Search results for: fatal

Authors: Hacer Y. Teke, Sultan Pehlivan, Mustafa Karapırlı, Asude Gökmen, Sait Özsoy

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The case is here presented of a patient with DMD with electrocardiograph findings within normal limits who underwent spinal surgery then developed the rarely seen complication of cardiac tamponade which resulted in death. A 17-year old male with DMD was admitted to hospital for spinal surgery. Due to a postoperative drop in hemoglobin, blood transfusion was administered to the patient, no complication developed and he was discharged on the third day. Four days after discharge, the patient worsened at home and an ambulance was called. Before the nearest hospital was reached, the patient died in the ambulance. An autopsy was performed. A fatal but rarely seen complication of Acute Myocardial Infarction (AMI) is myocardial rupture. 85% of ruptures occur in the first week of AMI but just as they can be seen on the day of the infarct, they can also be seen 2 weeks later. The case presented here had infarction findings related to different times and in different areas.

Keywords: duchenne muscular dystrophy, myocardial infarction, myocardial rupture, anesthesia

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Authors: Ehsan Mehryaar, Seyed Armin Motahari Tabari

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Without a doubt, soil shear strength is the most important property of the soil. The majority of fatal and catastrophic geological accidents are related to shear strength failure of the soil. Therefore, its prediction is a matter of high importance. However, acquiring the shear strength is usually a cumbersome task that might need complicated laboratory testing. Therefore, prediction of it based on common and easy to get soil properties can simplify the projects substantially. In this paper, A hybrid model based on the classification and regression tree algorithm and logistic regression is proposed where each leaf of the tree is an independent regression model. A database of 189 points for clay soil, including Moisture content, liquid limit, plastic limit, clay content, and shear strength, is collected. The performance of the developed model compared to the existing models and equations using root mean squared error and coefficient of correlation.

Keywords: model tree, CART, logistic regression, soil shear strength

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Authors: Joshua Chew, Vesa Cheng, David Thomson

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Background: Hereditary angioedema (HAE) or C1 esterase deficiency is a relatively rare entity that has a potential for significant anesthetic complications. Methods: A literature review was performed of published cases of surgery in patients with HAE. Results were limited to English language only and cases were examined for management strategies and successful prevention of acute attacks. Results: The literature revealed the successful use of C1 esterase inhibitors as the most common agent in surgical prophylaxis therapy. Other therapeutic targets described included kallikrein inhibitors and bradykinin B2 receptor antagonists. Conclusions: Therapeutic targets that exist for the management of acute attacks in HAE have been successfully employed in the setting of surgery. The data is currently limited and could not be used as a firm evidence base, but the limited outcomes seen are positive and reassuring for the prospective anesthetic management of this potentially fatal condition.

Keywords: anesthesia, C1 esterase deficiency, hereditary angioedema, surgical prophylaxis

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Authors: Hocine Hammoum, Karima Bouzelha, Lounis Ziani, Lounis Hamitouche

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In this paper, we study a complex structure which is an apartment building surmounted by a reinforced concrete water tank. The tank located on the top floor of the building is a container with capacity of 1000 m³. The building is complex in its design, its calculation and by its behavior under earthquake effect. This structure located in Algiers and aged of 53 years has been subjected to several earthquakes, but the earthquake of May 21^st, 2003 with a magnitude of 6.7 on the Richter scale that struck Boumerdes region at 40 Kms East of Algiers was fatal for it. It was downgraded after an investigation study because the central core sustained serious damage. In this paper, to estimate the degree of its damages, the seismic performance of the structure will be evaluated taking into account the hydrodynamic effect, using a static equivalent nonlinear analysis called pushover.

Keywords: performance analysis, building, reinforced concrete tank, seismic analysis, nonlinear analysis, hydrodynamic, pushover

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Authors: Lluís Bermúdez, Isabel Morillo

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Road safety involves carrying out a determined and explicit policy to reduce accidents. In the city of Barcelona, through the Local Road Safety Plan 2013-2018, in line with the framework that has been established at the European and state level, a series of preventive, corrective and technical measures are specified, with the priority objective of reducing the number of serious injuries and fatalities. In this work, based on the data from the accidents managed by the local police during the period 2010-2019, an analysis is carried out to verify whether the measures established in the Plan to reduce the accident rate have had an effect or not and to what extent. The analysis focuses on the type of accident and the type of vehicles involved. Different count regression models have been fitted, from which it can be deduced that the number of serious and fatal victims of the accidents that have occurred in the city of Barcelona has been reduced as the measures approved by the authorities.

Keywords: accident reduction, count regression models, road safety, urban traffic

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Authors: Chung-Young Lee, Se-Hee Ahn, Ilhwan Kim, Du-Min Go, Dae-Yong Kim, Jun-Gu Choi, Youn-Jeong Lee, Jae-Hong Kim, Hyuk-Joon Kwon

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The polymerase of avian influenza A virus (AIV) is a heterotrimer composed of PB2, PB1 and PA. PB2 plays a role in overcoming the host barrier; however, the genetic prerequisites for avian PB2 to acquire mammalian pathogenic mutations have not been well elucidated. Here, we demonstrated that key amino acid mutations (I66M, I109V and I133V, collectively referred to as MVV) of prototypic avian PB2 increase the replication efficiency of recombinant PR8 virus carrying the mutated PB2 in both avian and mammalian hosts. The MVV mutations caused no weight loss in mice, but they did allow replication in infected lungs, and the viruses acquired fatal mammalian pathogenic mutations such as Q591R/K, E627K, or D701N in the infected lungs. The MVV mutations are located at the interfaces of the trimer and are predicted to increase the strength of this structure. Thus, gaining MVV mutations might be the first step for AIV to acquire mammalian pathogenicity. These results provide new insights into the evolution of AIV in birds and mammals.

