Search results for: Hemodialysis patients

Authors: Ashwin Belle, Bryce Benson, Mark Salamango, Fadi Islim, Rodney Daniels, Kevin Ward

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A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.

Keywords: Critical care, early warning systems, emergency medicine, heart rate variability, hemodynamic instability, rapid response team.

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Authors: L. S. Godlevsky, N. V. Kresyun, V. P. Martsenyuk, K. S. Shakun, T. V. Tatarchuk, K. O. Prybolovets, L. F. Kalinichenko, M. Karpinski, T. Gancarczyk

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Structures of eye bottom were extracted using multiscale texture gradient method and color characteristics of macular zone and vessels were verified in CIELAB scale. The difference of average values of L*, a* and b* coordinates of CIE (International Commision of Illumination) scale in patients with diabetes and healthy volunteers was compared. The average value of L* in diabetic patients exceeded such one in the group of practically healthy persons by 2.71 times (P < 0.05), while the value of a* index was reduced by 3.8 times when compared with control one (P < 0.05). b* index exceeded such one in the control group by 12.4 times (P < 0.05). The integrated index on color difference (ΔE) exceeded control value by 2.87 times (P < 0.05). More pronounced differences with ΔE were followed by a shorter period of MA appearance with a correlation level at -0.56 (P < 0.05). The specificity of diagnostics raised by 2.17 times (P < 0.05) and negative prognostic index exceeded such one determined with the expert method by 2.26 times (P < 0.05).

Keywords: Diabetic retinopathy, multiscale texture gradient, color spectrum analysis.

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Authors: Boroňová I., Bernasovská J., Kľoc J., Tomková Z., Petrejčíková E., Gabriková D., Mačeková S.

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Osteoporosis is a complex health disease characterized by low bone mineral density, which is determined by an interaction of genetics with metabolic and environmental factors. Current research in genetics of osteoporosis is focused on identification of responsible genes and polymorphisms. TNFRSF11B gene plays a key role in bone remodeling. The aim of this study was to investigate the genotype and allele distribution of A163G (rs3102735) osteoprotegerin gene promoter and G1181C (rs2073618) osteoprotegerin first exon polymorphisms in the group of 180 unrelated postmenopausal women with diagnosed osteoporosis and 180 normal controls. Genomic DNA was isolated from peripheral blood leukocytes using standard methodology. Genotyping for presence of different polymorphisms was performed using the Custom Taqman®SNP Genotyping assays. Hardy-Weinberg equilibrium was tested for each SNP in the groups of participants using the chi-square (χ²) test. The distribution of investigated genotypes in the group of patients with osteoporosis were as follows: AA (66.7%), AG (32.2%), GG (1.1%) for A163G polymorphism; GG (19.4%), CG (44.4%), CC (36.1%) for G1181C polymorphism. The distribution of genotypes in normal controls were follows: AA (71.1%), AG (26.1%), GG (2.8%) for A163G polymorphism; GG (22.2%), CG (48.9%), CC (28.9%) for G1181C polymorphism. In A163G polymorphism the variant G allele was more common among patients with osteoporosis: 17.2% versus 15.8% in normal controls. Also, in G1181C polymorphism the phenomenon of more frequent occurrence of C allele in the group of patients with osteoporosis was observed (58.3% versus 53.3%). Genotype and allele distributions showed no significant differences (A163G: χ²=0.270, p=0.605; χ²=0.250, p=0.616; G1181C: χ²= 1.730, p=0.188; χ²=1.820, p=0.177). Our results represents an initial study, further studies of more numerous file and associations studies will be carried out. Knowing the distribution of genotypes is important for assessing the impact of these polymorphisms on various parameters associated with osteoporosis. Screening for identification of “at-risk” women likely to develop osteoporosis and initiating subsequent early intervention appears to be most effective strategy to substantially reduce the risks of osteoporosis.

Keywords: Osteoporosis, Real-time PCR method, SNP polymorphisms.

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Authors: Rajashekar Patil, S. Mohan Kumar, Shreya Ajmera

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To understand complex living system an effort has made by mechanical engineers and dentists to deliver prompt products and services to patients concerned about their aesthetic look. Since two decades various bracket systems have designed involving techniques like milling, injection molding which are technically not flexible for the customized dental product development. The aim of this paper to design, develop a customized system which is economical and mainly emphasizes the expertise design and integration of engineering and dental fields. A custom made selfadjustable lingual bracket and customized implants are designed and developed using computer aided design (CAD) and rapid prototyping technology (RPT) to improve the smiles and to overcome the difficulties associated with conventional ones. Lengthy orthodontic treatment usually not accepted by the patients because the patient compliance is lost. Patient-s compliance can be improved by facilitating faster tooth movements by designing a localized dental vibrator using advanced engineering principles.

Keywords: Orthodontics, Prosthodontics, Lingual bracket, Implants, Dental vibrator, Computer aided design, Rapid prototyping technology.

