Search results for: disease severity

Authors: Osagiede Efosa Kelvin

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The Ebola virus disease (EVD); also Ebola hemorrhagic fever, is a disease of humans and other primates caused by Ebola viruses. Signs and symptoms typically start between two days and three weeks after contracting the virus as a fever, sore throat, muscle pain, and headaches. Then, vomiting, diarrhoea and rash usually follow, along with decreased function of the liver and kidneys. At this time, some people begin to bleed both internally and externally. The first death in Nigeria was reported on 25 July 2014: a Liberian-American with Ebola flew from Liberia to Nigeria and died in Lagos soon after arrival. As part of the effort to contain the disease, possible contacts were monitored –353 in Lagos and 451 in Port Harcourt On 22 September, the World Health Organisation reported a total of 20 cases, including eight deaths. The WHO's representative in Nigeria officially declared Nigeria Ebola-free on 20 October after no new active cases were reported in the follow-up contact. This paper looks at the Ebola Virus in general and the measures taken by Nigeria to combat its spread.

Keywords: Ebola virus, hemorrhagic fever, Nigeria, outbreak

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Authors: Saleh Abu Dabous, Khaled Hamad, Rami Al-Ruzouq

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Bridge condition assessment and rating provide essential information needed for bridge management. This paper reviews bridge inspection and condition rating practices and introduces a defect-based urgency index. The index is estimated at the element-level based on the extent and severity of the different defects typical to the bridge element. The urgency index approach has the following advantages: (1) It facilitates judgment submission, i.e. instead of rating the bridge element with a specific linguistic overall expression (which can be subjective and used differently by different people), the approach is based on assessing the defects; (2) It captures multiple defects that can be present within a deteriorated element; and (3) It reflects how critical the element is through quantifying critical defects and their severity. The approach can be further developed and validated. It is expected to be useful for practical purposes as an early-warning system for critical bridge elements.

Keywords: condition rating, deterioration, inspection, maintenance

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Authors: Hazel Ann Gianelli Cu, Stephanie Co, Radcliff Cobankiat

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Objectives: TRC101/Veverimer is an orally administered, non absorbed, sodium- and counterion-free hydrochloric acid binder for the treatment of metabolic acidosis associated with chronic kidney disease. The main objective of this study is to determine the efficacy of TRC 101/ Veverimer 6g/day in increasing serum bicarbonate levels of chronic kidney disease patients with metabolic acidosis. In this meta analysis, we also aim to look at safety outcomes, adverse effects and if the level of serum bicarbonate reached metabolic alkalosis when given TRC101/Veverimer. Methodology: Pubmed, Cochrane, Google Scholar and Science direct were used to search for randomized controlled trials about TRC101/Veverimer use in Chronic kidney disease patients with metabolic acidosis. Search strategy according to the Prisma checklist was done with evaluation of biases and synthesis of results using the Cochrane Review Manager software 5.4. Results: Two randomized controlled trials involving 371 chronic kidney disease patients were included in this study. Results show there was a significant increase in the serum bicarbonate level when given TRC101/Veverimer compared to the placebo. Both studies had a significant number of participants who completed the studies until the end. P value of <0.00001 was used in both studies with a confidence interval of 95%. Conclusion: TRC101/Veverimer 6g/day was shown to effectively and safely increase serum bicarbonate or achieve normalization in chronic kidney disease patients with metabolic acidosis as compared with a placebo. This was associated with delayed progression of kidney disease with improvement of physical functioning, however longer duration of future studies is ideal in order to assess further the long advantages and consequences of TRC 101/Veverimer.

Keywords: chronic kidney disease, metabolic acidosis, Veverimer, TRC101

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Authors: Sintayehu W. Dejene, Ignas M. A. Heitkönig, Herbert H. T. Prins, Zewdu K. Tessema, Willem F. de Boer

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Current theories on diversity-disease relationships describe host species diversity and species identity as important factors influencing disease risk, either diluting or amplifying disease prevalence in a community. Whereas the simple term ‘diversity’ embodies a set of animal community characteristics, it is not clear how different measures of species diversity are correlated with disease risk. We, therefore, tested the effects of species richness, Pielou’s evenness and Shannon’s diversity on bTB risk in cattle in the Afar Region and Awash National Park between November 2013 and April 2015. We also analysed the identity effect of a particular species and the effect of host habitat use overlap on bTB risk. We used the comparative intradermal tuberculin test to assess the number of bTB infected cattle. Our results suggested a dilution effect through species evenness. We found that the identity effect of greater kudu - a maintenance host – confounded the dilution effect of species diversity on bTB risk. bTB infection was positively correlated with habitat use overlap between greater kudu and cattle. Different diversity indices have to be considered together for assessing diversity-disease relationships, for understanding the underlying causal mechanisms. We posit that unpacking diversity metrics is also relevant for formulating control strategies to manage cattle in ecosystems characterized by seasonally limited resources and intense wildlife-livestock interactions.

Keywords: evenness, diversity, greater kudu, identity effect, maintenance hosts, multi-host disease ecology, habitat use overlap

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Authors: Aisha Arshad, Samina Naz Mukry, Tahir Shamsi

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Background: Immune thrombocytopenia (ITP) is an autoimmune disorder. Besides platelets counts, immature platelets fraction (IPF) can be used as tool to predict megakaryocytic activity in ITP patients. The clinical biomarkers like Neutrophils to lymphocytes ratio (NLR) and platelet to lymphocytes ratio(PLR) predicts inflammation and can be used as prognostic markers.The present study was planned to assess the ratios in ITP and their utility in predicting prognosis after treatment. Methods: A total of 111 patients of ITP with same number of healthy individuals were included in this case control study during the period of January 2015 to December 2017.All the ITP patients were grouped according to guidelines of International working group of ITP. A 3cc blood was collected in EDTA tube and blood parameters were evaluated using Sysmex 1000 analyzer.The ratios were calculated by using absolute counts of Neutrophils,Lymphocytes and platelets.The significant (p=<0.05) difference between ITP patients and healthy control groups was determined by Kruskal wallis test, Dunn’s test and spearman’s correlation test was done using SPSS version 23. Results: The significantly raised total leucocytes counts (TLC) and IPF along with low platelets counts were observed in ITP patients as compared to healthy controls.In ITP groups,very low platelet count with median and IQR of 2(3.8)3x109/l with highest mean and IQR IPF 25.4(19.8)% was observed in newly diagnosed ITP group. The NLR was high with prognosis of disease as higher levels were observed in P-ITP. The PLR was significantly low in ND-ITP ,P-ITP, C-ITP, R-ITP and compared to controls with p=<0.001 as platelet were less in number in all ITP patients. Conclusion: The IPF can be used in evaluation of bone marrow response in ITP. The simple, reliable and calculated NLR and PLR ratios can be used in predicting prognosis and response to treatment in ITP and to some extend the severity of disease.

