Search results for: traditional Chinese medicine syndrome

Authors: Murorunkwere Marie Claire

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Introduction: In Sub-Saharan Africa and specifically in Rwandan rural areas, mother-to-Child human immunodeficiency virus transmission remains a big challenge. This is mainly due to lack of awareness and ignorance among pregnant rural women, leading to neglect regular taking of prophylactic antiretroviral treatment and to persistently beliefs in traditional healers and home deliveries. This paper explores the factors associated with stagnant reduction in human immunodeficiency virus vertical transmission among pregnant rural women and provides solutions to tackle it. Methodology: The first phase of this research will be a qualitative survey was conducted to assess the knowledge, attitudes and practices towards vertical human immunodeficiency virus transmission among pregnant women in one rural district in Rwanda. The data generated from phase one of this research will be used to address the main factors revealed through community mobilization and motivation on attending required antenatal consultations and hospital deliveries, proper and regular antiretroviral treatment taking, and discouraging beliefs in traditional healers and home deliveries. Refresher training seminars will also be organized for healthcare providers qualified on conducting deliveries about current measures to maximize the reduction of chances that can lead to mother -child contamination (to avoid early rupture of membranes and to prevent any source of contamination). Results: This paper is expected to contribute in a significant reduction of the vertical human immunodeficiency virus transmission burden among pregnant rural women. Conclusion: Strong campaigns on prevention of mother- to-child human immunodeficiency virus transmission and community mobilization of pregnant rural women, and house to house education and continuous reminders as well as training seminars to health care personnel on updated measures is, key in addressing vertical human immunodeficiency virus transmission.

Keywords: attitudes transformation, community mobilisation, pregnant rural women, vertical HIV transmission

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Authors: Sait Ozsoy, Hacer Yasar Teke, Mustafa Dalgic, Cetin Ketenci, Ertugrul Gok, Kenan Karbeyaz, Azem Irez, Mesut Akyol

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Self-mutilating behavior or self-injury behavior (SIB) is defined as: intentional harm to one’s body without intends to commit suicide”. SIB cases are commonly seen in psychiatry and forensic medicine practices. Despite variety of SIB methods, cuts in the skin is the most common (70-97%) injury in this group of patients. Subjects with SIB have one or more other comorbidities which include depression, anxiety, depersonalization, and feeling of worthlessness, borderline personality disorder, antisocial behaviors, and histrionic personality. These individuals feel a high level of hostility towards themselves and their surroundings. Researches have also revealed a strong relationship between antisocial personality disorder, criminal behavior, and SIB. This study has retrospectively evaluated 6,599 autopsy cases performed at forensic medicine institutes of six major cities (Ankara, Izmir, Diyarbakir, Erzurum, Trabzon, Eskisehir) of Turkey in 2013. The study group consisted of all cases with SIB findings (psychopathic cuts, cigarette burns, scars, and etc.). The relationship between causes of death in the study group (SIB subjects) and the control group was investigated. The control group was created from subjects without signs of SIB. Mann-Whitney U test was used for age variables and Chi-square test for categorical variables. Multinomial logistic regression analysis was used in order to analyze group differences in respect to manner of death (natural, accident, homicide, suicide) and analysis of risk factors associated with each group was determined by the Binomial logistic regression analysis. This study used SPSS statistics 15.0 for all its statistical and calculation needs. The statistical significance was p <0.05. There was no significant difference between accidental and natural death among the groups (p=0.737). Also there was a unit increase in number of cuts in psychopathic group while number of accidental death decreased (95% CI: 0.941-0.993) by 0.967 times (p=0.015). In contrast, there was a significant difference between suicidal and natural death (p<0.001), and also between homicidal and natural death (p=0.025). SIB is often seen with borderline and antisocial personality disorder but may be associated with many psychiatric illnesses. Studies have shown a relationship between antisocial personality disorders with criminal behavior and SIB with suicidal behavior. In our study, rate of suicide, murder and intoxication was higher compared to the control group. It could be concluded that SIB can be used as a predictor of possibility of one’s harm to him/herself and other people.

Keywords: autopsy, cause of death, forensic science, self-injury behaviour

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Authors: K. Pankaj, R. K. Chaudhary, B. P. Mishra, S. Kochar

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Introduction: Consultation-Liaison psychiatry is a branch of psychiatry that includes clinical service, teaching and research. A consultation-liaison psychiatrist plays a role in having an expert opinion and linking the patients to other medical professionals and the patient’s bio-psycho-social aspects that may be leading to his/her symptoms. Consultation-Liaison psychiatry has been recognised as 'The guardian of the holistic approach to the patient', underlining its pre-eminent role in the management of patients who are admitted in a tertiary care hospital. Aims/ Objectives: The aim of the study was to analyse the utilization of psychiatric services and reasons for referrals in a tertiary care hospital. Materials and Methods: The study was done in a tertiary care hospital. The study included all the cases referred from different Inpatient wards to the psychiatry department for consultation. The study was conducted on 300 patients over a 3 month period. International classification of diseases 10 was used to diagnose the referred cases. Results: The majority of the referral was from the Medical Intensive care unit (22%) followed by general medical wards (18.66%). Majority of the referral was taken for altered sensorium (24.66%), followed by low mood or unexplained medical symptoms (21%). Majority of the referrals had a diagnosis of alcohol withdrawal syndrome (21%) as per International classification of diseases criteria, followed by unipolar Depression and Anxiety disorder (~ 14%), followed by Schizophrenia (5%) and Polysubstance abuse (2.6%). Conclusions: Our study concludes the importance of utilization of consultation-liaison psychiatric services. Also, the study signifies the need for sensitization of our colleagues regarding psychiatric sign and symptoms from time to time and seek psychiatric consult timely to decrease morbidity.

