Detection Of Causes Research Articles

»Relationships are Key« A Semantic Relationship Awareness Framework for Operational Technology Monitoring

Critical infrastructures in areas like road traffic management naturally rely on the broad use of "Operational Technology (OT)" to ensure efficient and safe road traffic monitoring (RTM) through "OT objects", like sensors and actuators, whereby monitoring OT itself ("OTM") is evenly crucial. OTM is highly challenging, not least due to massive heterogeneity of OT, immense complexity and size, and omnipresence of evolution. As a consequence, knowledge about interdependencies between OT objects in form of semantic relationships is often outdated or simply not available. Thus, in case of incidents, detection of cause and effect in the sense of a situational picture of OT is missing. In order to counteract this fundamental deficiency, we aim to automatically discover semantic relationships between OT objects, to build up an ontological knowledge base as prerequisite for achieving OT situation awareness. Thereby, the contribution of this paper is threefold. First, a systematic exploration of the induced challenges is provided, derived from an in-depth analysis of real-world OT message logs in the area of RTM. Based on that, we sketch out a research roadmap, thereby guiding the identification of existing concepts and technologies appearing to be useful for realizing a framework for semantic relationship awareness, being the crucial pre-step for achieving OT situation awareness. Finally, a first proof-of-concept prototype is put forward, complemented by an evaluation of its applicability and a detailed comparison to related approaches.

AXIOLOGY OF THE DOCUMENT IN THE ACTIVITIES OF THE NATIONAL POLICE OF UKRAINE

Introduction. In this article, a comprehensive analysis of determining the value of a document in the activity of the National Police in Ukraine is carried out in order to establish the significance of documents in police activity. Police officers work and process a large number of documents that directly affect the legality of the exercise of authority and the level of effectiveness of this body. Therefore, the question of the significance of documents in police activity is quite important. Summary of the main results of the study. For a comprehensive and objective disclosure of the chosen topic, a study of the essence of police activity was carried out in order to establish the place of the document in the relevant sphere of authority, as a result of which a conclusion was made regarding the main essential areas of police activity, namely: protection of public order and public safety, human and citizen's rights and freedoms, prevention of offenses, detection of causes of offenses, termination of offenses, investigation of committed offences. That requires processing and creating a significant number of documents in the course of exercising police powers, in these areas of their activity. The origin of the document as a material carrier of information was also analyzed, a historical tour of the origin of this term was carried out, and its quintessence was determined. The features of the document are highlighted and its types are defined. As a result, the concept of a document was formed as a material medium for recording, storing and transmitting information. This definition fully corresponds to the essence of the application of the document in police activity, which is the basis for establishing the relationship between the document and police activity. Having determined the main issues of the researched topic, an analysis of the place of documents in the activity of the police in Ukraine was carried out through the specification of their manifestations, in the course of the exercise of police powers. Based on this, it was established that certain types of documents must be drawn up in the activities of the police, which are related both to organizational and administrative activities, and to the application of preventive or coercive measures. Conclusions. So, after analyzing the chosen topic, you can come to conclusions about the undoubted value of the document in police activities. Namely, the document serves in police activities as a means of recording information about the exercise of certain powers by police officers, certification of the fact of the performance of official duties, certain facts, and serves as a means of proof. In addition, the document records a fact that has legal significance and causes the emergence, change or termination of legal relations and a change in the legal status of a person. Therefore, the document is an important component of police activity in Ukraine.

