Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 19

Search results for: Rihab Ben Lamine

19 Graph Planning Based Composition for Adaptable Semantic Web Services

Authors: Rihab Ben Lamine, Raoudha Ben Jemaa, Ikram Amous Ben Amor

Abstract:

This paper proposes a graph planning technique for semantic adaptable Web Services composition. First, we use an ontology based context model for extending Web Services descriptions with information about the most suitable context for its use. Then, we transform the composition problem into a semantic context aware graph planning problem to build the optimal service composition based on user's context. The construction of the planning graph is based on semantic context aware Web Service discovery that allows for each step to add most suitable Web Services in terms of semantic compatibility between the services parameters and their context similarity with the user's context. In the backward search step, semantic and contextual similarity scores are used to find best composed Web Services list. Finally, in the ranking step, a score is calculated for each best solution and a set of ranked solutions is returned to the user.

Keywords: semantic web service, web service composition, adaptation, context, graph planning

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18 Culturable Diversity of Halophilic Bacteria in Chott Tinsilt, Algeria

Authors: Nesrine Lenchi, Salima Kebbouche-Gana, Laddada Belaid, Mohamed Lamine Khelfaoui, Mohamed Lamine Gana

Abstract:

Saline lakes are extreme hypersaline environments that are considered five to ten times saltier than seawater (150 – 300 g L-1 salt concentration). Hypersaline regions differ from each other in terms of salt concentration, chemical composition and geographical location, which determine the nature of inhabitant microorganisms. In order to explore the diversity of moderate and extreme halophiles Bacteria in Chott Tinsilt (East of Algeria), an isolation program was performed. In the first time, water samples were collected from the saltern during pre-salt harvesting phase. Salinity, pH and temperature of the sampling site were determined in situ. Chemical analysis of water sample indicated that Na +and Cl- were the most abundant ions. Isolates were obtained by plating out the samples in complex and synthetic media. In this study, seven halophiles cultures of Bacteria were isolated. Isolates were studied for Gram’s reaction, cell morphology and pigmentation. Enzymatic assays (oxidase, catalase, nitrate reductase and urease), and optimization of growth conditions were done. The results indicated that the salinity optima varied from 50 to 250 g L-1, whereas the optimum of temperature range from 25°C to 35°C. Molecular identification of the isolates was performed by sequencing the 16S rRNA gene. The results showed that these cultured isolates included members belonging to the Halomonas, Staphylococcus, Salinivibrio, Idiomarina, Halobacillus Thalassobacillus and Planococcus genera and what may represent a new bacterial genus.

Keywords: bacteria, Chott, halophilic, 16S rRNA

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17 Effect of Synthesis Method on Structural, Morphological Properties of Zr0.8Y0.2-xLax Oxides (x=0, 0.1, 0.2)

Authors: Abdelaziz Ghrib, Samir Hattali, Mouloud Ghrib, Mohamed Lamine Aouissia, David Ruch

Abstract:

In the present study, the solid solutions with a chemical composition of Zr0.8Y0.2-xLaxO2 (x=0, 0.1, 0.2) were synthesized via two routes, by hydrothermal method using NaOH as precipitating agent at 230°C for 15h and by the sol–gel process using citric acid as complexing agent. Compounds have been characterized by powder X-ray diffraction (XRD), Scanning Electron Microscopy (SEM), Thermo gravimetric Analysis (TGA) and Differential Thermal Analysis (DTA) techniques for appropriate characterization of the distinct thermal events occurring during synthesis. All the compounds crystallize in cubic fluorite structure, as indicated by X-ray diffraction studie. The microstructure of oxides synthesized by sol-gel showed porosity that increased with the lanthanum La3+ contents compared to hydrothermal method which gives a single crystal oxide.

Keywords: oxide, hydrothermal, rare earth, solubility, sol-gel, ternary mixture

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16 Multivariate Dependent Frequency-Severity Modeling of Insurance Claims: A Vine Copula Approach

Authors: Islem Kedidi, Rihab Bedoui Bensalem, Faysal Manssouri

Abstract:

In traditional models of insurance data, the number and size of claims are assumed to be independent. Relaxing the independence assumption, this article explores the Vine copula to model dependence structure between multivariate frequency and average severity of insurance claim. To illustrate this approach, we use the Wisconsin local government property insurance fund which offers several insurance protections for motor vehicles, property and contractor’s equipment claims. Results show that the C-vine copula can better characterize the multivariate dependence structure between frequency and severity. Furthermore, we find significant dependencies especially between frequency and average severity among different coverage types.

