Search results for: Invasive Disease

Authors: Nneka N. Uchegbu, Charles N. Ishiwu

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The nutritional composition and hypoglycaemic effect of crackers produced from a blend of sprouted pigeon pea, unripe plantain, and brewers’ spent grain and fed to Alloxan induced diabetic rat was investigated. Crackers were produced from different blends of sprouted pigeon pea, unripe plantain and brewers’ spent grain. The crackers were evaluated for proximate composition, amino acid profile and antinutritional factors. Blood glucose levels of normal and diabetic rats fed with the control sample and different formulations of cracker were measured. The protein content of the samples were significantly different (p < 0.05) from each other with sample A having the lowest value and sample B with the highest value. The values obtained showed that the samples contained most of the amino acids that are found in plant proteins. The levels of antinutritional factor determined were generally low. Administration of the formulated cracker meals led to a significant reduction in the fasting blood glucose level in the diabetic rats. The present study concluded that consumption of crackers produced from this composite flour can be recommended for the diabetics and those who are sceptical about the disease.

Keywords: crackers, diabetics rat, sprouted pigeon pea, unripe plantain and brewers’ spent grain

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Authors: Hosein Alimadadi, Fatemeh Farahmand, Ali Jafarian, Nasir Fakhar, Mohammad Hassan Sohouli, Neda Raeesi

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Backgroundsː Regarding the important role of liver transplantation as the only treatment in many cases of end-stage liver disease in children, the aim of this study is to investigate the complications of liver transplantation and their management in children referred to the Children's Medical Center. Methods: This study is a cross-sectional study on pediatric patients who have undergone liver transplants in the years 2016 to 2021. The indication for liver transplantation in this population was confirmed by a pediatric gastroenterologist, and a liver transplant was performed by a transplant surgeon. Finally, information about the patient before and after the transplantation was collected and recorded. Results: A total of 53 patients participated in this study, including 25 (47.2%) boys and 28 (52.8%) girls. The most common causes of liver transplantation were cholestatic and metabolic diseases. The most common early complication of liver transplantation in children was acute cellular rejection (ACR) and anastomotic biliary stricture. The most common late complication in these patients was an infection which was observed in 56.6% of patients. Among the drug side effects, neurotoxicity (convulsions) was seen more in patients, and 15.1% of the transplanted patients died. Conclusion: In this study, the most common early complication of liver transplantation in children was ACR and biliary stricture, and the most common late complication was infection. Neurotoxicity (convulsions) was the most common side effect of drugs.

Keywords: liver transplantation, complication, infection, survival rate

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Authors: Shailendra Kumar, Lokesh Kashyap, Puneet Khanna, Nishant Patel, Rakesh Kumar, Arshad Ayub, Kelika Prakash, Yudhyavir Singh, Krithikabrindha V.

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Introduction: Spinal anesthesia is considered a standard anesthesia technique for caesarean delivery. The incidence of spinal hypotension during caesarean delivery is 70 -80%. Spinal hypotension may cause cerebral hypoperfusion in the mother, but physiologically cerebral autoregulatory mechanisms accordingly prevent cerebral hypoxia. Cerebral blood flow remains constant in the 50-150 mmHg of Cerebral Perfusion Pressure (CPP) range. Near-infrared spectroscopy (NIRS) is a non-invasive technology that is used to detect Cerebral Desaturation Events (CDEs) immediately compared to other conventional intraoperative monitoring techniques. Objective: The primary aim of the study is to correlate the change in cerebral oxygen saturation using NIRS with respect to a fall in mean blood pressure after spinal anaesthesia and to find out the effects of spinal hypotension on neonatal APGAR score, neonatal acid-base variations, and presence of Postoperative Delirium (POD). Methodology: NIRS sensors were attached to the forehead of all the patients, and their baseline readings of cerebral oxygenation on the right and left frontal regions and mean blood pressure were noted. Subarachnoid block was given with hyperbaric 0.5% bupivacaine plus fentanyl, the dose being determined by the individual anaesthesiologist. Co-loading of IV crystalloid solutions was given to the patient. Blood pressure reading and cerebral saturation were recorded every 1 minute till 30min. Hypotension was a fall in MAP less than 20% of the baseline values. Patients going for hypotension were treated with an IV Bolus of phenylephrine/ephedrine. Umbilical cord blood samples were taken for blood gas analysis, and neonatal APGAR was noted by a neonatologist. Study design: A prospective observational study conducted in a population of Thirty ASA 2 and 3 parturients scheduled for lower segment caesarean section (LSCS). Results: Mean fall in regional cerebral saturation is 28.48 ± 14.7% with respect to the mean fall in blood pressure 38.92 ± 8.44 mm Hg. The correlation coefficient between fall in saturation and fall in mean blood pressure is 0.057, and p-value {0.7} after subarachnoid block. A fall in regional cerebral saturation occurred 2±1 min before a fall in mean blood pressure. Twenty-nine out of thirty patients required vasopressors during hypotension. The first dose of vasopressor requirement is needed at 6.02±2 min after the block. The mean APGAR score was 7.86 and 9.74 at 1 and 5 min of birth, respectively, and the mean umbilical arterial pH of 7.3±0.1. According to DRS-98 (Delirium Rating Scale), the mean delirium rating score on postoperative day 1 and day 2 were 0.1 and 0.7, respectively. Discussion: There was a fall in regional cerebral oxygen saturation, which started before with respect to a significant fall in mean blood pressure readings but was statistically not significant. Maximal fall in blood pressure requiring vasopressors occurs within 10 min of SAB. Neonatal APGAR scores and acid-base variations were in the normal range with maternal hypotension, and there was no incidence of postoperative delirium in patients with post-spinal hypotension.