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Authors: Vladyslav Povoroznyuk, Larysa Martynyuk, Iryna Syzonenko, Liliya Martynyuk

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Medical, social, and economic relevance of osteoporosis is caused by reducing quality of life, increasing disability and mortality of the patients as a result of fractures due to the low-energy trauma. This study is aimed to examine the associations of metabolic syndrome components, bone mineral density (BMD) and trabecular bone score (TBS) in menopausal women with non-vertebral fractures. 1161 menopausal women aged 50-79 year-old were examined and divided into three groups: A included 419 women with increased body weight (BMI - 25.0-29.9 kg/m²), B – 442 females with obesity (BMI >29.9 kg/m²)i and C – 300 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). BMD of lumbar spine (L1-L4), femoral neck, total body and forearm was investigated with usage of dual-energy X-ray absorptiometry. The bone quality indexes were measured according to Med-Imaps installation. All analyses were performed using Statistical Package 6.0. BMD of lumbar spine (L1-L4), femoral neck, total body, and ultradistal radius was significant higher in women with obesity and metabolic syndrome compared to the pre-obese ones (p<0.001). TBS was significantly higher in women with increased body weight compared to obese and metabolic syndrome patients. Analysis showed significant positive correlation between waist circumference, triglycerides level and BMD of lumbar spine and femur. Significant negative association between serum HDL level and BMD of investigated sites was established. The TBS (L1-L4) indexes positively correlated with HDL (high-density lipoprotein) level. Despite the fact that BMD indexes were better in women with metabolic syndrome, the frequency of non-vertebral fractures was significantly higher in this group of patients.

Keywords: Bone mineral density, trabecular bone score, metabolic syndrome, fracture.

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Authors: Manisha Rathi, Thierry Chaussalet

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Hospital staff and managers are under pressure and concerned for effective use and management of scarce resources. The hospital admissions require many decisions that have complex and uncertain consequences for hospital resource utilization and patient flow. It is challenging to predict risk of admissions and length of stay of a patient due to their vague nature. There is no method to capture the vague definition of admission of a patient. Also, current methods and tools used to predict patients at risk of admission fail to deal with uncertainty in unplanned admission, LOS, patients- characteristics. The main objective of this paper is to deal with uncertainty in health system variables, and handles uncertain relationship among variables. An introduction of machine learning techniques along with statistical methods like Regression methods can be a proposed solution approach to handle uncertainty in health system variables. A model that adapts fuzzy methods to handle uncertain data and uncertain relationships can be an efficient solution to capture the vague definition of admission of a patient.

Keywords: Admission, Fuzzy, Regression, Uncertainty

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Authors: P. Sanzo

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Increased physical fitness participation has been paralleled by increasedoveruse injuries such as insertional Achilles tendinosis (AT). Treatment has provided inconsistentresults. The use of extracorporeal shockwave therapy (ECSWT) offers a new treatment consideration.The purpose of this study was to assess the effects of ECSWTon pain, function, range of motion (ROM), joint mobility and strength in patients with AT. Thirty subjects were treated with ECSWT and measures were takenbefore and three months after treatment. There was significant differences in visual analog scale (VAS) scores for pain at rest (p=0.002); after activity (p= 0.0001); overall improvement(p=0.0001); Lower Extremity Functional Scale (LEFS) scores (p=0.002); dorsiflexion range of motion (ROM) (p=0.0001); plantarflexion strength (p=0.025); talocrural joint anterior glide (p=0.046); and subtalar joint medial and lateral glide (p=0.025).ECSWT offers a new intervention that may limit the progression of the disorder and the long term healthcare costs associated with AT.

Keywords: Extracorporeal shockwave therapy, shockwave therapy, Achilles tendinosis, range of motion, strength, joint mobility

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Authors: Anjan Babu G, Sumana G, Rajasekhar M

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Many inherited diseases and non-hereditary disorders are common in the development of renal cystic diseases. Polycystic kidney disease (PKD) is a disorder developed within the kidneys in which grouping of cysts filled with water like fluid. PKD is responsible for 5-10% of end-stage renal failure treated by dialysis or transplantation. New experimental models, application of molecular biology techniques have provided new insights into the pathogenesis of PKD. Researchers are showing keen interest for developing an automated system by applying computer aided techniques for the diagnosis of diseases. In this paper a multilayered feed forward neural network with one hidden layer is constructed, trained and tested by applying back propagation learning rule for the diagnosis of PKD based on physical symptoms and test results of urinalysis collected from the individual patients. The data collected from 50 patients are used to train and test the network. Among these samples, 75% of the data used for training and remaining 25% of the data are used for testing purpose. Further, this trained network is used to implement for new samples. The output results in normality and abnormality of the patient.

Keywords: Dialysis, Hereditary, Transplantation, Polycystic, Pathogenesis.

