1 COVID-19: What Went Wrong. Ignoring the Tell-tale Signs! , Sara Surani and Salim Surani The biggest pandemics of all, claiming more than 100 million lives, have long been forgotten. Technology, resources and ad-vancements in research have made people felt they we are invin-cible. SARS, MERS, Swine flu (H1N1), Ebola and other epidemics have challenged the world [1], but the complacence and delays fol-lowing public health advice have had immense implications, both on the societal level with high mortality rates, and on a global level with countries’ economies crashing. Social consequences of eco-nomic and health setbacks have been severe 2 DMFT Index and OHI-S in Children Attending Public Schools in Abuja, Nigeria , Nathan U Ikimi, Funmilayo Jumoke Morebise, Alade Azeez, Busayo Immaculate Oludara, Olumide Alabi and Wisdom Temitope Olatunbosun To examine the relationship between DMFT and OHI-S among children attending the Local Education Agency (LEA) schools in Gwarinpa, Abuja.This is a descriptive cross-sectional survey of 270 pupils from the six primary Schools in Gwarinpa present at the 2019 National children’s day celebration organized by a non-governmental organization (NGO), “Eat Right Society of Nigeria”. Interviewer administered questionnaire was used to obtain socio-demographic data from the pupils and oral examination with children seated in an upright position under natural light was done by another NGO “Early 5years of Life International Initiative” (Abuja5). Collected data were tested statistically using SPSS software (ver.20.0; IBM, Chicago, IL, USA).The study population is made up of 44.1% males and 55.9% females, between 4 - 20 years of age with mean age (± SD) at 11.42 ± 2.6. Prevalence of tooth decay in children reported in this study was 11.9% with mean DMFT = 0.124 ± 0.5. Females had less tooth decay (11.3%) and statistical significantly better oral hygiene (70.2%) than males (47.9%).There was no statistically significant difference between gender and DMFT; however, females had less decayed teeth with a significantly higher percentage of good oral hygiene compared to their male counterpart.From this study, a clear relationship between DMFT and OHI-S exist among the pupils of six primary schools in Gwarinpa, Abuja. More oral health campaigns should be done to create oral health awareness among children. In addition, free oral health care for children should be prioritized by the Federal Government of Nigeria and implemented to local government level. School oral health visits by Dentist should be initiated by the Federal Ministry of health in collaboration with Non-governmental organizations. 3 A Benign Giant Prostate Hyperplasia Causing Fatal Death without any Prior Symptomatology, a Rare Case Study , Juna Musa, Elton Cekaj, Mohammed K Badi, Carlos Rivera, Edlira Horjeti, Henri Fero, Loran Rakovica and Ali Guy Benign Prostatic Hyperplasia (BPH) is a common progressive disease of ageing men that is characterized prostate enlargement leading to lower urinary tract symptoms. Prostate volume have been shown to directly correlate with age, men over the age of 50 have a 40% risk of BPH and those over 80 years have 90% risk. Giant prostatic hyperplasia (GPH) is a rare form of BPH and it is commonly seen in patients neglecting their symptoms or inadequately treated disease. BPH symptoms vary with the grade of the disease ranging from asymptomatic to incontinence, nocturia, hematuria, dysuria and urinary retention in more severe forms such as in GPH. Herein we present a case of a 53 years old male patient that presented with altered mental status, pale skin and urinary retention. During the ultrasound examination a huge prostate gland was discovered. 4 Diagnostic Strategies for COVID-19 , Krishan Karla, Shashidhar KN and Krishna S Nallagangula COVID-19; single stranded positive RNA (+ssRNA) virus causes common cold to severe diseases viz., Severe Acute Respiratory Syndrome (SARS). At this point of time, prevalence of this pandemic virus increases exponentially and become global health burden. Asymptomatic/paucisymptomatic respiratory failure; characterized by leucopenia, leukocytosis, lymphonia and thrombocytopenia along with elevated levels of hepatic aminotransferases [Aspartate transaminase (AST) and Alanine Transaminase (ALT)] and lactate dehydrogenase (LDH). Detection of viral genome by reverse transcription polymerase chain reaction (RT-PCR) is the World Health Organization (WHO) recommended diagnostic modality. Enhanced inflammatory cytokines level will be observed in serum of severe patients. In the present scenario, therapeutic strategies for this infection are only supportive. Drastic research is needed for structural characterization of virus and pathophysiology of the disease. There is a need for strengthening of research in diagnostic and therapeutic areas to control the prevalence and cure the disease; increases survival rate with decreased mortality. Aggressive social isolation is the best way for progressive reduction of prevalence 5 The Rationale for the Use of Antiretroviral Therapy in COVID-19: Where Hope Meets Skepticism! , Maha S Husain, Sahar Fatima, Iqbal Ratnani and Salim Surani Affecting nearly 300,000 people around the world and claim-ing greater than 10,000 lives, the novel coronavirus-related respi-ratory illness has been declared a global pandemic and a public health emergency by the WHO [1]. The roots of this problem can be traced into early December of 2019, when the Index cases of what were investigated as ‘pneumonia of unknown origin’ were reported in Wuhan, the epicenter of the disease in China 6 Correlational Study between Dream Content and Somatic Symptoms: When the Dream Alerts on an Incubated Symptom , Mbangmou Romuald Stone and Nguimfack Léonard This study questions the function of the dream in general, and the relation between the manifest content of the dream and the physical symptoms that the dreamer experiences during the period of illness. Based on studies on the relationship between manifest dream content and the onset of inflammatory somatic symptoms in dreamers, initiated by Vaschide and Pieron since the 1900s, and the observation of several clinical cases received during the last five years, we set ourselves the objective in this work of quantifying the link between the intensity of the somatic symptoms felt by the patient, and the frequency of appearance of dreams whose manifest content solicits the dysfunctional physiological system. In other words, it is a question of checking statistically if there is a relationship between the dream that the patient has during his nights, and, the place of expression and the intensity of the symptoms he feels in his body. The synthesis activation theory allowed us to formulate the hypotheses and to interpret the results. It turns out in the light of the results of this study that the physical symptoms experienced by the patient can significantly modify the manifest content of their dreams 7 Tuberculosis the Big Mime , S Benzerga, C Michaux, E Calvo Lasso De Lavega and T Staub Tuberculosis is a high prevalence disease in different part of world. Even though pulmonary presentation is the most frequent, let’s not forget the extra-pulmonary one which is less frequent and which symptoms are not specific and can mime other diseases 8 Unusual Histological Variant of a Primary Osseous Tumor of the Jaw in a 27-Year-Old Female: Review of the Literature and Case Presentation , Erisa Kola, Leart Berdica, Teona Bushati, Alfred Aga, Ali Guy, Ina Kola, Edlira Horjeti, Klejda Hoxha, Fareeha Nasir and Juna Musa Introduction: Osteosarcoma is the most common primary malignant bone tumor and represents 20% of head and neck malignancies. Meanwhile osteosarcoma of the jaw is a rare entity, distinct from the conventional type commonly arising in the long bones. According to literature it comprises 6.5 - 7% of all osteosarcomas. WHO has acknowledged several variants of osteosarcoma that differ in location, clinical manifestation and the degree of cytologic atypia [1]. These lesions can arise de novo and present as primary bone tumors, or in a pre-excisting condition such as previous head and neck radiation. Also, hereditary retinoblastoma, Paget’s disease of bone, previous history of fibrous dysplasia, or trauma has been associated with the development of osteosarcomas. From a histopathologic point of view, osteosarcomas are commonly classified as osteoblastic, chondroblastic, or fibroblastic, although several unusual microscopic subtypes have also been reported.Material and Methods: The aim of this article is to highlight the importance of clinical, radiological and histopathologic correlations in order to reach an accurate definite diagnosis in the setting of effective surgical management of this kind of lesions. We share our experience presenting a case of chondroblastic variant of osteosarcoma of the maxilla in a 27-year-old woman, and a critical review of the literature.Conclusion: Osteosarcoma of the jaw is challenging both to diagnose and manage. The biological behavior of osteosarcomas in the jaws differs from tumors of other skeletal bones. Histopathological examination with adequate specimen evaluation is the key to accurate diagnosis and staging. Microscopically, the essential criterion of osteosarcomas is direct production of osteoid or immature bone by tumor cells. Osteosarcoma should always be considered in the differential diagnosis of expansile lesions of the jaws. Hence, early diagnosis and adequate surgical resection are the keys to better survival 9 Corona Virus Prevention , Dana Churchill How to stay safe with the virus popping up all over the place: Keep your immunity strong so your body can fight it if necessary, takes several steps 10 Survey on Molecular Marker and Diagnosis of Helicobacter pylori , Bassam Oudh Al Johny This paper will discuss Helicobacter pylori which is a bacterium start in human epithelial cells of the gastrointestinal tract. Its infection is related to many different diseases, such as chronic gastritis, peptic ulcers, gastric lymphoma and adenocarcinoma. The infection by Helicobacter pylori is found more than 50% of the world. It is found deep in epithelial cells that hide mucus in the human stomach, where neutral Helicobacter pylori are prevalent. This bacterium is reported as the leading cause of various gastrointestinal illnesses, chronic gastritis, excretory ulcer, abdominal cancer and gastric mucosa related lymphoid tissue (MALT) lymphoma. In this study for the improvement of two PCR-based techniques for detecting Helical kinds of Helicobacter pylori. Molecular diagnosis of Helicobacter pylori strain by using 16S rDNA PCR amplification and direct examination 11 The Relation of Helicobacter pylori Infection to Gastric Cancer , Abdulaziz Radhi S ALjohni, Bassam Oudh Al Johny and Mohamed Morsi M Ahmed Background: Helicobacter pylori (H.P.) is a very common bacteria that affect half of the population. It has been incriminated in cancer stomach and gastric lymphoma.Objective: This work aims to discuss the relation and mechanism of H.P. in causing gastric carcinoma.Review of Literature: H.P. has different methods of transmission like oral-oral, fecal-oral, gastro-oral and gastro gastric. The microbiological features of H.P. support its growth and protect it from oxidative damage that enhancing its survival rate. H.P. is now determined as one of the most critical carcinogenic infectious agents because it's a high risk of developing stomach cancer. Gastric cancer is the third type of cancer leading to death and it is due to different causes and risk factors. There are many factors affect the outcome of patients who had infected with H.P. and increase the risk of developing cancer. These are environmental, host-related and virulence factors. All of these factors participate in the development of gastric cancer by two mechanisms, direct inflammatory effects and indirect through mutations in the cell-cycle regulating genes. Conclusion: H.P. infection has an important carcinogenic role in the development of cancer stomach. Eradication of H.P. will decrease the risk of developing stomach cancer. 12 Evaluation of Stability Studies on Transdermal Patches of Econazole and Luliconazole , Gaurav Jain and Rakesh Patel TDDS i.e. transdermal drug delivery system has been an increased interest in the drug administration on diseased skin (topical delivery) as well as for systemic delivery of drugs. Econazole and Luliconazole is synthetic antifungal agent used for most kinds of fungal infections including superficial and invasive fungal infections. The formulated patches of the drug were evaluated for stability studies. Stability studies were carried out as per ICH guidelines at three different temperature and RH for 3 months for the optimized formulations of transdermal patches of econazole. The results indicates that the transdermal patches of econazole and luliconazole showing better results at 32°C ± 2°C/60% RH ± 5% 13 Coronavirus Disease (Covid-19) in India - An Overview , PK Kavitha Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new Coronavirus was identified as the cause of a disease outbreak that originated in China. After starting in China, Coronavirus is now spreading fast in many countries including India.The virus is now known as the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). The disease it causes is called Coronavirus disease 2019 (COVID-19). COVID-19 is spreading fast across the globe, currently affecting 177 countries, with around 234000 patients and 10000 deaths as on 21st March. It took around three months to reach first 100,000 patients, but the next 100,000 came in under two weeks.In India, a total of 15,404 samples from 14,514 individuals have been tested for SARS-CoV2 as on 20th March 2020 6 PM IST. A total of 236 individuals have been confirmed positive among suspected patients and contacts of known patients. As on 21st March, four deaths have been reported in India due to COVID-19.Cases of COVID-19 have been reported in a growing number of countries, including the U.S. Public health groups, such as the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC), are monitoring the situation and posting updates on their websites. The World Health Organization called it a pandemic on March 11, 2020. COVID-19 was identified in Wuhan, China on December 31, 2019; the disease has spread across the world, affecting over 200,000 people in 166 countries and more than 8,700 deaths. 14 Epidemiological Profile and Classification of Autoimmune Diseases in an Internal Medicine Service in Lomé (Togo) , Komi Dzidzonu Nemi, Lihanimpo Djalogue, Abou Bakari Tchala, Toyi Tchamdja, Kossi Kodjo, Abdou Razak Moukaila, Komi Edem Mossi, Kodjo Agbéko Djagadou, Abago Balaka and Mohaman Awalou Djibril The purpose of this study was to describe the epidemiology and classification of autoimmune diseases in the department of Internal Medicine of Sylvanus Olympio teaching hospital of Lomé. This is a retrospective study conducted from 1st January 2018 to December 31st 2019 in this department. During the study period, 959 patients were received in the department. Among them, 72 had autoimmune diseases, i.e. a prevalence of 7.5%. The average age of the patients was 31.51 years (range: 17 and 74) and the sex ratio (M/F) was 0.46. The 20 to 39 age group was the most represented (69.44%). Organ-specific autoimmune diseases were type 1 diabetes mellitus (N = 48; 66.7%), Graves' disease (N = 13; 18.05%), autoimmune hemolytic anemia (N = 4; 5.6%) and autoimmune atrophic thyroiditis (N = 2; 2.77%). Graves' disease was associated with type 1 diabetes in one patient. Systemic autoimmune diseases were Rheumatoid arthritis (N = 4; 5.6%), systemic lupus erythematosus (N = 3; 4.2%) and MCTD (N = 1; 1.38%). Rheumatoid arthritis was associated with diabetes in one patient. MCTD was associated with atrophic thyroiditis in also one patient. This study shows that the autoimmune diseases in the Internal Medicine department of Sylvanus Olympio teaching hospital of Lomé are dominated by endocrinopathies namely type1 diabetes and Graves' disease 15 Remarks about Immunosenescence , PhD. Zamir Calamita This is a mini-review addressing the main aspects of immunosenescence, including: predisposition towards infections, inflammation, autoimmunity, cancer, response to vaccines, allergy, stress, nutrition and physical activity. Remarks are made about this complex network of possible alterations relating to aging. 16 Liddle’s Syndrome Associated with Acromegaly due to Enhanced Renal and Extrarenal ENaC Channel Activity: The First Case Report that Explained this Rare Association , Juna Musa, Jovan Basho, Florian Toti, Suela Mumajesi, Mohammed Badi, Adi Abduli, Loran Rakovica and Ali Guy Liddle’s syndrome is a rare genetic autosomal dominant disease affecting the activity of the epithelial sodium channels (ENaC) or the amiloride-sensitive sodium channels, which leads the kidneys to excrete potassium but retain too much sodium and water causing early, frequent and severe, high blood pressure associated with low plasma renin, metabolic alkalosis and normal to low levels of aldosterone [1,2]. Disease-associated mutations either activate the channel directly or abrogate aldosterone-inhibited retrieval of ENaC subunits from the plasma membrane [3]. The end result of these mutations is increased expression of activated ENaC channels at the plasma membrane of principal cells which manifests as severe early onset hypertension with hypokalemia unresponsive to spironolactone [4]. We observed an isolated case of a Liddle’s syndrome in a 23-year-old man who presented with signs of acromegaly. The patient initially presented to the emergency room with palpitations, weakness of the extremities and a three-year history of low potassium levels and uncontrolled hypertension. Six months later he was admitted again to the hospital with signs of hypokalemia, including palpitations, fatigue and weakness. Upon further evaluation, he was found to have low renin and aldosterone levels. Physical examination revealed mild diastolic hypertension, acromegalic features, weight gain, excessive sweating, widening of both hands and feet [5]. Laboratory results revealed increased levels of GH and IGF-1-a. After oral administration of oral glucose levels of IGF-1 remained elevated. MR imaging of the brain revealed a 1.3 x 1.2 x 0.7 cm pituitary adenoma. A diagnosis of acromegaly and Liddle syndrome was made. Coexisting acromegaly and Liddle syndrome are reported together only in rare cases and it can be explained due to enhanced renal and extrarenal ENaC activity 17 Atypical Hemolytic Uremic Syndrome in a One-Year Old Male Patient, Successfully Treated with Eculizumab , Henri Fero, Juna Musa, Diamant Shtiza, Ergys Cuka, Loran Rakovica, Blina Abdullahu, Klejda Hoxha, Fareeha Nasir and Ali Guy Atypical hemolytic uremic syndrome is a rare form of thrombotic microangiopathies resulting from various genetic mutations of the complement factors. Thrombotic microangiopathies include Thrombotic thrombocytopenic purpura, primary HUS further divided into typical HUS or Shiga-toxin related HUS, atypical HUS and secondary forms of HUS.The most common clinical features of the Hemolytic Uremic Syndrome are: kidney failure, thrombocytopenia resulting in hemorrhagic phenomena and also intravascular hemolytic anemia. Most commonly HUS is a diagnosis made from excluding all other plausible causes. HUS predominantly affects pediatric ages 18 Normal-Pressure Hydrocephalus: Past, Present and Future Management and the Relevance of New Insight of Neuropsychology Assessment for Measure of the Cognitive-Behavioral Sequelae , Juna Musa, Angela Guy, Henri Fero, Kristi Saliaj, Ergys Cuka, Loran Rakovica, Inva Mamica, Viola Sulollari and Ali Guy Normal Pressure Hydrocephalus (NPH) is a neurological disorder characterized by normal or mildly elevated intracranial pres-sure. Distinguishing NPH from other neurodegenerative disorders such as Alzheimer’s disease and vascular dementia is challenging. Therefore, it may be undiagnosed and inappropriately managed. Patients with NPH are treated surgically with placement of a ven-triculoperitoneal shunt; subsequently, most of them have shown clinical improvement in gait disturbance, bladder dysfunction, and cognitive functions. The case study within the present report aims to contribute new insights relative to the management and assess-ment of NPH. The present case additionally helps to inform the relevance of neuropsychological evaluation specific to the cognitive and behavioral sequelae of NPH. The case discussion provides data relative to the intersection of medical and psychological domains that further advance the classification and differentiation of NPH from other medical diseases or cognitive impairments. Further, the implementation of prospective neuropsychological assessments is discussed to help distinguish and inform more succinct diagnoses and appropriate treatment modalities for future providers managing the care of those suffering from NPH or NPH-like symptoms 19 Recurrent Sweet’s Syndrome in a Case of Smoldering Multiple Myeloma and Chronic Hepatitis C , Mark Obri, Arjun Pandya, James Lerakis, Alexander Isla, Michael Rich MD, Ania Henning MD Background: Sweet’s Syndrome, also known as acute febrile neutrophilic dermatosis, is a rare inflammatory skin disorder that presents as a rapid onset of tender, inflammatory lesions, which usually appear on the arms, face, and neck. It is histologically characterized by a neutrophilic infiltrate in the dermis with karyorrhexis and massive papillary dermal edema. Sweet’s is subdivided into three classifications based on etiology: classical, malignancy-associated, and drug-induced.Case Presentation: We present the case of a 55 year old African American woman with a past medical history of smoldering multiple myeloma and hepatitis C who presented to the emergency department with widespread tender bullous lesions on the extremities, trunk, inguinal area, and vulva, along with accompanying polyarthritis. The patient was treated empirically with intravenous methylprednisolone for suspected autoimmune disease following rule out of infectious etiology and vasculitis. Biopsies of the lesions on subsequent hospitalization demonstrated neutrophilic infiltrate of the dermis, and the patient was diagnosed with Sweet’s Syndrome. Conclusion: It is unknown whether this patient's Sweet’s Syndrome was secondary to her smoldering multiple myeloma, hepatitis C, or idiopathic. We believe that smoldering multiple myeloma was the likely underlying culprit given the link between blood malignancies and Sweet’s Syndrome, the widespread presentation of the lesions, and similar presentations reported in cases of multiple myeloma. Based on our case study, we recommend patients diagnosed with Sweet’s Syndrome receive appropriate workup for blood malignancies and hepatitis C 20 Does Work at Fuel Station for Long Period Affect Leukocytes Count? , Rana Zaini, Haytham Dahlawi, Sara Al-Shehri, Mariam Al-Fahmi, Jawaher Khaled3, Norah Al-Barakah and Wojdan Ahmed Al-Sayyali. Exposure to benzene has been significantly associated with many health disorders and reported to cause abnormality in hematological parameters; haemoglobin (Hb) concentration, red blood cells (RBCs) and white blood cells (WBC) level. Thus, the aim of this study was to evaluate the association between exposure to benzene for a long period of time (more than 12 months with daily 8-hour time) and the level of hematological parameters among fuel station workers at Taif city in Western region of the Saudi Arabia. This case-control study involved thirteen participants (10 fuel station workers and three control individuals) aged between 25 to 45 years. Three healthy individuals were considered as control group. The result of this study showed normal level of all haematological parameters including haemoglobin (Hb), red blood cells (RBCs), white blood cells and platelets when complete blood count (CBC) was investigated for ten workers. Moreover, the level of neutrophils and lymphocytes were reported within the normal ranges. We conclude that benzene exposure had no effects on haematological parameters among workers who exposed to benzene for long period of time when compared to the control group. However, further study are required to confirm these finding with larger sample size 21 Propositions for Improvement of Health Care Organization (Lessons of Covid-19 Crisis) , Coulic Véry, Dobos S, Mboti F and Martin M The so called “COVID-19 crisis” has shown some insufficiencies in the national health care services all over the world, the difficulties of WHO to be respected, but also the reserves of local inventiveness and adaptation abilities. The aim of the present work is to try to a better understanding of the possible ways of improving the organization of health care including help to WHO and reinforcing its task 22 What is the Best Needle for Spinal Thoracic Anesthesia: Pencil Point Needle or Cut Point Needle? Letter to Editor   , Luiz Eduardo Imbelloni We recently demonstrated the safety of thoracic spinal anesthe-sia by the study with MRI in 50 patients [1]. In order to verify the incidence of neurological complications in spinal thoracic anesthe-sia, a study was carried out comparing the two most frequently used needles (Cut vs Point Pencil) in 300 patients divided into two groups of 150 patients, puncture success was observed in all pa-tients with 20 (6.6%) paresthesia with no significant difference between the needles [2]. All paresthesia were transient and no neurologic complications were observed. In 2012, we conducted a study of 636 patients undergoing spinal thoracic anesthesia in different types of surgery (laparoscopic cholecystectomy, hernior-rhaphy, urologic, gynecologic and orthopedic surgeries) with hy-perbaric or isobaric bupivacaine, showing that low doses of local anesthetics (5 to 10 mg) and thoracic puncture reduce the latency time, the degree of motor block and cardiocirculatory changes, without neurological complications (3) 23 Anxiety Level and Associated Factors during Coronavirus Disease 2019 (COVID-19) Pandemic in Pregnant Women   , Leo Simanjuntak and Patrick Anando Simanjuntak Background: Coronavirus disease-2019 (COVID-19) pandemic is spreading widely throughout the world, causing global health crisis and one of the greatest challenges we have ever faced. Indonesia is one of the countries that has been severely affected by COVID-19. The COVID-19 pandemic has created some serious concerns including anxiety in pregnant women. However, due to mental and physical changes in pregnancy, pregnant women are likely to be affected by the virus. At present there is no evidence that pregnant women are at higher risk of severe illness from COVID-19 than the general population. Research is currently ongoing to understand the impacts of COVID-19 in pregnant women. This study aimed to assess the anxiety level and associated factors during COVID-19 pandemic in pregnant women. Methods: This study used cross-sectional design using primary data on April 2020 at Leo Simanjuntak (Obstetrician and Gynecologist) outpatient clinic. Based on defined criteria, 120 subjects were recruited in this study. Anxiety level assessed using Hamilton Anxiety Rating Scale (HAM-A). Demographic data collected using research questionnaire. Logistic regression were used to identify associated factors on anxiety level.Results: Our results showed majority of the pregnant women (71%) showed no anxiety. The rest of these pregnant women (29%) showed mild anxiety level (23%) and moderate anxiety (6%). Multivariate data analysis showed that healthcare workers were associated to higher anxiety level, with OR 5.56 (95% CI .33 - 24.09).Conclusion: Informative and educative advices and suggestions of COVID-19 to pregnant women and their family, such as washing hands frequently, maintain social and physical distancing, using mask to cover the mouth and nose when around others, living healthy life, and doing all the activities from home, can make pregnant women not worried about COVID-19 pandemic, which is supported by this study. 24 Physical Activity Level and Prevalence of Obesity among Adults’ Population of Abeokuta, Ogun State, Nigeria , AS Adekoya, CI Ojo, OA Mafimidiwo and FO Oyeleke Objective: To examine the effect of physical activity level (PAL) on the prevalence of obesity among adults (20 - 64 yr) in Abeokuta, Ogun State, Nigeria.Designs: 120 adult males and 120 adult females were randomly selected to participate in the study. Body mass index (BMI) was measured using cut-off ≥ 30 kg/m2 and the physical activity assessed according to WHO/FAO work classification.Results: Mean BMI was high above the cut-off (7.2% for rural male and 11% for urban male, p = 0.169) and (28.3% for urban female but lower than the cut-off among rural female 7.7%, p = 0.006). The pattern of physical activity significantly fell on the sedentary side, mostly among the urban subjects. There were positive changes (statistically insignificant) in physical activity level (PAL) and a similar shift in obesity prevalence among the sub-population.Conclusion: The PAL among the population, emphasize the adverse effect of sedentarism on the increasing risks of obesity and chronic degenerative diseases. Participation in physical activity programs should be emphasized 25 Karydakis Flap Reconstruction for Pilonidal Disease , Aybala Yildiz, Alp Yildiz, Veysel Baris Turhan, Engin Kucukdiler and Erkan Karacan The reported incidence rate of pilonidal disease is 25 per 100,000 people. Initially, the pathogenesis was considered to be congenital. Today, however, the theory that it is acquired is more widely accepted. Work by Georgios Karydakis who highlighted 3 main factors contributing to pilonidal disease had a pivotal role in this paradigm shift. As the primary treatment still surgery, we present our karydakis flap experience in this study. Fourty-four patients has enrolled for this study. All patients has diagnosed pilonidal sinus disease and treated by the same surgical team with Karydakis flap reconstruction. The most common post-operative complication was fluid collection. 2 patients developed fluid collection under the flap site which reduce spontaneously. No hemorrhagia has occurred. 1 patient developed wound infection. No hematoma, bleeding occurred and no need for secondary powder application. No flap necrosis occurred, also wound dehiscence and early recurrence were not found. When low recurrence rates, patient comfort and cosmetic results are evaluated together, Karydakis technique emerges a method that is preferred by physicians and patients. 26 21 Days of Social Synergistic Pilot Survey on Community Participation to Determine the Level Virulence of COVID-19 in Africa before Re-Opening of the Education Sector in an efficiency, Affordable and Sustainable Approach , Maurice B Silali 21 days of Synergistic community participation survey [2] to determine reopening of education sector in Africa remain a key cradle to create psycho social confidence in parents, pupils and students since they left school colleges and universities without completion of their first term or semester exams in mid-march 2020 after the confirmation of the first case of COVID-19 virus [9]. 21 days study period is the maximum incubation period of COVID - 19 Virus to show sign and symptoms in an infected individual 27 Failed ERCP in Extrahepatic Cholangiocarcinoma with Obstructive Jaundice and Cholangitis: An Alternative Approach , Amit Sahu and Arpita Sahu Cholangiocarcinoma accounting for 2% of all human malignancies is a rare malignant neoplasm of the biliary tract epithelium. Early stages, being asymptomatic, may go unnoticed and by the time it manifests, the disease process is advanced and usually unresectable. The most common presentation is obstructive jaundice with a lot them progressing to biliary sepsis, septicemia, liver failure and death. Chemotherapy and radiotherapy are ineffective in inoperable tumors. Biliary drainage, either endoscopic or percutaneous, remains the mainstay of palliation in these tumors. Endoscopic cannulation retrogradely across the tumor tissue is difficult and may often prove futile. Percutaneous transhepatic biliary drainage and biliary stenting is a viable, rewarding palliative option with high technical success and low complication rates. 28 Constitutional Homeopathy of the Five Elements based on Traditional Chinese Medicine , Huang Wei Ling Introduction: Homeopathy is based on the study of the symptoms caused by each substance given to a normal subject, and then applied to each patient who presents similar symptoms (similimum). However, there is still doubt regarding exactly the origin of these symptoms and how the medication act in the energy point of view. Purpose: To demonstrate that the signs and symptoms presented by the patients are related to the Five Elements Theory (Wood, Fire, Earth, Metal and Water) of Traditional Chinese Medicine and to expose the development of specific treatment with homeopathy medications for each massive organ of the Five Elements Theory, treating the root and not only the symptom. Methods: Observational studies were conducted from Western medicine, homeopathic medicine, and Traditional Chinese Medicine. These different types of reasoning were compiled on the metaphor of the tree, a diagram comparing the differences between the three approaches. Results: The diagram showed the roots as the Five Elements (Wood-Liver-Phosphorus; Fire-Heart-Sulphur; Earth-Spleen-Calcaria carbonica; Metal-Lung-Silicia; Water-Kidney-Natrum muriaticum), the branches representing each specialty in Western medicine, the leaves of each branch representing the signs and symptoms. Conclusion: Instead of treating the symptoms presented by the patients using homeopathic medications according to Western Medicine reasoning (horizontal model), the author proposes the premise of the use of Traditional Chinese Medicine, in an energy-based treatment (vertical model). Focusing on the root of the problem and not only on the symptoms. 29 The Covid-19 Treatment Soup: Is Combination Therapy Better? , Pooja H Patel and Salim Surani. The number of people affected by SARS-CoV-2 virus and con-tracting the coronavirus disease (COVID) continues to increase worldwide. While everyone eagerly awaits the discovery of a vaccine to help curb this pandemic, there will still be a few more months before a vaccine is approved and available in the market. In the interim, it is imperative to identify treatment modalities that can help improve outcomes for COVID infected patients as well as reduce mortality. Developing a new antiviral drug may take years before it is approved for clinical use and may not be the most fea-sible route during these immediate needs. T 30 Rate of Recurrence After Isolated Coarctation Repair: A Retrospective Study in a Single Tertiary Centre , Sami M AlAhmari, Khalid S Alnajashi, Ahmed Elway, Howida Alqethamy, Turki AlQahtani and Merna M Atiyah. Objectives: To retrospectively determine the incidence of recoarctation within two years of repair of isolated coarctation of the aorta in patients aged less than 14 years and operated on in our institution, and to identify the risk factors for recoarctation in our study cohort.Methods: Review of hospital records from 1990-2016 yielded 350 patients aged less than 14 years who had undergone repair of coarctation of the aorta, 84 of whom had isolated coarctation and comprised the study cohort. We studied possible factors influencing the risk of recoarctation, including sex, delivered term or preterm, age group at diagnosis (neonate, infant, child), administration of prostaglandin E1, type of aortic valve (bicuspid, tricuspid), type of coarctation (juxtaductal, preductal, postductal), surgical approach and type of surgical procedure (end-to-end anastomosis, extended end-to-end anastomosis, subclavian flap). We use binary logistic regression to analyse associations between the above-listed patient characteristics and identify independent predictors of recoarctation requiring intervention.IntroductionResults: Reintervention by catheterisation was required within two years of surgery by 23 (27.4%) of the 84 patients with isolated coarctation, 11 of whom (47.8%) had developed recoarctation within one year of surgery. Binary logistic regression of the examined variables between those who did and did not develop recoarctation failed to identify any significant risk factors for recoarctation (χ2 (8) = 6.532, p = 0.558).Conclusion: In our cohort, the incidence of recoarctation within two years of repair of isolated coarctation of the aorta in patients aged less than 14 years is 27.4%. We were unable to identify any risk factors for recoarctation 31 Detection of Malignant Region of Diseased Images Using Thermal Camera , Lakshman K, Siddharth B Dabhade, Sachin Deshmukh, Ranjan Maheshwari and Mrudul Behare. In medical science, abnormal growth of any cell is called cancer. Malignant region is nothing but the location of extra growth of any cell in the body. In this paper, we make attention on the different types of malignant region detection techniques using Thermal Infrared Images. We studied various imaging methods like thermal imaging, x-ray, magnetic resonance imaging (MRI), optical imaging of abnormal cell in human body. It is analyzed that malignant regions of body helps to prove the cancer cells those are present within the body. The early detection of malignant region helps in saving the life of an individual. To obtain thermal images, a thermal camera is used which can detect temperature variations in the body, as low as 0.1°C. Thermal cameras capture the surface skin temperature which can vary due to emotion-specific, bio-physiological states in the human body. 32 Teething Problems and its Management through Unani Medicine , Neelam Quddusi, Misbahuddin Azhar and Nighat Anjum. Teething is the emergence of teeth sequentially through the gums in infants. In this period, infants are become irritable due to gingival swelling and sensitivity. The management of this phase through Unani Medicine has been documented in Unani Classics. The Unani drugs used in this period are completely safe and effective. This article aims to describe the clinical signs and symptoms and role of Unani medicine in teething problems. 