A framework for progress measurement based on integrated monitoring of prerequisites and work performance

The successful implementation of construction projects necessitates the establishment of an efficient system for project execution planning and control, with parameters that ensure an effective assessment of the construction work status, timely detection of variance causes, and reliable trend analysis. In this regard, a set of parameters has been developed, among which the actual progress of works on a project holds a significant place. Existing approaches to progress measurement is mostly focused on studying methods for calculating the percentage of completed works and their applicability to specific types of works and organizational levels. However, key issues persist, such as delayed identification of variance causes and inadequate method sensitivity to initial variances when damages are still minor, and potential effects of corrective measures are greatest. Therefore, this paper proposes a framework for progress measurement based on integrated monitoring of prerequisites for tasks and work performances. While progress monitoring at the project level is organized within workflows, monitoring within each workflow is provided for sub-workflows related to ensuring prerequisites, material procurement, and construction work execution. Visualization of sub-workflows is facilitated through planned and actual cumulative curves of completed works in percentage, whose interrelationships promptly indicate potential project issues. The application of the proposed framework ensures better synchronization of construction works, improved control of prerequisites, rapid detection of causes, along with efficient variance management. The framework includes a clear division of responsibilities for implementing sub-workflows, where site management and specialized services of a company are responsible for ensuring prerequisites and material procurement, while production forces of a company primarily handle the execution of construction works. Such an approach allows for direct determination of issues or quick and efficient delineation of responsibilities, which represents a common issue in practice. This contributes to the motivation of employees and enhances the performance of the project management team.

Causal debiasing for unknown bias in histopathology-A colon cancer use case.

Advancement of AI has opened new possibility for accurate diagnosis and prognosis using digital histopathology slides which not only saves hours of expert effort but also makes the estimation more standardized and accurate. However, preserving the AI model performance on the external sites is an extremely challenging problem in the histopathology domain which is primarily due to the difference in data acquisition and/or sampling bias. Although, AI models can also learn spurious correlation, they provide unequal performance across validation population. While it is crucial to detect and remove the bias from the AI model before the clinical application, the cause of the bias is often unknown. We proposed a Causal Survival model that can reduce the effect of unknown bias by leveraging the causal reasoning framework. We use the model to predict recurrence-free survival for the colorectal cancer patients using quantitative histopathology features from seven geographically distributed sites and achieve equalized performance compared to the baseline traditional Cox Proportional Hazards and DeepSurvival model. Through ablation study, we demonstrated benefit of novel addition of latent probability adjustment and auxiliary losses. Although detection of cause of unknown bias is unsolved, we proposed a causal debiasing solution to reduce the bias and improve the AI model generalizibility on the histopathology domain across sites. Open-source codebase for the model training can be accessed from https://github.com/ramon349/fair_survival.git.

RADIOLOGICAL EVALUATION OF PEDIATRIC SENSORINEURAL HEARING LOSS AT A TERTIARY CARE CENTER IN CENTRAL INDIA

Objective: Hearing dysfunction is the most common sensory deficit in children. If hearing is lost, especially in children's, it may have a huge impact on life, interfering with the acquisition of spoken language and social development. It is therefore important to detect any abnormalities at an early age. Patients with complaint of inability to hear since birth attending ENT OPD, M.Y.H Hospital, Indore and patients referred to M.Y.H hospital from district hospitals with inability to hear since birth were evaluated clinically and audiometry was done. Patients with SNHL fulfilling the inclusion criteria were considered and their radiological evaluation was done. High resolution computed tomography scan (HRCT) of temporal bone were used in radiological evaluation of patients with congenital sensorineural. SUBJECTS AND METHODS: The study was conducted at a tertiary care centre Maharaja Yashwantrao Holkar (MYH) hospital and Mahatma Gandhi Memorial Medical College (MGMMC), Indore in the Department of otorhinolaryngology and head & neck surgery. Cases with hearing loss from 1 to 16 years of age were selected. A detailed medical history with primary focus on inability to hear was obtained with emphasis on previous hospital stays, developmental delay, maternal history, family history. Complete ENT examination was done. Our study included a total 30 children. All chil Results: dren were between 1-16 years of age with sensorineural hearing loss. Majority 11(36.67%) of the participated in the study were between 5-8 years of age. Cochlear anomaly was found in 03(10%) patients. Cochlea was found normal in 27(90%) on both the ears, 03(10%) child had hypoplastic cochlea bilaterally, none were with aplastic cochlea. Vestibular anomaly was seen normal in 28(93.33%) patients on bilateral side. 02(6.67%) patients were present with dysplastic vestibule. SSC was found dysplastic/malformed in 04(13.33%) patients who had dysplastic/malformed semicircular canal. Conclusion: The selection of candidates for hearing aid trials and cochlear implantation requires consideration of a variety of clinical, audiological and radiological factors. Imaging is a fundamental part of the preoperative workup, it provides the surgeon with details which will lead him to a successful cochlear implantation with no or minimal complications. HRCT temporal bone provided us the information about the presence of various inner ear malformations including cochlea, vestibule, SCC, IAC. Mastoid, pneumatization, variations in vascular anatomy which included forward lying sigmoid sinus and high riding jugular bulb. All these findings are important for a detection of cause of SNHL in patients.