Keywords: avian influenza A virus, prototypic PB2, polymerase activity, mammalian pathogenicity, first-step mutations

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Authors: José Luis Lorenzo Bayona, Ljiljana Medic-Pejic, Isabel Amez Arenillas, Blanca Castells Somoza

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The communication presents the study results carried out by the Official Laboratory J. M. Madariaga (LOM) of the Polytechnic University of Madrid to analyze the reliability of methane detection systems used in underground mining. Poor firedamp control in work can cause from production stoppages to fatal accidents and since there is currently a great variety of equipment with different functional characteristics, a study is needed to indicate which measurement principles have the highest degree of confidence. For the development of the project, a series of fixed, transportable and portable methane detectors with different measurement principles have been selected to subject them to laboratory tests following the methods described in the applicable regulations. The test equipment has been the one usually used in the certification and calibration of these devices, subject to the LOM quality system, and the tests have been carried out on detectors accessible in the market. The conclusions establish the main advantages and disadvantages of the equipment according to the measurement principle used; catalytic combustion, interferometry and infrared absorption.

Keywords: ATEX standards, gas detector, methane meter, mining safety

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Authors: Christopher Oyediran, Nicola Ubayasiri, Christopher Gough

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Splenic artery aneurysms are often clinically occult, occasionally identified incidentally with imaging. The pathogenesis of aneurysms is complex, but certain factors are thought to contribute to their development. Given the potential fatal complications of rupture, a high index of suspicion is required to make an early diagnosis. We present a case of a 36-year-old female with a history of endometriosis and multiple sclerosis who presented to the Emergency Department with sudden onset epigastric pain and collapse. On arrival, she was pale and clammy with profound tachycardia and hypotension. An ultrasound done in the resuscitation department revealed abdominal free fluid. She was resuscitated with blood and transferred for emergent laparotomy. Laparotomy revealed massive haemoperitoneum from the spleen. She underwent emergency splenectomy and inspection of the spleen revealed a splenic artery aneurysm. She received our massive transfusion protocol followed by a short stay on ITU, making a good post-operative recovery and was discharged home a week later.

Keywords: aneurysm, human chorionic gonadotrophin (hCG), resuscitation, laparotomy

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Authors: Kaustubh Chakradeo, Michael Delves, Sofya Titarenko

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Malaria is a serious disease which affects hundreds of millions of people around the world, each year. If not treated in time, it can be fatal. Despite recent developments in malaria diagnostics, the microscopy method to detect malaria remains the most common. Unfortunately, the accuracy of microscopic diagnostics is dependent on the skill of the microscopist and limits the throughput of malaria diagnosis. With the development of Artificial Intelligence tools and Deep Learning techniques in particular, it is possible to lower the cost, while achieving an overall higher accuracy. In this paper, we present a VGG-based model and compare it with previously developed models for identifying infected cells. Our model surpasses most previously developed models in a range of the accuracy metrics. The model has an advantage of being constructed from a relatively small number of layers. This reduces the computer resources and computational time. Moreover, we test our model on two types of datasets and argue that the currently developed deep-learning-based methods cannot efficiently distinguish between infected and contaminated cells. A more precise study of suspicious regions is required.

Keywords: convolution neural network, deep learning, malaria, thin blood smears

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Authors: Thota Sai Prakash, B. Yaswanth, Jhade Bhuvaneswar, Marreddy Divakar Reddy, Shyam Ji Gupta

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Across the globe, there are a lot of chronic diseases, and heart disease stands out as one of the most perilous. Sadly, many lives are lost to this condition, even though early intervention could prevent such tragedies. However, identifying heart disease in its initial stages is not easy. To address this challenge, we propose an automated system aimed at predicting the presence of heart disease using advanced techniques. By doing so, we hope to empower individuals with the knowledge needed to take proactive measures against this potentially fatal illness. Our approach towards this problem involves meticulous data preprocessing and the development of predictive models utilizing classification algorithms such as Support Vector Machines (SVM), Decision Tree, and Random Forest. We assess the efficiency of every model based on metrics like accuracy, ensuring that we select the most reliable option. Additionally, we conduct thorough data analysis to reveal the importance of different attributes. Among the models considered, Random Forest emerges as the standout performer with an accuracy rate of 96.04% in our study.

