Search results for: cardiac patient

Authors: Mehran Yazdi, Luc Beaulieu

Abstract:

Artifact is one of the most important factors in degrading the CT image quality and plays an important role in diagnostic accuracy. In this paper, some artifacts typically appear in Spiral CT are introduced. The different factors such as patient, equipment and interpolation algorithm which cause the artifacts are discussed and new developments and image processing algorithms to prevent or reduce them are presented.

Keywords: CT artifacts, Spiral CT, Artifact removal.

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Authors: Rania Mustafa

Abstract:

This audit was conducted at Manchester University NHS Foundation Trust, Wythenshawe Hospital Radiology and Accident and Emergency [A&E] Department to assess the appropriateness of clinical information in X-ray requests, specifically in cases of acute ankle injuries. As per the Ottawa Ankle Rules and the recommendations of National Institute for Health and Care Excellence [NICE] and the Royal College of Radiology, we aimed to evaluate the appropriateness of referrals and the thoroughness of clinical information provided by Emergency Department [ED] clinicians for ankle radiography. Our goal was to achieve 100% compliance with these guidelines. The audit involved a comprehensive analysis spanning the period from August 2022 to January 2023, encompassing patient records, radiographic orders, and clinical assessments. Data collection included patient demographics, presenting complaints, clinical assessments, adherence to Ottawa Ankle Rules criteria, and subsequent radiography orders. Here we conducted two audit cycles, involving 38 patients in the first cycle and 86 patients in the second cycle. The data were furtherly filtered to include all patients who were referred from the ED for an ankle Xray with a history of acute trauma and age of more than 18 years. The key finding was that in August 2022, 60% of cases met the Ottawa Ankle Rules criteria accurately, indicating a need for improvement in adherence. However, by January 2023, there was a notable improvement, with 95% of cases accurately meeting the criteria. This significant change reflects an increased alignment with best practices for ankle radiography referrals.

Keywords: Ankle, injuries, Ottawa Ankle Rule, X-rays.

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Authors: Farahnaz Amini, Woo Yun Kin, Lazwani Kolandaiveloo

Abstract:

Availability of different genetic tests after completion of Human Genome Project increases the physicians’ responsibility to keep themselves update on the potential implementation of these genetic tests in their daily practice. However, due to numbers of barriers, still many of physicians are not either aware of these tests or are not willing to offer or refer their patients for genetic tests. This study was conducted an anonymous, cross-sectional, mailed-based survey to develop a primary data of Malaysian physicians’ level of knowledge and perception of gene profiling. Questionnaire had 29 questions. Total scores on selected questions were used to assess the level of knowledge. The highest possible score was 11. Descriptive statistics, one way ANOVA and chi-squared test was used for statistical analysis. Sixty three completed questionnaires were returned by 27 general practitioners (GPs) and 36 medical specialists. Responders’ age ranges from 24 to 55 years old (mean 30.2 ± 6.4). About 40% of the participants rated themselves as having poor level of knowledge in genetics in general whilst 60% believed that they have fair level of knowledge; however, almost half (46%) of the respondents felt that they were not knowledgeable about available genetic tests. A majority (94%) of the responders were not aware of any lab or company which is offering gene profiling services in Malaysia. Only 4% of participants were aware of using gene profiling for detection of dosage of some drugs. Respondents perceived greater utility of gene profiling for breast cancer (38%) compared to the colorectal familial cancer (3%). The score of knowledge ranged from 2 to 8 (mean 4.38 ± 1.67). Non- significant differences between score of knowledge of GPs and specialists were observed, with score of 4.19 and 4.58 respectively. There was no significant association between any demographic factors and level of knowledge. However, those who graduated between years 2001 to 2005 had higher level of knowledge. Overall, 83% of participants showed relatively high level of perception on value of gene profiling to detect patient’s risk of disease. However, low perception was observed for both statements of using gene profiling for general population in order to alter their lifestyle (25%) as well as having the full sequence of a patient genome for the purpose of determining a patient’s best match for treatment (18%). The lack of clinical guidelines, limited provider knowledge and awareness, lack of time and resources to educate patients, lack of evidence-based clinical information and cost of tests were the most barriers of ordering gene profiling mentioned by physicians. In conclusion Malaysian physicians who participate in this study had mediocre level of knowledge and awareness in gene profiling. The low exposure to the genetic questions and problems might be a key predictor of lack of awareness and knowledge on available genetic tests. Educational and training workshop might be useful in helping Malaysian physicians incorporate genetic profiling into practice for eligible patients.

Keywords: Gene Profiling, Knowledge, Malaysia, Physician.