Keywords: neutrophils, platelets, lymphocytes, infection

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Authors: Oluwaponmile David Alao

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Due to an increase in the death rate as a result of heart attack. There is need to develop a system that can be useful in the diagnosis of the disease at the medical centre. This system will help in preventing misdiagnosis that may occur from the medical practitioner or the physicians. In this research work, heart disease dataset obtained from UCI repository has been used to develop an intelligent prediction diagnosis system. The system is modeled on a feedforwad neural network and trained with back propagation neural network. A recognition rate of 86% is obtained from the testing of the network.

Keywords: heart disease, artificial neural network, diagnosis, prediction system

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Authors: Ditsapelo M. McFarland

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Background: Despite the availability of the Pap smear services in urban areas in Botswana, most women in such areas do not seem to screen regular for prevention of the cervical cancer disease. Reasons for non-use of the available Pap smear services are not well understood. Beliefs about cancer may influence participation in cancer screening in these women. The purpose of this study was to develop an instrument to measure beliefs about cervical cancer and Pap smear screening among Black women in Botswana, and evaluate the psychometric properties of the instrument. Significance: Instruments that are designed to measure beliefs about cervical cancer and screening among black women in Botswana, as well as in the surrounding region, are presently not available. Valid and reliable instruments are needed for exploration of the women’s beliefs about cervical cancer. Conceptual Framework: The Health Belief Model (HBM) provided a conceptual framework for the study. Methodology: The study was done in four phases: Phase 1: item generation: 15 items were generated from literature review and qualitative data for each of four conceptually defined HBM constructs: Perceived susceptibility, severity, benefits, and barriers (Version 1). Phase 2: content validity: Four experts who were advanced practice nurses of African descent and were familiar with the content and the HBM evaluated the content. Experts rated the items on a 4-point Likert scale ranging from: 1=not relevant, 2=somewhat relevant, 3=relevant and 4=very relevant. Fifty-five items were retained for instrument development: perceived susceptibility - 11, severity - 14, benefits - 15 and barriers - 15, all measuring on a 4-point Likert scale ranging from strongly disagree (1) to strongly agree (4). (Version 2). Phase 3: pilot testing: The instrument was pilot tested on a convenient sample of 30 women in Botswana and revised as needed. Phase 4: reliability: the revised instrument (Version 3) was submitted to a larger sample of women in Botswana (n=300) for reliability testing. The sample included women who were Batswana by birth and decent, were aged 30 years and above and could complete an English questionnaire. Data were collected with the assistance of trained research assistants. Major findings: confirmatory factor analysis of the 55 items found that a number of items did not adequately load in a four-factor solution. Items that exhibited reasonable reliability and had low frequency of missing values (n=36) were retained: perceived barriers (14 items), perceived benefits (8 items), perceived severity (4 items), and perceived susceptibility (10 items). confirmatory factor analysis (principle components) for a four factor solution using varimax rotation demonstrated that these four factors explained 43% of the variation in these 36 items. Conclusion: reliability analysis using Cronbach’s Alpha gave generally satisfactory results with values from 0.53 to 0.89.

Keywords: cervical cancer, factor analysis, psychometric evaluation, varimax rotation

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Authors: Manish Subedi, Bijay Bartaula, Ashok R. Pant, Purbesh Adhikari, Sanjib K. Sharma

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Background: The pattern of glomerular disease varies worldwide. In absence of kidney disease/Kidney biopsy registry in Nepal, the exact etiology of different forms of glomerular disease is primarily unknown in our country. Method: We retrospectively analyzed 175 cases of renal biopsies performed from dated September 2014 to August 2016 at B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Results: The commonest indication for renal biopsy was nephrotic syndrome (34.9%), followed by Systemic lupus erythematosus with suspected renal involvement (22.3%). Majority of patients were in the 30-60 year bracket (57.2%), with the mean age of the patients being 35.37 years. The average number of glomeruli per core was 13, with inadequate sampling in 5.1%. IgA nephropathy (17%) was found to be the most common primary glomerular disease, followed by membranous nephropathy (14.6%) and FSGS (14.6%). The commonest secondary glomerular disease was lupus nephritis. Complications associated with renal biopsy were pain at biopsy site in 18% of cases, hematuria in 6% and perinephric hematoma in 4% cases. Conclusion: The commonest primary and secondary glomerular disease was IgA nephropathy and lupus nephritis respectively. The high prevalence of Systemic lupus erythematosus with lupus nephritis among Nepalese in comparison with other developing countries warrants further evaluation. As an initial attempt towards documentation of glomerular diseases in the national context, this study should serve as a stepping stone towards the eventual establishment of a full-fledged national registry of glomerular diseases in Nepal.