Keywords: support vector machines, decision tree, random forest

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Authors: Jan C. Droste, Justine Burns, Nithin Narayan

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Introduction: Life-threatening detrimental effects of inappropriate adrenaline (epinephrine) administration, e.g., by giving the wrong dose, in the context of anaphylaxis management is well documented in the medical literature. Half of the fatal anaphylactic reactions in the UK are iatrogenic, and the median time to a cardio-respiratory arrest can be as short as 5 minutes. It is therefore imperative that hospital doctors of all grades have active and accurate knowledge of the correct route, site, and dosage of administration of adrenaline. Given this time constraint and the potential fatal outcome with inappropriate management of anaphylaxis, it is alarming that surveys over the last 15 years have repeatedly shown only a minority of doctors to have accurate knowledge of adrenaline administration as recommended by the UK Resuscitation Council guidelines (2008 updated 2012). This comparison of survey results of the medical workforce over several years in a small NHS District General Hospital was conducted in order to establish the effect of the employment of multiple educational methods regarding adrenaline administration in anaphylaxis in adults. Methods: Between 2010 and 2017, several education methods and tools were used to repeatedly inform the medical workforce (doctors and advanced clinical practitioners) in a single district general hospital regarding the treatment of anaphylaxis in adults. Whilst the senior staff remained largely the same cohort, junior staff had changed fully in every survey. Examples included: (i) Formal teaching -in Grand Rounds; during the junior doctors’ induction process; advanced life support courses (ii) In-situ simulation training performed by the clinical skills simulation team –several ad hoc sessions and one 3-day event in 2017 visiting 16 separate clinical areas performing an acute anaphylaxis scenario using actors- around 100 individuals from multi-disciplinary teams were involved (iii) Hospital-wide distribution of the simulation event via the Trust’s Simulation Newsletter (iv) Laminated algorithms were attached to the 'crash trolleys' (v) A short email 'alert' was sent to all medical staff 3 weeks prior to the survey detailing the emergency treatment of anaphylaxis (vi) In addition, the performance of the surveys themselves represented a teaching opportunity when gaps in knowledge could be addressed. Face to face surveys were carried out in 2010 ('pre-intervention), 2015, and 2017, in the latter two occasions including advanced clinical practitioners (ACP). All surveys consisted of convenience samples. If verbal consent to conduct the survey was obtained, the medical practitioners' answers were recorded immediately on a data collection sheet. Results: There was a sustained improvement in the knowledge of the medical workforce from 2010 to 2017: Answers improved regarding correct drug by 11% (84%, 95%, and 95%); the correct route by 20% (76%, 90%, and 96%); correct site by 40% (43%, 83%, and 83%) and the correct dose by 45% (27%, 54%, and 72%). Overall, knowledge of all components -correct drug, route, site, and dose-improved from 13% in 2010 to 62% in 2017. Conclusion: This survey comparison shows knowledge of the medical workforce regarding adrenaline administration for treatment of anaphylaxis in adults can be considerably improved by employing a variety of educational methods.

Keywords: adrenaline, anaphylaxis, epinephrine, medical education, patient safety

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Authors: Jelena Maletkovic

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Background: Endogenous Cushing’s syndrome is a rare disease, but iatrogenic or drug related Cushing syndrome from glucocorticoid products is commonly seen in clinical practice. With high dose and long term use of glucocorticoids, patients can develop isolated hypothalamic-pituitary-adrenal (HPA) suppression, or HPA axis suppression can be accompanied by overt iatrogenic Cushing’s syndrome. This is a rare case where severe Cushing’s syndrome developed from an unknown medication and was followed by severe and prolonged adrenal insufficiency and multiple potentially fatal complications. Case: This is a 37-year-old woman who is presented to Emergency Room (ER) with shortness of breath and chest pain. Four months prior to this presentation the patient was a generally healthy woman who was looking for improvement in her appearance and visited local Rejuvenation Clinic. After initial consultation with a nurse, she was contacted by a physician over the phone and was advised to start taking multiple injectable medications that will arrive by mail. Medications without any labels on bottles were delivered and the patient started daily intramuscular injections. Over the next two months, she noticed rounding of her face and swelling around her eyes. She gained 20 pounds, mostly abdominal fat and became extremely fatigued. Her muscles on legs were visibly decreasing in size and she felt significant muscle weakness. Unexplained bruising occurred. She started growing hair on face and developed secondary amenorrhea. New severe back pain started. She developed depression and headaches. Finally, over a few days, a number of red-purple stretch marks that were sensitive and painful appeared over her abdomen, upper part of arms and legs. She then became suspicious that these dramatic symptoms are caused by injectable medication and she discontinued injections. Over the next few days she presented to ER with low blood pressure and oxygen saturation of 75%. Studies revealed extensive pneumonia as well as multiple pulmonary emboli. Her white blood count was elevated with 32 000 and she also had acute kidney failure on admission. She was treated for sepsis and was also given stress dose steroids. Steroids were tapered over 48 hours and discontinued. After being discharged to home, on her first visit to endocrinology clinic she had undetectable ACTH of < 2pg/mL and undetectable 8am cortisol of < 0.2mcg/dL. She did not respond to an intramuscular injection of cosyntropin 250mcg and her repeated cortisol after 60 minutes was only 1mcg/dL. The patient was diagnosed with adrenal insufficiency and was started on hydrocortisone 20mg+10mg. It took close to 2 years of slow tapering for recovery of this patient’s HPA axis and resolve all the sequelae from Cushing’s syndrome. Conclusion: Misuse and abuse of glucocorticoids have been present almost since these medications were discovered. This is a rare case where not only severe Cushing’s syndrome in full clinical picture developed but also the patient suffered multiple potentially fatal complications and prolonged adrenal insufficiency. Visits to herbal, rejuvenation, esthetic, and similar clinics are becoming more and more popular and physicians need to be aware of possible non-benign nature of medications that their patients may be using.