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Authors: Yujin Jeong, Youkyung Son, Myounghwan Choi, Sanghyub Lee, Sangyeol Lee, Changho Hwang, Kyo-in Koo

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Dysphasia is difficulty in swallowing food because of oral cavity impairments induced by stroke, muscle damage, tumor. Intermittent oro-esophageal (IOE) tube feeding is one of the well-known feeding methods for the dysphasia patients. However, it is hard to insert at the proper position in esophagus. In this study, we design and fabricate the IOE tube guide using 3-dimensional (3D) printer. The printed IOE tube is tested in a mannequin (Airway Management Trainer, Co., Ltd., Copenhagen, Denmark) mimicking human’s esophagus. The gag reflex point is measured as the design point in the mannequin. To avoid the gag reflex, we design various shapes of IOE tube guide. One structure is separated into three parts; biting part, part through oral cavity, connecting part to oro-esophageal. We designed 6 types of IOE tube guide adjusting length and angle of these three parts. To evaluate the IOE tube guide, it is inserted in the mannequin, and through the inserted guide, an endoscopic camera successfully arrived at the oro-esophageal. We had planned to apply this mannequin-based design experience to patients in near future.

Keywords: Dysphagia, feeding method, IOE tube guide, 3-D printer.

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Authors: Tsu-Yun Chiu, Tsung-Hsueh Lu, Tain-Junn Cheng

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Background: Traditional chronic disease management did not pay attention to effects of geographic factors on the compliance of treatment regime, which resulted in geographic inequality in outcomes of chronic disease management. This study aims to examine the geographic distribution and clustering of quality indicators of diabetes care. Method: We first extracted address, demographic information and quality of care indicators (number of visits, complications, prescription and laboratory records) of patients with diabetes for 2014 from medical information system in a medical center in Tainan City, Taiwan, and the patients’ addresses were transformed into district- and village-level data. We then compared the differences of geographic distribution and clustering of quality of care indicators between districts and villages. Despite the descriptive results, rate ratios and 95% confidence intervals (CI) were estimated for indices of care in order to compare the quality of diabetes care among different areas. Results: A total of 23,588 patients with diabetes were extracted from the hospital data system; whereas 12,716 patients’ information and medical records were included to the following analysis. More than half of the subjects in this study were male and between 60-79 years old. Furthermore, the quality of diabetes care did indeed vary by geographical levels. Thru the smaller level, we could point out clustered areas more specifically. Fuguo Village (of Yongkang District) and Zhiyi Village (of Sinhua District) were found to be “hotspots” for nephropathy and cerebrovascular disease; while Wangliau Village and Erwang Village (of Yongkang District) would be “coldspots” for lowest proportion of ≥80% compliance to blood lipids examination. On the other hand, Yuping Village (in Anping District) was the area with the lowest proportion of ≥80% compliance to all laboratory examination. Conclusion: In spite of examining the geographic distribution, calculating rate ratios and their 95% CI could also be a useful and consistent method to test the association. This information is useful for health planners, diabetes case managers and other affiliate practitioners to organize care resources to the areas most needed.

Keywords: Geocoding, chronic disease management, quality of diabetes care, rate ratio.

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Authors: R. F. Ajayi, U. Sidwaba, U. Feleni, S. F. Douman, E. Nxusani, L. Wilson, C. Rassie, O. Tovide, P. G. L. Baker, S. L. Vilakazi, R. Tshikhudo, E. I. Iwuoha

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Pyrazinamide (PZA) is among the first-line pro-drugs  in the tuberculosis (TB) combination chemotherapy used to treat  Mycobacterium tuberculosis. Numerous reports have suggested that  hepatotoxicity due to pyrazinamide in patients is due to inappropriate  dosing. It is, therefore necessary to develop sensitive and reliable  techniques for determining the PZA metabolic profile of diagnosed  patients promptly and at point-of-care. This study reports the  determination of PZA based on nanobiosensor systems developed  from disuccinimidyl octanedioate modified Cytochrome P450-2E1  (CYP2E1) electrodeposited on gold substrates derivatised with  (poly(8-anilino-1-napthalene sulphonic acid) PANSA/PVP-AgNPs  nanocomposites. The rapid and sensitive amperometric PZA  detection gave a dynamic linear range of 2µM to 16µM revealing a  limit of detection of 0.044µM and a sensitivity of 1.38µA/µM. The  Michaelis-Menten parameters; KM, KM app and IMAX were calculated to  be 6.0µM, 1.41µM and 1.51x10-6 A, respectively, indicating a  nanobiosensor suitable for use in serum.

Keywords: Cytochrome P450-2E1, Disuccinimidyl octanedioate, Pyrazinamide, Tuberculosis.

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Authors: Elif Derya UBEYLI, Inan GULER

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A new approach based on the consideration that electroencephalogram (EEG) signals are chaotic signals was presented for automated diagnosis of electroencephalographic changes. This consideration was tested successfully using the nonlinear dynamics tools, like the computation of Lyapunov exponents. This paper presented the usage of statistics over the set of the Lyapunov exponents in order to reduce the dimensionality of the extracted feature vectors. Since classification is more accurate when the pattern is simplified through representation by important features, feature extraction and selection play an important role in classifying systems such as neural networks. Multilayer perceptron neural network (MLPNN) architectures were formulated and used as basis for detection of electroencephalographic changes. Three types of EEG signals (EEG signals recorded from healthy volunteers with eyes open, epilepsy patients in the epileptogenic zone during a seizure-free interval, and epilepsy patients during epileptic seizures) were classified. The selected Lyapunov exponents of the EEG signals were used as inputs of the MLPNN trained with Levenberg- Marquardt algorithm. The classification results confirmed that the proposed MLPNN has potential in detecting the electroencephalographic changes.