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Authors: Elie H. Karam, Antoine B. Abche

Abstract:

It is known that the heart interacts with and adapts to its venous and arterial loading conditions. Various experimental studies and modeling approaches have been developed to investigate the underlying mechanisms. This paper presents a model of the left ventricle derived based on nonlinear stress-length myocardial characteristics integrated over truncated ellipsoidal geometry, and second-order dynamic mechanism for the excitation-contraction coupling system. The results of the model presented here describe the effects of the viscoelastic damping element of the electromechanical coupling system on the hemodynamic response. Different heart rates are considered to study the pacing effects on the performance of the left-ventricle against constant preload and afterload conditions under various damping conditions. The results indicate that the pacing process of the left ventricle has to take into account, among other things, the viscoelastic damping conditions of the myofilament excitation-contraction process.

Keywords: Myocardial sarcomere, cardiac pump, excitationcontraction coupling, viscoelasicity

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Authors: S. Fallah, M. Seifi, M. Firoozrai, T. Godarzi, M. Jafarzadeh, L. H. Ghohari

Abstract:

The ε4 allele of the ε2, ε3 and ε4 protein isoform polymorphism in the gene encoding apolipoprotein E (Apo E) has previously been associated with increased cardiac artery disease (CAD); therefore to investigate the significance of this polymorphism in pathogenesis of CAD in Iranian patients with stenosis and control subjects. To investigate the association between  Apo E polymorphism and coronary artery disease we performed a comparative case control study of the frequency of Apo E  polymorphism in One hundred CAD patients with stenosis who underwent coronary angiography (>50% stenosis) and 100 control subjects (<10% stenosis). The Apo E alleles and genotypes were determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). We observed an association between the Apo E polymorphism and CAD in this study. These data suggest that the Apo ε4 and ε2 alleles increase the risk for CAD in Iranian population (χ2 =4.26, p= 0.05, OR=2 and χ2 =0.38, p=0.53, OR=1.2). These results suggest that ε4 and ε2 alleles are risk factors for stenosis.

Keywords: Arterial blood vessels, atherosclerosis, cholesterol.

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Authors: Saimir Heta, Kers Kapaj, Rialda Xhizdari, Ilma Robo

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Dealing with emerging cases of dental malpractice with justifications that stem from the clear rules of dental ethics is a phenomenon with an increasing trend in today's dental practice. Dentists should clearly understand how far the limit of malpractice goes, with or without minimal or major consequences, for the affected patient, which can be justified as a complication of dental treatment, in support of the rules of dental ethics in the dental office. Indeed, malpractice can occur in cases of lack of professionalism, but it can also come as a consequence of anatomical and physiological limitations in the implementation of the dental protocols, predetermined and indicated by the patient in the paragraph of the treatment plan in his personal card. Let this article serve as a short communication between readers and interested parties about the problems that dental malpractice can bring to the community. Malpractice should not be seen only as a professional wrong approach, but also as a phenomenon that can occur during dental practice. The aim of this article is presentation of the latest data published in the literature about malpractice. The combination of keywords is done in such a way with the aim to give the necessary space for collecting the right information in the networks of publications about this field, always first from the point of view of the dentist and not from that of the lawyer or jurist. From the findings included in this article, it was noticed that the diversity of approaches towards the phenomenon depends on the different countries based on the legal basis that these countries have. There is a lack of or a small number of articles that touch on this topic, and these articles are presented with a limited amount of data on the same topic. Dental malpractice should not be hidden under the guise of various dental complications that we justify with the strict rules of ethics for patients treated in the dental chair. The individual experience of dental malpractice must be published with the aim of serving as a source of experience for future generations of dentists.

Keywords: Dental ethics, malpractice, professional protocol, random deviation, dental tourism.

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Authors: C. De Lazzari, E. Del Prete, I. Genuini, F. Fedele

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Cardiovascular human simulator can be a useful tool in understanding complex physiopathological process in cardiocirculatory system. It can also be a useful tool in order to investigate the effects of different drugs on hemodynamic parameters. The aim of this work is to test the potentiality of our cardiovascular numerical simulator CARDIOSIM© in reproducing flow/pressure coronary waveforms in presence of two different drugs: Amlodipine (AMLO) and Adenosine (ADO). In particular a time-varying intramyocardial compression, assumed to be proportional to the left ventricular pressure, was related to the venous coronary compliances in order to study its effects on the coronary blood flow and the flow/pressure loop. Considering that coronary circulation dynamics is strongly interrelated with the mechanics of the left ventricular contraction, relaxation, and filling, the numerical model allowed to analyze the effects induced by the left ventricular pressure on the coronary flow.

Keywords: Cardiovascular system, Coronary blood flow, Hemodynamic, Numerical simulation.

