Search results for: Samir Kumar Pal
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1755

Search results for: Samir Kumar Pal

1545 Body Farming in India and Asia

Authors: Yogesh Kumar, Adarsh Kumar

Abstract:

A body farm is a research facility where research is done on forensic investigation and medico-legal disciplines like forensic entomology, forensic pathology, forensic anthropology, forensic archaeology, and related areas of forensic veterinary. All the research is done to collect data on the rate of decomposition (animal and human) and forensically important insects to assist in crime detection. The data collected is used by forensic pathologists, forensic experts, and other experts for the investigation of crime cases and further research. The research work includes different conditions of a dead body like fresh, bloating, decay, dry, and skeleton, and data on local insects which depends on the climatic conditions of the local areas of that country. Therefore, it is the need of time to collect appropriate data in managed conditions with a proper set-up in every country. Hence, it is the duty of the scientific community of every country to establish/propose such facilities for justice and social management. The body farms are also used for training of police, military, investigative dogs, and other agencies. At present, only four countries viz. U.S., Australia, Canada, and Netherlands have body farms and related facilities in organised manner. There is no body farm in Asia also. In India, we have been trying to establish a body farm in A&N Islands that is near Singapore, Malaysia, and some other Asian countries. In view of the above, it becomes imperative to discuss the matter with Asian countries to collect the data on decomposition in a proper manner by establishing a body farm. We can also share the data, knowledge, and expertise to collaborate with one another to make such facilities better and have good scientific relations to promote science and explore ways of investigation at the world level.

Keywords: body farm, rate of decomposition, forensically important flies, time since death

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1544 Prospective Validation of the FibroTest Score in Assessing Liver Fibrosis in Hepatitis C Infection with Genotype 4

Authors: G. Shiha, S. Seif, W. Samir, K. Zalata

Abstract:

Prospective Validation of the FibroTest Score in assessing Liver Fibrosis in Hepatitis C Infection with Genotype 4 FibroTest (FT) is non-invasive score of liver fibrosis that combines the quantitative results of 5 serum biochemical markers (alpha-2-macroglobulin, haptoglobin, apolipoprotein A1, gamma glutamyl transpeptidase (GGT) and bilirubin) and adjusted with the patient's age and sex in a patented algorithm to generate a measure of fibrosis. FT has been validated in patients with chronic hepatitis C (CHC) (Halfon et al., Gastroenterol. Clin Biol.( 2008), 32 6suppl 1, 22-39). The validation of fibro test ( FT) in genotype IV is not well studied. Our aim was to evaluate the performance of FibroTest in an independent prospective cohort of hepatitis C patients with genotype 4. Subject was 122 patients with CHC. All liver biopsies were scored using METAVIR system. Our fibrosis score(FT) were measured, and the performance of the cut-off score were done using ROC curve. Among patients with advanced fibrosis, the FT was identically matched with the liver biopsy in 18.6%, overestimated the stage of fibrosis in 44.2% and underestimated the stage of fibrosis in 37.7% of cases. Also in patients with no/mild fibrosis, identical matching was detected in 39.2% of cases with overestimation in 48.1% and underestimation in 12.7%. So, the overall results of the test were identical matching, overestimation and underestimation in 32%, 46.7% and 21.3% respectively. Using ROC curve it was found that (FT) at the cut-off point of 0.555 could discriminate early from advanced stages of fibrosis with an area under ROC curve (AUC) of 0.72, sensitivity of 65%, specificity of 69%, PPV of 68%, NPV of 66% and accuracy of 67%. As FibroTest Score overestimates the stage of advanced fibrosis, it should not be considered as a reliable surrogate for liver biopsy in hepatitis C infection with genotype 4.

Keywords: fibrotest, chronic Hepatitis C, genotype 4, liver biopsy

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1543 Early Gastric Cancer Prediction from Diet and Epidemiological Data Using Machine Learning in Mizoram Population

Authors: Brindha Senthil Kumar, Payel Chakraborty, Senthil Kumar Nachimuthu, Arindam Maitra, Prem Nath

Abstract:

Gastric cancer is predominantly caused by demographic and diet factors as compared to other cancer types. The aim of the study is to predict Early Gastric Cancer (ECG) from diet and lifestyle factors using supervised machine learning algorithms. For this study, 160 healthy individual and 80 cases were selected who had been followed for 3 years (2016-2019), at Civil Hospital, Aizawl, Mizoram. A dataset containing 11 features that are core risk factors for the gastric cancer were extracted. Supervised machine algorithms: Logistic Regression, Naive Bayes, Support Vector Machine (SVM), Multilayer perceptron, and Random Forest were used to analyze the dataset using Python Jupyter Notebook Version 3. The obtained classified results had been evaluated using metrics parameters: minimum_false_positives, brier_score, accuracy, precision, recall, F1_score, and Receiver Operating Characteristics (ROC) curve. Data analysis results showed Naive Bayes - 88, 0.11; Random Forest - 83, 0.16; SVM - 77, 0.22; Logistic Regression - 75, 0.25 and Multilayer perceptron - 72, 0.27 with respect to accuracy and brier_score in percent. Naive Bayes algorithm out performs with very low false positive rates as well as brier_score and good accuracy. Naive Bayes algorithm classification results in predicting ECG showed very satisfactory results using only diet cum lifestyle factors which will be very helpful for the physicians to educate the patients and public, thereby mortality of gastric cancer can be reduced/avoided with this knowledge mining work.

Keywords: Early Gastric cancer, Machine Learning, Diet, Lifestyle Characteristics

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1542 Sustainability in Retaining Wall Construction with Geosynthetics

Authors: Sateesh Kumar Pisini, Swetha Priya Darshini, Sanjay Kumar Shukla

Abstract:

This paper seeks to present a research study on sustainability in construction of retaining wall using geosynthetics. Sustainable construction is a way for the building and infrastructure industry to move towards achieving sustainable development, taking into account environmental, socioeconomic and cultural issues. Geotechnical engineering, being very resource intensive, warrants an environmental sustainability study, but a quantitative framework for assessing the sustainability of geotechnical practices, particularly at the planning and design stages, does not exist. In geotechnical projects, major economic issues to be addressed are in the design and construction of stable slopes and retaining structures within space constraints. In this paper, quantitative indicators for assessing the environmental sustainability of retaining wall with geosynthetics are compared with conventional concrete retaining wall through life cycle assessment (LCA). Geosynthetics can make a real difference in sustainable construction techniques and contribute to development in developing countries in particular. Their imaginative application can result in considerable cost savings over the use of conventional designs and materials. The acceptance of geosynthetics in reinforced retaining wall construction has been triggered by a number of factors, including aesthetics, reliability, simple construction techniques, good seismic performance, and the ability to tolerate large deformations without structural distress. Reinforced retaining wall with geosynthetics is the best cost-effective and eco-friendly solution as compared with traditional concrete retaining wall construction. This paper presents an analysis of the theme of sustainability applied to the design and construction of traditional concrete retaining wall and presenting a cost-effective and environmental solution using geosynthetics.

