Search results for: patients

Authors: Ravi Kiran Pothamsetty, Radha Rani Ghosh, Baby Paul Thaliath

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Radiation therapy has undergone many advancements and evloved from 2D to 3D. Recently, with rapid pace of drug discoveries, cutting edge technology, and clinical trials has made innovative advancements in computer technology and treatment planning and upgraded to intensity modulated radiotherapy (IMRT) which delivers in homogenous dose to tumor and normal tissues. The present study was a hospital-based experience comparing two different conformal radiotherapy techniques for brain tumors. This analytical study design has been conducted at Regional Cancer Centre, India from January 2014 to January 2015. Ten patients have been selected after inclusion and exclusion criteria. All the patients were treated on Artiste Siemens Linac Accelerator. The tolerance level for maximum dose was 6.0 Gyfor lenses and 54.0 Gy for brain stem, optic chiasm and optical nerves as per RTOG criteria. Mean and standard deviation values of PTV98%, PTV 95% and PTV 2% in IMRT were 93.16±2.9, 95.01±3.4 and 103.1±1.1 respectively; for 3DCRT were 91.4±4.7, 94.17±2.6 and 102.7±0.39 respectively. PTV max dose (%) in IMRT and 3D-CRT were 104.7±0.96 and 103.9±1.0 respectively. Maximum dose to the tumor can be delivered with IMRT with acceptable toxicity limits. Variables such as expertise, location of tumor, patient condition, and TPS influence the outcome of the treatment.

Keywords: IMRT, 3D CRT, Brain, tumors, OARs, RTOG.

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Authors: Vladyslav Povoroznyuk, Anna Musiienko, Nataliia Dzerovych, Roksolana Povoroznyuk

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Osteoporosis and obesity are widespread diseases in people over 50 years associated with changes in structure and body composition. Нigher body mass index (BMI) values are associated with greater bone mineral density (BMD). However, trabecular bone score (TBS) indirectly explores bone quality, independently of BMD. The aim of our study was to evaluate the relationship between the BMD and TBS parameters in Ukrainian men suffering from obesity. We examined 396 men aged 40-89 years. Depending on their BMI all the subjects were divided into two groups: Group I – patients with obesity whose BMI was ≥ 30 kg/m² (n=129) and Group II – patients without obesity and BMI of < 30 kg/m² (n=267). The BMD of total body, lumbar spine L₁-L₄, femoral neck and forearm were measured by DXA (Prodigy, GEHC Lunar, Madison, WI, USA). The TBS of L₁- L₄ was assessed by means of TBS iNsight® software installed on DXA machine (product of Med-Imaps, Pessac, France). In general, obese men had a significantly higher BMD of lumbar spine L₁-L₄, femoral neck, total body and ultradistal forearm (p < 0.001) in comparison with men without obesity. The TBS of L₁-L₄ was significantly lower in obese men compared to non-obese ones (p < 0.001). BMD of lumbar spine L₁-L₄, femoral neck and total body significantly differ in men aged 40-49, 50-59, 60-69, and 80-89 years (p < 0.05). At the same time, in men aged 70-79 years, BMD of lumbar spine L₁-L₄ (p=0.46), femoral neck (p=0.18), total body (p=0.21), ultra-distal forearm (p=0.13), and TBS (p=0.07) did not significantly differ. A significant positive correlation between the fat mass and the BMD at different sites was observed. However, the correlation between the fat mass and TBS of L₁-L₄ was also significant, though negative.

Keywords: Bone mineral density, trabecular bone score, obesity, men.

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Authors: Kifah Tout, Nisrine Sinno, Mohamad Mikati

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Many studies have focused on the nonlinear analysis of electroencephalography (EEG) mainly for the characterization of epileptic brain states. It is assumed that at least two states of the epileptic brain are possible: the interictal state characterized by a normal apparently random, steady-state EEG ongoing activity; and the ictal state that is characterized by paroxysmal occurrence of synchronous oscillations and is generally called in neurology, a seizure. The spatial and temporal dynamics of the epileptogenic process is still not clear completely especially the most challenging aspects of epileptology which is the anticipation of the seizure. Despite all the efforts we still don-t know how and when and why the seizure occurs. However actual studies bring strong evidence that the interictal-ictal state transition is not an abrupt phenomena. Findings also indicate that it is possible to detect a preseizure phase. Our approach is to use the neural network tool to detect interictal states and to predict from those states the upcoming seizure ( ictal state). Analysis of the EEG signal based on neural networks is used for the classification of EEG as either seizure or non-seizure. By applying prediction methods it will be possible to predict the upcoming seizure from non-seizure EEG. We will study the patients admitted to the epilepsy monitoring unit for the purpose of recording their seizures. Preictal, ictal, and post ictal EEG recordings are available on such patients for analysis The system will be induced by taking a body of samples then validate it using another. Distinct from the two first ones a third body of samples is taken to test the network for the achievement of optimum prediction. Several methods will be tried 'Backpropagation ANN' and 'RBF'.

Keywords: Artificial neural network (ANN), automatic prediction, epileptic seizures analysis, genetic algorithm.