33 The Best Way to Prevent and Treat coronavirus Infections , Leonid Tell. The method goes as follows:Do not attempt to reduce body temperature increase by endo and exogenous pyrogens.2. Breath hot alkaline vapor on a regular basis.3. If pneumonia develops, use conventional methods of treatment ,but no use of antipyretics.4. If there is a need to switch to artificial ventilation for the patient (which would occur rarely considering the rules are fol-lowed), then be sure to use hot, humid, alkaline air during ventilation 34 Calf Pressure Ulcers: Facts Defying the Prevailing Concept   , Jochanan E Naschitz, Segal Galit, Zaygraykin Natalia, Starikov Natalia and Leibovitz Gregory. Background: According to the classical concept the capillary closing pressure is 30 - 32 mmHg and the calf interface pressure is 10 - 20 mmHg. So, pressure ulcers cannot occur on the calf. Observations from the bedside oppose the concept.Aim: To examine the features and clinical context of what appear to be calf pressure ulcers.IntroductionResults: Six out of 1631 patients newly admitted to our institution during a 15 month period had skin ulcers on their calves, resembling typical pressure ulcers. In four patients the calf ulcers evolved concurrently with pressure ulcers at other sites. Two patients had a single calf ulcer and no other pressure ulcer. By the ulcers' location, the clinical context and the normal appearance of the adjacent skin, the calf ulcers differed from venous, ischemic, neuropathic and vasculitic ulcers. Except for their elongated shape, contrasting to the round shape of pressure ulcers at other sites, the calf ulcers were similar to typical pressure ulcers. Calf pressure ulcers have been ignored in the literature, maybe as a consequence of the longtime dominant theory concerning pathophysiology of pressure injury. Recent studies have revised the classical concept, showing that tissue pressures can become critical at levels inferior to conventional capillary closure pressure, depending on systemic influences. Conclusion: Six case histories provide evidence that calf ulcers may be genuine pressure ulcers and lend support to the contemporary, comprehensive theory of pressure injury. Design: Prospective observational study in a long-term geriatric and palliative care unit.Methods: Guideline directed diagnosis and treatment of skin ulcers. 35 The Difficulties of Socio-professional Reintegration of Patients Suffering from Chronic Psychiatric Affections in Lomé , Komi Dzidzonu Nemi, Kokou Dodzi Mawulolo Dogbe, Essohanam Tambourou, Mohaman Awalou Djibril and Kolou Simliwa Dassa The aim of this study was to describe the difficulties of socio-professional reintegration of patients suffering from chronic mental disorders in Lomé. This is a transversal and descriptive study conducted from 1st February to 31st April 2018 concerning patients with chronic mental disorders but stabilized and monitored by the Psychiatry service of the Campus University Hospital of Lomé. Fifty-one (51) stabilized patients were involved. The social and family reintegration was almost total (N = 50). Professional reinte-gration was not effective in 37 patients (72.5%). The sex ratio (M/F) was 0.94. The mean age was 40.7 +/- 10 years (range 15 and 59 years). The majority (46%) were single. Psychoses represented 62.16% (N = 23) of the diagnoses retained, followed by severe depression (N = 11; 29.72%) and mania (N = 3; 8.10%). Neuroleptics were used in 81% and antidepressants in 46% of cases. Before chronic mental disorders and their management, 64.8% (N = 24) of patients were in the private sector. The reasons for the non-resumption of activity according to the patients were: the side effects of psychotropic drugs (N = 16; 43.2%), the lack of motivation (N = 15; 40.5%), the dismissal (N = 4; 10.8%) and social stigma (N = 2; 5.4%). The obstacles to professional reintegration according to the accompanying persons were: non-compliance with customary laws (N = 11), possession by the spirits (N = 7), the curse (N = 5) and enchantment (N = 5). The difficulties of professional reintegration of patients suffering from chronic psychiatric affections are topical in our country. A refocused study including the community level and supporting the daily experience of these patients would be desirable to complete our work. 36 Obstetrical Complications Linked to Female Genital Mutilation in the 3rd Reference Obstetric Service at Chu Point G. Bamako/Mali , Kanté Ibrahim Ousmane, Coulibaly Ahmadou, Traoré Mamadou Salia, Sima Mamadou, Théra Tiounkani Augustin, Daou Seydou Z, Fané Seydou, Traoré Alassane, Traoré Youssouf and Teguété Ibrahima. Aim: To study obstetric complications linked to female genital mutilation (FGM). Patients and Methods: Our study was carried out in the obstetrics department CHU Point G. It was a case/control study. The case be-ing the excised woman and the witness, the non-excised woman. Our study lasted sixteen months, from 01/01/2019 to 04/30/2020. Were included, primiparas from 14 to 49 years old excised or not. Not all non-consenting women were detained. The sample size was calculated based on the case/control sample. Data collection was done on individual questionnaires. Data analysis and processing was done on SPSS 12.0 and Word 2013. Statistical tests: Chi2. P < 0.05. Results: During our study we had 1518 deliveries of which 266 women included. The major age group was 14 - 19, or 51.1% in the cases and controls. The Bambara’s and Songhai’s were the majority ethnic groups in the two cases with respectively 34.6% and 31.1% with P < 0.00. The illiterate and the secondary level were respectively in the majority in the cases and the controls with re-spectively 57.8% and 59.3% with P < 0.00. Type 3 circumcision accounted for 12%. Episiotomy was performed in 56.4% of the cases and 5.3% in the controls with P < 0.05. The tears were noted in 51.1% in the cases against 11.3% in the controls and complicated in 23.5% with P < 0.05. Conclusion: FGM was a frequent practice in our countries and can be a source of obstetric complications such as hemorrhage due to tear of the soft parts. Measures must be taken to eradicate this scourge. 37 The Human Body-Field   , Edward F Block. This work details the interaction of the human body-field with the electromagnetic phenomena of the biosphere of the earth. The overall Human body-field is described in detail and the role of healing modalities in maintaining the harmony of the Human body-field is elucidated.A protocol for healer-client interaction to harmonize the client Human body-field is presented 38 Guidelines for Using Personal Protective Equipment while Exercising , Daniela Benavidez. Daily life has changed drastically for nearly the entire world following the outbreak of the Covid-19 pandemic. Personal protective equipment (PPE) such as facemasks, gloves, face shields, and goggles have become the norm in many communities for people engag-ing in societal activities outside the home 39 Echocardiographic Assessment at 1-Year Follow-Up Post-Percutaneous Pulmonary Valve Implantation at the Prince Sultan Cardiac Center: A Single-Center Experience , Al Asmari Own, Atiyah Merna, Al Essa Mohammed, Almohaizy Omar, Al Sahari Atif, Mohsin Shazia, Al Khalaf Khalaf and Al Najashi Khalid Background:Congenital heart defects affect roughly 1 in 150 people and are often associated with right ventricular outflow tract (RVOT) dysfunction. The aim of the study was to evaluate the echocardiographic changes within the right ventricle following percutane-ous pulmonary valve implantation (PPVI).Methods: The echocardiographic data of 57 patients who had pulmonary valve stenosis and/or regurgitation and had undergone PPVI treatment and completed at least 1 year of regular follow-up at the Prince Sultan Cardiac Center from January 2012 to December 2015 were analyzed at the baseline level (before PPVI) and at 6 and 12 months following the PPVI treatment. Pulmonary insufficiency was graded from 0 to 4 based on severity: 0, none; 1, trivial; 2, mild; 3, moderate; 4, severe/free).Results: There was a significant reduction in the RVOT gradient. At baseline, 95% of the subjects demonstrated pulmonary insufficien-cy (grades 2-4); at 12 months, 28% had decreased pulmonary insufficiency and 72% had limited to no pulmonary regurgitation. Other parameters, including right ventricular volumes, fractional area change, and the tricuspid regurgitant jet width/body surface area, did not demonstrate any significant change. Early follow-up echocardiographic data demonstrated persistent improvement in the RVOT gradient and pulmonary regurgitation level over the 1-year follow-up.Conclusion: PPVI was seen to ameliorate RVOT dysfunction in most subjects. 40 A Chronicle from the Eye of the Storm: Impact of the Coronavirus Pandemic on the Cremona’s Hospital , Lia A Beccara, Francesca Mangiatordi, Simone Francavilla, Patrizia Arisi, Laura Bocchi, Maurizio Taglia, Sara Ponton, Elena Bucella, Giacomo Marino, Andrea Nocchi, Carlotta Pacioni, Antonio Labate, Maria Perrone, Anna Savini, Luca Andriollo, Giang Truong, Giorgio Morelli, Michela Pollastri and Antonio Cuzzoli Objective:To draw an accurate picture of the condition of the Cremona public Hospital from February 21st to April 20th 2020, in par-ticular the Emergency Unit management of the Coronavirus pandemic.Design:A retrospective analysis of data from the institutional database was conducted. Setting: Data from the Emergency Unit of the ASST Cremona Hospital (Lombardia, Italy), a secondary level public hospital. Patients:All the patients aged > 13 years that were admitted to the Emergency Room (ER) during the Coronavirus pandemic. Intervention:We retrospectively analyzed the ER access records, the discharge/hospitalization reports from ER department and data from the national discharge register were analyzed by the informatic services using the Sql Oracle language. Measurements and Main Results:From February 21st to April 20th 2020, 5078 patients were admitted to the ER at the Cremona Hospital. Out of 5078 patients evaluated, 2226 (43.8%) were hospitalized and 2852 (56.2%) were discharged. Of the 2226 patients hospitalized (average age 67.1 ± 37.4, 1791 (76.4%) received a diagnosis of SARS-CO-V2 infection. 1198 hospitalized patients recei-ved a diagnosis of SARS Covid interstitial pneumonia. The average stay in ER was 771 ± 919 min for patients who have subsequently been hospitalized, while the patients discharged had an ER stay of 465 ± 808 min. The total COVID positive patients’ deaths, hospita-lized through the ER, were 333, equal to the 19.6% of the total admissions from ER.Conclusion:ER team has put together all the competences and abilities to exploit the limited resources available, in order to better manage the emergency 41 Caregivers’ Perception and Practices on Malaria in Children Under Five in EkombeBonji Health Area, Kumba Health District, South West Region of Cameroon , NkengafacNyiawung Fobellah, Anna Njunda Longoh, FolefockAjua Richard Medterrand and Efengo Vanessa Background:Malaria is one of the diseases which contribute significantly to morbidity and mortality in Africa with 91% of deaths being children under-five. Despite all efforts to combat malaria, this disease still remains the leading killer of under five children kill-ing a child every minute. Malaria usually progress to its severe state within a very short period of time. Generally mothers/caregivers are the first to recognize fever in children and also determine the decision to seek care. Therefore, recognition of the symptoms of malaria by caregivers and their practices toward seeking treatment is invaluable in order for malaria to be treated in a timely manner. Objectives:The objective of this study was to determine the prevalence of malaria in children under five, and also to investigate the local perceptions, practices and treatment-seeking behaviour for malaria among their caregivers. Methodology:This study was a cross sectional descriptive, community based study done from January to march 2014. Children under five years were enrolled for the study. Malaria RDT was done for parasitological evaluation. Questionnaires were administered to children’s caregivers to collect socio-demographic data, knowledge regarding malaria, preventive measures and treatment seeking behavioursResults:Of the 350 children examined, 174 (49.7%) [95% CI: 44.37- 55.07%] were infected with malaria (plasmodium falciparum). Male and females were similarly infected (41.4% vs. 51.6%) with no significant difference (p = 0.4).The prevalence appeared to be highest 41 (23.6%) in the age group [24-36] months. Caregivers 280(80%) had proper knowledge on malaria with 316(90.3%) mentioning mosquito bite as the cause of malaria. Likewise fever/hot body was perceived as the commonest symptom of malaria by 332 (95%) of caregivers [95% CI: 91.9-987%]. With regards to caregivers’ practices on prevention, 308(88%) use insecticide treated nets (ITN) as a preventive method. Only 205 (58.6%) of caregivers sought treatment at the health facility when their child was ill. As few as 119 (34%) did so within 24 hours of onset of symptoms. The most common home remedies employed were tepid sponging and use of anti pyreticsConclusion:Caregivers had a good knowledge of malaria (including its aetiologic agent, signs and symptoms and preventive mea-sures). They also had a good practice towards preventive measures. However, the prevalence of malaria in under-five was high and only a lesser majority of caregivers sought treatment at the health facility in a timely manner 42 The Influence of Pre-Existing Heart Failure on Community-Acquired Pneumonia Outcomes , CaÈ™caval Virginia, Fetco-MereuÈ›Äƒ Diana, CaproÈ™ Natalia, Grib Livi, Matcovschi Sergiu and DumitraÈ™ Tatiana Background: Community-acquired pneumonia is a common infectious disease, that is being associated with high mortality, especially in patients with comorbidities, such as heart failure. Also, preexisting heart failure increases pneumonia mortality by 30 - 50%, therefore it is important to identify patients who are in the risk group.Methods: This is a retrospective study, where we examined causes of death in 62 patients with community-acquired pneumonia and heart failure, with emphasis on clinical, laboratory and microbiological characteristics. Results: Our results show that cardiovascular disease, especially heart failure, represents a heavy load on the outcomes of community-acquired pneumonia patients and that progression of heart failure, it's complications and other co-morbidities increase the risk of death associated with pneumonia.Conclusion: The obtained data suggests that community-acquired pneumonia is not only affecting the respiratory system, but it is also a systematic inflammation process that affects the cardiovascular system 43 Comparison of Propofol and Fentanyl in Prevention of Emergence of Delirium after Sevoflurane Anesthesia, Hiren R Patel and Geeta ParikhIntroduction:The occurrence of emergence agitation in children after sevoflurane anaesthesia is common with an incidence ranging between 10 to 80%. Aim: To study Propofol and Fentanyl in Prevention of Emergence of Delirium after Sevoflurane Anesthesia.Material and Methods: After approval from ethical committee and written informed consent from parents or guardian, 115 chil-dren with ASAI and II aged 2 to 6 years, were selected for elective urological surgery, under sevoflurane anaesthesia. Patients were divided into three groups i.e. Group C (Control), Group F (Fentanyl), and Group P (Propofol). All collected data enter into the IBM SPSS 20th (statistical parameter of soci 20th and analyzed it. Continuous data expressed as mean Â± sd and non-continuous expressed as in percentages. Anova test, kruskal wallis and chi square (fisher exact) test have been performed to carry out p value at 95% CI. p value 44 Endoprosthetic Replacement of the Distal Femur for Giant Cell Tumor: A Case Report , Khaled Khelil, Saber Saadi, Abderrazek Rafrafi, Khalil Amri, Rami Ben Arab, Talel Znagui and Lotfi Nouisri Giant cell tumor occur mainly in young adults and account for 5% of all primary tumors of bone. It generally affect the metaphysoepiphyseal region of long bones, as well as less often flat bones. Distal femur and proximal tibia are the most common sites followed by the distal radius. Though this tumor is classified as benign, it is characterized by a high potential of local aggressiveness, a high risk of recurrence, a risk of metastasis and malignant degeneration. Although these tumors are fully studied, their treatment remains a subject of debate, in fact the challenge is to resect the entire tumor while maintaining the proper functioning of the affected limb. Currently, with the technical advances in the prosthetic field, the use of massive prosthesis after resection showed it superiority compared to the other methods of reconstruction. In this presentation, we aimed to report the case of a patient with distal femoral giant cell tumor treated by en bloc resection and reconstruction by a hinge massive prosthesis with good functional outcome 45 Infection Control Measures in Dialysis Units during COVID-19 Pandemic   , Ahmed Daoud, Mahmoud Mohamed, Hatem Ali, Mostafa Alfishawy and Karim Soliman The world is passing through a serious pandemic caused by the novel coronavirus (COVID-19). The clinical course of infection is widely variable ranging from asymptomatic presentation to multi-organ system failure and death [1,2]. Comorbidities as hyperten-sion, cardiovascular diseases, acute and chronic kidney diseases in COVID-19 patients portend poor outcome and are associated with high mortality rate 46 Priority Setting in Surgical Management of Breast Abscess in Newborn: Case Report , B Hamillour Neonatal breast enlargement often occurs during the neonatal period is a common response which occurs under the influence of falling levels of maternal estrogen at the end of pregnancy [1]. This situation takes place in both sexes without prevalence, with sometimes milk secretion [4]. Spontaneous resolution requires reassuring parents [1-4].Mastitis or abscess of the breast in the newborn is a rare condition which is observed in 5% of cases [3]. Staphylococcus aureus is the bacterium commonly responsible for all major of breast abscess [11].Ultrasonography as an essential non-invasive diagnostic approach is well recognised as a first-line examination in the setting of breast abscess [6]. Our case illustrates the importance of rapid surgical management as a compliment to medical treatment and the ideal time to undertake surgical breastfeeding in order to avoid serious complications as generalized sepsis breast hypoplasia, and scarring [ 47 Does Sneezing Play a Role in Multiple Sclerosis? , Homayoun Roshanisefat Objectives: The modern era of multiple sclerosis (MS) biomarkers has been ongoing for many years, with the periodical approval and renewing of MS criteria we are still facing many challenges. The new revision was recently approved, a few years after McDon-ald’s Criteria, it was also followed by a promise to find new landmarks for the establishment of an MS diagnosis and its courses. An innate immunological clinical sign - which can better connect the suspected etiology and the disease is of major interest. Data Sources: A literature search was performed using medical and health science search engines to find publications from Janu-ary 1940 to December 2019.Data Extraction: Data were extracted if any of the following keywords were mentioned in combination: sneezing, MS, stroke, bio-marker, the nasal cavity. The search was expanded to the medical conditions included in this study.Data Synthesis: Sneezing is a very clear sign and health reaction which has never been studied in MS and may potentially have a clinical impact. The sneeze function can, through other diseases and life events, teach us its importance and common understanding with MS. This review will focus on the sneeze in different medical conditions and use these comorbidities as a proxy to understand inflammation and their association with MS.Conclusion: Sneezing is one of the common health reactions against pathogens, allergens, temperature changes, lightning, and cerebral injuries. This study has found a sign that sneezing has an untold role in MS and comorbidities such as a stroke. Measuring sneezes has the potential of becoming a clinical biomarker in MS. 48 Coronavirus and Multiple Sclerosis, Autopsy and Biopsy and Choice of Therapy , Homayoun Roshanisefat Background: Coronavirus in trigeminal nerve (TGN) has for decades been studied as a candidate neurotropic virus associated with multiple sclerosis (MS). The novel coronavirus 2019 (COVID-19) outbreak in infected cases is challenging the whole immune system. The lesson from MS treatment and a new era of COVID-19 therapies are of value to review.Method: Searched databases to identify the strongest evidence of biopsy, autopsy, and cerebrospinal fluid (CSF), when using key-words MS and coronavirus, from January 1940 to April 2020. The result presents a solid knowledge of biopsy and autopsy for the association of COVID-19 and MS, then COVID-19 single and combination therapies being evaluated as presented in clinical use or clinical trials and compare common sites with MS. Results: All therapies with proven clinical efficacy against COVID-19 and its current deployment in COVID-19 and their common aspect with MS therapies (MSTR) and immunology are screened. Some MSTR despite some different side-effect e.g. risk for infection or cardiac arrest are candidates of being used as COVID-19 life-saving therapy. Conclusion:This global health disaster caused by airborne virus COVID-19, has created a new break to learn more about MS etiology and this airborne agent and future drug choices when reviewing the five months COVID-19 data through significant medical reports on World Wide Web 49 Relationship between Educational Level and Incidence of Obesity among Adults in Abeokuta, Ogun State, Nigeria ,   AS Adekoya, CI Ojo3, OA Mafimidiwo and FO Oyeleke This study examined the relationship between educational level and the incidence of obesity among adults in Abeokuta, Ogun State, Nigeria. A total of 240 respondents were selected from two different localities i.e. rural and urban, with their ages ranging from 20 years and 64 years. The educational level details were obtained based on the personal information given. The prevalence of obesity was determined using the Body Mass Index cut-off (≥ 30 kg/m2) to estimate those obese. The data were analyzed using descriptive and correlative parameters to demonstrate the influence of educational level and its resultant effect on income level and incidence of obesity across the sampled population. The results showed the highest level of among the rural males of lower educational status. Adjustments were made to establish relationship between educational attainments and BMI graphically. Conclusively, the study affirmed that educational level determines the income level and obesity mostly among the urban population. Findings of this nature can further provide functional insights into some socioeconomic developments that can help to overcome obesity epidemic 50 Nutritional Challenges and Management in Post-surgical Non-Hodgkin Lymphoma , Edwina Raj, Shivaram H V, Girish3, Prakash Dorraiswamy, Rebecca Renee, Deeksha Acharya Non-Hodgkin Lymphoma (NHL) is a type of cancer that arises in the white blood cells called lymphocytes, when the cells start dividing uncontrollably. We present a 46 year old woman who was a known case of NHL (proximal jejunum which is quite uncom-mon) post 5th cycle of chemotherapy who presented with history of fever, abdominal pain with vomiting. The patient underwent ex-ploratory laparotomy, resection of perforated segment of distal jejunum and peritoneal lavage with primary anastomosis. a nutrition care plan was devised to prevent nutritional deficiencies and minimize the effect of catabolism. Nutrition intervention supports the overall recovery and surgical outcome. the patient showed remarkable improvement despite the nutritional risk and the nutritional challenges presented to us. The treatment included total parenteral nutrition progressing to soft diet with high protein prior to dis-charge, which aids in quick recovery, faster wound healing and tissue repair. 51 Complementary Feeding Practices Associated with Wasting of Children 6 - 23 Months Old in Dilala, Lualaba Province, Democratic Republic of the Congo, 2017 , Ngoy Bulaya Emmanuel, Horwood Christiane, Mapatano Mala Ali, Muyer Telo M-C, Ntiba Assumpta Ruth, Mutombo Beya P Malnutrition is in high prevalence in some developing countries, like Democratic Republic of the Congo mostly among children from six to 23 months. Complementary feeding is among the main causes of malnutrition worldwide. Objective: The present study aimed to assess the complementary feeding practices associated with acute malnutrition in Democratic Republic of the Congo. Design (Methodology):A community-based cross-sectional study was conducted from October 23rd to November 25th 2017 in DI-LALA Health Zone, using a three-stage stratified sampling technique. In 10 Health Areas, 698 children six to 23 months old were as-sessed on nutritional status and their mothers interviewed on complementary feeding practices. Household questionnaire pretested and revised, standardized anthropometry equipment and World Health Organization recommendations were used with trained data collectors. ENA for SMART and Logistic regression on SPSS 23 were used to data analysis. Results:Wasting was associated with lack of knowledge on minimum meal frequency (adjusted odds ratio = 2.4, CI 1.14 - 5.11), minimum dietary diversity (adjusted odds ratio = 0.23, CI 0.055 - 0.981) and protected source of drinking water (adjusted odds ratio = 0.50, CI 0.26-0.93). Conclusion:Wasting was more increased among children whose mothers were without knowledge on minimum meal frequency of complementary feeding, but more prevented in children having met minimum dietary diversity and in children from household with protected source of drinking water. 52 Burnout Syndrome (BS) among Emergency Medical Workers , Nataliya Petrova, Michail Duben, Sarkis Pogosyan and Vladimir Bratslavsky. The doctors and nurses belong to “person-person” professions. The features of these professions are: high responsibility, a large number of contacts with people, including the people with negative emotions. So they have the high risk of emotional stress. The work in emergency services is the work in difficult and even extreme situations with a high level of response, consequences for life and health. So this medical staff have a real risk of BS with its negative influence to health. In this article the results of BS study among emergency medical workers are presented. It was used a three-factor model of K. Maslach and S. Jackson (in the adaptation of N.E. Vodopianova): the level of emotional exhaustion, depersonalization, reduction of professional achievements were analyzed. The study involved 125 employees. The distribution according to the degree of emotional exhaustion was as follows: 10.8% of the respondents had a low degree, 16.2% had an average degree, 32.4% had a high degree and 40.6% had an extremely high degree of emotional exhaustion. The distribution by the degree of depersonalization was as follows: 5.4% of the respondents had a medium degree, 10.8% had a high degree, 83.8% had an extremely high degree. The distribution by the degree of depersonalization was as follows: 62.2% of the respondents had a low degree, 32.4% - an average degree and 5.4% of employees had a high degree. The distri-bution of emotional burnout in total was as follows: 2.7% of respondents had a low degree, 8.1% had an average degree, 37.8% had a high degree, and 51.4% of respondents had an extremely high degree of emotional burnout. There are differences between some groups of respondents. The necessity of measures for the prevention of the syndrome among doctors has been proved 53 Madelung’s Disease and Upper Airway Involvement: A Case Report , Daniela Furno, Giovanni Addolorato2., Gaetano Paludetti and Gabriella Cadoni. Madelung’s disease is a rare condition characterized by multiple and symmetrical deposits of adipose tissue concerning especially neck, shoulders, upper limbs and upper thorax. This lipomatous tissue could cause extrinsic compression or recurrent laryngeal nerve compression because of infiltration of fat [1,2].In this case, we will describe a 66-year-old man affected by Madelung’s disease, with larynx-tracheal anatomical alteration, showed by CT scan and flexible laryngoscopy 54 Prevalence of Depression and Anxiety in Rural Health Centre Chitral: A Cross Sectional Study , Sidra Kanwal, Nisar Hussain and Waris Qidwai Introduction:Globally depression is a leading cause of disability and contributes to one third of global burden of diseases. More than 150 million adults suffer from depression at any point in time and nearly one million commit suicides every year. Despite immense diversity in the socio-cultural environments in Pakistan, there is an overall very high prevalence of anxiety and depression in rural Pakistan.Patients and Methodology: All patients from March to August 2015 presented to family medicine clinics in rural health area Booni Centre Chitral for general medical problems fulfilling the inclusion criteria recruited via convenience sampling. Data then entered in SPSS 21. Patient health questionnaire (PHQ 9) and generalized anxiety disorder (GAD) 7 questionnaires were administered for as-sessment of depression and anxiety respectively. Sociodemographic factors were also assessed.Results:In a sample size of 230 patients 71% of participants were of range of 18 - 35 years. Mean age was 31.3 years. Male were 118 (51.3%) were found to be in higher proportion as compare to females.Prevalence of depression of found to be 67%, and GAD was found to be 33.5%, living alone and female gender were found to be associated with Depression and anxiety with p-value = < 0.005 and p-value = 0.025 respectively.Conclusion: As there is a high rate of depression in Chitral, education and support from family, friends is a strong factor in dealing with depression. Launch of a mental health program in Chitral specifically addressing gender and different age groups will be a big step towards successful rehabilitation of individuals. 55 Prediction of Fall among Patients with Parkinson’s Disease: A Cross-Sectional Study, India , Aiswarya Anilkumar, M Bagavandas and Geetha Veliah. Background: The cross-sectional study aimed to identify the risk factors that lead to fall among patients with Parkinson’s disease, assess the stage of severity; its contribution to fall, and also predict fall among the patients. Methods: 94 patients diagnosed with Parkinson’s disease were included using non-probability convenience sampling. A semi-struc-tured questionnaire was employed to understand the demographic data, risk factors, disease severity, balance, and level of function-ing using the Hoehn and Yahr scale, Berg Balance scale and Activities-Specific Balance Confidence scale respectively. Regression analysis was performed to identify the risk factors that lead to fall. A logistic regression analysis was performed to predict fall and Multivariate Analysis of Variance was employed to understand the difference in scores concerning the different stages of severity.Results: The regression model showed that the Activities-Specific Balance Confidence score and severity of disease are the strongest contributing risk factors of fall among the participants (p < 0.001). Using Multivariate Analysis of Variance we conclude that there is a significant difference in the average mean Activities-Specific Balance Confidence score from 52.45 to 28.57 when patient proceeds to stage 3 (mild to moderate bilateral disease) from stage 2.5 (mild bilateral disease with recovery on pull test) according to the Hoehn and Yahr staging. Activities- Specific Balance Confidence score which in turn implies the level of functioning was found to be the variable used for prediction of fall.Conclusion: An effective awareness regarding the stage transition where there is a high risk of fall needs to be understood. The Activities-Specific Balance Confidence score helps us predict the risk of fall among patients 56 An Approach to Visualize Digital Transformation in Healthcare , Shuichiro Yamamoto. Background: The healthcare industry is faced to the digital transformation (DX) to realize the digital healthcare enterprises using digital technology for healthcare services. Japanese Ministry of Economy, Trade and Industry published the DX promotion index (DXPI) to assess the DX maturity of Japanese companies. Although the DXPI provides the requirements of DX, it lacks design approaches on business values, models and processes to digitalize healthcare services. We are trying to propose ArchiMate based diagrams on the business value, model and process to create healthcare services to meet the DXPI. ArchiMate is the EA modelling language to represent business, application and technology architecture.Method: Three key business diagrams are extracted from DXPI. The business diagrams are business value, business model, and business process diagrams. We define the three corresponding tables for business diagrams. These table elements are shown to be mapped to ArchiMate model elements. By using the mapping, three business diagrams are able to develop in ArchiMate.Results: The approach is applied to visualize a digital transformation in healthcare service in a large hospital. The visual diagrams have been described by the proposed approach using ArchiMate, an EA modeling language. The result showed the applicability of the method to visualize healthcare digital transformation.Conclusion: The proposed approach is effective to visualize the digital transformation in the healthcare industry by clarifying business values, models and processes. 57 Acute Toe Ischemia in a Patient Receiving Ergotamine , W Skouri, O.Hentati, H Tounsi, W Garbouj, M Eleuch, J Ouali, R Amri. 58 Relief Helpline by Voluntary Doctors in the Times of COVID19 , Ankur Rakesh and Shubhank Singh. The World Health Organization (WHO) declared the COVID19 as a pandemic on 11 March 2020 and as mitigation measures, countries adopted different strategies to control the spread, in-cluding social distancing and strict lockdown measures [1]. The re-public of India went into a strict nationwide lockdown on 24 March 2020. This was expected to deaccelerate the spread of the virus in the country but had expected collateral damage which included limited access for people with common ailments and psychological stress [2]. In any disaster, the first responders are always a mem-ber of the local community and COVID19 was no different. Here we share the experience of how a group of doctors came together to provide voluntary service to the public through phone and online consults to contribute to alleviating the suffering of the population amidst the pandemic. 59 Effects of a Combined Therapy of ATRA+VEGF on Distal Organs of Emphysematous Mice Model   , Shivangi Mishra, Megha Neolia, Sherya Patil, Amit Kumar Tyagi and Jai Prakash Muyal. Pulmonary emphysema is principally associated with the lung. The inflammation is the main cause of emphysema that triggers release of inflammatory mediators. Such inflammatory mediators might get spilled out from the lung to the proximal and distal or-gans, hence may affects other organ’s functioning as well. In this light, firstly, we attempted to determine the spillage of inflammatory mediators on liver and heart organs of emphysematous lung mice model. Secondly, to elucidate the beneficial role of ATRA+VEGF supplementation towards such spillage of inflammatory mediators by studying the antioxidant levels, which leads in tissue damage and hence affects its function. To analyse these two objectives, in silico study has been performed for the prediction of the gene interaction network between elastase, ATRA, and VEGF, respectively with extracellular regulated kinases (ERK) pathway. Furthermore, antioxidant levels and histo-pathology were studied in before elastase-treatment, after elastase-treatment and after elastase-treated group received ATRA+VEGF conditions using liver and heart tissues. Elastase-treated group received ATRA+VEGF has proven to be beneficial in reducing inflammation as the levels of anti-oxidants was significantly reduced. Moreover, the tissue architecture of liver and heart was improved due to the ATRA+VEGF supplementation. At last, gene interaction network results provide a promising role of ATRA and VEGF in rectification of inflammation via involvement of spilled out inflammatory mediators. However, an elaborate experimental study is further required to investigate the beneficial role of ATRA+VEGF therapy on ERK pathway towards amelioration of inflammation. 