Keywords: cerebral oxygenation, LSCS, NIRS, spinal hypotension

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Authors: Dudu Ka Ruth Mkhize

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Adolescents are at the front and centre of poor mathematics performance in schools. Literature has concluded in some countries that there is a permanent and perpetual mathematics crisis in schools of the persistent poor performance in mathematics by teens. There is no shortage of interventions and research to solve this problem. However, none has capitalised on the cognitive prowess of adolescents, which was revealed at the turn of the century by the introduction of neuroimaging technologies such as structural and functional magnetic resonance imaging (sMRI and fMRI). This research found that brain growth during adolescence results in enhanced cognitive abilities essential for mathematics learning. This paper is based on the four-year case study of rural high school adolescents who had a negative attitude towards mathematics and hence were failing mathematics. But through a ten-day intervention where teaching revolved around invoking their cognitive ability, their attitude and motivation for mathematics changed for the better. The paper concludes that despite educational psychology being part of teacher education as well as education systems, there are numerous overlooked gems of psychological theories which have the potential to enhance academic achievement for youth in schools. A recommendation is made to take cues from positive psychology, whose establishment was a rejection of the dominance of the disease model in psychology. Similarly, the general perspective of poor mathematics performance can take a u-turn towards the cognitive ability acquired by adolescents because of their developmental stage.

Keywords: adolescence, cognitive growth, mathematics performance

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Authors: Musarat Ishaq, Tara Karnezis, Ramin Shayan

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Lipedema, a poorly understood chronic disease of adipose hyper-deposition, is often mistaken for obesity and causes significant impairment to mobility and quality-of-life. To identify molecular mechanisms underpinning lipedema, we employed comprehensive omics-based comparative analyses of whole tissue, adipocyte precursors (adipose-derived stem cells (ADSCs)), and adipocytes from patients with or without lipedema. Transcriptional profiling revealed significant differences in lipedema tissue, adipocytes, and ADSCs, with altered levels of mRNAs involved inproliferation and cell adhesion. One highly up-regulated gene in lipedema adipose tissue, adipocytes and ADSCs, ZIC4, encodes Zinc Finger Protein ZIC 4, a class of transcription factor which may be involved in regulating metabolism and adipogenesis. ZIC4 inhibition impaired the adipogenesis of ADSCs into mature adipocytes. Epigenetic regulation study revealed overexpression of ZIC4 is involved in decreased promoter DNA methylation and subsequent decrease in adipogenesis. These epigenetic modifications can alter adipocytes microenvironment and adipocytes differentiation. Our study show that epigenetic events regulate the ability of ADSCs to commit and differentiate into mature adipocytes by modulating ZIC4.

Keywords: lipedema, adipose-derived stem cells, adipose tisue, adipocytes, zinc finger protein, epigenetic

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Authors: Muhammad Imran Hussain, Ramisha Ibtisam, Tayyaba Fatima, Huba Khalid, Ayesha Aziz, Khansa, Adan Sitara, Anam Shahzad, Aymen Jabeen

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Vitamin D supports the immune system fight TB by inhibiting Interferon-gamma (IFN-γ) and lowering host inflammation. The purpose of the research was to see if giving the vitamin D supplements to TB patients affected their prognosis. A randomized placebo control study of 200 TB patients was performed among which 106 received 400,000 IU of injectable vitamin D3 and 94 received placebo for 2 doses. Assessment was carried out at the end of every month for 3 months. IFN-γ responses to whole blood stimulation generated by the Mycobacterium tuberculosis sonicate (MTBs) antigen and early secreted and T cell activated 6 kDa (ESAT6) were assessed at 0 and 12 weeks. The statistical analysis used descriptive statistics (mean and standard deviation), Friedman's test and Fisher's test. The vitamin D group gained significantly more weight (+3.90 pounds) and had less persistent lung disease on imaging (1.33 zones vs. 1.84 zones). They also had a 50% decrease in cavity size. Additionally, patients with low baseline serum concentrations of 25-(OH)D had a significant increase in MTB-induced IFN-γ production after taking vitamin D supplements. Vitamin D administration in large amounts can hasten the recovery of TB patients. The findings point is a therapeutically useful activity of Vitamin D's in the management for tuberculosis.

Keywords: tuberculosis, vitamin D, interferon gamma, protein, infection

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Authors: Dongliu Li

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Objective: This study systematically evaluates the incidence and influencing factors of economic toxicity in patients with gynecological malignant tumors. Methods: Literature on economic toxicity of gynecological malignancies were comprehensively searched in Pubmed, The Cochrane Library, Web of Science, Embase, CINAHL, CNKI, Wanfang Database, Chinese Biomedical Literature database and VIP database. The search period is up to February 2024. Stata 17 software was used to conduct a single-group meta-analysis of the incidence of economic toxicity in gynecological malignant tumors, and descriptive analysis was used to analyze the influencing factors. Results: A total of 11 pieces of literature were included, including 6475 patients with gynecological malignant tumors. The results of the meta-analysis showed that the incidence of economic toxicity in gynecological malignant tumors was 40% (95%CI 31%—48%). The influencing factors of economic toxicity in patients with gynecological malignant tumors include social demographic factors, medical insurance-related factors and disease-related factors. Conclusion: The incidence of economic toxicity in patients with gynecological malignant tumors is high, and medical staff should conduct early screening of patients according to relevant influencing factors, personalized assessment of patients' economic status, early prevention work and personalized intervention measures.

Keywords: gynecological malignancy, economic toxicity, the incidence rate, influencing factors, systematic review

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Authors: Syed M. Shahid, Rozeena Shaikh, Syeda N. Nawab, Abid Azhar

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Diabetes mellitus (DM) is a prevalent non-communicable disease worldwide. DM may lead to many vascular complications like hypertension, nephropathy, retinopathy, neuropathy and foot infections. Pathogenesis of diabetic nephropathy (DN) is implicated by the polymorphisms in genes encoding the specific components of renin angiotensin aldosterone system (RAAS) which include angiotensinogen (AGT), angiotensin-II receptor and angiotensin converting enzyme (ACE) genes. This study was designed to explore the possible association of AG (M268T) polymorphism in the patients of diabetes and nephropathy in Pakistan. Study subjects included 100 controls, 260 diabetic patients without renal insufficiency and 190 diabetic nephropathy patients with persistent albuminuria. Fasting blood samples were collected from all the subjects after getting institutional ethical approval and informed consent. The biochemical estimations, PCR amplification and direct sequencing for the specific region of AGT gene was carried out. A significantly high frequency of TT genotype and T allele of AGT (M268T) was observed in the patients of diabetes with nephropathy as compared to controls and diabetic patients without any known renal impairment. The TT genotype and T allele of AGT (M268T) polymorphism may be considered as a genetic risk factor for the development and progression of nephropathy in diabetes. Further cross sectional population studies would be of help to establish and confirm the observed possible association of AGT gene variations with development of nephropathy in diabetes.