Keywords: glomerular, Nepal, renal biopsy, systemic lupus erythematoses

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Authors: Muhtasim Shafi Kader, Fizar Ahmed, Annesha Acharjee

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Machine learning and data mining are crucial in health care, as well as medical information and detection. Machine learning approaches are now being utilized to improve awareness of a variety of critical health issues, including diabetes detection, neuron cell tumor diagnosis, COVID 19 identification, and so on. Parkinson’s disease is basically a disease for our senior citizens in Bangladesh. Parkinson's Disease indications often seem progressive and get worst with time. People got affected trouble walking and communicating with the condition advances. Patients can also have psychological and social vagaries, nap problems, hopelessness, reminiscence loss, and weariness. Parkinson's disease can happen in both men and women. Though men are affected by the illness at a proportion that is around partial of them are women. In this research, we have to get out the accurate ML algorithm to find out the disease with a predictable dataset and the model of the following machine learning classifiers. Therefore, nine ML classifiers are secondhand to portion study to use machine learning approaches like as follows, Naive Bayes, Adaptive Boosting, Bagging Classifier, Decision Tree Classifier, Random Forest classifier, XBG Classifier, K Nearest Neighbor Classifier, Support Vector Machine Classifier, and Gradient Boosting Classifier are used.

Keywords: naive bayes, adaptive boosting, bagging classifier, decision tree classifier, random forest classifier, XBG classifier, k nearest neighbor classifier, support vector classifier, gradient boosting classifier

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Authors: Enas El Sayed Abutaleb, Mohamed Taher Eldesoky, Shahenda Abd El Rasol

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Background: Muscle energy techniques (MET) have been widely used by manual therapists over the past years, but still limited research validated its use and there was limited evidence to substantiate the theories used to explain its effects. Objective: To investigate the effect of muscle energy technique (MET) on anterior pelvic tilt in patients with lumbar spondylosis. Design: Randomized controlled trial. Subjects: Thirty patients with anterior pelvic tilt from both sexes were involved, aged between 35 to 50 years old and they were divided into MET and control groups with 15 patients in each. Methods: All patients received 3 sessions/week for 4 weeks where the study group received MET, Ultrasound and Infrared, and the control group received U.S and I.R only. Pelvic angle was measured by palpation meter, pain severity by the visual analogue scale and functional disabilities by the Oswestry disability index. Results: Both groups showed significant improvement in all measured variables. The MET group was significantly better than the control group in pelvic angle, pain severity, and functional disability as p-value were (0.001, 0.0001, 0.0001) respectively. Conclusion and implication: The study group fulfilled greater improvement in all measured variables than the control group which implies that application of MET in combination with U.S and I.R were more effective in improving pelvic tilting angle, pain severity and functional disabilities than using electrotherapy only.

Keywords: anterior pelvic tilt, lumbar spondylosis, muscle energy technique exercise, pelvic tilting angle

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Authors: Nurten Akgun, Dilum Dissanayake, Neil Thorpe, Margaret C. Bell

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Cycling has gained a great attention with comparable speeds, low cost, health benefits and reducing the impact on the environment. The main challenge associated with cycling is the provision of safety for the people choosing to cycle as their main means of transport. From the road safety point of view, cyclists are considered as vulnerable road users because they are at higher risk of serious casualty in the urban network but more specifically at roundabouts. This research addresses the development of an enhanced mathematical model by including a broad spectrum of casualty related variables. These variables were geometric design measures (approach number of lanes and entry path radius), speed limit, meteorological condition variables (light, weather, road surface) and socio-demographic characteristics (age and gender), as well as contributory factors. Contributory factors included driver’s behavior related variables such as failed to look properly, sudden braking, a vehicle passing too close to a cyclist, junction overshot, failed to judge other person’s path, restart moving off at the junction, poor turn or manoeuvre and disobeyed give-way. Tyne and Wear in the UK were selected as a case study area. The cyclist casualty data was obtained from UK STATS19 National dataset. The reference categories for the regression model were set to slight and serious cyclist casualties. Therefore, binary logistic regression was applied. Binary logistic regression analysis showed that approach number of lanes was statistically significant at the 95% level of confidence. A higher number of approach lanes increased the probability of severity of cyclist casualty occurrence. In addition, sudden braking statistically significantly increased the cyclist casualty severity at the 95% level of confidence. The result concluded that cyclist casualty severity was highly related to approach a number of lanes and sudden braking. Further research should be carried out an in-depth analysis to explore connectivity of sudden braking and approach number of lanes in order to investigate the driver’s behavior at approach locations. The output of this research will inform investment in measure to improve the safety of cyclists at roundabouts.

Keywords: binary logistic regression, casualty severity, cyclist safety, roundabout

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Authors: Nirupama Dixit, Anyaa Mittal, Neeru Sood

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Alzheimer’s disease (AD) is a progressive form of dementia, contributing to up to 70% of cases, mostly observed in elderly but is not restricted to old age. The pathophysiology of the disease is characterized by specific pathological changes in brain. The changes (i.e. accumulation of metal ions in brain, formation of extracellular β-amyloid (Aβ) peptide aggregates and tangle of hyper phosphorylated Tau protein inside neurons) damage the neuronal connections irreversibly. The current issues in improvement of life quality of Alzheimer's patient lies in the fact that the diagnosis is made at a late stage of the disease and the medications do not treat the basic causes of Alzheimer's. The targeted delivery of drug through the blood brain barrier (BBB) poses several limitations via traditional approaches for treatment. To overcome these drug delivery limitation, nanoparticles provide a promising solution. This review focuses on current strategies for efficient targeted drug delivery using nanoparticles and improving the quality of therapy provided to the patient. Nanoparticles can be used to encapsulate drug (which is generally hydrophobic) to ensure its passage to brain; they can be conjugated to metal ion chelators to reduce the metal load in neural tissue thus lowering the harmful effects of oxidative damage; can be conjugated with drug and monoclonal antibodies against BBB endogenous receptors. Finally this review covers how the nanoparticles can play a role in diagnosing the disease.