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Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini

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Background: There is growing evidence that Cerebral Vascular Accident (CVA) can be a consequence of COVID-19 infection. Understanding novel treatment approaches is important in optimizing patient outcomes. Case: This case explores the use of Virtual Reality (VR) in the treatment of a 23-year-old COVID-positive female presenting with left hemiparesis in August 2020. Imaging showed right globus pallidus, thalamus, and internal capsule ischemic stroke. Conventional rehabilitation was started two weeks later, with VR included. This game-based VR technology developed for stroke patients was based on upper extremity exercises and functions for stroke. Physical examination showed left hemiparesis with muscle strength 3/5 in the upper extremity and 4/5 in the lower extremity. The range of motion of the shoulder was 90-100 degrees. The speech exam showed a mild decrease in fluency. Mild lower lip dynamic asymmetry was seen. Babinski was positive on the left. Gait speed was decreased (75 steps per minute). Intervention: Our game-based VR system was developed based on upper extremity physiotherapy exercises for post-stroke patients to increase the active, voluntary movement of the upper extremity joints and improve the function. The conventional program was initiated with active exercises, shoulder sanding for joint ROMs, walking shoulder, shoulder wheel, and combination movements of the shoulder, elbow, and wrist joints, alternative flexion-extension, pronation-supination movements, Pegboard and Purdo pegboard exercises. Also, fine movements included smart gloves, biofeedback, finger ladder, and writing. The difficulty of the game increased at each stage of the practice with progress in patient performances. Outcome: After 6 weeks of treatment, gait and speech were normal and upper extremity strength was improved to near normal status. No adverse effects were noted. Conclusion: This case suggests that VR is a useful tool in the treatment of a patient with COVID-19 related CVA. The safety of developed instruments for such cases provides approaches to improve the therapeutic outcomes and prognosis as well as increased satisfaction rate among patients.

Keywords: COVID-19, stroke, virtual reality, rehabilitation.

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Authors: Insung Jung, Gi-Nam Wang

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In this paper, we present user pattern learning algorithm based MDSS (Medical Decision support system) under ubiquitous. Most of researches are focus on hardware system, hospital management and whole concept of ubiquitous environment even though it is hard to implement. Our objective of this paper is to design a MDSS framework. It helps to patient for medical treatment and prevention of the high risk patient (COPD, heart disease, Diabetes). This framework consist database, CAD (Computer Aided diagnosis support system) and CAP (computer aided user vital sign prediction system). It can be applied to develop user pattern learning algorithm based MDSS for homecare and silver town service. Especially this CAD has wise decision making competency. It compares current vital sign with user-s normal condition pattern data. In addition, the CAP computes user vital sign prediction using past data of the patient. The novel approach is using neural network method, wireless vital sign acquisition devices and personal computer DB system. An intelligent agent based MDSS will help elder people and high risk patients to prevent sudden death and disease, the physician to get the online access to patients- data, the plan of medication service priority (e.g. emergency case).

Keywords: Neural network, U-healthcare, MDSS, CAP, DSS.

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Authors: Fereshteh Shacheraghi, Mohammad Reza Shakibaie, Hanieh Noveiri

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Fourty one strains of ESBL producing P.aeruginosa which were previously isolated from burn patients in Kerman University general hospital, Iran were subjected to PCR, RFLP and sequencing in order to determine the type of extended spectrum β- lactamases (ESBL), the restriction digestion pattern and possibility of mutation among detected genes. DNA extraction was carried out by phenol chloroform method. PCR for detection of bla genes was performed using specific primer for each gene. Restriction Fragment Length Polymorphism (RFLP) for ESBL genes was carried out using EcoRI, NheI, PVUII, EcoRV, DdeI, and PstI restriction enzymes. The PCR products were subjected to direct sequencing of both the strands for identification of the ESBL genes.The blaCTX-M, blaVEB-1, blaPER-1, blaGES-1, blaOXA-1, blaOXA-4 and blaOXA-10 genes were detected in the (n=1) 2.43%, (n=41)100%, (n=28) 68.3%, (n=10) 24.4%, (n=29) 70.7%, (n=7)17.1% and (n=38) 92.7% of the ESBL producing isolates respectively. The RFLP analysis showed that each ESBL gene has identical pattern of digestion among the isolated strains. Sequencing of the ESBL genes confirmed the genuinety of PCR products and revealed no mutation in the restriction sites of the above genes. From results of the present investigation it can be concluded that blaVEB-1 and blaCTX-M were the most and the least frequently isolated ESBL genes among the P.aeruginosa strains isolated from burn patients. The RFLP and sequencing analysis revealed that same clone of the bla genes were indeed existed among the antibiotic resistant strains.

Keywords: ESBL genes, PCR, RFLP, Sequencing, P.aeruginosa

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Authors: Noor Ayuni Che Zakaria, Takashi Komeda, Cheng Yee Low, Kaoru Inoue, Fazah Akhtar Hanapiah

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Previous studies have shown that there are arguments regarding the reliability and validity of the Ashworth and Modified Ashworth Scale towards evaluating patients diagnosed with upper limb disorders. These evaluations depended on the raters’ experiences. This initiated us to develop an upper limb disorder part-task trainer that is able to simulate consistent upper limb disorders, such as spasticity and rigidity signs, based on the Modified Ashworth Scale to improve the variability occurring between raters and intra-raters themselves. By providing consistent signs, novice therapists would be able to increase training frequency and exposure towards various levels of signs. A total of 22 physiotherapists and occupational therapists participated in the study. The majority of the therapists agreed that with current therapy education, they still face problems with inter-raters and intra-raters variability (strongly agree 54%; n = 12/22, agree 27%; n = 6/22) in evaluating patients’ conditions. The therapists strongly agreed (72%; n = 16/22) that therapy trainees needed to increase their frequency of training; therefore believe that our initiative to develop an upper limb disorder training tool will help in improving the clinical education field (strongly agree and agree 63%; n = 14/22).