Keywords: RAAS, AGT (M268T), diabetes, nephropathy

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Authors: Mitakshara Sharma, Sonal Sharma

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Vesiculobullous diseases are heterogeneous group of dermatological disorders with protean manifestations. The most important technique for the patients with vesiculobullous diseases is conventional histopathology and confirmatory tests like direct immunofluorescence (DIF) and indirect immunofluorescence (IIF). DIF has been used for decades to investigate pathophysiology and in the diagnosis. It detects molecules such as immunoglobulins and complement components. It is done on the perilesional skin. Diagnosis of DIF test depends on features like primary site of the immune deposits, class of immunoglobulin, number of immune deposits and deposition at other sites. The aim of the study is to correlate DIF with clinical and histopathological findings and to analyze the utility of DIF in the diagnosis of these disorders. It is a retrospective descriptive study conducted for 2 years from 2015 to 2017 in Department of Pathology, GTB Hospital on perilesional punch biopsies of vesiculobullous lesions. Biopsies were sent in Michael’s medium. The specimens were washed, frozen and incubated with fluorescein isothiocyanate (FITC) tagged antihuman antibodies IgA, IgG, IgM, C3 & F and were viewed under fluorescent microscope. Out of 401 skin biopsies submitted for DIF, 285 were vesiculobullous diseases, in which the most common was Pemphigus vulgaris (34%) followed by Bullous pemphigoid (21.5%), Dermatitis herpetiformis (16%), Pemphigus foliaceus (11.9%), Linear IgA disease (11.9%), Epidermolysisbullosa (2.39%) and Pemphigus herpetiformis (1.7%). We will be presenting the DIF findings in the all these vesiculobullous diseases. DIF in conjugation with histopathology gives the best diagnostic yield in these lesions. It also helps in the diagnosis whenever there is a clinical and histopathological overlap.

Keywords: antibodies, direct immunofluorescence, pemphigus, vesiculobullous

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Authors: Ashish Kumar Agrahari, Amit Kumar

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Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal blood disorder that manifests with hemolytic anemia, thrombosis, and peripheral blood cytopenias. The disease is caused by the deficiency of two glycosylphosphatidylinositols (GPI)-anchored proteins (CD55 and CD59) in the hemopoietic stem cells. The deficiency of GPI-anchored proteins has been associated with the somatic mutations in phosphatidylinositol glycan class A (PIGA). However, the mutations that do not cause PNH is associated with the multiple congenital anomalies-hypotonia-seizures syndrome 2 (MCAHS2). To best of our knowledge, no computational study has been performed to explore the atomistic level impact of PIGA mutations on the structure and dynamics of the protein. In the current work, we are mainly interested to get insights into the molecular mechanism of PIGA mutations. In the initial step, we screened the most pathogenic mutations from the pool of publicly available mutations. Further, to get a better understanding, pathogenic mutations were mapped to the modeled structure and subjected to 50ns molecular dynamics simulation. Our computational study suggests that four mutations are highly vulnerable to altering the structural conformation and stability of the PIGA protein, which illustrates its association with PNH and MCAHS2 phenotype.

Keywords: homology modeling, molecular dynamics simulation, missense mutations PNH, MCAHS2, PIGA

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Authors: Isaac Makundi, Kazuo Nishigaki

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The Tsushima leopard cat (TLC) Prionailurus bengalensis euptilurus, designated a National Natural Monument of Japan, inhabits Tsushima Island, Nagasaki Prefecture, Japan. TLC is considered a subspecies of P. bengalensis, and lives only on Tsushima Island. TLCs are threatened by various infectious diseases. Feline leukemia virus (FeLV) causes a serious infectious disease with a poor prognosis in cats. Therefore, the transmission of FeLV from Tsushima domestic cats (TDCs) to TLCs may threaten the TLC population. We investigated the FeLV infection status of both TDCs and TLCs on Tsushima Island by screening blood samples for FeLV p27 antigen and using PCR to amplify the full-length FeLV env gene. The prevalence of FeLV was 6.4% in TDCs and 0% in TLCs. We also demonstrated that the virus can replicate in the cells of TLCs, suggesting its potential cross-species transmission. The viruses in TDCs were classified as genotype I/clade 3, which is prevalent on a nearby island, based on previous studies of FeLV genotypes and FeLV epidemiology. The FeLV viruses identified on Tsushima Island can be further divided into two lineages within genotype I/clade 3, which are geographically separated in Kamijima and Shimojima, indicating that FeLV may have been transmitted to Tsushima Island at least twice. Monitoring FeLV infection in the TDC and TLC populations is highly recommended as part of the TLC surveillance and management strategy.

Keywords: epidemiology, Feline leukemia virus, Tsushima Island, wildlife management

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Authors: Chee Wai Ku, Pui See Chin

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As an emerging alternative to hysterectomy, uterine artery embolization (UAE) has been widely used in the management of fibroids and in controlling postpartum hemorrhage (PPH) unresponsive to other therapies. Research has shown UAE to be a safe, minimally invasive procedure with few complications and minimal effects on future fertility. We present two cases highlighting the use of UAE in preventing PPH in a patient with a large fibroid at the time of cesarean section and in the treatment of secondary PPH refractory to other therapies in another patient. We present a 36-year primiparous woman who booked at 18+6 weeks gestation with a 13.7 cm subserosal fibroid at the lower anterior wall of the uterus near the cervix and a 10.8 cm subserosal fibroid in the left wall. Prophylactic internal iliac artery occlusion balloons were placed prior to the planned classical midline cesarean section. The balloons were inflated once the baby was delivered. Bilateral uterine arteries were embolized subsequently. The estimated blood loss (EBL) was 400 mls and hemoglobin (Hb) remained stable at 10 g/DL. Ultrasound scan 2 years postnatally showed stable uterine fibroids 10.4 and 7.1 cm, which was significantly smaller than before. We present the second case of a 40-year-old G2P1 with a previous cesarean section for failure to progress. There were no antenatal problems, and the placenta was not previa. She presented with term labour and underwent an emergency cesarean section for failed vaginal birth after cesarean. Intraoperatively extensive adhesions were noted with bladder drawn high, and EBL was 300 mls. Postpartum recovery was uneventful. She presented with secondary PPH 3 weeks later complicated by hypovolemic shock. She underwent an emergency examination under anesthesia and evacuation of the uterus, with EBL 2500mls. Histology showed decidua with chronic inflammation. She was discharged well with no further PPH. She subsequently returned one week later for secondary PPH. Bedside ultrasound showed that the endometrium was thin with no evidence of retained products of conception. Uterotonics were administered, and examination under anesthesia was performed, with uterine Bakri balloon and vaginal pack insertion after. EBL was 1000 mls. There was no definite cause of PPH with no uterine atony or products of conception. To evaluate a potential cause, pelvic angiogram and super selective left uterine arteriogram was performed which showed profuse contrast extravasation and acute bleeding from the left uterine artery. Superselective embolization of the left uterine artery was performed. No gross contrast extravasation from the right uterine artery was seen. These two cases demonstrated the superior efficacy of UAE. Firstly, the prophylactic use of intra-arterial balloon catheters in pregnant patients with large fibroids, and secondly, in the diagnosis and management of secondary PPH refractory to uterotonics and uterine tamponade. In both cases, the need for laparotomy hysterectomy was avoided, resulting in the preservation of future fertility. UAE should be a consideration for hemodynamically stable patients in centres with access to interventional radiology.