Keywords: consultation-liaison, psychiatry, referral, tertiary care hospital

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Authors: Manushi Srivastava

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Introduction: Doctor’s role, and relation with respect to patient care is at the core of medical ethics. The rapid pace of medical advances along with increasing consumer awareness about their rights and hike in cost of effective health care demand a robust, transparent and patient-friendly medical care system. However, doctors’ role performance is still in the frame of activity-passivity model of Doctor-Patient Relationship (DPR) where doctors act as parent and use to instruct their patients, without their consensus that is not going to help in the 21st century. Thus the current situation is a new challenge for traditional doctor-patient relationship after the introduction of Consumer Protection Act (CPA) in medical profession and the same is evidenced by increasing cases of medical litigation. To strengthen this system of medical services, the doctor plays a vital role, and the same should be reviewed in the present context. Objective: To understand the opinion of consultants regarding medical negligence and effect of Consumer Protection Act in terms of current practices of patient care. Method: This is a cross-sectional study in which both quantitative and qualitative methods are applied. Total 69 consultants were selected from multi-specialty hospitals of densely populated Varanasi city catering a population of about 1.8 million. Two-stage sampling was used for selection of respondents. At the first stage, selection of major wards (Medicine, Surgery, Ophthalmology, Gynaecology, Orthopaedics, and Paediatrics) was carried out, which are more susceptible to medical negligence. At the second stage, selection of consultants from the respective wards was carried out. In-depth Interviews were conducted with the help of semi-structured schedule. Two case studies of medical negligence were also carried out as part of the qualitative study. Analysis: Data were analyzed with the help of SPSS software (21.0 trial version). Semi-structured research tool was used to know consultant’s opinion about the pattern of medical negligence cases, litigations and claims made by patient community and inclusion of government medical services in CPA. Statistical analysis was done to describe data, and non-parametric test was used to observe the association between the variables. Analysis of Verbatim was used in case-study. Findings and Conclusion: Majority (92.8%) of consultants felt changes in the behaviour of community (patient) after implementation of CPA, as it had increased awareness about their rights. Less than half of the consultants opined that Medical Negligence is an Unintentional act of doctors and generally occurs due to communication gap and behavioural problem between doctor and patients. Experienced consultants ( > 10 years) pointed out that unethical practice by doctors and mal-intention of patient to harass doctors were additional reasons of Medical Negligence. In-depth interview revealed that now patients’ community expects more transparency and hence they demand cafeteria approach in diagnosis and management of cases. Thus as study results, we propose ‘Agreement Model’ of DPR to re-ensure ethical practice in medical profession.

Keywords: doctors, communication, consumer protection act (CPA), medical error

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Authors: Shafait Hussain Ali

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Since its outbreak in China, the Covid_19 19 disease has been caused by the corona virus SARS N coyote 2. Italy was the first Western country to be severely affected, and the first country to take drastic measures to control the disease. In start of December 2019, the sudden outbreaks of the Coronary Virus Disease was caused by a new Corona 2 virus (SARS-CO2) of acute respiratory syndrome in china city Wuhan. The World Health Organization declared the epidemic a public health emergency of international concern on January 30, 2020,. On February 14, 2020, 49,053 laboratory-confirmed deaths and 1481 deaths have been reported worldwide. The threat of the disease has forced most of the governments to implement various control measures. Therefore it becomes necessary to analyze the Italian data very carefully, in particular to investigates and to find out the present condition and the number of infected persons in the form of positive cases, death, hospitalized or some other features of infected persons will clear in simple form. So used such a model that will clearly shows the real facts and figures and also understandable to every readable person which can get some real benefit after reading it. The model used must includes(total positive cases, current positive cases, hospitalized patients, death, recovered peoples frequency rates ) all features that explains and clear the wide range facts in very simple form and helpful to administration of that country.

Keywords: machine learning tools and techniques, rapid miner tool, Naive-Bayes algorithm, predictions

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Authors: Francisco Luis Reyes

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The multiple-case study explores the intricacies of three Puerto Rican Community Music (CM) initiatives. This research concentrates on the teaching and learning dynamics of three of the nation’s traditional musical genres, Plena, Bomba, and Música Jíbara, which have survived for centuries through oral transmission and enculturation in community settings. Accordingly, this research focuses on how music education is carried out in Puerto Rican CM initiatives that foster and preserve the country’s traditional music. This study examines the CM initiatives of La Junta, in Santurce (Plena), Taller Tambuyé in Rio Piedras (Bomba), and Decimanía (Música Jíbara), an initiative that stems from the municipality of Hatillo. In terms of procedure, 45–60-minute semi-structured interviews were conducted with organizers and administrators of the CM initiatives to gain insight into the educational philosophy of each project. Following this, a second series of 45–60-minute semi-structured interviews were undertaken with CM educators to collect data on their musical development, teaching practices, and relationship with learners. Subsequently, four weeks were spent observing/participating in each of the three CM initiatives. In addition to participant observations in these projects, five CM learners from each locale were recruited for two one-on-one semi-structured interviews at the beginning and end of the data collection period. The initial interview centered on the participants’ rationale for joining the CM initiative whereas the exit interview focused on participants’ experience within it. Alumni from each of the CM initiatives partook in 45–60-minute semi-structured interviews to investigate their understanding of what it means to be a member of each musical community. Finally, observations and documentation of additional activities hosted/promoted by each initiative, such as festivals, concerts, social gatherings, and workshops, were undertaken. These three initiatives were chosen because of their robust and dynamic practices in fostering the musical expressions of Puerto Rico. Data collection consisted of participant observation, narrative inquiry, historical research, philosophical inquiry, and semi-structured interviews. Data analysis for this research involved relying on theoretical propositions, which entails comparing the results—from each case and as a collective— to the arguments that led to the basis of the research (e.g., literature review, research questions, hypothesis). Comparisons to the theoretical propositions were made through pattern matching, which requires comparing predicted patterns from the literature review to findings from each case. Said process led to the development of an analytic outlook of each CM case and a cross-case synthesis. The purpose of employing said data analysis methodology is to present robust findings about CM practices in Puerto Rico and elucidate similarities and differences between the cases that comprise this research and the relevant literature. Furthermore, through the use of Sound Links’ Nine Domains of Community Music, comparisons to other community projects are made in order to point out parallels and highlight particularities in Puerto Rico.

Keywords: community music, Puerto Rico, music learning, traditional music

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Authors: Ashwini Mahesh Jagatap

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This paper presents the language learning strategy with respect to speaking skill with collaborative learning approach. Collaborative learning has been proven to be efficient learning methodology for all kinds of students. Students are working in groups of two or more, reciprocally searching for understanding, Solutions, or meanings, or creating a product. The presentation highlights the different stages which can be implemented during actual implementation of the methodology in the class room teaching learning process.

Keywords: collaborative classroom, collaborative learning approach, language skills, traditional teaching

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Authors: Ya-Chuan Hsu, Wen-Chen Ouyang, Wei-Siang Huang

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Problem/Background: With constantly increasing aged populations, quality of life (QOL) in persons with dementia has become a significant research concern. The Alzheimer’s Related Quality of Life (ADRQL) is a high-validated, theory-derived, and multidimensional instrument. It has widely utilized in many countries, except in Taiwan. However, diverse results of quality of life from different countries by using the same measurement can provide the potential to help understand the impact of cultural contributor on QOL. Objective: To investigate the extent to which quality of life on older adults with dementia in Taiwan. Methods: Cross-sectional, descriptive study conducted in an assisting living facility affiliated with a daycare center in southern Taiwan. A purposeful sample of 34 participants was recruited. Inclusion criteria included those who were at least 65 years old, able to communicate, and diagnosed with mild to moderate dementia. The QOL was measured by Chinese version ADRQL. This observational instrument consists of 30 items that is divided into five subscales with the full range of each subscale scores from 0 to 100.0. Higher scores indicate better QOL. Results: The means for subscale of the Social Interaction, Awareness of Self, Feelings and Mood, Enjoyment of Activities, and Response to Surroundings were 87.9, 74.7, 91.3, 64.5, and 90.3, respectively. The overall mean for the ADQOL was 0.83. Conclusion: Findings suggest that the level of Enjoyment of Activities is the lowest and may convey information about a need of evaluation on arrangement of facility’s activities.

