricearechanging due to which there is significant dropofannual rice production. Although from corners of the country, many farmers have attempted to adapt the methods of cultivation to the changing climatic conditions, lack of access to technologies, and fund allocation from the governmental level, it is difficult for the mtobringchanges in rice production by the crown without any institutional help. This systematic study effectively presents the magnitude of the impact on rice cultivation due to climatic changes inrecenttimesinNepal. This review aims to bring the current scenarioofNepal’sricefarming, and it impacts due to changing climate, which can subsequently contribute in devising plans for proper governance, formulating policies, and allocation of funds for the betterment.

Keywords: rice, climate change, rice production, nepal, agriculture

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13160 Time Series Analysis of Radon Concentration at Different Depths in an Underground Goldmine

Authors: Theophilus Adjirackor, Frederic Sam, Irene Opoku-Ntim, David Okoh Kpeglo, Prince K. Gyekye, Frank K. Quashie, Kofi Ofori

Abstract:

Indoor radon concentrations were collected monthly over a period of one year in 10 different levels in an underground goldmine, and the data was analyzed using a four-moving average time series to determine the relationship between the depths of the underground mine and the indoor radon concentration. The detectors were installed in batches within four quarters. The measurements were carried out using LR115 solid-state nuclear track detectors. Statistical models are applied in the prediction and analysis of the radon concentration at various depths. The time series model predicted a positive relationship between the depth of the underground mine and the indoor radon concentration. Thus, elevated radon concentrations are expected at deeper levels of the underground mine, but the relationship was insignificant at the 5% level of significance with a negative adjusted R2 (R2 = – 0.021) due to an appropriate engineering and adequate ventilation rate in the underground mine.

Keywords: LR115, radon concentration, rime series, underground goldmine

Procedia PDF Downloads 41
13159 Diet and Exercise Intervention and Bio–Atherogenic Markers for Obesity Classes of Black South Africans with Type 2 Diabetes Mellitus Using Discriminant Analysis

Authors: Oladele V. Adeniyi, B. Longo-Mbenza, Daniel T. Goon

Abstract:

Background: Lipids are often low or in the normal ranges and controversial in the atherogenesis among Black Africans. The effect of the severity of obesity on some traditional and novel cardiovascular disease risk factors is unclear before and after a diet and exercise maintenance programme among obese black South Africans with type 2 diabetes mellitus (T2DM). Therefore, this study aimed to identify the risk factors to discriminate obesity classes among patients with T2DM before and after a diet and exercise programme. Methods: This interventional cohort of Black South Africans with T2DM was followed by a very – low calorie diet and exercise programme in Mthatha, between August and November 2013. Gender, age, and the levels of body mass index (BMI), blood pressure, monthly income, daily frequency of meals, blood random plasma glucose (RPG), serum creatinine, total cholesterol (TC), triglycerides (TG), LDL –C, HDL – C, Non-HDL, ratios of TC/HDL, TG/HDL, and LDL/HDL were recorded. Univariate analysis (ANOVA) and multivariate discriminant analysis were performed to separate obesity classes: normal weight (BMI = 18.5 – 24.9 kg/m2), overweight (BMI = 25 – 29.9 kg/m2), obesity Class 1 (BMI = 30 – 34.9 kg/m2), obesity Class 2 (BMI = 35 – 39.9 kg/m2), and obesity Class 3 (BMI ≥ 40 kg/m2). Results: At the baseline (1st Month September), all 327 patients were overweight/obese: 19.6% overweight, 42.8% obese class 1, 22.3% obese class 2, and 15.3% obese class 3. In discriminant analysis, only systolic blood pressure (SBP with positive association) and LDL/HDL ratio (negative association) significantly separated increasing obesity classes. At the post – evaluation (3rd Month November), out of all 327 patients, 19.9%, 19.3%, 37.6%, 15%, and 8.3% had normal weight, overweight, obesity class 1, obesity class 2, and obesity class 3, respectively. There was a significant negative association between serum creatinine and increase in BMI. In discriminant analysis, only age (positive association), SBP (U – shaped relationship), monthly income (inverted U – shaped association), daily frequency of meals (positive association), and LDL/HDL ratio (positive association) classified significantly increasing obesity classes. Conclusion: There is an epidemic of diabesity (Obesity + T2DM) in this Black South Africans with some weight loss. Further studies are needed to understand positive or negative linear correlations and paradoxical curvilinear correlations between these markers and increase in BMI among black South African T2DM patients.

