Abstract: The mechanisms underlying the association between
obesity and asthma may be related to a decreased immunological
tolerance induced by a defective function of regulatory T cells
(Tregs). The aim of this study is to establish the potential link
between these diseases and CD4+, CD25+ FoxP3+ Tregs as well as T
helper cells (Ths) in children. This is a prospective case control
study. Obese (n:40), asthmatic (n:40), asthmatic obese (n:40) and
healthy children (n:40), who don't have any acute or chronic diseases,
were included in this study. Obese children were evaluated according
to WHO criteria. Asthmatic patients were chosen based on GINA
criteria. Parents were asked to fill up the questionnaire. Informed
consent forms were taken. Blood samples were marked with CD4+,
CD25+ and FoxP3+ in order to determine Tregs and Ths by flow
cytometric method. Statistical analyses were performed. p≤0.05 was
chosen as meaningful threshold. Tregs exhibiting anti-inflammatory
nature were significantly lower in obese (0,16%; p≤0,001), asthmatic
(0,25%; p≤0,01) and asthmatic obese (0,29%; p≤0,05) groups than
the control group (0,38%). Ths were counted higher in asthma group
than the control (p≤0,01) and obese (p≤0,001) groups. T cell
immunity plays important roles in obesity and asthma pathogeneses.
Decreased numbers of Tregs found in obese, asthmatic and asthmatic
obese children may help to elucidate some questions in
pathophysiology of these diseases. For HOMA-IR levels, any
significant difference was not noted between control and obese
groups, but statistically higher values were found for obese
asthmatics. The values obtained in all groups were found to be below
the critical cut off points. This finding has made the statistically
significant difference observed between Tregs of obese, asthmatic,
obese asthmatic and control groups much more valuable. These
findings will be useful in diagnosis and treatment of these disorders
and future studies are needed. The production and propagation of
Tregs may be promising in alternative asthma and obesity treatments.
Abstract: The effects of hypertension are often lethal thus its
early detection and prevention is very important for everybody. In
this paper, a neural network (NN) model was developed and trained
based on a dataset of hypertension causative parameters in order to
forecast the likelihood of occurrence of hypertension in patients. Our
research goal was to analyze the potential of the presented NN to
predict, for a period of time, the risk of hypertension or the risk of
developing this disease for patients that are or not currently
hypertensive. The results of the analysis for a given patient can
support doctors in taking pro-active measures for averting the
occurrence of hypertension such as recommendations regarding the
patient behavior in order to lower his hypertension risk. Moreover,
the paper envisages a set of three example scenarios in order to
determine the age when the patient becomes hypertensive, i.e.
determine the threshold for hypertensive age, to analyze what
happens if the threshold hypertensive age is set to a certain age and
the weight of the patient if being varied, and, to set the ideal weight
for the patient and analyze what happens with the threshold of
hypertensive age.
Abstract: 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.
Abstract: Background: The objectives of this study were to
assess patient’s knowledge of appropriate sublingual glyceryl
trinitrate (GTN) use as well as to investigate how patients commonly
store and carry their sublingual GTN tablets. Methodology: This was
a cross-sectional survey, using a validated researcher-administered
questionnaire. The study involved cardiac patients receiving
sublingual GTN attending the outpatient and inpatient departments of
Taiping Hospital, a non-academic public care hospital. The minimum
calculated sample size was 92, but 100 patients were conveniently
sampled. Respondents were interviewed on 3 areas, including
demographic data, knowledge and use of sublingual GTN. Eight
items were used to calculate each subject’s knowledge score and six
items were used to calculate use score. Results: Of the 96 patients
who consented to participate, majority (96.9%) were well aware of
the indication of sublingual GTN. With regards to the mechanism of
action of sublingual GTN, 73 (76%) patients did not know how the
medication works. Majority of the patients (66.7%) knew about the
proper storage of the tablet. In relation to the maximum number of
sublingual GTN tablets that can be taken during each angina episode,
36.5% did not know that up to 3 tablets of sublingual GTN can be
taken during each episode of angina. Fifty four (56.2%) patients were
not aware that they need to replace sublingual GTN every 8 weeks
after receiving the tablets. Majority (69.8%) of the patients
demonstrated lack of knowledge with regards to the use of sublingual
GTN as prevention of chest pain. Conclusion: Overall, patients’
knowledge regarding the self-administration of sublingual GTN is
still inadequate. The findings support the need for more frequent
reinforcement of patient education, especially in the areas of
preventive use, storage and drug stability.