Keywords: Alzheimer's disease, β-amyloid plaques, blood brain barrier, metal chelators, nanoparticles

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Authors: Paula C. Ferreira, Ana Margarida Veiga Simão, Nádia Pereira, Aristides Ferreira, Alexandra Marques Pinto, Alexandra Barros, Vitor Martinho

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Cyberbullying is a phenomenon of worldwide concern regarding children and adolescents’ mental health and risk behavior. Bystanders of this phenomenon can help diminish the incidence of this phenomenon if they engage in pro-social behavior. However, different social-cognitive and affective bystander reactions may surface because of the lack of contextual information and emotional cues in cyberbullying situations. Hence, this study investigated how cyberbullying bystanders’ unpleasant emotions could be related to their personal moral beliefs and their behavioral intentions to cyberbully or defend the victim. It also proposed to investigate how their normative beliefs of perceived severity about cyberbullying behavior could be related to their personal moral beliefs and their behavioral intentions. Three groups of adolescents participated in this study, namely a first of group 402 students (5th – 12th graders; Mage = 13.12; SD = 2.19; 55.7% girls) to compute explorative factorial analyses of the instruments used; a second group of 676 students (5th – 12th graders; Mage = 14.10; SD = 2.74; 55.5% were boys) to run confirmatory factor analyses; and a third group (N = 397; 5th – 12th graders; Mage = 13.88 years; SD = 1.45; 55.5% girls) to perform the main analyses to test the research hypotheses. Self-report measures were used, such as the Personal moral beliefs about cyberbullying behavior questionnaire, the Normative beliefs of perceived severity about cyberbullying behavior questionnaire, the Unpleasant emotions about cyberbullying incidents questionnaires, and the Bystanders’ behavioral intentions in cyberbullying situations questionnaires. Path analysis results revealed that unpleasant emotions were mediators of the relationship between adolescent cyberbullying bystanders’ personal moral beliefs and their intentions to help the victims in cyberbullying situations. Moreover, adolescent cyberbullying bystanders’ normative beliefs of gravity were mediators of the relationship between their personal moral beliefs and their intentions to cyberbully others. These findings provide insights for the development of prevention and intervention programs that promote social and emotional learning strategies as a means to prevent and intervene in cyberbullying.

Keywords: cyberbullying, normative beliefs of perceived severity, personal moral beliefs, unpleasant emotions

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Authors: Retno A. Vinarti, Lucy M. Hederman

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This research describes a knowledge model for a system which give personalized alert to users about infectious disease risks in the context of weather, location and time. The knowledge model is based on established epidemiological concepts augmented by information gleaned from infection-related data repositories. The existing disease risk prediction research has more focuses on utilizing raw historical data and yield seasonal patterns of infectious disease risk emergence. This research incorporates both data and epidemiological concepts gathered from Atlas of Human Infectious Disease (AHID) and Centre of Disease Control (CDC) as basic reasoning of infectious disease risk prediction. Using CommonKADS methodology, the disease risk prediction task is an assignment synthetic task, starting from knowledge identification through specification, refinement to implementation. First, knowledge is gathered from AHID primarily from the epidemiology and risk group chapters for each infectious disease. The result of this stage is five major elements (Person, Infectious Disease, Weather, Location and Time) and their properties. At the knowledge specification stage, the initial tree model of each element and detailed relationships are produced. This research also includes a validation step as part of knowledge refinement: on the basis that the best model is formed using the most common features, Frequency-based Selection (FBS) is applied. The portion of the Infectious Disease risk model relating to Person comes out strongest, with Location next, and Weather weaker. For Person attribute, Age is the strongest, Activity and Habits are moderate, and Blood type is weakest. At the Location attribute, General category (e.g. continents, region, country, and island) results much stronger than Specific category (i.e. terrain feature). For Weather attribute, Less Precise category (i.e. season) comes out stronger than Precise category (i.e. exact temperature or humidity interval). However, given that some infectious diseases are significantly more serious than others, a frequency based metric may not be appropriate. Future work will incorporate epidemiological measurements of disease seriousness (e.g. odds ratio, hazard ratio and fatality rate) into the validation metrics. This research is limited to modelling existing knowledge about epidemiology and chain of infection concepts. Further step, verification in knowledge refinement stage, might cause some minor changes on the shape of tree.

Keywords: epidemiology, knowledge modelling, infectious disease, prediction, risk

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Authors: In Hee Shim, Dong Sik Bae

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Introduction: Obesity and unfavorable lipid profile may be linked to depressive disorders. This study compared the levels of obesity, lipid profiles and depression severity of patients with depressive disorders. Methods: This study included 156 patients diagnosed with a depressive disorder who were hospitalized between March 2012 and February 2016. The patients were categorized into mild to moderate and severe depressive groups, based on Hamilton Depression Rating Scale scores (Mild to moderate depression 8-23 vs. severe depression ≥ 24). The charts of the patients were reviewed to evaluate body mass index and lipid profiles, including total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TG), confounding factors, such as other general medical disorders (hypertension, diabetes mellitus, and dyslipidemia), except smoking status (insufficient data). Demographic and clinical characteristics, such as age, sex, comorbidities, family history of mood disorders, psychotic features, and prescription patterns were also assessed. Results: Compared to the mild to the moderate depressive group, patients with severe depression had significantly lower rate of male and comorbidity. The patients with severe depression had a significantly lower TG than patients in the mild to moderate depressive group. After adjustment for the sex and comorbidity, there were no significant differences between the two groups in terms of the obesity and lipid profiles, including TG. Conclusion: These results did not show a significant difference in the association between obesity, lipid profiles and the depression severity. The role of obesity and lipid profiles in the pathophysiology of depression remains to be clarified.

Keywords: depression, HAM-D, lipid profiles, obesity

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Authors: Kenji Gwee

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In Singapore, the death penalty remains in active use for murder and drug trafficking of controlled drugs such as heroin. As such, the psychological assessment of defendants can often be of high stakes. The Test of Memory Malingering (TOMM) is employed by government psychologists to determine the degree of effort invested by defendants, which in turn inform on the veracity of overall psychological findings that can invariably determine the life and death of defendants. The purpose of this study was to find out if defendants facing the death penalty were more likely to invest less effort during psychological assessment (to fake bad in hopes of escaping the death sentence) compared to defendants facing lesser penalties. An archival search of all forensic cases assessed in 2012-2013 by Singapore’s designated forensic psychiatric facility yielded 186 defendants’ TOMM scores. Offence severity, coded into 6 rank-ordered categories, was analyzed in a one-way ANOVA with TOMM score as the dependent variable. There was a statistically significant difference (F(5,87) = 2.473, p = 0.038). A Tukey post-hoc test with Bonferroni correction revealed that defendants facing lower charges (Theft, shoplifting, criminal breach of trust) invested less test-taking effort (TOMM = 37.4±12.3, p = 0.033) compared to those facing the death penalty (TOMM = 46.2±8.1). The surprising finding that those facing death penalties actually invested more test taking effort than those facing relatively minor charges could be due to higher levels of cooperation when faced with death. Alternatively, other legal avenues to escape the death sentence may have been preferred over the mitigatory chance of a psychiatric defence.