Keywords: iatrogenic, Cushing's syndrome, adrenal crisis, steroid abuse

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Authors: Sivanandan Balakrishnan, Sara Moridpour, Richard Tay

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Heavy vehicles make a significant contribution to many developed economies, including Australia, because they are a major means of transporting goods within these countries. With the increase in road freight, there will be an increase in the heavy vehicle traffic proportion, and consequently, an increase in the possibility of collisions involving heavy vehicles. Crashes involving heavy vehicles are a major road safety concern because of the higher likelihood of fatal and serious injury, especially to any small vehicle occupant involved. The primary objective of this research is to identify the factors influencing injury severity to occupants in vehicle collisions involving heavy vehicle at T- intersection using a binary logit model in Victoria, Australia. Our results show that the factors influencing injury severity include occupants' gender, age and restraint use. Also, vehicles' type, movement, point-of-impact and damage, time-of-day, day-of-week and season, higher percentage of trucks in traffic volume, hit pedestrians, number of occupants involved and type of collisions are associated with severe injury.

Keywords: binary logit model, heavy vehicle, injury severity, T-intersections

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Authors: Mohammad Ali Hasanzadeh, Thierry Vanelslander, Eddy Van De Voorde

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Nowadays maritime transport is a key element in international trade and global supply chain. Economies of scale in transporting goods are one of the most attractive elements of using ships. Without maritime transport, almost no globalization of economics can be imagined. Within maritime transport, ports are the interface between lands and see. Even though using ships help cargo owners to have a competitive margin but an accident in port during loading or unloading or even moving cargoes within the terminal can diminish such margin. Statistics shows that due to the high-speed notion of activities within ports, collision accidents are the most common type of accidents. To mitigate such accidents, the appropriate risk exposures have to be defined and calculate, later on risk probabilities can be determined for each type of accident, i.e. fatal, severe, moderate and minor ones. Having such risk probabilities help managers to define the effectiveness of each collision risk control option. This research defined travelled distance as main collision risk exposure in container terminals, taking all the related items into consideration, it was calculated for Shahid Rajae container terminals. Following this finding, collision risk probabilities were computed.

Keywords: collision accident, container terminal, maritime transport, risk exposure

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Authors: Ali Baker, Russel Krawitz

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This paper describes a rare occurrence where a potentially fatal complication of COVID-19 infection (MIS-A) was misdiagnosed as an acute abdomen. As most patients with this syndrome present with fever and gastrointestinal symptoms, they may inadvertently fall under the care of the surgical unit. However, unusual imaging findings and a poor response to anti-microbial therapy should prompt clinicians to suspect a non-surgical etiology. More than half of MIS-A patients require ICU admission and vasopressor support. Prompt referral to a physician is key, as the cornerstone of treatment is IVIG and corticosteroid therapy. A 32 year old woman presented with right sided abdominal pain and fevers. She had also contracted COVID-19 two months earlier. Abdominal examination revealed generalised right sided tenderness. The patient had raised inflammatory markers, but other blood tests were unremarkable. CT scan revealed extensive lymphadenopathy along the ileocolic chain. The patient proved to be a diagnostic dilemma. She was reviewed by several surgical consultants and discussed with several inpatient teams. Although IV antibiotics were commenced, the right sided abdominal pain, and fevers persisted. Pan-culture returned negative. A mild cholestatic derangement developed. On day 5, the patient underwent preparation for colonoscopy to assess for a potential intraluminal etiology. The following day, the patient developed sinus tachycardia and hypotension that was refractory to fluid resuscitation. That patient was transferred to ICU and required vasopressor support. Repeat CT showed peri-portal edema and a thickened gallbladder wall. On re-examination, the patient was Murphy’s sign positive. Biliary ultrasound was equivocal for cholecystitis. The patient was planned for diagnostic laparoscopy. The following morning, a marked rise in cardiac troponin was discovered, and a follow-up echocardiogram revealed moderate to severe global systolic dysfunction. The impression was post-COVID MIS with myocardial involvement. IVIG and Methylprednisolone infusions were commenced. The patient had a great response. Vasopressor support was weaned, and the patient was discharged from ICU. The patient continued to improve clinically with oral prednisolone, and was discharged on day 17. Although MIS following COVID-19 infection is well-described syndrome in children, only recently has it come to light that it can occur in adults. The exact incidence is unknown, but it is thought to be rare. A recent systematic review found only 221 cases of MIS-A, which could be included for analysis. Symptoms vary, but the most frequent include fever, gastrointestinal, and mucocutaneous. Many patients progress to multi-organ failure and require vasopressor support. 7% succumb to the illness. The pathophysiology of MIS is only partly understood. It shares similarities with Kawasaki disease, macrophage activation syndrome, and cytokine release syndrome. Importantly, by definition, the patient must have an absence of severe respiratory symptoms. It is thought to be due to a dysregulated immune response to the virus. Potential mechanisms include reduced levels of neutralising antibodies and autoreactive antibodies that promote inflammation. Further research into MIS-A is needed. Although rare, this potentially fatal syndrome should be considered in the unwell surgical patient who has recently contracted COVID-19 and poses a diagnostic dilemma.