Abstract: Pulmonary Function Tests are important non-invasive
diagnostic tests to assess respiratory impairments and provides
quantifiable measures of lung function. Spirometry is the most
frequently used measure of lung function and plays an essential role
in the diagnosis and management of pulmonary diseases. However,
the test requires considerable patient effort and cooperation,
markedly related to the age of patients resulting in incomplete data
sets. This paper presents, a nonlinear model built using Multivariate
adaptive regression splines and Random forest regression model to
predict the missing spirometric features. Random forest based feature
selection is used to enhance both the generalization capability and the
model interpretability. In the present study, flow-volume data are
recorded for N= 198 subjects. The ranked order of feature importance
index calculated by the random forests model shows that the
spirometric features FVC, FEF25, PEF, FEF25-75, FEF50 and the
demographic parameter height are the important descriptors. A
comparison of performance assessment of both models prove that, the
prediction ability of MARS with the `top two ranked features namely
the FVC and FEF25 is higher, yielding a model fit of R2= 0.96 and
R2= 0.99 for normal and abnormal subjects. The Root Mean Square
Error analysis of the RF model and the MARS model also shows that
the latter is capable of predicting the missing values of FEV1 with a
notably lower error value of 0.0191 (normal subjects) and 0.0106
(abnormal subjects) with the aforementioned input features. It is
concluded that combining feature selection with a prediction model
provides a minimum subset of predominant features to train the
model, as well as yielding better prediction performance. This
analysis can assist clinicians with a intelligence support system in the
medical diagnosis and improvement of clinical care.
Abstract: Content Based Image Retrieval (CBIR) coupled with
Case Based Reasoning (CBR) is a paradigm that is becoming
increasingly popular in the diagnosis and therapy planning of medical
ailments utilizing the digital content of medical images. This paper
presents a survey of some of the promising approaches used in the
detection of abnormalities in retina images as well in
mammographic screening and detection of regions of interest
in MRI scans of the brain. We also describe our proposed
algorithm to detect hard exudates in fundus images of the
retina of Diabetic Retinopathy patients.
Abstract: The management of Helicobacter pylori (H. pylori)
eradication is still a matter of discussion, full effectiveness is rarely
achieved, and it has many adverse effects. The use of probiotics may
be associated with better eradication rates and possibly prevention of
adverse events due to antibiotic therapy. The present clinical study
was undertaken to evaluate the efficacy of a specially designed
fermented milk product, containing Bifidobacterium lactis B420, on
the eradication of H. pylori infection in a prospective, randomized,
double-blind, controlled study in humans. Four test fermented milks
(FM) were specially designed in which counts of viable cells in all
products were 10^10 Log CFU. 100 mL-1 for Bifidobacterium lactis -
Bifidobacterium species 420. 190 subjects infected with H. pylori,
with previous diagnosis of functional dyspepsia according to Rome
III criteria entered the study. Bifidobacterium lactis B420,
administered twice a day for 90 days was not able to eradicate H.
pylori in Brazilian patients with functional dyspepsia.
Abstract: 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.