60 Effects of a Combined Therapy of ATRA+VEGF on Distal Organs of Emphysematous Mice Model , Shivangi Mishra, Megha Neolia, Sherya Patil, Amit Kumar Tyagi and Jai Prakash Muyal. Pulmonary emphysema is principally associated with the lung. The inflammation is the main cause of emphysema that triggers release of inflammatory mediators. Such inflammatory mediators might get spilled out from the lung to the proximal and distal or-gans, hence may affects other organ’s functioning as well. In this light, firstly, we attempted to determine the spillage of inflammatory mediators on liver and heart organs of emphysematous lung mice model. Secondly, to elucidate the beneficial role of ATRA+VEGF supplementation towards such spillage of inflammatory mediators by studying the antioxidant levels, which leads in tissue damage and hence affects its function. To analyse these two objectives, in silico study has been performed for the prediction of the gene interaction network between elastase, ATRA, and VEGF, respectively with extracellular regulated kinases (ERK) pathway. Furthermore, antioxidant levels and histo-pathology were studied in before elastase-treatment, after elastase-treatment and after elastase-treated group received ATRA+VEGF conditions using liver and heart tissues. Elastase-treated group received ATRA+VEGF has proven to be beneficial in reducing inflammation as the levels of anti-oxidants was significantly reduced. Moreover, the tissue architecture of liver and heart was improved due to the ATRA+VEGF supplementation. At last, gene interaction network results provide a promising role of ATRA and VEGF in rectification of inflammation via involvement of spilled out inflammatory mediators. However, an elaborate experimental study is further required to investigate the beneficial role of ATRA+VEGF therapy on ERK pathway towards amelioration of inflammation. 61 The Effect of Over the Counter and Synthetic Vitamin B6 (Pyridoxine) and Vitamin B12 (Cyanocobalamin) on the Behavior of Liver and Non-Liver Cells , Adriatico Aileen, Garcia Victor, Vega Huerta Salvador, Conway Michelle and Tawil Bill. The class B vitamins are involved in numerous essential metabolic pathways, it is critical to study the effects of these vitamins at length. In this study, the use of Human Foreskin Fibroblast (HFF) was used to optimize the Vitamin B concentration to be used later in Clone 9 (C9), liver epithelial cell line. The initial cell adhesion and cell proliferation percentages were measured at 5 ug/mL, 10 ug/mL, and 20 ug/mL of synthetic and over the counter (OTC) formulations of Vitamins B6 and B12. In general, HFF-1 and Clone 9 cells displayed favorable rates of proliferation when treated with varying concentrations of Vitamin B6 and Vitamin B12 and the combination of these with concentrations of 5 ug/mL, 10 ug/mL and 20 ug/mL. When administered separately, synthetic Vitamin B12 increased C9 cell proliferation more dramatically than synthetic Vitamin B6. The data suggests a synergistic effect increases cell proliferation the most. This is evident in combined synthetic vitamins B6 and B12 (10,000% increase at 20 ug/mL), but also present in the combined OTC vitamins B6 and B12 (6000% increase at 20 ug/mL). C9 cell morphology appears consistent in all the condi-tions except for the presence of dark pigmentation in the cells treated with combined B vitamins. The liver is an important organ in the body and performs a fundamental role in the regulation of metabolism, secretion, storage and detoxification. In conclusion, hepatic diseases are areas of concern, thus, it is necessary to identify substances for the treatment of liver diseases, protection of the liver and regeneration of hepatic cells. 62 Effect of COVID-19 Pandemic on Mental Health of Medical Students: Incite to Post-pandemic Response by Medical Educator , Dolapo Babalola. The pandemic caused by the novel severe acute respiratory syndrome coronavirus-2 has halted the education and clinical ex-posure of trainee medical doctors in medical education institutes as soon as the spread of the infection proofed uncontrollable in the country or region that homes the medical school. In addition, lock-down and reduction of social contact is a needed measure imposed on medical students just like on other undergraduate academic students, regular citizens, and other facet of the socio-economic system [1]. And this is understandable due to the high infectious rate of the novel coronavirus, the need to safeguard the lives of medical students, and the need to keep medically unripe medical students off the frontline COVID-19 treatment risk, among many other reasons. 63 Dural Arteriovenous Fistula Presenting with Exophthalmos, Hemiparesis and Seizures: Resolution after Endovascular Treatment - Case Report , Aminur Rahman, Sirintara Pongpech, Pakorn Jiarakongmun, Ekachat Chanthanaphak, Wittawat Takong, Kittiphop Somboonnithiphol, Thanaboon Worakijthamrongchai and Firoz Ahmed Quraishi. A concomitant focal seizure with left hemipaeresis and exophthalmos in the context of an aggressive cavernous dural arteriove-nous fistula (dAVF) is a variable neurological presentation. Here, we report a 73 years old female who presented with a 5-months history of progressive painless exophthalmos with conjunctival chemosis of right eye without any visual impairment. But now she had admitted to the hospital due to new onset of focal seizures with mild left hemipaeresis. Emergency MDCT scan brain showed suspected small malignant dural ateriovenous fistula of right sphenoparietal sinus with cerebral venous congestion and tiny hem-orrhagic venous infarction at right operculum and right exophthalmos. Cerebral angiography demonstrated right cavernous dAVF fed by branches from the right ascending pharyngeal artery and right middle meningeal artery, right accessory meningeal artery, bilateral arteries of foramen rotendum, dural branch of left vertebral artery with drainage to the right superior ophthalmic vein, right sphenoparietal sinus and right frontal cortical vein which was consistent with Cognard Type IIb dAVF. Successful transvenous embolization of the right cavernous via the right inferior petrosal sinus was done by using fibre coils and NBCA. Post- embolization control angiogram showed complete obliteration of right cavernous dAVF feeding vessels. Subsequent clinical follow up revealed that she had dramatic improvement of proptosis, chemosis and neurological symptoms along with cessation of seizures. 64 COVID-19: Containment Strategy and Related Complexities in Developing Countries; New Normal and New World Order , Sheikh Mohammad Fazle Akbar, Mamun Al Mahtab, Md Sakirul Islam Khan, Ananta Shrestha, SP Singh and Hasan Ozkan. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most likely originated from zoonotic coronavirus in China, has caused coronavirus disease 2019 (COVID-19). Currently, COVID-19, a pandemic declared by World Health Organization (WHO) in March 2020, has spread widely across the world, affecting 215 countries and territories, leading to more than 21 million confirmed cases, and 762,000 deaths. The virus is transmitted mainly via droplet infection and recently airborne infection has also been identified as a possible mode for transmission. The pathogenesis of COVID-19 seems to be highly complex and involve organs other than lungs and bronchial tree. Although the virus is not so cytopathic, it causes serious types of diseases by modulation the immune system of the infected persons. The health care delivery systems of developed and advanced countries, especially the Group Seven (G7) countries, formulated different programs to contain the pandemic. However, almost all developed countries, including the United States of America (USA) failed to provide a viable program for containment of the virus even after spending trillions of dollars. UK initially took an aberrant path to contain the virus and finally altered it. Germany, France, and Italy also had high morbidity and mortality. Canada tried to control the pandemic, but it also embraced considerable mortality. Among G7 member countries, Japan contained the virus with minimum cases and minimum mortality by profound cooperation from its people and due to its unique health system for all of it’s citizen. The countries those are in between G7 countries and developing ones are also highly affected by COVID-19 pandemic with considerable morbidity and mortality. Developing and resource-constrained countries are highly variable regarding their population, economic status, and nature of governance. All of them did their best to contain the pandemic. However, several long-lasting problems and realities as well as the 65 Parkinson’s Disease Patients with Dopamine Dysregulation Syndrome-Editorial Review , Hristina Popovska and Igor Petrov. Over the past decade, it has been identified a novel disease entity in patients with Parkinson’s disease, impulse-compulsive spec-trum disorder. Dopamine dysregulation syndrome (DDS) included in this group, is a syndrome characterized for a patients treated with dopaminergic therapy, especially Levodopa. The phenomenology of this syndrome is in a close relation with the current under-standing of the basal ganglia function and its impact on a long-term management in patients with Parkinson’s disease. Patients treated with dopaminergic therapy, develop cognitive and behavioral disturbances besides motor symptoms. The PD therapy which basically is dopamine replacement therapy (DRT) can relieve the motor symptoms. On the other hand, recent studies show that the same therapy can be a cause of behavioral alterations, especially when it is abused by the patients. It is very important to differentiate the psychological symptoms whether they are related to the disease itself or are Ð° side effect from the therapy. 66 Acral Myxoinflammatory Fibroblastic Sarcoma of the Foot: A Case Report , Khaled Khelil, Saber Saadi, Abderrazek Rafrafi, Rami Ben Arab, Talel Znagui, Nadia Boujelben, Mounira Khezami and Lotfi Nouisri. Myxoinflammatory fibroblastic sarcoma is a rare low grade malignant soft tissue tumor, mainly affecting middle-aged persons, and located in the distal extremities. The absence of clinical and radiological signs specific to this tumor makes it confused with many benign lesions and leads to inappropriate treatment. Though it is classified as a low grade tumor, it is reported to have an important infiltrative character responsible for a considerable rate of local recurrence. The therapeutic management of this tumor remains a subject of debate, there are no formal standard treatment protocols. In this presentation, we aimed to report the case of a patient with myxoinflammatory fibroblastic sarcoma of the foot treated successfully by surgery with adjuvant radiotherapy 67 Forecasting the Trends and Probable Impact of COVID-19 on South Asian Region Based on the Publicly Available Data , Ramesh Athe, Rinshu Dwivedi, Sravan Kumar Yadav Paka, Vishal Ambavade, Spoorthi M and Rajendra Hegadi. The COVID-19 pandemic has become a public-health threat globally exerting a devastating impact on patients, healthcare provid-ers, healthcare systems, and the financial health of economy. Undoubtedly, both developed and developing nations are struggling to control the pandemic, the situation is not different in the South Asian Region (SAR). Lack of social-distancing due to higher popula-tion, health-inequalities, lack of adequate health infrastructure, and unpreparedness of health-system is placing tremendous chal-lenge to control COVID-19 in these countries. Accurate predictions and forecasting are required for the readiness of healthcare sys-tems for future plan-of-action. The present study was undertaken to forecast the trends in outbreak of COVID-19 in SAR (7 countries) based on the publicly available cases data, drawn from the https://ourworldindata.org/coronavirus-source-data. We used Double Exponential Smoothing Model to predict the trends in the total confirmed and death cases caused by COVID-19. Findings reveal the highest point-forecast for confirmed (2.54%) and death (1.77%) cases in India. Similarly, lowest confirmed case rate has been recorded for nepal (0.71%) and in terms of death rate, Maldives (1.54%) recorded the lowest number of cases across SAR. Keeping in view the limited healthcare resources in SAR, accurate forecasting, strong disease-surveillance, and avoidance of acute-care for infected-cases is vital. 68 Occupational Hazards, Illnesses and Injuries among Nurses Working in Different Clinical Areas of Work (Units) , Namrata Arora Charpe and Rennie Joshua. Health and wellbeing of employees in the workplace are important concerns that should continue to receive attention in any organisation. Traditionally hospitals are directed towards curative services, not preventive services, it is very important to maintain optimum health of the staff in the healthcare industry as they take care of the sick clients. The study was conducted with the major objective to assess the risk and hazards faced by nurses in different clinical areas of work (Units). Quantitative descriptive cross-sectional method was used for the study. The study was conducted with a sample of 588 respondents (unit managers, registered nurses and assistant nurses). The findings revealed that nurses do encounter a considerable level of occupational hazards. Critical Care and Cardiology Unit were found to be the units with the highest risk of occupational hazards and injuries while the lowest risk was observed in the outpatient and day care unit. Chi square analysis of data revealed a significant association of Clinical Area of work (Unit) with exposure to blood borne pathogens and biological hazards, radiation, toxic fumes and anaesthetic agents, irritation from disinfectants and sterilants and chemical/toxic medicatio 69 Synthesis of Some Oxazine Compounds Derived from TDI and Schiff Bases   , Ghufran T Sadeek, Mohammad S Al-Ajely and Neam H Saleem. It is known from ongoing research on heterocyclic compounds that these compounds are used as drug and drug carriers, Accord-ing to FDI reports that these compounds forms 90% drug for cancer and 75% drugs for different diseases. It was also known from our studies on oxazine compounds that this type of heterocyclic compounds had versatile application in medicine. In this study, new 3,1-Benzoxazine compounds (S7-12) were prepared by cyclization reaction of some 2-(benzylidene-amino) benzoic acids (S1-6) with Toluene diisocyanate (TDI) under reflex conditions in chloroform. The structure of the synthesized compounds were confirmed by IR, 1HNMR spectral studies 70 Concept and Management of Nephritis (Waram- i Kuliya) in Unani Medicine , Quddusi N, Bilal Ahmad, Usama Akram, Mohammad Fazil and AA Khan. Unani System of Medicine puts great emphasis on lifestyle management for the promotion of health and prevention and treatment of disease. Therefore, it is of immense relevance to present times as lifestyle diseases are imposing the greatest burden on healthcare. With the changes in the lifestyle, many diseases have emerged in the past few decades. These include diabetes, hypertension lead-ing to kidney failure and other disorders especially in developing countries. Unani physicians have described a number of drugs to strengthen and tone up kidneys. These drugs help in restoring the functions of kidneys. The paper includes the concept of kidney disease with special reference to nephritis, its types and the single drugs along with their evidence based researches. 71 Successful Handling of Covid-19 in a Young Patient with SCID due to CARMIL2 (RLTPR) Deficiency: Case Report and Review of Literature , Khaled Mohammed Al-Qahtani, Ali Saleh Alhamdan, Wael F Alblowi, Mohammed Manei Al-Amri and Mohammed Hasan Almalki. The authors herein report a case of severe combined immunodeficiency (SCID) secondary to a rare genetic mutation of CARMIL2. Presented initially as a case of celiac disease then further investigated to reach the diagnosis of SCID secondary to CARMIL2. Further-more, the patient has got infected by the recent pandemic COVID-19 and surprisingly passed through the infection asymptomatically. Consequently, discussion regarding of the association and pathophysiology of SCID and COVID-19 and how the underlying disease affected the results of the course of the disease. Interestingly, in our case the rationale of asymptomatic presentation of the disease is not clearly explained in the current literature whether its due to escape of the cytokine storm that the infection causes. Our hypoth-esis is that due to the severe immunodeficiency in our patient, it evidently helped her to avoid dysregulated immune responses to the virus and escape possible immunopathology status. 72 Do Training Programs Change the Attitude of Health Care Providers toward Venous Thromboembolism Prophylaxis? , Ebtisam Bakhsh, Anas H Barakat and Emad R Issak. Background: Venous thromboembolism (VTE) is a universal health problem` which causes mortality. Prophylaxis of venous throm-boembolism is useful in decreasing mortality and morbidity rates. There is a worldwide deficiency in awareness about venous thromboembolism.Aims: To investigate the knowledge, attitude, and practice of venous thromboembolism prophylaxis between medical staff in Saudi medical community before and after a training workshop.Materials and Methods: This study includes three medical professions from 20 rural hospitals in Saudi Arabia. A survey was used to record their answers. Data analyzed using suitable statistical methods.Results: Training has a significant (p < 0.001) positive impact on the awareness of the availability of VTE guidelines (39.9% and 90.9%) before and after training, respectively. Also, the availability of risk assessment form has been increased (p < 0.001) after train-ing (37.5% and 89.1%) before and after training, respectively. Participants’ prescription of VTE prophylaxis for patients upon admis-sion was significantly (p-value < 0.001) increased (23.2% and 67.6%) before and after training, respectively. Before training, most of the hospitals had no mechanical prophylaxis devices (84.3%). However, after training this percent decreased (38.9%) significantly (p < 0.001). The most prevalent barrier to implement thromboprophylaxis guidelines fully was that each physician had his own ap-proach to provide thromboprophylaxis (50.2%). That was decreased significantly (p < 0.001) after training (35.6%).Conclusion: Training and education are very important to help increase the awareness and to change attitudes of health care provid-ers toward VTE prophylaxis. Addressing the barriers toward VTE prophylaxis implementation is necessary. Health care providers are willing to help in planning and implementation and this is an excellent strategy for implementation of VTE prophylaxis 73 Mini Review - Semi-solid Media for Transformed Cell Culturing   , Pratibha M and Abirami B Cell culture techniques help us to understand the cell biology in a much better way. Transformed cell culturing will be one of the useful methods to understand the cancer cell physiology and morphology but culturing of transformed cells in-vitro is a challenging task. The cellular outcome read-outs such as cell signals, cellular secretions, gene expression and downregulation, morphology, etc., vary depending upon the microenvironment given to the cells. Therefore, it is essential to culture the cells in an environment similar to in- vivo for understanding the cell biology behind various mechanisms. This mini review aims at summarizing the conventional and advancements in culturing the transformed cells. Different techniques are highly exploited to study transformed cells, with the most commonly used 3-D semi-solid media culturing method. It is a selective media with suitable substrate that supports the growth of anchorage-independent transformed cells and is useful to elucidate results from products of each cell differentially localized in the media. Early research using soft agar helped to understand and characterize the transformed cells whereas advancements in the semi-solid media helps to screen a wide range of anti-cancer drugs, to study gene regulation, and in biosensors. The major setback of this technique remains a hindrance to extract viable cells from the media. There by to overcome the drawback of conventional semi-solid media technique, over the years, various components are incorporated and substituted to provide a within reach in-vivo condi-tions. More recently, using semi-solid matrix/scaffolds like matrigel/laminin/alginate, co-culturing of other cells with transformed cells provides the in vivo like niche 74 Sleep Disturbances in Era of COVID-19 Pandemic , Shaleen Sunesara and Salim Surani. Coronavirus illness, also known as COVID-19, is an illness caused by a new coronavirus now referred to as severe acute respi-rational syndrome coronavirus 2. The virus was first identified in an outbreak of respiratory cases in Wuhan City, China. Most of the people who initially suffered from the illness in Wuhan had visited the Huanan Seafood market and as a result, the virus is perceived to have a zoonotic cause [1]. Coronavirus was first reported to the World Health Organization (WHO) on December 31, 2019. WHO, then declared the coronavirus pandemic an international medical emergency on January 30th 2020. Currently, the total coronavirus cases are more than 11.6 million with 537,000 deaths and 6.27 million recoveries [2]. In the United States, there are more than 3 million confirmed cases of COVID-19 where 132,000+ victims have died from this virus while 901,000 others have fully recovered 75 Impact of the Use of Safety Engineered Devices on the Rate of Needle Stick Injuries Caused by a Needle on a Disposable Syringe Among Emergency Nurses in Egypt , Ismail G, Noureldin A, Girgis S, Bassiouny R, El-Sayed A, Ahmed A, Elzamarany E, El-Sayed M, Hegazi A and Abdelghaffar H Background: Due to the recognition of risks associated with NSIs, safety strategies have been adopted to lessen the risk of injury and have shown to be effective in reducing NSIs.Methods: Eight university hospitals reporting the highest rates of NSIs (Phase 1) were selected for the intervention (Phase 2). Sharp injury protection syringes were supplied, and training on the use of safety devices was conducted. Questionnaires were re-adminis-tered post-intervention, focusing on injuries due to needles on disposable syringes.Results: Injury rates of at least one injury due to needle on disposable syringe in the past three months were significantly reduced from 30.3/100 person in phase 1 to 2.16/100 person in phase 2 (P-value < 0.0001). Conclusions: Results show that interventions using both educational training on universal precautions and safe work practices as well as the use of sharp injury protection syringes lead to reductions in NSIs among nurses. This is the first study that assessed the risk of needle on a disposable syringe in particular, followed by the implementation of safety engineered devices in attempt to lessen the risk of injury. Evaluations of safety interventions of this sort, across other departments of hospital units and among other person-nel are needed 76 Deciphering the Healthcare Expense with Focus on the Real Cost of Doctors to Patients in India , Sumangala Bhat K Indian healthcare service is dominated by the private sector and public funding for healthcare is minimal. The increasing cost of healthcare services brings in hardships to the underprivileged both in terms of accessibility and affordability, pushing many families into debt traps. Despite several survey and analysis reports available on various aspects of healthcare service in India, a practical analysis of the cost components and their relative contribution to the hospital bills is scanty. This study has been carried out con-sidering the criticality of finding the real cost enhancement components of healthcare. Hospital bills of random cases from India and abroad have been subjected for cost-split analysis under four heads like diagnostics, doctors’ consultation fees, medicines, and hospital facilities. The study has revealed hospital facilities as the top-ranking cost component (45%) followed by medicines (26%), diagnostics (24%) and doctors’ consultation (5%) in the Indian context. The pattern is slightly different in the other countries, with hospital facilities on top (45%), followed by diagnostics (22%), doctors’ consultation fees (19%) and medicines (14%). Hence there is a contrast in the hospital fees components other than hospital facilities between India and other countries compared. Doctors’ consultation fees ranked the least in India and last but one in other countries, with a large difference between them. Costs of the medicines and diagnostics are the real components contributing to the enhanced cost of hospital expenses in India 77 Oral and Intravenous Iodine Treatment - A Hope to Treat 2019-nCoV Virus Infected Patients , Mohammad Azizur Rahman To present intravenous iodine infusion (IVI) treatment, which has been used in serious bacterial infections in the past and has been off the agenda with widely used antibiotics. With the antiviral feature of iodine, to report the rationale of the use in patients with coronavirus infected and symptomatic patients. Also, to report the effective use of iodine therapy as an antiviral product that is safe, easy to use, easy to access and extremely cost-effective in the event of a possible excessive patient burden in hospitals. 78 Giant Thymolipoma Tackled with Clamshell Thoracotomy , Narendran Balasubbiah, Narasimman Sathiamurthy, Jasjit Singh Nijhar and Nurul Akmar Misron Thymus gland tumour with mature adipocytes named thymolipoma, is a slow growing benign tumour in the mediastinum which does not cause any symptoms till it grows to a significant size. This case report is about a patient presented with respiratory distress requiring intubation and intensive care admission due to a giant tumour in the mediastinum. It was diagnosed a thymolipoma after computed tomography imaging of the thorax showed a fat density tumour and a core biopsy revealing benign lipomatous lesion. Patient made a complete recovery after undergoing a clamshell thoracotomy and resection of tumour 79 IFR and IVUS on a Middle Lesion - Case Report , Visconti Mariano, Lopardo César and Cafaro Germán Complementary imaging methods and functional assessment of vascular lesions arises from the limitations of coronary angiography in certain scenes. We will talk about the use given to iFR, IVUS and SyncVision in a 75-year-old patient diagnosed with AMI who, after having undergone primary culprit vessel angioplasty, re-enters to the hemodynamic room for assessment of intermediate tandem injury in the anterior descending artery in proximal and medial segment. The iFR values were 0.68 distal, 0.94 between the two lesion and 0.99 proximal. IVUS and SyncVision showed an irregular and irregular calcified plaque with a luminal area of 3.5 mm2 on distal injury. We decided to treat only the distal lesion with a pharmacological stent (Microport Firehawk 3.0 x 13 mm) at 12 atm. After angioplasty, the iFR control had a value of 0.93 distal to the stent. IVUS showed stent under expansion. Post dilation was performed with a 3.5x8mm balloon with successful results. These complementary methods allowed us to carry out a focused therapy specifically to the segment that presented a hemodynamically significant lesion, without compromising the remaining segments or collateral branches, thus reducing the extension covered by angioplasty and avoiding the possible need to carry out therapy in an area that involves the origin of a large caliber diagonal branch 80 Membrane Vesicle - A Universal Mechanism Functional Transport in the Digestive System , Morozov IA and Tkachenko PE The article describes the mechanism and principle of the use of membrane vesicles in the implementation of the main functions of these organs: secretion of hydrochloric acid by parietal cells, absorption of nutrients in the small intestine and liquid at concentration bile by epithelial cells of the gallbladder. Evidence is given of the intracellular formation of hydrochloric acid in the tubulovesicles of parietal cells and the turnover of its secretory membranes during the secretory cycle, which ensures their multiple use and explaining the extraordinary lifespan of these unique cells. On this basis, a reliable mechanism of inhibition of HCl secretion by H+ -K + -ATPase blockers are described. The article discusses in detail the endocytic mechanism of absorption of ions and nutrients by enterocytes. The mechanism of participation of the apical contractile complex of brush borders of epithelial cells in the initiation of endocytosis and cytoplasmic microtubules in the transport of membrane vesicles through the cytoplasm is analysed in detail. Based on our own research and numerous works in the world scientific literature, it was concluded that there are two energy-dependent modes of transport in the absorptive epithelium of the digestive organs - transmembrane (ionic and nutritional) homeostasis, carried out by the ATPase system of the basal plasmalemma, and vesicular (endocytic), implemented by the apical complex edges and microtubules of the cytoplasm. Both modes of transport are interconnected and are under constant cellular control. It is concluded that this is directly related to the majority of cells, including those that secrete various substances: hydrochloric acid by parietal cells, enzymes by the main cells of the stomach glands and exocrinocytes of the pancreas, hormones by endocrine cells of the APUD system and, finally, mediators by nerve cells... To clarify the problem of cell transport, it is proposed to distinguish between two types of them: homeostatic and functional. The first is carried out mainly in relation to ions on the basolateral membrane with the help of its ATPase systems and provides intracellular homeostasis and nutritional co - transport, while the second (functional) determines the performance of the main specific function with the help of membrane vesicles 81 Ophthalmic Manifestations and Type 4 of Hypersensitivity of Steven Johnson Syndrome-Toxic Epidermal Necrosis in Infants-Management and Literature Review , Juna Musa, Blina Abdullahu, Ali Guy, Luela Hallunovaj, Amro Elrefaei, Benan Barakat, Ina Kola, Ermira Kola, Holgena Cepani, Inva Mamica and Alketa Tandili. The article describes the mechanism and principle of the use of membrane vesicles in the implementation of the main functions of these organs: secretion of hydrochloric acid by parietal cells, absorption of nutrients in the small intestine and liquid at concentration bile by epithelial cells of the gallbladder. Evidence is given of the intracellular formation of hydrochloric acid in the tubulovesicles of parietal cells and the turnover of its secretory membranes during the secretory cycle, which ensures their multiple use and explaining the extraordinary lifespan of these unique cells. On this basis, a reliable mechanism of inhibition of HCl secretion by H+ -K + -ATPase blockers are described. The article discusses in detail the endocytic mechanism of absorption of ions and nutrients by enterocytes. The mechanism of participation of the apical contractile complex of brush borders of epithelial cells in the initiation of endocytosis and cytoplasmic microtubules in the transport of membrane vesicles through the cytoplasm is analysed in detail. Based on our own research and numerous works in the world scientific literature, it was concluded that there are two energy-dependent modes of transport in the absorptive epithelium of the digestive organs - transmembrane (ionic and nutritional) homeostasis, carried out by the ATPase system of the basal plasmalemma, and vesicular (endocytic), implemented by the apical complex edges and microtubules of the cytoplasm. Both modes of transport are interconnected and are under constant cellular control. It is concluded that this is directly related to the majority of cells, including those that secrete various substances: hydrochloric acid by parietal cells, enzymes by the main cells of the stomach glands and exocrinocytes of the pancreas, hormones by endocrine cells of the APUD system and, finally, mediators by nerve cells... To clarify the problem of cell transport, it is proposed to distinguish between two types of them: homeostatic and functional. The first is carried out mainly in relation to ions on the basolateral membrane with the help of its ATPase systems and provides intracellular homeostasis and nutritional co - transport, while the second (functional) determines the performance of the main specific function with the help of membrane vesicles. 82 Case Report “A Dissecting Aneurism of the Aortic Arch at the Left Subclavian Origin Extending to Descending Thoracic and Abdominal Aorta with False and True Lumens” , Juna Musa, Loran Rakovica, Fjolla Hyseni, Ali Guy, Mina Mikel, Masum Rrahman, Marsela Ceno, Valon Vokshi, Viola Sulollari, Ineida Boshnjaku and Nosehy Yousef Aneurysm of the descending thoracic (DTA) and thoraco-abdominal aorta (TAA) is a life-threatening disorder given the risks of aortic dissection which requires quick and accurate diagnosis. However, correct diagnosis of AAD could be difficult in some instances because of the wide variety of clinical presentations. The clinical picture depends on the aortic branches involved, the size and direction of the dissection, the duration of symptoms, and the location of intimae tear.In this case report, 48 years old male presented with sudden onset of severe interscapular heaviness type of pain of three hours duration, associated with radiation to anterior chest wall and sweating. He is non-smoker but hypertensive. ECG showed sinus rhythm, with ST-depression and T-wave inversion in the infero-lateral leads. Timed multi-slice helical CT acquisition was taken and revealed a dissection flap of the aortic arch beginning nearly at the left subclavian origin extending up to involve the whole descending thoracic and abdominal aorta with false and true lumens. Cardio thoracic surgeon consultation was obtained 83 Anticancer, Antioxidant and Immunomodulator Ingredients of Halwa-i Gheekwar: A Review , Quddusi N, Bilal Ahmad, Usama Akram, Mohammad Fazil and AA Khan Halwa-i Gheekwar (HG) is a polyherbal formulation used in various diseases for preventive and curative purposes. It is prepared by adding herbal drugs to the base (Qiwam) which contains sugar. The formulation has been described to possess aphrodisiac, ner-vine tonic and laxative properties and is used to treat joint pain, lumbago, cough and dyspnoea. Single drugs, used as ingredients of HG include Withania somnifera, Elettaria cardamomum, Curcuma amada, Euryale ferox, Cinnamomum cassia, Orchis mascula, Alpinia galangal, Cinnamomum zeylanicum, Zingiber officinale, Asparagus racemosus, Syzygium aromaticum, Saussurea lappa, Celastrus peni-culatus, Rubia cordifolia, Juglans regia, Prunus amygdalus, Cocos nucifera, Chlorophytum borivilianum, Aloe vera,Phoenix dactylifera, etc., Cotemporary studies on these single drugs demonstrate their activities as anticancer, antioxidant and immunomodulator agents. This review article has discussed the medicinal importance of HG in the light of recent studies on its individual ingredients. 84 Anti-Suit-Injunctions in Germany , Johann Pitz ACTA SCIENTIFIC MEDICAL SCIENCES (ISSN: 2582-0931) Volume 4 Issue 10 October 2020Anti-Suit-Injunctions in GermanyJohann Pitz*Vossius and Partner in Munich, Germany *Corresponding Author: Johann Pitz, Vossius and Partner in Munich, Germany.Short CommunicationReceived: August 19, 2020Published: September 17, 2020© All rights are reserved by Johann Pitz.Anti-suit-injunctions (ASIs) are court-ordered, cross-border litigation prohibitions with the aim of preventing proceedings in other countries than the location of the court by way of interim injunctions. These are not directed against the foreign court itself, but rather against the plaintiff with the aim of prohibiting the initi-ation or continuation of parallel court proceedings. While this legal instrument has a long tradition in common law countries such as the UK and the USA, it is so far not recognized in the civil law ju-risdictions across Europe apart from UK. In multinational disputes concerning standard-essential patents (SEPs) ASIs have been granted by US and UK courts in order to block parallel national infringement proceedings elsewhere until a decision on the world-wide FRAND license was reached before the UK or US courts 85 Aquapathogenesis is the Nature of Human Diseases Dynamic Hirudotests: New Possibilities of Integral Diagnostics of the State of Human Bodies and His Systems - Study of the Dynamism of the Human Aquasystem , AI Krashenyuk The article is devoted to the review of dynamic hirudotests developed by the author and based on well-known biophysical static methods: the Akabane thermopuncture test, the Kirlianography test (Gas-discharge visualization - GDV), and the information-entro-py method of academician. G.N. Dulnev with the new device “Eniotron-3”. Professor Postnov’s S.E. Boundary water and the “SPE-effect” (Sinitsyn-Petrosyan-Elkin) method were used as additional test systems. “SPE-effect” implemented with the original “Aqaphone” device 86 Chemical Health Risk Assessment (CHRA) in a Wet Assay and Fire Assay Laboratory (WAFAL) , Arif Susanto, Mila Tejamaya, Roro N Wulan and Edi K Putro Numerous chemicals with a variety of characteristic can be found in every laboratory, including in quality control in a wet assay and fire assay laboratory (WAFAL). Contact with those chemicals might pose health risks to workers and therefore this should be carefully controlled. Thus, chemical health risk assessment (CHRA) needs to be performed in any laboratory in order to recognize, assess, and control the risks arising from these chemicals. This study was aimed to semi-quantitatively assess the level of chemicals health risks from 11 chemicals that were used in WAFAL. Both the inhalation and dermal route of entry were evaluated. 