A STUDY ON RISK FACTORS OF TOXOCARA SEROPOSITIVITY PREVALENCE AND THE RESULTS OF TOXOCARIASIS TREATMENT WITH ORAL ALBENDAZOL IN CHRONIC URTICARIA AT CAN THO DERMATO-VENEREOLOGY HOSPITAL IN 2021

Background: Chronic urticaria (CU) is defined by recurrent episodes lasting for six weeks or more and generally characterized by the sudden appearance of hives (wheal), angioedema or both. Most are idiopathic, however, one of the causes of chronic urticaria can be parasitic infection, especially Toxocariasis. Albendazol is used as a treatment for Toxocariasis. Therefore, the detection of causes, risk factors and specific treatment of the causes helps to solve chronic urticaria. Objectives: (1) To determine of Toxocara seropositivity in patients with chronic urticaria and identify the risk factors for toxocariasis; (2) To evaluate the results of oral albendazol in the treatment of toxocariasis in chronic urticatia. Materials and Method: A descriptive cross-sectional study of 66 chronic urticaria patients who had the result of serology for Toxocara. Results: The seroprevalence of Toxocaraiasis in this population was 19.7%. Factors such as a history of consuming the raw vegetables, raising dogs and cats habit or soil-contacting frequently were at higher risk of toxocariasis in patients with chronic urticaria. Clinical symptoms such as itching and hives in patients were significantly reduced. 30.8% of patients had ELISA results (-) after 3 months of completing treatment; 23.07% of patients had liver dysfunction; and 15.4% of patients reported side effects of epigastric pain or digestive disorders during treatment. Conclusion: The seroprevalence of Toxocaraiasis in this population was 19.7%. Several factors have been identified to be associated with Toxocara seropositivity. Albendazol in the treatment of Toxocara infections is highly effective and relatively safe.

APPLICATION OF STATISTICAL PROCESS CONTROL CHARTS: A CASE STUDY IN DAIRY INDUSTRY

Quality is a major part for entire industrial ecosystem when it comes to achieving, maintaining, and, improving the quality of products and services taking consideration of customer needs. Special causes responsible for controllable variations can be detected with the help of quality control charts-one of the quality management tools. Process can be improved by removing detected causes of variation bringing process under control. Statistical Process Control (SPC) Charts are quality control tools based on statistical principles which help to achieve quality of products by detecting special cause(s) of variation in the process involved. This paper incorporates a case study on application of Statistical Process Control (SPC) Charts tested at Sujal Dairy Pvt Ltd, Kathmandu, Nepal. Corresponding mean charts (Xbar charts) and range charts (R-Charts) represent data regarding quality variation for weight of milk pouch and SNF (Solid-Non-Fats) for both packaging machine 1 and machine 2. Results show that SNF variation for both machine and weight variation for machine 2 have been found to be under control whereas weight variation for machine 1 has been found to be out of control. Possible causes of variation have been grouped with the help of fishbone diagram and then compared with standard operating procedures for machine which led to detection of causes of variation. Finally, process has been better improved after removal of detected causes of variation bringing process under control.