Keywords: Upper limb disorders, Clinical education tool, Inter/intra-raters variability, Spasticity, Modified Ashworth Scale.

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Authors: Naoto Suzuki

Abstract:

Many ophthalmologists find it difficult to distinguish between small retinal hemorrhages and dust artifacts when using fundus photography for the diagnosis of diabetic retinopathy. Six patients with diabetic retinopathy underwent fundus photography, which revealed dust artifacts in the photographs of some patients. We constructed an experimental device similar to the optical system of the fundus camera and colored the fundi of the artificial eyes with khaki, sunset, rose and sunflower colors. Using the experimental device, we photographed dust artifacts using each artificial eyes. We used Scilab 5.4.0 and SIVP 0.5.3 softwares to convert the red, green, and blue (RGB) color space to the hue, saturation, and value (HSV) color space. We calculated the differences between the areas of manifestations and perimanifestations and the areas of dust artifacts and periartifacts using average HSVs. The V values in HSV for the manifestations were as follows: hemorrhages, 0.06 ± 0.03; hard exudates, −0.12 ± 0.06; and photocoagulation marks, 0.07 ± 0.02. For dust artifacts, visualized in the human and artificial eyes, the V values were as follows: human eye, 0.19 ± 0.03; khaki, 0.41 ± 0.02; sunset, 0.43 ± 0.04; rose, 0.47 ± 0.11; and sunflower, 0.59 ± 0.07. For the human and artificial eyes, we calculated two sensitivity values of dust artifacts compared to manifestation areas. V values of the HSV color space enabled the differentiation of small hemorrhages, hard exudates, and photocoagulation marks from dust artifacts.

Keywords: Diabetic retinopathy, HSV color space, small hemorrhages, hard exudates, photocoagulation marks.

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Authors: Niwatchai Namwichisirikul

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Due to the emergence of “Humanized Healthcare" introduced by Professor Dr. Prawase Wasi in 2003[1], the development of this paradigm tends to be widely implemented. The organizations included Healthcare Accreditation Institute (public organization), National Health Foundation, Mahidol University in cooperation with Thai Health Promotion Foundation, and National Health Security Office (Thailand) have selected the hospitals or infirmaries that are qualified for humanized healthcare since 2008- 2010 and 35 of them are chosen to be the outstandingly navigating organizations for the development of humanized healthcare, humanized healthcare award [2]. The research aims to study the current issue, characteristics and patterns of hospital administration contributing to humanized healthcare system in Thailand. The selected case studies are from four hospitals including Dansai Crown Prince Hospital, Leoi; Ubolrattana Hospital, Khon Kaen; Kapho Hospital, Pattani; and Prathai Hospital, Nakhonrachasima. The methodology is in-depth interviewing with 10 staffs working as hospital executive directors, and representatives from leader groups including directors, multidisciplinary hospital committees, personnel development committees, physicians and nurses in each hospital. (Total=40) In addition, focus group discussions between hospital staffs and general people (including patients and their relatives, the community leader, and other people) are held by means of setting 4 groups including 8 people within each group. (Total=128) The observation on the working in each hospital is also implemented. The findings of the study reveal that there are five important aspects found in each hospital including (1) the quality improvement under the mental and spiritual development policy from the chief executives and lead teams, leaders as Role model and they have visionary leadership; (2) the participation hospital administration system focusing on learning process and stakeholder- needs, spiritual human resource management and development; (3) the relationship among people especially staffs, team work skills, mutual understanding, effective communication and personal inner-development; (4) organization culture relevant to the awareness of patients- rights as well as the participation policy including spiritual growth achieving to the same goals, sharing vision, developing public mind, and caring; and (5) healing structures or environment providing warmth and convenience for hospital staffs, patients and their relatives and visitors.

Keywords: Hospital administration, Humanized healthcare.

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Authors: Shu-Mei Liu, Feng-Chuan Pan

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According to the governmental data, the cases of oral cancers doubled in the past 10 years. This had brought heavy burden to the patients- family, the society, and the country. The literature generally evidenced the betel nut contained particular chemicals that can cause oral cancers. Research in Taiwan had also proofed that 90 percent of oral cancer patients had experience of betel nut chewing. It is thus important to educate the betel-nut hobbyists to cease such a hazardous behavior. A program was then organized to establish several training classes across different areas specific to help ceasing this particular habit. Purpose of this research was to explore the attitude and intention toward ceasing betel-nut chewing before and after attending the training classes. 50 samples were taken from a ceasing class with average age at 45 years old with high school education (54%). 74% of the respondents were male in service or agricultural industries. Experiences in betel-nut chewing were 5-20 years with a dose of 1-20 pieces per day. The data had shown that 60% of the respondents had cigarette smoking habit, and 30% of the respondents were concurrently alcoholic dependent. Research results indicated that the attitude, intentions, and the knowledge on oral cancers were found significant different between before and after attendance. This provided evidence for the effectiveness of the training class. However, we do not perform follow-up after the class. Noteworthy is the test result also shown that participants who were drivers as occupation, or habitual smokers or alcoholic dependents would be less willing to quit the betel-nut chewing. The test results indicated as well that the educational levels and the type of occupation may have significant impacts on an individual-s decisions in taking betel-nut or substance abuse.