7 chemicals were found as hazardous to inhalation route of entry, 8 chemicals to dermal contact, and three of them both hazardous to inhalation and dermal route of entry. Through inhalation, it was found that six chemicals were at moderate risk, and one chemical at low risk to human health. On the other hand, high health risks were shown by dermal contact of six chemicals, and other two chemicals were at moderate risk. 87 Is it Possible the Training of Prospective Memory to Enhance Activities of Daily Living and Executive Function in People with Mild Cognitive Impairment? A Single-blind Randomized Controlled Trial , Christina Agogiatou, Nefeli Markou, Eleni Poptsi and Magda Tsolaki. Objective: The majority of elderly have deficits in Prospective Memory (PM) which are associated with difficulties in activities of daily living (ADL). Until today, only a few studies of prospective memory training have seemed to improve the cognitive functions, nevertheless this benefit has not been transferred to ADL. The aim of this study was the enhancement of executive functions, the generalization of training to other cognitive domains and the transference of these benefits to ADL. Methods: From 156 patients with Mild Cognitive Impairment (MCI) who were examined at our Neurological Department and our day center, 102 people were randomly classified in one experimental Prospective Memory Group (PM/G) and one Control Group (C/G), matched in age, gender, education, cognitive and functional status. Sixty-two out of them completed the study. The PM/G (n = 33) attended 48 one-hour sessions of PM training, twice a week for 6 months whereas the C/G (n = 29) did not participate at any intervention and were in a waiting list. Neuropsychological assessment including a test for PM was performed at baseline and after the end of the intervention. Results: At the follow up, the PM/G outperformed the C/G in working memory (p < 0.05), in verbal fluency (p < 0.05), and in ADL (p < 0.05). At the end of the training the PM/G improved verbal memory (p < 0.05), verbal fluency (p < 0.05) and ADL (p < 0.05). The C/G showed deterioration in verbal fluency (p < 0.05) whilst remained at the same performance level of ADL. Conclusion: The PM intervention via the utilization of the decided tool, didn’t succeed in improving PM, however it helped partici-pants to improve executive functions, verbal memory and ADL 88 Incidence and Causes of Needlestick Injury among Nurses in Emergency Departments of Egyptian University Hospitals   , Ismail G, Abdel-Raouf H, Abdel-Wahab S, Abdullah A, Anwar M, Bassyouni R, El-Amir M, El-Sayed A, El-Zamarany E, Girgis SA, Higazi A, Rashed H, Sayed A, Zakki M, Bayan N and Abdelghaffar H Background:Rates of NSIs among hospital HCWs worldwide range between 14.9% to 69.4%, with the highest rates occurring in nurses. In Egypt several NSI studies have already been published, but there has been a gap in research since 2013.Objective: The present study aims to provide an updated assessment of the current situation of sharp injuries among nurses across several university hospitals in Egypt.Methods: A cross-sectional survey was conducted on 895 nurses across 13 university hospitals in Egypt between September 2018 and February 2019. A self-filled survey was administered, collecting detailed information on the history of every NSI incident occur-ring in the past 3 months.Results: 41.5% (n = 371) of nurses reported ≥ 1 NSI during the past three months. Hollow needles were the most common category of sharp device injury (81%) and 54.3% of injuries occurred when the devices were used for injecting a patient. Nurses that received safety training in the past year and reported a job experience of > 10 yrs were at a lesser risk of experiencing a NSI. Conclusion: The rate of NSI indicates a high risk of blood borne infections among HCWs in Egypt. Without appropriate assessments of the burden of NSI, directed prevention efforts, availability of pre and post-exposure prophylaxis for bloodborne injuries and exten-sive training programs for HCW, NSIs will remain a major challenge. 89 Determination of Phytochemical and Antioxidant Activities of Aloe vera Gel Extracts , Mohammed Fadlalla Mohamed, Salma Elghali Mustafa and Omer Abdalla Ahmed Hamdi This study aimed to determine the phytochemical and antioxidant activities of Aloe vera gel extracts. The phytochemical obtained by different methods(methanol macerated, methanol soxhlet and aqueous extract). The extract of Aloe vera Gel was subjected to primary phytochemical screening. Methanol macerated method revealed the presence of various phytochemicals. It resulted in the abundance of flavonoids, terpenoids, steroids, tannins, alkaloids, phenolic compounds, quinines, anthraquinones, and saponins. The results for the flavonoids, tannins and Alkaloids concentrations were 3.45, 1.20 and 2.60%, respectively. To investigate the antioxi-dant activity, Aloe vera Gel was successively extracted using n-hexane, dichloromethane and methanol. These extracts were analyzed using the DPPH radical scavenging method. The results found that the methanol extract is more effective in the free radical antioxi-dant (66.85%) followed by Dichloromethane (36.80%) and then Hexane (26.85%) 90 Circumstances of Discovery of Arterial Hypertension (AHT) in a Department of Internal Medicine in Lomé (Togo) , Komi Dzidzonu Nemi, Lihanimpo Djalogue, Abou-Bakari Tchala, Kodjo Agbeko Djagadou, Toyi Tchamdja, Yawovi Mawufemo Tsevi, Komi Edem Mossi, Abdou Razak Moukaila, Abago Balaka and Mohaman Awalou Djibril. The aim of this study was to describe the circumstances in which arterial hypertension was discovered in known non-hyperten-sive patients admitted to the Internal Medicine department of the Sylvanus Olympio teaching hospital of Lomé. It is a retrospective and descriptive study conducted from 1st January 2015 to 31 December 2017 from the files of patients with hypertension in whom the diagnosis of hypertension was made in the Internal Medicine department. During the period of study, 176 patients suffering from arterial hypertension were received in the department. Among them, 105 were not known to have hypertension. The average age was 55, 69 years (extremes of 20 and 89 years) with a sex ratio (M/F) of 0, 90. Hypertension was essential in 97, 14% (N = 102) and secondary in 2.85% of cases (N = 3). It was grade 1 in 28, 57% (N = 30); grade 2 in 44, 76% (N = 47) and grade 3 in 26, 66% of cases (N = 28). Cardiovascular risk factors associated with hypertension were diabetes mellitus (55, 23%), obesity (15, 23%), dyslipidae-mia (8, 57%, family history of hypertension (7, 62%) and alcoholism (6, 67%). The discovery of hypertension has been fortuitous in 79, 19% of cases (N = 80). It has been revealed by symptoms in 13, 33% (N = 14) and by complications in 10.47% of cases (N = 11). hypertension unknown is frequent in the Internal Medicine department of the Sylvanus Olympio Teaching Hospital, especially in diabetics. More emphasis must be placed on its prevention in our country by promoting new methods of raising awareness and educating the population. 91 First Comprehensive Entomological Surveillance of Mosquitoes in Central Iran with Focus on Invasive Species , Fatemeh Abedi-Astaneh, Asghar Talbalaghi, Mohammad Nikpour, Ali Abbasi, Mostafa Abdollahi, Mohammad Javad Bagheri, Mohammad Elmifard, Taher Orooji and Ahmad Oveis Mosquitoes are well-known vectors of some medically important diseases worldwide. Vector-borne diseases (VBD) account for 17% of all infectious diseases and more than 90% of the world’s population is at risk of vector-borne diseases. Monitoring of mosqui-to populations is essential prior to the implementation of any population management strategies. According to the recommendations of international health authorities, such as the World Health Organization, the standard design for collection of adult mosquitoes is a key operation to address the issue of VBD. In view of the incidence of Zika, Chikungunya and Dengue Fever epidemics in countries neighboring Iran and tackle the occurrence threat of VBD, a surveillance action was implemented in the Province of Qom, Iran, in line with the actions of local law enforcement authorities; the city of Qom is, the holy city of the Shiite religion and is rich in sacred places, such as the sanctuary of Bibi Fatima Masoumeh and the Holy Mosque of Jamkaran. It is characterized by the presence of pilgrims of different ethnic backgrounds from Iran as well as from over 100 countries world-wide. The city of Qom (Figure 1) acts as crossroads for the country, and can be at risk of transmission of mosquito-vectored diseases. Considering the risk of transmission of the above-mentioned diseases, in addition to West Nile Virus, not transmitted by Aedes mosquitoes, a qualitative entomological investigation of all mosquito species, including the invasive species, Aedes albopictus and Aedes aegypti, was conducted.One of the outcomes of this study was cooperation and scientific contribution of the two countries, Iran and Italy, on the popula-tion management strategies of Aedes albopictus. Rather extensive Italian experience was carefully utilized in designing the current scientific work concluding in publication of a manual in Farsi as well as in Italian languages entitled, “Lessons Learned from Rome to Qom in the Study of Aedes”. Until now Iran has not been seriously considered at the risk of invasive mosquito species and the present study will be of help in the population management in the event of eventual establishment of invasive mosquito vector spe-cies. This contribution provides information concerning early and rather broad entomological surveillance conducted on mosquito populations in central Iran and on the risk of related VBD. During the 28 weeks of a field collecting campaign, a total of 83,414 adult mosquitoes were collected. During the investigation, no invasive mosquito species were recorded. There was a total of 15 mosquito species belonging to 5 genera in the collections. In addition to mosquitoes, 933 specimens of sandflies were also collected which were initially not the objective of the study. The field-collected mosquito data were analyzed using GIS and SPSS 92 Utilization of Healthcare Services during COVID-19 Lockdown- A Community based Mixed Approach , Saravanan Chinnaiyan, Suhanya Rajakumari G and Sophia Eveangelin C. Background: India reported its first case on January 30th, 2020. As the virulence and infectivity of COVID-19 progresses, the Govern-ment of India ordered national lockdown from 24th March to break the transmission of viruses. More than 100 days of lockdown created an arduous effect in access to healthcare for various reasons.Aim: To evaluate the utilization of healthcare services during COVID-19 lockdown.Methods: It is a community based mixed study. Participants were selected by simple random sampling for quantitative method and convenience sampling is used for the qualitative Method. Univariate and thematic analysis was performed. Results: Among 246 Participants, only 12.2% had access to healthcare facilities. 86% of respondents were screened for COVID-19 before entering the hospital. Nearly 78% of the respondents haven’t followed up their regular health check-ups. About 81.7% wor-ried about their health status and only 17.5% had telephonic and web consultants. Conclusion:Making proper priority planning and channelization of healthcare facilities for all types the patients and irrespective of the age group can reach out to healthcare foremost during the pandemic crisis. Child and maternal health services, vaccination, immunization, treatment of tuberculosis (DOTS),hemodialysis, and cancer treatment (chemotherapy,radiotherapy) should be handled with proper care and prime concern. 93 Optimal Preparation for Safe Airway Management During Covid-19 , Hassan Shaaib and Muhammad Ali Abbas. Airway management is the core skill of anesthesiologists, intensive care units, and emergency care providers. Clinicians assured that oxygenation is not possible without an open and safe airway. The Severe Acute Respiratory Syndrome-Corona-2 Virus (SARS-CoV-2), which causes COVID-19, is encapsulated with single-stranded ribonucleic acid and is highly contagious. Authors believed that the transfer of the virus occurs primarily through direct contact with the patient or contaminated surfaces or through the spread of droplets (i.e., relatively large particles deposited in the air) and smaller particles staying longer in the air. Any airway management or procedures in emergency, operation theatre, and intensive care departments can produce aerosols to increase the risk of contamination. For the above reason, healthcare professionals who are treating patients with COVID-19 are at risk of developing the disease. The purpose of the current study is to review the methods that reduce the risk of an airborne viral spread, maximize the early attempt success, and encourage the use of indirect glottic visualization with video laryngoscopy (VL). The mentioned measures are approved to reduce personnel exposure in all adult COVID 19 patients who are requiring airway management in all emergency departments, hospital wards, and ICUs. The author highlights the needed measures that require to be taken for the safety of the health care workers associated with the airway procedure while providing high-quality patient care to the COVID-19, suspected, or confirmed patients 94 Role of Artificial Intelligence in Health Care: Are We Ready? , Pahnwat Tonya Taweesedt and Salim Surani Roomba. Self-driving cars. Spotify. Although these are all seem-ingly different entities from one another, they all have at least one thing in common. They use artificial intelligence (AI) and related technologies to complete tasks and simplify the user experience. As AI continues to gain prominence in modern-day computing systems, companies that offer consumer products or services have started to implement these technologies into their final products and workflows. The healthcare industry is also beginning to adopt these technologies as they offer improvements to aspects of pa-tient care, research applications, and administrative processes. So, what exactly is artificial intelligence and what benefits does it con-fer to healthcare? 95 The Effectiveness of Combined Mental Practice and Conventional Physiotherapy for the Improvement of Upper Extremity Function and Activity of Daily Performance in Post-stroke Hemiplegic Patients: A Comparative Study , Basil Kum Meh, Maurice Douryang, Franklin Buh Chu, Alain Marsanaud Tedah, Emmanuel Sako Haddison, Faustin Atemkeng Tsatedem and Joseph Fondop Objective: To evaluate the effectiveness of Conventional Physiotherapy (CP) alone versus Conventional Physiotherapy (CP) associ-ated to Mental Practice (MP) on post-stroke hemiplegic patients.Methods: An experimental study was undertaken on 20 post-stroke hemiplegic patients (sub-acute and chronic). Participants were allocated into two groups using consecutive sampling: the experimental group (11) received MP+CP while the control group (09) received CP alone. The experimental group received 20 minutes of MP+CP 3 times a week for 5 weeks. The control group received CP alone. The Wolf Motor Function Test (WMFT) and the Frenchay Activity Index (FAI) was used to evaluate UE functions and ADP, respectively by a blinded rater. Results: In the Experimental group: the mean scores for the WMFT and FAI before treatment were 40.0 and 38.5, 28.4 and 24.5 for the sub-acute and chronic patients respectively; after intervention, they were respectively; 56.3 and 36.4, 33.2 and 26.5.While in theControl group: before treatment, they were respectively; 28.9 and 33.0, 22.4 and 28.4. After treatment, we had; 41.5 and 27.5, 25.3 and 26.0. Conclusion: MP+CP was found to improve post-stroke hemiplegic patient’s UE function and ADP after five weeks of treatment. 96 “Multi Molecule Theory” with Gravitation as Binding Force between Molecules Can Explain Brownian Motion , Satyavarapu Naga Parameswara Gupta Here in this paper we try to explain one of the foundations of Nanobiotechnology, i.e., the Physics portion. This paper is based on FINAL results of 4th paper we developed for explaining. What are the foundational reasons of Brownian motion and how it works? The Physics and the calculations behind the force and individual velocities of molecules with relevant theoretical analysis as proposed in the FIRST paper. In the fourth paper, more than 7000 iterations were conducted, and concluded ‘Gravitation’ is the final force of attraction between molecules. So, for explaining Brownian Motions, we can safely infer that the force field between Molecular pairs is Gravitation. In this paper we will discuss the positive theory behind MMT.We also observed that “Gravitation” as the force of attraction is NOT sufficient to give enough force between a single pair of Mol-ecules. But the collective vectoral sum of these forces of Multiple molecules in MMT, with sufficient number of iterations will explain these motions. For this theory of MMT EXCEL simulations were developed about month back. Keywords: Nanobiotechnology; Multi Molecule Theory; Dynamic Universe Model; Gravitation; Force Field; Subbarao Simulations; Grazing Radiation Frequency Changes; Formation of Elements; Nucleosynthesis 97 Pandemic and Modern Medicine: Time to Recognize and Correct Previous Misconceptions , Igor Klepikov A year ago, few people doubted the scientific validity and prac-tical feasibility of existing approaches to the treatment of acute pneumonia (AP). Even the use of a single antibiotic as the main treatment for completely different and disparate diseases was a common situation, the contradiction of which to the basics of clini-cal medicine was not questioned. The activity of antibiotics only against bacterial pathogens without additional effects on other manifestations of the disease did not prevent them from achieving the image of an almost panacea 98 Evaluation of Route of Administration (Via Portal Vein) for Assessing the Role of Stem Cell Therapy in Cirrhosis of Liver , Mamun Al Mahtab, Ahmed Lutful Moben, Md Abdur Rahim, Md Ashraful Alam, Faiz Ahmad Khondaker, Sheikh Mohammad Noor-E-Alam, Md Sakirul Islam Khan, Md Zahurul Huq, Musarrat Mahtab and Sheikh Mohammad Fazle Akbar Aims and Objectives: The safety and efficacy of stem cell administration via portal vein was assessed in patients with cirrhosis of liver (LC). Materials and Methods: In order to increase the numbers of white blood cell, 20 patients with liver cirrhosis were administered with granulocyte colony-stimulating factor at a dose of 60 IU, daily for 3 to 4 days. Stem cells were isolated from these patients as CD34-positive cells and variable numbers of autologous stem cells were injected to LC patients for once. Various hematological and clinical parameters of these patients were evaluated at point 0 (before administration of stem cells) and 1 and 3 months after admin-istrations. Results: None of these 20 patients died within 3 months of observation period. Regarding safety issues, there was no notable adverse event including acute liver failure related to stem cell therapy in these patients. Stem cell therapy had a dominant effect on ascites in this cohort. Although 7 of 20 patients had ascites at the start of therapy, 2 of these patients became ascites free at the end of 3 months of follow up. On the other hand, 5 patients of LC who did not have ascites at base line developed ascites during therapy. Different bio-chemical parameters of these patients remain mostly unchanged and did not show any significant difference dur to stem cell therapy. However, serum albumin level was increased significantly after 1 and 3 months. Conclusion: The safety of stem cell therapy via portal vein has been shown here. The efficacy of stem cell therapy via portal vein may not be notable. However, observed effects of this therapy on ascites reduction in some patients and on effect on serum albumin indicate that repeated administration of stem cell therapy may be needed for maintaining quality of life. 99 Behavioural and Psychological Problems in Dementia , Swaleha Mujawar, Miliind Sose, Chetan Dewan, Suprakash Chaudhury and Daniel Saldanha Behavioural disturbances in the form of agitation and aggression occur frequently in persons with dementia. Mean prevalence of behavioural disturbances in dementia is reported to be as high as 46.2%. Various psychological and behavioural symptoms reported in dementia apart from agitation and aggression include apathy, delusions, hallucinations, irritability, eating disturbances and sleep disorders. Other symptoms seen include hyperactivity, affective symptoms including depression and anxiety. The neurobiological changes seen in dementia include decrease in cholinergic and serotonergic activity, alterations in the noradrenergic systems; de-crease in the norepinephrine level and an increase in the level of its major metabolite 3-methoxy-4-hydroxyphcnylglycol. Tools used for assessing include the behavioral pathology in Alzheimer’s disease rating scale (BFHAVE-AD), the Cohen-Mansfield Agitation In-ventory (CMAI), the neuropsychiatric inventory (NPI) and the behavioral rating scale for dementia (BRSD). A variety of treatments are available to alleviate the behavioural symptoms. Antipsychotics have been found to be the treatment of choice for behavioural disturbances. Treatment of depression in dementia comprises pharmacotherapy and nonpharmacological strategies, such as psy-chological interventions to enhance quality of life. Psychological intervention begins with the development of a daily routine and the organization of activities which the patient enjoys. A detailed treatment regime is discussed in the article below 100 Rules of Engagement in Minimal Blood Loss Palatoplasty Using Saline Hydro Dissection: A Useful Learning Curve for Younger Cleft Surgeons in Manoeuvring Areas of Static Resistance due to Tight Tissue Planes , Bona Lotha and Zeinalddin M Minimal blood loss in palatoplasty can be achieved with adrenaline saline hydro dissection, and a good knowledge of key anatomi-cal structures as well as the stubborn areas of static resistance, where dissection is difficult because of fixed tissue planes. With the advent of minimal incision palatoplasty, button-hole and medial-only incision procedures, the amount of blood loss is significantly re-duced in most palate operations. The two-stage palate repair also leads to less blood loss and is a popular concept among cleft groups worldwide following the initial promotion by Swedish cleft groups at Gothenburg. The learning curve is reasonable and techniques can be added, as one gains more experience with cleft palate surgeries 101 BactClass: Simplifying the Use of Machine Learning in Biology and Medicines , Tian Tong Liu and Maurice HT Ling Machine learning has many applications in biology and medicine. However, most existing tools require substantial programming skills, which can be a challenge to many biologists. Here, we present BactClass as a command-line tool for machine learning algo-rithms on formatted data, aiming to reduce the challenges faced by biologists who are interested to use machine learning approaches. BactClass is part of the Bactome project (https://github.com/mauriceling/bactome) and is licensed under GNU General Public Li-cence version 3 for academic and non-commercial purposes only 102 Wandering Diagnosis of Rheumatoid Arthritis in Lomé: Regarding a Case Secondary to Self-Medication based on Diclofenac for 11 Years , Komi Dzidzonu Nemi, Kodjo Agbeko Djagadou, Abou Bakari Tchala, Komi Edem Mossi, Abdou Razak Moukaila, Lihanimpo Djalogue, Toyi Tchamdja, Abago Balaka and Mohaman Awalou Djibril. This is a 45-year-old housewife who was referred by a paediatrician for an inability to lead an active life following polyarthralgia with bilateral deformity of the hand and bilateral knee swelling requiring self-medication based on diclofenac for 11 years without success. The examination on his admission noted a blood pressure = 151/120 mmHg, a deterioration of the general condition, the ulnar gale and a bilateral knee swelling. Additional tests have enabled to note: a biological inflammatory syndrome, microalbumin-uria (165mg / 24h), one of bone mineralisation focal both wrists, a global toe interphalangeal distal joint spaces and metacarpopha-langeal joint of the 3 rd ray right with erosion the adjacent metacarpal head, and multiple geodes of the carpal bones with bilateral carpal joint space pinching with tendency to form carpal block. There was also left atrial hypertrophy and apico-lateral subepicardial ischemia on the electrocardiogram and papillary excavation at the fundus. The diagnosis of rheumatoid arthritis was made based on a score greater than 6 from the American College of Rheumatology and the European League Against Rheumatism (2010). Man-agement was carried out by corticosteroid therapy based on prednisone combined with functional rehabilitation of the joints. The frequency of rheumatoid arthritis would be underestimated in our country because of self-medication since the disease is sensitive to NSAIDs very accessible to the population, especially in illicit drug sales markets. We must make our populations more aware of the harmful effects of this practice. 103 Understanding Quality Assessment in Research and Meta-Analysis , Dhananjoy Shaw, Syed Murtaza Hussain Andrabi and Deepak Singh In academia, research is utilized as an indispensable tool for either discovering or inventing new knowledge or modifying the current knowledge of the academic discipline. Numerous types of research designs are used in the academic research and each design has its own advantages and disadvantages [1]. How much a particular research design contributes to the ultimate aim of research (i.e. finding new knowledge or modifying the current knowledge) determines the superiority of that research design in comparison to others. A technique that ranks the research designs based on their contribution to the advancement of knowledge or the modification of the current knowledge is known as the hier-archy of evidence. Hierarchy of evidence is defined as a technique to ranks the study or research designs on the basis of the relative strength of their results or evidence 104 An Observational Study Regarding Usage of Favipiravir for COVID-19 Therapy , Md Azizul Islam, AKM Faizul Huq, Azizur Rahman, Md Sakirul Islam Khan, Mamun Al Mahtab and Sheikh Mohammad Fazle Akbar Background: A pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (CO-VID-2019) has shattered the globe with no prophylactic vaccine or anti-SARS-CoV-2 medication inducing a morbidity of more than 75 million patients and mortality of more than one million individuals in the world. Aims: This open level observational study has been designed to assess the therapeutic potentiality of favipiravir, an antiviral drug, originally developed for another coronavirus in patients with mild COVID-19.Materials and Methods: A total of 45 COVID-19 patients positive for (SARS-CoV-2) confirmed by polymerase chain reaction (PCR) of nasal swab were enrolled in this study in Combined Military Hospital (CMH), Dhaka, Bangladesh. The patients were provided with standard of care (SoC) plus favipiravir for 10 days. Results: No notable adverse event was recorded due to usage of favipiravir in these patients during the observation period. All pa-tients became negative for SARS-CoV-2 and they were discharged from the hospital within a mean period of 12.4 days (the shortest period being 3 days and longest was 30 days).Conclusion: Although this is an open level study, it seems that favipiravir is safe and effective for treatment of mild COVID-patients. However, a double-blind, controlled study with large sample size would be required to validate its clinical usage and registration 105 Amputation Treatment with Least Number of Postoperative Complications based on the Atherosclerotic and Diabetic Changes of Blood Vessels of Lower Extremities , Demil Omerovic, Adnan Papovic, Adnana Talic-Tanovic, Edina Tanovic, Amila Jaganjac, HadÅ¾an Konjo, Emina RovÄanin and Hana Omerovic Atherosclerosis is the most common arterial damage characterized by blood clotting due to the local thickening of the intima that is called atheroma or plaque. It is usually not diagnosed until critical stenosis, thrombosis, aneurysm or emboli occur. If severe artery clogging occurs, there is high risk for lower extremities, where gangrene appears to be the major consequence that has to be surgi-cally treated by an amputation treatment. This study is a retrospective comparative study that includes 124 patients, both genders, of different age groups. The aim of the study is to show the effects of amputation procedures with the lowest complication rate due to lower extremity vascularization. This study has shown that atherosclerotic and diabetic changes of the blood vessels of the lower extremities are more common in male gender, in the third age range where clogging is most often verified on the pedal arteries causing the gangrene of the toes. The most common surgical procedures are amputation of the toes with the most common complication defined as edge inflammation, while the lowest number of local complications was observed in the lower and upper leg amputations.Since it has been proven that advanced atherosclerosis cannot fully regenerate, the goal of the treatment is to reduce the effect of the disease through prevention. Special attention should be made to male gender in third age range with comorbidities, and if the need for surgical treatment becomes necessary, it is to be realized in accordance with the findings of the blood flow rate at the lower extremities without delay 106 Covid-19 and Mental Health of Health Professionals in India , Bhakti Murkey, Sureshkumar Mehta and S K Verma Uncertainty generates anxiety and the advent of Covid-19 has taken uncertainty to another level for the human race. This dis-ease caused by the SARS-CoV-2 virus was identified as a public health emergency by the World Health Organization and declared a pandemic on 11th March 2020 [1]. History has been re-written since then, with up to two-thirds of the world’s population under ‘lock-down’ and an exorbitant economical crisis, contracting the world’s GDP and causing unemployment world-wide. The entire healthcare sector has been shaken with the increasing number of infected people and a major proportion losing their lives to the same. Not only general population, but doctors and healthcare professionals in particular have succumbed to this grave adversity. 107 The Role of Zingiber officinale (Ginger) Extract in the Kiss1 Gene Expression in the Ovary and Blood of Wistar Rats , Izuchukwu Azuka Okafor, Uchenna Somtochukwu Nnamah, Johnson Okwudili Nweke, Jude Amechi Nnaka, Selasie Ahiatrogah, Uche Valentine Okeke and Chukwuemerie Christian Okoro Background: Ginger (Zingiber officinale) is one of the most commonly consumed dietary condiments and herbal supplements in the world. Aim: This study investigated the effect of methanolic extract of Zingiber officinale (MEZO) on the expression level of the Kiss1 gene in the blood and ovary of Wistar rats. Methods: Fifteen (15) Wistar rats with an average weight of 147g were randomly divided into three (3) groups (A-C). Group A was given no treatment and served as the normal control group. Groups B and C received only oral administration of 200 mg/kg and 400 mg/kg of MEZO respectively. MEZO was administered once a day for 21 days. Results: Group C showed a significantly reduced relative intensity of Kiss1 gene expression in the blood compared to the control (p = 0.006). There is also a significant increase between the expression intensity observed in the blood compared to the ovary in each experimental group except in group C (group A = CI: 0.55 - 0.94, p = 0.013; group B = CI: 0.69 - 0.86, p = 0.001; group C= CI: -0.09 - 0.73, p = 0.076). However, there is no significant correlation (between the Kiss1 gene relative expression intensity and reproductive hormones. There is no significant difference in the hormonal levels, oxidative stress, and relative ovarian weights across the experi-mental groups (p > 0.05).Conclusion: High dose of MEZO showed the potentials of causing the downregulation of Kiss1 gene expression in the blood without any corresponding change in the reproductive hormonal levels 108 An Observational Study Regarding Usage of Favipiravir for COVID-19 Therapy , Md Azizul Islam, AKM Faizul Huq, Azizur Rahman, Md Sakirul Islam Khan, Mamun Al Mahtab and Sheikh Mohammad Fazle Akbar Background: A pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (CO-VID-2019) has shattered the globe with no prophylactic vaccine or anti-SARS-CoV-2 medication inducing a morbidity of more than 75 million patients and mortality of more than one million individuals in the world. Aims: This open level observational study has been designed to assess the therapeutic potentiality of favipiravir, an antiviral drug, originally developed for another coronavirus in patients with mild COVID-19.Materials and Methods: A total of 45 COVID-19 patients positive for (SARS-CoV-2) confirmed by polymerase chain reaction (PCR) of nasal swab were enrolled in this study in Combined Military Hospital (CMH), Dhaka, Bangladesh. The patients were provided with standard of care (SoC) plus favipiravir for 10 days. Results: No notable adverse event was recorded due to usage of favipiravir in these patients during the observation period. All pa-tients became negative for SARS-CoV-2 and they were discharged from the hospital within a mean period of 12.4 days (the shortest period being 3 days and longest was 30 days).Conclusion: Although this is an open level study, it seems that favipiravir is safe and effective for treatment of mild COVID-patients. However, a double-blind, controlled study with large sample size would be required to validate its clinical usage and registration 109 An Intelligent Virus Infection Detecting System based on Immunoglobulinâ€™s (IgM and IgG): Proposed Model , Mittal Desai and Atul Patel The potential information remains in the blood test results. Currently the whole world is under the outbreak of Coronavirus dis-eases 2019 (COVID19), so there is a need of developing an accurate assisting tool that analyzes the immune system of healthy persons and COVID19 infected persons. In this paper an intelligent model is proposed for the same, in the context of mainly comparing im-munoglobulin (IgM and IgG) from blood test results. Furthermore, various combinations of IgM, IgG and other immunoglobulin’s will be studied for identifying severity of diseases. The aim of the study is to build preventive intelligent model that can predict human body is currently fighting with some unknown infection or not and severity of it 110 Journey of Profound Life Lessons, Learning, Change and Self-awareness: Preparation for a Role Transition from a Senior Saudi Registered Nurse to a Specialist Palliative Care Nurse , Fatimah Alabduljabbar Background:A transition journey took me as a Saudi Senior Registered Nurse (SRN), and a woman seeking continuous challenges and improvements, overseas to prepare for a Specialist Palliative Care Nurse role (SPCN). This is also due to the lack of opportunities in my country. This paper describes my preparation, sheds some light from transition theories, including the transition challenges involved in general and more specifically to my case. More importantly, the learning and blessings gained throughout the process. Methods:Owing to the nature of the transition process, I use complex mixture of methods. Through auto-ethnography self-reflec-tion, I deliberately make myself vulnerable as I attempt to provide a clear analysis of the diverse experiences of a transitioning SRN to a SPCN role. My literature review draws from a wide range of sources, disciplines and compares these to my experiences. Addition-ally, I use different tools and means to gain more understanding.Results:Challenges of transitioning to SPCN include role ambiguity, the need to fill the educational gap, and adapting to a new culture. Benefits include increased space to pursue my passion and ability to make a positive impact as well as self-awareness and change.Conclusion:True improvements in quality of healthcare needs to be more inclusive and consider smooth transition of RNs to SPCNs. The Saudi government and stakeholders are encouraged to provide more opportunities for nurses to fulfill the increasing demands. Nurses are encouraged to seek opportunities to improve life. 111 Ethics and Professionalism in Medical Practice , Ajaz Ahmad Rather and Sanan Ajaz Rather In the present era of materialism where everyone is in the rat race of earning by all illegal means what so ever possible, keep-ing aside all the ethical principles and professionalism, it becomes mandatory to throw some light on this subject. In the field of medi-cine it is essential to maintain these two principles as it involves in dealing with patients life, thus making it more pertinent to discuss this issue in detail with special reference to medical profession. Nowadays we find a trust deficit between patients and doctors re-sulting in violence, patient doctor conflicts and medico legal issues probably because we are concentrating less on this issue. In most of the medical colleges of the country medical ethics is not taught as a part of curriculum as there is an old dictum that “Ethics are caught but not taught”. This seems to be the need of the hour that medical ethics and professionalism may be taught as a subject and included religiously as a part of curriculum during medical course. At the outset let us define what do we mean by ethics and profes-sionalism 112 Autopsies Findings and Evolution of the Therapeutic Strategies of the SARS-CoV-2 , Q Piacevoli, L Marchioni and G Garotto In light of the ongoing health emergency, we have launched a preliminary investigation into the alleged correlation between CO-VID-19 and all the other clinical manifestations.SARS-CoV-2 has rapidly spread across the world, causing extensive morbidity and mortality, though the histopathologic basis of severe disease cases has yet to be studied in detail.Autopsy has contributed significantly to our understanding of numerous disease processes, but for several reasons, autopsy re-ports following deaths related to SARS- CoV-2 have been limited 113 A Systematic Review on the Sufficiency of PubMed and Google Scholar for Biosciences , Yun Hwee Teo and Maurice HT Ling NCBI PubMed is the de facto bibliographic database for biosciences but has been shown to be insufficient for the purpose of systematic review and meta-analysis, which requires comprehensiveness. Among bibliographic databases, Google Scholar is most comprehensive. With arguments that PubMed, supplemented with Google Scholar, may be sufficient for a systematic review in biosci-ences; we reviewed 18 studies to determine whether a combination of PubMed and Google Scholar is sufficient. Current literature shows that the combined coverage of Google Scholar and PubMed is between 85% to 98% of the universe of bioscience articles, which may be sufficient. However, Google Scholar alone is not sufficient as the concordance between PubMed and Google Scholar is 30.3% with 20.3% of the articles unique to PubMed. 