Keywords: capital sentencing, offence severity, Singapore, Test of Memory Malingering

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Authors: Oliver Chunho Ma, Tszying Chang

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Background: Traditional Chinese Medicine (TCM) has been widely used in the treatment of eczema. However, there is currently a lack of comprehensive research on the overall effectiveness of TCM in treating eczema, particularly using the Eczema Area and Severity Index (EASI) score as an evaluation tool. Meta-analysis can integrate the results of multiple studies to provide more convincing evidence. Objective: To conduct a systematic review and meta-analysis based on the EASI score to evaluate the overall effectiveness of TCM in the treatment of eczema. Specifically, the study will review and analyze published clinical studies that investigate TCM treatments for eczema and use the EASI score as an outcome measure, comparing the differences in improving the severity of eczema between TCM and other treatment modalities, such as conventional Western medicine treatments. Methods: Relevant studies, including randomized controlled trials (RCTs) and non-randomized controlled trials, that involve TCM treatment for eczema and use the EASI score as an outcome measure will be searched in medical literature databases such as PubMed, CNKI, etc. Relevant data will be extracted from the selected studies, including study design, sample size, treatment methods, improvement in EASI score, etc. The methodological quality and risk of bias of the included studies will be assessed using appropriate evaluation tools (such as the Cochrane Handbook). The results of the selected studies will be statistically analyzed, including pooling effect sizes (such as standardized mean differences, relative risks, etc.), subgroup analysis (e.g., different TCM syndromes, different treatment modalities), and sensitivity analysis (e.g., excluding low-quality studies). Based on the results of the statistical analysis and quality assessment, the overall effectiveness of TCM in improving the severity of eczema will be interpreted. Expected outcomes: By integrating the results of multiple studies, we expect to provide more convincing evidence regarding the specific effects of TCM in improving the severity of eczema. Additionally, subgroup analysis and sensitivity analysis can further elucidate whether the effectiveness of TCM treatment is influenced by different factors. Besides, we will compare the results of the meta-analysis with the clinical data from our clinic. For both the clinical data and the meta-analysis results, we will perform descriptive statistics such as means, standard deviations, percentages, etc. and compare the differences between the two using statistical tests such as independent samples t-test or non-parametric tests to assess the statistical differences between them.

Keywords: Eczema, traditional Chinese medicine, EASI, systematic review, meta-analysis

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Authors: Teja Koduru

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Untreated Lyme disease can lead to neurological, cardiac, and dermatological complications. Rapid diagnosis of the erythema migrans (EM) rash, a characteristic symptom of Lyme disease is therefore crucial to early diagnosis and treatment. In this study, we aim to utilize deep learning frameworks including Tensorflow and Keras to create deep convolutional neural networks (DCNN) to detect images of acute Lyme Disease from images of erythema migrans. This study uses a custom database of erythema migrans images of varying quality to train a DCNN capable of classifying images of EM rashes vs. non-EM rashes. Images from publicly available sources were mined to create an initial database. Machine-based removal of duplicate images was then performed, followed by a thorough examination of all images by a clinician. The resulting database was combined with images of confounding rashes and regular skin, resulting in a total of 683 images. This database was then used to create a DCNN with an accuracy of 93% when classifying images of rashes as EM vs. non EM. Finally, this model was converted into a web and mobile application to allow for rapid diagnosis of EM rashes by both patients and clinicians. This tool could be used for patient prescreening prior to treatment and lead to a lower mortality rate from Lyme disease.

Keywords: Lyme, untreated Lyme, erythema migrans rash, EM rash

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Authors: Zahra Rakhshan Masoudi, Sona Rostampour Yasouri

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Considering that the only way to save the lives of patients and healthy people who have suffered sudden accidents is blood transfusion, what is important is the presence of the known HCV virus as the most important cause of the disease after blood transfusion. HCV is one of the major global problems, and its transmission through blood causes life-threatening complications and extensive legal, social and economic consequences. On the one hand, unfortunately, there is still no effective vaccine available to prevent HCV. In Iran, the exact statistics of the prevalence of this disease have not yet been fully announced. The main purpose of this study is to investigate the prevalence rate and rapid diagnosis of HCV among those who refer to laboratory centers in Tehran. From spring to winter of 1401 (2022-2023), 2166 blood samples were collected from laboratory centers in Tehran. Blood samples were evaluated for the presence of HCV by Electrochemiluminescence (ECL) and PCR techniques along with specific HCV primers. In general, 36 samples (1.6%) were tested positive by the mentioned techniques. The results indicated that the ECL technique is a sensitive and specific diagnostic method for detecting HCV in the early stages of the disease and can be very helpful and provide the possibility of starting the treatment steps to prevent the exacerbation of the disease earlier. Also, the results of PCR technique showed that PCR is an accurate, sensitive and fast method for definitive diagnosis of HCV. It seems that the incidence rate of this disease is increasing in Iran, and investigating the spread of the disease throughout Iran for a longer period of time in the continuation of our research can be helpful in the future to take the necessary measures to prevent the transmission of the disease to people and the rapid onset Treatment steps for patients with HCV should be carried out.