Keywords: dependency modeling, government insurance, insurance claims, vine copula

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15 Evaluation of Combined System of Constructed Wetland/Expended Clay Aggregate in Greywater Treatment

Authors: Eya Hentati, Mona Lamine, Jalel Bouzid

Abstract:

In this study, a laboratory-scale was designed and fabricated to treat single house greywater in the north of Tunisia with a combination of physical and natural treatments systems. The combined system includes a bio-filter composed of LECA® (lightweight expanded clay aggregate) followed by a vertical up-flow constructed wetland planted with Iris pseudacorus and Typha Latifolia. Applied two hydraulic retention times (HRTs) with two different plants types showed that a bio-filter planted with Typha Latifolia has an optimum removal efficiency for degradation of organic matter and transformation of nitrogen and phosphate at HRT of 30 h. The optimum removal efficiency of biochemical oxygen demand (BOD), chemical oxygen demand (COD), and suspended solids (SS) ranged between 48-65%, between while the nutrients removal was in the range of 70% to 90%. Fecal coliforms dropped by three to four orders of magnitude from their initial concentration, but this steel does not meet current regulations for unlimited irrigation. Hence further improvement procedures are suggested.

Keywords: constructed wetland, greywater treatment, nutriments, organics

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14 Effect of Innovation and Its Determinants on the Performance of Small and Medium-Sized Enterprises

Authors: Rihab Hentati, Younes Boujelbene

Abstract:

Nowadays we realize more and more than the value of a company is not only a function of its means of production but depends essentially on the managerial aptitude and orientation to implement the material and human means for generating profitability. Indeed, a productive R&D activity, a good strategy, and innovation are originally supplementary benefits that increase the value of the business. Is this ‘value-added’ closely linked to innovation? The purpose of our research is to Meta-analyze the results of 56 empirical studies in order to explain the overall effect of innovation on performance of small and medium-sized enterprises. In order to justify the differences in the results, we look for the moderating factors that may affect the innovation-performance relationship. We find a positive and significant relationship between innovation and performance in small and medium-sized enterprises. The results also note a positive relationship between entrepreneurial orientation, research and development (R&D), and performance in SMEs. In addition, innovation has a strong impact on performance measured both with accounting and market index. The originality of the article is based on a rigorous synthesis, based on several statistical tools, of an important subject of research in finance.

Keywords: innovation, performance, entrepreneurial orientation, meta-analysis, moderator variables

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13 New Practical and Non-Malleable Elgamal Encryption for E-Voting Protoco

Authors: Karima Djebaili, Lamine Melkemi

Abstract:

Elgamal encryption is a fundamental public-key encryption in cryptography, which is based on the difficulty of discrete logarithm problem and the Diffie-Hellman problem. Supposing the Diffie–Hellman problem is computationally infeasible then Elgamal is secure under a chosen plaintext attack, where security indicates it is difficult for the attacker, given the ciphertext, to restore the whole of the plaintext. However, although it is secure against chosen plaintext attack, Elgamal is absolutely malleable i.e. is not secure against an adaptive chosen ciphertext attack, where the attacker can recover the plaintext. We present a extension on Elgamal encryption which result in non-malleability against adaptive chosen plaintext attack using concatenation and a cryptographic hash function, our evidence utilizes the device of plaintext aware. The algorithm proposed can be used in cryptography voting protocol given its level security. Our protocol protects the confidentiality of voters because each voter encrypts their choice before casting their vote, offers public verifiability using a signing algorithm, the final result is correctly computed using homomorphic property, and works even in the presence of an adversary due to the propriety of non-malleability. Moreover, the protocol prevents some parties colluding to fix the vote results.

Keywords: Elgamal encryption, non-malleability, plaintext aware, e-voting

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12 Sales-Based Dynamic Investment and Leverage Decisions: A Longitudinal Study

Authors: Rihab Belguith, Fathi Abid

Abstract:

The paper develops a system-based approach to investigate the dynamic adjustment of debt structure and investment policies of the Dow-Jones index. This approach enables the assessment of relations among sales, debt, and investment opportunities by considering the simultaneous effect of the market environmental change and future growth opportunities. We integrate the firm-specific sales variance to capture the industries' conditions in the model. Empirical results were obtained through a panel data set of firms with different sectors. The analysis support that environmental change does not affect equally the different industry since operating leverage differs among industries and so the sensitivity to sales variance. Including adjusted-specific variance, we find that there is no monotonic relation between leverage, sales, and investment. The firm may choose a low debt level in response to high sales variance but high leverage to attenuate the negative relation between sales variance and the current level of investment. We further find that while the overall effect of debt maturity on leverage is unaffected by the level of growth opportunities, the shorter the maturity of debt is, the smaller the direct effect of sales variance on investment.