114 Clinical Outcome of Late Initiation of Antiviral Therapy in Patient with Negative COVID-19 PCR Test , Mohammed M Al-Amri, Wael F Alblowi, Hassan Y Alghar, Abdulmohsen H Almeffarej and Ala J Malhis 54 Years old Indian diabetic gentleman. Presented to emergency medicine department with one day of shortness of breath, cough and Right sided chest pain. Accompanied with 4 days history of fever, not documented. Patient was desating on Room air (54% oxy-gen saturation) intubated by ER team. Chest X Ray revealed bilateral peripheral consolidation and patchy infiltrates bilaterally. CT of the chest showed Bilateral lung infiltrates and effusion Plus multi focal ground glass opacities. Patient was investigated for COVID 19, underwent total of 4 swabs. The first swab being probable for COVID 19 and the next 3 sample were negative for COVID 19. Treated with triple antiviral therapy (Ribavirin, Lopinavir/Ritonavir and Interferon beta1b), methylprednisolone and Ceftriaxone. Clinicians should be alert to the COVID 19 infection symptoms even with negative swab result. 115 Telemedicine and Telehealth in the Era of COVID-19 and Beyond , Zainab J Gandhi, Zabeen Mahuwala and Juzar Ali The COVID-19 pandemic has accelerated the implementation of telemedicine and its use for patient care. Telemedicine has been used in the past in many settings in non-crisis patient encounters and at many points of care, ranging from emergency room trauma units to clinic outpatient encounters in rural and semi-urban remote areas and as part of chronic care management. It has also been helpful in selected settings during natural disasters to improve access to care where conventional patient-doctor encounters were not possible. With its increased use during the current COVID-19 pandemic, it is important to review if this is truly a step forward in increasing access to care in challenging environments. This review article will attempt to outline the pros and cons of this emerging modality of healthcare delivery 116 Zingiber officinale (Ginger) Extract has No Effect on Kiss1 Gene Expression in the Testis and Blood but May Cause Inflammation-induced Morphological Sperm Disruptions in Wistar Rats , Izuchukwu Azuka Okafor, Uchenna Somtochukwu Nnamah, Johnson Okwudili Nweke, Jude Amechi Nnaka, Selasie Ahiatrogah and Uche Valentine Okeke The COVID-19 pandemic has accelerated the implementation of telemedicine and its use for patient care. Telemedicine has been used in the past in many settings in non-crisis patient encounters and at many points of care, ranging from emergency room trauma units to clinic outpatient encounters in rural and semi-urban remote areas and as part of chronic care management. It has also been helpful in selected settings during natural disasters to improve access to care where conventional patient-doctor encounters were not possible. With its increased use during the current COVID-19 pandemic, it is important to review if this is truly a step forward in increasing access to care in challenging environments. This review article will attempt to outline the pros and cons of this emerging modality of healthcare delivery. 117 Recommendations for False Negative Covid-19 PCR Tests Patients , Benabdellah A, Brahimi H, Badla Y, Benabdellah Y and Labdouni MH The current Covid-19 pandemic imposes a diagnostic strategy for the care of patients. The sensitivity for the Covid-19 PCR is 56 to 83%. A single negative test can rule out Covid-19 in the majority of situations. However, since the negative predictive value of the test is between 88 and 95%, it is essential to ensure the follow-up of these patients. For those with typical symptoms, a negative test should be interpreted with caution and a second test may be indicated. 118 Children's Eye Health as Impacted by the Coronavirus Disease (Covid-19) Pandemic: A Systematic Review ,   Samuel Chibueze Osuji. There is a rapid change in the global landscape of health and development occasioned by the novel Coronavirus disease (CO-VID-19) pandemic. This paper explores the possible impact of the coronavirus disease (COVID-19) pandemic on the eye health of children in low and middle-income countries. With causes of childhood blindness arising from unmet eye care needs of children, coronavirus associated challenges have an advanced impact on children’s eye health through direct pathological anomalies, poor up-take of immunization, travel restrictions to access care, reprioritization of health resources, weak health systems, and economic con-sequences. Adequate hygiene through handwashing, vigilance on toddlers, immunization of children, and accessing care for obvious pathological anomalies like conjunctivitis, measles, mumps, and rubella are all advocated for parents and caregivers to protect the eye health of children. Also, holistic interventions to the challenges of children’s eye health occasioned by the Coronavirus pandemic will require evidence from health systems research to guide meaningful interventions in the protection of children’s eye health. Govern-ments at all levels must unite efforts with development partners to strengthen health systems and secure the eye health of children in a coronavirus pandemic (COVID-19) era 119 History of Pandemic Vaccinations - From Concept to Commercial Use , Ansha Khurana and Aanya Bhatia. History doesn’t repeat itself but it often rhymes, as said Mark Twain. It often guides the future. The authors discuss some of the key historical pandemics and mankind’s response to them, along with the development of pandemic vaccines. Currently the key strategy arguably rests on the discovery of a vaccine for Covid-19, presumably, the only escape route from the current crisis. While our scien-tists endeavour to find the vaccine, washing hands, social distancing and treatment advances remain the pillars for fighting COVID with a number of unsolved questions for any potential vaccines. 120 Suicide Risk Assessment Must be Collaborative ,   Konrad Michel. When faced with a patient who may have suicide ideas or plans, clinicians usually perform a suicide risk assessment. However, short-term suicide prediction is a virtually impossible task. Suicidal individuals often deny suicidal plans, even when the issue is addressed directly by the clinician. An important aspect of the communication problem between patient and clinician is that the tra-ditional medical model of suicide does not match with the inner experience of the suicidal patient. Here, it is argued that suicide risk assessment must be a collaborative process, in which patient and clinician together explore the individual’s actual suicide risk and jointly develop adequate measures to keep the patient safe 121 Quality Medical Service for Quality Assurance in Neurosciences and Medical Sciences Using International Standard Organization, Quality Standards and Concepts of Total Quality management (TQM) , Upadhyay PK, Tiwary G and Pant I. Non-standardization of services and lack of quality services with special operating procedures are main culprits for non-delivery of quality medical service which lead to less patient satisfaction leading to multiple patient – doctor relationship, legal and compensa-tion cases. In this study we concentrated on the improvement of quality health and medical care services (QMS) using International Standard Organization (ISO) standards and application of total quality management (TQM) in health and medical care services so that a proper level of quality service may be assured(quality assurance) using bench marking with highest level in the field. Thereby patient satisfaction is also increased leading to lesser conflict and better earning of the healthcare system. This may thus save time and finance which can be utilized for further enhancement of medical and health services to upgrade to match best in the field and can be used as bench marking for other health care services 122 The Effect of Neo-adjuvant Cancer Therapy on Fitness for Anaesthesia and Surgery; A Prospective Cohort Study , Samir Rahmani, Dermot Burke, Paul Jarvis, Nicolas Orsi, Michele Cummings, Shelagh Turvill and Simon J Howell. Background:Rectal cancer treatment with neoadjuvant radiotherapy or chemoradiotherapy (NAT) prior to anaesthesia and surgery may reduce fitness and so increase perioperative risk. Understanding the mechanisms by which NAT reduces functional capacity will inform the development of preoperative risk reduction strategies such as prehabilitation. We hypothesized that the effects of NAT are mediated through the inflammatory response and changes in body composition with loss of muscle.Objectives:The objectives of the study were to examine the associations between changes in functional reserve measured by cardio-pulmonary exercise testing (CPET) and the inflammatory responses and changes in body composition produced by NAT.Design: Prospective cohort study.Setting:United Kingdom regional cancer centre.Patients:Thirty-six patients (28 male) who received preoperative long course chemoradiotherapy (LCCR) n = 24, or short course radiotherapy (SCRT) n = 12 prior to rectal cancer surgery were studied.Patients unable to perform CPET were excluded.Main Outcome Measures:Assessments were made before and within two weeks after NAT. Anaerobic threshold (AT) and peak oxy-gen consumption (VO2peak) were measured by CPET. Body composition was assessed by bioelectrical impedance and blood samples taken for assay of cytokines and other inflammatory markers.Results:LCCR patients had a significant decline in VO2peak (p = 0.005) and reductions in several anthropometric variables (all p < 0.01) after NAT. SCRT patients had no significant changes in their functional capacity data but showed changes in a number of anthro-pometric variables (all p < 0.04) after NAT. Cytokines and inflammatory markers showed wide variability. There were no clinically important associations between changes in functional capacity and changes in either anthropomorphic variables or biomarkers. Conclusion: Our data confirm the impact of NAT on fitness for surgery. They are not consistent with an association between the changes in functional capacity seen with preoperative NAT and either changes in body composition or the inflammatory response to preoperative cancer treatment. 123 Knowledge of Tooth Avulsion and its Management among Clinical Dental Students and Interns , Brenda Ighoteguono Mohammed and Joan Emien Enabulele Objective: To assess the knowledge of clinical dental students and interns in the emergency management of traumatic tooth avulsion.Materials and Method: This was a descriptive cross-sectional study of clinical dental students and interns at the University of Be-nin/University of Benin Teaching Hospital. A 13-item self-administered questionnaire which sought information on the demographic characteristics of the participants, knowledge of tooth avulsion, factors that influence success of replantation, storage media and cur-rent developments in storage media for storing an avulsed tooth was used. Data was analyzed using IBM SPSS 21.0.Results: The study population consisted of house officers (56.9%), final year dental students (24.1%) and penultimate dental stu-dents (18.9%). Majority (82.8%) knew that an avulsed tooth is a tooth that has been completely dislodged from its socket in the alveolar bone. Majority of (90.4%) of those who had received information regarding tooth avulsion knew what an avulsed tooth was (p < 0.0001). There was increased experience with permanent tooth avulsion with increasing status of the respondents from penultimate student to house officers (p < 0.0001). A higher proportion (90.9%) of the house officers compared to the final year students (28.6%) and penultimate students (18.2%) opined that an avulsed permanent tooth should not be replanted in its socket in all cases and this was statistically significant (p = 0.002). Majority (74.1%) of the respondents stated that dental treatment for an avulsed tooth be sought immediately after the traumatic incident. The most prevalent influencing factor observed was mechanical damage during avulsion and replantation (81.0%). The most prevalent media selected was isotonic saline solution (81.0%), followed by Hank’s balanced salt solution (72.4%) and patient’s mouth/saliva (69.0%). The most prevalent current development in storage media reported by the respondents was egg albumin (39.7%), followed by coconut water (34.5%). Conclusion: There is need for improved knowledge regarding management of traumatic tooth avulsion 124 Analysis of Consistency of Prime-boost Covid-19 Baseline and Safety Data   , Dragutin Novosel and Matija AlanoviÄ‡ Recently, some concerns [1-3] have been raised about the reli-ability of data presented in the current paper [4], which reported results from a non-randomised phase 1/2 study of a novel vaccine from Russia. The critics of the study [4] concentrated on potential data inconsistencies [1-3] in figures and analyzed them visually (here we ignore theoretical discussions about special features of the vaccine and/or vector). However, the baseline data and results of the safety data should be considered as well 125 Multiple Myeloma Revealed by a Cerebrovascular Accident: A Case Report , Sondess Arfa, Maissa Thabet, Samia Younes and Olfa Berriche Introduction: Venous thromboembolic disease is reported to be frequent among MM. However, stroke is rarely reported in this population. We reported a case of MM diagnosed in a 68-year-old admitted with a stroke.Case Report: A 70-year-old, with a history of high blood pressure, presented with right hemiparesis associated with speech impair-ment. Neurological examination revealed right hemiparesis, right facial paralysis and Broca aphasia. The brain CT showed a stroke in the left middle cerebral artery (MCA) territory. The protein immunoelectrophoresis revealed an IgA Kappa type gammapathy (Figure 2). The bone assessment was free of abnormalities. The sternal puncture showed spinal cord infiltration by 13% dystrophic plasmocytes. The diagnosis of multiple myeloma at stage II A was retained and the patient was treated by the association Prednisone-Melphalan.Conclusion:We reported a rare case of cerebral vascular accident revealing the diagnosis of multiple myeloma 126 Diabetic Retinopathy Detection-MobileNet Binary Classifier , Aruna Pavate, Jay Mistry, Rahul Palve and Nirav Gami Background and Purpose:According to the International Diabetes Federation (IDF) the total number of people in India who are suf-fering from diabetes were around 50.8 million in the year 2010, and it will rise to 87.0 million by 2030. Diabetic Retinopathy is a one of the major complications that exhibits because of Type II diabetes. Diabetic Retinopathy causes blindness in the population of age mostly in between 20 to 64 years. In long term diabetic retinopathy blood vessels disturb the normal flow of fluid out the eye and that comes pressure on the eyeball and this may cause damage to nerves that emerge in glaucoma. Early detection of Diabetic retinopathy and treatment can significantly reduce the risk of vision loss. Analysis Method:The manual diagnosis of Diabetic retinopathy by ophthalmologists takes time, effort and also includes more costs and can be misdiagnosed if computer aided diagnosis systems are not used. Recently, Deep Learning has become one of the most common methods to achieve high performance results in many areas, especially in medical image analysis and classification. This work addresses the problem of prediction of diabetic retinopathy in advance to avoid further complications in the near future. The proposed classifier was built using MobileNet architecture-a lightweight, mobile friendly architecture, which is trained using retinal fundus images from Aptos 2019 challenge dataset. Findings: The proposed enhanced model gives an accuracy of 95% and precision, recall, f-1 scores are 0.95, 0.98 and 0.97 respec-tively. Presented results demonstrate that this model achieves promising results and can be deployed as an application for clinical testing. This work attempts to suggest the diabetic retinopathy complications in advance. The intention of the work is to help the practitioners not to replace the ophthalmologist 127 Risk Factors and Practices on Diabetic Foot Among Patients at the Buea and Limbe Regional Hospital, South West Region of Cameroon , Moleka Marcus Obase, Nkengafac Nyiawung Fobellah, Elroy Patrick Weledji, Mekiako Bella Ikile and Belleh Nyiawung Fobellah Background: Diabetes mellitus (DM) foot complications are a leading cause of many admissions in health facilities and death.Objective: The aims of this study were to determine the 1) proportion of patients with associated risk factors of diabetic foot ulcer-ation, and 2) the association between practices and clinical foot examination. Methods:This was a cross-sectional study using time limited sampling. Participants were known adult diabetic patients attending the Buea Regional Hospital (BRH) and Limbe Regional Hospital (LRH) who fulfilled the inclusion criteria. Also a clinical foot examina-tion was conducted to check for common foot deformities, nail care, skin of foot condition, foot pulses, sensory neuropathy and foot wear assessment. Fourteen questions were asked regarding practices of foot care. Each question was assigned one mark for correct response. A score of more than 70% (10 - 14), 50 - 70% (7 - 9) and less than 50% (<7) were graded as good, satisfactory and poor for practices.Results:A total of 404 diabetic patients were recruited in the study. The mean age of the respondents was 56.8 ± 13.5 years. Mean-while, 320 (79.2%) and 82 (20.8%) had favourable and unfavourable attitudes respectively. Whereas 156 (38.6%), 169 (41.8%) and 79 (19.6%) of the respondents had good, satisfactory and poor practices respectively. The educational level of the respondents had significant statistical association with knowledge (p < 0.01) and attitudes (p < 0.01) but not practices regarding foot care. Sex had significant association with knowledge (p < 0.01) regarding diabetic foot care. Sex and monthly income of the respondents were not significantly associated with attitudes and practices. 91 (22.5%) of the respondents had some associated risk factors of diabetic foot ulceration. Improper foot wear had shown significant statistical association with the occurrence of blisters (p < 0.01) and swelling (p < 0.01) regarding foot care respectively.Conclusion: More than one third of diabetic patients had good practices while less than one third had good habits. Close to one quar-ter of the patients have risk factors of diabetic foot ulceration. Foot wear had showed significant association with the occurrences of blisters and swelling. The results of this study highlight the gaps in practices and underscore the urgent need for a patient friendly educational intervention coupled with regular physician reinforcement to reduce the risk of diabetic foot ulcer and amputations.Keywords:Diabetic Foot Care; Practices; Prevention; Risk Factors 128 Comparison of Audiometric Findings with Internet-based Hearing Screening Tests and the Relationship with Other Associated Factors in Adults , Chan Nyein, Sherly Deborah, Dhanalekshmi Unnikrishnan Meenakshi and Usha Kumari Hearing loss is one of the most challenging problems confronting medicine since it may affect the personality so adversely that it can lower someone’s quality of life.The aim of the study is to establish the validity of internet based hearing test.The hearing status of adults was evaluated by comparing audiometric findings and internet-based hearing screening test along with questionnaires to assess the potential risk factors associated with hearing loss. This cross-sectional study included 256 participants (18 to 40 years of both genders) by simple random sampling method, of which 245 had completed all the procedures. The study was carried out by using Pure Tone Audiometry (PTA), two internet-based speech-in-noise tests: internet test 1 (HearCom Digit Triplet Test offered by MED-EL) and internet test 2 (Speech in Noise Test by National Health Service) and survey questionnaires.Descriptive statistics and Pearson Chi-Square test was used to analyze the data. All presentations and data evaluations were carried out by using SPSS version 21.0. The prevalence of hearing loss was 26.1% with PTA; 5.3% with internet test 1 and 47.3% with internet test 2. Among two inter-net-based hearing screening tests, internet test 1 is significantly correlated with PTA averages (p <0.05, 2-tailed) and the correlation coefficients showed weak association between the different tests. The study showed a significant correlation between audiograms and internet-based hearing tests and significant differences with associated factors as evaluated by using an extensive questionnaire. This study suggests that internet-based hearing test is feasible to screen for hearing status online and the data are of great value in applications and for advanced studies.Though an internet-based hearing test cannot replace a clinical pure-tone audiogram, it is a feasible screening tool for hearing ability in a large-scale population 129 Quality Management System in Medical Laboratory Practice: Knowledge and Perceptions of Medical Laboratorians in Saudi Arabia , Abdulraheem Almalki Medical laboratorians play an important role in clinical and public health settings by providing test results. The quality of the test-ing process has a major impact on health outcomes. This study aimed to measure the knowledge and perceptions of laboratorians employed in Saudi Arabia. A cross-sectional study was conducted with laboratorians working at different hospitals using a previously published and validated questionnaire through a social media application. A total of 263 laboratorians completed the questionnaire. The majority of participants were specialists with fewer than 5 years of experience. In general, laboratorians were shown to be knowledgeable. The majority agreed that the level of education, the number of years of experience, the professional credentials and the turnover rate of positions had a significant impact on quality assurance objectives. In conclusion, laboratorians need to be trained about quality systems and encouraged to have a role to ensure the highest level of service 130 Temporomandibular Disorders in Children: A Mini Review , Karoline de Melo Magalhães, Bruna Caroline Tomé Barreto, Eduardo Otero Amaral Vargas and Ana Maria Bolognese Temporomandibular disorders (TMD) are dysfunctions that comprehend disorders of masticatory muscles, the temporoman-dibular joints and occlusion. They may be caused by macro or microtrauma, anatomical, genetic, systemic or psychological factors. Studies show that up to 30% of children and adolescents may present some type of TMD. Signs and symptoms of the condition may be diagnosed by questioning its history, palpating the painful areas, observing mouth opening and closing and performing analgesic blocking. Image exams such as panoramic radiograph, computed tomography, magnetic resonance and ultrasound may help this procedure. Possible treatments are patient education, physical therapy, behavioral therapy, medication prescription, occlusal splints, occlusal adjustment, orthodontic treatment, or even surgeries. A gold standard treatment has not been yet assessed, but considering the short age of patients, reversible procedures should be preferred when possible 131 Multicultural Competencies of Healthcare Professionals and Disability-Inclusive in Telehealth during the COVID-19 Pandemic , Si-Yi Chao, Keith B Wilson and Carrie L Acklin There is evidence that people with disabilities are more likely to be discriminated against and to have disproportionate health care disparities compared to people who are able-bodied during the devastating COVID-19 pandemic. In light of COVID-19, telehealth has been transformed to the primary health care delivery due to social restrictions of most, globally. Disability-inclusive telehealth design can promote culturally diverse groups access and more accurate COVID-19 information, knowledge, public health measures, and guidelines of preventive strategies for acquiring COVID-19. Applying multicultural competencies is required for healthcare providers to maximize health engagement and outcomes of PWD. In many areas of health care, healthcare professionals recognize needs, expec-tations, and perceptions of diverse disability populations. That being said, healthcare professionals should implement appropriate interactions with a patient with a disability and provide culturally responsive telehealth services for other underrepresented groups as well. Hence, the multicultural competencies of healthcare professionals and disability responsive telehealth systems can assist PWD to mitigate health care disparities 132 Pandemic Success or Global Leadership Failure? How History Will Look at it , Salim Surani and Pahnwat Tonya Taweesedt The year 2020 will be remembered in history as one of the most monumental years. The COVID-19 pandemic has created havoc, affecting more than 59 million people globally, with a death toll greater than 1.4 million people worldwide [1]. The messages from global leaders have been at odds with the scientists and the public health authorities, especially in the United States. While the global threat was dealt with at a fast pace, the virus had been downplayed by politicians and leaders in an effort to minimize the financial and economic impact of the pandemic, which in reality exacerbated these impacts 133 Utilization of Tropical Feed Stuff by Heteroclarias Hybrid Catfish in the Face of COVID-19 Lockdown , Isah Mohammed Chado, Dadi-Mamud Naomi John, Ibrahim Baba Usman, Musa Alhaji Isah, Amidu Musa Mohammed and Mohammed Safiya Yunus Fish farming is a growing business in the tropics, spreading to localities in Nigeria. High cost of feed discourage new farmers. The COVID-19 lockdown experience made it necessary for people to be involved in one thing or the other in order to survive the pan-demic, emphasis and create awareness on aquaculture. Tropical countries are endowed with locally available fish feed ingredient including Fish meal, Blood meal, Maize meal, soybean meal, Moringa leaf, and cassava flour which could be utilized for fast growth of fish. This work evaluate the effects and tolerance of blood meal in the diet of hybrid catfish (Heteroclarias). Six isonitrogenious diets of 40 percent crude protein were produced from these ingredients. There were unboiled blood meal and boiled blood meal with high protein contents of animal source. The SGR of fish fed diet v (3.61 ± 0.19) were significantly higher than those fed control diet I (2.98 ± 0.15) difference. There were high final weight in fishes of fed diet VI (406.77 ± 13.94g ) from an initial weight of (63.20± 6.26g) to a weight gain of 343.57 ± 19.68g . There are high FCE (46.74 ± 7.26) and PER (26.71 ± 0.77) of fishes fed diet V, the diets were more efficient than others while fish fed diet II and III had better FCR (0.05). Local feed ingredients are nutritious, Blood meal used in fish feed can be prepared in two forms, boiled and un-boiled. The inclusion of blood meal and moringa leaf in the diet of hybrid catfish is recommended for fast growth and appreciable weight for quick economic gain in the face of COVID-19 pandemic 134 Thermographic Diagnostic of Different Skin Reactions After Intradermal Testing , Evgeni Stanev, Maria Dencheva and Georgi Nikolov We present a case of an intradermal allergy test involving positive and negative reactions to allergens. The standard reading is supplemented by thermal imaging and calculation of an indicator related to the change in temperature due to allergic reactions in the examined skin areas (dT). The results show that the temperature reading can complement the standard test, and the dT indicator can be used to distinguish positive from negative reactions 135 Open Cholecystectomy Under Thoracic Epidural Block - A Case Report   , Asim B Mohammad We present a clinical case of a 37-year-old housewife of Pakistani origin, who presented with right hypochondrial pain. Ultrasound analysis of her abdomen revealed cholelithiasis and the decision for an elective cholecystectomy was taken. The patient refused gen-eral anaesthetic due to fear that she may not regain consciousness, therefore thoracic (T6-T7) epidural block was offered. Following a review of published literature, we believe this to be the first reported case of open cholecystectomy under thoracic epidural block, for reasons of patient choice. The procedure was a success and the patient was discharged with no further incident. 136 Posterior Reversible Encephalopathy Syndrome in Primigravida with Severe Pre-eclampsia and Hellp , Sevim Özden, Christina Lindegaard Poulsen and Mohammed R Khalil Posterior reversible encephalopathy syndrome (PRES) is a neuroradiologic condition characterized by a range of symptoms such as headache, nausea, vomiting, blurred vision, altered consciousness, seizures, and focal neurological symptoms. It can be associated with HELLP syndrome. In this case report, we present 29 years old primigravida at 36+6 weeks’ gestation with HELLP syndrome and severe preeclampsia with loss of vision on both eyes. The patient was further examined with a CT brain scan, which initially indicated that she had posterior reversible encephalopathy syndrome (PRES). Neuro radiologist provided a second interpretation of the CT brain scan with no sign of PRES. However, the clinical presentation indicated signs of PRES and the patient got treatment with anti-hypertensive and Magnesium Sulphate at the intensive care unit and had uneventful caesarean section performed. This case report emphasizes the importance of early recognition, correct treatment, and management to prevent further complications. 137 The Urgent Need to Increase Palliative Care Services for Children with Cancer in the United States , Robert W Buckingham and Renata Ferretti Background:The discovery of a fatal disease marks the beginning of the child dying trajectory. However, the lack of availability of palliative care services for children with cancer is a challenge for families in the United States.Aim: This study is two-fold. The first is to identify the demand for palliative care services for children with cancer. The second is to determine the precise and geographical availability of palliative care services for children in the end-stage disease in the United States.Design: This study is secondary research.Data Sources:The research’s base is data from organizations as the CDC and NHPCO. The criteria for selecting other studies has focused on research with a confirmed data source that addresses pediatric palliative care services and challenges facing by children with cancer between 1996 to 2020.Results: In 2016, in the United States, 2118 children aged less than 19 years died from cancer and of this total, 37% died at parent›s homes. It appears that the majority of these children were not supported by palliative care service, given that only 3.48% of palliative care services clearly stated that they have a pediatric program, out of a total of 2,330 listed on the NHPCO website.Conclusion:The number of palliative care services for children should be increased in the United States. Adult›s palliative care services could consider training their staff to address the needs of children and families. Governmental Agencies could encourage further research to develop more pediatric programs and services for children who are facing a terminal illness 138 Covid-19: Africa Versus the World , Oderinde GP, Musa SA, Ndu M, Adeyinka A and Abdulazeez MA Africa is the largest and most populous continent after Asia but with highest number of countries. Africa represents about 1/6 of the world population but Africa is the least represented in the world Genomic population. During the outbreak of COVID-19 there was much concern about Africa due to numerous inadequate health facilities. Data was gotten from the official World Health Orga-nization (WHO) website and was cleaned and arranged in Microsoft Excel version 2019. The data was then visualized using Tableau Public version 10.4. Africa was compared to other regions in two categories: New cases and Deaths. In the number of new cases and deaths, Africa and Western Pacific regions were lower than other regions with the number in Africa being slightly higher than that of Western Pacific from 23rd May and 30th May respectively. The results showed that Africa performs better when compared with the rest of the world in new cases and deaths rate as a result of COVID-19. There is need for equal representation of Africa populace in the genomic world data. 139 Consecutive Changes in Nerve Conduction Studies After Surgery for Carpal Tunnel Syndrome – Useful Parameters for Evaluating Postoperative Recovery , Mikio Muraoka and Kenji Watanabe Objective: We quantitatively evaluated indicators of postoperative recovery from surgery for carpal tunnel syndrome (CTS) and determined the most sensitive nerve conduction study [NCS] parameters. Materials and Methods: NCSs were performed in 50 hands with CTS preoperatively, and at 1 and 3 months postoperatively. Four NCS parameters were assessed: abductor pollicis brevis-distal motor latency (APB-DML), index-distal sensory latency (DSL), 2nd lumbrical – interossei latency difference (2L-INT), and ring finger test (Ring). Results: The 33 hands in which APB compound muscle action potentials (CMAPs) were preoperatively detected showed significant improvement in APB-DML over time. The 46 hands for which 2L CMAPs were preoperatively detected showed significant improve-ment in 2L-INT over time, clearly reflecting postoperative recovery. Index-sensory nerve action potentials (SNAPs) and Ring-SNAPs were undetected in 41 hands and 50 hands, respectively, and remained undetected at 3 months in 27 hands and 45 hands, respec-tively.Conclusion: Our findings suggest that 2L-INT and APB-DML, in this order, are suitable parameters for evaluating postoperative re-covery of CTS, while Index-DSL and Ring using SNAPs are not useful. 140 Oral Manifestations in Two Patients with a History of Asymptomatic COVID-19 , Thabet Maissa, Kaltoum Mohamed, Romdhane Wiem, Fakhfakh Rym, Mzabi Anis and Laouani Chadia The coronavirus disease 2019 (COVID-19) presents an important and urgent threat to global health. The lungs are the primary site of infection for COVID-19, with patients presenting symptoms ranging from mild flu-like symptoms to fulminant pneumonia and potentially lethal respiratory distress 141 The Challenges of an Unpredictable Fat Romance: A Proposal to Turn the Face-clock Back with Total Aesthetic Recall of the Aging-face, Following an Anticlimax of Gaga Euphoria , Lotha Bona and Mohammed Zeinalddin Fat grafting for facial rejuvenation is often followed by significant and unpredictable resorption within the first few months. No one has been able to validate the best technique to ensure long term volumetric retention of fat transfer and results continue to be unpredictable. Fat alone as a filler for facial rejuvenation may not be the best option, and other modalities should be considered in addition for treating the aging face. A combination of well standardized, and evidence-based invasive and non-invasive procedures can effectively reduce the effects of aging. 142 Patient Experience on International Safety Goals Using Adapted Net Promoter Score - NPS-S   , Salvador Gullo Neto and Philip Greiner Objective:Assessing patients’ perception of safety issues in health institutions is a challenge. The use of simple tools to quantify this perception would bring important benefits to the healthcare sector. Our aim is to describe the use of a traditional market tool for the evaluation of customer experience and satisfaction, the Net Promoter Score (NPS), to assess patients’ perception of the practice of international safety goals in health institutions. Methods: Through a mobile application, we present to patients the basic concepts of the 6 international patient safety goals of the World Health Organization and at the end of each instruction, we request their evaluation, using the NPS tool with questions adapted to the patient safety scenario. We call this adapted NPS of Net Promoter Safety Score, NPS–S. Results: During a 6 months period, 352 users download the app in more than 94 different healthcare services in Brazil and made 1719 evaluations about their safety experience, with the average NPS-S of 45%, that means a score in the improvement zone. Conclusions: patient engagement is essential for the reduction of adverse events. In this study, the Net Promoter Safety Score adap-ted to patient safety issues, the NPS–S, was easy to understand by users and may be a very useful tool to translate patient perceptions into manageable data, helping health institutions to develop the culture of safety 143 A Minimal Invasive Entry; Punch Tool   , Bulent Cihantimur, Yavuz Ozsular and Ozgur Aglamis An entry point is required for minimally invasive procedures requiring access to the subcutaneous tissue on the face and in the body. Such minimally invasive procedures can be generalized as thread applications, filling applications, and fat graft applications. 