Keywords: electrochemiluminescence, HCV, PCR, prevalence

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Authors: Ritu Nambiar, Shazia Tariq, Sumaira Jamil, Farida Munawar, Imelda Israell

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GBS has emerged as a leading cause of neonatal infections worldwide and clinical trials have demonstrated that giving IAP was effective in reducing early onset GBS (EOGBS) disease of the newborn. There is no available data on the prevalence of GBS in the UAE, therefore, a retrospective chart analysis of our parturients were done to look at our prevalence. The aim of this study is: 1. To study the prevalence of GBS colonization of parturients at al Rahba Hospital following universal screening between 35-37 week. 2. To look at efficacy of GBS intrapartum antibiotic prophylaxis by NICU admission for EO GBS disease of the newborn. 1) The prevalence of GBS in our patient population is 24.15%. 2) Incidence of EO GBS disease of the newborn was 0.6%.

Keywords: GBS Screening, universal intrapartum antibiotic prophylaxis, parturients, newborn

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Authors: Shweh Fern Loo, Jun Yin Ong, Than Zaw Oo

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Acute respiratory distress syndrome (ARDS) is a common serious condition of bilateral lung infiltrates that develops secondary to various underlying conditions such as diseases or injuries. ARDS with severe hypercapnia is associated with higher ICU mortality and morbidity. Venovenous Extracorporeal membrane oxygenation (VV-ECMO) support has been established to avert life-threatening hypoxemia and hypercapnic respiratory failure despite optimal conventional mechanical ventilation. However, VV-ECMO is relatively not advisable in particular groups of patients, especially in multi-organ failure, advanced age, hemorrhagic complications and irreversible central nervous system pathology. We presented a case of a 79-year-old Chinese lady without any pre-existing lung disease admitted to our hospital intensive care unit (ICU) after acute presentation of breathlessness and chest pain. After extensive workup, she was diagnosed with rapidly progressing acute interstitial pneumonia with ARDS and hypercapnia respiratory failure. The patient received lung protective strategies of mechanical ventilation and neuromuscular blockage therapy as per clinical guidelines. However, hypercapnia respiratory failure was refractory, and she was deemed not a good candidate for VV-ECMO support given her advanced age and high vasopressor requirements from shock. Alternative therapy with extracorporeal CO2 removal (ECCO2R) was considered and implemented. The patient received 12 days of ECCO2R paired with muscle paralysis, optimization of lung-protective mechanical ventilation and dialysis. Unfortunately, the patient still had refractory hypercapnic respiratory failure with dual vasopressor support despite prolonged therapy. Given failed and futile medical treatment, the family opted for withdrawal of care, a conservative approach, and comfort care, which led to her demise. The effectivity of extracorporeal CO2 removal may depend on disease burden, involvement and severity of the disease. There is insufficient data to make strong recommendations about its benefit-risk ratio for ECCO2R devices, and further studies and data would be required. Nonetheless, ECCO2R can be considered an alternative treatment for refractory hypercapnic respiratory failure patients who are unsuitable for initiating venovenous ECMO.

Keywords: extracorporeal CO2 removal (ECCO2R), acute respiratory distress syndrome (ARDS), acute interstitial pneumonia (AIP), hypercapnic respiratory failure

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Authors: Hsien Hua Kuo, Wen Chun Lin, Chia Chi Hsu, Hsien Wen Kuo

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Objective: Despite the high prevalence of musculoskeletal disorders (MSDs) among nurses, which has been consistently observed in the studies of Western countries, very little information regarding intensity of workload and work-related quality of life (WRQOL) related to MSDs among nurses is available in Taiwan. The objective of this study is to investigate the factors affecting musculoskeletal disorders in nurses from a hospital. Methods: 550 nurses from a hospital in Taoyuan were interviewed using a modified standardized Nordic Musculoskeletal (NMQ) questionnaire which contained the demographic information, workplace condition and musculoskeletal disorders. Results: Response rate of nurses were 92.5% from a teaching hospital. Based on medical diagnosis by physician, neck of musculoskeletal disorders had the highest percentage in nine body portions. The higher percentage of musculoskeletal disorders in nurses found from wards of internal and surgery. Severity and symptoms of musculoskeletal disorders diagnosed by self-reported questionnaire significantly correlated with WRQOL, job satisfaction and intensity of workload among nurses based on the logistic regression model. Conclusion: The severity and symptoms of musculoskeletal disorders among nurses showed a dose-dependent with WRQOL and workload. When work characteristics in hospital were modified, the severity of musculoskeletal disorders among nurses will be decreased and alleviated. Comment: Multifaceted ergonomic intervention programme to reduce the prevalence of MSDs among nurses was by encouraging nurses to do more physical activity which will make them more flexible and increase their strength. Therefore, the head nurse should encourage nurses to regularly physical activity and to modify unfitting ergonomic environment in order to reduce the prevalence of MSDs.

Keywords: musculoskeletal disorders, nurse, WRQOL, job satisfaction

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Authors: Rezvan Hosseinian

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Aim: Systemic sclerosis (SSc) is a chronic connective tissue disease with the clinical hallmark of skin thickening and tethering. The correlation of musculoskeletal features with other parameters should be considered in SSc patients. Methods: We reviewed the records of all patients who had more than one visit and standard anteroposterior radiography of hand. We used univariate analysis, and factors with p<0.05 were included in logistic regression to find out dependent factors. Results: Overall, 180 SSc patients were enrolled in our study, 161 (89.4%) of whom were women. The median age (IQR) was 47.0 years (16), and 52% had a diffuse subtype of the disease. In multivariate analysis, tendon friction rubs (TFRs) were associated with the presence of calcinosis, muscle tenderness, and flexion contracture (FC) on physical examination (p<0.05). Arthritis showed no differences in the two subtypes of the disease (p=0.98), and in multivariate analysis, there were no correlations between radiographic arthritis and serological and clinical features. The radiographic results indicated that disease duration correlated with joint erosion, acro-osteolysis, resorption of the distal ulna, calcinosis and radiologic FC (p< 0.05). Acro-osteolysis was more frequent in the dcSSc subtype, TFRs, and anti-TOPO I antibody. Radiologic FC showed an association with skin score, calcinosis and haematocrit <30% (p<0.05). Joint flexion on radiography was associated with disease duration, modified Rodnan skin score, calcinosis, and low hematocrit (P<0.01). Conclusion: Disease duration was a main dependent factor for developing joint erosion, acro-osteolysis, bone resorption, calcinosis, and flexion contracture on hand radiography. Acro-osteolysis presented in the severe form of the disease. Acro-osteolysis was the only dependent variable associated with bone demineralization.