Keywords: Chaotic signal, Electroencephalogram (EEG) signals, Feature extraction/selection, Lyapunov exponents

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Authors: Okolie Uchenna, Ehiemere Ijeoma, Ezenduka Pauline, Ogbu Sylvester

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A cross sectional survey design was used to collect data from 370 diabetic patients. Two instruments were used in obtaining data; in-depth interview guide and researchers- developed questionnaire. Fisher's exact test was used to investigate association between the identified factors and nonadherence. Factors identified were: socio-demographic factors such as: gender, age, marital status, educational level and occupation; psychosocial obstacles such as: non-affordability of prescribed diet, frustration due to the restriction, limited spousal support, feelings of deprivation, feeling that temptation is inevitable, difficulty in adhering in social gatherings and difficulty in revealing to host that one is diabetic; health care providers obstacles were: poor attitude of health workers, irregular diabetes education in clinics , limited number of nutrition education sessions/ inability of the patients to estimate the desired quantity of food, no reminder post cards or phone calls about upcoming patient appointments and delayed start of appointment / time wasting in clinics.

Keywords: Behavior change, diabetes mellitus, dietarymanagement, diet adherence.

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Authors: Hua Cao, Laurent Peyrodie, Olivier Agnani, Cécile Donzé

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Multiple Sclerosis (MS) is a disease which affects the central nervous system and causes balance problem. In clinical, this disorder is usually evaluated using static posturography. Some linear or nonlinear measures, extracted from the posturographic data (i.e. center of pressure, COP) recorded during a balance test, has been used to analyze postural control of MS patients. In this study, the trend (TREND) and the sample entropy (SampEn), two nonlinear parameters were chosen to investigate their relationships with the expanded disability status scale (EDSS) score. 40 volunteers with different EDSS scores participated in our experiments with eyes open (EO) and closed (EC). TREND and 2 types of SampEn (SampEn1 and SampEn2) were calculated for each combined COP’s position signal. The results have shown that TREND had a weak negative correlation to EDSS while SampEn2 had a strong positive correlation to EDSS. Compared to TREND and SampEn1, SampEn2 showed a better significant correlation to EDSS and an ability to discriminate the MS patients in the EC case. In addition, the outcome of the study suggests that the multi-dimensional nonlinear analysis could provide some information about the impact of disability progression in MS on dynamics of the COP data.

Keywords: Balance, multiple sclerosis, nonlinear analysis, postural sway.

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Authors: Thusitha Mabotuwana, Christopher S. Hall

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Radiologists routinely make follow-up imaging recommendations, usually based on established clinical practice guidelines, such as the Fleischner Society guidelines for managing lung nodules. In order to ensure optimal care, it is important to make guideline-compliant recommendations, and also for patients to follow-up on these imaging recommendations in a timely manner. However, determining such compliance rates after a specific finding has been observed usually requires many time-consuming manual steps. To address some of these limitations with current approaches, in this paper we discuss a methodology to automatically detect finding-specific follow-up recommendations from radiology reports and create a visualization for relevant subsequent exams showing the modality transitions. Nearly 5% of patients who had a lung related follow-up recommendation continued to have at least eight subsequent outpatient CT exams during a seven year period following the recommendation. Radiologist and section chiefs can use the proposed tool to better understand how a specific patient population is being managed, identify possible deviations from established guideline recommendations and have a patient-specific graphical representation of the imaging pathways for an abstract view of the overall treatment path thus far.

Keywords: Follow-up recommendations, care pathways, imaging pathway visualization, follow-up tracking.

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Authors: Dennys Robson Girardi, Hugo Bulegon, Claudia Maria Moro Barra

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Leprosy is an infectious disease caused by Mycobacterium Leprae, this disease, generally, compromises the neural fibers, leading to the development of disability. Disabilities are changes that limit daily activities or social life of a normal individual. When comes to leprosy, the study of disability considered the functional limitation (physical disabilities), the limitation of activity and social participation, which are measured respectively by the scales: EHF, SALSA and PARTICIPATION SCALE. The objective of this work is to propose an on-line monitoring of leprosy patients, which is based on information scales EHF, SALSA and PARTICIPATION SCALE. It is expected that the proposed system is applied in monitoring the patient during treatment and after healing therapy of the disease. The correlations that the system is between the scales create a variety of information, presented the state of the patient and full of changes or reductions in disability. The system provides reports with information from each of the scales and the relationships that exist between them. This way, health professionals, with access to patient information, can intervene with techniques for the Prevention of Disability. Through the automated scale, the system shows the level of the patient and allows the patient, or the responsible, to take a preventive measure. With an online system, it is possible take the assessments and monitor patients from anywhere.