Keywords: acute-abdomen, MIS, COVID-19, ICU

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Authors: Eddy Neuhaus, Hanif Shirinzadeh, Cigdem Karaaslan, Elif Ince, Hande Gurer-Orhan, Sibel Suzen

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Reactive oxygen species (ROS) and oxidative stress can cause fatal damage to essential cell structures, including DNA. It is known that use of antioxidants could be advantageous in the prevention of various diseases such as cancer, cardiovascular diseases and neurodegenerative disorders. Since antioxidant properties of the indole ring-containing melatonin (MLT) has been described and evaluated, MLT-related compounds such as MLT metabolites and synthetic analogues are under investigation to determine which exhibit the highest activity with the lowest side-effects. Owing to indole and hydrazones appealing physiological properties and are mostly found in numerous biologically active compounds a series of indole-7-carbaldehyde hydrazone derivatives were synthesized, characterized and in vitro antioxidant activity was investigated by evaluating their reducing effect against oxidation of a redox-sensitive fluorescent probe. Cytotoxicity potential of all indole-based MLT analogues was investigated both by lactate dehydrogenase leakage assay and by MTT assay. This work was supported by The Scientific and Technological Research Council of Turkey (TÜBİTAK) Research and Development Grant 112S599.

Keywords: melatonin, antioxidant activity, indole, hydrazone, oxidative stress

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Authors: Lowanika Victor Tibane, David Mamba

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Human body, animals, and plants depend on certain essential metals in permissible quantities for their survival. Excessive metal concentration may cause severe malfunctioning of the organisms and even fatal in extreme cases. Because of gold mining in the Witwatersrand basin in South Africa, enormous untreated mine dumps comprise elevated concentration of essential trace elements. Elevated quantities of trace metal have direct negative impact on the quality of soil for different land use types, reduce soil efficiency for plant growth, and affect the health human and animals. A total of 21 subsoil samples were examined using inductively coupled plasma optical emission spectrometry and X-ray fluorescence methods and the results elevated men concentration of Fe (36,433.39) > S (5,071.83) > Cu (1,717,28) > Mn (612.81) > Cr (74.52) > Zn (68.67) > Ni (40.44) > Co (9.63) > P (3.49) > Mo > (2.74), reported in mg/kg. Using various contamination indices, it was discovered that the sites surveyed are on average moderately contaminated with Co, Cr, Cu, Mn, Ni, S, and Zn. The ecological risk assessment revealed a low ecological risk for Cr, Ni and Zn, whereas Cu poses a very high ecological risk.

Keywords: essential trace elements, soil contamination, contamination indices, toxicity, descriptive statistics, ecological risk evaluation

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Authors: Mohammad H. Ruhipour, Mahdi Goharrokhi, Mahsa Ghasemi, Artadokht Ostadsarayi

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In this paper, we are aiming to study the consequences of chlorine gas leak in direct chlorine gas injection compared to using bleach (sodium hypochlorite), studying the negative effects both on the environment and individuals. This study was performed in the cooling towers of a natural fractioning unit of Bandar-e-IMAM petrochemical plant. Considering that chlorine gas is highly toxic and based on the health regulation, its release into the surrounding environment can be very dangerous for people and even fatal for individuals. We studied performing quantitative studies in the worst cases of event incidence. In addition, studying alternative methods with a lower risk was also on the agenda to select the least likely possible option causing an accident. In this paper chlorine gas release consequences have been evaluated by using PHAST software. Reaching to 10 ppm of chlorine gas concentration was basis of hazardous area determination. The results show that the full chlorine gas line rupture scenario in Pasquill category F, were worst case, and many people could be harmed around cooling towers area because of chlorine gas inhalation.

Keywords: chlorine gas, consequence modeling, cooling towers, direct chlorination, risk assessment, system failure

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Authors: Meksem Nabila, Bordjiba Ouahiba, Meraghni Messaouda, Meksem Amara Leila, Djebar Mohhamed Reda

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The problems of protection of the cultures are being more and more important that they interest great number of farmers and scientists because of the excessive use of the organic phytosanitary products of synthesis that causes fatal damages on the environment. To reduce the inconveniences produced by these pesticides, the use of "biopesticides" originated from plants could be an alternative. The aim of this work is the valuation of a botanical species: Eucalyptus camaldulensis from Northeastern Algeria which extracts are supposed to have an antimicrobial activity, similar to pesticides. The extraction of secondary metabolites from the leaves of E. camaldulensis was realized using methanol and water, and measurements of total polyphenols were made by spectrometric method. Determination of the antimicrobial activity of the extracts at issue was realized in vitro on phyto-pathogenic fungal and bacterial stumps. Tests of comparison were included in the essays by using the chemical pesticidal products of synthesis. The obtained results show that the plant contains polyphenols with an efficiency mattering of the order of 22 %. These polyphenols have a strong fungicidal and bactericidal pesticidal activity against various microbial stumps and the values of the zones of inhibition are more important compared with that obtained in the presence of the chemicals of synthesis (fungicide).