Keywords: fertility preservation, secondary postpartum hemorrhage, uterine embolization, uterine fibroids

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Authors: Sundaresan Sivapatham, B. Prabhu

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Cancer results from a multistage, multi-mechanism carcinogenesis process that involves mutagenic, cell death and epigenetic mechanisms, during the three distinguishable but closely allied stages: initiation, promotion, and progression. Chemoprevention is promising in the realm of cancer prevention and it has been shown to reduce the risk of development of carcinoma in highly susceptible individuals such as those with known genetic mutations or high level of risk factors. The present study is aimed at the need of early detection of bladder cancer in order to improve performance in the treatment of this disease. Consumption of certain natural products like DIM is associated with a reduction in cancer incidence in humans. The study showed the protective effects of Diindolylmethane in N-Butyl-N-(4-hydroxybutyl) nitrosamine treated rats. Results of the study had shown the changes in the tumor markers, biomarkers and histopathological alterations in experimental rats when compared to control rats. The protective effects of DIM were shown from the results of cell proliferation, apoptotic markers and histopathological findings when compared with experimental control animals. Hence, our results speculate that the tumor markers, apoptotic markers, histopathological changes and cell proliferation index measured as PCNA serves as an indicator suggestive of protective effects of DIM in BBN induced urinary bladder carcinogenesis.

Keywords: bladder cancer, N-Butyl-N-(4-hydroxybutyl) nitrosamine, diindolylmethane, histopathology

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Authors: Zeina Nasr, Bashar Merheb

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The honey bee is a social insect that had driven the human interest much more than any other organism. Beekeeping practices dated the appearance of Man on earth and now it provides a hobby or a secondary work that contributes to the family revenue and requires a little time engagement and money investment. Honey production is not the only contribution of honey bees to the economy, since honey bees play an important role in the pollination. Bee keeping in Lebanon is an important part of the agricultural economy. However, a growing concern about bees is spreading globally, due to an accelerated decline of bees colonies. This raises the alert to preserve and protect local bee strains against uncontrolled introduction of foreign strains and invasive parasitic species. Mitochondrial DNA (mtDNA) markers are commonly used in studying genetic variation in the Apis mellifera species. The DraI-COI-COII test is based on the analysis of the intergenic region between the two genes COI and COII. The different honey bee strains differ in the presence or absence of the p sequence and the number of Q sequences present. A. m. syriaca belonging to the lineage Z, is the native honey bee subspecies in Lebanon, Syria, Jordan, and Palestine. A. m. syriaca is known for its high defensiveness, even though it has many important advantages. However, commercial breeder strains, such as the Italian (A. m. ligustica), and Carniolan (A. m. carnica) strains, have been introduced by beekeepers and regularly used for honey production. This raises worries about the disappearance of the local subspecies. It is obvious that identifying A. m. syriaca colonies and protecting them against uncontrolled mating with other bee strains is a crucial step to protect and improve the original local strain. This study aims to reveal the existing sub-species of honey bee in Akkar – Lebanon and to assess the influence of introgression on the hybridization of the local strain. This will help to identify areas of pure A.m. syriaca population over this district to be considered in choosing syriaca reserves. We collected samples of bees from different regions of Akkar district in order to perform mtDNA analysis. We determined the restriction fragments length of the intergenic region COI-COII, using the restriction enzyme DraI. The results showed both the C and the Z lineages. Four restriction patterns were identified among the restriction maps of the studied samples. The most abundant mitochondrial lineage is the Z lineage constituting about 60% of the identified samples. Al-Dreib region reported the lowest introgression with foreign mtDNA of 21% making it the most suitable area for a genetic reserve of syriaca in Akkar based on its lowest introgression and suitable environment in addition to the attitude of local beekeepers to conserve the local strain. Finally, this study is the first step in constructing conservation programs for the preservation of the local strain and should be generalized to the whole Lebanese population, consistent with the effort done in neighboring countries.

Keywords: Akkar Lebanon, Apis millefera syriaca, DraI-COI-COII test, mitochondrial DNA

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Authors: Hae-Jun Lee, Ji-Sun Shin, Kyung-Tae Lee

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Potentilla species (Rosasease) have been used in traditional medicine to treat different ailment, disease or malady. In this study, we investigated the anti-inflammatory effects of ethanol extracts of NUTT (EPP) in lipopolysaccharide (LPS)-induced Raw 264.7 macrophages and septic mice. EPP suppressed LPS-induced nitric oxide (NO) and prostaglandin E2 (PGE2) production in LPS-induced Raw 264.7 macrophages. Consistent with these observations, EPP reduced the expressions of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) by downregulation of their promoter activities. EPP inhibited tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-1β (IL-1β) at production and mRNA levels. Molecularly, EPP attenuated the LPS-induced transcriptional activity, and DNA-binding activity of nuclear factor-κB (NF-κB), and this was associated with a decrease of translocation and phosphorylation of p65 NF-κB by inhibiting the inhibitory κB-α (IκB-α) degradation and IκB kinase-α/β (IKK-α/β) phosphorylation. Furthermore, EPP suppressed the LPS-induced activation of activator protein-1 (AP-1) by reducing the expression of c-Fos and c-Jun in nuclear. EPP also reduced the phosphorylation of mitogen-activated protein kinase (MAPK), such as p38 MAPK and c-Jun N-terminal kinase/stress-activated protein kinase (JNK). In a sepsis model, pretreatment with EPP reduced the LPS-induced lethality. Collectively, these results suggest that the anti-inflammatory effects of EPP were associated with the suppression of NF-κB and AP-1 activation, and support its possible therapeutic role for the treatment of sepsis.