INVESTMENT ATTRACTIVENESS OF AGRICULTURAL ENTERPRISES AS A PREREQUISITE FOR THE IMPLEMENTATION OF INNOVATIVE DEVELOPMENT STRATEGIES

Introduction. At the current stage, the scientific-technological and innovative component in the activity of agricultural enterprises is gaining extraordinary importance. Studying the role of investments in agriculture, highlighting the factors that affect the investment attractiveness of the industry, will allow to develop effective strategies for the development of enterprises in the agrarian sector, to implement innovative solutions and mechanisms to improve the investment attractiveness of agricultural production. Methods. The authors used the following research methods: a systematic approach for understanding the agricultural enterprise as an open system under the influence of factors of marketing environment; monographic method for clarification of the essence of investment attractiveness and the detection of cause and effect relationships between investment attractiveness and innovative development, statistical methods for analysing the dynamics of investment processes in the agricultural sector of Ukraine and a graphic method for the identification of results. Results. As a result of the research, the importance of investment attractiveness as a prerequisite for the implementation of the marketing strategy of innovative development is substantiated. Factor affecting investment attractiveness is researched in the context of the agricultural industry, taking into account the peculiarities and specifics of the industry. An analysis of the essence of each factor was carried out, conclusions were drawn based on the analysis and methodical approaches for making strategic management decisions and forming innovative development strategies are outlined. Іt was established that the agricultural sector is potentially attractive for investment. The role of investments in agriculture in general is described, the need for investment support is substantiated, its implementation with the help of mechanisms of state involvement. Variants of innovative development strategies are offered depending on the level of investment attractiveness. Discussion. Further scientific research should be aimed at identifying and forecasting synergistic effects from the integrated application of marketing approaches, strategic management of the enterprise, increasing the level of investment attractiveness of enterprises in the agrarian sector. Keywords: investment attractiveness, agricultural enterprise, strategy, innovative development.

A Descriptive Analysis of Computed Tomography Urography (CTU) Cases in Patients With Hematuria in Comparison with Ultrasound Kub(US) And Cystoureteroscopy (CU)

The aim of our study was to correlate and evaluate the accuracy of Computed Tomography Urography (CTU) results with other imaging modalities in patients who presented with haematuria in 2020. Retrospectively comparison of CTU findings with ultrasound KUB(US) and cytoureteroscopy (CU) also have been made. This is a retrospective study in which all CTU cases in a total of 186 patients with hematuria in 2020 were included in this study. The data was retrieved from the PACS system at Department of Radiology in Hospital Sultanah Nur Zahirah Kuala Terengganu. Frequency of the clinical manifestation were calculated among the patients and compared between US, CU and CTU findings. A total of 186 patients with hematuria involved in this study. Demographic data on clinical information have exhibited microscopic hematuria, calculi, hydronephrosis and renal calculi yielded higher percentage with 81.7%, 82.8%, 72.0% and 63.4%, respectively. The correlation between hematuria and US together with CTU findings was not significant with p value of 0.259. The data also revealed 133 patients (71.5%) had similar US and CTU findings. Meanwhile, 76.0% patients who underwent CU also yielded consistent findings with CTU. This study demonstrated no significant correlation between CTU - US findings in the detection of causes of hematuria. However, there was a good correlation of US and CU with CTU in a detection causes of hematuria with almost equal accuracy and sensitivity.