Keywords: Oral cancer, betel-nut ceasing class, attitude, intention

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Authors: Kay-Anne Haykal, Issack Biyong

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The post-traumatic stress disorder (PTSD) rises from exposure to a traumatic event and appears by a persistent experience of this event. Several psychiatric co-morbidities are associated with PTSD and include mood disorders, anxiety disorders, and substance abuse. The main objective was to compare the criteria for PTSD according to the literature to those used to diagnose a patient in a francophone hospital and to check the correspondence of these two criteria. 700 medical charts of admitted patients on the medicine or psychiatric unit at the Montfort Hospital were identified with the following diagnoses: major depressive disorder, bipolar disorder, anxiety disorder, substance abuse, and PTSD for the period of time between April 2005 and March 2006. Multiple demographic criteria were assembled. Also, for every chart analyzed, the PTSD criteria, according to the Manual of Mental Disorders (DSM) IV were found, identified, and grouped according to pre-established codes. An analysis using the receiver operating characteristic (ROC) method was elaborated for the study of data. A sample of 57 women and 50 men was studied. Age was varying between 18 and 88 years with a median age of 48. According to the PTSD criteria in the DSM IV, 12 patients should have the diagnosis of PTSD in opposition to only two identified in the medical charts. The ROC method establishes that with the combination of data from PTSD and depression, the sensitivity varies between 0,127 and 0,282, and the specificity varies between 0,889 and 0,917. Otherwise, if we examine the PTSD data alone, the sensibility jumps to 0.50, and the specificity varies between 0,781 and 0,895. This study confirms the presence of an underdiagnosed and treated PTSD that causes severe perturbations for the affected individual.

Keywords: Post-Traumatic Stress Disorder, diagnosis, co-morbidities, mental health disorders.

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Authors: Ritwik Dutta, Marilyn Wolf

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This paper describes the tradeoffs and the design from scratch of a self-contained, easy-to-use health dashboard software system that provides customizable data tracking for patients in smart homes. The system is made up of different software modules and comprises a front-end and a back-end component. Built with HTML, CSS, and JavaScript, the front-end allows adding users, logging into the system, selecting metrics, and specifying health goals. The backend consists of a NoSQL Mongo database, a Python script, and a SimpleHTTPServer written in Python. The database stores user profiles and health data in JSON format. The Python script makes use of the PyMongo driver library to query the database and displays formatted data as a daily snapshot of user health metrics against target goals. Any number of standard and custom metrics can be added to the system, and corresponding health data can be fed automatically, via sensor APIs or manually, as text or picture data files. A real-time METAR request API permits correlating weather data with patient health, and an advanced query system is implemented to allow trend analysis of selected health metrics over custom time intervals. Available on the GitHub repository system, the project is free to use for academic purposes of learning and experimenting, or practical purposes by building on it.

Keywords: Flask, Java, JavaScript, health monitoring, long term care, Mongo, Python, smart home, software engineering, webserver.

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Authors: Ş. Çiftcioğlu, E. Efe

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In recent years, cancer has been at the top of diseases that cause death in children. Adequate and balanced nutrition plays an important role in the treatment of cancer. Cancer and cancer treatment is affecting food intake, absorption and metabolism, causing nutritional disorders. Appropriate nutrition is very important for the cancerous child to feel well before, during and after the treatment. There are various difficulties in feeding children with cancer. These are the cancer-related factors. Other factors are environmental and behavioral. As health professionals who spend more time with children in the hospital, nurses should be able to support the children on nutrition and help them to have balanced nutrition. This study aimed to evaluate the importance of nursing approaches in the nutrition of children with cancer. This article is planned as a review article by searching the literature on this field. Anorexia may develop due to psychogenic causes or chemotherapeutic agents or accompanying infections and nutrient uptake may be reduced.  In addition, stomatitis, mucositis, taste and odor changes in the mouth, the feeling of nausea, vomiting and diarrhea can also reduce oral intake and result in significant losses in the energy deficit. In assessing the nutritional status of children with cancer, determining weight loss and good nutrition is essential anamnesis of a child.  Some anthropometric measurements and biochemical tests should be used to evaluate the nutrition of the child. The nutritional status of pediatric cancer patients has been studied for a long time and malnutrition, in particular under nutrition, in this population has long been recognized. Yet, its management remains variable with many malnourished children going unrecognized and consequently untreated. Nutritional support is important to pediatric cancer patients and should be integrated into the overall treatment of these children.

Keywords: Cancer treatment, children, complication, nutrition, nursing approaches.

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Authors: Amal E. Shehata, Manal E. Fareed

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Osteoarthritis (OA) is the most prevalent and far common debilitating form of arthritis which can be defined as a degenerative condition affecting synovial joint. Patients suffering from osteoarthritis often complain of dull ache pain on movement. Physical agents can fight the painful process when correctly indicated and used such as heat or cold therapy Aim. This study was carried out to: Compare the effect of cold, warm and contrast therapy on controlling knee osteoarthritis associated problems. Setting: The study was carried out in orthopedic outpatient clinics of Menoufia University and teaching Hospitals, Egypt. Sample: A convenient sample of 60 adult patients with unilateral knee osteoarthritis. Tools: three tools were utilized to collect the data. Tool I : An interviewing questionnaire. It comprised of three parts covering  sociodemographic data, medical data and adverse effects of the treatment protocol. Tool II : Knee Injury and Osteoarthritis Outcome Score (KOOS) It consists of five main parts. Tool II1 : 0-10 Numeric pain rating scale. Results: reveled that the total knee symptoms score was decreased from moderate symptoms pre intervention to mild symptoms after warm and contrast method of therapy, but the contrast therapy had significant effect in reducing the knee symptoms and pain than the other symptoms. Conclusions: all of the three methods of therapy resulted in improvement in all knee symptoms and pain but the most appropriate protocol of treatment to relive symptoms and pain was contrast therapy.