144 Medication Adherence of Patients with Neurological Conditions in the Era of COVID-19 Pandemic: Is there an Impact? , Asmaa Hazim, Latifa Adarmouch and Houda Guennouni Assimi Background: Strategies implemented around the globe to face COVID-19 pandemic raised some challenges in ensuring care continu-ity and might have impacted Patient Medication adherence which is crucial for patients with chronic neurologic diseases. Methods: We conducted adescriptive cross-sectional study with a total of 83 patients with chronic neurological conditions. Data was collected through a directed questionnaire using Medication Adherence Reasons Scale. We have also compared levels of treatment adherence according to sociodemographic characteristics. To our knowledge, this is the first study conducted in Morocco aiming to assess patient medication adherence in Neurology. Results: The mean age in our study was 55,4 ± 19.2, Women represented 44,6%. Our study found 59% of nonadherence versus 41% of full medication adherence. The main reported reasons for treatment discontinuation were the patient’s inability to ride to the pharmacy (24.5%), financial reasons (22.4%), social reasons (20.4%), side effects occurrence (16.3%), perception of the medication as unnecessary or ineffective (both 14,3 %). We found a correlation between socio-economic level and medication adherence (p = 0.023). Interestingly, COVID-19 pandemic was cited as the main factor standing behind 18 patients answers.World Health Organization estimates overall poor adherence to 50%, our results were even higher. Noteworthy, the correlation highlighted between socio-economic level and medication adherence could be the reflection of a growing socio-economic divide. Fur-thermore, COVID-19 pandemic might be an aggravating factor of nonadherence probably because of the difficult access to healthcare facilities, lockdown, overall context of anxiety, economic impact of the outbreak, and possible shortage in drugs. Conclusion: The already poor observance highlighted by our study will probably worsen after COVID-19 pandemic and its expected impact on national economy. 145 Magnetic Resonance Imaging Diagnostics of Changes in the Articular Cartilage of the Knee Joint in Football Players , MM Pirnazarov, AA Sadikov and DE Makhmudov The success of targeted surgical and medical treatment leads to an increase in clinical interest in the early diagnosis of degenera-tive changes in articular cartilage. Magnetic resonance imaging (MRI) is currently the most effective non-invasive method for visual-izing and monitoring of damages of the articular cartilage of the knee joint. This article presents the results of a study of the articular cartilage of the knee joint in athletes based on the measurement of T2 relaxation time. Numerous studies have shown positive results in identifying structural changes in articular cartilage.. 146 Case Report: E-cigarette or Vaping Induced Lung Injury , Kyle Meggison, Veronica Tucci and Alfredo Tirado Electronic cigarettes have grown in popularity over the past few years. The medical literature and mainstream media have pub-lished accounts of e cigarettes causing severe respiratory distress in younger patients despite being marketed as a “safer” alternative to regular cigarettes. There have been cases throughout the country where individuals who use these products experience severe respiratory distress. This case report describes the clinical course of a young patient presenting to the emergency department in acute respiratory distress. We discuss the pathophysiology, incidence, prevalence, and morbidity and mortality of EVALI (E cigarette or vaping induced lung injury) 147 Influence of Hard Drinking Water with High Content of Calcium, Magnesium and Sodium on Morphofunctional Development of Prepuberty Age Children , Aizman Roman Idelevich, Trofimovich EM and Nedovesova SA The article describes the effect of long-term consumption of drinking water with high content of vital cations of calcium, mag-nesium and sodium on physical development of adolescents 11 - 12-years old. In the examined children, compared with the control group, there was found a decrease in the level of physical development, relative strength, volume of external respiration and func-tional reserves of the cardiovascular system 148 Influence of Hard Drinking Water with High Content of Calcium, Magnesium and Sodium on Morphofunctional Development of Prepuberty Age Children , Aizman Roman Idelevich, Trofimovich EM and Nedovesova SA The article describes the effect of long-term consumption of drinking water with high content of vital cations of calcium, mag-nesium and sodium on physical development of adolescents 11 - 12-years old. In the examined children, compared with the control group, there was found a decrease in the level of physical development, relative strength, volume of external respiration and func-tional reserves of the cardiovascular system 149 Biological Activity Markers Useful in the Diagnosis of Chronic Diarrhea   , Cristina Voicu and Sorin RuginÄƒ Chronic diarrhea is a manifestation with a strong impact on patients’ quality of life. A correct and early diagnosis is the desidera-tum of any clinician.We evaluated 82 patients through blood tests and endoscopic investigations. Following the investigations, the patients were di-vided into three groups.In these groups were analyzed the exponents of the systemic inflammatory syndrome, red cell distribution width and the fecal calprotectin in order to try to determine activity markers useful in the diagnosis of chronic diarrhea 150 Vaccinating Saves Life, Not Vaccines in Refrigerator Shelves: Learning Lessons from Developed Countries! , Salim Surani, Rahul Dadhwal and George Udeani Since the first case of SARS-CoV-2 diagnosed in December 2019 in Hubei Province Wuhan, China, the world has grappled with find-ing the prevention and therapeutics to end the pandemic [1]. The virus has infected almost 80 million patients globally and account-ed for approximately 1.8 million death globally, with the United States ad India leading the toll with 19 million and 10 million in-fections. (The U.S. death toll during the Spanish Flu Pandemic was 675,000; World War II was 407,000, Iraq/Afghanistan War was 6,746. For comparison, COVID-19 has taken 325,000 lives in the U.S. in less than one year) [2,3]. Initial efforts towards diagnos-tic testing helped diagnose and isolate infected patients with the hope of curbing down the pandemic. This served as an addition to massive education efforts regarding the use of face cloth cover-ings, physical distancing, hand washing, and disinfecting surfaces (only to be muddied by the politicization of public health measures leading to an ineffective public health campaign and further trans-mission of the virus). Therapeutics with multiple new medicines, repurpose drugs, and convalescent plasma were studied with controversial data emerging. The only steroid that is proving to be an effective drug among hospitalized patients in reducing the mortality is steroid [4]. The race for the vaccine is ongoing—there are more than 100 contenders with more than ten companies ap-proaching the finish line. 151 A Minimal Invasive Clitoral Hoodoplasty Technique with J-Plasma   , Bülent Cihantimur, Özgür AÄŸlamÄ±ÅŸ and Yavuz Özsular Background: Various techniques have been identified for clitoral hoodoplasty that is commonly applied in cosmetic gynecology surgeries. The aim of this study is to investigate whether or not the technique applied with a minimally invasive and neuroprotective approach is effective in terms of cosmetic appearance and sexual function. Material and Method: A total of 82 women were included in the study. During the operation, J-Plasma®, using the plasma of helium gas as an energy source, was employed to dissect, coagulate, and tighten the clitoral hood and the surrounding tissue. All the partici-pants were assessed with FGSIS and FSFI before the application and at 6th and 12th month after the application.Results: No serious complication was observed in the long-term follow-up of the patients. While the FSFI mean score obtained by summing the scores of FSFI parameters was 24.1 ± 1.5 in the pre-treatment period, this value increased to 29.4 ± 1.5 and 30.4 ± 1.7 at the 6th and 12th months after the treatment, respectively. The difference between the pre-treatment, post-treatment 6th month, post-treatment 12th month FSFI mean scores was statistically significant. While the FGSIS mean score obtained by summing the scores of FGSIS parameters was 19.7 ± 1.8 in the pre-treatment period, this value increased to 21.9 ± 1.7 and 22.7 ± 1.8 at the 6th and 12th months after the treatment, respectively. The mean score in two periods after the treatment was also significantly higher than pre-treatment period.Conclusion: This technique can be a new alternative minimal-invasive clitoral hoodoplasty technique by targeting minimal tissue extraction from an area with few nerve endings in the technique described and using an energy source with low vertical and thermal diffusivity as the energy source. 152 Immediate Hypersensitivity Reaction Following Patch Test to Celecoxib , Syrine Ben-Hammamia, Ahmed Zaiem, Sihem El-Aidli and Riadh Daghfous AbstractPatch-tests (PT) are usually safe. Complications are quite rare, and immediate anaphylactoid reactions are exceptional We report a case of a 38-year-old woman, who presented late toxidermia after celecoxib use, and then was explored by PT three months later. This PT was performed with celecoxib diluted to 30%. The patient developed twenty minutes later general itchy erythema, which regressed in an hour, under anti-histamine treatment. This case leads to reconsider possible immediate complications after PT and therefore increase vigilance for at least 30 minutes after patchingPT: Punch Tool; VSS: Vancouver Scar Scale; PDO: Polydioxanone. 153 Coronavirus Disease (COVID-19) and the Critical Role of Healthcare Professionals: A Systematic Review , Lucas José de Azevedo-Silva, Matheus de Carvalho Sales-Peres, André de Carvalho Sales-Peres, Ana Flávia Sanches Borges and Silvia Helena de Carvalho Sales-Peres Objective: To investigate the factors related to HCW exposition and infection by coronavirus SARS-CoV-2 (COVID-19). Methods: The study was reported according to PRISMA Statement guidelines. The work protocol was registered on International Prospective Register of Systematic Reviews – PROSPERO (CRD42020200236) and eligibility criteria were defined in relation to PI-COS. PubMed, EMBASE, Web of Science and SCOPUS were systematically searched, considering related key MeSH (Medical Subject Headings) terms. We considered case reports, case series and clinical researches published in peer-reviewed journals, that have addressed epidemiological and protective features of HCW and its association with COVID-19 exposure and infection. The selected studies brought information about HCW that were exposed and/or infected by COVID-19. We evaluated the exposition and infection data related to occupational characteristics and protective measures adopted by HCW. Results: Eighteen studies reported the characteristics in 10,103 HCW exposed or infected by COVID-19; associations of male (n = 1,448; 30.5%); exposed HCW (n = 746; 7.38%) and infected professionals (n = 523; 5.17%); of 274 professionals positive for the COVID-19, 132 (48.17%) were nurses, 87 (31.75%) were doctors, 33 (12.05%) were dentists and 22 (8.04%) were HCW from other occupations; 2,288 of them (67.59%) reported wearing face-shield, 2.287 (67.56%) face mask, 2.089 (61.71%) protective clothes, 77 (2.27%) gloves and 24 (0.71%) shoe cover; of 196 HCW, 123 (62.75%) reported hand washing as a preventive measure. Conclusions: Health care professionals, especially those with direct contact with infected patients, leading to greater exposition, should take extra precautions to avoid COVID-19 contamination during the current pandemic 154 Quality of Life Among the Type 2 Diabetes Mellitus Clients in Tabuk, Saudi Arabia , Mathar Mohideen, Jay Ablao, Mohammed Alrashidi and Ahmed Hakami AbstractObjective: The objective of this study is to assess the quality of life using the D39 questionnaire in the patients of diabetes Mellitus in Tabuk, KSA. Keywords: Quality of Life; Diabetes Mellitus; Saudi ArabiaBackground: The emerging rise in number of diabetes and rising complications need special attention by the health care providers. One of the key management of the diabetes is on the self-effort of the patients. Compliance is the best way to control diabetes and to prevent its complications. The behavior of the client on the health advices helps to control diabetes. Enlightening and encourag-ing patient to manage diabetes can go a long way in lowering the burden of diabetes, on health care services Primarily focuses in enhancing quality of care to those domains that considered to be areas of poor quality of life. Furthermore, the result may give a clear understanding about the factors that affect quality of life that can contribute in disease management, self-care management, effective ways in prolonging quality of life and to lessen the sufferings of the patients with diabetes.Methods: A Cross sectional study was conducted among the type 2 diabetes mellitus clients from the diabetic clinic in Tabuk city, KSA. Sample size was 75. This study was carried out for the period of 6 months. Convenience sampling method was used to select the participants. The Diabetes 39 (D-39) Instrument Evaluation, containing five dimensions: energy and mobility (15 items), diabetes control (12), anxiety and worry (4) social overload (5) and sexual behaviour (3), was used to collect the data.Results and Discussion: The results of this study revealed that the nearly half of the clients who participated in this study was hy-pertensive (48%). Nearly one fourth of the clients were suffering from diabetes more than 10 years. The mean scores on the quality of life questionnaire dimensions include, Energy and mobility: Mean-42.88, SD-17.57, Diabetes Control: Mean-37.65, SD-13.54, Anxiety and worry: Mean-11.01, SD-4.88, Sexual behavior: Mean- 9.07, SD-5.4, Social burden: Mean-13.15, SD-5.43. Overall scores in the QOL shows improvement is needed in all the subsections.Conclusion: This study identified the impact of clients self-perceived quality of life. Most of the studies have reported the similar findings. These results indicate the necessity of improving the quality of life (Qol) of client with diabetes and strengthening diabetes education program 155 Multiple Repeated Coronary Bypass Surgery Using the MICS Method with Using an Intraoperative Flowmeter , Kazaryan AV, Sigaev IY, Starostin MV, Keren MA, Morchadze BD, Pilipenko IV, Kydachev IF and Shoniya ZD Repeated coronary bypass surgery (redo-CABG) is still an operation of increased complexity and accompanied by a higher risk of morbidity and mortality compared to the primary CABG. Resternotomy remains the most necessary access in surgical practice with repeated heart surgery, despite a recognized high risk. The high risk of redo-CABG is largely due to technical difficulties: re-access and cardiolysis. The shortcomings of resternotomy have led to the development of alternative access to the heart, including for the implementation of redo-CABG. The purpose of our communication is to provide a clinical case of successful redo-CABG using the MICS technique. Output. Performing redo-CABG on the method of MICS in patients with the return of angina after CABG leads to an improvement in the results of surgical treatment: reducing the frequency of complications associated with resternotomy and short-ening the rehabilitation period. 156 Knowledge of Islamic Religious Officials Toward Kidney Transplant and Donation , W Fadili, A Errai, M Labrassi, M Lakmichi, Z Dahami, S Moudouni, I Laouad and I Sarf Background: Kidney transplantation is the best therapeutic choice of patients with end stage renal disease as it improves quality of life and survival rates. However, it is limited by the scarity of donors in part due to negative attitudes of muslims toward organ dona-tion.The aim of this study was to evaluate the knowledge of islamic religious officials toward organ donation and transplantation.Keywords: Islam; Religious Officials; Kidney DonationMethods: Cross-sectional study of 125 islamic religious officials. A questionnaire was provided to the study group, asking about their knowledge and views toward kidney donation.Results: In our study, 57% of religious officials refused to participate due to a lack of information on kidney transplantation. Most of the participants were in favor to kidney donation (88,9%) and believed that it was compatible with islamic judgments (94,4%), but none of them accepted the principle of brain-deceased donor.Conclusion: It is clear that improving the knowledge of religious officials on organ donation is an important step in changing the cultural beliefs of muslim populations. 157 Quality Assurance and Standard in Medical Sciences with Special Reference to Neurosciences and Quality and Standard in Operation Theatres, Wards and Intensive Care , Upadhyay PK, Tiwary G, Kritika and Kartikeya Although Medical science is a novel, pious and respectable profession of late has been marred by multiple controversies due to de-teriorating patient – doctor and other medical and health professional relationship. Mainly due to lack of proper communication and lack proper and operating procedures. There was also lack of quality standards in many aspects and there was neither good quality assurance nor proper quality bench markings. These aspects are briefly discussed in general and reference to Wards, Intensive care, and operation theatre in particular apart from other special operating procedures (SOP) 158 Concepts, History of Quality in Medical Sciences with Special Reference to Neurosciences and Neurosurgery and World Giants of Quality and their Quality Theories and Philosophies , Upadhyay PK, Tiwary G, Kritika and Kartikeya The quality has been in the consideration of mankind since the evolution of humanity. It was considered much more important when it comes to the human life, health and medical sciences. Although quality was consideration and practiced from ancient periods in health and medical sciences, but quality development was taken on front seat by Industrial development in late 19th century and early 20th century which is still continuing. Quality in health and medical science also developed parallel to this. Most of the method-ology, theory and philosophy in quality development where proposed applied by management gurus of Industry which were applied simultaneously to the health and medical services quality management services 159 COVID-19 Pandemic: Egyptian Health Care Providers Burn Out , Esmael Ali Hamed Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province, and has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic [1]. 160 Contribution of 4% Sodium Citrate in Hemodialysis Catheter Lock , Daniel Tony Eyeni Sinomono Context: Due to its antithrombotic and antibacterial properties, 4% sodium citrate is an alternative to unfractionated heparin in locking hemodialysis catheters. Our study aims to assess the clinical efficacy, risks and cost of the 4% sodium citrate lock compared to the heparin lock for hemodialysis catheters. Methodology: This is a single-center, prospective, randomized study. The patients were divided into two groups in which the cath-eters were locked either with 4% sodium citrate solution or with unfractionated heparin; this. We studied thrombotic, infectious, hemorrhagic complications and the cost of each type of lock. Results: 47 patients made up our population. 23 catheters had 4% sodium citrate as their lock and 22 unfractionated heparin. There was no significant difference in thrombotic catheter dysfunction (p = 0.4) as well as in the occurrence of infectious events (p = 0.7). No local hemorrhagic complication was found in the 4% citrate lock group. The citrate lock allowed a saving of more than 100% compared to heparin. Conclusion: 4% sodium citrate is as effective as heparin in maintaining catheter patency. It is less expensive than the latter and would lead to fewer local bleeding complications. However, its effectiveness in preventing catheter-related infections remains to be demonstrated. there was no significant difference in thrombotic catheter dysfunction (p = 0.4) as well as in the occurrence of infec-tious events (p = 0.7). No local hemorrhagic complication was found in the 4% citrate lock group. The citrate lock allowed a saving of more than 100% compared to heparin. 161 The Use of Vaginal Progesterone in Risk Reduction of Preterm Birth in Pregnant Women with Short Cervix , Sana Monem and Chro Najmaddin Fattah Background: Preterm labour is a major health challenge in obstetrics. Many risk factors being identified, the most common one is short cervical length, can be diagnosed by transvaginal ultrasound scan after 13 weeks of pregnancy. Vaginal progesterone is the most bioavailable form of progesterone that have effect on uterine and cervix. Progesterone is thought to inhibit the production of proinflammatory cytokines and prostaglandins within the uterus and to inhibit myometrial contractilityObjectives: The objective of this study is to assess the usefulness of vaginal progesterone suppositories in reduction of preterm birth in asymptomatic singleton pregnancy women with short cervix.Patients and Methods: This is a study on the daily use of (100mg or 200mg) of vaginal progesterone by 79 women in a prospective Randomized Controlled study. Between 24-34 weeks of gestation with short cervix of <29mm confirmed by transvaginal ultrasound and followed prospectively.Result: Preterm labour among vaginal progesterone group were less but statistically nonsignificant. The preterm labour among who received 100 mg was significantly lower than other 200mg.Conclusion: The study found the advantage of progesterone pessary in a women with short cervical length <25 mm in mid-trimester of pregnancy with no history of preterm labour. 162 A Comparative Study of the Exactness of Certain Last Menstrual Period and Ultrasonography in Forecasting the Date of Delivery , Peter Waibode Alabrah, Dennis Oju Allagoa, Anthony Okeoghene Eguvbe, Bassey Offiong Porbeni-Fumudoh and Spencer Ebobrah The study aimed to determine between last menstrual period and ultrasonography which is more exact in predicting the delivery date.This prospective comparative study utilized 311 participants with certain last menstrual period at between 8 to less than 24 week gestation. The participants were scanned and followed up to delivery. The date of birth as forecasted by the crown-rump length (CRL), biparietal diameter (BPD), and femur length (FL) were analyzed and compared with estimates derived from the last menstrual period (LMP).The results showed that ultrasound biometry was better than certain LMP in estimating the day of delivery by a minimum of 0.7 days. Less than 10% of the subjects delivered on the day predicted altogether by the methods employed in calculating the date of de-livery. The BPD was the best predictor of the date of delivery and the length of the pregnancy (mean and median duration being 279.2 and 279 days respectively) while the FL performed slightly more exact than the CRL. Combination of any two or three ultrasonic variables statistically did not improve the accuracy of prediction. When ultrasound was used instead of certain LMP, the number of post term pregnancies reduced from 4% to 0.4%. All predictions by CRL fell within term.Ultrasound biometry was more exact than certain last menstrual period in dating, and its utilization, reduced the number of post term deliveries. A second trimester biparietal diameter was the best parameter in dating pregnancy. Combining more than one ultra-sonic measurements did not result in improved datingaccuracy 163 Pharmacological and Analytical Aspects of Esculetin: A Comprehensive Review , Manoj Gadewar, Lakhveer Singh, Mohd Kafeel and Dharmender Plants have been used as a source of food material and natural remedies for the treatment of various ailments. Medicinal plants exhibit various pharmacological activities due to the presence of one or more phytoconstituents such as alkaloids, glycosides, flavo-noids, terpenes etc. Coumarins (1, 2 benzopyrones) are a large group of naturally occurring secondary metabolites present in higher plants. Esculetin (6, 7-dihydroxycoumarin) is a coumarin derivative found in a plant, Cichorium intybus which is widely distributed in Europe and other parts of the world. It is also present in a Chinese plant, Bougainllra spectabillis and usedas folk medicines. Although it is found in herbal medicines, exhibit various pharmacological actions such as antioxidant, hepatoprotective, anti-inflammatory, anticancer, hypoglycemic and chemopreventive action. Only limited scientific research has been published. The aim of this review is to collect all available scientific information which will provide valuable information to researchers in further development and screening methods for the treatment of various diseases by using esculetin as a potential molecule 164 Childhood Obesity and Health Risks of Overweight Children , Anila Kalleshi Childhood obesity is a serious medical condition that affects children and adolescents. Children who are obese are above the nor-mal weight for their age and height. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age. Many co-morbid conditions like metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association with childhood obesity.The theme of this project aimed to include in a medical examination all children aged from 6 years old up to 15 years old (children of primary schools in one city of Albania). Before doing the medical examination, children parents were informed about the project, through an informing meeting, where it was explained the purpose of the project, how it will be done, who was the medical staff doing the medical visits. 165 Prevalence of Horizontal Strabismus in Pediatrics Patients at University Eye Hospital ,   Amirzda Shir Mohammad and Hamid Mohammad Naim. Introduction:Strabismus is a clinical condition in which the eyes are not aligned properly and are pointed in different directions when looking at an object. Strabismus is a type of illness that requires medical and surgical treatment. If left untreated, amblyopia will increase the eyes of patients.Objective of the Study: Prevalence of strabismus in children visiting at University Eye Hospital in March 25 and 21 September 2019.Materials and Methods: The research design was cross-sectional study. The ophthalmology research site was universityeye hospi-tal. The total included cases were 1862 Strabismus patients the age was sixteen and under who were referred for examination and treatment of ocular diseases within the prescribed period. Age and sex information were collected from patients’ files were analyzed using Microsoft excel. Patients by age were into four groups (0 - 1) years, (2 - 5) years, (6 - 10) years and (11 - 16) years. Result:This study were examined the numbers of (1862) children in the 25 March to 21 September 2019 at the university eye hos-pital. Including their number of strabismus patients during the study was 3.59%. The average age is 9 years. The number of boys 37 (55.22%) and the number of girls is 30 (44.77%). The most common type of strabismus is the esotropia form (73.1%), exotropia were (26.9%). Alternate strabismus (55.2%), unilateral strabismus (44.8%).Conclusion: This study shows that the most common type of strabismus was esotropia boys were more affected than girls 166 Plastics, Bisphenol and COVID: Bisphenol B is Necessarily not Better than Bisphenol A , Samiksha Jain, Sumanpreet Kaur, Deepak Kumar, Rajasri Bhattacharyya and Dibyajyoti Banerjee It is of common knowledge that plastics are bad for the envi-ronment and also bad for human health [1]. It leaches out toxic chemicals which are often endocrine disruptors [2,3]. One such chemical is Bisphenol A that is already banned [4,5]. Awareness about Bisphenol A toxicity is gradually increasing, and there are user-friendly methods of Bisphenol A detection [6-9]. However, Bisphenol A is not an isolated chemical that leaches out from plas-tics. Bisphenols are a group of related chemicals that leaches out from the plastics [10-12]. We can take the example of Bisphenol B. It is chemically related to Bisphenol A [13], but its acute toxicity is more 167 Laparoscopic Ventral Hernia Repair: A Systematic Institutional Review , Tuhin Shah, Ashish Prasad Rajbhandari, Rabin Koirala and Sunil Shrestha Introduction: Incisional hernia is the most common long term surgical complication after laparotomy. LVHR is performed regularly at many centers as the first choice for ventral hernia repair to reap the benefits of MIS.Methods: All patients with ventral hernia were included in the study who agreed to undergo LVHR. Patients with incarcerated, obstructed or strangulated hernias were excluded. 26 patients were included who underwent IPOM repair over 24 months. Patient characteristics, demographics, perioperative and postoperative data was recorded and analyzed. Results: Indications for LVHR were paraumbilical hernia in 15 (57.7%), epigastric hernia in 1 (3.8%), incisional hernia in 8 (30.8%) and umbilical port site hernia in 2 (7.7%) cases. The mean operative time for all laparoscopic ventral hernia repair was 82 (62-132) minutes. Nine patients developed some form of complications, 7 (26.9%) had developed a seroma and 2 (7.7%) had superficial surgi-cal site infection and managed conservatively. There was no conversion to open procedure, no recurrences and no mortality.Conclusion:Ventral hernias are frequent with an increase in the number of surgery happening now. The benefits of smaller surgical wounds, shorter hospital stay, fewer complications, lower post-operative pain and early recovery with IPOM has prompted many to use this technique of repair with good results.Keywords: LVHR; IPOM Repair; Ventral Hernia; Incisional Hernia; Laparoscopic Ventral Hernia Repair; Intraperitoneal Onlay Mesh Repair 168 Severe Community-acquired Pneumonia in Obese Patients and Need for Mechanical Ventilation , Fetco-MereuÈ›Äƒ Diana, CaÈ™caval Virginia, Matcovschi Sergiu, Grib Livi, Talmaci Cornelia, Èšerna Eudochia, Chihai Viorica and DumitraÈ™ Tatiana Background:Community-acquired pneumonia (CAP) is a heterogeneous entity with a variable clinical presentation and a wide range of responsible pathogens that differ depending upon age, comorbidities and recent exposures. Obesity is associated with an increased risk of acquiring infections such as community-acquired pneumonia.Methods: In this retrospective case-control study, we analyzed 82 case histories of patients hospitalized with severe community-acquired pneumonia, from January 2017 to November 2019, based on clinical, laboratory and instrumental data.Results: The results of the study showed that invasive mechanical ventilation and tracheostomy was applied more frequently for obese patients with severe community-acquired pneumonia.Among the comorbidities, the presence of chronic obstructive pulmo-nary disease (COPD) had a weak positive correlation with severe CAP evolution in the group with obesity.Conclusion: Obesity, in association with COPD, has been shown to have a negative impact on CAP severity, explained by higher rate of application of invasive mechanical ventilation and the need for tracheostomy.Keywords: Severe Community-acquired Pneumonia; Obesity; Invasive Ventilation; Comorbidities; Clinical Characteristics 169 Digestive Sarcoidosis: About 11 Cases , Mzabi Anis, Thabet Maissa*, Zorgati Hend, Boufares Ahmed, Anoun Jihed, Ben Fredj Fatma, Rezgui Amel and Laouani Chedia During sarcoidosis, digestive involvement is rare and occurs mainly in a context of multisystemic condition. It can affect all seg-ments of the digestive tract. We conducted 11 patients with digestive sarcoidosis (9 women and 2 men) of average age at diagnosis 44.16 years [26 - 75]. The revealing symptoms were mainly weight loss and abdominal pain in 8 cases respectively. Digestive involve-ment was isolated in 4 cases, revealing in 5 cases and associated with mediastino-pulmonary involvement (n = 2), ocular involve-ment (n = 2) and neurological involvement (n = 2). Hepatomegaly was found in 7 cases: splenomegaly in 4 cases. The multinodular aspect of hepatosplenomegaly was noted in 3 cases. Two patients had pancreatic involvement and one had gastric involvement. The angiotensin converting enzyme was measured in all of our patients and was increased in 7 patients with a mean of 98.72 IU/ml. The treatment included corticosteroid therapy in all cases; methotrexate in 1 case and 4 patients were on PPI. 170 COVID-19 Associated Transverse Myelitis: A Rare Neurologic Complication   , Keith Brown, Matthew Everwine, James Brady and David Roshal LThe SARS-CoV-2 virus typically affects the respiratory tract inducing cough and shortness of breath with associated viral prodro-mal symptoms. However, the virus’s predilection for the respiratory tract is not exclusive. There have been reports of different neu-rologic implications from COVID-19 infections. One such sequela, albeit rare, includes acute transverse myelitis. Transverse myelitis is an acute inflammatory condition of the spinal cord manifesting with myelopathy. Given its uncommon occurrence, the literature involving acute transverse myelitis secondary to COVID-19 is limited to case reports. The case that follows describes a 31 year old female complaining of acute back pain with lower extremity weakness in the setting of transverse myelitis from COVID-19. Diagnosis was made via MRI with contrast which demonstrated focal enhancement of the spinal cord at T3-T4. The patient underwent further evaluation including lumbar puncture, all of which was unrevealing. She was subsequently diagnosed with acute transverse myelitis from COVID-19 and placed on intravenous steroids with interval symptomatic improvement. Given evolving evidence of the SARS-CoV-2 virus’s involvement in organ systems other than the respiratory tract, it is imperative to keep a broad differential for neurologi-cal complaints when dealing with a known COVID-19 positive patient 171 Association Between Body Mass Index and Blood Pressure Among Rural Indian Adults , Partha Sarathi Datta Introduction: Measures of Body Mass Index (BMI) and blood pressure are important for assessing the health status of adults. Objectives: To find out the association between the BMI and blood pressure among rural adults of Indian origin.Methods: Anthropometric measurements, such as stature, body weight, were measured using standard methodology. Systolic (SBP) and Diastolic (DBP) blood pressure were recorded according to a proper methodology. A schedule was used to collect data on the socio-demographic profile, behavioral activity, weekly physical activity and family history of hypertension etc. Results: Among the total study participants 259 (19.98%) were overweight and 98 (7.56%) were obese. 28.47% of the study partici-pants had stage-I hypertension while 71.53% had normal blood pressure. A significant correlation was observed between BMI and Blood pressure. 172 Thoracic Spinal Anesthesia for Surgical Treatment of Bilateral Gynecomastia in Adoslecent Patient. Case Report , Thaís Bezerra Ventura, Luiz Eduardo Imbelloni, Márcia Morete and Odir Pereira Borges Filho Background: Gynecomastia is defined as the benign proliferation of breast tissue in men. being physically uncomfortable, psycho-logically distressing and generating distress in teenagers. If clinical treatment does not resolve the best approach, it is surgical treat-ment that brings the best benefit in the medium and long term. Case Report: Male patient, 15 years old, 70 kg and height of 165 cm, ASA I, Goldman I, without allergies, or other comorbidities, was indicated to undergo surgical correction of bilateral gynecomastia. Multimodal anesthesia with spinal thoracic anesthesia with local anesthetic and fentanyl, NSAID, dypirone, dextroketamine and surgical wound infiltration with levobupivacaine was indicated. Segmental thoracic anesthesia (C4 to T9), grade 1 motor block, without cardiocirculatory changes and neurological complications were obtained. At the end of the procedure, the patient went from the operating table to the transport stretcher without assistance.Conclusion: This multimodal anesthetic technique using hyperbaric local anesthetic is safe since it generates few adverse effects, predominance of sensitive roots, quick recovery and provides segmental anesthesia 173 Medication Errors Related to Warfarin from a Safety Reporting System Database , Saleh Alanazi, Hessa Al Muqati, Huda Al Enazi, Tahani Alsufian, Thamer AlOtaibi, Hind AlBadli, Amirah Alsaleh, Sara Al Mowalad, Saad Al Obaidy, Khalil Majid and Salah Al Dekhil This study aimed to analyze the safety reports of the organization of King Abdulaziz Medical City (KAMC); these safety reports included warfarin as a medication error or near-miss. The goal of this analysis is to optimize the reporting of incidents in the safety reporting system and to determine the factors contributing to errors in warfarin prescriptions.In this retrospective study, we used reports from 2013 to 2016 related to warfarin collected from the organization’s safety report system database. The data were extracted and analyzed to determine the number of yearly reports, contributing factors, and person-affected outcomes.Overall, 78 incidents were reported (2013: n = 4, 2014: n = 19, 2015: n = 22, 2016: n = 33); 73% of them did not reach the patient, and 26.9% did reach the patient. Of the 26.9% (n = 21) that reached the patient, 16 did not cause harm, and only 5 of the patients needed monitoring to confirm a lack of harm.There was a significant increase in warfarin-reported incidents over the years, which is an indication of an increased frequency of voluntary reporting in the system, along with a higher number of errors in warfarin prescriptions. The higher percentage of near-misses indicates a need to educate qualified healthcare providers, who are informed about fair culture and national and international safety standards for high-alert medication, about this issue. The organization implemented a new healthcare informatics system in 2015 and 2016; this new system was one of the important contributing factors, in addition to medication preparation errors and a lack of proper medication reconciliation. 