Keywords: sustainability, retaining wall, geosynthetics, life cycle assessment

Procedia PDF Downloads 2019
1541 Prognostic Value of Serum Matrix Metalloproteinase (MMP-9) in Critically Ill Septic Patients

Authors: Sherif Sabri, Nael Samir, Mohamed Ali, Ahmed ElSakhawy

Abstract:

Introduction: There is growing evidence to support the hypothesis that serum matrix metalloproteinase -9 in could be an early predictor of mortality in septic patients. Aim of the work: Study the relationship of matrix metalloproteinase 9 in patients with SIRS in comparison to septic patients in day 0 and day 2. Patients and Methods: This is a prospective observational study conducted on 40 adult critically ill patients staying more than 24 hours in ICU either surgical or medical department, El Fayoum General Hospital in the period from November 2014 to March 2015. Patients met at least two of the criteria for severe inflammatory response syndrome (SIRS). Diagnostic criteria include several clinical and laboratory findings of sepsis induced tissue hypoperfusion or organ dysfunction. Samples were grouped as drawn either at admission, or at day 2 after admission. Results: Patients were divided into two groups: The non-sepsis (SIRS) group, which included 15 (37.5%) patients with no later evidence of sepsis were enrolled as controls. The Sepsis group, which included 25 patients diagnosed to have SIRS with later evidence of sepsis with positive culture. Exploring serum level of MMP-9 in non-survivors and survivors, there was significant increase in non-survivors if compared to survivors at admission p-value 0.001 (mean value in survivors 4.4mg/dl±4.1mg/dl at admission versus mean value in non-survivors 11.9mg/dl±5.8mg/dl) and after two days of admission was also significant increase p-value 0.001 (mean value in survivors 10.9mg/dl ±9.4mg/dl versus mean value in non-survivors 22.6mg/dl±10.4). Conclusion: MMP-9 levels in septic patients have a beneficial role in ICU for high-risk stratification as it is an independent marker of mortality in severe sepsis.

Keywords: matrix metalloproteinase (MMP-9), sepsis, septic shock, systemic inflamatory response syndrome

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1540 Groundwater Recharge Pattern in East and West Coast of India: Evidence of Dissimilar Moisture Sources

Authors: Ajit Kumar Behera, Saranya P., Sudhir Kumar, Krishnakumar A

Abstract:

The stable isotope (δ¹⁸ O and δ²H) composition of groundwater of the coastal areas of Periyar and Mahanadi basins falling along East and West coast of India during North-East (NE) monsoon season have been studied. The east and west coast regions are surrounded by the Bay of Bengal and the Arabian Sea respectively, which are considered to be the primary sources for precipitation over India. The major difference between the Bay of Bengal and the Arabian Sea is that a number of large rivers feed the Bay of Bengal, whereas the Arabian Sea is fed by very few small rivers, resulting in enriched stable isotopic composition of the Arabian Sea than the Bay of Bengal. Previous studies have reported depleted ratios of stable isotopes during Northeast monsoon along East and West coasts due to the influence of the Bay of Bengal moisture source. The isotopic composition of groundwater of the Mahanadi delta in the east coast region varies from -6.87 ‰ to -3.40 ‰ for δ¹⁸ O and -45.42 ‰ to -22.43‰ for δ²H. However, the groundwater of the Periyar basin in the west coast has enriched stable isotope value varying from -4.3‰ to -2.5 ‰ for δ¹⁸ O and for δ²H from -23.7 to -6.4 ‰ which is a characteristic of South-West monsoon season. This suggests the groundwater system of the Mahanadi delta and the Periyar basins are influenced by dissimilar moisture sources. The δ¹⁸ O and δ² H relationship (δ²H= 6.513 δ¹⁸ O - 1.39) and d-excess value (< 10) in the east coast region indicates the influence of NE monsoon implying the quick groundwater recharge after precipitation with significant amount of evaporation. In contrast, the δ¹⁸ O and δ²H regression line (δ²H= 8.408 δ¹⁸ O + 11.71) with high d-excess value (>10) in the west coast region implies delayed recharge due to SW monsoon. The observed isotopic enrichment in west coast suggests that NE winter monsoon rainfall does not replenish groundwater quick enough to produce isotopic depletion during the season.

Keywords: Arabian sea, bay of Bengal, groundwater, monsoon, stable isotope

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1539 Performance Evaluation of Solid Lubricant Characteristics at Different Sliding Conditions

Authors: Suresh Kumar Reddy Narala, Rakesh Kumar Gunda

Abstract:

In modern industry, mechanical parts are subjected to friction and wear, leading to heat generation, which affects the reliability, life and power consumption of machinery. To overcome the tribological losses due to friction and wear, a significant portion of lubricant with high viscous properties allows very smooth relative motion between two sliding surfaces. Advancement in modern tribology has facilitated the use of applying solid lubricants in various industrial applications. Solid lubricant additives with high viscous thin film formation between the sliding surfaces can adequately wet and adhere to a work surface. In the present investigation, an attempt has been made to investigate and evaluate the tribological studies of various solid lubricants like MoS¬2, graphite, and boric acid at different sliding conditions. The base oil used in this study was SAE 40 oil with a viscosity of 220 cSt at 400C. The tribological properties were measured on pin-on-disc tribometer. An experimental set-up has been developed for effective supply of solid lubricants to the pin-disc interface zone. The results obtained from the experiments show that the friction coefficient increases with increase in applied load for all the considered environments. The tribological properties with MoS2 solid lubricant exhibit larger load carrying capacity than that of graphite and boric acid. The present research work also contributes to the understanding of the behavior of film thickness distribution of solid lubricant using potential contact technique under different sliding conditions. The results presented in this research work are expected to form a scientific basis for selecting the best solid lubricant in various industrial applications for possible minimization of friction and wear.

Keywords: friction, wear, temperature, solid lubricant

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1538 Socio-Economic Problems in Treatment of Non-Union Both Bones Fracture of the Leg: A Retrospective Study

Authors: Rajendra Kumar Kanojia

Abstract:

Treatment of fracture both bones of leg following trauma is done intially at nearby primary health care center.primary management for shock,pain,control of bleeding,plaster application. These are treated for primay fixation of fracture, debridment of wound. Then, they were refered to tertiary care where they were again and planned for further treatment. This leads to loss of lot of time, money, job, etc.