Keywords: eucalyptus camaldulensis, biopesticide, polyphenols, antimicrobial activity

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Authors: Danish Farooq, Janos Juhasz

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Car-motorcycle accidents have been observed higher in recent years, which caused mainly riders’ fatalities and serious injuries. In-depth crash investigation methods aim to investigate the main factors which are likely involved in fatal road accidents and injury outcomes. The main objective of this study is to investigate the involved factors in car-motorcycle accidents in Budapest city. The procedure included statistical analysis and data sampling to identify car-motorcycle accidents by dominant accident types based on collision configurations. The police report was used as a data source for specified accidents, and simulation models were plotted according to scale (M 1:200). Car-motorcycle accidents were simulated in Virtual Crash software for 5 seconds before the collision. The simulation results showed that the main involved factors to car-motorcycle accidents were human behavior and view obstructions. The comprehensive, in-depth analysis also found that most of the car drivers and riders were unable to perform collision avoidance manoeuvres before the collision. This study can help the traffic safety authorities to focus on simulated involved factors to solve road safety issues in car-motorcycle accidents. The study also proposes safety measures to improve safe movements among road users.

Keywords: car motorcycle accidents, in-depth analysis, microscopic simulation, safety measures

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Authors: Abdul Matin, Salik Nawaz, Suk-Yul Jung

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Balamuthia mandrillaris is well known to cause fatal Balamuthia amoebic encephalitis (BAE). Amoebic transmission into the central nervous system (CNS), haematogenous spread is thought to be the prime step, followed by blood-brain barrier (BBB) dissemination. Macrophages are considered to be the foremost line of defense and present in excessive numbers during amoebic infections. The aim of the present investigation was to evaluate the effects of macrophages alone or primed with cytokines on the biological characteristics of Balamuthia in vitro. Using human brain microvascular endothelial cells (HBMEC), which constitutes the BBB, we have shown that Balamuthia demonstrated > 90% binding and > 70% cytotoxicity to host cells. However, macrophages further increased amoebic binding and Balamuthia-mediated cell cytotoxicity. Furthermore, macrophages exhibited no amoebicidal effect against Balamuthia. Zymography assay demonstrated that macrophages exhibited no inhibitory effect on proteolytic activity of Balamuthia. Overall, to our best knowledge, we have shown for the first time macrophages has no inhibitory effects on the biological properties of Balamuthia in vitro. This also strengthened the concept that how and why Balamuthia can cause infections in both immuno-competent and immuno-compromised individuals.

Keywords: Balamuthia mandrillaris, macrophages, cytokines, human brain microvascular endothelial cells, Balamuthia amoebic encephalitis

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Authors: Salma Ainine, Colin Ritchie, Tracey McFee

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Background: The societal impact of antibiotic resistance is a major public health concern. The increase in the incidence of resistant bacteria can ultimately be fatal. Objective: To analyse the appropriateness of antibiotic prescribing in Dundee Dental Hospital, ultimately improving the safety and quality of patient care. Methods: Two examiners independently cross-checked approximately fifty consecutive prescriptions, and corresponding patient case notes, for three data collection cycles between August 2014–September 2015. The Scottish Dental Clinical Effectiveness Program (SDCEP) Drug Prescribing for Dentistry guidelines was the standard utilised. The criteria: clinical justification, regime justification, and review arrangements was measured, and compared to the standard. Results: Cycle one revealed 42% of antibiotic prescriptions were appropriate. Interventions included: multiple staff meetings, an introduction of a checklist attached to the prescription pack, and production of patient leaflets explaining indications for antibiotics. Cycle two and three revealed 44%, and 30% compliance, respectively. Conclusion: The results of the audit have yet to meet target standards set out in prescribing guidelines. However, steps are being taken and change has occurred on a cultural level.

Keywords: antibiotic resistance, antibiotic stewardship, dental infection, hygiene standards

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Authors: Awol Seid Ebrie

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HIV results as an incurable disease, AIDS. After a person is infected with virus, the virus gradually destroys all the infection fighting cells called CD4 cells and makes the individual susceptible to opportunistic infections which cause severe or fatal health problems. Several studies show that the CD4 cells count is the most determinant indicator of the effectiveness of the treatment or progression of the disease. The objective of this paper is to investigate the progression of the disease over time among patient under HAART treatment. Two main approaches of the generalized multilevel ordinal models; namely the proportional odds model and the nonproportional odds model have been applied to the HAART data. Also, the multilevel part of both models includes random intercepts and random coefficients. In general, four models are explored in the analysis and then the models are compared using the deviance information criteria. Of these models, the random coefficients nonproportional odds model is selected as the best model for the HAART data used as it has the smallest DIC value. The selected model shows that the progression of the disease increases as the time under the treatment increases. In addition, it reveals that gender, baseline clinical stage and functional status of the patient have a significant association with the progression of the disease.