Keywords: Leprosy, Medical Informatics, Decision SupportSystem, Disability.

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Authors: Ayesha Zaman, Tanvir Atahary, Shahida Rafiq

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Functional Magnetic Resonance Imaging(fMRI) is a noninvasive imaging technique that measures the hemodynamic response related to neural activity in the human brain. Event-related functional magnetic resonance imaging (efMRI) is a form of functional Magnetic Resonance Imaging (fMRI) in which a series of fMRI images are time-locked to a stimulus presentation and averaged together over many trials. Again an event related potential (ERP) is a measured brain response that is directly the result of a thought or perception. Here the neuronal response of human visual cortex in normal healthy patients have been studied. The patients were asked to perform a visual three choice reaction task; from the relative response of each patient corresponding neuronal activity in visual cortex was imaged. The average number of neurons in the adult human primary visual cortex, in each hemisphere has been estimated at around 140 million. Statistical analysis of this experiment was done with SPM5(Statistical Parametric Mapping version 5) software. The result shows a robust design of imaging the neuronal activity of human visual cortex.

Keywords: Echo Planner Imaging, Event related Response, General Linear Model, Visual Neuronal Response.

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Authors: Sarah Beaver, Renee Bryce

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Audiograms detect hearing impairment, but missing values pose problems. This work explores imputations in an attempt to improve accuracy. This work implements Linear Regression, Lasso, Linear Support Vector Regression, Bayesian Ridge, K Nearest Neighbors (KNN), and Random Forest machine learning techniques to impute audiogram frequencies ranging from 125 Hz to 8000 Hz. The data contain patients who had or were candidates for cochlear implants. Accuracy is compared across two different Nested Cross-Validation k values. Over 4000 audiograms were used from 800 unique patients. Additionally, training on data combines and compares left and right ear audiograms versus single ear side audiograms. The accuracy achieved using Root Mean Square Error (RMSE) values for the best models for Random Forest ranges from 4.74 to 6.37. The R2 values for the best models for Random Forest ranges from .91 to .96. The accuracy achieved using RMSE values for the best models for KNN ranges from 5.00 to 7.72. The R2 values for the best models for KNN ranges from .89 to .95. The best imputation models received R2 between .89 to .96 and RMSE values less than 8dB. We also show that the accuracy of classification predictive models performed better with our imputation models versus constant imputations by a two percent increase.

Keywords: Machine Learning, audiograms, data imputations, single imputations.

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Authors: Wan-I Lee, Nelio Mendoza Figueredo

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The impact of COVID-19 has a significant effect on all sectors of society globally. Health information technology (HIT) has become an effective health strategy in this age of distancing. In this regard, Mobile Health (mHealth) plays a critical role in managing patient and provider workflows during the COVID-19 pandemic. Therefore, the users' perception of service quality about mHealth services plays a significant role in shaping confidence and subsequent behaviors regarding the mHealth users' intention of use. This study's objective was to explore levels of user attributes analyzed by a qualitative method of how health practitioners and patients are satisfied or dissatisfied with using mHealth services; and analyzed the users' intention in the context of Taiwan during the COVID-19 pandemic. This research explores the experienced usability of a mHealth services during the Covid-19 pandemic. This study uses qualitative methods that include in-depth and semi-structured interviews that investigate participants' perceptions and experiences and the meanings they attribute to them. The five cases consisted of health practitioners, clinic staff, and patients' experiences using mHealth services. This study encourages participants to discuss issues related to the research question by asking open-ended questions, usually in one-to-one interviews. The findings show the positive and negative attributes of mHealth service quality. Hence, the significant importance of patients' and health practitioners' issues on several dimensions of perceived service quality is system quality, information quality, and interaction quality. A concept map for perceptions regards to emergency uses' intention of mHealth services process is depicted. The findings revealed that users pay more attention to "Medical care", "ease of use" and "utilitarian benefits" and have less importance for "Admissions and Convenience" and "Social influence". To improve mHealth services, the mHealth providers and health practitioners should better manage users' experiences to enhance mHealth services. This research contributes to the understanding of service quality issues in mHealth services during the COVID-19 pandemic.

Keywords: COVID-19, mobile health, mHealth, service quality, use intention.