Keywords: fracture both bones leg, non-union, ilizarov, cost

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1537 Microscopic Examination of the Pre-Hatching Development of the Chicken Ovary

Authors: Mohamed Alsafy, Samir El-Gendy, Ashraf Karkoura, Doha Shokry

Abstract:

The purpose of the current study was to investigate the development of the chicken ovary. One hundred fertilized egg of Alexandria breed of chicken used. The whole embryo has undergone the light microscopic examination at HH20 (E.3), HH21 (E.3.5), HH23 (E.4), HH29 (E.6) and HH34 (E.8). The ovary has undergone the light microscopic examination at HH38 (E.12) and HH42 (E.16), SEM at HH26 (E.5), HH29 (E.6), HH36 (E.10), HH38 (E.12), HH39 (E.13) and HH42 (E.16), TEM at HH38 (E.12) and HH42 (E.16). The genital ridge appeared by a thickening of the coelomic epithelium medioventral surface of the developing mesonephroi at HH20 (E.3). The boundaries of the undifferentiating gonads defined clearly separated from the mesonephroi. The undifferentiated gonads bulged as a distinct organ in the coelomic cavity at HH23 (E.4). At the initial stages of the gonadogenesis, the germinal epithelium was stratified squamous epithelium. The PGCs appeared at the genital ridge at HH21 (E.3.5). The PGCs observed at the dorsal mesentery with few microvilli and showed positive PAS reaction due to the glycogen content in their cytoplasm. The left-right gonadal asymmetry firstly detected by the number of PGCs migrating toward the left gonadal ridge more than the right at HH20 (E.3) and the macroscopic examination of gonadal asymmetry began at HH34 (E.8). The left ovary appeared a smooth rod-shape, its stroma showed lipid droplets, and its parenchyma showed an extensive arrangement of interstitial cords at HH42 (E.16).

Keywords: ovary, Alexandria chicken, light microscopy, SEM, TEM

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1536 Setting the Baseline for a Sentinel System for the Identification of Occupational Risk Factors in Africa

Authors: Menouni Aziza, Chbihi Kaoutar, Duca Radu Corneliu, Gilissen Liesbeth, Bounou Salim, Godderis Lode, El Jaafari Samir

Abstract:

In Africa, environmental and occupational health risks are mostly underreported. The aim of this research is to develop and implement a sentinel surveillance system comprising training and guidance of occupational physicians (OC) who will report new work-related diseases in African countries. A group of 30 OC are recruited and trained in each of the partner countries (Morocco, Benin and Ethiopia). Each committed OC is asked to recruit 50 workers during a consultation in a time-frame of 6 months (1500 workers per country). Workers are asked to fill out an online questionnaire about their health status and work conditions, including exposure to 20 chemicals. Urine and blood samples are then collected for human biomonitoring of common exposures. Some preliminary results showed that 92% of the employees surveyed are exposed to physical constraints, 44% to chemical agents, and 24% to biological agents. The most common physical constraints are manual handling of loads, noise pollution and thermal pollution. The most frequent chemical risks are exposure to pesticides and fuels. This project will allow a better understanding of effective sentinel systems as a promising method to gather high quality data, which can support policy-making in terms of preventing emerging work-related diseases.

Keywords: sentinel system, occupational diseases, human biomonitoring, Africa

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1535 A Study on Consumer Awareness, Safety Perceptions and Practices About Food Preservatives and Flavouring Agents Used in Packed / Canned Foods from South India

Authors: Harsha Kumar H. N., Anshu Kumar Jha, Khushboo Kamal Taneja, Krishan Kabra, Mohamed Hafeez Sadiq

Abstract:

Introduction: The increasing use of preservatives and flavouring agents has the potential to cause health problem among the people. There are no published studies from India exploring the awareness, safety perception, & practices about Food Preservatives (FPs) and Flavouring Agents (FAs). So this study was conducted with the objectives of assessing the awareness, safety perceptions & practices about Food Preservatives (FPs), Flavouring Agents (FAs) in commonly bought / purchased packed food items. Materials & method: This cross-sectional study was conducted in January 2012. Sample size of 126 was computed using the formula for infinite population. People who bought packed food items in malls were approached and requested to fill a pre-tested semi-structured questionnaire. The questionnaire explored awareness, safety perception & practices of FPs & FAs. Data was then analyzed using SPSS version 10.0. Chi-square test was used to know if the observed differences were statistically significant. ‘p’ value <0.05 was considered significant. Results: Totally 123 people (males- 48.8% and females-51.2%) participated (response rate of 97.6%) in the study. Majority of the people were aware about presence of ‘FPs’ (91.7%) and ‘FAs’ (84.9%) though their knowledge was inadequate. Breakup of the study subjects according to level of awareness about FPs was as follows (%): Good (37.4), Satisfactory (40.6), Poor (22) & FAs (%): Good (49.6), Satisfactory (36) & Poor (14). Distribution according to type of practices for FPs was as follows (%): Favourable (14), Unfavourable (86) & FAs (%): Favourable (30.5), Unfavourable (69.5). There was a gap between knowledge and practices. Conclusion: Though there was awareness, the knowledge was inadequate. Unfavourable practices were observed. The gaps in the knowledge and unhealthy practices need to be addressed by public awareness campaign.

Keywords: food preservatives, flavouring agents, knowledge and practices, general population

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1534 Advanced Mouse Cursor Control and Speech Recognition Module

Authors: Prasad Kalagura, B. Veeresh kumar

Abstract:

We constructed an interface system that would allow a similarly paralyzed user to interact with a computer with almost full functional capability. A real-time tracking algorithm is implemented based on adaptive skin detection and motion analysis. The clicking of the mouse is activated by the user's eye blinking through a sensor. The keyboard function is implemented by voice recognition kit.