Keywords: nonproportional odds model, proportional odds model, random coefficients model, random intercepts model

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Authors: Keshari Shrestha, Philip Vatterott

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Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal drug-related syndrome. DRESS classically presents with a diffuse maculopapular rash, fevers, and eosinophilia more than three weeks after drug exposure. DRESS can present with multi-organ involvement, with liver damage being the most common and severe. Pulmonary involvement is a less common manifestation and is associated with poor clinical outcomes. Chest imaging is often nonspecific, and symptoms can range from mild cough to acute respiratory distress syndrome (ARDS) . This is a case of a 49-year-old female with a history of recent clostridium difficile colitis status post treatment with oral vancomycin who presented with rash, acute liver and kidney failure, as well as diffuse nodular alveolar lung opacities concerning for DRESS syndrome with multi-organ involvement. Clinical Course: This patient initially presented to an outside hospital with clostridium difficile colitis, acute liver injury, and acute kidney injury. She developed a desquamating maculopapular rash in the setting of recent oral vancomycin, meloxicam, and furosemide initiation. She was hospitalized on two additional occasions with worsening altered mental status, liver injury, and acute kidney injury and was initiated on intermittent hemodialysis. Notably, she was found to have systemic eosinophilia (4100 cells/microliter) several weeks prior. She was transferred to this institution for further management where she was found to have encephalopathy, jaundice, lower extremity edema, and diffuse bilateral rhonchorous breath sounds on pulmonary examination. The patient was started on methylprednisolone for suspected DRESS syndrome. She underwent an evaluation for alternative causes of her organ failure. Her workup included a negative infectious, autoimmune, metabolic, toxic, and malignant work-up. Abdominal computed tomography (CT) and ultrasound were remarkable for evidence of hepatic steatosis and possible cirrhotic morphology. Additionally, a chest CT demonstrated diffuse and symmetric nodular alveolar lung opacities with peripheral sparing not consistent with acute respiratory distress syndrome or edema. Ultimately, her condition continued to decline, and she required intubation on several occasions. On hospital day 25 she succumbed to distributive shock in the setting of probable sepsis and multi-organ failure. Discussion: DRESS syndrome occurs in 1 in 1,000 to 10,000 patients with a mortality rate of around 10%. Anti-convulsant, anti-bacterial, anti-viral, and sulfonamide drugs are the most common drugs implicated in the development of DRESS syndrome; however, the list of offending agents is extensive . The diagnosis of DRESS syndrome is made after excluding other causes of disease such as infectious and autoimmune etiologies. The RegiSCAR scoring system is used to diagnose DRESS syndrome with 2-3 points indicating possible disease, 4-5 probable disease, and >5 definite disease. This patient scored a 7 on the RegiSCAR scale for eosinophilia, rash, organ involvement, and exclusion of other causes (infectious and autoimmune). While the pharmacologic trigger in this case is unknown, it is speculated to be caused by vancomycin, meloxicam, or furosemide due to the favorable timeline of initiation. Despite aggressive treatment, DRESS syndrome can often be fatal. Because of this, early diagnosis and treatment of patients with suspected DRESS syndrome is imperative.

Keywords: drug reaction with eosinophilia and systemic symptoms, multi-organ failure, pulmonary involvement, renal failure

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Authors: Esra Ece Var

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Beekeeping plays essential role both in terms of agricultural yields and agricultural economy; they produce honey, wax, royal jelly, apitoxin, pollen, and propolis. Nowadays, these natural products become more importantly suitable and preferable for nutrition, food supplement, medicine, and industry. However, to produce organic honey, majority of the apiaries are located in remote or distant rural areas where utilities such as electricity and Internet network are not available. Additionally, due to colony failures, world honey production decreases year by year despite the increase in the number of beehives. The objective of this paper is to develop a smart beehive monitoring system for apiaries including those that do not have access to Internet network. In this context, temperature and humidity inside the beehive, and ambient temperature were measured with RFID sensors. Control center, where all sensor data was sent and stored at, has a GSM module used to warn the beekeeper via SMS when an anomaly is detected. Simultaneously, using the collected data, an unsupervised machine learning algorithm is used for detecting anomalies and calibrating the warning system. The results show that the smart beehive monitoring system can detect fatal anomalies up to 4 weeks prior to colony loss.

Keywords: beekeeping, smart systems, machine learning, anomaly detection, apiculture

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Authors: Surajit Chakrabarty, Piyush Chauhan, Subhasis Panda, Sujoy Bhattacharya

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A large proportion of roads in India are not well maintained as per the laid down public safety guidelines leading to loss of direction control and fatal accidents. We propose a technique to detect speed breakers and potholes using mobile sensor data captured from multiple vehicles and provide a profile of the road. This would, in turn, help in monitoring roads and revolutionize digital maps. Incorporating randomness in the model formulation for detection of speed breakers and potholes is crucial due to substantial heterogeneity observed in data obtained using a mobile application from multiple vehicles driven by different drivers. This is accomplished with Hidden Markov Models, whose hidden state sequence is found for each time step given the observables sequence, and are then fed as input to LSTM network with peephole connections. A precision score of 0.96 and 0.63 is obtained for classifying bumps and potholes, respectively, a significant improvement from the machine learning based models. Further visualization of bumps/potholes is done by converting time series to images using Markov Transition Fields where a significant demarcation among bump/potholes is observed.