Keywords: dynamic panel, investment, leverage decision, sales uncertainty

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11 Fixed-Frequency Pulse Width Modulation-Based Sliding Mode Controller for Switching Multicellular Converter

Authors: Rihab Hamdi, Amel Hadri Hamida, Ouafae Bennis, Fatima Babaa, Sakina Zerouali

Abstract:

This paper features a sliding mode controller (SMC) for closed-loop voltage control of DC-DC three-cells buck converter connected in parallel, operating in continuous conduction mode (CCM), based on pulse-width modulation (PWM). To maintain the switching frequency, the approach is to incorporate a pulse-width modulation that utilizes an equivalent control, inferred by applying the SM control method, to produce a control sign to be contrasted and the fixed-frequency within the modulator. Detailed stability and transient performance analysis have been conducted using Lyapunov stability criteria to restrict the switching frequency variation facing wide variations in output load, input changes, and set-point changes. The results obtained confirm the effectiveness of the proposed control scheme in achieving an enhanced output transient performance while faithfully realizing its control objective in the event of abrupt and uncertain parameter variations. Simulations studies in MATLAB/Simulink environment are performed to confirm the idea.

Keywords: DC-DC converter, pulse width modulation, power electronics, sliding mode control

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10 Continuous-Time Analysis And Performance Assessment For Digital Control Of High-Frequency Switching Synchronous Dc-Dc Converter

Authors: Rihab Hamdi, Amel Hadri Hamida, Ouafae Bennis, Sakina Zerouali

Abstract:

This paper features a performance analysis and robustness assessment of a digitally controlled DC-DC three-cell buck converter associated in parallel, operating in continuous conduction mode (CCM), facing feeding parameters variation and loads disturbance. The control strategy relies on the continuous-time with an averaged modeling technique for high-frequency switching converter. The methodology is to modulate the complete design procedure, in regard to the existence of an instantaneous current operating point for designing the digital closed-loop, to the same continuous-time domain. Moreover, the adopted approach is to include a digital voltage control (DVC) technique, taking an account for digital control delays and sampling effects, which aims at improving efficiency and dynamic response and preventing generally undesired phenomena. The results obtained under load change, input change, and reference change clearly demonstrates an excellent dynamic response of the proposed technique, also as provide stability in any operating conditions, the effectiveness is fast with a smooth tracking of the specified output voltage. Simulations studies in MATLAB/Simulink environment are performed to verify the concept.

Keywords: continuous conduction mode, digital control, parallel multi-cells converter, performance analysis, power electronics

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9 Sterilization Incident Analysis by the Association of Litigation and Risk Management Method

Authors: Souhir Chelly, Asma Ben Cheikh, Hela Ghali, Salwa Khefacha, Lamine Dhidah, Mohamed Ben Rejeb, Houyem Said Latiri

Abstract:

The hospital risk management department is firstly involved in the methodological analysis of grade zero sterilization incidents. The system is based on a subsequent analysis process in compliance with the ongoing requirements of the Haute Autorité de santé (HAS) for a reactive approach to risk, allowing to identify failures and start the appropriate preventive and corrective measures. The use of the association of litigation and risk management (ALARM) method makes easier the grade zero analysis and brings to light the team or institutional, organizational, temporal, individual factors representative of undesirable effects. Two main factors come out again from this analysis, pre-disinfection step of the emergency block unsupervised instrumentalist intern was poorly done since she did not remove the battery from micro air motor. At the sterilization unit, the worker who was not supervised by the nurse did the conditioning of the motor without having checked it if it still contained the battery. The main cause is that the management of human resources was inadequate at both levels, the instrumental trainee in the block who was not supervised by his supervisor and the worker of the sterilization unit who was not supervised by the responsible nurse. There is a lack of research help, advice, and collaboration. The difficulties encountered during this type of analysis are multiple. The first is based on its necessary acceptance by the various actors of care involved, which should not perceive it as a tool leading to individual punishment, but rather as a means to improve their practices.