Keywords: anti-inflammation, activator protein-1, nuclear factor κB, Potentilla paradoxa Nutt

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Authors: MD. Kamruzzaman

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As a developing country, Bangladesh has seen an increase in total GDP in recent years. But it can be further improved by developing “Health-Care” (HC) services because it has enormous infrastructure problems all over the country. Bangladesh's HC system is now clearly poised to undergo reform at any process level, including prevention, diagnosis, and treatment. Although the Bangladeshi government is trying to develop the HC sector, due to health corruption in this sector, the improvement has not accelerated yet. For this reason, lots of Bangladeshi people are facing acute diseases. Regarding the prevention, diagnosis, and treatment of disease, this research will illustrate the law relating to health and HC to ensure excellent health and well-being. Firstly, this paper investigates health under Bangladeshi law from different perspectives related to the HC system. A massive gap has been investigated in this research after comparing Bangladeshi and international health law (HL). Secondly, a practical scenario is investigated and compared with international HC law. It is evident that the Bangladeshi HC system did not achieve a satisfactory standard level concerning international law. A staggering 70% of Bangladesh's population lives in rural areas, with no restrictions on access to hospitals and clinics. However, it is clear that proper HC infrastructure and some new medical practices are urgently needed to ensure HC quality. Finally, this research provides suggestions for developing a HC system to ensure the health of all Bangladeshi people that needs to be immediately implemented by the Bangladeshi government. This research has practical implications in the HC system for any developing country to maintain their citizen's safety.

Keywords: HC system, law relating, bangladeshi HL, international HL, human HC suggestions

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Authors: Xinyuan Y. Song, Kai Kang

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Joint models for analyzing longitudinal and survival data are widely used to investigate the relationship between a failure time process and time-variant predictors. A common assumption in conventional joint models in the survival analysis literature is that all predictors are observable. However, this assumption may not always be supported because unobservable traits, namely, latent variables, which are indirectly observable and should be measured through multiple observed variables, are commonly encountered in the medical, behavioral, and financial research settings. In this study, a joint modeling approach to deal with this feature is proposed. The proposed model comprises three parts. The first part is a dynamic factor analysis model for characterizing latent variables through multiple observed indicators over time. The second part is a random coefficient trajectory model for describing the individual trajectories of latent variables. The third part is a proportional hazard model for examining the effects of time-invariant predictors and the longitudinal trajectories of time-variant latent risk factors on hazards of interest. A Bayesian approach coupled with a Markov chain Monte Carlo algorithm to perform statistical inference. An application of the proposed joint model to a study on the Alzheimer's disease neuroimaging Initiative is presented.

Keywords: Bayesian analysis, joint model, longitudinal data, time-to-event data

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Authors: Ashok E. Kalange

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Diagnosis according to Ayurveda is to find the root cause of a disease. Out of the eight different kinds of examinations, Nadi-Pariksha (pulse examination) is important. Nadi-Pariksha is done at the root of the thumb by examining the radial artery using three fingers. Ancient Ayurveda identifies the health status by observing the wrist pulses in terms of 'Vata', 'Pitta' and 'Kapha', collectively called as tridosha, as the basic elements of human body and in their combinations. Diagnosis by traditional pulse analysis – NadiPariksha - requires a long experience in pulse examination and a high level of skill. The interpretation tends to be subjective, depending on the expertise of the practitioner. Present work is part of the efforts carried out in making Nadi-Parikshan objective. Nadi Parikshan Yantra (three point pulse examination system) is developed in our laboratory by using three pressure sensors (one each for the Vata, Pitta and Kapha points on radial artery). The radial pulse data was collected of a large number of subjects. The radial pulse data collected is analyzed on the basis of relative amplitudes of the three point pulses as well as in frequency and time domains. The same subjects were examined by Ayurvedic physician (Nadi Vaidya) and the dominant Dosha - Vata, Pitta or Kapha - was identified. The results are discussed in details in the paper.

Keywords: Nadi Parikshan Yantra, Tridosha, Nadi Pariksha, human pulse data analysis

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Authors: Lilah Inzelberg, David Rand, Stanislav Steinberg, Moshe David Pur, Yael Hanein

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Human facial expressions carry important psychological and neurological information. Facial expressions involve the co-activation of diverse muscles. They depend strongly on personal affective interpretation and on social context and vary between spontaneous and voluntary activations. Smiling, as a special case, is among the most complex facial emotional expressions, involving no fewer than 7 different unilateral muscles. Despite their ubiquitous nature, smiles remain an elusive and debated topic. Smiles are associated with happiness and greeting on one hand and anger or disgust-masking on the other. Accordingly, while high-resolution recording of muscle activation patterns, in a non-interfering setting, offers exciting opportunities, it remains an unmet challenge, as contemporary surface facial electromyography (EMG) methodologies are cumbersome, restricted to the laboratory settings, and are limited in time and resolution. Here we present a wearable and non-invasive method for objective mapping of facial muscle activation and demonstrate its application in a natural setting. The technology is based on a recently developed dry and soft electrode array, specially designed for surface facial EMG technique. Eighteen healthy volunteers (31.58 ± 3.41 years, 13 females), participated in the study. Surface EMG arrays were adhered to participant left and right cheeks. Participants were instructed to imitate three facial expressions: closing the eyes, wrinkling the nose and smiling voluntary and to watch a funny video while their EMG signal is recorded. We focused on muscles associated with 'enjoyment', 'social' and 'masked' smiles; three categories with distinct social meanings. We developed a customized independent component analysis algorithm to construct the desired facial musculature mapping. First, identification of the Orbicularis oculi and the Levator labii superioris muscles was demonstrated from voluntary expressions. Second, recordings of voluntary and spontaneous smiles were used to locate the Zygomaticus major muscle activated in Duchenne and non-Duchenne smiles. Finally, recording with a wireless device in an unmodified natural work setting revealed expressions of neutral, positive and negative emotions in face-to-face interaction. The algorithm outlined here identifies the activation sources in a subject-specific manner, insensitive to electrode placement and anatomical diversity. Our high-resolution and cross-talk free mapping performances, along with excellent user convenience, open new opportunities for affective processing and objective evaluation of facial expressivity, objective psychological and neurological assessment as well as gaming, virtual reality, bio-feedback and brain-machine interface applications.