Keywords: deep learning, hidden Markov model, pothole, speed breaker

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Authors: Romasa Qasim, G. M. Sayedur Rahman, Nahid Hasan, M. Shazzad Hosain

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Millions of people worldwide suffer from Hepatitis C, one of the fatal diseases. Interferon (IFN) and ribavirin are the available treatments for patients with Hepatitis C, but these treatments have their own side-effects. Our research focused on the development of an orally taken small molecule drug targeting the proteins in Hepatitis C Virus (HCV), which has lesser side effects. Our current study aims to the Pharmacophore based drug development of a specific small molecule anti-viral drug for Hepatitis C Virus (HCV). Drug designing using lab experimentation is not only costly but also it takes a lot of time to conduct such experimentation. Instead in this in silico study, we have used computer-aided techniques to propose a Pharmacophore-based anti-viral drug specific for the protein domains of the polyprotein present in the Hepatitis C Virus. This study has used homology modeling and ab initio modeling for protein 3D structure generation followed by pocket identification in the proteins. Drug-able ligands for the pockets were designed using de novo drug design method. For ligand design, pocket geometry is taken into account. Out of several generated ligands, a new Pharmacophore is proposed, specific for each of the protein domains of HCV.

Keywords: pharmacophore-based drug design, anti-viral drug, in-silico drug design, Hepatitis C virus (HCV)

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Authors: Hitendra Raj Joshi, Bipin Lamichhane

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Groundwater is the main source of water for the industries of Balaju Industrial District (BID) and the denizens of Balaju-Boratar area. The quantity of groundwater is in a fatal condition in the area than earlier days. Water levels in shallow wells have highly lowered and deep wells are not providing an adequate amount of water as before because of higher extraction rate than the recharge rate. The main recharge zone of the shallow aquifer lies at the foot of Nagarjuna mountain, where recent colluvial debris are accumulated. Urbanization in the area is the main reason for decreasing water table. Recharge source for the deep aquifer in the region is aquiclude leakage. Sand layer above the Kalimati clay is the shallow aquifer zone, which is limited only in Balaju and eastern part of the Boratar, while the layer below the Kalimati clay spreading around Gongabu, Machhapohari, and Balaju area is considered as a potential area of deep aquifer. Over extraction of groundwater without considering water balance in the aquifers may dry out the source and can initiate the land subsidence problem. Hence, all the responsible of the industries in BID area and the denizens of Balaju-Boratar area should be encouraged to practice artificial groundwater recharge.

Keywords: aquiclude leakage, Kalimati clay, groundwater recharge

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Authors: Shahd Alshammari

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This paper considers one of Margaret Atwood’s short stories ‘Lusus Naturae'. Through a critical lens that makes use of Julia Kristeva’s work on Powers of Horror and abjection, this paper suggests that the monstrous girl is the disabled woman, the abject in society. The monster is used as a metaphor for the unknown, the misunderstood, and the ‘different’ woman. Culturally Relevant Teaching (CRT) is a pedagogy that calls for making course material accessible and relevant to students. Through the study of literary texts, we are able to help create agency inside and outside the classroom. Stories are a necessary part of establishing connections across borders and boundaries. Stories are meant to raise awareness both inside and outside the classroom. The discussion is equally important, and the text is meant to facilitate relevant questions that the students need to consider when it comes to identity. Questions to consider are: what does it mean to be a ‘girl’ today, and what implications and consequences are at hand when you fail to perform this gendered identity? Gender is sometimes a fatal bond in the Middle East, and even more so, is the disability. In the case of our unnamed protagonist, she undergoes a process of un-becoming, a non-linear process of growing up. In a sense, it is a counter-Bildungsroman. The reading of this text emphasizes that a non-linear narrative is sometimes necessary for the female protagonist’s self-awareness and development. Discussion in class facilitates this sense of agency and questioning of gender and disability.

Keywords: disability, gender, literature, pedagogy

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Authors: Anita Khadka, Gregory Epiphaniou, Carsten Maple

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There is a dramatic surge in the adoption of machine learning (ML) techniques in many areas, including the nuclear industry (such as fault diagnosis and fuel management in nuclear power plants), autonomous systems (including self-driving vehicles), space systems (space debris recovery, for example), medical surgery, network intrusion detection, malware detection, to name a few. With the application of learning methods in such diverse domains, artificial intelligence (AI) has become a part of everyday modern human life. To date, the predominant focus has been on developing underpinning ML algorithms that can improve accuracy, while factors such as resiliency and robustness of algorithms have been largely overlooked. If an adversarial attack is able to compromise the learning method or data, the consequences can be fatal, especially but not exclusively in safety-critical applications. In this paper, we present an in-depth analysis of five adversarial attacks and three defence methods on a crack detection ML model. Our analysis shows that it can be dangerous to adopt machine learning techniques in security-critical areas such as the nuclear industry without rigorous testing since they may be vulnerable to adversarial attacks. While common defence methods can effectively defend against different attacks, none of the three considered can provide protection against all five adversarial attacks analysed.

Keywords: adversarial machine learning, attacks, defences, nuclear industry, crack detection

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