Keywords: atherogenic dyslipidaemia, dietary interventions, obesity, south africans

Procedia PDF Downloads 364
13158 Forecasting the Sea Level Change in Strait of Hormuz

Authors: Hamid Goharnejad, Amir Hossein Eghbali

Abstract:

Recent investigations have demonstrated the global sea level rise due to climate change impacts. In this study climate changes study the effects of increasing water level in the strait of Hormuz. The probable changes of sea level rise should be investigated to employ the adaption strategies. The climatic output data of a GCM (General Circulation Model) named CGCM3 under climate change scenario of A1b and A2 were used. Among different variables simulated by this model, those of maximum correlation with sea level changes in the study region and least redundancy among themselves were selected for sea level rise prediction by using stepwise regression. One models of Discrete Wavelet artificial Neural Network (DWNN) was developed to explore the relationship between climatic variables and sea level changes. In these models, wavelet was used to disaggregate the time series of input and output data into different components and then ANN was used to relate the disaggregated components of predictors and predictands to each other. The results showed in the Shahid Rajae Station for scenario A1B sea level rise is among 64 to 75 cm and for the A2 Scenario sea level rise is among 90 to 105 cm. Furthermore the result showed a significant increase of sea level at the study region under climate change impacts, which should be incorporated in coastal areas management.

Keywords: climate change scenarios, sea-level rise, strait of Hormuz, forecasting

Procedia PDF Downloads 267
13157 Targeting Matrix Metalloprotease-9 to Reduce Coronary Artery Manifestations of Kawasaki’s Disease

Authors: Mohammadjavad Sotoudeheian, Navid Farahmandian

Abstract:

Kawasaki disease (KD) is the primary cause of acquired pediatric heart disease as an acute vasculitis. In children with prolonged fever, rash, and inflammation of the mucosa KD must be considered as a clinical diagnosis. There is a persuasive suggestion of immune-mediated damage as the pathophysiologic cascade of KD. For example, the invasion of cytotoxic T-cells supports a viral etiology and the inflammasome of the innate immune system is a critical component in the vasculitis formation in KD. Animal models of KD propose the cytokine profiles, such as increased IL-1 and GM-CSF, which cause vascular damage. CRP and IFN-γ elevated expression and the upregulation of IL-6, and IL-10 production are also described in previous studies. Untreated KD is a critical risk factor for coronary artery diseases and myocardial infarction. Vascular damage may encompass amplified T-cell activity. SMAD3 is an essential molecule in down-regulating T-cells and increasing expression of FoxP3. It has a critical effect in the differentiation of regulatory T-cells. The discrepancy of regulatory T-cells and pro-inflammatory Th17 has been studied in acute coronary syndrome during KD. However in the coronary artery damaged lymphocytes and IgA plasma cells are seen at the lesion locations, the major immune cells in the coronary lesions are monocytes/macrophages and neutrophils. These cells secrete TNF-α, and activates matrix metalloprotease (MMP)-9, reducing the integrity of vessels and prompting patients to arise aneurysm. MMPs can break down the components of the extracellular matrix and assist immune cell movement. IVIG as an effective form of treatment clarified the role of the immune system, which may target pathogenic antigens and regulate cytokine production. Several reports have revealed that in the coronary arteries, high expression of MMP-9 in monocyte/macrophage results in pathologic cascades. Curcumin is a potent antioxidant and anti-inflammatory molecule. Curcumin decreases the production of reactive oxygen and nitrogen species and inhibits transcription factors like AP-1 and NF-κB. Curcumin also contains the characteristics of inhibitory effects on MMPs, especially MMP-9. The upregulation of MMP-9 is an important cellular response. Curcumin treatment caused a reverse effect and down-regulates MMP-9 gene expression which may fund the anti-inflammatory effect. Curcumin inhibits MMP-9 expression via PKC and AMPK-dependent pathways in Human monocytes cells. Elevated expression and activity of MMP-9 are correlated with advanced vascular lesions. AMPK controls lipid metabolism and oxidation, and protein synthesis. AMPK is also necessary for the MMP-9 activity and THP-1 cell adhesion to endothelial cells. Curcumin was shown to inhibit the activation of AMPKα. Compound C (AMPK inhibitor) inhibits MMP-9 expression level. Therefore, through inactivating AMPKs and PKC, curcumin decreases the MMP-9 level, which results in inhibiting monocyte/macrophage differentiation. Compound C also suppress the phosphorylation of three major classes of MAP kinase signaling, suggesting that curcumin may suppress MMP-9 level by inactivation of MAPK pathways. MAPK cascades are activated to induce the expression of MMP-9. Curcumin inhibits MAPKs phosphorylation, which contributes to the down-regulation of MMP-9. This study demonstrated that the potential inhibitory properties of curcumin over MMP-9 lead to a therapeutic strategy to reduce the risk of coronary artery involvement during KD.