Keywords: disease subsets, hand radiography, joint erosion, sclerosis

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Authors: Nasrin Azarbani

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Aim: Systemic sclerosis (SSc) is a chronic connective tissue disease with the clinical hallmark of skin thickening and tethering. Correlation of musculoskeletal features with other parameters should be considered in SSc patients. Methods: We reviewed the records of all patients who had more than one visit and standard anteroposterior radiography of hand. We used univariate analysis, and factors with p<0.05 were included in logistic regression to find out dependent factors. Results: Overall, 180 SSc patients were enrolled in our study, 161 (89.4%) of whom were women. Median age (IQR) was 47.0 years (16), and 52% had diffuse subtype of the disease. In multivariate analysis, tendon friction rubs (TFRs) was associated with the presence of calcinosis, muscle tenderness, and flexion contracture (FC) on physical examination (p<0.05). Arthritis showed no differences in the two subtypes of the disease (p=0.98), and in multivariate analysis, there were no correlations between radiographic arthritis and serological and clinical features. The radiographic results indicated that disease duration correlated with joint erosion, acro-osteolysis, resorption of distal ulna, calcinosis and radiologic FC (p< 0.05). Acro-osteolysis was more frequent in the dcSSc subtype, TFRs, and anti-TOPO I antibody. Radiologic FC showed an association with skin score, calcinosis and haematocrit <30% (p<0.05). Joint flexion on radiography was associated with disease duration, modified Rodnan skin score, calcinosis, and low haematocrit (P<0.01). Conclusion: Disease duration was a main dependent factor for developing joint erosion, acro-osteolysis, bone resorption, calcinosis, and flexion contracture on hand radiography. Acro-osteolysis presented in the severe form of the disease. Acro-osteolysis was the only dependent variable associated with bone demineralization.

Keywords: sclerosis, disease subsets, joint erosion, musculoskeletal

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Authors: Wang, Kuei-Ing, Jou-Fan Shih

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This study adopts deterrence theory as well as social identities as moderators, and explores their moderating affects on online toxic disinhibition. Survey and Experimental methodologies are applied to test the research model and four hypotheses are developed in this study. The controllability of identity positively influenced the behavior of toxic disinhibition both in experimental and control groups while the fluidity of the identity did not have significant influences on online disinhibition. Punishment certainty, punishment severity as well as social identity negatively moderated the relation between the controllability of the identity and the toxic disinhibition. The result of this study shows that internet users hide their real identities when they behave inappropriately on internet, but once they acknowledge that the inappropriate behavior will be found and punished severely, the inappropriate behavior then will be weakened.

Keywords: seductive properties of internet, online disinhibition, punishment certainty, punishment severity, social identity

Procedia PDF Downloads 484

Authors: Phontip Kanlahasuth

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This paper presents the environmental safety and occupational health risk assessment of rocket static test by assessing risk level from probability and severity and then appropriately applying the risk control measures. Before the environmental safety and occupational health measures are applied, the serious hazards level is 31%, medium level is 24% and low level is 45%. Once risk control measures are practically implemented, the serious hazard level can be diminished, medium level is 38%, low level is 45% and eliminated level is 17%. It is clearly shown that the environmental safety and occupational health measures can significantly reduce the risk level.

Keywords: rocket static test, hazard, risk, risk assessment, risk analysis, environment, safety, occupational health, acceptable risk, probability, severity, risk level

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Authors: Ammal Mokhtar Metwally, Amal Elsaied, Ghada A. Abdel-Latef, Ebtissam M. Salah El-Din, Hanaa R. M. Attia

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The link between various diet therapies and autism is controversial and limited. Nutritional interventions aim to increase antioxidant levels suggesting a positive effect on the improvement of autism severity. In this study, the effectiveness of a 90-day Dates fruits consumption fruits (a non-pharmacological and risk-free option) on alleviating autism severity symptoms in individuals with ASD was investigated. The study examined also whether the baseline or improvements of some of the clinical and laboratory characteristics of the subjects affected their response to dates fruits intake on the severity of ASD symptoms. Methodology: This study involved a randomized controlled, double-blind 3-month dates fruits intake. 131 Egyptian children aged 3-12 years with confirmed ASD were enrolled in the study. cases were randomized in one of the three groups as follows; 1st regimen: Group I on 3 dates’ fruits/day (47 cases), 2nd regimen: Group II on 5 dates’ fruits/day (42 cases), and 3rd regimen: group III; nondates group (42 cases). ASD severity was assessed using both the Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-V) criteria and the Childhood Autism Rating Scale (CARS) analysis. The following measures were assessed before and after the regimens: blood levels of three oxidative markers; Malondialdehyde (MDA), glutathione peroxidase (GPX1), and superoxide dismutase (SOD), nutritional, dietary assessment & anthropometric measurements Results: A significant reduction in the mean score of autism was detected based on CARS scores for those on dates’ regimens compared to those on non-dates (p < 0.01). Participants on 5 dates’ fruits/day for three months showed the highest improvement for autism severity based on both CARS and DSM5 compared to those in 3 dates’ fruits/day and non-dates groups. Responders to dates fruits intake as reflected on the Improvement of autism severity based on CARS diagnosis was detected among 78.7 % and 62.9 % based on CARS and DSM5 diagnosis, respectively. Responders had significant improvement in BMI z score and in the ratio levels of both MDA/SOD and MDA/GPX. Conclusion: The positive results of this study suggest that palm dates fruits could be recommended for children with ASD as adjuvant therapy on a daily regular basis to achieve consistent improvement of autism symptoms Objective: Investigate the effectiveness of a 90-day Dates fruits consumption fruits on alleviating autism severity symptoms in individuals with ASD and explore the clinical and laboratory characteristics of the subjects affected their response to dates fruits intake. Methodology: The study was a randomized controlled, double-blind for 3-month. 131 autistic Egyptian children aged 3-12 years were enrolled in one of the three groups; 1st: on 3 dates’ fruits/day (47 cases), 2nd: Group II on 5 dates’ fruits/day (42 cases), and 3rd: group III; nondates group (42 cases). Conclusion: The positive results of this study suggest that palm dates fruit (a non-pharmacological and risk-free option) could be recommended for children with ASD as adjuvant therapy on a daily regular basis to achieve consistent improvement of autism symptoms.