Abstract: In this paper, we propose an intelligent system that is
used for monitoring the health conditions of patients. Monitoring the
health condition of patients is a complex problem that involves
different medical units and requires continuous monitoring especially
in rural areas because of inadequate number of available specialized
physicians. The proposed system will improve patient care and drive
costs down comparing to the existing system in Jordan. The proposed
system will be the start point to faster and improve the
communication between different units in the health system in
Jordan. Connecting patients and their physicians beyond hospital
doors regarding their geographical area is an important issue in
developing the health system in Jordan. The ability of making
medical decisions, the quality of medical is expected to be improved.
Abstract: Background: The effectiveness of mirror therapy
(MT) has been investigated in acute hemiplegia. The present study
examines whether MT, given during chronic stroke, was more
effective in promoting motor recovery of the lower extremity and
walking speed than standard rehabilitation alone. Methods: The study
enrolled 30 patients with chronic stroke. Fifteen patients each were
assigned to the treatment group and the control group. All patients
received a conventional rehabilitation program for a 4-week period.
In addition to this rehabilitation program, patients in the treatment
group received mirror therapy for 4 weeks, 5 days a week. Main
measures: Passive ankle joint dorsiflexion range of motion, gait
speed, Brunnstrom stages of motor recovery, plantar flexor muscle
tone by Modified Ashworth Scale. Results: No significant difference
was found in the outcome measures among groups before treatment.
When compared with standard rehabilitation, mirror therapy
improved Ankle ROM, Brunnstrom stages and waking speed
(p < 0.05). However, there were no significant differences between
two groups on MAS (P > 0.05).Conclusion: Mirror therapy combined
with a conventional stroke rehabilitation program enhances lowerextremity
motor recovery and walking speed in chronic stroke
patients.
Abstract: Background: With the perceived pain and poor
function experienced following knee arthroplasty, patients usually
feel un-satisfied. Yet, a controversy still persists on the appropriate
operative technique that doesn’t affect proprioception much.
Purpose: This study compared the effects of Cruciate Retaining
(CR) and Posterior Stabilized (PS) total knee arthroplasty (TKA on
dynamic balance, pain and functional performance following
rehabilitation.
Methods: Thirty patients with CRTKA (group I), thirty with
PSTKA (group II) and fifteen indicated for arthroplasty but weren’t
operated on yet (group III) participated in the study. The mean age
was 54.53±3.44, 55.13±3.48 and 55.33±2.32 years and BMI
35.7±3.03, 35.7±1.99 and 35.73±1.03 kg/m2 for groups I, II and III
respectively. The Berg Balance Scale (BBS), WOMAC pain subscale
and Timed Up-and-Go (TUG) and Stair-Climbing (SC) tests were
used for assessment. Assessments were conducted four weeks preand
post-operatively, three, six and twelve months post-operatively
with the control group being assessed at the same time intervals. The
post-operative rehabilitation involved hospitalization (1st week),
home-based (2nd-4th weeks), and outpatient clinic (5th-12th weeks)
programs, follow-up to all groups for twelve months.
Results: The Mixed design MANOVA revealed that group I had
significantly lower pain scores and SC time compared with group II
three, six and twelve months post-operatively. Moreover, the BBS
scores increased significantly and the pain scores and TUG and SC
time decreased significantly six months post-operatively compared
with four weeks pre- and post-operatively and three months postoperatively
in groups I and II with the opposite being true four weeks
post-operatively. But no significant differences in BBS scores, pain
scores and TUG and SC time between six and twelve months postoperatively
in groups I and II.
Interpretation/Conclusion: CRTKA is preferable to PSTKA,
possibly due to the preserved human proprioceptors in the un-excised
PCL.
Abstract: Background and aim: It has not been well studied
whether fentanyl-thiopental (FT) is effective and safe for PSA in
orthopedic procedures in Emergency Department (ED). The aim of
this trial was to evaluate the effectiveness of intravenous FT versus
fentanyl-midazolam (FM) in patients who suffered from shoulder
dislocation or distal radial fracture-dislocation.