Keywords: Knee Osteoarthritis, Cold, Warm and Contrast Therapy.

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

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Osteoporosis is one of the important problems in postmenopausal women due to an increased risk of sudden and unexpected fractures. This study is aimed to determine the connection between bone mineral density (BMD) and trabecular bone score (TBS) in Ukrainian women suffering from metabolic syndrome. Participating in the study, 566 menopausal women aged 50-79 year-old were examined and divided into two groups: Group A included 336 women with no obesity (BMI ≤ 29.9 kg/m²), and Group B – 230 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). Dual-energy X-ray absorptiometry was used for measuring of lumbar spine (L1-L4), femoral neck, total body and forearm BMD and bone quality indexes (last according to Med-Imaps installation). Data were analyzed using Statistical Package 6.0. A significant increase of lumbar spine (L1-L4), femoral neck, total body and ultradistal radius BMD was found in women with metabolic syndrome compared to those without obesity (p < 0.001) both in their totality and in groups of 50-59 years, 60-69 years, and 70-79 years. TBS was significantly higher in non-obese women compared to metabolic syndrome patients of 50-59 years and in the general sample (p < 0.05). Analysis showed significant positive correlation between body mass index (BMI) and BMD at all levels. Significant negative correlation between BMI and TBS (L1-L4) was established. Despite the fact that BMD indexes were significantly higher in women with metabolic syndrome, the frequency of vertebral and non-vertebral fractures did not differ significantly in the groups of patients.

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

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Authors: Jitendra Jain, Cassandra Hidajat, Hansraj Riteesh Bookun

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Graft patency underpins long-term prognosis after coronary artery bypass grafting surgery (CABG). The benefits of the combined use of only the left internal mammary artery and radial artery, referred to as total arterial revascularisation (TAR), on long-term clinical outcomes and quality of life are relatively unknown. The aim of this study was to identify whether there were differences in long term clinical outcomes between recipients of TAR compared to a cohort of mostly arterial revascularization involving the left internal mammary, at least one radial artery and at least one saphenous vein graft. A retrospective analysis was performed on all patients who underwent TAR or were re-vascularized with supplementary saphenous vein graft from February 1996 to December 2004. Telephone surveys were conducted to obtain clinical outcome parameters including major adverse cardiac and cerebrovascular events (MACCE) and Short Form (SF-36v2) Health Survey responses. A total of 176 patients were successfully contacted to obtain postop follow up results. The mean follow-up length from time of surgery in our study was TAR 12.4±1.8 years and conventional 12.6±2.1. PCS score was TAR 45.9±8.8 vs LIMA/Rad/ SVG 44.9±9.2 (p=0.468) and MCS score was TAR 52.0±8.9 vs LIMA/Rad/SVG 52.5±9.3 (p=0.723). There were no significant differences between groups for NYHA class 3+ TAR 9.4% vs. LIMA/Rad/SVG 6.6%; or CCS 3+ TAR 2.35% vs. LIMA/Rad/SVG 0%.

Keywords: CABG, MACCEs, quality of life, total arterial revascularization.

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Authors: Farahnaz Amini, Woo Yun Kin, Lazwani Kolandaiveloo

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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: Claude Takenga, Rolf-Dietrich Berndt, Erling Si, Markus Diem, Guohui Qiao, Melanie Gau, Michael Brandstoetter, Martin Kampel, Michael Dworzak

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In patients with acute lymphoblastic leukaemia (ALL), treatment response is increasingly evaluated with minimal residual disease (MRD) analyses. Flow Cytometry (FCM) is a fast and sensitive method to detect MRD. However, the interpretation of these multi-parametric data requires intensive operator training and experience. This paper presents a pipeline-software, as a ready-to-use FCM-based MRD-assessment tool for the daily clinical practice for patients with ALL. The new tool increases accuracy in assessment of FCM-MRD in samples which are difficult to analyse by conventional operator-based gating since computer-aided analysis potentially has a superior resolution due to utilization of the whole multi-parametric FCM-data space at once instead of step-wise, two-dimensional plot-based visualization. The system developed as a telemedical network reduces the work-load and lab-costs, staff-time needed for training, continuous quality control, operator-based data interpretation. It allows dissemination of automated FCM-MRD analysis to medical centres which have no established expertise for the benefit of an even larger community of diseased children worldwide. We established a telemedical network system for analysis and clinical follow-up and treatment monitoring of Leukaemia. The system is scalable and adapted to link several centres and laboratories worldwide.

Keywords: Data security, flow cytometry, leukaemia, telematics platform, telemedicine.