Keywords: MMP-9, coronary artery aneurysm, Kawasaki’s disease, curcumin, AMPK, immune system, NF-κB, MAPK

Procedia PDF Downloads 302
13156 Quinazoline Analogue as a Pet Tracer for Imaging PDE10A: Radiosynthesis and Biological Evaluation

Authors: Anjani Kumar Tiwari, Neelam Kumari, Anil Mishra

Abstract:

The family of phosphodiesterases (PDEs) plays a critical role in control of the level, localization, and duration of intracellular 3’-5’-cyclic adenosine monophosphate (cAMP) and 3’-5’-cyclic guanosine monophosphate (cGMP) signals by specifically hydrolyzing these cyclic nucleotides. As the involvement of cyclic nucleotide second messengers in cell signaling and homeostasis is established, the regulation of these pathways in the brain by various PDE isoforms is an area of considerable interest, as they are involved in nearly all brain functions and in the etiology of neuropsychiatric diseases. The PDE10A isoform, isolated from different species and characterized regarding structure and function, has received much attention in recent years, particularly in the context of schizophrenia and Huntington’s disease, which are both related to a role of PDE10A in the regulation of striatal dopaminergic neurotransmission. Quinazoline analogue 1-(4-methoxyphenyl)-6,7-dimethoxyquinazoline, was evaluated as specific PET marker for phosphodiesterase (PDE) 10A. Here, we report the radiosynthesis of [11C]2 and the in vitro and in vivo evaluation of [11C]2 as a potential positron emission tomography (PET) radiotracer for imaging PDE10A in the central nervous system (CNS). The radiosynthesis of [11C]2 was achieved by O-methylation of the corresponding des-methyl precursor with [11C]methyl iodide. [11C]2 was obtained with ∼50% radiochemical yield. PET imaging studies in rat brain displayed initial specific uptake with very rapid clearance of [11C]2 from brain. Though [11C]2 is not an ideal radioligand for clinical imaging of PDE10A in the CNS. Modified analogue of quinazoline having a higher potency for inhibiting PDE10A and improved pharmacokinetic properties will be necessary for imaging this enzyme with PET.

Keywords: PDE10A, PET, radiotracer, quinazoline

Procedia PDF Downloads 182
13155 The Grinding Influence on the Strength of Fan-Out Wafer-Level Packages

Authors: Z. W. Zhong, C. Xu, W. K. Choi

Abstract:

To build a thin fan-out wafer-level package, the package had to be ground to a thin level. In this work, the influence of the grinding processes on the strength of the fan-out wafer-level packages was investigated. After different grinding processes, all specimens were placed on a three-point-bending fixture installed on a universal tester for three-point-bending testing, and the strength of the fan-out wafer-level packages was measured. The experiments revealed that the average flexure strength increased with the decreasing surface roughness height of the fan-out wafer-level package tested. The grinding processes had a significant influence on the strength of the fan-out wafer-level packages investigated.