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Authors: J. Bernasovská, R. Lohajová Behulová, E. Petrejčiková, I. Boroňová, I. Bernasovský

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Y chromosome microdeletions are the most common genetic cause of male infertility and screening for these microdeletions in azoospermic or severely oligospermic men is now standard practice. Analysis of the Y chromosome in men with azoospermia or severe oligozoospermia has resulted in the identification of three regions in the euchromatic part of the long arm of the human Y chromosome (Yq11) that are frequently deleted in men with otherwise unexplained spermatogenic failure. PCR analysis of microdeletions in the AZFa, AZFb and AZFc regions of the human Y chromosome is an important screening tool. The aim of this study was to analyse the type of microdeletions in men with fertility disorders in Slovakia. We evaluated 227 patients with azoospermia and with normal karyotype. All patient samples were analyzed cytogenetically. For PCR amplification of sequence-tagged sites (STS) of the AZFa, AZFb and AZFc regions of the Y chromosome was used Devyser AZF set. Fluorescently labeled primers for all markers in one multiplex PCR reaction were used and for automated visualization and identification of the STS markers we used genetic analyzer ABi 3500xl (Life Technologies). We reported 13 cases of deletions in the AZF region 5,73%. Particular types of deletions were recorded in each region AZFa,b,c .The presence of microdeletions in the AZFc region was the most frequent. The study confirmed that percentage of microdeletions in the AZF region is low in Slovak azoospermic patients, but important from a prognostic view.

Keywords: AZF, male infertility, microdeletions, Y chromosome.

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Authors: Amer A. Hasan, Mehri Igci, Ersin Borazan, Rozhgar A. Khailany, Emine Bayraktar, Ahmet Arslan

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Gastric Cancer (GC) has high morbidity and fatality rate in various countries. It is still one of the most frequent and deadly diseases. Gastrokine1 (GKN1) and gastrokine2 (GKN2) genes are highly expressed in the normal stomach epithelium and play important roles in maintaining the integrity and homeostasis of stomach mucosal epithelial cells. In this study, 47 paired samples that were grouped according to the types of gastric cancer and the clinical characteristics of the patients, including gender and average of age. They were investigated with gene expression analysis and mutation screening by monitoring RT-PCR, SSCP and nucleotide sequencing techniques. Both GKN1 and GKN2 genes were observed significantly reduced found by (Wilcoxon signed rank test; p<0.05). As a result of gene screening, no mutation (no different genotype) was detected. It is considered that gene mutations are not the cause of gastrokines inactivation. In conclusion, the mRNA expression level of GKN1 and GKN2 genes statistically was decreased regardless the gender, age, or cancer type of patients. Reduced of gastrokine genes seem to occur at the initial steps of gastric cancer development.

Keywords: Diagnostic biomarker, gastric cancer, nucleotide sequencing, semi-quantitative RT-PCR.

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Authors: J. F. Pollo Gaspary, F. Peron Gaspary, E. M. Simão, R. Concatto Beltrame, G. Orengo de Oliveira, M. S. Ristow Ferreira, J.C. Mairesse Siluk, I. F. Minello, F. dos Santos de Oliveira

Abstract:

Background: Although palliative care policies and services have been developed, research in this area continues to lag. An integrated model of palliative care is suggested, which includes complementary and alternative services aimed at improving the well-being of patients and their families. The palliative aquatics care multi-device (AuBento) uses several electromagnetic techniques to decrease pain and promote well-being through relaxation and interaction among patients, specialists, and family members. Aim: The scope of this paper is to present a preliminary design study of a device capable of exploring the various existing theories on the biomedical application of magnetic fields. This will be achieved by standardizing clinical data collection with sensory integration, and adding new therapeutic options to develop an advanced palliative aquatics care, innovating in symptom and pain management. Methods: The research methodology was based on the Work Package Methodology for the development of projects, separating the activities into seven different Work Packages. The theoretical basis was carried out through an integrative literature review according to the specific objectives of each Work Package and provided a broad analysis, which, together with the multiplicity of proposals and the interdisciplinarity of the research team involved, generated consistent and understandable complex concepts in the biomedical application of magnetic fields for palliative care. Results: Aubento ambience was idealized with restricted electromagnetic exposure (avoiding data collection bias) and sensory integration (allowing relaxation associated with hydrotherapy, music therapy, and chromotherapy or like floating tank). This device has a multipurpose configuration enabling classic or exploratory options on the use of the biomedical application of magnetic fields at the researcher's discretion. Conclusions: Several patients in diverse therapeutic contexts may benefit from the use of magnetic fields or fluids, thus validating the stimuli to clinical research in this area. A device in controlled and multipurpose environments may contribute to standardizing research and exploring new theories. Future research may demonstrate the possible benefits of the aquatics care multi-device AuBento to improve the well-being and symptom control in palliative care patients and their families.

Keywords: Advanced palliative aquatics care, magnetic field therapy, medical device, research design.

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Authors: G. Aloisio, L. T. De Paolis, A. De Mauro, A. Mongelli

Abstract:

One of the essential requirements of a realistic surgical simulator is to reproduce haptic sensations due to the interactions in the virtual environment. However, the interaction need to be performed in real-time, since a delay between the user action and the system reaction reduces the immersion sensation. In this paper, a prototype of a coronary stent implant simulator is present; this system allows real-time interactions with an artery by means of a specific haptic device. To improve the realism of the simulation, the building of the virtual environment is based on real patients- images and a Web Portal is used to search in the geographically remote medical centres a virtual environment with specific features in terms of pathology or anatomy. The functional architecture of the system defines several Medical Centres in which virtual environments built from the real patients- images and related metadata with specific features in terms of pathology or anatomy are stored. The searched data are downloaded from the Medical Centre to the Training Centre provided with a specific haptic device and with the software necessary both to manage the interaction in the virtual environment. After the integration of the virtual environment in the simulation system it is possible to perform training on the specific surgical procedure.