Keywords: dementia, quality of life, elders, Alzheimer’s related quality of life

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Authors: Hervice Roméo Fogno Fotsoa, Germaine Djuidje Kenmoe, Claude Vidal Aloyem Kazé

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One of the main applications of machine learning is the prediction of time series. But a more accurate prediction requires a more optimal model of machine learning. Several optimization techniques have been developed, but without considering the input variables disposition of the system. Thus, this work aims to present a new machine learning architecture optimization technique based on their optimal input variables disposition. The validations are done on the prediction of wind time series, using data collected in Cameroon. The number of possible dispositions with four input variables is determined, i.e., twenty-four. Each of the dispositions is used to perform the prediction, with the main criteria being the training and prediction performances. The results obtained from a static architecture and a dynamic architecture of neural networks have shown that these performances are a function of the input variable's disposition, and this is in a different way from the architectures. This analysis revealed that it is necessary to take into account the input variable's disposition for the development of a more optimal neural network model. Thus, a new neural network training algorithm is proposed by introducing the search for the optimal input variables disposition in the traditional back-propagation algorithm. The results of the application of this new optimization approach on the two single neural network architectures are compared with the previously obtained results step by step. Moreover, this proposed approach is validated in a collaborative optimization method with a single objective optimization technique, i.e., genetic algorithm back-propagation neural networks. From these comparisons, it is concluded that each proposed model outperforms its traditional model in terms of training and prediction performance of time series. Thus the proposed optimization approach can be useful in improving the accuracy of time series forecasts. This proves that the proposed optimization approach can be useful in improving the accuracy of time series prediction based on machine learning.

Keywords: input variable disposition, machine learning, optimization, performance, time series prediction

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Authors: Fiorenza Misale

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The painful phenomenon of so-called white deaths and accidents at work, unfortunately, is always current. The key is to act on the culture of security through effective measures of attitudes and behaviors that go far beyond the knowledge and the know-how. It is necessary that there is an ‘introjection’ of safety culture through the conscious involvement of all workers. The legislation on work safety identifies the main tool to promote the culture of safety at work and prevention within the workplace. In law the term education is used to distinguish itself from the information with which they will simply theoretically transmit, and from the training with which they will provide the practical skills. The new decree fact fills several gaps in previous legislation and stresses the importance of training in the workplace, that is, the main activity through which it is possible to achieve the active participation of all workers in the company’s prevention system. This system is built only through the dissemination of risk information, the circulation of information, comparison and dialogue between all actors involved that are the necessary elements for a correct transmission of the culture of worker safety. Training activity should put the focus on work experience in order to bring out all the knowledge needed to identify and assess the risks in the work place, and especially the action to eliminate or control them, integrating, when necessary, the missing knowledge. In addition to traditional training and information systems can be utilized for the purpose of training that are able to affect both one emotionally and aesthetically, team-theatre is one of them. Among the methods of company theater that can be used in work safety we have: Lesson show, theater workshop, improvised theater, forum theater, theater playback. The theater can represent a complementary approach to traditional training and give information on safety measures, demonstrating that there are more engaging outreach tools. Team-theatre allows identification with the characters, a transmission of emotions and moods and it is through the staging of a story that the individual processes new information. It’ also s a means of experiential training that allows you to work with your mind, body, emotions.The aim of one work is the use of corporate theater on the personnel working in the health sector. Through a questionnaire we are able to analyze the knowledge of occupational safety and current risks; in particular in health care which is to be administered before and after the play.

Keywords: theater, training, occupational health, safety

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Authors: Nemeh Ahmad Al-Akour, Ibrahem Alfaouri

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Objective: To examine the level of maternal awareness of SIDS and its prevention amongst Jordanian mothers in the north of Jordan, as well as to determine their SIDS-related infant care practices. Design: A cross-sectional design. Setting: The study was conducted in maternal out-patients clinics of two teaching hospitals and three maternal and child health clinic in three major health care centers in Northern Jordan. Participants: A total of 356 mothers of infants attending the maternal and child health clinics were included in this study. Measurements and findings: A self-administered questionnaire was used for collecting data study. In this study, 64%of mothers didn’t hear about SIDS, while only 7% of mothers were able to identify factors risk-reducing recommendations. Avoidance of prone sleeping was the most frequently identified recommendation (5%). There were 67.7% of mothers who put their infant in a lateral position to sleep, 61% used soft mattress surface for their babies sleep and 25.8% who shared a bed with their babies. Employed mother, mothers of higher age, and mothers living within a nuclear family were the only factors associated with maternal awareness of SIDS. Friends were the highest a source of knowledge of SIDS for mothers (44.7%). Key conclusions: There was a low level of awareness of SIDS and its associated risk factor among the mothers in Jordan. The mothers' misconception about smoking and sleeping position for their infants requires further efforts. Implications for practice: To ensure raising awareness of infant care practice regarding SIDS, a national educational intervention on SIDS risk reduction strategies and recommendations is necessary for maintaining a low rate of SIDS in the population.

Keywords: bed sharing, infant care, Jordan, sleep position, sudden infant death

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Authors: Maryam Memarian, Mahmood Naghizadeh

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Deconstruction is an approach that is entirely incompatible with the traditional prevalent architecture. Considering the fact that this approach attempts to put architecture in sharp contrast with its opposite events and transpires with attending to the neglected and missing aspects of architecture and deconstructing its stable structures. It also recklessly proceeds beyond the existing frameworks and intends to create a different and more efficient prospect for space. The aim of deconstruction architecture is to satisfy both the prospective and retrospective visions as well as takes into account all tastes of the present in order to transcend time. Likewise, it ventures to fragment the facts and symbols of the past and extract new concepts from within their heart, which coincide with today’s circumstances. Since this approach is an attempt to surpass the limits of the prevalent architecture, it can be employed to design places in which creative events occur and imagination and ambition flourish. Thought-provoking artistic events can grow and mature in such places and be represented in the best way possible to all people. The concept of event proposed in the plan grows out of the interaction between space and creation. In addition to triggering surprise and high impressions, it is also considered as a bold journey into the suspended realms of the traditional conflicts in architecture such as architecture-landscape, interior-exterior, center-margin, product-process, and stability-instability. In this project, at first, through interpretive-historical research method and examining the inputs and data collection, recognition and organizing takes place. After evaluating the obtained data using deductive reasoning, the data is eventually interpreted. Given the fact that the research topic is in its infancy and there is not a similar case in Iran with limited number of corresponding instances across the world, the selected topic helps to shed lights on the unrevealed and neglected parts in architecture. Similarly, criticizing, investigating and comparing specific and highly prized cases in other countries with the project under study can serve as an introduction into this architecture style.