Keywords: autism spectrum disorders, palm dates fruits, CARS, DSM5, oxidative markers

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Authors: Clara Luwe, Oliver Harness, Helena Meally, Kim Martin, Alexandra Harrington

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Background: The role of ‘Renal Specialist Podiatrist’ originated in 2022 due to prevailing evidence of patients with diabetes and end-stage renal disease (ESRD) on haemodialysis (HD) and active ulcerations that were at higher risk of rapid deterioration, foot-related hospital admissions, and lower limb amputations. This role started in April 2022 with the aim of screening all patients on haemodialysis and instigating preventative measures to reduce serious foot related complications. Methods: A comprehensive neurovascular foot assessment was completed to establish baseline vascular status and identify those with peripheral arterial disease (PAD) for all patients on HD. Individual’s foot risk was stratified, advice and education tailored and issued. Identifying all diabetes patients on HD as high-risk for diabetic foot complications. Major Findings: All patients screened revealed over half of the caseload had diabetes, and more than half had a clinical presentation of PAD. All those presenting with ulcerations had a diagnosis of diabetes. Of the presenting ulcerations, the majority of these ulcers predated the renal specialist post and were classified as severe >3 SINBAD Score. Since April’22, complications have been identified quicker, reducing the severity (SINBAD<3 or below), and have improved healing times, in line with the national average. During the eight months of the role being in place, we have seen a reduction in minor amputations and no major amputations. Conclusion: By screening all patients on haemodialysis and focusing on education, early recognition of complications, appropriate treatment, and timely onward referral, we can reduce the risk of foot Diabetic foot ulcerations and lower limb amputations. Having regular podiatry input to stratify and facilitate high-risk, active wound patients across different services has helped to keep these patients stable, prevent amputations, and reduce foot-related hospital admissions and mortality from foot-related disease. By improving the accessibility to a specialist podiatrist, patients felt able to raise concerns sooner. This has helped to implement treatment at the earliest possible opportunity, enabling the identification and healing of ulcers at an earlier and less complex stage (SINBAD <3), thus, preventing potential limb-threatening complications.

Keywords: renal, podiatry, haemodialysis, prevention, early detection

Procedia PDF Downloads 48

Authors: Arezoo Fallahi

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Background and purpose: Non-alcoholic fatty liver is one of the most common liver disorders, which, as the most important cause of death from liver disease, has unpleasant consequences and complications. The aim of this study was to investigate the effect of an educational intervention based on a health belief model to prevent non-alcoholic fatty liver among women. Materials and Methods: This experimental study was performed among 110 women referring to comprehensive health service centers in Malayer City, west of Iran, in 2023. Using the available sampling method, 110 Participants were divided into experimental and control groups. The data collection tool included demographic characteristics and a questionnaire based on the health belief model. In The experimental group, three one-hour training sessions were conducted in the form of pamphlets, lectures and group discussions. Data were analyzed using SPSS software version 21, by correlation tests, paired t-tests independent t-tests. Results: The mean age of participants was 38.07±6.28 years, and Most of the participants were middle-aged, married, housewives with academic education, middle-income and overweight. After the educational intervention, the mean scores of the constructs include perceived sensitivity (p=0.01), perceived severity (p=0.01), perceived benefits (p=0.01), guidance for internal (p=0.01) and external action (p=0.01), and perceived self-efficacy (p=0.01) in the experimental group were significantly higher than the control group. The score of perceived barriers in the experimental group decreased after training. The perceived obstacles score in the test group decreased after the training (15.2 ± 3.9 v.s 11.2 ± 3.3, (p<0.01). Conclusion: The findings of the study showed that the design and implementation of educational programs based on the constructs of the health belief model can be effective in preventing women from developing higher levels of non-alcoholic fatty liver.

Keywords: health, education, believe, behaviour

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Authors: Md. Shakhawat Hossain, Jimma Hossain, Md. Naushad Ali

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Acute pancreatitis is a dangerous medical emergency in the practice of gastroenterology. Management of acute pancreatitis needs multidisciplinary approach with support starts from emergency to ICU. So, there is a chance of mismanagement in every steps, especially in low resource settings. Other factors such as patient’s financial condition, education, social custom, transport facility, referral system from periphery may also challenge the current guidelines for management. The present study is intended to determine the clinico-pathological profile, severity assessment and challenges of management of acute pancreatitis in a government laid tertiary care hospital to image the real scenario of management in a low resource place. A total 100 patients of acute pancreatitis were studied in this prospective study, held in the Department of Gastroenterology, Rangpur medical college hospital, Bangladesh from July 2017 to July 2018 within one year. Regarding severity, 85 % of the patients were mild, whereas 13 were moderately severe, and 2 had severe acute pancreatitis according to the revised Atlanta criteria. The most common etiologies of acute pancreatitis in our study were gall stone (15%) and biliary sludge (15%), whereas 54% were idiopathic. The most common challenges we faced were delay in hospital admission (59%) and delay in hospital diagnosis (20%). Others are non-adherence of patient party, and lack of investigation facility, physician’s poor knowledge about current guidelines. We were able to give early aggressive fluid to only 18% of patients as per current guideline. Conclusion: Management of acute pancreatitis as per guideline is challenging when optimum facility is lacking. So, modified guidelines for assessment and management of acute pancreatitis should be prepared for low resource setting.

Keywords: acute pancreatitis, challenges of management, severity, prognosis

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