Keywords: affective expressions, affective processing, facial EMG, high-resolution electromyography, independent component analysis, wireless electrodes

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Authors: Rajinder Pal Kaur, Amit Sharma, Anuj Kumar Sharma, Govind Prasad Sahu

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The existence of chaos in the marine ecosystems may cause planktonic blooms, disease outbreaks, extinction of some plankton species, or some complex dynamics in oceans, which can adversely affect the sustainable marine ecosystem. The control of the chaotic plankton-fish dynamics is one of the main motives of marine ecologists. In this paper, we have studied the impact of phytoplankton refuge, zooplankton refuge, and fear effect on the chaotic plankton-fish dynamics incorporating phytoplankton, zooplankton, and fish biomass. The fear of fish predation transfers the unpredictable(chaotic) behavior of the plankton system to a stable orbit. The defense mechanism developed by prey species due to fear of the predator population can also terminate chaos from the given dynamics. Moreover, the impact of external disturbances like seasonality, noise, periodic fluctuations, and time delay on the given chaotic plankton system has also been discussed. We have applied feedback mechanisms to control the complexity of the system through the parameter noise. The non-feedback schemes are implemented to observe the role of seasonal force, periodic fluctuations, and time delay in suppressing the given chaotic system. Analytical results are substantiated by numerical simulation.

Keywords: plankton, chaos, noise, seasonality, fluctuations, fear effect, prey refuge

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Authors: Chariya Laohavich

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At the current, the trends in the lung disease at a university hospital are the treat and diagnosis by bronchoscopy. Bronchoscopic cryotherapy is a long time procedure 1-4 hours. The cryo probe is sensitive and easy to be damaged and expensive. We have this study management for protection the cryo probe, user satisfaction and qualities work. This study conducted in 4 stages: stage 1 for a survey of problems and assessment of user’s needs; stage 2 for designing and developing the Rama-chest cryo arm for a bronchoscopy process; stage 3 for test-implementing the Rama-chest cryo arm in real situations, studying its problems and obstacles, and evaluating the user satisfaction; and stage 4 for an overall assessment and improvement. The sample used in this study consisted of a total of 15 Ramathipbodi Hospital’s Bronchoscopist and bronchoscopist’s nurse who had used the Rama-chest cryo arm for bronchoscopic cryotherapy from January to June 2016. Objective: To study efficacy and user satisfaction on the Rama-chest cryo arm innovation for bronchoscopic cryotherapy. Data were collected using a Rama-chest cryo arm satisfaction assessment form and analysed based on mean and standard deviation. Result is the Rama-chest cryo arm was an innovation that accommodated during bronchoscopic cryotherapy. The subjects rated this the cryo arm as being most satisfactory (M = 4.86 ± , SD 0.48. Therefore we have developed a cryo arm that uses local material, practical and economic. Our innovation is not only flexible and sustainable development but also lean and seamless. This produced device can be used as effectively as the imported one, and thus can be eventually substituted.

Keywords: efficacy, satisfaction, Rama-chest cryo arm, innovation, bronchoscopic cryotherapy

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Authors: Jose Hernandez, Lina Martínez, Gustavo Gonzalez, Carlos Lázaro, Diana Castrillon, Jonathan Cardona, Laura Mejía, Yina Sanchez, Luisa Ochoa, Evert Jimenez

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Objectives: Economic analyses of tuberculosis control interventions are usually focused on the payer’s perspective. To assess the overall economic impact of the disease, out-of-pocket and indirect costs are also required. This research is aimed to estimate overall economic impact under DOTS-strategy (Directly Observed Therapy Short Course). Methods: A cross-sectional survey of 91 adult tuberculosis patients in treatment for at least two months was conducted from the society perspective. A standardized questionnaire was used in three different cities of Colombia: Medellin (poverty is 17.7%), Monteria (poverty is 36.9%) and Quibdó (poverty is 51.2%). Costs were converted to 2013 USD and categorized into two periods: diagnostics phase and treatment. Results: The median cost during diagnostics was 13$ (±SD 9.5). The median monthly patient out-of-pocket costs during treatment were 32$ (±SD 6.8), equivalent to 17% of patient’s median monthly income, estimated in 186$ (±SD 23). Costs recorded in Medellin were 47$ in Monteria was 18$ and in Quibdó was 13$. Conclusion: Patient costs under DOTS strategy are high even when services are provided free of charge. The creation or strengthening of community-based treatment supervisors could greatly impact costs of tuberculosis and lower drop-outs.

Keywords: tuberculosis, costs and cost analysis, health promotion, Colombia

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Authors: M. M. Nor, H. I. Sheikh, M. F. H. Hassan, S. Mokhtar, A. Suganthi, A. Fadhlina

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Black grass jelly (BGJ) is a popular black jelly used in preparing various drinks and desserts. Food industries often use preservatives to maintain the physicochemical properties of foods, such as color and texture. These preservatives (e.g., phosphoric acid) are linked with deleterious health effects such as kidney disease. Using gelling agents, carrageenan, and gelatin to make BGJ could improve its physiochemical and textural properties. This study was designed to optimize BGJ-selected physicochemical and textural properties using carrageenan and gelatin. Various black grass jelly formulations (BGJF) were designed using an I-optimal mixture design in Design Expert® software. Data from commercial BGJ were used as a reference during the optimization process. The combination of carrageenan and gelatin added to the formulations was up to 14.38g (~5%), respectively. The results showed that adding 2.5g carrageenan and 2.5g gelatin at approximately 5g (~5%) effectively maintained most of the physiochemical properties with an overall desirability function of 0.81. This formulation was selected as the optimum black grass jelly formulation (OBGJF). The leaching properties and floating duration were measured on the OBGJF and commercial grass jelly for 20 min and 40 min, respectively. The results indicated that OBGJF showed significantly (p<0.0001) lower leaching rate and floating time (p<0.05). Hence, further optimization is needed to increase the floating duration of carrageenan and gelatin-based BGJ.