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Authors: Tahseen A. Jilani, Huda Yasin, Madiha Yasin, C. Ardil

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In this paper we use data mining techniques to investigate factors that contribute significantly to enhancing the risk of acute coronary syndrome. We assume that the dependent variable is diagnosis – with dichotomous values showing presence or  absence of disease. We have applied binary regression to the factors affecting the dependent variable. The data set has been taken from two different cardiac hospitals of Karachi, Pakistan. We have total sixteen variables out of which one is assumed dependent and other 15 are independent variables. For better performance of the regression model in predicting acute coronary syndrome, data reduction techniques like principle component analysis is applied. Based on results of data reduction, we have considered only 14 out of sixteen factors.

Keywords: Acute coronary syndrome (ACS), binary logistic regression analyses, myocardial ischemia (MI), principle component analysis, unstable angina (U.A.).

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Authors: C.K. Hindumathy

Abstract:

Alcohol and water extracts of Cymbopogon citratus was investigated for anti-bacterial properties and phytochemical constituents. The extract was screened against four gram-negative bacteria Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus vulgaris) and two grampositive bacteria Bacillus subtilis and Staphylococcus aureus at four different concentrations (1:1, 1:5, 1:10 and 1:20) using disc diffusion method. The antibacterial examination was by disc diffusion techniques, while the photochemical constituents were investigated using standard chemical methods. Results showed that the extracts inhibited the growth of standard and local strains of the organisms used. The treatments were significantly different (P = 0.05). The minimum inhibitory concentration of the extracts against the tested microorganisms ranged between 150mg/ml and 50mg/ml. The alcohol extracts were found to be generally more effective than the water extract. The photochemical analysis revealed the presence of alkaloids and phenol but absence of cardiac and cyanogenic glycosides. The presence of alkaloid and phenols were inferred as being responsible for the anti-bacterial properties of the extracts.

Keywords: Cymbopogon citratus; gram negative and grampositive

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Authors: Teka Haile, Behailu Hawulte, Solomon Alemayehu

Abstract:

Background: HIV virological failure still remains a problem in HV/AIDS treatment and care. This study aimed to describe the prevalence and identify the factors associated with viral non-suppression among HIV-positive adult patients on antiretroviral therapy in Woliso Town, Oromia, Ethiopia. Methods: A retrospective cross-sectional study was conducted among 424 HIV-positive patient’s attending antiretroviral therapy (ART) in Woliso Town during the period from August 25, 2020 to August 30, 2020. Data collected from patient medical records were entered into Epi Info version 2.3.2.1 and exported to SPSS version 21.0 for analysis. Logistic regression analysis was done to identify factors associated with viral load non-suppression, and statistical significance of odds ratios were declared using 95% confidence interval and p-value < 0.05. Results: A total of 424 patients were included in this study. The mean age (± SD) of the study participants was 39.88 (± 9.995) years. The prevalence of HIV viral load non-suppression was 55 (13.0%) with 95% CI (9.9-16.5). Second-line ART treatment regimen (Adjusted Odds Ratio (AOR) = 8.98, 95% Confidence Interval (CI): 2.64, 30.58) and routine viral load testing (AOR = 0.01, 95% CI: 0.001, 0.02) were significantly associated with virological non-suppression. Conclusion: Virological non-suppression was high, which hinders the achievement of the third global 95 target. The second-line regimen and routine viral load testing were significantly associated with virological non-suppression. It suggests the need to assess the effectiveness of antiretroviral drugs for epidemic control. It also clearly shows the need to decentralize third-line ART treatment for those patients in need.

Keywords: Virological non-suppression, HIV-positive, ART, Woliso Town, Ethiopia.

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Authors: Ammar Ayad Issa Al-Rifaie, Zuhreya Muazu, Maysam Ali Abdulwahid, Dermot Gleeson

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The aim of this audit was to examine the efficiency of alcohol history documentation and screening for hazardous drinkers at the Medical Admission Unit (MAU) of Northern General Hospital (NGH), Sheffield, to identify any potential for enhancing clinical practice. Data were collected from medical clerking sheets, ICE system and directly from 82 patients by three junior medical doctors using both CAGE questionnaire and AUDIT-C tool for newly admitted patients to MAU in NGH, in the period between January and March 2015. Alcohol consumption was documented in around two-third of the patient sample and this was documented fairly accurately by health care professionals. Some used subjective words such as 'social drinking' in the alcohol units’ section of the history. CAGE questionnaire was applied to only four patients and none of the patients had documented advice, education or referral to an alcohol liaison team. AUDIT-C tool had identified 30.4%, while CAGE 10.9%, of patients admitted to the NGH MAU as hazardous drinkers. The amount of alcohol the patient consumes positively correlated with the score of AUDIT-C (Pearson correlation 0.83). Re-audit is planned to be carried out after integrating AUDIT-C tool as labels in the notes and presenting a brief teaching session to junior doctors. Alcohol misuse screening is not adequately undertaken and no appropriate action is being offered to hazardous drinkers. CAGE questionnaire is poorly applied to patients and when satisfactory and adequately used has low sensitivity to detect hazardous drinkers in comparison with AUDIT-C tool. Re-audit of alcohol screening practice after introducing AUDIT-C tool in clerking sheets (as labels) is required to compare the findings and conclude the audit cycle.