Keywords: Medical Simulation, Web Portal, Virtual Reality.

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Authors: C. Barreto Carvalho, C. da Motta, M. Sousa, J. Cabral, A. L. Carvalho, E. B. Peixoto

Abstract:

The aim of the current study was to develop and validate a Response to Stressful Situations Scale (RSSS) for the Portuguese population. This scale assesses the degree of stress experienced in scenarios that can constitute positive, negative and more neutral stressors, and also describes the physiological, emotional and behavioral reactions to those events according to their intensity. These scenarios include typical stressor scenarios relevant to patients with schizophrenia, which are currently absent from most scales, assessing specific risks that these stressors may bring on subjects, which may prove useful in non-clinical and clinical populations (i.e. Patients with mood or anxiety disorders, schizophrenia). Results from Principal Components Analysis and Confirmatory Factor Analysis of two adult samples from general population allowed to confirm a three-factor model with good fit indices: χ2 (144)= 370.211, p = 0.000; GFI = 0.928; CFI = 0.927; TLI = 0.914, RMSEA = 0.055, P(rmsea ≤0.005) = .096; PCFI = .781. Further data analysis of the scale revealed that RSSS is an adequate assessment tool of stress response in adults to be used in further research and clinical settings, with good psychometric characteristics, adequate divergent and convergent validity, good temporal stability and high internal consistency.

Keywords: Assessment, stress events, stress response, stress vulnerability.

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Authors: Ramón Cruzat, Sergio F. Ochoa, Ignacio Casas, Luis A. Guerrero, José Bravo

Abstract:

Patients under health treatments that involve long  stays at a hospital or health center (e.g. cancer, organ transplants and  severe burns), tend to get bored or depressed because of the lack of  social interaction with family and friends. Such a situation also  affects the evolution and effectiveness of their treatments. In many  cases, the solution to this problem involves extra challenges, since  many patients need to rest quietly (or remain in bed) to their being  contagious. Considering the weak health condition in which usually  are these kinds, keeping them motivated and quiet represents an  important challenge for nurses and caregivers. This article presents a  mobile ubiquitous game called MagicRace, which allows hospitalized  kinds to interact socially with one another without putting to risk  their sensitive health conditions. The game does not require a  communication infrastructure at the hospital, but instead, it uses a  mobile ad hoc network composed of the handheld devices used by  the kids to play. The usability and performance of this application  was tested in two different sessions. The preliminary results show  that users experienced positive feelings from this experience.

 

Keywords: Ubiquitous game, children's emotional support, social isolation, mobile collaborative interactions.

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Authors: Chaudhary Itisha, Shankar Manu

Abstract:

Patient satisfaction represents a crucial aspect in the evaluation of health care services. Preoperative teaching provides the patient with pertinent information concerning the surgical process and the intended surgical procedure as well as anticipated patient behavior (anxiety, fear), expected sensation, and the probable outcomes. Although patient education is part of Accreditation protocols, it is not uniform at most places. The aim of this study was to try to assess the benefit of preoperative patient education on selected post-operative outcome parameters; mainly, post-operative pain scores, requirement of additional analgesia, return to activity of daily living and overall patient satisfaction, and try to standardize few education protocols. Dependent variables were measured before and after the treatment on a study population of 302 volunteers. Educational intervention was provided by the Investigator in the preoperative period to the study group through personal counseling. An information booklet contained detailed information was also provided. Statistical Analysis was done using Chi square test, Mann Whitney u test and Fischer Exact Test on a total of 302 subjects. P value <0.05 was considered as level of statistical significance and p<0.01 was considered as highly significant. This study suggested that patients who are given a structured, individualized and elaborate preoperative education and counseling have a better ability to cope up with postoperative pain in the immediate post-operative period. However, there was not much difference when the patients have had almost complete recovery. There was no difference in the requirement of additional analgesia among the two groups. There is a positive effect of preoperative counseling on expected return to the activities of daily living and normal work schedule. However, no effect was observed on the activities in the immediate post-operative period. There is no difference in the overall satisfaction score among the two groups of patients. Thus this study concludes that there is a positive benefit as suggested by the results for pre-operative patient education. Although the difference in various parameters studied might not be significant over a long term basis, they definitely point towards the benefits of preoperative patient education. 

Keywords: Patient education, post-operative pain, patient satisfaction, post-operative outcome.