Keywords: cincau, Mesona chinensis, black grass jelly, carrageenan, gelatin

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Authors: Noopur Anand, Amit Gupta

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Sewage divers are the workers involved in cleaning and maintaining of the sewerage lines by entering through manholes. The working conditions of sewage divers in India are more challenging than in other countries. Though India has legal acts framed to ensure protection of the divers called 'The Prohibition of Employment of Manual Scavengers and their Rehabilitation Act, 2013' by Ministry of Law and Justice but these are usually not implemented. Further, the divers are not even provided with safety gear like mask, eyewear, helmet, safety suit, safety belt, gloves, and shoes because of lack of initiative among the agencies/individuals employing them and low awareness of importance of the protective gear amongst workers themselves. Several reports and studies show that because of the non-availability of safety gear, many sewage workers get infected and many of them retire even before attaining superannuation and about 70% of the manual scavengers die while on job. Though there are neoprene safety suits, costing only a few thousand, available in the market which can suffice but is beyond the buying capacity of the sewage diver and agencies/individuals employing them are reluctant to procure it as they find it expensive. In absence of safety suits, the divers get exposed to the parasites, viruses, and disease-causing germs present in the sewage. The research was undertaken with the objective of developing an affordable safety-suit which would save diver from coming into direct contact with the sewage thus preventing infections and diseases. The low cost of the suit may also motivate their employers to procure them for sewage divers.

Keywords: manhole cleaner, manual scavenger, prototype, low-cost safety-suit

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Authors: K. Masingboon, S. Duangpaeng, N. Chaiwong

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Acute myocardial infarction (AMI) is the most common cause of death among Thai with coronary heart disease (CHD). Thai AMI survivors are most likely to have impaired health-related quality of life (HRQoL) due to their lifestyle, functional, and psychological problems. Guided by the Individual and Family Self-Management Theory, this study aimed to explore HRQoL and identify its predictors among Thai AMI survivors. 155 Thai AMI survivors were recruited by stratified random sampling from three hospitals located in eastern region of Thailand. HRQol was measured using the Short Form -12 Health Survey (SF-12). The Center for Epidemiologic studies Depression Scale (CES-D) was utilized to assess the presence of depression, and the Family Support questionnaire was administered to examine family support. Results revealed that 92 percent of Thai AMI survivors reported a generally high level of HRQoL and 80 percent of them reported higher level of HRQoL in physical health and mental health dimension. Depression and family support were significantly predicted HRQoL among Thai AMI survivors and accounted for 28.5 percent of variance (p < .001). Interestingly, depression was the most significant predictors of HRQoL (β = -.65, p < .001) In conclusion, depression is a significant predictor of HRQoL in Thai AMI survivors. Increasing awareness of depression among these survivors is important. Depressive symptoms in should be routinely assessed. In addition, intervention to improve HRQoL among Thai AMI survivors should be addressed through depressive symptom management and family collaboration.

Keywords: health-related quality of life, AMI survivors, predictors, collaboration

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Authors: Taleb L., Benarbia M., Brahmi M., Belmiloud H., Boukerche A.

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Introduction and purpose of the study: Cavum cancer in children and adolescents is rare and represents 8% of all nasopharyngeal cancers treated in our department. Our objective is to study its epidemiological, clinical, therapeutic, and evolutionary particularities. Material and methods: Retrospective study of 39 patients under 20 years old, treated for undifferentiated non-metastatic carcinoma of the nasopharynx at the Emir Abdelkader Cancer Center between 2014 and 2020. Results and statistical analysis: Median age was 14 years [7-19 years], with a sex ratio of 2.9. The median time to diagnosis was 5.6 months [1 to 14 months], the circumstances of the discovery of which were dominated by lymph node syndrome in 43.6% of cases (n=17) followed by a rhinological syndrome in 30.8% of cases (n=13). The tumor stage was T1 for two patients (5.1%), T2 for 8 (20.5%), T3 for 9 (23.1%), T4 for 20 (51.3%), N0 for 2 (5 .1%) N1 for 4 (10.3%), N2 for 28 (71.8%) and N3 for 5 (12.8%). All patients received induction chemotherapy followed by concomitant radiotherapy with cisplatin. The dose of irradiation delivered to the cavum and adenopathies was 66 Gy with fractionation of 2 Gy per session in 69.2% of cases (n=27) and 1.8 Gy in 30.8% of cases (n=12). With a median follow-up of 51 months (15 to 97 months), the locoregional, metastatic, specific, and overall relapse-free survival rates at five years were 91.1%, 73.5%, 66.1%, and 68.4, respectively. Conclusion: Chemotherapy and radiotherapy treatment of cavum cancer in children and adolescents has allowed excellent locoregional control despite the advanced stage of the disease. However, the frequency of metastatic relapses could justify the possible use of systemic maintenance treatment.

Keywords: cancer, nasopharynx, radiotherapy, chemotherapy, survival

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Authors: Naso Isaiah Thanavisuth

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Medical cannabis can be used for treatment including pain, multiple sclerosis, Parkinson's disease, and cancer. However, medical cannabis leads to adverse effects (AEs), which is delta-9-tetrahydrocannabinol (THC). In previous studies, the major of THC metabolism enzymes are CYP2C9. Especially, the variation of CYP2C9 gene consist of CYP2C9*2 on exon 3 and CYP2C9*3 on exon 7 to decrease enzyme activity. Notwithstanding, there is no data describing whether the variant of CYP2C9 genes are apharmacogenetics marker for the prediction of THC-induced AEs in Thai patients. We want to investigate the association between CYP2C9 gene and THC-induced AEs in Thai patients. We enrolled 39 Thai patients with medical cannabis treatment who were classified by clinical data. The CYP2C9*2 and *3 genotyping were conducted using the TaqMan real time PCR assay. All Thai patients who received the medical cannabis consist of twenty-four (61.54%) patients were female, and fifteen (38.46%) were male, with age range 27- 87 years. Moreover, the most AEs in Thai patients who were treated with medical cannabis between cases and controls were tachycardia, arrhythmia, dry mouth, and nausea. Particularly, thirteen (72.22%) medical cannabis-induced AEs were female and age range 33 – 69 years. In this study, none of the medical cannabis groups carried CYP2C9*2 variants in Thai patients. The CYP2C9*3 variants (*1/*3, intermediate metabolizer, IM) and (*3/*3, poor metabolizer, PM) were found, three of thirty-nine (7.69%) and one of thirty-nine (2.56%), respectively. Although, our results indicate that there is no found the CYP2C9*2. However, the variation of CYP2C9 allele might serve as a pharmacogenetics marker for screening before initiating the therapy with medical cannabis for the prevention of medical cannabis-induced AEs.