Keywords: Alcohol screening, AUDIT-C, CAGE, Hazardous drinking.

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Authors: Gianluca Cornetta, Abdellah Touhafi, David J. Santos, Jose Manuel Vazquez

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In this work a new platform for mobile-health systems is presented. System target application is providing decision support to rescue corps or military medical personnel in combat areas. Software architecture relies on a distributed client-server system that manages a wireless ad-hoc networks hierarchy in which several different types of client operate. Each client is characterized for different hardware and software requirements. Lower hierarchy levels rely in a network of completely custom devices that store clinical information and patient status and are designed to form an ad-hoc network operating in the 2.4 GHz ISM band and complying with the IEEE 802.15.4 standard (ZigBee). Medical personnel may interact with such devices, that are called MICs (Medical Information Carriers), by means of a PDA (Personal Digital Assistant) or a MDA (Medical Digital Assistant), and transmit the information stored in their local databases as well as issue a service request to the upper hierarchy levels by using IEEE 802.11 a/b/g standard (WiFi). The server acts as a repository that stores both medical evacuation forms and associated events (e.g., a teleconsulting request). All the actors participating in the diagnostic or evacuation process may access asynchronously to such repository and update its content or generate new events. The designed system pretends to optimise and improve information spreading and flow among all the system components with the aim of improving both diagnostic quality and evacuation process.

Keywords: IEEE 802.15.4 (ZigBee), IEEE 802.11 a/b/g (WiFi), distributed client-server systems, embedded databases, issue trackers, ad-hoc networks.

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Authors: Mecheri Zeid Belmecheri, Maamar Ahfir, Izzet Kale

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Automatic cardiac auscultation is still a subject of research in order to establish an objective diagnosis. Recorded heart sounds as Phonocardiogram (PCG) signals can be used for automatic segmentation into components that have clinical meanings. These are the first sound, S1, the second sound, S2, and the systolic and diastolic components, respectively. In this paper, an automatic method is proposed for the robust segmentation of heart sounds. This method is based on calculating an intermediate sawtooth-shaped signal from the length variation of the recorded PCG signal in the time domain and, using its positive derivative function that is a binary signal in training a Recurrent Neural Network (RNN). Results obtained in the context of a large database of recorded PCGs with their simultaneously recorded Electrocardiograms (ECGs) from different patients in clinical settings, including normal and abnormal subjects, show on average a segmentation testing performance average of 76% sensitivity and 94% specificity.

Keywords: Heart sounds, PCG segmentation, event detection, Recurrent Neural Networks, PCG curve length.

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Authors: S. Kurien, S. Satpathy, S. K. Gupta, S. K. Arya, D. K. Sharma

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Advances in the use of health care technology have resulted in increased adverse events (AEs) related to the use of medical devices. The study focused on the existing reporting systems. This study was conducted in a tertiary care public sector hospital. Devices included Syringe infusion pumps, Cardiac monitors, Pulse oximeters, Ventilators and Defibrillators. A total of 211 respondents were recruited. Interviews were held with 30 key informants. Medical records were scrutinized. Relevant statistical tests were used. Resident doctors reported maximum frequency of AEs, followed by nurses; and least by consultants. A significant association was found between the cadre of health care personnel and awareness that the patients and bystanders have a risk of sustaining AE. Awareness regarding reporting of AEs was low, and it was generally done verbally. Other critical findings are discussed in the light of the barriers to reporting, reasons for non-compliance, recording system, and so on.

Keywords: Adverse events, health care technology, public sector hospital, reporting systems.

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Authors: B. S. Raghavendra, D. Narayana Dutt

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Many recent electrophysiological studies have revealed the importance of investigating meditation state in order to achieve an increased understanding of autonomous control of cardiovascular functions. In this paper, we characterize heart rate variability (HRV) time series acquired during meditation using nonlinear dynamical parameters. We have computed minimum embedding dimension (MED), correlation dimension (CD), largest Lyapunov exponent (LLE), and nonlinearity scores (NLS) from HRV time series of eight Chi and four Kundalini meditation practitioners. The pre-meditation state has been used as a baseline (control) state to compare the estimated parameters. The chaotic nature of HRV during both pre-meditation and meditation is confirmed by MED. The meditation state showed a significant decrease in the value of CD and increase in the value of LLE of HRV, in comparison with premeditation state, indicating a less complex and less predictable nature of HRV. In addition, it was shown that the HRV of meditation state is having highest NLS than pre-meditation state. The study indicated highly nonlinear dynamic nature of cardiac states as revealed by HRV during meditation state, rather considering it as a quiescent state.