Deep Learning Model for COVID-19-Infected Pneumonia Diagnosis Using Chest Radiography Images

Accurate and early detection of causes of pneumonia is important for implementing fast treatment and preventive strategies, reducing the burden of infections, and establishing more effective ways of interventions. After the outbreak of COVID-19, the new cases of pneumonia and conditions of breathing problems called acute respiratory distress syndrome have increased. Chest radiography, known as CXR or simply X-ray has become a significant source to diagnose COVID-19-infected pneumonia in designated institutions and hospitals. It is essential to develop automated computer systems to assist doctors and medical experts to diagnose pneumonia in a fast and reliable manner. In this work, we propose a deep learning (DL)-based computer-aided diagnosis system for rapid and easy detection of pneumonia using X-ray images. To improve classification accuracy and faster conversion of the models, we employ transfer learning and parallel computing techniques using well-known DL models such as VGG19 and ResNet50. Experiments are conducted on the large COVID-QU-Ex dataset of X-ray images with three classes, such as COVID-19-infected pneumonia, non-COVID-19 infections (other viral and bacterial pneumonia), and normal (uninfected) images. The proposed model outperformed compared methodologies, achieving an average classification accuracy of 96.6%. Experimental results demonstrate that the proposed method is effective in diagnosing pneumonia using X-ray images.

Pemanfaatan Aplikasi Smartphone untuk Meningkatkan Kemampuan Mengidentifikasi Hipoglikemia di Wilayah Kerja Puskesmas Simpang Kawat

Hypoglycemia has a serious impact on the morbidity, mortality and quality of life of people with Diabetes Mellitus (DM). To prevent or reduce the risk of hypoglycemia, education is very important, including identification of hypoglycemia, detection of causes, prevention efforts and early treatment efforts at home. The use of mobile applications strongly supports independent health management because it is easily accessible, portable, low cost, convenient for users, and has a wide reach. This community service aims to optimize the use of the smartphone application “NEDTA” to improve the ability to identify hypoglycemia in people with diabetes mellitus in the Simpang Kawat Health Center area of Jambi City. The partners of this Community Partnership Program are the Head of Simpang Kawat Health Center, the Person in Charge of the Non-Communicable Disease Program (PTM) and 40 people with DM who meet the criteria. The methods used include socialization, competency improvement, implementation of activities, monitoring and evaluation. The results of community service revealed that more than half (58%) had diabetes for more than 10 years and most (74%) had experienced hypoglycemia. There was an increase in the ability to identify hypoglycemia after using the NEDTA smartphone application from 40% of high ability patients (pre test) to 75% (post test). The Head of the Community Health Center in charge of the non-communicable disease program at the Simpang Kawat Health Center is expected to continue mentoring activities in the use of the NEDTA application so that DM sufferers are independent in recognizing hypoglycemia, supporting the prevention and eradication of non-communicable diseases (P2PTM) such as diabetes mellitus, hypertension and other non-communicable diseases and support the PIS-PK Program.

Abstract P306: A Specific 3-month Nursing Program After Laboratory Detection Of Non-adherence To Medication In Uncontrolled Hypertension Improves Adherence And Blood Pressure Control (ATHAN Trial)

Non-adherence to treatment is a known factor for uncontrolled hypertension. We hypothesized that the detection of non-adherence to antihypertensive treatment plus the implementation of a specific nursing program would ameliorate treatment adherence and blood pressure (BP) control.An interventional, prospective, randomized, study of 44 consecutively attended patients (age 58.1±12.9yr, 30 men/14 women) with 24h-BP ≥130/80 mmHg while receiving ≥2 antihypertensive drugs was performed. Partially or fully non-adherent patients (confirmed by urine determination of antihypertensives) were randomized (1:1) to receive a specific 3 month nursing program (group I) to improve adherence - evaluation of knowledge on BP goals, complications of high BP, indicated treatment; detection of causes of non-compliance and proposal of measures to improve it, with fortnightly follow-up -, or to routine follow-up (group C). Urine antihypertensives and 24h-BP were determined at baseline, 3 and 12 months. Baseline office SBP/DBP (mmHg) was 150.4±16.3 / 91.1±15.5, and the number of prescribed non-detected drugs was 2±1.4. Between-groups differences in variation (Δ) of BP at 3 and 12 months are shown (Table). In addition, at 3 months, the percentage of patients with controlled BP was 50%( 11 of 22) and 18.2% (4 of 22) in the I and C groups, respectively (p=0.026), and at 12 months was 60% (12 of 20) and 26.3% (5 of 19), respectively (p=0.034).In conclusion, a specific 3 month nursing intervention improves control of BP in patients with uncontrolled hypertension and inadequate therapeutic compliance. Both the BP decrease and the improvement in therapeutic adherence were maintained at 12 months.