174 Living Better with SCD , Safaa Eldeeb Your child can live a full, active life when he/she have sickle cell disease. They can participate in most of the similar activities as others. Making smart selections is essential in maintaining the condition from flare up into a crisis.Sickle cell disease (SCD) is a hereditary condition in which the structure of red blood cells is abnormal and its shape is like C letter that can get trapped in blood vessels and block them. This obstruc-tion is termed a painful crisis or sickle crisis.You will not have total control over how SCD alters their body. But they can take steps to cope with pain and to lessen chances of problems 175 Periosteal Aneurysmatic Bone Cyst: A Rare Case Treated by Pre-Surgery Endovascular Embolization , GE Vallati, L Teodoli, C Trobiani, F Cappelli and C Zoccali In this work we report the rare case of a periosteal aneurysmatic cyst found in a 30-year-old male patient. The patient came to our hospital for the detection of a painful swelling located on the lateral side of the right thigh; for this reason, he underwent objective examination and then X-rays, MRI examination and PET-CT. Once the diagnosis was established, in agreement with the orthopedists, in view of the rich vascularization of the lesion, it was decided to perform a pre-operative arterial embolization in order to reduce the complications related to the intervention, specifically reducing the risk of intraoperative bleeding, and promoting a better post-operative course. In this text we report the images and the technique used to perform the preoperative arterial embolization and therefore the results obtained 176 The Two Dominant Electromagnetic Frequencies of Life , Edward F Block IV Life began, developed and matured within the biosphere of the Earth. The 5 fundamental forces of physical reality played a major role in bringing together the material resources that made up the Earth upon which the biosphere was created and that allowed life to flourish 177 Navigating Nursing Clinical Experiences during the Covid-19 Pandemic , Tamara Jessica Brown The traditional clinical in the hospital has been turned upside down since the start of the Covid-19 pandemic. At the start of the pandemic, hospitals closed its doors to nursing students abruptly interrupting Spring 2020 hospital nursing clinical experiences. As a result, many schools of nursing made creative virtual simulation experiences for nursing students to obtain their clinical experi-ence. As student nurses return to clinical practice in their Fall 2020 semester in the hospital, schools of nursing, instructors, and hospi-tals must ensure the safety of students and patients 178 Covid-19 Treatment from a New Perspective for the First Time   , Akbar Mohammadrezaei By creating panic and pandemics, the covid-19 imposed high costs on governments and health systems in numerous countries. Unfortunately, due to the unknown nature of the disease, the costs were not useful. Doctors and scientists to solve the biggest chal-lenge off modern medicine were unified.I started my research on pathology and its treatment from the beginning of the disease and made good progress, but due to the immigration of my family and I to Canada, there was a interruption in the completion of the research. Now I’ll sum up and publish the results of the research 179 The Use of Negative Pressure Wound Treatment of Chronic Non-Healing Wounds , Ðšryvoruchko IA, Goltsev KA, Ivanova Yu V and Cheverda VM Treatment of chronic non-healing wounds in the lower extremities involves a variety of comprehensive treatments, including dehydration by vacuum-assisted closure (VAC) therapy, plastic closing surgical techniques, etc. The aim of the study was to analyze the results treatment of chronic non-healing wounds of lower limb with have used with VAC therapy. The retro- and prospective study included a review of data collected from 127 patients in 2011 - 2020 of both sexes with mean age of 59.8 years. All patients were divided into three groups: the 1st group (49), who after opening and sanitizing the purulent cavity was prepared the wound for the application of secondary sutures or for autodermoplasty by an open method using bandages with proteolytic enzymes, oint-ments on water-soluble basis, antiseptics; the 2nd group (57), who underwent VAC therapy after necrectomy, and the 3rd group (21), who underwent preparation of long-existing infected granulating wounds for autodermoplasty. The patients had initial local and systemic treatment, followed by VAC therapy, and were statistically analyzed. In 62 patients additional treatment was not required, in 25 patients were needed including a surgical plastic closing of your own skin. The 2 patients died before final closure due to other complications (myocardial infarction and stroke). In all the other patients, their wounds are completely healed. In order to eradicate the infection and close the wound the duration of VAC averaged 6.3 ± 0.32 days (from 2 to 16 days). The study confirmed the safety and effectiveness of VAC bandages in patients as to primary treatment and preparing this patients for autodermoplasty 180 Review: The Contribution of Technological Advancements in Breast Cancer from Next Generation Sequencing to Mass-Spectrophotometer , Zakaria Eltahir and Abdul Samad Firoz Breast Cancer has been recognized as a global health problem and a complex disease entity. When considering all cancer types, breast cancer is becoming the most frequent type of cancer affecting women of all ages and across the whole world. Era before next generation sequencing, diagnostic approaches employing genetic analysis were focused on individual factors and were unable to illustrate the comprehensive network of biological complexity encountering this aggressive disease. The introduction of next gen-eration sequencing has facilitated the acquisition of high resolution whole genome, exome and transcriptome sequencing data. This previously unattainable data enabled health professionals to gain a global view of breast cancer genomes and the full spectrum of its involvement. With the utilization of Next Generation Sequencing data from large number of breast cancer patients, it is expected that the exact signaling pathways, leading to the oncogenic transformation of breast tissue, become more understood. Next Generation Sequencing promises to revolutionize breast cancer research, therapy and diagnosis. Combining the recent technological advances and the ability to integrate data from the areas of genomics, transcriptomics and proteomics; scientists have a greater opportunity to further investigate tumor evolution, gene expression and protein involvements. In this article, we have reviewed the recent tech-nological advancements in breast cancer research and highlighted the contributions of Next Generation Sequencing technologies to such advancements 181 When Pandemic is Over: We Need to Deal with Long Term Sequelae of COVID , Salim Surani and Pahnwat Taweesedt 182 Epidemiological Profile of Noma in the Health District of Maroua , Bengondo C, Zing S, Ousmane A, Mboya M; Yemelie C The children are the children. Lemurian sweeper occupation in Afrique [1]. Currently,53 countries, all in the inter-tropical zone, declares carcass casing years [2]. The data on epidemiology duomo, especially at the Cameroun countries. C is for this reason we noisome propose degenerate study’s reprofile epidemiological du Noma dandle department du Diamaré.Keywords: Profile; Epidemiology; Noma; Diamaré; CameroonMaterial and Methods: They were a tenement descriptive in the hospital trainings of the department of the Diamaré. They’re out of timer, alliant' April 201 In December 2019. We have carried out a routine and comprehensive routines, representing unknow appen-dant to criteria of inclusion. The data s the tutorials by using a 24technic,then registered and analyzed at the help of ulogic Excel 2016.Results: A total, 25 patient says ayslenomatoeined. The media department age was 26.4 years. The exams client predominant, with unsex-ratio of 1.78. The classification of Montana computer effect unctuous, the most frequent in in 36% descas, followed du type I 26% and type IV with 12%. Prevalence is 0,004 per 100 inhabitants. The most frequent partner in the volume-free case is the oral diseased 72.73%. Then venaitla malnutrition 54.54% and malaria 27.27%. Other factors were plagued 9.09% and the patients viH of patients, which were it positive in 45.45% descas.Conclusion: Lemonades context survient, many, the10-year-olds, concerns the extra seventeen. They are patients with an oral dis-ease, malnutrients, patients who are a disease in ferities use our parasitize-even in minimally immunosuppressed patients 183 Mistrust in COVID-19 Vaccine during Pandemic!   , Salim Surani, Aiza Momin Khawaja and Pahnwat Tonya Taweesedt SARS-CoV-2 or severe acute respiratory syndrome initially emerged in Wuhan city (Hubei Province), China on December 8, 2019. Initially thought to be endemic, but soon the virus spread to Italy, the United States, and the rest of the world [1]. Before we know it, it created global chaos and economic turmoil and travel curtailment, and in many cases lockdown of the countries. To date (3/21/2021) it has infected 123,703,573 people globally and ac-counting for 2,725,105 death globally. The United States despite being the global leader failed to recognize the gravity of the situa-tion and the virus spread all over the country infecting 30,490,614 people and accounting for 554,962 death [2]. This is equivalent to 275 passengers in Boeing 747 and every day 5.5 of those Boeing crashes and every single passenger dies. Having the tragedy aside, the world has embraced the challenge effectively with therapeu-tics and vaccines for the prevention and treatment of COVID-19, emerging in record time 184 Serum Cytokine Profiles in Patients with Psoriasis , Hülya Çiçek, Lara Adnan Alkarkhi, Hüseyin Gürbüz and Zülal ErbaÄŸcÄ± Psoriasis is a common inflammatory autoimmune skin disease that affects 2 - 4% of the world's population.T cells including adipocytokines such as chemerin, Transforming Growth Factor-β1 (TGFβ1), FMS-associated Tyrosine kinase 3 ligand (FLT3-Ligand), Tumor Necrosis Factor Alpha (TNFα) and Interleukin β 1 (IL- β 1) infiltration, interleukins and cytokines play a role in the pathogen-esis of psoriasis.In this study, we aimed to evaluate the pathogenesis of psoriasis disease and to evaluate serum chemerin, serum lipid profiles, body mass index, and Psoriasis Area Severity Index (PASI) values in psoriasis patients who applied to dermatology polyclinic.Serum chemerin, TGF β1, FLT3-Ligand, TNF α, and IL-β 1 levels were investigated using the Enzyme-linked immunosorbent assay (ELISA) method. Serum C-reactive protein, total cholesterol, LDL, triglyceride fasting glucose and white blood cell levels were also evaluated.A total of 80 individuals (37 psoriasis and 43 healthy controls) were admitted to Gaziantep University Medical Faculty Dermatology Polyclinic between July 2016 to April 2017. Assessment of the activity of psoriasis was made with the PASI score.According to the results of this study, serum levels of chemerin, TGFβ1, FLT3-Ligand, IL-β1 and TNFα were found to be higher in patients with psoriasis than those in the control group (p < 0.01, p < 0.05, p < 0.01, p < 0.01, and p < 0.01).There was a significant positive correlation between PASI score and serum chemerin level (r = 0.695 ** p < 0.01). Serum total cholesterol, LDL and triglycer-ide levels of the control group were found to be lower as compared to the patient group and it is statistically significant (p < 0.01, p < 0.01 and p < 0.05, respectively).Serum total cholesterol, LDL and triglyceride levels of the control group were also found to be lower than those for the patient group and it is statistically significant (p < 0.01, p < 0.01 and p < 0.05, respectively).White blood cell counts (WBC) were significantly higher in the patient group (9.03 ± 3.31 versus 6.71 ± 1.65) (p < 0.01). CRP, PASI score were found to be pos-itively correlated with serum chemerin level and the relations are statistically significant (r = 0.425 ** p < 0.01) (r = .515 ** p < 0.01).As a result, high serum levels in patients with psoriasis indicate an inflammatory process and markers such as TGF β1, FLT3-Ligand, IL-β 1 and TNF α may be useful in determining the severity of psoriasis. 185 What Complications for Tunnelled Haemodialysis Catheters Placed with Venous Ultrasound? , Daniel Tony Eyeni Sinomono, Mohamed Arrayhani and Tarik Sqalli Houssaini Introduction and Objectives: Due to their flexibility, their diameter and the barrier antimicrobial in connection with a subcutane-ous tunnelling, catheters (KTT) tunnelled are increasingly used hey medialise. The object of our work is to determine the complica-tions of tunnelled catheters placed with a simple echolocation of the central venous passage. Materials and Methods: We carried out a prospective study spread over one year in the nephrology department of the CHU Has-san II in Fez. The KT T tunnels under echo guidance pour setting in haemodialysis without prior arteriovenous fistula (AVF), and in chronic haemodialysis patients after thrombosis of AVF. Results: We posed 35 KTT tunnels in 33 patients. The indication for the installation of tunnelled KTT was definitive in 3 chronic hae-modialysis patients (9.1%). The insertion site was right jugular for 32 tunnelled KTT (91.4%) and right femoral for the other three. Complications during insertion were uncomplicated arterial puncture in 4 cases (11.4%); a bend in 2 cases (5.7%); a deviation of the KT T in the subclavian vein in an obese patient and a sheet bleeding at the level of the tunnelling opening in two cases. We recorded a thrombosis of the arterial lumen after 2 months of use, one case of externalization of the subcutaneous segment after 14 months of use and two infections (5.71%) of the tunnel opening. Conclusion: The low incidence of thrombotic and infectious complications, but also of immediate complications, argues for a recom-mendation to place tunnelled catheters in haemodialysis despite the absence of a fluoroscopy. Keywords: Complications; Tunnelled; Haemodialysis; Catheters 186 The Algorithms Cruz Rodriguez (CR) are Proposing a Novel Vaccine RNA Peptide Against Liver Cancer Disease: Exosomes as Carrier in Cancer Progression , Cruz-Rodriguez L, Dilsiz N, Ziarati P, Hochwimmer B, Zayas Tamayo A and Lambert Brown D The liver cancer is the world's third most common malignancy in the world. Hepatocellular carcinoma (HCC) is accounting for about 90% of all primary liver cancer cases. Exosomes play a key role in tumor incidence, growth, and metastasis, offering novel clues into the clinical diagnosis and treatment of HCC. This article proposes a new RNA-peptide vaccine against liver cancer progression. This RNA-peptide projects involving RNA from SARS-CoV-2, and peptides from protein nuclear factor erythroid 2-related factor 2 (Nrf2) and human PARP-1 protein. Both peptides fusioned play the antitumural target role. As mRNA target, we used primers from Kemp V. “miRNA repertoire and host immune factor regulation upon avian coronavirus infection in eggs”: primers that were modified with poly adenine (A) sequence. We designed the peptides target from Nrf2 and PARP-1 human proteins. Our analysis, according to the algorithm CRUZ RODRIGUEZ (CR), we identified a miRNA-peptide with theorical fusion value stability FS=65.6 cruz, EA= 92.12 ro and BA= 1.4 where: Optimal Biological Action (OBA) are: 1.3 < OBA < 1.8 to treat liver cancer progression. Where, we are propos-ing, the exosomes and how these vesicles could function as carriers of RNA-peptide molecule. In this study, we expect that major histocompatibility complex l (MHC l) bind the molecule peptide (B) generated by hydrolysis (DEVD) of molecule RNA-peptide (AB) by caspase 3 or caspase 7; and induction of apoptosis pathways. Also, expect that MHC class II bind the molecule RNA-peptide (A) generated and recognition by appropriate T-cells at tumoral cells 187   All Trans Retinoic Acid Adjusts Gene Expression Profiling of Spermatogenesis Pathway in Elastase Treated Rat Lungs , Preeti Kumari, Basav Hazarika, Amit Tyagi and Jai Prakash Muyal Pulmonary emphysema is a chronic lung disease and is due to persistent inflammation. The inflammatory mediators generated during emphysema are thought to be infiltrated into the circulatory system, leading to systemic inflammation and hence, affecting function of other vital organs, here, a spermatogenesis process in testicular tissue. The impending role of ATRA towards the molecu-lar mechanisms prevailing systemic inflammation due to inflammatory mediator’s overspills in emphysema is inadequately implicit. Therefore, the present study deals with investigating the potential effect of ATRA on physiological functions of testis tissue in an established elastase induced emphysema rat model. Three experimental groups (i.e. control, SS; emphysema, ES; and therapy, EA) were prepared. Subsequently, testis from each rat was collected for tissue-histopathology and real-time PCR based mRNA expression analyses. Independent to this, for understanding the interaction between ATRA with target proteins an in silicostudy was conducted.Testis histopathology photomicrographs clearly shows a decrease in number of leydig cells in ES than SS, however, an increase in number of leydig cells was seen in EA. The mRNA expression of NF-κB, TNF-α, TNFR1A, AMH and NANOS2 was up regulated in ES group as compared to SS group while the same were significantly reduced in EA group. However, a significant reduction in the mRNA expressions of the male fertility genes that is FSHR, RBM3, DAZL, CDYL and TGFβ1were obtained in ES group than SS group, nevertheless in ATRA supplemented group (EA), the mRNA levels were increased significantly. Not only this, a reduction of CAT and GPx activities in testis tissue of elastase treated lungs (ES) was noticed than the SS group and an induction in the levels of CAT and GPx was obtained in EA group as compared to ES. In conclusion, ATRA supplementation has proven to be beneficial in reducing the inflammation along with maintaining the normal testis architecture as well as the male fertility genes. 188 Traumatic Extra Pleural Hematoma: How to Manage this Condition? , Cecília Pacheco, Marina Costa, Rui Castro, Luís Ribeiro and Sara Lopes A 74-year-old man presented with blunt thoracic trauma af-ter a 4m fall. Contrast-enhanced thoracoabdominal computed tomography (CT) showed a loculated right effusion and multiple rib fractures (Figure 1, panels A-B). His condition was stable. A haemothorax was suspected but agreement on a possible extra pleural hematoma (EPH) lead to a conservative approach . Patient was transferred to the ICU. On day 3, the patient presented with a haemorragic shock and CT showed increment of the collected ef-fusion, with mediastinal shift (Figure 2, panels A-B). Intravascular volume expansion, RBC transfusion, blind drainage and aspiration was performed. There was no ongoing blood loss and patient re-turned to stability. Thoracic surgery is not available in our hospital but they were consulted and there was an agreement on to post-pone transfer. Thoracoscopic surgery was performed on day 8. There were no complications and the patient was discharged. He Ìs doing well since then 189 Vasospastic Angina in a Patient with Induced Metabolic Disorders: A Case Report , PS Popov, AS Zhuravleva, IA Kurnikova, TV Nikishova and TS Polikarpova Background: Currently, cases of disorders associated with patients’ activities or the use of supplements and drugs are rarely re-ported. We observed a patient, a former professional bodybuilder. This sport is well known for use of some groups of pharmaceuticals with an ambiguous cardiovascular effect.Keywords: Vasospastic Angina; Acute Coronary Syndrome; Unstable Angina; Athlete’s Heart; BodybuildingObjective: To assess the relationship between the patient’s professional activity and cardiovascular disease.Discussion: When analyzing the data of the presented patient admitted to the specialized Department of Cardiology with acute coro-nary syndrome, the association was revealed between cardiovascular dysfunction, lipid metabolism and previous self-medication of drugs that can lead to coronary artery spasm and potentially increase the risk of sudden cardiac death 190 Trace Result in Xpert MTB/RIF Ultra: A Diagnostic Dilemma and Interpretation?   , Binit Kumar Singh, Pankaj Jorwal, Manish Soneja, Rohini Sharma and Naveet Wig With the development and implementation of newer diagnos-tic modalities for diagnosis of tuberculosis, issues related to inter-pretation and implication of these results in clinical context have created a new hurdle in front of clinicians and program managers. Apart from the presently approved ones, there are many diagnos-tic tools awaiting approval from WHO for their use in high burden, resource-limited countries 191 Calling Upon the International Community to Rise against the Atrocities in Myanmar by the Myanmar Military Janta , Mamun Al Mahtab, Kamrul Hasan Khan, A B M Faroque, Sitesh Chandra Bachar, Nuzhat Choudhury, Md. Abdur Rahim, Mohammad Helal Uddin, Sheikh Mohammad Noor-E-Alam, Musarrat Mahtab and Sheikh Mohammad Fazle Akbar Around 146 BC, the Battle of Carthage[1](The Third Punic War) reminds us the documented event ofethnic cleansing cam-paigns of the Roman Empire. More than 2000 years have passed af-ter the Battle of Carthage. However, the trend and tendency of the so-called supremacy of majority class over the minority regarding ethnic cleansing are still going on. Although political, economic, religious grouping and demand of racial superiority have always influenced the concept of this inhumane mentality, the impact of this on health care delivery system has poorly been addressed 192 Does COVID-19 Spread Slow or Fast in African Countries? A Narrative Review Article 2021 , Amira Sidig, Khabab Abbasher, Mazin Salah-Eldien Hassan, Mutaz F Digna, Abbasher Hussien, Radi Tofaha Alhusseini, Hussien Abbasher and Mohamed Abbasher In African countries, the number of new coronavirus cases is increasing. The virus has hit most African countries. However, the degree is less than that of China, the United States and Europe. On February 14, it was confirmed that the coronavirus pandemic had spread to Africa. 193 Chakras’ Energies Deficiencies as One of the Causes of Anosmia and Loss of Taste in SARS-CoV-2 Infection Patients , Huang WL Introduction and Purpose: Anosmia can be considered to be an unknown symptom in COVID-19. More than half of patients with COVID-19 have anosmia and eighty-four percent of patients presented both smell and taste disorders. In traditional Chinese medi-cine, all the five external sensorial organs are related to five massive organs (Liver - vision, Heart - comunication, Spleen - taste, Lung - smell and Kidney - hearing). The purpose of this study is to demonstrate that patients that is acquiring SARS-CoV-2 infections have energies deficiencies in the internal massive organs that are responsible for the sense of taste and smell.Methods: Through two clinical cases reports of patients that had SARS-CoV-2 infections and reported to have lack of sense of smell and taste as one of the symptoms. These patients did the measurement of the internal organs energies through radiesthesia proce-dure before they acquired SARS-CoV-2 infection. Another research did by the author studying the energy of the internal organs in a thousand patients during 2015 to 2020, prior to COVID-19 pandemic, were included in this study. Results: It was revelead that all the internal organs of the two case report patients were in the lowest level of energy, including the Lung and Spleen, that are responsible for the sense of smell and taste respectively. The treatment to replenish the energy of these organs were started weeks before the SARS-CoV-2 infection and it was sustained after the SARS-CoV-2 infection treatment, for a period of one year or more, using highly diluted medications according to the theory created by the author entitled Constitutional Homeopathy of Five Elements based on Traditional Chinese Medicine. In the researcher made by the author in her clinic in Brazil, it was found that more than 90% of the patients had no energy in any internal massive organs, including the Lung and the Spleen responsible for sense of smell and taste. Conclusion: In this study, the author is demonstrating that patients with lack of sense of taste and smell who underwent to SARS-CoV-2 infection have internal organs energies deficiences including the Lung and Spleen and the treatment replenishing these ener-gies are very important to treat the cause of these symptoms 194 Oral Hygiene of Both Genders among Medical and Technical Institute Students in Erbil City (A Comparative Study) , Faraed Dawood Salman, Shahida Rassul Hussein and Jabbar Hussein Kamel Background: Different oral hygiene aids are important in influencing patient’s ability caring of their teeth. Thus, this study aimed comparing oral hygiene among male and female students at Medical Technical Institute (MTI) and Technical Institute (TI) in Erbil city.Materials and Method: A cross-sectional study was conducted among institute students. A total of 800 students (400 MTI: 240 males, 196 female), (400 TI: 209 males, 191 female) were individually asked requested information related to oral hygiene such as: tooth-brushing frequency, tooth-brushing technique, tongue brush, dental floss and toothpick.Results: Concerning tooth-brushing frequency once/day male TI students showed highly significant difference (49.7%) at {p-value = 0.003} level more than male MTI students (36.7%) at {p-value= 0.003} level, for twice/day brushing frequency there was no statisti-cal significant difference for both groups. Concerning gender: female of both groups MTI and TI students reported higher percentages concerning brushing frequency, tongue brush and dental floss than male. Female MTI (96.4%, 51%, 58%) at {p = 0.03, 0.009, 0.01} level more than male MTI (84.3%, 25.5%, 28%), female TI students showed (96.4%, 34.03%, 40.8%) at {p-value = 0.003, 0.08, 0.00} level than male TI (89.95%, 27.75%, 24.8%). In contrast to tooth- pick aid was more popular among male students of both groups (MTI 51%, TI 52.15%) at {p = 0.001, 0.00} level, also for vertical brushing technique male of both groups showed higher percentage more than female (MTI 55.4%, TI 47.84%) at {p = 0.06} level, finally for brushing time total male TI students brushed more than 2 minutes (43.5%) than MTI students (42%) at {p = 0.33} level.Conclusion: The finding of this study had shown that both groups showed good oral hygiene, female of MTI and TI reported higher percentages than male regarding brushing frequency, tongue brush and dental floss in contrast to male of both groups applying verti-cal brushing technique and toothpick showed higher percentages than female of both groups. Brushing time more than 2 minutes was more prevalent among TI students, unlike brushing time for 2 minutes was prevalent in MTI students. 195 Study of Antibacterial Activity, Phytochemicals and Physico-chemical for Green Corrosion Inhibitors in Different Corrosive Media from Marrubium vulgare L Crude Extract , Salem Mohamed Edrah, FouzyAlafid, Salma Moftah Alamen, Hanan Soheal Alnade ,Wesam A Kollab and Miftah Bdeewi The aim of this research study use the Marrubium vulgare L. water- ethanolic extract for the inhibition of the corrosion of metals (Iron, Copper and Aluminium) in aqueous solutions, including phytochemicals- physicochemical analysis and antibacterial activity. Which reveled to resulted that this extract as a good inhibitor for selected metals corrosion, also is positively toward existing of phy-tochemicals which qualitatively analyzed such as alkaloids, flavonoids, tannins and saponins, while, Physico-chemical parameters, quantitatively phytochemical analyzed for obtained alkaloids, flavonoids and saponins were 56.86, 67.35 and 71.83%, respectively. Also, the physico-chemical parameters moisture content, loss on drying, Total Ash value, water-soluble ash, acid-insoluble ash and alcohol-soluble extractive were 11.26, 19.10, 13.40, 7.90, 10.48 and 8.31%, respectively. Furthermore, the volume of H2 of hydrogen producing from the reaction of metal coupons in acidic and alkali medium in were 170, 140, 150, 180, 80 and 40 g/cm3, respectively. And whereas, values varied widely among samples, but in general, most samples were had a good results, and the inhibition was found increased within increasing the concentration of the plant crude extract in solutions medium leads to highest protection of metals from corrosion. As an obtained results, that the crude extract of extract of Marrubium vulgare L acts as a mixed-type inhibitor and may aid as an active corrosion inhibitor of metals in aqueous solution. From the acquired results of antibacterial the examination exhibited that the crude extract of leaves was very effective against all types of bacteria Escherichia Coli, Klebsiella pneumonia, Proteus vulgaris and Staphylococcus aureus. The abstract should be clear, relative, descriptive, self-explanatory and no longer than 400 words. Do not include references or formulae or any special character in the abstract. 196 Biochemical Parameters of Rabbit Blood Serum in the Treatment of Limb Bone Fracture with Autologous Platelet-rich Plasma , Khegay Lyubov Nikolaevna and Gafforov Azamat Uygunovich Introduction into the body of autologous platelet-rich plasma (ÐPRP) is one of the most promising procedures in tissue restoration. After platelet destruction, ÐPRP contains α-granules, from which, after activation, transforming growth factor-beta, vascular endo-thelial growth factor and epidermal growth factor are released. This study investigated the effect of autologous platelet-rich plasma on biochemical markers of rabbit blood during bone fracture regeneration. Changes in the concentrations of aspartate aminotransferase, alanine aminotransferase, total bilirubin, alkaline phos-phatase, total protein and urea were found. Disorders of enzyme activity and protein metabolism allow indirectly assessing the therapeutic effect of autologous platelet-rich plasma 197 Expression of e4 Mutant APOE Gene in a select South Indian Population Indicates Relation to Coronary Artery Disease , Lima Hazarika, Supriyo Sen and Sanjeev Ranjan The polymorphic human Apolipoprotein E (APOE) gene encodes 3 common epsilon (ε) alleles (ε2, ε3, and ε4), reported to influence the risk of Alzheimer's disease (AD) and cardiovascular diseases. Studies indicated that individuals with the e4 version of APOE gene is associated with higher cholesterol levels. The genetic architecture of coronary artery disease (CAD) is largely determined by the effects of genetic variants, yet genetic detection is not usually followed in CAD. There have been no prospective studies so far in India. The present study attempted to evaluate the correlation between the expressions of APOE gene in a selected south Indian sample. Genetic detection among the CAD patients to screen for associations between APOE and CAD by polymerase chain reaction, (PCR) followed by evaluation of the mRNA expression of the e4 variant of the gene by the reverse transcriptase-polymerase chain reaction (RT-PCR). A significant association of APOE4 gene variant to CAD was observed in the studied subjects. Twelve out of fourteen cases and one out of thirteen controls carried the APOE e4 variant. Confirmation of APOE4 mRNA expression in the CAD patients by RT- PCR implied that all the CAD cases transcribed mRNA of the gene in study, suggesting a potential candidature of the APOE e4 allele in CAD pathogenesis. To conclude, expression of APOE4 variant is a significant predictor of CAD in a sample of south Indian people. The findings reveal a possibility of using the expression of the APOE4 variant as prognosis in suspected CAD patients when confirmed by studies on larger cohorts or populations 198 Ankle Sprain, Physiotherapy from the Evaluation of the Injury, the Assessment of its Severity to the Restoration of Podal Movement , Npochinto Moumeni Ibrahim, Bahebeck François and Fred Dikongue Le traitement des entorses a longtemps a été très controversé entre les partisans de la réparation chirurgicale primaire et ceux du traitement par immobilisation (plâtrée, attelle, etc.) ou par traitement fonctionnel (orthopédique et kinésithérapique). Pour des raisons anatomiques et physiopathologiques, de risque de laxité, d’instabilité et de récidive. Le traitement fonctionnel est toujours d’actualité pour l’entorse de la cheville. Il englobe: une immobilisation relative par strapping ou orthèse semi-rigide et une mo-bilisation articulaire précoce. Cependant, parmi les techniques de rééducation proposées, beaucoup n’ont pas fait l’objet d’études comparatives. Aucune étude comparative en Europe central et de l’est n’a été identifiée. Des moyens de mesure fiables existent tout de même pour attester l’efficience des techniques. La reprogrammation neuromusculaire est de mise dans ce processus au regard des récepteurs proprioceptifs animant le schéma équilibre, marche et cervelet d’un côté, et douleur, réaction post douleur, contrôle moteur et réponse proprioceptive de l’autre côté. Nous proposons dans cette revue générale des mis au point, certes pas nouvelles, mais récapitulatives, vivifiée et associées, et luminées notre expérience clinique 199 Asthma and Stress: The Double Conundrum   , Karmakar Saurabh, Sharma Priya and H Ameet Asthma is a heterogeneous disease characterized by chronic airway inflammation and defined by a history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and intensity, together with vari-able expiratory airflow limitation. Patients of bronchial asthma suffer from progressive and persistent decline in lung function throughout life, the degree of decline varying among individuals. Asthma affects 339 million people and leads to an annual mortality of 420,000 worldwide [1]. Asthma is a common disease in society and prevalence is rising. 