Keywords: Correlation dimension, Embedding dimension, Heartrate variability, Largest Lyapunov exponent, Meditation, Nonlinearity score.

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Authors: Desmond B. Keenan, Paul Grossman

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In order to provide accurate heart rate variability indices of sympathetic and parasympathetic activity, the low frequency and high frequency components of an RR heart rate signal must be adequately separated. This is not always possible by just applying spectral analysis, as power from the high and low frequency components often leak into their adjacent bands. Furthermore, without the respiratory spectra it is not obvious that the low frequency component is not another respiratory component, which can appear in the lower band. This paper describes an adaptive filter, which aids the separation of the low frequency sympathetic and high frequency parasympathetic components from an ECG R-R interval signal, enabling the attainment of more accurate heart rate variability measures. The algorithm is applied to simulated signals and heart rate and respiratory signals acquired from an ambulatory monitor incorporating single lead ECG and inductive plethysmography sensors embedded in a garment. The results show an improvement over standard heart rate variability spectral measurements.

Keywords: Heart rate variability, vagal tone, sympathetic, parasympathetic, spectral analysis, adaptive filter.

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Authors: D. Šedivý, S. Fialová

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The main purpose of this study is to show differences between the numerical solution of the flow through the artificial heart valve using Newtonian or non-Newtonian fluid. The simulation was carried out by a commercial computational fluid dynamics (CFD) package based on finite-volume method. An aortic bileaflet heart valve (Sorin Bicarbon) was used as a pattern for model of real heart valve replacement. Computed tomography (CT) was used to gain the accurate parameters of the valve. Data from CT were transferred in the commercial 3D designer, where the model for CFD was made. Carreau rheology model was applied as non-Newtonian fluid. Physiological data of cardiac cycle were used as boundary conditions. Outputs were taken the leaflets excursion from opening to closure and the fluid dynamics through the valve. This study also includes experimental measurement of pressure fields in ambience of valve for verification numerical outputs. Results put in evidence a favorable comparison between the computational solutions of flow through the mechanical heart valve using Newtonian and non-Newtonian fluid.

Keywords: Computational modeling, dynamic mesh, mechanical heart valve, non-Newtonian fluid, SDOF.

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Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Ahmed A. Khamis, Abeer Kharshid, Nor Azizah Aziz

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The effect of statins dose intensity (SDI) on glycemic control in patients with existing diabetes is unclear. Also, there are many contradictory findings were reported in the literature; thus, it is limiting the possibility to draw conclusions. This project was designed to compare the effect of SDI on glycated hemoglobin (HbA1c%) control in outpatients with Type 2 diabetes in the endocrine clinic at Hospital Pulau Pinang, Malaysia, between July 2015 and August 2016. A prospective cohort study was conducted, where records of 345 patients with Type 2 diabetes (Moderate-SDI group 289 patients and high-SDI cohort 56 patients) were reviewed to identify demographics and laboratory tests. The target of glycemic control (HbA1c < 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, and the results were presented as descriptive statistics. From 289 moderate-SDI cohorts with a mean age of 57.3 ± 12.4 years, only 86 (29.8%) cases were shown to have controlled glycemia, while there were 203 (70.2%) cases with uncontrolled glycemia with confidence interval (CI) of 95% (6.2–10.8). On the other hand, the high-SDI group of 56 patients with Type 2 diabetes with a mean age 57.7±12.4 years is distributed among 11 (19.6%) patients with controlled diabetes, and 45 (80.4%) of them had uncontrolled glycemia, CI: 95% (7.1–11.9). The study has demonstrated that the relative risk (RR) of uncontrolled glycemia in patients with Type 2 diabetes that used high-SDI is 1.15, and the excessive relative risk (ERR) is 15%. The absolute risk (AR) is 10.2%, and the number needed to harm (NNH) is 10. Outpatients with Type 2 diabetes who use high-SDI of statin have a higher risk of uncontrolled glycemia than outpatients who had been treated with a moderate-SDI.

Keywords: Cohort study, diabetes control, dose intensity, HbA1c, Malaysia, statin, Type 2 diabetes mellitus, uncontrolled glycemia.