Keywords: ALARM (Association of Litigation and Risk Management Method), incident, risk management, sterilization

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8 An Approach for Association Rules Ranking

Authors: Rihab Idoudi, Karim Saheb Ettabaa, Basel Solaiman, Kamel Hamrouni

Abstract:

Medical association rules induction is used to discover useful correlations between pertinent concepts from large medical databases. Nevertheless, ARs algorithms produce huge amount of delivered rules and do not guarantee the usefulness and interestingness of the generated knowledge. To overcome this drawback, we propose an ontology based interestingness measure for ARs ranking. According to domain expert, the goal of the use of ARs is to discover implicit relationships between items of different categories such as ‘clinical features and disorders’, ‘clinical features and radiological observations’, etc. That’s to say, the itemsets which are composed of ‘similar’ items are uninteresting. Therefore, the dissimilarity between the rule’s items can be used to judge the interestingness of association rules; the more different are the items, the more interesting the rule is. In this paper, we design a distinct approach for ranking semantically interesting association rules involving the use of an ontology knowledge mining approach. The basic idea is to organize the ontology’s concepts into a hierarchical structure of conceptual clusters of targeted subjects, where each cluster encapsulates ‘similar’ concepts suggesting a specific category of the domain knowledge. The interestingness of association rules is, then, defined as the dissimilarity between corresponding clusters. That is to say, the further are the clusters of the items in the AR, the more interesting the rule is. We apply the method in our domain of interest – mammographic domain- using an existing mammographic ontology called Mammo with the goal of deriving interesting rules from past experiences, to discover implicit relationships between concepts modeling the domain.

Keywords: association rule, conceptual clusters, interestingness measures, ontology knowledge mining, ranking

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7 Availability of Safety Measures and Knowledge Towards Hazardous Waste Management among Workers in Scientific Laboratories of Two Universities in Lebanon

Authors: Inaam Nasrallah, Pascale Salameh, Abbas El-Outa, Assem Alkak, Rihab Nasr, Wafa Toufic Bawab

Abstract:

Background: Hazardous Waste Management(HWM). is critical to human health outcomes and environmental protection. This study evaluated the knowledge regarding safety measures to be applied when collecting and storing waste in scientific laboratories of two universities in Lebanon.Method: A survey-based observational study was conducted in scientific laboratories of the public university and that of a private university, where a total of 309 participants were recruited.Result: The mean total knowledge score on safety measures of HWM was 9.02±4.34 (maximum attainable score, 13). Significant association (p<0.05) was found between knowledge score and job function, years of experience, educational level, professional status, work schedule, and training on proper HWM. Participants had adequate perceptions regarding the impact of HWM on health and the environment. Linear regression modeling revealed that knowledge score was significantly higher among bachelor level lab workers compared to those with doctoral degrees (p=0.043), full-time schedule workers versus part-timers (p=0.03), and among public university participants as compared to those of the private university (p<0.001).Conclusion: This study showed good knowledge concerning HWM in the scientific laboratoriesof the studied universities in Lebanon and a good awareness of the HWM on health and the environment. It highlights the importance of culture, attitude, and practice on proper HWM in the academic scientific laboratory.

Keywords: hasardous waste, safety measures, waste management, knwoledge score, scientific laboratory workers

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6 Comparative Analysis of Control Techniques Based Sliding Mode for Transient Stability Assessment for Synchronous Multicellular Converter

Authors: Rihab Hamdi, Amel Hadri Hamida, Fatiha Khelili, Sakina Zerouali, Ouafae Bennis

Abstract:

This paper features a comparative study performance of sliding mode controller (SMC) for closed-loop voltage control of direct current to direct current (DC-DC) three-cells buck converter connected in parallel, operating in continuous conduction mode (CCM), based on pulse-width modulation (PWM) with SMC based on hysteresis modulation (HM) where an adaptive feedforward technique is adopted. On one hand, for the PWM-based SM, the approach is to incorporate a fixed-frequency PWM scheme which is effectively a variant of SM control. On the other hand, for the HM-based SM, oncoming an adaptive feedforward control that makes the hysteresis band variable in the hysteresis modulator of the SM controller in the aim to restrict the switching frequency variation in the case of any change of the line input voltage or output load variation are introduced. The results obtained under load change, input change and reference change clearly demonstrates a similar dynamic response of both proposed techniques, their effectiveness is fast and smooth tracking of the desired output voltage. The PWM-based SM technique has greatly improved the dynamic behavior with a bit advantageous compared to the HM-based SM technique, as well as provide stability in any operating conditions. Simulation studies in MATLAB/Simulink environment have been performed to verify the concept.