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Authors: Permphan Dharmasaroja

Abstract:

Acute disseminated encephalomyelitis (ADEM) has been reported to develop after a hymenoptera sting, but its pathogenesis is not known in detail. Myelin basic protein (MBP)- specific T cells have been detected in the blood of patients with ADEM, and a proportion of these patients develop multiple sclerosis (MS). In an attempt to understand the mechanisms underlying ADEM, molecular mimicry between hymenoptera venom peptides and the human immunodominant MBP peptide was scrutinized, based on the sequence and structural similarities, whether it was the root of the disease. The results suggest that the three wasp venom peptides have low sequence homology with the human immunodominant MBP residues 85-99. Structural similarity analysis among the three venom peptides and the MS-related HLA-DR2b (DRA, DRB1*1501)-associated immunodominant MHC binding/TCR contact residues 88-93, VVHFFK showed that hyaluronidase residues 7-12, phospholipase A1 residues 98-103, and antigen 5 residues 109-114 showed a high degree of similarity 83.3%, 100%, and 83.3% respectively. In conclusion, some wasp venom peptides, particularly phospholipase A1, may potentially act as the molecular motifs of the human 3HLA-DR2b-associated immunodominant MBP88-93, and possibly present a mechanism for induction of wasp sting-associated ADEM.

Keywords: central nervous system, Hymenoptera, myelin basicprotein, molecular mimicry.

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Authors: H. Merhni, A. Sbiti, I. Ratbi, A. Sefiani

Abstract:

The proximal spinal muscular atrophy (SMA) is a group of neuromuscular disorders characterized by progressive muscle weakness due to the degeneration and loss of anterior motor neurons of the spinal cord. Depending on the age of onset of symptoms and their evolution, four types of SMA, varying in severity, result in a mutations of the SMN gene (survival of Motor neuron). We have analyzed the DNA of 295 patients referred to our genetic counseling; since January 1996 until October 2014; for suspected SMA. The homozygous deletion of exon 7 of the SMN gene was found in 133 patients; of which, 40.6% were born to consanguineous parents. In countries like Morocco, where the frequency of heterozygotes for SMA is high, genetic testing should be offered as first-line and, after careful clinical assessment, especially in newborns and infants with congenital hypotonia unexplained and prognosis compromise. The molecular diagnosis of SMA allows a quick and certainly diagnosis, provide adequate genetic counseling for families at risk and suggest, for couples who want prenatal diagnosis. The analysis of the SMN gene is a perfect example of genetic testing with an excellent cost/benefit ratio that can be of great interest in public health, especially in low-income countries. We emphasize in this work for the benefit of the generalization of molecular diagnosis of SMA by the technique of PCR-enzymatic digestion in other centers in Morocco.

Keywords: Exon7, PCR-digestion, SMA, SMN gene.

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Authors: Kasra Afsahi, Maryam Soheilifar, Nazanin Vahed, Omid Seyed Esmaeili, S. Hossein Hosseini

Abstract:

The most common cause of shoulder pain occurs when rotator cuff tendons become trapped under the bony area in the shoulder. This pilot study was performed to evaluate the feasibility of Virtual Reality based rehabilitation of shoulder impingement syndrome in athletes. Three consecutive patients with subacromial impingement syndrome were enrolled. The participants were rehabilitated for 5 times a week for 4 weeks, 20 sessions in total (with duration of each session being 60 minutes). In addition to the conventional rehabilitation program, a 10-minute game-based virtual reality exercise was administered. Primary outcome measures were range of motion evaluated with goniometer, pain sensation, disability intensity using ‘The Disabilities of the Arm, Shoulder and Hand Questionnaire’, muscle strength using ‘dynamometer’; pain threshold with 'algometer' and level of satisfaction. There were significant improvements in the range of motion, pain sensation, disability, pain threshold and muscle strength compared to basis (P < 0.05). There were no major adverse effects. This study showed the usefulness of VR therapy as an adjunct to conventional physiotherapy in improving function in patients with shoulder impingement syndrome.

Keywords: Shoulder impingement syndrome, VR therapy, feasibility, rehabilitation.

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Authors: Osuagwu Justine Ugochukwu, Sazali Abd Wahab, Sunday Sunday Akpan

Abstract:

Investigating the effects of transformational and transactional leadership styles on the performance of healthcare employees at the University Teaching Hospital (UNTH) in Enugu, Nigeria, was the goal of the research. The respondents were asked to fill out a structured questionnaire. The respondents were chosen using a straightforward random sampling technique and consisted of 370 health workers at the hospital. The result of the analysis revealed that transactional and transformational leadership style has a positive while ambidextrous leadership has a negative effect on healthcare workers' performance in UNTH, Enugu. Therefore, the management of public hospitals that have the capacity to change their top management approach to leadership styles will gain substantial support from their employees’ thereby increasing organizational commitment and performance among health workers. This will have remarkable social implications, one of which is a change in the work culture and attitude of medical personnel from the seemingly anti-community of patients to friendly engagement and treatment of patients leading to a harmonious coexistence among these individuals in society. Investigating ambidextrous leadership and the use of nonparametric analysis is unique and has brought knowledge to leadership literature.

Keywords: Workers’ performance, transformational leadership, transactional leadership, governance quality, ambidextrous leadership.

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