Keywords: embedded ARM7 processor, mouse pointer control, voice recognition

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1533 Numerical Studies on Thrust Vectoring Using Shock-Induced Self Impinging Secondary Jets

Authors: S. Vignesh, N. Vishnu, S. Vigneshwaran, M. Vishnu Anand, Dinesh Kumar Babu, V. R. Sanal Kumar

Abstract:

The study of the primary flow velocity and the self impinging secondary jet flow mixing is important from both the fundamental research and the application point of view. Real industrial configurations are more complex than simple shear layers present in idealized numerical thrust-vectoring models due to the presence of combustion, swirl and confinement. Predicting the flow features of self impinging secondary jets in a supersonic primary flow is complex owing to the fact that there are a large number of parameters involved. Earlier studies have been highlighted several key features of self impinging jets, but an extensive characterization in terms of jet interaction between supersonic flow and self impinging secondary sonic jets is still an active research topic. In this paper numerical studies have been carried out using a validated two-dimensional k-omega standard turbulence model for the design optimization of a thrust vector control system using shock induced self impinging secondary flow sonic jets using non-reacting flows. Efforts have been taken for examining the flow features of TVC system with various secondary jets at different divergent locations and jet impinging angles with the same inlet jet pressure and mass flow ratio. The results from the parametric studies reveal that in addition to the primary to the secondary mass flow ratio the characteristics of the self impinging secondary jets having bearing on an efficient thrust vectoring. We concluded that the self impinging secondary jet nozzles are better than single jet nozzle with the same secondary mass flow rate owing to the fact fixing of the self impinging secondary jet nozzles with proper jet angle could facilitate better thrust vectoring for any supersonic aerospace vehicle.

Keywords: fluidic thrust vectoring, rocket steering, supersonic to sonic jet interaction, TVC in aerospace vehicles

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1532 Optimisation of Metrological Inspection of a Developmental Aeroengine Disc

Authors: Suneel Kumar, Nanda Kumar J. Sreelal Sreedhar, Suchibrata Sen, V. Muralidharan,

Abstract:

Fan technology is very critical and crucial for any aero engine technology. The fan disc forms a critical part of the fan module. It is an airworthiness requirement to have a metrological qualified quality disc. The current study uses a tactile probing and scanning on an articulated measuring machine (AMM), a bridge type coordinate measuring machine (CMM) and Metrology software for intermediate and final dimensional and geometrical verification during the prototype development of the disc manufactured through forging and machining process. The circumferential dovetails manufactured through the milling process are evaluated based on the evaluated and analysed metrological process. To perform metrological optimization a change of philosophy is needed making quality measurements available as fast as possible to improve process knowledge and accelerate the process but with accuracy, precise and traceable measurements. The offline CMM programming for inspection and optimisation of the CMM inspection plan are crucial portions of the study and discussed. The dimensional measurement plan as per the ASME B 89.7.2 standard to reach an optimised CMM measurement plan and strategy are an important requirement. The probing strategy, stylus configuration, and approximation strategy effects on the measurements of circumferential dovetail measurements of the developmental prototype disc are discussed. The results were discussed in the form of enhancement of the R &R (repeatability and reproducibility) values with uncertainty levels within the desired limits. The findings from the measurement strategy adopted for disc dovetail evaluation and inspection time optimisation are discussed with the help of various analyses and graphical outputs obtained from the verification process.

Keywords: coordinate measuring machine, CMM, aero engine, articulated measuring machine, fan disc

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1531 Big Data in Telecom Industry: Effective Predictive Techniques on Call Detail Records

Authors: Sara ElElimy, Samir Moustafa

Abstract:

Mobile network operators start to face many challenges in the digital era, especially with high demands from customers. Since mobile network operators are considered a source of big data, traditional techniques are not effective with new era of big data, Internet of things (IoT) and 5G; as a result, handling effectively different big datasets becomes a vital task for operators with the continuous growth of data and moving from long term evolution (LTE) to 5G. So, there is an urgent need for effective Big data analytics to predict future demands, traffic, and network performance to full fill the requirements of the fifth generation of mobile network technology. In this paper, we introduce data science techniques using machine learning and deep learning algorithms: the autoregressive integrated moving average (ARIMA), Bayesian-based curve fitting, and recurrent neural network (RNN) are employed for a data-driven application to mobile network operators. The main framework included in models are identification parameters of each model, estimation, prediction, and final data-driven application of this prediction from business and network performance applications. These models are applied to Telecom Italia Big Data challenge call detail records (CDRs) datasets. The performance of these models is found out using a specific well-known evaluation criteria shows that ARIMA (machine learning-based model) is more accurate as a predictive model in such a dataset than the RNN (deep learning model).

Keywords: big data analytics, machine learning, CDRs, 5G

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1530 Diagnostic Accuracy of the Tuberculin Skin Test for Tuberculosis Diagnosis: Interest of Using ROC Curve and Fagan’s Nomogram

Authors: Nouira Mariem, Ben Rayana Hazem, Ennigrou Samir

Abstract:

Background and aim: During the past decade, the frequency of extrapulmonary forms of tuberculosis has increased. These forms are under-diagnosed using conventional tests. The aim of this study was to evaluate the performance of the Tuberculin Skin Test (TST) for the diagnosis of tuberculosis, using the ROC curve and Fagan’s Nomogram methodology. Methods: This was a case-control, multicenter study in 11 anti-tuberculosis centers in Tunisia, during the period from June to November2014. The cases were adults aged between 18 and 55 years with confirmed tuberculosis. Controls were free from tuberculosis. A data collection sheet was filled out and a TST was performed for each participant. Diagnostic accuracy measures of TST were estimated using ROC curve and Area Under Curve to estimate sensitivity and specificity of a determined cut-off point. Fagan’s nomogram was used to estimate its predictive values. Results: Overall, 1053 patients were enrolled, composed of 339 cases (sex-ratio (M/F)=0.87) and 714 controls (sex-ratio (M/F)=0.99). The mean age was 38.3±11.8 years for cases and 33.6±11 years for controls. The mean diameter of the TST induration was significantly higher among cases than controls (13.7mm vs.6.2mm;p=10-6). Area Under Curve was 0.789 [95% CI: 0.758-0.819; p=0.01], corresponding to a moderate discriminating power for this test. The most discriminative cut-off value of the TST, which were associated with the best sensitivity (73.7%) and specificity (76.6%) couple was about 11 mm with a Youden index of 0.503. Positive and Negative predictive values were 3.11% and 99.52%, respectively. Conclusion: In view of these results, we can conclude that the TST can be used for tuberculosis diagnosis with a good sensitivity and specificity. However, the skin induration measurement and its interpretation is operator dependent and remains difficult and subjective. The combination of the TST with another test such as the Quantiferon test would be a good alternative.