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Authors: Raad Nari, Maura Moriaty, Maha T. Barakat

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Introduction: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a new class of oral anti-diabetic drugs with a unique mechanism of action. They are used to improve glycaemic control in adults with type 2 diabetes by enhancing urinary glucose excretion. In the UAE, there has been certainly an increased use of these medications. As with any new medication, there are safety considerations related to their use in patients with type two diabetes. A retrospective study was conducted at the three main centres of the Imperial College London Diabetes Centre. Methodology: All patients in electronic database (Diamond) from October 2014 to October 2017 were included with a minimum of six months usage of sodium glucose co-transporter inhibitors that comprise canagliflozin, dapagliflozin and empagliflozin. There were 15 paired sample biochemical and clinical correlations. The analysis was done at the start of the study, three months and six months apart. SPSS version 24 was used for this study. Conclusion: This study of sodium glucose co-transporter-2 inhibitors used showed significant reductions in weight, glycated haemoglobin A1C, systolic and diastolic blood pressures. As the case with systematic reviews, there were similar changes in liver enzymes, raised total cholesterol, low density lipopoptein and high density lipoprotein. There was slight improvement in estimated glomerular filtration rate too. Our analysis also showed that they increased in the incidence of urinary tract symptoms and incidence of urinary tract infections.

Keywords: SGLT2 inhibitors dapagliflozin empagliflozin canagliflozin, adverse effects, amputation diabetic ketoacidosis DKA, urinary tract infection.

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Authors: M. J. Pourvaghar, Sh. Khoshemehry

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Adopting inappropriate body posture during addiction can cause muscular and skeletal deformities. This study is aimed at investigating the effects of a program of the selected corrective exercises on the kyphosis of addicted male patients. Materials and methods: This was a quasi-experimental study. This study has been carried out using the semi-experimental method. The subjects of the present study included 104 addicted men between 25 to 45 years of age. In 2014, these men were referred to one of the NA (Narcotic Anonymous) centres in Kashan in 2015. A total of 24 people suffering from drug withdrawal, who had abnormal kyphosis, were purposefully selected as a sample. The sample was randomly divided into two groups, experimental and control; each group consisted of 12 people. The experimental group participated in a training program for 12 weeks consisting of three 60 minute sessions per week. That includes strengthening, stretching and PNF exercises (deep stretching of the muscle). The control group did no exercise or corrective activity. The Kolmogorov-Smirnov test was used to assess normal distribution of data; and a paired t-test and covariance analysis test were used to assess the effectiveness of the exercises, with a significance level of P≤0.05 by using SPSS18. The results showed that three months of the selected corrective exercises had a significant effect (P≤ 0.005) on the correction of the kyphosis of the addicted male patients after three months of rehabilitation (drug withdrawal) in the experimental group, while there was no significant difference recorded in the control group (P≥0.05). The results show that exercise and corrective activities can be used as non-invasive and non-pharmacological methods to rehabilitate kyphosis abnormalities after drug withdrawal and treatment for addiction.

Keywords: Kyphosis, corrective exercises, addict, drug withdrawal.

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Authors: Domenica Tambasco, Riina Bray

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Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and reduced function. Management of symptoms include medications, physical treatments and mindfulness therapies. Myofascial Release is a modality that has been successfully applied in various musculoskeletal conditions. However, to the author’s best knowledge, it is not yet recognized as a self-management therapy option in Fibromyalgia. In this study, we investigated whether Self-applied Myofascial Release (SMR) is associated with overall improved function and symptoms in Fibromyalgia. Eligible adult patients with a confirmed diagnosis of Fibromyalgia at Women’s College Hospital were recruited to SMR. Sessions ran for 1 hour once a week for 7 weeks, led by the same two physiotherapists knowledgeable in this physical treatment modality. The main outcome measure was an overall impact score for function and symptoms based on the validated assessment tool for fibromyalgia, the Revised Fibromyalgia Impact Questionnaire (FIQR), measured pre- and post-intervention. Both descriptive and analytical methods were applied and reported. We analyzed results using a paired t-test to determine if there was a statistically significant difference in mean FIQR scores between initial (pre-intervention) and final (post-intervention) scores. A clinically significant difference in FIQR was defined as a reduction in score by 10 or more points. Our pilot study showed that SMR appeared to be a safe and effective intervention for our fibromyalgia participants and the overall impact on function and symptoms occurred in only 7 weeks. Further studies with larger sample sizes comparing SMR to other physical treatment modalities (such as stretching) in an randomized control trial (RCT) are recommended.

Keywords: Fibromyalgia, myofascial release, fibromyalgia impact questionnaire, fibromyalgia assessment status.

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Authors: W. Astiata, A. Wasif

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In this paper, an overview is made on the educational and research activities in the field of physical medicine and rehabilitation in Libya, including development in rehabilitation science, research, training, occupational therapy, physiotherapy and physiatrist, which are mainly concerned with the patients in Libya[3] [13].

Keywords: Physiotherapy, Rehabilitation, Libya, Graduates, Institutions, Universities, Research, Education, Courses.