Keywords: CYP2C9, medical cannabis, adverse effects, THC, P450

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Authors: Rudy C. Flores, Felicisima E. Tungol, Armando A. Villafuerte, Abraham S. Antonio, Roy N. Oroyo, Henry A. Cruz

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An assessment of the biosecurity strategies of selected fishponds in Bataan was conducted by the researchers from Bataan Peninsula State University Orani Campus to determine the present status of Biosecurity strategies being practice by selected freshwater and brackish water fishpond operators in the province to have an initial data of their system of safeguarding cultured fishes against possible diseases. Likewise, it aims to evaluate the extent of implementation of the following areas of Biosecurity namely; fishpond location, perimeter, entrance, building/ pond structure, shipping, new stocks, feeds, dead stocks, soil and water treatment, disinfection and vaccination program. The results of the assessment revealed that the present average status of the surveyed fish ponds in Bataan based on the data gathered from selected fishpond operators is poor for 44.64% and fair for 12.61%, which means that more than one- half of the surveyed fishpond do not have the first and second line of defense against diseases and there is always a higher risk of infection, contamination and possibility of disease outbreak. This indicates that fishpond operators in Bataan need technological interventions to improve their harvest and prevent heavy losses from fish diseases, although biosecurity is satisfactory for 12.92% and very good for 9.16%, which indicate that 22.08% of the surveyed fishponds have their own strategies to keep their stocks from diseases.

Keywords: biosecurity, fishpond operators, soil and water treatment, filtration system, bird scaring devices

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Authors: Lamia Bensissaid

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Goals: Endometriosis affects 6 to 10% of women of childbearing age. 17 to 44% of them have ovarian endometriomas. Medical and surgical treatments represent the two therapeutic axes with which PMA can be associated. Laparoscopic intraperitoneal ovarian cystectomy is described as the reference technique in the management of endometriomas by learned societies (CNGOF, ESHRE, NICE). However, it leads to a significant short-term reduction in the AMH level and the number of antral follicles, especially in cases of bilateral cystectomy, large cyst size or cystectomy after recurrence. Often, the disease is at an advanced stage with several surgical patients. Most have adhesions, which increase the risk of surgical complications and suboptimal resection and, therefore recurrence of the cyst. These results led to a change of opinion towards a conservative approach. Sclerotherapy is an old technique which acts by fibrinoid necrosis. It consists of injecting a sclerosing agent into the cyst cavity. Results : Recurrence was less than 15% for a 12-month follow-up; these rates are comparable to those of surgery. It does not seem to have a negative impact on ovarian reserve, but this is not sufficiently evaluated. It has an advantage in IVF pregnancy rates compared to cystectomy, particularly in cases of recurrent endometriomas. It has the advantages: · To be done on an outpatient basis. · To be inexpensive. · To avoid sometimes difficult and iterative surgery: · To allow an increase in pregnancy rates and the preservation of the ovarian reserve compared to iterative surgery. · of great interest in cases of bilateral endometriomas (kissing ovaries) or recurrent endometriomas. Conclusions: Ethanol sclerotherapy could be a good alternative to surgery.

Keywords: Endometrioma, Sclerotherapy, infertility, Ethanol

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Authors: Sascha E. Oswald, Jan Busch

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The in-situ dechlorination of contamination by chlorinated solvents in groundwater via zero-valent iron (nZVI) is potentially an efficient and prompt remediation method. A key requirement is that nZVI has to be introduced in the subsurface in a way that substantial quantities of the contaminants are actually brought into direct contact with the nZVI in the aquifer. Thus it could be a more flexible and precise alternative to permeable reactive barrier techniques using granular iron. However, nZVI are often limited by fast agglomeration and sedimentation in colloidal suspensions, even more so in the aquifer sediments, which is a handicap for the application to treat source zones or contaminant plumes. Colloid-supported nZVI show promising characteristics to overcome these limitations and Carbo-Iron Colloids is a newly developed composite material aiming for that. The nZVI is built onto finely ground activated carbon of about a micrometer diameter acting as a carrier for it. The Carbo-Iron Colloids are often suspended with a polyanionic stabilizer, and carboxymethyl cellulose is one with good properties for that. We have investigated the transport behavior of Carbo-Iron Colloids (CIC) on different scales and for different conditions to assess its mobility in aquifer sediments as a key property for making its application feasible. The transport properties were tested in one-dimensional laboratory columns, a two-dimensional model aquifer and also an injection experiment in the field. Those experiments were accompanied by non-invasive tomographic investigations of the transport and filtration processes of CIC suspensions. The laboratory experiments showed that a larger part of the CIC can travel at least scales of meters for favorable but realistic conditions. Partly this is even similar to a dissolved tracer. For less favorable conditions this can be much smaller and in all cases a particular fraction of the CIC injected is retained mainly shortly after entering the porous medium. As field experiment a horizontal flow field was established, between two wells with a distance of 5 meters, in a confined, shallow aquifer at a contaminated site in North German lowlands. First a tracer test was performed and a basic model was set up to define the design of the CIC injection experiment. Then CIC suspension was introduced into the aquifer at the injection well while the second well was pumped and samples taken there to observe the breakthrough of CIC. This was based on direct visual inspection and total particle and iron concentrations of water samples analyzed in the laboratory later. It could be concluded that at least 12% of the CIC amount injected reached the extraction well in due course, some of it traveling distances larger than 10 meters in the non-uniform dipole flow field. This demonstrated that these CIC particles have a substantial mobility for reaching larger volumes of a contaminated aquifer and for interacting there by their reactivity with dissolved contaminants in the pore space. Therefore they seem suited well for groundwater remediation by in-situ formation of reactive barriers for chlorinated solvent plumes or even source removal.

Keywords: carbo-iron colloids, chlorinated solvents, in-situ remediation, particle transport, plume treatment

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