Keywords: tuberculosis, tuberculin skin test, ROC curve, cut-off

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1529 Hydrogen Production Through Thermocatalytic Decomposition of Methane Over Biochar

Authors: Seyed Mohamad Rasool Mirkarimi, David Chiaramonti, Samir Bensaid

Abstract:

Catalytic methane decomposition (CMD, reaction 4) is a one-step process for hydrogen production where carbon in the methane molecule is sequestered in the form of stable and higher-value carbon materials. Metallic catalysts and carbon-based catalysts are two major types of catalysts utilized for the CDM process. Although carbon-based catalysts have lower activity compared to metallic ones, they are less expensive and offer high thermal stability and strong resistance to chemical impurities such as sulfur. Also, it would require less costly separation methods as some of the carbon-based catalysts may not have an active metal component in them. Since the regeneration of metallic catalysts requires burning of the C on their surfaces, which emits CO/CO2, in some cases, using carbon-based catalysts would be recommended because regeneration can be completely avoided, and the catalyst can be directly used in other processes. This work focuses on the effect of biochar as a carbon-based catalyst for the conversion of methane into hydrogen and carbon. Biochar produced from the pyrolysis of poplar wood and activated biochar are used as catalysts for this process. In order to observe the impact of carbon-based catalysts on methane conversion, methane cracking in the absence and presence of catalysts for a gas stream with different levels of methane concentration should be performed. The results of these experiments prove conversion of methane in the absence of catalysts at 900 °C is negligible, whereas in the presence of biochar and activated biochar, significant growth has been observed. Comparing the results of the tests related to using char and activated char shows the enhancement obtained in BET surface area of the catalyst through activation leads to more than 10 vol.% methane conversion.

Keywords: hydrogen production, catalytic methane decomposition, biochar, activated biochar, carbon-based catalyts

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1528 Chemical Composition, in vitro Antioxidant Activity and Gas Chromatography–Mass Spectrometry Analysis of Essential Oil and Extracts of Ruta chalpensis aerial Parts Growing in Tunisian Sahara

Authors: Samir Falhi, Neji Gharsallah, Adel Kadri

Abstract:

Ruta chalpensis L. is a medicinal plant in the family of Rutaceae, has been used as an important traditional in the Mediterranean basin in the treatment of many diseases. The current study was devoted to investigate and evaluate the chemical composition, total phenolic, flavonoid and tannin contents, and in vitro antioxidant activities of ethyl acetate, ethanol and hydroalcoholic extracts and essential oil from the aerial parts of Ruta chalpensis from Tunisian Sahara. Total phenolic, flavonoid and tannin contents of extracts ranged from 40.39 ± 1.87 to 75.13 ± 1.22 mg of GAE/g, from 22.62 ± 1.55 to 27.51 ± 1.04 mg of QE/g, and from 5.56 ± 1.32 to 10.89 ± 1.10 mg of CE/g respectively. Results showed that the highest antioxidant activities was determined for ethanol extract with IC50 value of 26.23 ± 0.91 µg/mL for 2,2-diphenyl-1-picrylhydrazyl assay, and for hydroalcoholic extract with EC50 value of 412.95±6.57 µg/mL and 105.52±2.45 mg of α-tocopherol/g for ferric reducing antioxidant power and total antioxidant capacity assays, respectively. Furthermore, Gas Chromatography–Mass Spectrometry (GC-MS) analysis of essential oil led to identification of 20 compounds representing 98.96 % of the total composition. The major components of essential oil were 2-undecanone (39.13%), 2-nonanone (25.04), 1-nonene (13.81), and α-limonene (7.72). Spectral data of Fourier-transform infrared spectroscopy analysis (FT-IR) of extracts revealed the presence of functional groups such as C= O, C─O, ─OH, and C─H, which confirmed its richness on polyphenols and biological active functional groups. These results showed that Ruta chalpensis could be a potential natural source of antioxidants that can be used in food and nutraceutical applications.

Keywords: antioxidant, FT-IR analysis, GC-MS analysis, phytochemicals contents, Ruta chalpensis

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1527 Acacia mearnsii De Wild-A New Scourge on Cork Oak Forests of El Kala National Park (North-Eastern Algeria)

Authors: Samir Chekchaki, ArifaBeddiar

Abstract:

Nowadays, more and more species are introduced outside their natural range. If most of them remain difficult, some may adopt a much more dynamic behavior. Indeed, we have witnessed in recent decades, the development of high forests of Acacia mearnsii in El Kala National Park. Introduced indefinitely, this leguminous intended to make money (nitrogen supply for industrial plantations of Eucalyptus), became one of the most invasive and more costly in terms of forest management. It has crossed all barriers: it has acclimatized, naturalized and then expanded through diverse landscapes; entry into competition with native species such as cork oak and altered ecosystem functioning. Therefore, it is interesting to analyze this new threat by relying on plants as bio-indicator for assessing biodiversity at different scales. We have identified the species present in several plots distributed in a range of vegetation types subjected to different degrees of disturbance by using the braun-blanquet method. Fifty-six species have been recorded. They are distributed in 48 genera and 29 families. The analysis of the relative frequency of species correlated with relative abundance clearly shows that the Acacia mearnsii feels marginalized. The ecological analysis of this biological invasion shows that disruption of either natural or anthropogenic origin (fire, prolonged drought, cut) represent the factors that exacerbate invasion by opening invasion windows. The lifting of seeds of Acacia mearnsii lasting physical dormancy (and variable) is ensured by the thermal shock in relation to its heliophilous character.

Keywords: Acacia mearnsii De Wild, El Kala National park, fire, invasive, vegetation

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1526 Development of Monoclonal Antibodies against the Acute Hepatopancreatic Necrosis Disease Toxins

Authors: Naveen Kumar B. T., Anuj Tyagi, Niraj Kumar Singh, Visanu Boonyawiwat, Shanthanagouda A. H., Orawan Boodde, Shankar K. M., Prakash Patil, Shubhkaramjeet Kaur

Abstract:

Since 2009, Acute Hepatopancreatic Necrosis Disease (AHPND) outbreaks have increased rapidly, and these have led to the major economic losses to the global shrimp industry. In comparison to other treatments, passive immunity and monoclonal antibody (MAb) based farmer level kit have proved their importance in controlling and treating the diseases in the shrimp industry. In the present study, MAbs were produced against the recombinant PirB protein Vibrio parahaemolyticus strain causing AHPND. Briefly, Balb/C mice were immunized with rPirB at 15 days interval, and antibody titer was determined by ELISA. Spleen cells from mice showing high antibody titer were fused with SP2O myeloma cells for hybridoma production. Among 130 hybridomas, four showed high antibody titer and positive reactivity in an immunoblot assay. In Western blot assay, three out of four MAbs (4C4, 2C2 and 4G3) showed reactivity to rPirB protein. However, in the natural host, only Mab clone 4G3 show strong reactivity (with a strain of V. parahemolyticus causing EMS/AHPND). These clones also showed reactivity with less than 20 kDa proteins in AHPND free V. parahaemolyticus (Thailand stain). Further, on from MAb 4G3 clone, four panels of single cell MAbs clones (G3F5, G3B8, G3H2, and G3D6) were produced of which three showed strong positive reactivity to rPirB protein in the Western blot. These MAbs have potential for controlling and prevention of the AHPND through passive immunity and development of filed level rapid diagnostic kits.