Antimicrobial Resistance and Its Spread Is a Global Threat.

Antimicrobial resistance (AMR) is a challenge to human wellbeing the world over and is one of the more serious public health concerns. AMR has the potential to emerge as a serious healthcare threat if left unchecked, and could put into motion another pandemic. This establishes the need for the establishment of global health solutions around AMR, taking into account microdata from different parts of the world. The positive influences in this regard could be establishing conducive social norms, charting individual and group behavior practices that favor global human health, and lastly, increasing collective awareness around the need for such action. Apart from being an emerging threat in the clinical space, AMR also increases treatment complexity, posing a real challenge to the existing guidelines around the management of antibiotic resistance. The attribute of resistance development has been linked to many genetic elements, some of which have complex transmission pathways between microbes. Beyond this, new mechanisms underlying the development of AMR are being discovered, making this field an important aspect of medical microbiology. Apart from the genetic aspects of AMR, other practices, including misdiagnosis, exposure to broad-spectrum antibiotics, and lack of rapid diagnosis, add to the creation of resistance. However, upgrades and innovations in DNA sequencing technologies with bioinformatics have revolutionized the diagnostic industry, aiding the real-time detection of causes of AMR and its elements, which are important to delineating control and prevention approaches to fight the threat.

Post-mortem magnetic resonance imaging with computed tomography-guided biopsy for foetuses and infants: a prospective, multicentre, cross-sectional study

BackgroundPost-mortem imaging has been suggested as an alternative to conventional autopsy in the prenatal and postnatal periods. Noninvasive autopsies do not provide tissue for histological examination, which may limit their clinical value, especially when infection-related morbidity and mortality are suspected.MethodsWe performed a prospective, multicentre, cross-sectional study to compare the diagnostic performance of post-mortem magnetic resonance imaging with computed tomography-guided biopsy (Virtopsy®) with that of conventional autopsy in foetuses and infants. Cases referred for conventional autopsy were eligible for enrolment. After post-mortem imaging using a computed tomography scanner and a magnetic resonance imaging unit, computed tomography-guided tissue sampling was performed. Virtopsy results were compared with conventional autopsy in determining the likely final cause of death and major pathologies. The primary outcome was the proportion of cases for which the same cause of death was determined by both methods. Secondary outcomes included the proportion of false positive and false negative major pathological lesions detected by virtopsy and the proportion of computed tomography-guided biopsies that were adequate for histological examination.ResultsOverall, 101 cases (84 fetuses, 17 infants) were included. Virtopsy and autopsy identified the same cause of death in 91 cases (90.1%, 95% CI 82.7 to 94.5). The sensitivity and specificity of virtopsy for determining the cause of death were 96.6% (95% CI 90.6 to 98.8) and 41.7% (95% CI 19.3 to 68.0), respectively. In 32 cases (31.7%, 95% CI 23.4 to 41.3), major pathological findings remained undetected by virtopsy, and in 45 cases (44.6%, 95% CI 35.2 to 54.3), abnormalities were diagnosed by virtopsy but not confirmed by autopsy. Computed tomography-guided tissue sampling was adequate for pathological comments in 506 of 956 biopsies (52.7%) and added important diagnostic value in five of 30 cases (16.1%) with an unclear cause of death before autopsy compared with postmortem imaging alone. In 19 of 20 infective deaths (95%), biopsies revealed infection-related tissue changes. Infection was confirmed by placental examination in all fetal cases.ConclusionsVirtopsy demonstrated a high concordance with conventional autopsy for the detection of cause of death but was less accurate for the evaluation of major pathologies. Computed tomography-guided biopsy had limited additional diagnostic value.Trial registrationClinicalTrials.gov (NCT01888380).