Keywords: anti-architecture, creativity, deconstruction, event

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Authors: Prince Mugoya, Collins Oduor Ondiek, Patrick Kanyi Wamuyu

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Refugee Job Board Website is a web-based application that provides a platform for organizations to post jobs specifically for refugees. Organizations upload job opportunities and refugees can view them on the website. The website also allows refugees to input their skills and qualifications. The methodology used to develop this system is a waterfall (traditional) methodology. Software development tools include Brackets which will be used to code the website and PhpMyAdmin to store all the data in a database.

Keywords: information technology, refugee, skills, utilization, economy, jobs

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Authors: Arjun Chatterjee

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The India-China border clash in Galwan valley in June 2020, the first deadly skirmish between the two Asian giants in the Himalayan border area in over four decades, highlighted the need to examine the notion of ‘authenticity’ in journalistic practices. Information emanating from such remotely located, sparsely populated, and not well-demarcated international land borders have limited sources, restricted to official sources, which have their own narrative. Geopolitical goals and ambitions embolden narratives of nationalism in the media, and these often challenge the notion and understanding of authenticity in journalism. The Indian press, contrary to the Chinese press, which is state-owned, is diverse and also confrontational, where narratives of nationalism are differentially interpreted, embedded, and realised. This paper examines how authenticity has become a variable, rather than a constant, in conflict reporting of the Sino-Indian border clash and how authenticity is interpreted similarly or differently in conflict journalism. The paper reports qualitative textual analysis of two leading English language newspapers – The Times of India and The Hindu, and two mainstream regional language newspapers, Amar Ujala (Hindi) and Ananda Bazar Patrika (Bengali), to evaluate the ways in which representations of information function in conflict reporting and to recontextualize (and thus change or modify the meaning of) that which they represent, and with what political and cultural implications.

Keywords: India-China, framing, conflict, media narratives, border dispute

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Authors: Vikrant Gupta, Amrit Goswami

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The fixed income market forms the basis of the modern financial market. All other assets in financial markets derive their value from the bond market. Owing to its over-the-counter nature, corporate bonds have relatively less data publicly available and thus is researched upon far less compared to Equities. Bond price prediction is a complex financial time series forecasting problem and is considered very crucial in the domain of finance. The bond prices are highly volatile and full of noise which makes it very difficult for traditional statistical time-series models to capture the complexity in series patterns which leads to inefficient forecasts. To overcome the inefficiencies of statistical models, various machine learning techniques were initially used in the literature for more accurate forecasting of time-series. However, simple machine learning methods such as linear regression, support vectors, random forests fail to provide efficient results when tested on highly complex sequences such as stock prices and bond prices. hence to capture these intricate sequence patterns, various deep learning-based methodologies have been discussed in the literature. In this study, a recurrent neural network-based deep learning model using long short term networks for prediction of corporate bond prices has been discussed. Long Short Term networks (LSTM) have been widely used in the literature for various sequence learning tasks in various domains such as machine translation, speech recognition, etc. In recent years, various studies have discussed the effectiveness of LSTMs in forecasting complex time-series sequences and have shown promising results when compared to other methodologies. LSTMs are a special kind of recurrent neural networks which are capable of learning long term dependencies due to its memory function which traditional neural networks fail to capture. In this study, a simple LSTM, Stacked LSTM and a Masked LSTM based model has been discussed with respect to varying input sequences (three days, seven days and 14 days). In order to facilitate faster learning and to gradually decompose the complexity of bond price sequence, an Empirical Mode Decomposition (EMD) has been used, which has resulted in accuracy improvement of the standalone LSTM model. With a variety of Technical Indicators and EMD decomposed time series, Masked LSTM outperformed the other two counterparts in terms of prediction accuracy. To benchmark the proposed model, the results have been compared with traditional time series models (ARIMA), shallow neural networks and above discussed three different LSTM models. In summary, our results show that the use of LSTM models provide more accurate results and should be explored more within the asset management industry.

Keywords: bond prices, long short-term memory, time series forecasting, empirical mode decomposition

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Authors: Danyi Wang, Andrew Schriefer, Dennis O'Rourke, Brajendra Kumar, Yang Liu, Fei Zhong, Juergen Scheuenpflug, Zheng Feng

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Purpose: It has been recognized that the microbiome plays critical roles in disease pathogenesis, including cancer, autoimmune disease, and multiple sclerosis. To develop a clinical-grade assay for exploring microbiome-derived clinical biomarkers across disease areas, a two-phase approach is implemented. 1) Identification of the optimal sample preparation reagents using pre-mixed bacteria and healthy donor stool samples coupled with proprietary Sigma-Aldrich® bioinformatics solution. 2) Exploratory analysis of patient samples for enabling precision medicine. Study Procedure: In phase 1 study, we first compared the 16S sequencing results of two ATCC® microbiome standards (MSA 2002 and MSA 2003) across five different extraction kits (Kit A, B, C, D & E). Both microbiome standards samples were extracted in triplicate across all extraction kits. Following isolation, DNA quantity was determined by Qubit assay. DNA quality was assessed to determine purity and to confirm extracted DNA is of high molecular weight. Bacterial 16S ribosomal ribonucleic acid (rRNA) amplicons were generated via amplification of the V3/V4 hypervariable region of the 16S rRNA. Sequencing was performed using a 2x300 bp paired-end configuration on the Illumina MiSeq. Fastq files were analyzed using the Sigma-Aldrich® Microbiome Platform. The Microbiome Platform is a cloud-based service that offers best-in-class 16S-seq and WGS analysis pipelines and databases. The Platform and its methods have been extensively benchmarked using microbiome standards generated internally by MilliporeSigma and other external providers. Data Summary: The DNA yield using the extraction kit D and E is below the limit of detection (100 pg/µl) of Qubit assay as both extraction kits are intended for samples with low bacterial counts. The pre-mixed bacterial pellets at high concentrations with an input of 2 x106 cells for MSA-2002 and 1 x106 cells from MSA-2003 were not compatible with the kits. Among the remaining 3 extraction kits, kit A produced the greatest yield whereas kit B provided the least yield (Kit-A/MSA-2002: 174.25 ± 34.98; Kit-A/MSA-2003: 179.89 ± 30.18; Kit-B/MSA-2002: 27.86 ± 9.35; Kit-B/MSA-2003: 23.14 ± 6.39; Kit-C/MSA-2002: 55.19 ± 10.18; Kit-C/MSA-2003: 35.80 ± 11.41 (Mean ± SD)). Also, kit A produced the greatest yield, whereas kit B provided the least yield. The PCoA 3D visualization of the Weighted Unifrac beta diversity shows that kits A and C cluster closely together while kit B appears as an outlier. The kit A sequencing samples cluster more closely together than both the other kits. The taxonomic profiles of kit B have lower recall when compared to the known mixture profiles indicating that kit B was inefficient at detecting some of the bacteria. Conclusion: Our data demonstrated that the DNA extraction method impacts DNA concentration, purity, and microbial communities detected by next-generation sequencing analysis. Further microbiome analysis performance comparison of using healthy stool samples is underway; also, colorectal cancer patients' samples will be acquired for further explore the clinical utilities. Collectively, our comprehensive qualification approach, including the evaluation of optimal DNA extraction conditions, the inclusion of positive controls, and the implementation of a robust qualified bioinformatics pipeline, assures accurate characterization of the microbiota in a complex matrix for deciphering the deep biology and enabling precision medicine.