Keywords: DC-DC converter, hysteresis modulation, parallel multi-cells converter, pulse-width modulation, robustness, sliding mode control

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5 Management of Blood Exposure Risk: Knowledge and Attitudes of Caregivers in Pediatric Dapartments

Authors: Hela Ghali, Oumayma Ben Amor, Salwa Khefacha, Mohamed Ben Rejeb, Sirine Frigui, Meriam Tourki Dhidah, Lamine Dhidah, Houyem Said Laatiri

Abstract:

Background: Blood exposure accidents are the most common problem in hospitals that threaten healthcare professionals with a high risk of infectious complications which weighs heavily on health systems worldwide. Paramedics are the highest risk group due to the nature of their daily activities. We aimed to determine knowledge and attitudes about the management of blood-exposure accidents among nurses and technicians in two pediatric departments. Materials/Methods: This is a cross-sectional descriptive study conducted on March 2017, carried out with the care staff of the pediatric ward of the Farhat Hached Teaching Hospital of Sousse and pediatric surgery of the Fattouma Bourguiba University Hospital in Monastir, using a pre- tested and self-administered questionnaire. Data entry and analysis were performed using Excel software. Results: The response rate was 85.1%. A female predominance (82.5%) was reported among respondents with a sex ratio of 0.21. 80% of the participants were under 35 years old. Seniority of less than 10 years was found in 77.5% of respondents. Only 22.5% knew the definition of a blood- exposure accident. 100% and 95% of participants reported the relative risk, respectively, to hepatitis and AIDS viruses. However, only 15% recognized the severity factors of a blood-exposure accident. Hygiene compliance was the most important dimension for almost the entire population for the prevention. On the other hand, only 12.5% knew the meaning of 'standard precautions' and ¼ considered them necessary for at-risk patients only. 40% reported being exposed at least once, among them, 87.5% used betadine, and 77.5% said that anti-infectious chemoprophylaxis is necessary regardless of the patient's serological status. However, 52.5% did not know the official reporting circuit of management of blood-exposure accident in their institutions. Conclusion: For better management of risks in hospitals and an improvement of the safety of the care, a reinforcement of the sensibilization of the caregivers with regard to the risks of blood exposure accident is necessary, while developing their knowledge to act in security.

Keywords: attitudes, blood-exposure accident, knowledge, pediatric department

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4 Medical Authorizations for Cannabis-Based Products in Canada: Sante Cannabis Data on Patient’s Safety and Treatment Profiles

Authors: Rihab Gamaoun, Cynthia El Hage, Laura Ruiz, Erin Prosk, Antonio Vigano

Abstract:

Introduction: Santé Cannabis (SC), a Canadian medical cannabis-specialized group of clinics based in Montreal and in the province of Québec, has served more than 5000 patients seeking cannabis-based treatment prescription for medical indications over the past five years. Within a research frame, data on the use of medical cannabis products from all the above patients were prospectively collected, leading to a large real-world database on the use of medical cannabis. The aim of this study was to gather information on the profiles of both patients and prescribed medical cannabis products at SC clinics and to assess the safety of medical cannabis among Canadian patients. Methods: Using a retrospective analysis of the database, records of 2585 patients who were prescribed medical cannabis products for therapeutic purposes between 01-November 2017 and 04-September 2019 were included. Patients’ demographics, primary diagnosis, route of administration, and chemovars recorded at the initial visits were investigated. Results: At baseline: 9% of SC patients were female, with a mean age of 57 (SD= 15.8, range= [18-96]); Cannabis products were prescribed mainly for patients with a diagnosis of chronic pain (65.9% of patients), cancer (9.4%), neurological disorders (6.5%), mood disorders (5.8 %) and inflammatory diseases (4.1%). Route of administration and chemovars of prescribed cannabis products were the following: 96% of patients received cannabis oil (51% CBD rich, 42.5% CBD:THC); 32.1% dried cannabis (21.3% CBD:THC, 7.4% THC rich, 3.4 CBD rich), and 2.1% oral spray cannabis (1.1% CBD:THC, 0.8% CBD rich, 0.2% THC rich). Most patients were prescribed simultaneously, a combination of products with different administration routes and chemovars. Safety analysis is undergoing. Conclusion: Our results provided initial information on the profile of medical cannabis products prescribed in a Canadian population and the experienced adverse events over the past three years. The Santé Cannabis database represents a unique opportunity for comparing clinical practices in prescribing and titrating cannabis-based medications across different centers. Ultimately real-world data, including information about safety and effectiveness, will help to create standardized and validated guidelines for choosing dose, route of administration, and chemovars types for the cannabis-based medication in different diseases and indications.