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Authors: P. H. Tee, S. M. Zamri, K. M. Kasim, S. K. Tiew

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This study evaluates the management of osteoporosis in a tertiary care government hospital in Malaysia. As the number of admitted patients having osteoporotic fractures is on the rise, osteoporotic medications are an increasing financial burden to government hospitals because they account for half of the orthopedic budget and expenditure. Comprehensive knowledge among practitioners is important to detect early and avoid this preventable disease and its serious complications. The purpose of this study is to evaluate the awareness, knowledge, and practices in managing osteoporosis among practitioners in Hospital Tengku Ampuan Rahimah (HTAR), Klang. A questionnaire from an overseas study in managing osteoporosis among primary care physicians is adapted to Malaysia’s Clinical Practice Guideline of Osteoporosis 2012 (revised 2015) and international guidelines were distributed to all orthopedic practitioners in HTAR Klang (including surgeons, orthopedic medical officers), endocrinologists, rheumatologists and geriatricians. The participants were evaluated on their expertise in the diagnosis, prevention, treatment decision and medications for osteoporosis. Collected data were analyzed for all descriptive and statistical analyses as appropriate. All 45 participants responded to the questionnaire. Participants scored highest on expertise in prevention, followed by diagnosis, treatment decision and lastly, medication. Most practitioners stated that own-initiated continuing professional education from articles and books was the most effective way to update their knowledge, followed by attendance in conferences on osteoporosis. This study confirms the importance of comprehensive training and education regarding osteoporosis among tertiary care physicians and surgeons, predominantly in pharmacotherapy, to deliver wholesome care for osteoporotic patients.

Keywords: Awareness, knowledge, osteoporosis, practices.

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Authors: Yujun Zheng, Qin Song, Haihe Shi, and Jinyun Xue

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There are a number of different cars for transferring hundreds of close contacts of swine influenza patients to hospital, and we need to carefully assign the passengers to those cars in order to minimize the risk of influenza spreading during transportation. The paper presents an approach to straightforward obtain the optimal solution of the relaxed problems, and develops two iterative improvement algorithms to effectively tackle the general problem.

Keywords: Influenza spread, discrete optimization, stationary point, iterative improvement

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Authors: Bryce Benson, Sooin Lee, Ashwin Belle

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Unrecognized or delayed identification of patient deterioration is a key cause of in-hospitals adverse events. Clinicians rely on vital signs monitoring to recognize patient deterioration. However, due to ever increasing nursing workloads and the manual effort required, vital signs tend to be measured and recorded intermittently, and inconsistently causing large gaps during patient monitoring. Additionally, during deterioration, the body’s autonomic nervous system activates compensatory mechanisms causing the vital signs to be lagging indicators of underlying hemodynamic decline. This study analyzes the predictive efficacy of the Analytic for Hemodynamic Instability (AHI) system, an automated tool that was designed to help clinicians in early identification of deteriorating patients. The lead time analysis in this retrospective observational study assesses how far in advance AHI predicted deterioration prior to the start of an episode of hemodynamic instability (HI) becoming evident through vital signs? Results indicate that of the 362 episodes of HI in this study, 308 episodes (85%) were correctly predicted by the AHI system with a median lead time of 57 minutes and an average of 4 hours (240.5 minutes). Of the 54 episodes not predicted, AHI detected 45 of them while the episode of HI was ongoing. Of the 9 undetected, 5 were not detected by AHI due to either missing or noisy input ECG data during the episode of HI. In total, AHI was able to either predict or detect 98.9% of all episodes of HI in this study. These results suggest that AHI could provide an additional ‘pair of eyes’ on patients, continuously filling the monitoring gaps and consequently giving the patient care team the ability to be far more proactive in patient monitoring and adverse event management.

Keywords: Clinical deterioration prediction, decision support system, early warning system, hemodynamic status, physiologic monitoring.

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Authors: Ganetsou Evanthia, Koutsikos Emmanouil, Austin Anna Maria

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Information technology has long served the needs of individuals for learning and entertainment, but much less for children in sickness. The aim of the proposed online video game is to provide immersive learning opportunities as well as essential social and emotional scenarios for hospital-bound children with long-term illness. Online self-paced courses on chosen school subjects, including specialized software and multisensory assessments, aim at enhancing children’s academic achievement and sense of inclusion, while doctor minigames familiarize and educate young patients on their medical conditions. Online ethical dilemmas will offer children opportunities to contemplate on the importance of medical procedures and following assigned medication, often challenging for young patients; they will therefore reflect on their condition, re-evaluate their perceptions about hospitalization, and assume greater personal responsibility for their progress. Children’s emotional and psychosocial needs are addressed by engaging in social conventions, such as interactive, daily, collaborative mini games with other hospitalized peers, like virtual competitive sports games, weekly group psychodrama sessions, and online birthday parties or sleepovers. Social bonding is also fostered by having a virtual pet to interact with and take care of, as well as a virtual nurse to discuss and reflect on the mood of the day, engage in constructive dialogue and perspective-taking, and offer reminders. Access to the platform will be available throughout the day depending on the patient’s health status. The program is designed to minimize escapism and feelings of exclusion and can flexibly be adapted to offer post-treatment and a support online system at home.

Keywords: Hospitalized children, interactive games, long-term illness, cognitive enhancement, socioemotional development.

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Authors: Yi-Yun Ko, Der-Ming Liou

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The Electronic Health Record (EHR) system is very general and we should pay more attention to a patient-s privacy. The patient-s consent is one of the elements when dealing with privacy topics. This study focuses on the creating and managing of patient consent. The integration of the HL7 standards and the IHE BPPC profile provides a base for the creation of patient consent. Establishing the platform offers the patients a way to create, revoke or update their consents. Through this platform, they can manage their consents in an easier manner.