Keywords: 16S rRNA sequencing, analytical validation, bioinformatics pipeline, metagenomics

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Authors: Cansu Gülser, Tuğce Ercan

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The construction sector is a key driver of the global economy, contributing significantly to growth and employment through a diverse array of sub-sectors. However, it faces challenges due to its project-based nature, which often hampers long-term collaboration and broader incentives beyond individual projects. These limitations are frequently discussed in scientific literature as obstacles to innovation and industry-wide change. Traditional practices and unwritten rules further hinder the adoption of new processes within the construction industry. The disadvantages of the construction industry’s project-based structure in fostering innovation and long-term relationships include limited continuity, fragmented collaborations, and a focus on short-term goals, which collectively hinder the development of sustained partnerships, inhibit the sharing of knowledge and best practices, and reduce incentives for investing in innovative processes and technologies. This structure typically emphasizes specific projects, which restricts broader collaborations and incentives that extend beyond individual projects, thus impeding innovation and change. The temporal complexities inherent in project-based sectors like construction make it difficult to address societal challenges through collaborative efforts. Traditional management approaches are inadequate for scaling up innovations and adapting to significant changes. For systemic transformation in the construction sector, there is a need for more collaborative relationships and activities beyond traditional supply chains. This study delves into the concept of an innovation ecosystem within the construction sector, highlighting various research findings. It aims to explore key questions about the components that enhance innovation capacity, the relationship between a robust innovation ecosystem and this capacity, and the reasons why innovation is less prevalent and implemented in this sector compared to others. Additionally, it examines the main factors hindering innovation within companies and identifies strategies to improve these efforts, particularly in developing countries. The innovation ecosystem in the construction sector generates various outputs through interactions between business resources and external components. These outputs include innovative value creation, sustainable practices, robust collaborations, knowledge sharing, competitiveness, and advanced project management, all of which contribute significantly to company market performance and competitive advantage. This article offers insights and strategic recommendations for industry professionals, policymakers, and researchers interested in developing and sustaining innovation ecosystems in the construction sector. Future research should focus on broader samples for generalization, comparative sector analysis, and application-focused studies addressing real industry challenges. Additionally, studying the long-term impacts of innovation ecosystems, integrating advanced technologies like AI and machine learning into project management, and developing future application strategies and policies are also important.

Keywords: construction industry, innovation ecosystem, innovation ecosystem components, project management

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Authors: Amena Omer Syeda, Harita Shyam

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Background: Anorexia a common symptom among patients with prolonged illness leading to anorexia-cachexia syndrome with a prevalence rate of 70%. In order to provide effective health care and better response to treatment, appetite should be assessed on admission and then periodically for earlier nutrition intervention. Functional Assessment of Anorexia/Cachexia Therapy (FAACT) appetite scale is 12 questions, patient-rated, symptom specific measure for appetite, and distress from anorexia. It assigns a score ranging from 0 (worst response) to 4 (best response). Therefore, proposing a total score of ≤24 may be sufficient to make a diagnosis of anorexia. Objectives: To assess the FAACT scale by co-relating the scores with the Nutritional intake and BMI of Cancer Patients. Methods: The FAACT scores of 100 cancer in-patients receiving chemotherapy or radiation as treatment, their 24-hour calorie and protein intake and BMI were recorded. The data was then statistically analyzed. Results: The calorie and protein intake and FAACT scores both showed a significant positive co-relation (p<0.001), inferring that the patients with a FAACT score of ≤24 where not meeting their calorie as well as protein requirements, hence rightly categorizing them as anorexic. The co-relation between BMI and FAACT scores showed a weak co-relation and was not statistically significant (p > 0.05).The FAACT scale thus is not sensitive to distinguish patients being under-weight, normal weight or obese. Conclusion: The FAACT scale helps in providing better palliative and nutritional care as it correctly assessed anorexia /cachexia in cancer patients and co-related significantly with their nutrient intake.

Keywords: appetite, cachexia, cancer, malnutrition

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Authors: Hayley Lawrence, Nabi Shah, Sarah Dyer