Keywords: shrimp, economic loss, AHPND, MAb

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1525 Numerical Study on Jatropha Oil Pool Fire Behavior in a Compartment

Authors: Avinash Chaudhary, Akhilesh Gupta, Surendra Kumar, Ravi Kumar

Abstract:

This paper presents the numerical study on Jatropha oil pool fire in a compartment. A fire experiment with jatropha oil was conducted in a compartment of size 4 m x 4 m x m to study the fire development and temperature distribution. Fuel is burned in the center of the compartment in a pool diameter of 0.5 m with an initial fuel depth of 0.045 m. Corner temperature in the compartment, doorway temperature and hot gas layer temperature at various locations are measured. Numerical simulations were carried out using Fire Dynamics Simulator (FDS) software at grid size of 0.05 m, 0.12 m and for performing simulation heat release rate of jatropha oil measured using mass loss method were inputted into FDS. Experimental results shows that like other fuel fires, the whole combustion process can be divided into four stages: initial stage, growth stage, steady profile or developed phase and decay stage. The fire behavior shows two zone profile where upper zone consists of mainly hot gases while lower zone is relatively at colder side. In this study, predicted temperatures from simulation are in good agreement in upper zone of compartment. Near the interface of hot and cold zone, deviations were reported between the simulated and experimental results which is probably due to the difference between the predictions of smoke layer height by FDS. Also, changing the grid size from 0.12 m to 0.05 m does not show any effect in temperatures at upper zone while in lower zone, grid size of 0.05 m showed satisfactory agreement with experimental results. Numerical results showed that calculated temperatures at various locations matched well with the experimental results. On the whole, an effective method is provided with reasonable results to study the burning characteristics of jatropha oil with numerical simulations.

Keywords: jatropha oil, compartment fire, heat release rate, FDS (fire dynamics simulator), numerical simulation

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1524 Investigating Naming and Connected Speech Impairments in Moroccan AD Patients

Authors: Mounia El Jaouhari, Mira Goral, Samir Diouny

Abstract:

Introduction: Previous research has indicated that language impairments are recognized as a feature of many neurodegenerative disorders, including non-language-led dementia subtypes such as Alzheimer´s disease (AD). In this preliminary study, the focal aim is to quantify the semantic content of naming and connected speech samples of Moroccan patients diagnosed with AD using two tasks taken from the culturally adapted and validated Moroccan version of the Boston Diagnostic Aphasia Examination. Methods: Five individuals with AD and five neurologically healthy individuals matched for age, gender, and education will participate in the study. Participants with AD will be diagnosed on the basis of the Moroccan version of the Diagnostic and Statistial Manual of Mental Disorders (DSM-4) screening test, the Moroccan version of the Mini Mental State Examination (MMSE) test scores, and neuroimaging analyses. The participants will engage in two tasks taken from the MDAE-SF: 1) Picture description and 2) Naming. Expected findings: Consistent with previous studies conducted on English speaking AD patients, we expect to find significant word production and retrieval impairments in AD patients in all measures. Moreover, we expect to find category fluency impairments that further endorse semantic breakdown accounts. In sum, not only will the findings of the current study shed more light on the locus of word retrieval impairments noted in AD, but also reflect the nature of Arabic morphology. In addition, the error patterns are expected to be similar to those found in previous AD studies in other languages.

Keywords: alzheimer's disease, anomia, connected speech, semantic impairments, moroccan arabic

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1523 Analgesic Efficacy of IPACK Block in Primary Total Knee Arthroplasty (90 CASES)

Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

Abstract:

 Background and aims: Peripheral regional anesthesia has been integrated into most analgesia protocols for total knee arthroplasty which considered among the most painful surgeries with a huge potential for chronicization. The adductor canal block (ACB) has gained popularity. Similarly, the IPACK block has been described to provide analgesia of the posterior knee capsule. This study aimed to evaluate the analgesic efficacy of this block in patients undergoing primary PTG. Methods: 90 patients were randomized to receive either an IPACK, an anterior sciatic block, or a sham block (30 patients in each group + multimodal analgesia and a catheter in the KCA adductor canal). GROUP 1 KCA GROUP 2 KCA+BSA GROUP 3 KCA+IPACK The analgesic blocks were done under echo-guidance preoperatively respecting the safety rules, the dose administered was 20 cc of ropivacaine 0.25% was used. We were to assess posterior knee pain 6 hours after surgery. Other endpoints included quality of recovery after surgery, pain scores, opioid requirements (PCA morphine)(EPI info 7.2 analysis). Results: -groups were matched -A predominance of women (4F/1H). -average age: 68 +/-7 years -the average BMI =31.75 kg/m2 +/- 4. -70% of patients ASA2 ,20% ASA3. -The average duration of the intervention: 89 +/- 19 minutes. -Morphine consumption (PCA) significantly higher in group 1 (16mg) & group 2 (8mg) group 3 (4mg) - The groups were matched . -There was a correlation between the use of the ipack block and postoperative pain Conclusions :In a multimodal analgesic protocol, the addition of IPACK block decreased pain scores and morphine consumption ,

Keywords: regional anesthesia, analgesia, total knee arthroplasty, the adductor canal block (acb), the ipack block, pain

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1522 Prevalence and Risk Factors of Metabolic Syndrome in Adults of Terai Region of Nepal

Authors: Birendra Kumar Jha, Mingma L. Sherpa, Binod Kumar Dahal

Abstract:

Background: The metabolic syndrome is emerging as a major public health concern in the world. Urbanization, surplus energy uptake, compounded by decreased physical activities, and increasing obesity are the major factors contributing to the epidemic of metabolic syndrome worldwide. However, prevalence of metabolic syndrome and its risk factors are little studied in Terai region of Nepal. The objectives of this research were to estimate the prevalence and to identify the risk factors of metabolic syndrome among adults in Terai region of Nepal. Method: We used a community based cross sectional study design. A total of 225 adults (age: 18 to 80 years) were selected from three district of Terai region of Nepal using cluster sampling by camp approach. IDF criteria (central obesity with any two of following four factors: triglycerides ≥ 150 mg/dl or specific treatment for lipid abnormality, reduced HDL, raised blood pressure and raised fasting plasma glucose or previously diagnosed type 2 diabetes) were used to assess metabolic syndrome. Interview, physical and clinical examination, measurement of fasting blood glucose and lipid profile were conducted for all participants. Chi-square test and multivariable logistic regression were employed to explore the risk factors of metabolic syndrome. Result: The overall prevalence of metabolic syndrome was 70.7%. Hypertension, increased fasting blood sugar, increased triglycerides and decreased HDL were observed in 50.7%, 32.4%, 41.8% and 79.1% of the subjects respectively. Socio-economic and behavioral risk factors significantly associated with metabolic syndrome were gender male (OR=2.56, 955 CI: 1.42-4.63; p=0.002), in service or retired from service (OR=3.72, 95% CI: 1.72-8.03; p=0.001) and smoking (OR= 4.10, 95% CI: 1.19-14.07; p=0.016). Conclusion: Higher prevalence of Metabolic syndrome along with presence of behavioral risk factors in Terai region of Nepal likely suggest lack of awareness and health promotion activities for metabolic syndrome and indicate the need to promote public health programs in this region to maintain quality of life.

Keywords: metabolic syndrome, Nepal, prevalence, risk factors, Terai

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1521 Early versus Late Percutaneous Tracheostomy in Critically Ill Adult Mechanically Ventilated Patients

Authors: Kamel Abd Elaziz Mohamed, Ahmed Yehia Mousa, Ahmed Samir ElSawy, Adel Mohamed Saleem

Abstract:

Introduction: Critically ill patients frequently require tracheostomy to simplify long term air way management. While tracheostomy indications have remained unchanged, the timing of elective tracheostomy for the ventilated patient has been questioned. Aim of the work: This study was performed to compare the differences between early and late percutaneous dilatational tracheostomy (PDT) regarding, mechanical ventilation duration (MVD), length of ICU stay, length of hospital stay, incidence of ventilator associated pneumonia and hospital outcome. Patients and methods: Forty patients who met the inclusion criteria were randomly divided into early PDT who had the tracheostomy within the first 10 days of mechanical ventilation (MV) and the late PDT who had the tracheostomy after 10 days of MV. On admission, demographic data and Acute Physiology and Chronic ill Health II and GCS were collected. The duration of mechanical ventilation, ICU length of stay (LOS) and hospital LOS were all calculated. Results: Total of 40 patients were randomized to either early PDT (n= 20) or late PDT (n= 20). There were no significant differences between both groups regarding demographic data or the scores: APACHE II (22.75± 7 vs 24.35 ± 8) and GCS (6.10 ±2 vs 7.10 ± 2.71). An early PDT showed fewer complications vs late procedure, however it was insignificant. There were significant differences between the two groups regarding mean (MVD) which was shorter in early PDT than the late PDT group (32.2± 10.5) vs (20.6 ± 13 days; p= 0.004). Mean ICU stay was shorter in early PDT than late PDT (21 .0± 513.4) vs (40.15 ±12.7 days; p 6 0.001). Mean hospital stay was shorter in early PDT than late PDT (34.60± 18.37) vs (55.60± 25.73 days; p=0.005). Patients with early PDT suffered less sepsis and VAP than late PDT, there was no difference regarding the mortality rate between the two groups. Conclusion: Early PDT is recommended for patients who require prolonged tracheal intubation in the ICU as outcomes like the duration of mechanical ventilation length of ICU stay and hospital stay were significantly shorter in early tracheostomy.

Keywords: intensive care unit, early PDT, late PDT, intubation

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1520 Removal of Cr (VI) from Water through Adsorption Process Using GO/PVA as Nanosorbent

Authors: Syed Hadi Hasan, Devendra Kumar Singh, Viyaj Kumar

Abstract:

Cr (VI) is a known toxic heavy metal and has been considered as a priority pollutant in water. The effluent of various industries including electroplating, anodizing baths, leather tanning, steel industries and chromium based catalyst are the major source of Cr (VI) contamination in the aquatic environment. Cr (VI) show high mobility in the environment and can easily penetrate cell membrane of the living tissues to exert noxious effects. The Cr (VI) contamination in drinking water causes various hazardous health effects to the human health such as cancer, skin and stomach irritation or ulceration, dermatitis, damage to liver, kidney circulation and nerve tissue damage. Herein, an attempt has been done to develop an efficient adsorbent for the removal of Cr (VI) from water. For this purpose nanosorbent composed of polyvinyl alcohol functionalized graphene oxide (GO/PVA) was prepared. Thus, obtained GO/PVA was characterized through FTIR, XRD, SEM, and Raman Spectroscopy. As prepared nanosorbent of GO/PVA was utilized for the removal Cr (VI) in batch mode experiment. The process variables such as contact time, initial Cr (VI) concentration, pH, and temperature were optimized. The maximum 99.8 % removal of Cr (VI) was achieved at initial Cr (VI) concentration 60 mg/L, pH 2, temperature 35 °C and equilibrium was achieved within 50 min. The two widely used isotherm models viz. Langmuir and Freundlich were analyzed using linear correlation coefficient (R2) and it was found that Langmuir model gives best fit with high value of R2 for the data of present adsorption system which indicate the monolayer adsorption of Cr (VI) on the GO/PVA. Kinetic studies were also conducted using pseudo-first order and pseudo-second order models and it was observed that chemosorptive pseudo-second order model described the kinetics of current adsorption system in better way with high value of correlation coefficient. Thermodynamic studies were also conducted and results showed that the adsorption was spontaneous and endothermic in nature.

Keywords: adsorption, GO/PVA, isotherm, kinetics, nanosorbent, thermodynamics

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1519 Antioxidant Activity and Hepatoprotective Potential of Genista quadriflora Munby against Paracetamol-Induced Liver Injury

Authors: Nacera Baali, Zahia Belloum, Souad Ameddah, Fadila Benayache, Samir Benayache, Chantal Wrutniak-Cabello

Abstract:

Allurement of herbs as health beneficial foods and as a source material for the development of new drugs, has led to greater furtherance in the study of herbal medicines during recent years. In the present study, in vitro antioxidant, free radical scavenging capacity, and hepatoprotective activity of butanolic extract from Genista quadriflora Munby (G.quadriflora) were evaluated using established in vitro models such as DPPH radical and hydrogen peroxide radical scavenging activities and antilipidperoxidation ability. Interestingly, the extract showed considerable in vitro antioxidant and free radical scavenging activities in a dose-dependent manner when compared to the standard antioxidant which verified the presence of antioxidant compound in extract tested. The hepatoprotective potential of G.quadriflora extract was also evaluated in male Wistar rats against paracetamol (APAP) induced liver damage. Therapy of G.quadriflora showed the liver protective effect on biochemical and histopathological alterations. Moreover, histological studies also supported the biochemical finding, that is, the maximum improvement in the histoarchitecture of the liver. Results revealed that G.quadriflora extract could protect the liver against APAP-induced oxidative damage by possibly increasing the antioxidant protection mechanism in rats. These findings are of great importance in view of the availability of the plant and its observed possible diverse applications in medicine and nutrition.