Detection of causes of defects in the cooked sausage production

The work presents a method for analysing hazardous factors in the cooked sausage production. The method includes the formation of a register of hazardous factors and the determination of cause-and-effect relationships between the hazards and their causes. The formed register includes 30 indicators and 25 factors affecting the occurrence of defects in cooked sausages. The critical control points of the cooked sausage production technology were determined, and a hazard analysis was carried out for each critical control point. In integration with the principles of HACCP, the developed method helps to reduce the number of defective products and increase customers` satisfaction.

Comparative Assessment of Imaging Modalities in Biliary Obstruction

Introduction: Complete assessment of biliary obstruction requires the use of various imaging modalities to confirm the presence, level and cause of obstruction which can help in treatment planning. Commonly used procedures include Ultrasonography (USG), Computed Tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP). Objective: To determine the accuracy, sensitivity and specificity and to compare the diagnostic accuracy of USG, CT scan and MRCP in assessing the level and cause of obstruction in patients with obstructive jaundice. Materials and Methods: This cross sectional descriptive study in 50 patients who presented in the department of Radiology and Imaging, Combined Military Hospital (CMH), Dhaka with symptoms and signs of obstructive jaundice above the age 20 years was carried out during the period from 01 October 2012 to 30 April 2013. The accuracy, sensitivity and specificity of each modality in assessing the level and cause of obstruction were determined. Results: MRCP detected level of obstruction in 100%, CT scan in 95.8% and USG in 90% cases. For detection of cause of obstruction, MRCP had the highest sensitivity (96.2%); followed by CT scan (88.4%) and USG (62.5%). The diagnostic accuracy for detection of cause of obstruction was the highest for MRCP (93.1%); followed by CT scan (89.8%) and USG (66%). Conclusion: MRCP has highest diagnostic accuracy and sensitivity by detecting the level and cause of obstruction most accurately. JAFMC Bangladesh. Vol 17, No 1 (June) 2021: 10-13

МЕХАНИЗМЫ И ПРОЯВЛЕНИЯ Т-КЛЕТОЧНО-ОПОСРЕДОВАННОЙ ГИПЕРЧУВСТВИТЕЛЬНОСТИ ПРИ НЕПЕРЕНОСИМОСТИ РАЗЛИЧНЫХ ГРУПП ПРОТИВОТУБЕРКУЛЕЗНЫХ ПРЕПАРАТОВ

The review presents current data on the possibility of immunological diagnosis of adverse reactions to various groups of anti-tuberculosis drugs (first-line anti-TB drugs, aminoglycosides, fluoroquinolones). Literature data are analyzed in terms of two possible types of drug interactions with the immune system. According to the first type, drugs bind covalently to endogenous proteins to form hapten-carrier complexes and induce a T-cell response. The second type of pharmacological interaction (p-i concept) involves drug interactions with antigen-recognizing receptor (TCR) molecules and/or major histocompatibility complex (HLA) proteins. Various clinical manifestations of anti-TB drug intolerance, caused by certain mutations in the lysosomal or mitochondrial apparatus of somatic cells of various organs, cause disturbances in tissue metabolism and activate Th-1 and Th-2 links of cellular immunity with the production of a different spectrum of cytokines, which is the basis for the development of immunological approaches to the detection of causes of intolerance. DOI: 10.57014/2587-6678-2022-3-22-36 Keywords: anti-tuberculosis chemotherapy drugs, side reactions, immune reactions, methods of determination.