Keywords: medical cannabis, real-world data, safety, pharmacovigilance

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3 In Silico Analysis of Deleterious nsSNPs (Missense) of Dihydrolipoamide Branched-Chain Transacylase E2 Gene Associated with Maple Syrup Urine Disease Type II

Authors: Zainab S. Ahmed, Mohammed S. Ali, Nadia A. Elshiekh, Sami Adam Ibrahim, Ghada M. El-Tayeb, Ahmed H. Elsadig, Rihab A. Omer, Sofia B. Mohamed

Abstract:

Maple syrup urine (MSUD) is an autosomal recessive disease that causes a deficiency in the enzyme branched-chain alpha-keto acid (BCKA) dehydrogenase. The development of disease has been associated with SNPs in the DBT gene. Despite that, the computational analysis of SNPs in coding and noncoding and their functional impacts on protein level still remains unknown. Hence, in this study, we carried out a comprehensive in silico analysis of missense that was predicted to have a harmful influence on DBT structure and function. In this study, eight different in silico prediction algorithms; SIFT, PROVEAN, MutPred, SNP&GO, PhD-SNP, PANTHER, I-Mutant 2.0 and MUpo were used for screening nsSNPs in DBT including. Additionally, to understand the effect of mutations in the strength of the interactions that bind protein together the ELASPIC servers were used. Finally, the 3D structure of DBT was formed using Mutation3D and Chimera servers respectively. Our result showed that a total of 15 nsSNPs confirmed by 4 software (R301C, R376H, W84R, S268F, W84C, F276C, H452R, R178H, I355T, V191G, M444T, T174A, I200T, R113H, and R178C) were found damaging and can lead to a shift in DBT gene structure. Moreover, we found 7 nsSNPs located on the 2-oxoacid_dh catalytic domain, 5 nsSNPs on the E_3 binding domain and 3 nsSNPs on the Biotin Domain. So these nsSNPs may alter the putative structure of DBT’s domain. Furthermore, we detected all these nsSNPs are on the core residues of the protein and have the ability to change the stability of the protein. Additionally, we found W84R, S268F, and M444T have high significance, and they affected Leucine, Isoleucine, and Valine, which reduces or disrupt the function of BCKD complex, E2-subunit which the DBT gene encodes. In conclusion, based on our extensive in-silico analysis, we report 15 nsSNPs that have possible association with protein deteriorating and disease-causing abilities. These candidate SNPs can aid in future studies on Maple Syrup Urine Disease type II base in the genetic level.

Keywords: DBT gene, ELASPIC, in silico analysis, UCSF chimer

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2 Control of an Outbreak of Vancomycin-Resistant Enterococci in a Tunisian Teaching Hospital

Authors: Hela Ghali, Sihem Ben Fredj, Mohamed Ben Rejeb, Sawssen Layouni, Salwa Khefacha, Lamine Dhidah, Houyem Said Laatiri

Abstract:

Background: Antimicrobial resistance is a growing threat to public health and motivates to improve prevention and control programs both at international (WHO) and national levels. Despite their low pathogenicity, vancomycin-resistant enterococci (VRE) are common nosocomial pathogens in several countries. The high potential for transmission of VRE between patients and the threat to send its resistance genes to other bacteria such as staphylococcus aureus already resistant to meticilin, justify strict control measures. Indeed, in Europe, the proportion of Enterococcus faecium responsible for invasive infections, varies from 1% to 35% in 2011 and less than 5% were resistant to vancomycin. In addition, it represents the second cause of urinary tract and wound infections and the third cause of nosocomial bacteremia in the United States. The nosocomial outbreaks of VRE have been mainly described in intensive care services, hematology-oncology and haemodialysis. An epidemic of VRE has affected our hospital and the objective of this work is to describe the measures put in place. Materials/Methods: Following the alert given by the service of plastic surgery concerning a patient carrier of VRE, a team of the prevention and healthcare security service (doctor + technician) made an investigation. A review of files was conducted to draw the synoptic table and the table of cases. Results: By contacting the microbiology laboratory, we have identified four other cases of VRE and who were hospitalized in Medical resuscitation department (2 cases, one of them was transferred to the Physical rehabilitation department), and Nephrology department (2 cases). The visit has allowed to detect several malfunctions in professional practice. A crisis cell has allowed to validate, coordinate and implement control measures following the recommendations of the Technical Center of nosocomial infections. In fact, the process was to technically isolate cases in their sector of hospitalization, to restrict the use of antibiotics, to strength measures of basic hygiene, and to make a screening by rectal swab for both cases and contacts (other patients and health staff). These measures have helped to control the situation and no other case has been reported for a month. 2 new cases have been detected in the intensive care unit after a month. However, these are short-term strategies, and other measures in the medium and long term should be taken into account in order to face similar outbreaks. Conclusion: The efforts to control the outbreak were not efficient since 2 new cases have been reported after a month. Therefore, a continuous monitoring in order to detect new cases earlier is crucial to minimize the dissemination of VRE.

Keywords: hospitals, nosocomial infection, outbreak, vancomycin-resistant enterococci

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1 A Patient-Centered Approach to Clinical Trial Development: Real-World Evidence from a Canadian Medical Cannabis Clinic

Authors: Lucile Rapin, Cynthia El Hage, Rihab Gamaoun, Maria-Fernanda Arboleda, Erin Prosk

Abstract:

Introduction: Sante Cannabis (SC), a Canadian group of clinics dedicated to medical cannabis, based in Montreal and in the province of Quebec, has served more than 8000 patients seeking cannabis-based treatment over the past five years. As randomized clinical trials with natural medical cannabis are scarce, real-world evidence offers the opportunity to fill research gaps between scientific evidence and clinical practice. Data on the use of medical cannabis products from SC patients were prospectively collected, leading to a large real-world database on the use of medical cannabis. The aim of this study was to report information on the profiles of both patients and prescribed medical cannabis products at SC clinics, and to assess the safety of medical cannabis among Canadian patients. Methods: This is an observational retrospective study of 1342 adult patients who were authorized with medical cannabis products between October 2017 and September 2019. Information regarding demographic characteristics, therapeutic indications for medical cannabis use, patterns in dosing and dosage form of medical cannabis and adverse effects over one-year follow-up (initial and 4 follow-up (FUP) visits) were collected. Results: 59% of SC patients were female, with a mean age of 56.7 (SD= 15.6, range= (19-97)). Cannabis products were authorized mainly for patients with a diagnosis of chronic pain (68.8% of patients), cancer (6.7%), neurological disorders (5.6%), and mood disorders (5.4 %). At initial visit, a large majority (70%) of patients were authorized exclusively medical cannabis products, 27% were authorized a combination of pharmaceutical cannabinoids and medical cannabis and 3% were prescribed only pharmaceutical cannabinoids. This pattern was recurrent over the one-year follow-up. Overall, oil was the preferred formulation (average over visits 72.5%) followed by a combination of oil and dry (average 19%), other routes of administration accounted for less than 4%. Patients were predominantly prescribed products with a balanced THC:CBD ratio (59%-75% across visits). 28% of patients reported at least one adverse effect (AE) at the 3-month follow-up visit and 12% at the six-month FUP visit. 84.8% of total AEs were mild and transient. No serious AE was reported. Overall, the most common side effects reported were dizziness (11.95% of total AEs), drowsiness (11.4%), dry mouth (5.5%), nausea (4.8%), headaches (4.6%), cough (4.4%), anxiety (4.1%) and euphoria (3.5%). Other adverse effects accounted for less than 3% of total AE. Conclusion: Our results confirm that the primary area of clinical use for medical cannabis is in pain management. Patients in this cohort are largely utilizing plant-based cannabis oil products with a balanced ratio of THC:CBD. Reported adverse effects were mild and included dizziness and drowsiness. This real-world data confirms the tolerable safety profile of medical cannabis and suggests medical indications not yet validated in controlled clinical trials. Such data offers an important opportunity for the investigation of the long-term effects of cannabinoid exposure in real-life conditions. Real-world evidence can be used to direct clinical trial research efforts on specific indications and dosing patterns for product development.

Keywords: medical cannabis, safety, real-world data, Canada

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