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Authors: Fahad Shahbaz Khan, Rao Muhammad Anwer, Olof Torgersson

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The vast amount of information hidden in huge databases has created tremendous interests in the field of data mining. This paper examines the possibility of using data clustering techniques in oral medicine to identify functional relationships between different attributes and classification of similar patient examinations. Commonly used data clustering algorithms have been reviewed and as a result several interesting results have been gathered.

Keywords: Oral Medicine, Cluto, Data Clustering, Data Mining.

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Authors: Elie H. Karam, Antoine B. Abche

Abstract:

It is known that the heart interacts with and adapts to its venous and arterial loading conditions. Various experimental studies and modeling approaches have been developed to investigate the underlying mechanisms. This paper presents a model of the left ventricle derived based on nonlinear stress-length myocardial characteristics integrated over truncated ellipsoidal geometry, and second-order dynamic mechanism for the excitation-contraction coupling system. The results of the model presented here describe the effects of the viscoelastic damping element of the electromechanical coupling system on the hemodynamic response. Different heart rates are considered to study the pacing effects on the performance of the left-ventricle against constant preload and afterload conditions under various damping conditions. The results indicate that the pacing process of the left ventricle has to take into account, among other things, the viscoelastic damping conditions of the myofilament excitation-contraction process. The effects of left ventricular dimensions on the hemdynamic response have been examined. These effects are found to be different at different viscoelastic and pacing conditions.

Keywords: Myocardial sarcomere, cardiac pump, excitationcontractioncoupling, viscoelasicity

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Authors: P. Murphy, D. Vasic, A. W. Gunaratne, T. Tugonon, M. Ison, C. Pagonis, E. T. Sitchon, A. Le Busque, T. J. Borody

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Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by an alteration in bowel movements. There are three different types of IBS: diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C) and IBS with mixed bowel habit (IBS-M). Antimicrobials are increasingly being used as treatment for all types of IBS. Due to this increased use and subsequent success, the gut microbiome as a factor in the etiology of IBS is becoming more apparent. Accepted standard treatment has focused on IBS-C and involves either vancomycin or rifaximin. Here, we report on a cohort of 18 patients treated with both vancomycin and rifaximin for IBS-D. These patients’ records were reviewed retrospectively. In this cohort, patients were aged between 24-74 years (mean 44 years) and nine were female. At baseline all patients had diarrhea, four with mucus and one with blood. Other reported symptoms include abdominal pain (n = 11) bloating (n = 9), flatulence (n = 7), fatigue (n = 4) and nausea (n = 3). Patient’s treatments were personalized according to their symptom severity and tolerability and were treated with a combination of rifaximin (500-3000 mg/d) and vancomycin (500 mg-1500 mg/d) for an ongoing period. Follow-ups were conducted between 2-32 weeks. Of all patients, 89% reported improvement of at least 1 symptom, one reported no change and one patient’s symptoms got worse. The success of this combination treatment could be due to the different mechanisms of action undertaken by each medication. Vancomycin works by inhibiting the cell wall of the bacteria and rifaximin by inhibiting protein synthesis. This success in treatment validates the idea that IBS-D may be driven by a bacterial infection of the gastrointestinal microbiome. As IBS-D presents similarly to Clostridium difficile and symptom improvement can occur with the same treatment as Clostridium difficile of rifaximin and vancomycin, there is reason to suggest that the infectious agent could be an unidentified strain of Clostridium. Although these results offer some validity to the theory, more research is required.

Keywords: Clostridium difficile infection, diarrhea predominant irritable bowel syndrome, microbiome, vancomycin/rifaximin combination.

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Authors: Nadia Masood Khan, Muhammad Salman Khan, Gul Muhammad Khan

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Cardiologists perform cardiac auscultation to detect abnormalities in heart sounds. Since accurate auscultation is a crucial first step in screening patients with heart diseases, there is a need to develop computer-aided detection/diagnosis (CAD) systems to assist cardiologists in interpreting heart sounds and provide second opinions. In this paper different algorithms are implemented for automated heart sound classification using unsegmented phonocardiogram (PCG) signals. Support vector machine (SVM), artificial neural network (ANN) and cartesian genetic programming evolved artificial neural network (CGPANN) without the application of any segmentation algorithm has been explored in this study. The signals are first pre-processed to remove any unwanted frequencies. Both time and frequency domain features are then extracted for training the different models. The different algorithms are tested in multiple scenarios and their strengths and weaknesses are discussed. Results indicate that SVM outperforms the rest with an accuracy of 73.64%.

Keywords: Pattern recognition, machine learning, computer aided diagnosis, heart sound classification, and feature extraction.