Methods: In this randomized double-blinded study, Seventy-six
eligible patients were entered the study and randomly received
intravenous FT or FM. The success rate, onset of action and recovery
time, pain score, physicians’ satisfaction and adverse events were
assessed and recorded by treating emergency physicians. The
statistical analysis was intention to treat.
Results: The success rate after administrating loading dose in FT
group was significantly higher than FM group (71.7% vs. 48.9%,
p=0.04); however, the ultimate unsuccessful rate after 3 doses of
drugs in the FT group was higher than the FM group (3 to 1) but it
did not reach to significant level (p=0.61). Despite near equal onset
of action time in two study group (P=0.464), the recovery period in
patients receiving FT was markedly shorter than FM group
(P
Abstract: Chemotherapy and radiotherapy are one of the major
treatment modalities that play important role in the management of a
number of different cancers. This study for the first time evaluates the
toxicity of these treatment modalities and its impact on quality of life
of cancer patients in Pakistan. The study also for the first time
determines what cancer patients of different ages and cancer stages
believe would be an effective intervention to manage their
psychosocial needs and treatment induced toxicity. The article also
provides evidence based approach for the use of variety of
interventions to mange cancer treatment induced morbidity and
toxicity. In light of the present study and reviewed research data,
evidence based recommendations are also made for selection of
appropriate interventions to manage Pain, Nausea and Vomiting,
Anxiety and Depression, Fatigue and Overall QOL of cancer
survivors.
Abstract: A game for training of breath (TRABR) for continuous
monitoring of pulmonary ventilation during the patients’ therapy
focuses especially on monitoring of their ventilation processes. It is
necessary to detect, monitor and differentiate abdominal and thoracic
breathing during the therapy. It is a fun form of rehabilitation where
the patient plays and also practicing isolated breathing. Finally the
game to practice breath was designed to evaluate whether the patient
uses two types of breathing or not.
Abstract: Monoamine oxidase A gene (MAOA) is suggested to
be a candidate gene implicated in many neuropsychiatric disorders,
including autism spectrum disorder (ASD). This meta-analytic review
evaluates the relationship between ASD and MAOA markers such as
30 bp variable number tandem repeats in the promoter region
(uVNTR) and single nucleotide polymorphisms (SNPs) by using
findings from recently published studies. It seems that in Caucasian
males, the risk of developing ASD increase with the presence of 4-
repeat allele in the promoter region of MAOA gene whereas no
differences were found between autistic patients and controls in
Egyptian, West Bengal and Korean population. Some studies point to
the importance of specific haplotype groups of SNPs and interaction
of MAOA with others genes (e. g. FOXP2 or SRY). The results of
existing studies are insufficient and further research is needed.
Abstract: Children are more susceptible to medication errors
than adults. Medication administration process is the last stage in the
medication treatment process and most of the errors detected in this
stage. Little research has been undertaken about medication errors in
children in the Middle East countries. This study was aimed to
evaluate how the paediatric nurses adhere to the medication
administration policy and also to identify any medication preparation
and administration errors or any risk factors. An observational,
prospective study of medication administration process from when
the nurses preparing patient medication until administration stage
(May to August 2014) was conducted in Saudi Arabia. Twelve
paediatric nurses serving 90 paediatric patients were observed. 456
drug administered doses were evaluated. Adherence rate was variable
in 7 steps out of 16 steps. Patient allergy information, dose
calculation, drug expiry date were the steps in medication
administration with lowest adherence rates. 63 medication
preparation and administration errors were identified with error rate
13.8% of medication administrations. No potentially life-threating
errors were witnessed. Few logistic and administrative factors were
reported. The results showed that the medication administration
policy and procedure need an urgent revision to be more sensible for
nurses in practice. Nurses’ knowledge and skills regarding to the
medication administration process should be improved.