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Aims: Lumbar punctures are a common bedside procedure performed in acute medicine. Published guidance exists on the standardised documentation of invasive procedures in order to reduce the risk of complications. The audit aim was to assess current standards of documentation in accordance with both the GMC and the National Standards for Invasive Procedures guidelines. A second cycle was conducted after introducing a standardised sticker created using current guidelines. This would assess whether the sticker improved documentation, aiming for 100% standard in each step of the procedure. Methods: An initial prospective audit of current practice was conducted over a 3-month period. Patients were identified by their presenting complaints and by colleagues assessing acute medical patients. Initial findings were presented locally, and a further prospective audit was conducted following the implementation of a standardised sticker. Results: 19 lumbar punctures were included in the first cycle and 13 procedures in the second. Pre-procedure documentation was collected for each cycle, whereby documentation of ‘Indication’ improved from 5.3% to 84.6%, ‘Consent’ from 84.2% to 100%, ‘Coagulopathy’ from 0% to 61.5%, ‘Drug Chart checked’ from 0% to 100%, ‘Position of patient’ from 26.3% to 100% and use of ‘Aseptic Technique’ from 83.3% to 100% from the first to the second cycle respectively. ‘Level of Doctor’ and ‘Supervision’ decreased from 53% to 31% and 53% to 46%, respectively, in the second cycle. Documentation of the procedure itself also demonstrated improvements, with ‘Level of Insertion’ 15.8% to 100%, ‘Name of Antiseptic Used’ 11.1% to 69.2%, ‘Local Anaesthetic Used’ 26.3% to 53.8%, ‘Needle Gauge’ 42.1% to 76.9%, ‘Number of Attempts’ 78.9% to 100% and ‘Traumatic/Atraumatic’ procedure 26.3% to 92.3%, respectively. A similar number of opening pressures were documented in each cycle at 57.9% and 53.8%, respectively, but its documentation was deemed ‘Not Applicable’ in a higher number of patients in the second cycle. Post-procedure documentation improved, with ‘Number of Samples obtained’ increasing from 52.6% to 92.3% and documentation of ‘Immediate Complications’ increasing from 78.9% to 100%. ‘Dressing Applied’ was poorly documented in the first cycle at 16.7%. This was not included on the standardised sticker, resulting in 0% documentation in the second cycle. Documentation of Clinicians’ Name and Bleep reduced from 63.2% to 15.4%, but when the name only was analysed, this increased to 84.6%. Conclusions: Standardised stickers for lumbar punctures do improve documentation and hence should result in improved patient safety. There is still room for improvement to reach 100% standard in each area, especially with respect to the clinician’s name and contact details being documented. Final adjustments will be made to the sticker before being included in a lumbar puncture kit, which will be made readily available in the acute medical wards. Future audits could be extended to include other common bedside procedures performed in acute medicine to ensure documentation of all these procedures reaches 100% standard.

Keywords: invasive procedure, lumbar puncture, medical record keeping, procedure checklist, procedure documentation, standardised documentation

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Authors: Bhawana, Roshan Kamal Topno, Maneesh Kumar, Major Madhukar, Krishna Pandey, Ganesh Chandra Sahoo, Manas Ranjan Dikhit, Surya Suman, Devendra Prasad Yadav, Rishikesh Kumar, Pradeep Das

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Viral co-infection is now very common across taxa and environments that are involved in congenital infections. Herpes simplex virus (HSV) and Rubella are the two serious viral infections, well categorized in TORCH Syndrome. Here we had endeavoured the seroprevalence of co-infection of HSV and Rubella. Systematic tests have been performed to check the virulence pattern of the co-infection. The study was conducted at Department of Virology, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, Bihar, India during January 2018-July 2018. 299 newly cases were attended with the sign and symptoms of HSV and Rubella. After taking written consent forms from all the subjects, blood samples were collected for serological detection. ELISA was performed to detect the presence of IgM antibody level. 12 patients were found to be IgM positive from each HSV and Rubella infection. The findings of our study showed that 6 patients were positive for both HSV and rubella and hence were co-infected. Such co-infection causes severe health problems as it leads to the mortality rate of the patients during viral infectivity. Epidemiologically, proper screening should be needed to check any chance of occurrence of such co-infection in the affected regions in large scale and take suitable preventive approach to decrease the case totality. Concern has to be given to aid proper diagnosis and treatment in order to decrease the spread of HSV and Rubella co-infection.

Keywords: HSV, Rubella, seroprevalence, co-infection, ELISA, viral infectivity

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Authors: Oluwafemi Akinlawon Atoyebi

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This paper examines alienation and fixation as critical issues of/around mental health -crisis, sickness, and healing- through ‘Bode Ojoniyi’s dramaturgy. Two of his dramatic memoirs, arguably written to address such a life-threatening crisis between him and his employer, where he externalizes perhaps his psychological crisis, are critically analysed. This is done through a reading of the three theatrical phenomena of the actor, the character, and the audience against how he plays around the concepts of alienation and fixation within the totality of his dramaturgy beyond what could be seen as a mere academic exercise. The paper situates his apt understanding of their representations as a reflective force of a consciousness that defies psychosomatic existential conflicts. It does so by adopting a qualitative method of analysis through a critical reading of the two dramatic memoirs. It also carries out a survey on the audience that experienced the performances of the memoirs and an interview with Ojoniyi. Using Jean-Paul Sartre’s Theory of Existential Consciousness, the study discovers that there is a way the three phenomena of the actor, the character, and the audience do find expression in Ojoniyi as an existential omniscient playwright-actor-character-audience who is able to transcend the parochialism of an alienated and a fixated self; that beyond the limiting artistic purview, the theatre as a stage is a phenomenon that is capable of capturing the totality of the experiences of a man in his world and that, often time, the depressed are victims of the myopic syndrome as they probably could not see or reflect on/about their realities beyond the self and the play of a casual order. The study concludes that the therapeutic effect of Ojoniyi’s dramatic memoirs, in their reading or performance, is needed by all and should be explored in proffering cures for psychosomatic patients, for it promises to be essentially useful beyond its confine –the Arts.

Keywords: alienation, fixation, the healing theatre, theatrical personalities

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Authors: Maria L. G. Lourenço, Keylla H. N. P. Pereira, Viviane Y. Hibaru, Fabiana F. Souza, João C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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The neonatal mortality rates in dogs are considered high, varying between 5.7 and 21.2% around the world, and the causes of the deaths are often unknown. Data regarding canine neonatal mortality are scarce in Brazil. This study aims at describing the neonatal mortality rates in dogs, as well as the main causes of death. The study included 152 litters and 669 neonates admitted to the São Paulo State University (UNESP) Veterinary Hospital, Botucatu, São Paulo, Brazil between January 2018 and September 2019. The overall mortality rate was 16.7% (112/669), with 40% (61/152) of the litters presenting at least one case of stillbirth or neonatal mortality. The rate of stillbirths was 7.7% (51/669), while the neonatal mortality rate was 9% (61/669). The early mortality rate (0 to 2 days) was 13.7% (92/669), accounting for 82.1% (92/112) of all deaths. The late mortality rate (3 to 30 days) was 2.7% (18/669), accounting for 16% (18/112) of all deaths. Infection was the causa mortis in 51.8% (58/112) of the newborns, of which 30.3% (34/112) were caused by bacterial sepsis, and 21.4% (24/112) were caused by other bacterial, viral or parasite infections. Other causes of death included congenital malformations (15.2%, 17/112), of which 5.3% (6/112) happened through euthanasia due to malformations incompatible with life; asphyxia/hypoxia by dystocia (9.8%, 11/112); wasting syndrome in debilitated newborns (6.2%, 7/112); aspiration pneumonia (3.6%, 4/112); agalactia (2.7%, 3/112); trauma (1.8%, 2/112); administration of contraceptives to the mother (1.8%, 2/112) and unknown causes (7.1%, 8/112). The neonatal mortality rate was considered high, but they may be even higher in locations without adequate care for the mothers and neonates. Therefore, prenatal examinations and early neonatal care are of utmost importance for the survival of these patients.