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Authors: Sheng-Chi Tseng, Der-Ming Liou

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The health record in the Electronic Health Record (EHR) system is more sensitive than demographic. It raises the important issue for the EHR requirement in privacy, security, audit trail, patient access, and archiving and data retention. The studies about the EHR system security are deficient. The aim of this study is to build a security environment for the EHR system by Integrating the Healthcare Enterprise (IHE) Audit Trail and Node Authentication Security (ATNA) profile. The CDAs can be access in a secure EHR environment.

Keywords: IHE ATNA, EHR security.

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Authors: S. Karthikeyan, Naveen Bindra

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Introduction: To update ourselves and understand the concept of latest electronic formats available for Health care providers and how it could be used and developed as per standards. The idea is to correlate between the patients Manual Medical Records keeping and maintaining patients Electronic Information in a Health care setup in this world. Furthermore, this stands with adapting to the right technology depending upon the organization and improve our quality and quantity of Healthcare providing skills. Objective: The concept and theory is to explain the terms of Electronic Medical Record (EMR), Electronic Health Record (EHR) and Personal Health Record (PHR) and selecting the best technical among the available Electronic sources and software before implementing. It is to guide and make sure the technology used by the end users without any doubts and difficulties. The idea is to evaluate is to admire the uses and barriers of EMR-EHR-PHR. Aim and Scope: The target is to achieve the health care providers like Physicians, Nurses, Therapists, Medical Bill reimbursements, Insurances and Government to assess the patient’s information on easy and systematic manner without diluting the confidentiality of patient’s information. Method: Health Information Technology can be implemented with the help of Organisations providing with legal guidelines and help to stand by the health care provider. The main objective is to select the correct embedded and affordable database management software and generating large-scale data. The parallel need is to know how the latest software available in the market. Conclusion: The question lies here is implementing the Electronic information system with healthcare providers and organization. The clinicians are the main users of the technology and manage us to “go paperless”. The fact is that day today changing technologically is very sound and up to date. Basically, the idea is to tell how to store the data electronically safe and secure. All three exemplifies the fact that an electronic format has its own benefit as well as barriers.

Keywords: Medical records, digital records, health information, electronic record system.

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Authors: M. Umar Farooq, T. Ahmad Afridi, M. Zia-Ul-Islam Arsalan, U. Hussain Haider, S. Ullah

Abstract:

Cancer, a leading fatal disease worldwide, can be treated with various techniques including radiation therapy. It involves the use of ionizing radiation to target cancer cells. On basis of source placement, radiation therapy is of two types i.e., Brachytherapy and External Beam Radiotherapy (EBRT). EBRT has evolved from 2-D conventional therapy to 3-D Conformal radiotherapy (3D-CRT) and then Intensity-Modulated Radiotherapy (IMRT). IMRT improves dose conformity and sparing of organs at risk. Volumetric Modulated Arc Therapy (VMAT) is a modern technique that uses treatment delivery in arcs with rotation of the gantry. In this report, a dosimetry comparison was performed between IMRT and VMAT. This study was conducted in the Radiotherapy Department of the Institute of Nuclear Medicine and Oncology Lahore (INMOL). Ten patients with Prostate Carcinoma were selected for this study to compare the methods. Simulation of these patients was done with help of a CT Simulator. All target volumes and organs were delineated by the oncologists. Then suitable fields/arcs were applied which cover volumes effectively. This was followed by the optimization of plans for both techniques for every patient. Finally, a comparison of evaluating parameters e.g., Conformity Index (CI), Volume Coverage, Homogeneity Index (HI), Organ Doses, and MUs (Monitor Units) was performed. We obtained better results of target conformity indices from VMAT (CI = 1.16) than IMRT (CI = 1.24). VMAT was better in organ sparing too. Also, VMAT shows fewer MUs (733 MUs) as compared to IMRT (2149 MUs). From this study, it is concluded that VMAT is a better treatment technique than IMRT. This technique will enhance treatment efficiency as it takes less time in obtaining the required results. Also, a very less scatter dose will be delivered to the patient.

Keywords: 2-D Conventional Radiotherapy, 3-D Conformal Radiotherapy, Intensity Modulated Radiotherapy, Prostate Carcinoma, Radiotherapy, Volumetric Modulated Arc Therapy.