Abstract: To evaluate the factors which predetermine the
coronary artery disease in patients having positive Exercise Tolerance
Test (ETT) that is treadmill results and coronary artery findings. This
descriptive study was conducted at Department of Cardiology,
Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
from 1st January, 2014 to 31st August, 2014. All patients who had
done ETT (treadmill) for chest pain diagnosis were studied. One
hundred and four patients underwent coronary angiogram after
positive treadmill result. Patients were divided into two groups
depending upon the angiographic findings, i.e. true positive and false
positive. Positive treadmill test patients who have coronary artery
involvement these are called true positive and who have no
involvement they are called false positive group. Both groups were
compared with each other. Out of 104 patients, 81 (77.9%) patients
had true positive ETT and 23 (22.1%) patients had false positive
ETT. The mean age of patients in positive ETT was 53.46± 8.06
years and male mean age was 53.63±8.36 years and female was
52.87±7.0 years. Sixty nine (85.19%) male patients and twelve
(14.81%) female patients had true positive ETT, whereas 15
(65.21%) males and 8 (34.79%) females had false positive ETT, this
was statistically significant (p
Abstract: Sports games conducted as a group are a form of
therapeutic exercise for aged people with decreased strength and for
people suffering from permanent damage of stroke and other
conditions. However, it is difficult for patients with different athletic
abilities to play a game on an equal footing. This study specifically
examines a computer video game designed for therapeutic exercise,
and a game system with support given depending on athletic ability.
Thereby, anyone playing the game can participate equally. This
video-game, to be specific, is a popular variant of balloon volleyball,
in which players hit a balloon by hand before it falls to the floor. In this
game system, each player plays the game watching a monitor on which
the system displays tailor-made video-game images adjusted to the
person’s athletic ability, providing players with player-adaptive assist
support. We have developed a multiplayer game system with an image
generation technique for the tailor-made video-game and conducted
tests to evaluate it.
Abstract: The objective of this study is to analyze the
prophylactic usage of low molecular weight heparin (LMWH) along
pregnancy and the correlation between their usage and month/week
of pregnancy, in the Department of Gynecology and Obstetrics, at
Clinical Hospital in Tetovo. A retrospective study was undertaken
during 01 January – 31 December 2012. Over of one year, the total
number of patients was 4636. Among the 1447 (32.21%) pregnant
women, 298 (20.59%) of them were prescribed LMWH. The majority
of patients given LMWH, 119 (39.93%) were diagnosed
hypercoagulable. The age group with the highest attendance was 25-
35, 141 patients (47.32%). For 195 (65.44%) patients, this was their
first pregnancy. Earliest stage of using LMWH was the second month
of pregnancy 4 (1.34%) cases. The most common patients were 70
women along the seventh month (23.49%), followed by 68 in the
ninth month of pregnancy (22.81%). Women in the 28th gestational
week, were found to be the most affected, a total of 55 (78.57%) were
in that week. Clexane 2000 and Fraxiparine 0.3 were the most
common for which low molecular weight heparin was prescribed.
The number of patients which received Clexane 2000 was 84
(28.19%), followed by those with Fraxiparine 0.3 81 (27.18%). The
administration of LMWH is associated with long hospitalization
(median 14,6 days).
Abstract: This study aimed at investigating whether the
functional brain networks constructed using the initial EEG (obtained
when patients first visited hospital) can be correlated with the
progression of cognitive decline calculated as the changes of
mini-mental state examination (MMSE) scores between the latest and
initial examinations. We integrated the time–frequency cross mutual
information (TFCMI) method to estimate the EEG functional
connectivity between cortical regions, and the network analysis based
on graph theory to investigate the organization of functional networks
in aMCI. Our finding suggested that higher integrated functional
network with sufficient connection strengths, dense connection
between local regions, and high network efficiency in processing
information at the initial stage may result in a better prognosis of the
subsequent cognitive functions for aMCI. In conclusion, the functional
connectivity can be a useful biomarker to assist in prediction of
cognitive declines in aMCI.