Keywords: neonate dogs, puppies, mortality rate, neonatal death

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Authors: M. L. Yeung

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With the surge of divorce rate and male cancer onset/death rates, the phenomenon of divorced wives in the facing cancer death of their ex-husbands is not uncommon in Hong Kong. Yet, there is a dearth of study on the experiences of bereaved-divorced wives in the Hong Kong cultural context. This project fills the knowledge gap by conducting a qualitative study for having interviewed four bereaved ex-wives, who returned to ex-husbands’ end-of-life caregiving and eventually grieved for the ex-spousal’s death. From the perspectives of attachment theory and disenfranchised grief in the Hong Kong cultural context, a ‘double-loss’ experience is found in which interviewees suffer from the first loss of divorce and the second loss of ex-husbands’ death. Traumatic childhood experiences, attachment needs, role ambiguity, unresolved emotions and unrecognized grief are found significant in their lived experiences which alert the ‘double-loss’ is worthy of attention. Extending a family-centered end-of-life and bereavement care services to divorced couples is called for, in which validation on the attachment needs, ex-couple reconciliation, and acknowledgement on the disenfranchised grief are essential for social work practice on this group of clienteles specifically in Hong Kong cultural context.

Keywords: changing family, disenfranchised grief, divorce, ex-spousal death, marriage

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Authors: S. K. Kakraliya, R. D. Jat, H. S. Jat, P. C. Sharma, M. L. Jat

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The traditional rice-wheat (RW) system in the IGP of South Asia is tillage, water, energy, and capital intensive. Coupled with more pumping of groundwater over the years to meet the high irrigation water requirement of the RW system has resulted in over-exploitation of groundwater. Replacement of traditional rice with less water crops such as maize under climate-smart agriculture (CSA) based management (tillage, crop establishment and residue management) practices are required to promote sustainable intensification. Furthermore, inefficient nutrient management practices are responsible for low crop yields and nutrient use efficiencies in maize-wheat (MW) system. A 7-year field experiment was conducted in farmer’s participatory strategic research mode at Taraori, Karnal, India to evaluate the effects of tillage and crop establishment (TCE) methods, residue management, mungbean integration, and nutrient management practices on crop yields, water productivity and profitability of MW system. The main plot treatments included four combinations of TCE, residue and mungbean integration [conventional tillage (CT), conventional tillage with mungbean (CT + MB), permanent bed (PB) and permanent bed with MB (PB + MB] with three nutrient management practices [farmer’s fertilizer practice (FFP), recommended dose of fertilizer (RDF) and site-specific nutrient management (SSNM)] using Nutrient Expert® as subplot treatments. System productivity, water use efficiency (WUE) and net returns under PB + MB were significantly increased by 25–30%, 28–31% and 35–40% compared to CT respectively, during seven years of experimentation. The integration of MB in MW system contributed ~25and ~ 28% increases in system productivity and net returns compared with no MB, respectively. SSNM based nutrient management increased the mean (averaged across 7 yrs) system productivity by 12- 15% compared with FFP. The study revealed that CSA based sustainable intensification (PB + MB) and SSNM approach provided opportunities for enhancing crop productivity, WUE and profitability of the MW system in India.

Keywords: Conservation Agriculture, Precision water and nutrient management, Permanent beds, Crop yields

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Authors: Malathi Iyer, Jayesh Vaidya

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The demographic dividend of India will last for thirty years from now. However, reduction in birth rate, an increase in working population, improvements in medicine and better health practices lead to an ever-expanding elderly population, bringing additional burden to the economy and putting an end to the demographic dividend. To reap the dividend India needs to train the youth for employability. The need of the hour is to improve their life skills which lead the youth to become industrious and have continuous employment. The study will be conducted in perceiving the skill gaps that exist in commerce students for employability. The analysis results indicate the relation between the core study and the right skills for the workforce, with the steps that are taken to open the window for the demographic dividend.

Keywords: demographic dividend, life skills, employability, workforce

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Authors: Zhuoyuan Wang, Benson T. H. Lim, Imriyas Kamardeen

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Effective service quality management has long been touted as a means of improving project and organisational performance. Particularly, in construction projects, main contractors are often seen as a broker between clients and subcontractors, and their service quality is thus associated with the overall project affinity and outcomes. While a considerable amount of research has focused on the aspect of clients-main contractors, very little research has been done to explore the effect of contractors’ service quality on subcontractors’ behaviours and so project outcomes. In addressing this gap, this study surveyed 97 subcontractors in the Chinese Construction industry and data was analysed using the Partial Least Square (PLS) Structural Equation Modelling (SEM) technique. The overall findings reveal that subcontractors categorised main contractors’ service quality into three dimensions: assurance; responsiveness; reliability and empathy. Of these, it is found that main contractors’ ‘assurance’ and ‘responsiveness’ positively influence subcontractors’ intention to engage in contractual behaviours. The results further show that the subcontractors’ intention to engage in organizational citizenship behaviours is associated with how flexible and committed the main contractors are in reliability and empathy. Collectively, both subcontractors’ contractual and organizational citizenship behaviours positively influence the overall project outcomes. In conclusion, the findings inform contractors different strategies towards managing and gaining subcontractors’ behaviour commitment in a socially connected, yet complex and uncertain, business environment.

Keywords: construction firms, organisational citizenship behaviour, service quality, social exchange theory

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Authors: Oyuna Weina

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This study examines how musicians use visual and zoological metaphors for singing technique and voice quality in a genre of traditional music called urtiin duu (‘long song’) in Alshaa, Inner Mongolia, China. Previous studies have discussed melodic contour in Mongol music, but little study of the intersection of singing technique, visual and zoological metaphors has yet been undertaken. The purpose of this study is to address this lack by analysing urtiin duu itself, traditional pedagogy and performances, all of which have been inspired and are assessed by reference to nature and mobile pastoral herding practices. This study investigates the visual and zoological metaphors related to urtiin duu especially colour, the shape of the circle and animals in the Mongol community. Urtiin duu singing is associated with certain colours in song texts, in selection of repertoire and in the status of singers. Musicians also use colour to describe timbre. These colours in turn reference worship of nature, religions, and daily practices of most Mongols in Alshaa. Moreover, voice quality and singing technique are often related to the animals not only in song text but also in the approach to breathing and to melodic contour. Additionally, the concept of boronhoi (‘the shape of circle’), not only is applied to the melodic contour but also to the voice quality and singing technique. These three factors illustrate the connections among nature, spiritual world and everyday herding life of Mongols. These different connections provide evidence of multi-layered meanings. In contemporary Alshaa, urtiin duu singers received Western musical training from the city and returned to their homelands to perform urtiin duu. In doing so, they are also trying to reconnect with the history, nature and spiritual world in order to achieve their ideal sound. Within a multicultural society, singers negotiate amongst themselves, and with ethnic groups, audiences and government officials. The power of the metaphor therefore assists and reconnects the strength of regional identity and ethnic identity in Alshaa.