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Authors: M Nazrul-Hakim, A Yaacob, Y Adam, A Zuraini

Abstract:

This study examined the toxicological effects and safety of polypeptide k isolated from the seeds of Momordica charantia in laboratory rats. 30 male Sprague Dawley rats (12 weeks old, bodyweight 180-200 g) were randomly divided into 3 groups (1000 mg/kg, 500 mg and 0 mg/kg). Rats were acclimatized to laboratory conditions for 7 days and at day 8 rats were dosed orally with polypeptide k (in 2% DMSO/normal saline) and the controls received the dosed vehicle only. Rats were then observed for 72 hours before sacrificed. Rats were anaesthetized by pentobarbital (50 mg/kg ip) and 2-3.0 mL of blood was taken by cardiac puncture and rats were scarified by anaesthetic overdose. Immediately, organs (heart, lungs, liver, kidneys) were weigh and taken for histology. Organ sections were then evaluated by a histopathologist. Serum samples were assayed for liver functions (ALT and γ-GT) and kidney functions (BUN and creatinine). All rats showed normal behavior after the dosing and no statistical changes were observed in all blood parameters and organ weight. Histological examinations revealed normal organ structures. In conclusion, dosing of rats up to 1000 mg/kg did not have any effects on the rat behavior, liver or kidney functions nor histology of the selected organs.

Keywords: Polypeptide k, safety, histology, toxicology, Momordica charantia

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Authors: O. E. Okafor, L. U. S. Ezeanyika, C. G. Nkwonta, C. J. Okonkwo

Abstract:

The effect of processing on plasma lipid profile and atherogenic indices of rats fed Artocarpus heterophyllus seed diets at different concentrations were investigated. Fifty five rats were used for this study, they were divided into eleven groups of five rats each (one control group and ten test groups), the test groups were fed raw, boiled, roasted, fermented and soaked diets at 10% and 40% concentrations. The study lasted for thirty five days. The diets led to significant decrease (p<0.05) in plasma cholesterol and triacylglycerol of rats fed 10% and 40% concentrations of the diets, and a significant increase (p<0.05) in high density lipoprotein (HDL) levels at 40% concentrations of the test diets. The diets also produced decrease in low density lipoprotein (LDL), very low density lipoprotein (VLDL), cardiac risk ratio (CRR), atherogenic index of plasma (AIP) and atherogenic coefficient (AC) at 40% concentrations except the soaked group that showed slight elevation of LDL, CRR, AC and AIP at 40% concentration. Artocarpus heterophyllus seeds could be beneficial to health because of its ability to increase plasma HDL and reduce plasma LDL, VLDL, cholesterol, triglycerides and atherogenic indices at higher diet concentration.

Keywords: Artocarpus heterophyllus, atherogenic indices, concentrations, lipid profile.

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Authors: Tony Austin, Shanghua Sun, Nathan Lea, Steve Iliffe, Dipak Kalra, David Ingram, David Patterson

Abstract:

Computer-based decision support (CDSS) systems can deliver real patient care and increase chances of long-term survival in areas of chronic disease management prone to poor control. One such CDSS, for the management of warfarin, is described in this paper and the outcomes shown. Data is derived from the running system and show a performance consistently around 20% better than the applicable guidelines.

Keywords: "Decision Support", "Anticoagulant Control"

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Authors: Marina Gorunescu, Florin Gorunescu, Kenneth Revett

Abstract:

Hepatocellular carcinoma, also called hepatoma, most commonly appears in a patient with chronic viral hepatitis. In patients with a higher suspicion of HCC, such as small or subtle rising of serum enzymes levels, the best method of diagnosis involves a CT scan of the abdomen, but only at high cost. The aim of this study was to increase the ability of the physician to early detect HCC, using a probabilistic neural network-based approach, in order to save time and hospital resources.

Keywords: Early HCC diagnosis, probabilistic neural network.

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Authors: Hind Bouami, Patrick Millot

Abstract:

Medication dispensing system is a life-critical system whose failure may result in preventable adverse events leading to longer patient stays in hospitals or patient death. Automation has led to great improvements in life-critical systems as it increased safety, efficiency, and comfort. However, critical risks related to medical organization complexity and automated solutions integration can threaten drug dispensing security and performance. Knowledge about the system’s complexity aspects and human machine parameters to control for automated equipment’s security and performance will help operators to secure their automation process and to optimize their system’s reliability. In this context, this study aims to document the operator’s situation awareness about automation risks and parameters involved in automation security and performance. Our risk management approach has been deployed in the North Luxembourg hospital center’s pharmacy, which is equipped with automated drug dispensing systems since 2009. With more than 4 million euros of gains generated, North Luxembourg hospital center’s success story was enabled by the management commitment, pharmacy’s involvement in the implementation and improvement of the automation project, and the close collaboration between the pharmacy and Sinteco’s firm to implement the necessary innovation and organizational actions for automated solutions integration security and performance. An analysis of the actions implemented by the hospital and the parameters involved in automated equipment’s integration security and performance has been made. The parameters to control for automated equipment’s integration security and performance are human aspects (6.25%), technical aspects (50%), and human-machine interaction (43.75%). The implementation of an anthropocentric analysis system before automation would have prevented and optimized the control of risks related to automation.

Keywords: Automated drug delivery systems, hospitals, human-centered automated system, risk management.

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