Keywords: genista quadriflora munby, antioxidant, liver, paracetamol, oxidative stress

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1518 Caregiver’s Perception Regarding Diagnosis Disclosure to Children Living with Human Immunodeficiency Virus in Resource-Limited Settings: Observational Study from India

Authors: Ramesh Chand Chauhan, Sanjay Kumar Rai, Shashi kant, Rakesh Lodha, Nand Kumar

Abstract:

Background: With a better understanding of HIV pathogenesis and availability of antiretroviral therapy more children are growing and entering in teenage group; informing children of their own HIV status has become an important aspect of long-term disease management. There is little evidence of how and when this type of disclosure takes place in a resource-limited setting. Methods: A cross-sectional study was conducted from June 2010 to May 2011 among a dyads of 156 HIV-infected children and their caregivers, those were visiting pediatric clinic at a tertiary care hospital in Delhi, India. The study protocol was approved by the Institute Ethics Committee. After taking written informed consent; pretested structured questionnaire was administered to caregivers during routine clinic visits. Information regarding socio-demographic characteristics, awareness of HIV infection status among children and their perception regarding disclosure was collected. Mean and frequencies were calculated and chi-square and logistic regression test were applied. Results: The mean age of children was 8.4 ±3.45 years. Among them 73.7% were male and 39.1% were orphans. Among 156 enrolled children, 74.4% (n=116) were of ≥ 6 years and were assessed for disclosure. Only 18.1% (n=21) children had been informed of their HIV status. Of those under 9 years, 6.4% knew their status, whereas 18.4% of 9-11 years and 35.5% of 12-14 years children knew they had HIV. Awareness among males (23.3%) was higher than females (3.3%). Both age and sex of child were significantly (p<0.01) associated with disclosure status. Other factors favoring disclosure were orphan-hood, non-perinatal mode of transmission (OR = 4.32; 95% CI 1.01-7.12), ART initiation (OR = 4.21; 95% CI 1.03-6.98), and caregiver educated beyond primary level (OR = 1.89; 95% CI 1.03-3.26). Repeated enquiry regarding the visit to clinic was the most common reason (66.6%) for disclosure. In 52.4% children disclosure was done with the involvement of other family members. 82.5% caregivers felt the age of > 10 years is appropriate for disclosing the HIV infection status to the child. Conclusion: Detailed guidelines on disclosure are required focusing on children of school-going age with perinatal infection who are not on ART and with caregivers of low educational status.

Keywords: HIV, children, India, disclosure

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1517 Variation of Manning’s Coefficient in a Meandering Channel with Emergent Vegetation Cover

Authors: Spandan Sahu, Amiya Kumar Pati, Kishanjit Kumar Khatua

Abstract:

Vegetation plays a major role in deciding the flow parameters in an open channel. It enhances the aesthetic view of the revetments. The major types of vegetation in river typically comprises of herbs, grasses, weeds, trees, etc. The vegetation in an open channel usually consists of aquatic plants with complete submergence, partial submergence, floating plants. The presence of vegetative plants can have both benefits and problems. The major benefits of aquatic plants are they reduce the soil erosion, which provides the water with a free surface to move on without hindrance. The obvious problems are they retard the flow of water and reduce the hydraulic capacity of the channel. The degree to which the flow parameters are affected depends upon the density of the vegetation, degree of submergence, pattern of vegetation, vegetation species. Vegetation in open channel tends to provide resistance to flow, which in turn provides a background to study the varying trends in flow parameters having vegetative growth in the channel surface. In this paper, an experiment has been conducted on a meandering channel having sinuosity of 1.33 with rigid vegetation cover to investigate the effect on flow parameters, variation of manning’s n with degree of the denseness of vegetation, vegetation pattern and submergence criteria. The measurements have been carried out in four different cross-sections two on trough portion of the meanders, two on the crest portion. In this study, the analytical solution of Shiono and knight (SKM) for lateral distributions of depth-averaged velocity and bed shear stress have been taken into account. Dimensionless eddy viscosity and bed friction have been incorporated to modify the SKM to provide more accurate results. A mathematical model has been formulated to have a comparative analysis with the results obtained from Shiono-Knight Method.

Keywords: bed friction, depth averaged velocity, eddy viscosity, SKM

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1516 Efficacy and Safety of Probiotic Treatment in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis

Authors: Samir Malhotra, Rajan K. Khandotra, Rakesh K. Dhiman, Neelam Chadha

Abstract:

There is paucity of data about safety and efficacy of probiotic treatment on patient outcomes in cirrhosis. Specifically, it is important to know whether probiotics can improve mortality, hepatic encephalopathy (HE), number of hospitalizations, ammonia levels, quality of life, and adverse events. Probiotics may improve outcomes in patients with acute or chronic HE. However, it is also important to know whether probiotics can prevent development of HE, even in situations where patients do not have acute HE at the time of administration. It is also important to know if probiotics are useful as primary prophylaxis of HE. We aimed to conduct an updated systematic review and meta-analysis to evaluate the safety and efficacy of probiotics in patients with cirrhosis. We searched PubMed, Cochrane library, Embase, Scopus, SCI, Google Scholar, conference proceedings, and references of included studies till June 2017 to identify randomised clinical trials comparing probiotics with other treatments in cirrhotics. Data was analyzed using MedCalc. Probiotics had no effect on mortality but significantly reduced HE (14 trials, 1073 patients, OR 0.371; 95% CI 0.282 to 0.489). There was not enough data to conduct a meta-analysis on outcomes like hospitalizations and quality of life. The effect on plasma ammonia levels was not significant (SMD -0.429; 95%CI -1.034 – 0.177). There was no difference in adverse events. To conclude, although the included studies had a high risk of bias, the available evidence does suggest a beneficial effect on HE. Larger studies with longer periods of follow-up are needed to determine if probiotics can reduce all-cause mortality.

Keywords: cirrhosis, hepatic encephalopathy, meta-analysis, probiotic

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