Keywords: Alshaa, urtiin duu, visual, zoological metaphors

Procedia PDF Downloads 356

Authors: S. Kudlacik-Kramarczyk, M. Kedzierska, B. Tyliszczak

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Recently, the continuous development of medicine and related sciences has been observed. Particular emphasis is directed on the development of biomaterials, i.e., non-toxic, biocompatible and biodegradable materials that may improve the effectiveness of treatment as well as the comfort of patients. This is particularly important in the case of cancer treatment. Currently, there are many methods of cancer treatment based primarily on chemotherapy and the surgical removal of the tumor, but it is worth noting that these therapies also cause many side effects. Among women, the most common cancer is breast cancer. It may be completely cured, but the consequence of treatment is partial or complete breast mastectomy and radiation therapy, which results in severe skin burns. The skin of the patient after radiation therapy is very burned, and therefore requires intensive care and high frequency of dressing changes. The traditional dressing adheres to the burn wounds and does not absorb adequate amount of exudate from injuries and the patient is forced to change the dressing every 2 hours. Therefore, the main purpose was to develop an innovative combination of dressing material with drug carriers that may be used in anti-cancer therapy. The innovation of this solution is the combination of these two products into one system, i.e., a transdermal system with the possibility of a controlled release of the drug- cytostatic. Besides, the possibility of modifying the hydrogel matrix with aloe vera juice provides this material with new features favorable from the point of view of healing processes of burn wounds resulting from the radiation therapy. In this study, hydrogel materials containing protein spheres with the active substance have been obtained as a result of photopolymerization process. The reaction mixture consisting of the protein (albumin) spheres incorporated with cytostatic, chitosan, adequate crosslinking agent and photoinitiator has been subjected to the UV radiation for 2 minutes. Prepared materials have been subjected to the numerous studies including the analysis of cytotoxicity using murine fibroblasts L929. Analysis was conducted based on the mitochondrial activity test (MTT reduction assay) which involves the determining the number of cells characterized by proper metabolism. Hydrogel materials obtained using different amount of crosslinking agents have been subjected to the cytotoxicity analysis. According to the standards, tested material is defined as cytotoxic when the viability of cells after 24 h incubation with this material is lower than 70%. In the research, hydrogel polymer materials containing protein spheres incorporated with the active substance, i.e. a cytostatic, have been developed. Such a dressing may support the treatment of cancer due to the content of the anti-cancer drug - cytostatic, and may also provide a soothing effect on the healing of the burn wounds resulted from the radiation therapy due to the content of aloe vera juice in the hydrogel matrix. Based on the conducted cytotoxicity studies, it may be concluded that the obtained materials do not adversely affect the tested cell lines, therefore they can be subjected to more advanced analyzes.

Keywords: hydrogel polymers, cytostatics, drug carriers, cytotoxicity

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Authors: Qinghui Li, Lei Zhang

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In China, sport will play a more important role in the future development of the national economy, are facing greater challenges. Sports industry development in this background,innovative technology and cultural forces which will play an important role. Therefore, as a guide of sports culture, the development of science and technology, display the sports scientific and technological achievements, culture showed important - Sports Academic Journals sports technology platform of talent, but also innovation and value-added will through its value function,play an important role in the development of China's sports development and sports industry. At the same time, in the Chinese academic journals of social environment has undergone great changes,one aspect is the national news publishing system reform, change, development group of scientific publishing market has become the mainstream trend of development; on the other hand, digitalization, internationalization development speed of academic journal soon, in such a social background, how sports academic journal of development? How to serve for the development of sports? This research will be based on the sports academic journals in the past, the development status and characteristics and now plays in the history and context of modern academic value and social value, to explore the new era background, especially the development of the reform of the cultural system, marketization and the digital innovation situation of sports academic periodical show in sports, sports industry development and play a more important role in study.

Keywords: sports academin journals, strong sporting nation, innovation, China

Procedia PDF Downloads 496

Authors: Patompong Satapornpong, Therdpong Tempark, Pawinee Rerknimitr, Jettanong Klaewsongkram, Chonlaphat Sukasem

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Dapsone (4, 4’-diaminodiphenyl sulfone, DDS) is broadly used for the treatment of inflammatory diseases and infections such as; leprosy, Pneumocystis jiroveci pneumonia in patients with HIV infection, neutrophilic dermatoses, dermatitis herpetiformis and autoimmune bullous disease. The severe cutaneous adverse drug reactions (SCARs) including, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) are rare but severe life-threatening adverse drug reactions. Dapsone is one of many culprit drugs induced SJS, TEN and DRESS. Notwithstanding, to our knowledge, there are no studies of the association of HLA class I alleles and dapsone-induced SCARs in non-leprosy Thai patients. This investigation was a prospective cohort study, which performed in a total of 45 non-leprosy patients. Fifteen patients of dapsone-induced SCARs were classified as following the RegiSCAR criteria, and 30 dapsone-tolerant controls were exposed to dapsone more than 6 months without any evidence of cutaneous reactions. The genotyping of HLA-A, -B and –C were performed using sequence-specific oligonucleotides (PCR-SSOs). The Ethics Committee of Ramathibodi hospital, Mahidol University, approved this study. Among all HLA class I alleles, HLA-A*24:07, HLA-B*13:01, HLA-B*15:02, HLA-C*03:04 and HLA-C*03:09 were significantly associated with dapsone-induced SCARs (OR = 10.55, 95% CI = 1.06 – 105.04, p = 0.0360; OR = 56.00, 95% CI = 8.27 – 379.22, p = 0.0001; OR = 7.00, 95% CI = 1.17 – 42.00, p = 0.0322; OR = 6.00, 95% CI = 1.24 – 29.07, p = 0.0425 and OR = 17.08, 95% CI = 0.82 – 355.45, p = 0.0321, respectively). Furthermore, HLA-B*13:01 allele had strong association with dapsone-induced SJS-TEN and DRESS when compared with dapsone-tolerant controls (OR = 42.00, 95% CI = 2.88 – 612.31, p = 0.0064 and OR = 63.00, 95% CI = 7.72 – 513.94 and p = 0.0001, respectively). Consequently, HLA-B*13:01 might serve as a pharmacogenetic marker for screening before initiating the therapy with dapsone for prevention of dapsone-induced SCARs.

Keywords: dapsone-induced SCARs, HLA-B*13:01, HLA class I alleles, severe cutaneous adverse reactions, Thai

Procedia PDF Downloads 231