Keywords: FOWLP strength, surface roughness, three-point bending, grinding

Procedia PDF Downloads 275
13154 Anti-Anxiety Activity of Ethyl Acetate Extract of Flowers Nerium indicum

Authors: Deepak Suresh Mohale, Anil V. Chandewar

Abstract:

Anxiety is defined as an exaggerated feeling of apprehension, uncertainty and fear. Nerium indicum is a well-known ornamental and medicinal plant belonging to the family Apocynaceae. A wide spectrum of biological activities has been reported with various constituents isolated from different parts of the plant. This study was conducted to investigate antianxiety activity of flower extract. Flowers were collected and dried in shade and coarsely powdered. Powdered mixture was extracted with ethyl acetate by maceration process. Extract of flowers obtained was subsequently dried in oven at 40-50 °C. This extract is then tested for antianxiety activity at low and high dose using elevated plus maze and light & dark model. Rats shown increased open arm entries and time spent in open arm in elevated Plus maze with treatment low and high dose of extract of Nerium indicum flower as compared to their respective control groups. In Light & dark Model, light box entries and time spent in light box increased with treatment low and high dose of extract of Nerium indicum flower as compared to their respective control groups. From result it is concluded that ethyl acetate extract of flower of Nerium indicum possess antianxiety activity at low and high dose.

Keywords: antianxiety, anxiety, kaner, nerium indicum, social isolation

Procedia PDF Downloads 389
13153 A Case of Prosthetic Vascular-Graft Infection Due to Mycobacterium fortuitum

Authors: Takaaki Nemoto

Abstract:

Case presentation: A 69-year-old Japanese man presented with a low-grade fever and fatigue that had persisted for one month. The patient had an aortic dissection on the aortic arch 13 years prior, an abdominal aortic aneurysm seven years prior, and an aortic dissection on the distal aortic arch one year prior, which were all treated with artificial blood-vessel replacement surgery. Laboratory tests revealed an inflammatory response (CRP 7.61 mg/dl), high serum creatinine (Cr 1.4 mg/dL), and elevated transaminase (AST 47 IU/L, ALT 45 IU/L). The patient was admitted to our hospital on suspicion of prosthetic vascular graft infection. Following further workups on the inflammatory response, an enhanced chest computed tomography (CT) and a non-enhanced chest DWI (MRI) were performed. The patient was diagnosed with a pulmonary fistula and a prosthetic vascular graft infection on the distal aortic arch. After admission, the patient was administered Ceftriaxion and Vancomycine for 10 days, but his fever and inflammatory response did not improve. On day 13 of hospitalization, a lung fistula repair surgery and an omental filling operation were performed, and Meropenem and Vancomycine were administered. The fever and inflammatory response continued, and therefore we took repeated blood cultures. M. fortuitum was detected in a blood culture on day 16 of hospitalization. As a result, we changed the treatment regimen to Amikacin (400 mg/day), Meropenem (2 g/day), and Cefmetazole (4 g/day), and the fever and inflammatory response began to decrease gradually. We performed a test of sensitivity for Mycobacterium fortuitum, and found that the MIC was low for fluoroquinolone antibacterial agent. The clinical course was good, and the patient was discharged after a total of 8 weeks of intravenous drug administration. At discharge, we changed the treatment regimen to Levofloxacin (500 mg/day) and Clarithromycin (800 mg/day), and prescribed these two drugs as a long life suppressive therapy. Discussion: There are few cases of prosthetic vascular graft infection caused by mycobacteria, and a standard therapy remains to be established. For prosthetic vascular graft infections, it is ideal to provide surgical and medical treatment in parallel, but in this case, surgical treatment was difficult and, therefore, a conservative treatment was chosen. We attempted to increase the treatment success rate of this refractory disease by conducting a susceptibility test for mycobacteria and treating with different combinations of antimicrobial agents, which was ultimately effective. With our treatment approach, a good clinical course was obtained and continues at the present stage. Conclusion: Although prosthetic vascular graft infection resulting from mycobacteria is a refractory infectious disease, it may be curative to administer appropriate antibiotics based on the susceptibility test in addition to surgical treatment.

Keywords: prosthetic vascular graft infection, lung fistula, Mycobacterium fortuitum, conservative treatment

Procedia PDF Downloads 151