Diagnostic Accuracy of MDCTA for Detection of Intracranial Aneurysm in Non Traumatic Subarachnoid Haemorrhage: A Cross-sectional Study

Introduction: Non Traumatic Subarachnoid Haemorrhage (NTSAH) constitutes a neurological emergency. Multi-Detector Computed Tomographic Angiography (MDCTA) provides significant advantages over Digital Subtraction Angiography (DSA) owing to its immediacy, non invasiveness, and comparable diagnostic accuracy. This warrants exploration of its utility as a fully integrated component of routine imaging and therapeutic algorithm for NTSAH, replacing DSA. Aim: To evaluate the potential of MDCTA of the Circle of Willis (COW) in the detection of causes of NTSAH and compare its diagnostic accuracy with DSA and/or intraoperative findings. Materials and Methods: This cross-sectional study enrolled 45 patients with suspected or confirmed intracranial vascular abnormality or SAH, and subjected to non contrast enhanced Computed Tomography (CT) and MDCTA of the COW. MDCTA findings like aneurysms, Arteriovenous Malformations (AVM), their morphological characteristics and anatomical COW variations were contrasted with DSA/operative findings in 24 patients and MDCTA’s accuracy was calculated. The data was analysed using statistical software R (Ross Ihaka and Robert Gentleman) v.4.0.2, employing Kappa coefficient. The p-value ≤0.05 indicated statistical significance. Results: Total of 45 subjects (mean age: 47.16±17.4 years, 17 females and 28 males) were included in the study. The mean aneurysmal size was 7.6±7.2 mm. Grade 3 or 4 (dense) SAH (48.88%) and aneurysms <3 mm in size (48.89%) were most common. MDCTA showed sensitivity, specificity, and positive and negative predictive values of 89%, 79%, 84% and 85%, respectively. Kappa test revealed a substantial agreement between CTA and DSA (kappa coefficient=0.68). Conclusion: MDCTA is a rapid, minimally invasive, and reliable substitute to DSA in diagnosing and characterising associated aneurysms and AVM, in most cases of NTSAH, aiding in further management of such patients.

365 Combining mechanisms of prosthetic valve dysfunction

Abstract A 32-year-old female was referred to our outpatient clinic for exertional dyspnoea that had worsened in the preceding months. She had a history of mitral and aortic valve replacement with bileaflet mechanical prosthesis (St. Jude Master n. 25 and Medtronic Open Pivot n. 16, respectively) for rheumatic heart disease. A recent echocardiography showed borderline-high trans-aortic gradients (mean 26 mmHg, peak 42 mmHg). Transthoracic echocardiography revealed abnormal aortic transprosthetic flow (peak velocity 442 cm/s, mean gradient 48 mmHg). Continuous Wave Doppler signal was rounded with a long acceleration time (108 ms). Effective orifice area (EOA) was 0.8 cmq (index EOA 0.48 cmq/mq) and Doppler Velocity Index 0.28. Further investigations revealed no signs of infections but suboptimal anticoagulation (INR 2.5). Transesophageal 3D echocardiography was suggestive for hypomobility of the prosthetic leaflets and the presence of an isoechoic mass encircling the ventricular side of the aortic prosthesis compatible with pannus overgrowth. Cardiac CT confirmed the presence of a symmetrical reduction in the systolic opening of both leaflets. The patient underwent a redo of aortic valve replacement that confirmed the presence of an asymmetric subprosthetic pannus overgrowing on the previously implanted surgical pledgets. After pannus debritment a St. Jude Regent n. 21 was implanted. The patient experienced complete symptomatic resolution. We presented the case of a prosthetic aortic valve dysfunction due to a combination of patient-prosthesis mismatch and pannus overgrowth. In our patient, as assessed in the old echocardiographic examinations, the presence of mildly elevated transprosthetic gradients was suggestive for prosthesis undersizing related to body surface area. In this scenario, subvalvular pannus formation caused significant changes in prosthetic valve transvalvular flow dynamic leading to prosthesis dysfunction. This case emphasises the crucial role of echocardiographic follow up in detection of causes of prosthetic heart valve dysfunction and how optimal valve sizing is paramount in aortic valve replacement.

Pharmacovigilance in Pakistan: A Peek into the Future Prospects

Pharmacovigilance in Pakistan: A Peek into the Future Prospects