Keywords: consent, EHR, HL7, IHE

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Authors: Kulaya Wimolwat, Panlop Chakravitthamrong, Neti Waranuch

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Background: Seborrheic dermatitis is a common chronic skin condition affecting the face, scalp, chest, and trunk. The cause of seborrheic dermatitis is still unknown. Sebum production, lipid composition, hormone levels, and Malassezia species have been suggested as important factors in the development of seborrheic dermatitis. Curcuma aeruginosa Roxb. extract-containing cream with anti-inflammatory and anti-androgenic properties may be beneficial for treating mild to moderate facial seborrheic dermatitis. Objectives: We evaluated the efficacy and safety of 2% C. aeruginosa Roxb. extract-containing cream in the treatment of mild to moderate seborrheic dermatitis. Methods: This was a prospective, open-label, and non-comparative study. Ten adult patients clinically diagnosed with mild to moderate seborrheic dermatitis were enrolled in a four-week study. The 2% C. aeruginosa Roxb. cream was applied twice daily to a lesional area on the face for four weeks. The Scoring Index (SI) ranking system on days 14 and 28 was compared with that at baseline to determine the efficacy of treatment. The adverse events (burning sensation and erythema) were evaluated on days 14 and 28 to determine the safety of the treatment. Results: Significant improvement was observed in the reduction of the mean SI at day 14 (2.9) and 28 (1.4) compared to that at baseline (4.9). An adverse reaction was observed on day 14 (mild erythema 20% and mild burning sensation 10%) and was resolved by the end of the study. Conclusion: This open-label pilot study has shown that there was a significant improvement in the severity in these seborrheic patients and most reported they were satisfied with it. Reported adverse events were all mild.

Keywords: Anti-androgenic, antifungals, anti-inflammatory, Curcuma aeruginosa, seborrheic dermatitis, efficacy, safety.

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Authors: Ogunduyile O. Oluwgbenga

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Recent advancements in sensor technologies and Wireless Body Area Networks (WBANs) have led to the development of cost-effective healthcare devices which can be used to monitor and analyse a person-s physiological parameters from remote locations. These advancements provides a unique opportunity to overcome current healthcare challenges of low quality service provisioning, lack of easy accessibility to service varieties, high costs of services and increasing population of the elderly experienced globally. This paper reports on a prototype implementation of an architecture that seamlessly integrates Wireless Body Area Network (WBAN) with Web services (WS) to proactively collect physiological data of remote patients to recommend diagnostic services. Technologies based upon WBAN and WS can provide ubiquitous accessibility to a variety of services by allowing distributed healthcare resources to be massively reused to provide cost-effective services without individuals physically moving to the locations of those resources. In addition, these technologies can reduce costs of healthcare services by allowing individuals to access services to support their healthcare. The prototype uses WBAN body sensors implemented on arduino fio platforms to be worn by the patient and an android smart phone as a personal server. The physiological data are collected and uploaded through GPRS/internet to the Medical Health Server (MHS) to be analysed. The prototype monitors the activities, location and physiological parameters such as SpO2 and Heart Rate of the elderly and patients in rehabilitation. Medical practitioners would have real time access to the uploaded information through a web application.

Keywords: Android Smart phone, Arduino Fio, Web application server, Wireless Body Area Networks.

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Authors: Laila Salah Seada, Ashraf Ibrahim, Fawaz Al Rashid, Ihab Abdo, Hassan Kasim, Waleed Al Mansi, Saud Al Shabli

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Background and Objectives: Colorectal carcinoma is increasing among both men and women worldwide. It has a multifactorial etiology including genetic factors, environmental factors and inflammatory conditions of the digestive tract. A clinicopathologic assessment of colorectal carcinoma in Hail region is done, considering any changing patterns in two 5-year periods from 2005-2009 (A) and from 2012 to 2017 (B). All data had been retrieved from histopathology files of King Khalid Hospital, Hail. Results: During period (A), 75 cases were diagnosed as colorectal carcinoma. Male patients comprised 56/75 (74.7%) of the study, with a mean age of 58.4 (36-97), while females were 19/75 (25.3%) with a mean age of 50.3(30-85) and the difference was significant (p = 0.05). M:F ratio was 2.9:1. Most common histological type was adenocarcioma in 68/75 (90.7%) patients mostly well differentiated in 44/68 (64.7%). Mucinous neoplasms comprised only 7/75 (9.3%) of cases and tended to have a higher stage (p = 0.04). During period (B), 115 cases were diagnosed with an increase of 53.3% in number of cases than period (A). Male to female ratio also decreased to 1.35:1, females being 44.83% more affected. Adenocarcinoma remained the prevalent type (93.9%), while mucinous type was still rare (5.2%). No distal metastases found at time of presentation. Localization of tumors was rectosigmoid in group (A) in 41.4%, which increased to 56.6% in group (B), with an increase of 15.2%. Iliocecal location also decreased from 8% to 3.5%, being 56.25% less. Other proximal areas of the colon were decreased by 25.75%, from 53.9% in group (A) to 40% in group (B). Conclusion: Colorectal carcinoma in Hail region has increased by 53.3% in the past 5 years, with more females being diagnosed. Localization has also shifted distally by 15.2%. These findings are different from Western world patterns which experienced a decrease in incidence and proximal shift of the colon cancer localization. This might be due to better diagnostic tools, population awareness of the disease, as well as changing of life style and/or food habits in the region.

Keywords: Colorectal cancer, Hail Region, changing pattern, distal shift.

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