200 Coagulopathy Associated with COVID-19 Pneumonia , DumitraÈ™ Tatiana, CaÈ™caval Virginia, Fetco-MereuÈ›Äƒ Diana, Chihai Viorica and DumitraÈ™ Grigore Individuals with COVIDâ€19 may have thrombotic and coagulation abnormalities, which can result in an increased number of thrombotic and thromboembolic events. In hospitalized patients, the rate of thrombotic events is ≈16%, varying between 11.5% to 29.4% in intensive care unit. Patients with severe forms of COVIDâ€19 can present with both arterial and venous thrombotic events, in consequence of a hypercoagulable state. COVIDâ€19–associated coagulopathy, represents a major component of the pathophysiol-ogy of this infectious disease, leading to widespread thrombosis. We present a clinical case of a patient with COVIDâ€19 associated coagulopathy, manifested through systemic thrombosis and concomitant nasal bleeding due to intravascular disseminated coagula-tion syndrome 201 The Prevalence and Risk Factors of Typhoid Fever in Bonassama Health District, Douala Cameroon , Bezejuh Emmerencia Fondongbeza, Sylvester Ndeso Atanga, Nkengafac Nyiawung Fobellah and Atabongafac Robert Lereh Introduction: Typhoid fever is an acute, life-threatening febrile illness, with greatest impact on human population thriving in poor hygienic conditions. In Cameroon, Typhoid fever is one of the most frequently reported infections, with little known about its preva-lence. Objective: Our main objective was to ascertain the prevalence of typhoid fever in Bonassama Health District and determine the risk factors for its transmission.Method: This was a descriptive cross- sectional study, carried out from March 2020 to November 2020. The study included 150 participants, who were recruited by convenient sampling method. The choice of inclusion of participants was made by probability of infectivity. For those who agreed to take part in the study, Stool samples were collected from them and sent for culture in the lab to isolate Salmonella, the causative agent of typhoid fever. Primary data was gotten by use of structured questionnaires, and secondary data results of stool analysis. Our data was analysed using Epi-info version 7.0 statistical software (CDC, Atlanta, GA, USA). The Ac-ceptable P value for this study was set at ≤ 0.05, and the confidence interval was aimed at 95%.Results: A prevalence rate of 31% of typhoid fever was gotten in this study. It is worth noting that 99.3% of participants had knowl-edge about typhoid fever. This study revealed that eating roadside food was significantly associated with acquiring typhoid fever as well as cooking and selling food by the road side with statistical significance of χ2 = 39.482 df = 3 P = .000 and χ2 = 38.342 df = 1 P = .000, respectively. Also, those who drank water from wells 58.7%, and those who drank water from unknown sources out of their homes (30.7%) were significantly infected showing a statistical significance of χ2 = 15.895 df = 1P = .000. Again those who do not practice regular hand hygiene 78.3% were significantly infected with statistical significance of \chi^2=38.810f df = 4 P = .000. Also, those with poor sewage disposals in their quarters 48.0% were significantly infected with typhoid fever, with a statistical significance of χ2 = 16.036 df = 1 P = .000.Conclusion: The prevalence of typhoid fever is very high 31% in the Bonassama Health District, and it is associated to poor water supply, poor food hygiene, and poor sewage disposal. Therefore the understanding and avoidance of factors influencing the occur-rence of typhoid fever in the Bonassama Health District is important in the management and prevention of the infection in the com-munity 202 The Potential Protective Influence of Argan (Argania spinosa L.) Oil on Thioacetamide-intoxicated Male Rats   , Isam M Abu Zeid, Mohammed Y Alomar, Ihsan Ullah, Mohammad S Alghamdi, Khalid A Altanji, Abdulrahman S Gommosani, Abdulrahman M Alhiqwi, Ahmed A Alakwa and Bassam A Khayyat In the study, we assessed that how Aragn oil affected male rats who had been exposed to thioacetamide (TAA). The 40 rats used in the study were categorized randomly into four groups. Group I was used as a control group. TAA was administered twice weekly to rats in Group II via intraperitoneal injection. Group III rats were given 700 mg/kg body weight argan oil orally, followed by the same amount of TAA as group two rats. Group IV rats received the same amount of argan oil as Group 3. The liver, kidney function, and lipid profile were evaluated after six weeks of treatment. This study found that argan oil aided male rats in recovering from TAA-induced physiological changes 203 Covid-19: Prospects for the Treatment and Rehabilitation of Post-covid Syndrome by Ayurvedic Method - Hirudotherapy , Krashenyuk AI Covid-19: Prospects for the Treatment and Rehabilitation of Post-covid Syndrome by Ayurvedic Method - Hirudotherapy 204 Stroke; Early Physiotherapy? What Content? Proposal of a Physiotherapy Content in Acute Phase (D1 to D14), part I. AVC; Kinésithérapie Précoce? Quel Contenu ? Proposition d’un Contenu Kinésithérapique en Phase Aiguë (J1 à J14). , Ibrahim Npochinto Moumeni, Yacouba Njankouo Mapoure, Emmanuel Moyse, Temgoua Michael, Njikam Moumeni Abdel-Nasser and MOULANGOU Jean Pierre Rehabilitation in the acute phase (D1 to D14) of stroke should not be neglected, at the expense of medical procedures. because, like the vital prognosis, the functional prognosis must also be requested early by non-rehabilitation physicians, and this in the acute phase. As a result, physiotherapy has a preponderant role in the initial care of the patient, which will make it possible to condition his functional recovery in the short and long term. The main principle of physical rehabilitation at this stage is to best influence the phenomenon of brain plasticity (natural and behavioural), in order to initiate the most functional recovery possible soon. This in particular thanks to early, strategic care, provoking slight difficulties, progressive in intensity depending on each patient, age, and pre-injury arrangements. The objectives at this phase will be first of all the awareness of the damaged functions, and the contribution, the patient's personal effort (in his motor recovery), the recovery of the lost functions: balance, walking, grip, cognitive impairment, etc ... (which will immediately impact on the depression. The goal is to allow the patient to acquire autonomy as quickly as possible on the one hand, and to prevent the installation of the syndrome (phenomenon) of under / hypo harmful use on the other hand (poorly adaptive plasticity). Faced with the diversity of clinical pictures encountered at this phase, both at the level of symptoms, that in terms of recovery capacities, it is for the therapist a real work of adaptation and ingenuity of physical activity and therapeutic. Many parameters influence the recovery at this stage (precocity, repetitions, stress, and the amount of time devoted to the rehabilitation clinic) moreover an intensity +++ is harmful during these first 14 days. You have to adjust to the abilities of each patient, and exploit the slightest visible movement, or cause his visibility to treat him by the amplified movement (movement therapy by movement for movement). There are many techniques in the literature dedicated to the rehabilitation of hemiparetic: methods neuro-facultative, motor learning theories, mental imagery ... In practice, some concepts are more commonly applied than others.However, it appears that few of them have been significantly proven for their application in the acute phase. Hence the content of physiotherapy during this phase deserved to be approached, discussed and proposed in the literature. In view of our many experi-ences acquired in neuro rehabilitation of movement, and physical medicine and rehabilitation in general, both in acute and chronic phase, This study provides practical concepts necessary for the content, the very bowl of physiotherapy during the first 14 days of acute stroke.Keywords: Stroke; Early Rehabilitation; Intensive Neurorehabilitation; Spastic Myopathy; Physiotherapy Technique in the 205 Stroke; Early Physiotherapy? What Content? Proposal of Physiotherapy Content in the Acute Phase (D1 at D14), Part II: Specific to the Patient Massively Injured by the Stroke , Ibrahim Npochinto Moumeni (Physical Therapist and Rehabilitation Medicine), Yacouba Njankouo Mapoure (MD, Neurologue), Emmanuel Moïse (Professeur des Neurosciences, Directeur Des Masters Biologie Moléculaire, Cellulaire et Physiopathologie du Vieillissement, Université Descartes, Versailles, Tours et Paris Diderot), Tengoua Teugam Michael (MD (Neurologue, Neurorééducation)) and Njikam Moumeni Abdel-Nasser (Rééducateur) The post-stroke complications can appear obviously from the first moments, or days post- stroke, such as skin disorders: hyper pressure on one side of the body or limb (eschar), swallowing pneumopathy, shoulder-hand syndrome, thromboembolic disorders (phlebitis), cardiovascular disorders (edema), vesicosphinters disorders (magnified by non-vertical), psychoaffective disorders, falls, depression, muscular amyotrophy and many others, complicating and making the functional prognosis dark and making the physio-therapist's work difficult on the one hand, and the patient's rehabilitation on the other hand. This shows the importance of early in-tervention (if no contraindication) of physical therapy, in order to improve the functional prognosis immediately (guiding post-injury plasticity) and maximize the use of the remaining residual capacities (behavioral plasticity). Just as the brain is time, the functional prognosis is also a question of time. For the limb that is not used (''use it, or lose it: use it and impregnate it'') loses its volume of corti-cal representation, at the level of the motor cortex, which could have been avoided if the physiotherapist with an early (with scientific content) by systemic, passive and analytical posture (relearning by soft and oriented task) while introducing as one moves away from the stroke active movements, evolving (as well as in constraint as in duration) according to the abilities of the subject, of the clinic of the day and of the previous day efforts. 206 Registered Containment Officers; A Grassroots-Level Mental Health Framework for South Africa , Dylan Grant Anthony Benyon Over the past two decades, progressive changes to mental health policies and legislature have been implemented all over the world, South Africa included. As a low- and middle-income country plagued by compounding factors such as high unemployment rates and high prevalence of HIV/AIDS, the execution of mental health reform initiatives in South Africa have been inconsistent and inadequate. Research indicates that there are significant gaps in South Africa’s mental healthcare system and the majority of funding and resources are funneled towards short-term curative interventions. As research in the field of adolescent mental health advances, it shows the importance of mental well-being in the development of children as well as the long-term effects on the emerging adults. This manuscript describes a preventative grassroots intervention designed to use resources currently available in South Africa to create long-term, generational changes while inherently destigmatizing mental illness. By appropriately training and registering Psychology Honours graduates as Registered Containment Officers and adapting the current Life Orientation curriculum to focus on psychological concepts and mental well-being, it is possible to create generations of children and adults with a psychological un-derstanding and a destigmatized perspective of mental health. This framework requires intersectoral collaboration from a number of regulating bodies and government departments, all with the aim of creating realistic preventative change in South Africa while creating employment, promoting mental health, and protecting the country’s future. 207 COVID-19 and the Mental Health Dilemma: How Mental Health Influences the Population during the Pandemic , Aiza MominKhawaja, Pahnwat Taweesedt and Salim Surani The coronavirus disease 2019 (COVID-19) has plagued the world in an unprecedented pandemic and has resulted in innumerable complications. The influence of mental illness on the public is an adverse side effect to the aftermath of this disease. Additionally, mental illness may worsen in the patients with COVID-19 who have been previously diagnosed with mental illness. In this article, we discussed neuropsychiatric syndromes in the general population during this COVID-19 pandemic 208 Effect of Green Coffee on Weight Management in Indian Population: A Pilot Study   , Heisnam David Singh and Mythily Subramaneyaan Obesity and overweight are among the serious health problems that affects the population globally. Obesity can have a negative impact on quality of life and also significantly reduces life expectancy. Obesity might contribute to cardiovascular dysfunction by end organ damage and hypertension. Recently, green coffee is used as a strategy for weight loss and weight maintenance as they increase energy expenditure and the decrease in metabolic rate during weight loss. Green coffee extract (GCE) is present in both green/raw coffee and roasted coffee, but much of the GCE is destroyed during the roasting process. In human subjects, it has been reported that the larger the coffee intake lesser the weight gain. In older adults, coffee consumption alters several glycaemic markers. Consumption of caffeinated coffee reduces long-term weight gain, which might be due to thermogenic effects and other pharmacologically active substances present in coffee. GCE modifies hormone secretion and glucose tolerance by facilitating the absorption of glucose from the distal, rather than the proximal part of the gastrointestinal tract. The aim of this pilot study is to assess the effectiveness of green coffee on weight management in Indian population. A total of 60 subjects both male and female aged between 18-70 years were enrolled in this study. This analysis excludes those who were pregnant, breast feeding, family planning, under 18 and on medication or any other health related issues. 209 Brucellosis and Public Health , Efstathios Koutsostathis This paper aims to present the major significance of early diagnosis and treatment of brucellosis at a primary healthcare level, so as to prevent the risk to public health that may occur from the spread of the disease. It initially introduces the epidemiological features of the disease and information regarding the ways it spreads, as well as its symptomatology, diagnosis and treatment. It then focuses on preventive measures to stop the wide-scale spread of brucellosis, mainly in Greece. Finally, it refers to the cost and effectiveness of these measures in practice and analyses the conclusions 210 Panniculitis at the Site of Subcutaneous Interferon Beta Injections in a Patient with Multiple Sclerosis , Rym Sahnoun, Syrine Ben-Hammamia, Ons Charfi, Ghozlane Lakhoua, Talel Badri and Ahmed Zaiem Interferon-β (INF-β) is associated with a high frequency of side effects, but severe local skin reactions are still rare. We report the case of complicated panniculitis induced by subcutaneous INF-β-1a injections in a 30-year-old woman, with a multiple sclerosis his-tory. The patient developed, four years after the start of subcutaneous INF-β-1a treatment, painful erythematous ulcerated indura-tion, which evolved into induration and fibrosis lesions. Through this case report, we would like to emphasize on the importance of preventive measures, to avoid such severe cutaneous adverse event, which may lead to lack of compliance and disease recrudescence. 211 Cutaneous Manifestation and Vasculitis of COVID-19 in Dermatology   , Kazumi Fujioka The emerging coronavirus disease 2019 (COVID-19) by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a worldwide outbreak and still has spread relentlessly and recrudescence because the new mutants begin to occur. The respi-ratory failure from acute respiratory distress syndrome (ARDS) presents the major cause of mortality and multi-organ failure repre-sents other causes of mortality in patients with COVID-19. It has been revealed that SARS-CoV-2 infection induces the protean clinical manifestations from head to toe, affecting the multiple organ systems including the lungs, heart, brain, kidney, skin, and vasculature. In this article, the cutaneous features and vasculitis in COVID-19 in dermatological field were reviewed. Based on the evidences, it is suggested that the common cutaneous manifestation caused by SARS-CoV-2 infection is chilblains. The direct-induced skin damage and/or a systemic inflammatory reaction by the indirect injury may be considered as the pathophysiological mechanisms in vasculitis of COVID-19. The author suggests that COVID-19 represents an endothelial disease and may be a systemic disease or a multiorgan disease based on the vasculitis in the microvasculature 212 Effect of Lipid Profile and Serum Creatinine on Hearing Loss in Diabetics , Muthumagesh Arunachalam, BP Belaldavar and Rajesh Radhakrishna Havaldar Diabetes mellitus is an endocrine disorder affecting multiple organ systems of which the ear is also a vulnerable end organ. There is a proposed strong association with the sensorineural part. This study aims to find the prevalence of sensorineural hearing loss in type 2 diabetic patients and additionally assess variations of lipid profile and serum creatinine and its influence on the hearing threshold in type 2 diabetics. A cross-sectional study was conducted with a sample size of 700 at a tertiary care referral hospital over a period of 10 years. They were subjected to a detailed history and ENT examination along with Pure Tone Audiometry and relevant hematological investigations comprising of HbA1c, blood urea, and serum creatinine. Urine analysis to look for microalbuminuria was performed. Sensorineural hearing loss in type II diabetics was found to be 62.85%. The total cholesterol levels were also found to be raised in hearing deprived patients. HDL and LDL levels were found to have a negligible effect on the hearing threshold. The serum creatinine levels were higher in patients with diabetes implicating an association with nephropathy. Microalbuminuria was found in nearly all patients with moderately severe to profound hearing loss. The results were statistically significant. It has been observed that short term sugar control is found to have a negligible effect over the sensorineural hearing than the long term sugar control which severely affects the neural component, as depicted by the lipid and creatinine levels in our study 213 Magnetic Resonance Imaging Contrast Agents - Issues of Concern, Safety, and Efficacy , Alain L Fymat This article addresses important issues regarding the use of certain MRI contrast agents (linear and macrocylic gadolinium-based, non-gadolinium-based, iron-based, others). Specific attention is devoted to their corresponding safety and efficacy, and to their use or repeated use in patients with certain medical conditions 214 New UHPLC-MS/MS Characterization of Ethanolic Extract from Talipariti elatum Sw. (Malvaceae) , Loïk Sylvius, Juliette Smith-Ravin, Odile Marcelin, Stéphanie Morin, Max Monan, Frantz François-Haugrin and José González From the red petals of the flowers from Talipariti elatum that grows in Martinica a direct UHPLC analysis was done to get the chemical composition from ethanolic extracts of this plant’s component. Thirty compounds have thus been identified, 26 of which were reported for the first time in the flowers of this spice by RP-HPLC coupled to a DAD detector and to a tandem ion trap mass spec-trometer in order to obtain a UV profile and a spectrum of fragmentations in negative mode making it possible to achieve provisional identification. Among them, various gossypetin-O-derivatives were tentatively identified in the sample with another three chemical components previously reported by our research team. 215 Can COVID-19 Cause Relapses in the Control of Epilepsy among Epileptic Patients Who were on Treatment and Controlled? A Case Report, Sudan, Khartoum, 2021 , Amira Siddig, Khabab Abbasher, Abbasher Hussien, Mazin Salah-Eldien Hassan, Ibrahim Mahgoub, Hussien Abbasher, Mohamed Abbasher and Radi Tofaha Alhusseini Introduction:Corona viruses are a group of related viruses that cause diseases in mammals and birds. Epilepsy is one of the com-monest neurological disorders. It is a clinical syndrome characterized by recurrent attacks of unprovoked seizures.Case Presentation: A 45 years old Sudanese male who was diagnosed as a case of generalized tonic-clonic epilepsy in the last two years and used to take levetiracetam 1000mg bid. He was well controlled; the last attack was two years ago. He was brought to the casualty complaining of generalized tonic-clonic convulsions. The attack was so severe to a degree that it didn't respond to I.V di-azepam; so he received I.V phenytoin and it didn't respond also. He received I.V levetiracetam, general anesthesia and then he was connected to a ventilator. His wife mentioned that he used to take his medication regularly and the condition was preceded by febrile illness, headache, sore throat and dry cough. A comprehensive and full neurological history and examination were done. Routine blood investigations were done including: complete blood count, random blood glucose, blood urea and creatinine, and radiological imaging including chest x-ray, brain MRI and EEG. Screening of COVID-19 was positive. This condition of COVID-19 on top of epilepsy caused induction of status-epilepticus attack that resulted in the death of the patient due to respiratory muscles paralysis.Conclusion: COVID-19 can cause relapse in the control of well-controlled epileptic patients. Also it can cause status-epilepticus and increases resistance against anti-epileptic drugs during the attack of status-epilepticus causing prolongation of attack period and difficulty in management and control. 216 Storage Dependent Cellular Changes in Blood Smears Prepared from EDTA Added Venous Blood Samples , Rintu P Sam, Shuhaib S, Deepa Revi and Rahul Raj AR Ethylene diamine tetra acetate (EDTA) added blood is commonly used to perform various analysis like the complete blood count in a hematology laboratory. Prolonged storage in EDTA can cause morphological changes in the cellular components of the blood which has some potential to tamper with the diagnosis and interpretation of results especially during peripheral blood smear re-porting and differential counting. This study aims to assess the morphology related variations in WBC and RBC in peripheral smears prepared from EDTA added blood stored at room temperature at different time periods. Peripheral smears were prepared from 20 healthy volunteers after 0 hrs, 2 hrs, 5 hours, 10 hours and 24 hours of storage in EDTA added blood collection containers. Pa-rameters affecting cellular morphology such as crenation, acanthocytes, bite cells, fragmentation and central pallor (for RBCs) and nuclear degeneration, number of lobes in nucleus and vacuolation in cytoplasm (for WBCs) were quantified microscopically in 10 fields/smear after Leishman staining. Students t-test was performed to determine if there was significant morphological variation at different time points and p value less than 0.05 was considered significant. There was significant increase in the number of RBCs with crenation, acanthocytes, bite cells in smears prepared after 2 hours while WBCs showed significant nuclear degeneration and cytoplasmic changes in smears prepared after 1 hour of storage. Maximum cellular distortion was seen in smears prepared after 24 hours of storage at room temperature. Morphological interpretations of RBCS should preferentially be done within 2 hours while for differential count should preferentially be done within 1 hour to minimize errors and misdiagnosis, when blood samples are stored at room temperature 217 Mass Chemoprophylaxis with Ivermectin against COVID-19 Pandemic: Review and Authors’ Perspective , Abdelmonem Awad Hegazy, Mohammed Saad Alghamdi, Waheed M Shouman and Raafat Awad Hegazy The current COVID-19 pandemic is a catastrophic health challenge widely spreading all over the world, caused by coronavirus “SARS-CoV-2” infections. It has been started for more than one year ago; and panic and fear are still dominated among people because of the ease with which infection spread among communities, as well as the high morbidity and mortality. Many preventive measures have been taken to prevent its spread, including physical body distancing, wearing face masks, etc. Unfortunately, the frequent muta-tions of the virus have made it resistant to usual measures such as use of convalescent plasma from patients cured from infections. Several vaccines have been developed and administered as an urgent measure to combat the infection. Such vaccines could be not available for all countries especially that of low- and middle income. Moreover, the time for development of an approved vaccine in the normal situations that might reach about 10 - 15 years, is not available for vaccines used in the current pandemic. On the other hand, ivermectin, a drug approved by FDA as a broad-spectrum antiparasitic drug, has been clinically tried in prophylaxis of COVID-19 patients’ contacts and proved high efficacy. It is a safe and effective drug and has given tremendous results in protection against acquiring COVID-19 infection in all studies. Therefore, we suggest that ivermectin could be used for mass chemoprophylaxis without mentioned risks on populations. This measure might assist in combating the current COVID-19 outbreaks 218 Reading Dynamics of Exophoric Persons: A Study with Infrared Reflexion Oculography (IROG) , Elfriede Stangler-Zuschrott and Alex Salomon The reading traces of 32 patients aged on average 32 years were registered by a binocular simultaneous infrared reflexion oculog-raphy unit (IROG). Seven of them had exophoria but no complaints, while 13 exophorics suffered from asthenopia or the inability to work at the VDU. The patients were compared to 12 persons with normal binocular vision. The differences in reading speed between paper-printed texts and screen reading was statistically highly significant. Normal persons showed a retardation of 11%. Exophoric persons without complaints showed a delay of 23%; although they were the best readers, they lost too much time in overcorrecting their divergence, the result could even be a convergent position. Exophoric persons with complaints showed a retardation of only 9% when reading on the screen because they had remarkable difficulties even in reading paper-printed texts: moments of decom-pensation into squint, unilateral suppression, readings stops, and fatigue. In general, the screen intensifies preexisting defects. The orthoptic findings correlated with the degree of eye strain. The worst cases had the largest squint angle, the lowest fusion range, and the weakest convergence power 219 Proliferating Trichilemmal Tumor: A Rare Tumor of Unpredictable Evolution , A Khouna, N Zizi and S Dikhaye The trichilemmic cyst (TC), also known as the hair cyst, is a rare adnexal tumor, developed from the isthmic portion of the hair follicle. More aggressive forms, such as proliferative trichilemmal tumors (PTT), and malignant proliferative trichilemmal tumors (MPTT) can occur, but they are much less common. PTT is generally benign, some cases with malignant transformation are described in the literature. Therefore the criteria of malignancy (clinical and histological) have been widely discussed. The real challenge is to distinguish the benign form from the malignant one 220 Pharmacotherapy of Immunopathological Syndromes Among Patients with Systemic Lupus Erythematosus Based on ABC/VEN Analysis , Ihor Hayduchok The article presents the results of the research of pharmacotherapy of immunopathological syndromes among patients with sys-temic lupus erythematosus based on ABC/VEN analysis. Systemic lupus erythematosus is a systemic autoimmune disease that devel-ops as a result of combined disorders of the immune system that lead to a chronic inflammatory process in many tissues and organs. Comprehensive understanding of immunopathological syndromes among patients with SLE is important for correct diagnosis and proper pharmacotherapy. With the spread of the coronavirus pandemic, the role of pharmacotherapy of immunopathological syn-dromes among patients with dual health disorders and in patients with systemic diseases becomes very relevant. Pharmacotherapy of immunopathological syndromes among patients with SLE is carried out against the background of basic therapy in accordance with the clinical protocol of medical care on the basis of international and national regulations. Using the ABC/VEN analysis author formed a list of drugs used in pharmacotherapy keeping in mind average cost of treatment. 221 Comprehensive Application of the Theory of Fuzzy Logic and Neural Networks to Predict the Demand for Drugs , Ramiz Alekperov Determining the need for medicines and medical supplies is directly related to the characteristics of their products, their actual con-sumption, and the identification of patterns of changes in demand for them. This article discusses the use of fuzzy logic and a neural network to predict the demand for pharmaceutical products in a distributed network, in conditions of insufficient information, a large assortment, and the influence of risk factors. A comprehensive approach to solving forecasting problems is proposed using: the theory of fuzzy logic - when forecasting emerging and unmet needs and a neural network - if there is a lot of retrospective information about the actual sale of drugs. A method for fuzzy classification of drug demand using ABC and XYZ analysis is described. Using this approach to solve the problems of forecasting demand allows you to get statistics and experience. The general algorithm, mathemati-cal interpretation, and examples of forecasting the demand for pharmaceutical products in the face of uncertainty of information are given, and the general structure of the system for forecasting the demand for drugs is described. A fragment of the program code for predicting the demand for drugs based on neural networks for cases with sufficient sales statistics is presented 222 Life-threatening Hemoperitoneum Following Cardiac Arrest by Myocardial Infarction: A Case Report of Successful Endovascular Management , José João Martins, Laura Costa, Anabela Mesquita and Luís Lencastre Spontaneous hepatic artery rupture with hemoperitoneum and haemorrhagic shock is a life-threatening condition, the serious-ness of this condition is multiplied if it follows another life-threatening event, in this case, a myocardial infarction with cardiac arrest. The following clinical case depicts a patient admitted to the intensive care unit following cardiac arrest, shortly after admission the patient becomes unstable with haemorrhagic shock that was found to be due a bleeding hepatic artery. The hemoperitoneum was controlled using atypical means with an endovascular approach. Our clinical case will hopefully demonstrate an atypical scenario where the source of clinical deterioration was not apparent and represents a very rare complication of cardiac resuscitation. This case demonstrates the need for a clinician to always be alert for rare complications and be able to quickly adapt 223 Rare Etiology of a Mediastinal Mass , Atig Amira, Ghriss Nouha, Thabet Maissa, Ben Yahia Wissal, Guiga Ahmed and Ghannouchi Neirouz A 22-year-old man, with no pathological history, was hospital-ized for right basal thoracic pain associated with unstated fever and weight loss of 6 kg in one month. Physical examination re-vealed fever at 38.6°C and polypnea at 32 cycles/minute. The rest of the examination was without abnormalities. In biology, there was a biological inflammatory syndrome. 224 Pheochromocytoma Multisystem Crises Treated with Emergency Surgery: A Case Report , Elisabete Coelho, Laura Costa, Fátima Assunção and Luís Lencastre The authors describe a case of a 50-year-old woman admitted in the emergency room with a shock with multiorgan disfunction. An adrenal mass was identified in the initial approach. She was admitted in the intensive care unit and had a progressive worsen-ing to multiorgan failure. The diagnosis of a pheochromocytoma multisystem crisis was done and she was treated successfully with emergency surgery. After surgery, however, an irreversible ischemia of her right hand and both limbs persisted leading to several amputations. After plastic surgery intervention, adaptation to prosthetics and functional rehabilitation, the patient was able to re-turn to her life. 225 COVID-19 and Seasonal Flu Data Reliability Analysis of New Cases Reported in Croatia , Dragutin Novosel, Matija AlanoviÄ‡ and Robert Å½unac Background: Recent reports have raised questions about the reliability of reported COVID-19 cases in Croatia. Analysis of the first-digit distribution in a dataset (Benford's law) is widely employed to review data consistency and is used to indicate data manipulation and/or data inconsistency.Methods: The frequency distribution of the first digit of the number of newly reported COVID-19 cases in Croatia (2020/02/26 - 2020/12/14) was analyzed using Benford's law. Additionally, the last seven seasons (2013/09/30 - 2020/01/12) of reported cases of seasonal flu were analyzed.Results: The number of newly reported cases of seasonal flu and newly reported cases of COVID- 19 in Croatia do follow a Benford distribution (P = 0.233). From July 18, 2020 until August 28, 2020 the number of newly reported COVID-19 cases did not follow a Benford distribution (P < 0.05).Interpretation: Our findings strongly suggest that the COVID-19 and seasonal flu data reported in Croatia are reliable. Further analyses are required to explain the disturbance observed in the summer of 2020 226 Commentary on Corona Virus and Khat: The Case of Horn Africa , Manderas Tariku, Mustefa Mohammedhussein, Aman Dule and Mohammedamin Hajure This commentary describes the relation between corona virus (COVID-19 infection) pandemic and khat use (plant with amphet-amine like effect), one of the most commonly used substance use, typically known for strengthening social interaction which contrast against the covid 19 prevention practices. The commentary also addresses some of the current measures to cope with the situation 227 An Innovative Technique of Laparoscopic Knot Tying: A Qualitative Explanatory Research , Forough Radfar, Mohammad Zeinalddin and Moein Zeinalddin Objective: To introduce an innovative laparoscopic knot tying technique using loop knot guide or needle knot guide designed for extracorporeal knot tying and using needle holder for intracorporeal knot tying to beergonomically more suitable than traditional knot tying techniques for minimally invasive surgery.Design:A qualitative, explanatory research design is used to describe a new technique oflaparoscopic knot tying using our self-designed loop and needle knot guide devices for extracorporeal knot tying and using needle holder for intracorporeal knot tying.Setting:Laparoscopic simulator trainer laboratory was used to examine different techniques of knot tying. No human or animal subjects were used. Method: Various knot tying techniques (laparoscopic knots, surgical knots, knitting knots,fishing knots, and sailor’s knots) were reviewed online using internet search engines, books and practical observation. The instruments which were used to assist in achiev-ing knot tying with correct configuration, appropriate shaping and maximum security were studied.We designed the new techniques of laparoscopic knot tying using our self-designed loop and needle knot guide and needle holder to cast the capsized form of the desired laparoscopic knot extracorporeally by working end of suture over them and pulling the standing end or needle end through it to form the sliding knot. Technique:Intracorporeal knot tying:Working end of suture is casted in form of capsizedconfiguration of the slip knot, on the shaft of needle holder before it is introduced into the body for intracorporeal suturing. Slip knot is formed by pulling the needle end of suture through the casted working end.Extracorporeal Knot tying: Working end of suture is casted in form of capsized configuration of the slip knot, on the shaft of an appropriately sized self-designed loop or needle knot guide and the standing end is pulled through the casted working end of suture by using loop or needle knot guide, to form a slip knot extracorporeally. The knot is slid on standing end by knot pusher to the site where knot is to be applied 228 Epidemiology and Social Impact of Enuresia in the Democratic Republic of Congo , Badiambile Mpulumba, Kasongo Musasa, Yacioko Matugulu, Kalonji Mukendi, Mulumba Mbuyi, Bakenge Manongo, Ntumba Bambi, Kalonji Mbaya, Kayembe Tshishimbi and Tshilunda Ngandu Introduction: Enuresia remains unknown in the Democratic Republic of Congo. The objective was to assess the epidemiology and social impact of bedwetting in order to promote the overall management of enuretic children in Mbujimayi. Methods: The study was descriptive across November 20 to December 20, 2020, including 272 family leaders of enuretic children. Results: Female sex was predominant (87.87%); the average age were 36.82 ±8.94 years; 79.41% were biological mothers and housewives (52.21%); 61.03% of fathers had the level of secondary and primary education for mothers (70.22%). The history of enuresis in both mother and father was (44.85% versus 18.75%). The case of bedwetting was 2 infants per household (34.56%). The blue hole affected both sexes in a positive way (50.77% versus 49.23%) and the 5-8 age group was affected (58%, 43%); 75% of the kids used to pee in bed every night. The enuretic child's managers did not consult a Doctor for bedwetting; The reason for the lack of consultation was that it would pass alone (62.87%). As for the impact, 43.38% of the respondents complained of the annoying smell. The origin of bedwetting was ignored by 39.34% of respondents, while 35.66% attributed a natural origin. Conclusion: Bedwetting is a common disorder in households, with a significant social impact. Raising awareness among enuretic children about the need to consult a doctor for care would be an asset in mitigating the consequences of this disorder. 229 Is Enhanced Recovery After Surgery Pathway (ERAS) Influential in Reducing Length of Patients Stay in Colorectal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials , Salah Nashi AlOtaibi Background: A systematic review and meta-analysis was conducted after identifying from the literature that enhanced recovery after surgery (ERAS) pathway reduces length of stay (LOS) and control health expenses after colorectal surgery. This review paper follows PRISMA guidelines and retrieved randomized controlled trials (RCTs) to assess the efficacy of ERAS pathway in reducing LOS after colorectal surgical discharge. In addition, this review paper aims to evaluate other post-operative complications such as mortal-ity rates, costs, and readmission rates with the implementation of ERAS pathway. Methods: Eligible RCTs (n = 17) were included in this review paper from PubMed, CINAHL Plus, EMBASE, and MEDLINE from Janu-ary 1st 2011 and March 31st 2020. Each trial was cross-checked in terms of its publication bias and quality rigor. Restrictions were set for English publications only. Results: A total of 7500 patients were included in 17 RCTs. The ERAS pathway was associated to shorter mean LOS [MD = -1.07 days, (-1.99, -0.15), p for effect < 0.001, p for heterogeneity < 0.0001, I2 = 98%] without increasing readmission rates and cost associated to colorectal surgery. Mortality rates were also controlled with the implementation of ERAS pathway as compared to standard care. Conclusion: There was significant evidence in reduction in mean LOS after colorectal surgery with the implementation of ERAS pathways. The appropriate ERAS pathway implementation results in controlling other secondary complications 230 B-SHOT a New Technique in Genital Area Rejuvenation; Co-Injection of Stromal Vascular Fraction and Adipose-Derived Mesenchymal Stem Cell , Bülent Cihantimur, Özgür AÄŸlamiÅŸ and Yavuz Özsular Purpose: We named the co-injection of stromal vascular fraction (SVF) and adipose-derived mesenchymal stem cell, which are cells with the highest regenerative capacity of the body derived from adipose tissue, as B-SHOT rejuvenation and investigated whether this new technique is effective in genital area rejuvenation. Material and Method: 40 female participants participated in the present study. 40 cc lipoaspiration material was reached from the abdominal region. By using fat micronizing device, lipoaspirate was subjected to non-enzymatic mechanical filtration up to 400 mi-crons and then centrifuged. The obtained Stromal Vascular Fraction (FAT JUICE) and adipose derived mesenchymal stem cells were injected with our B-SHOT technique to the clitoris, around the openings of skene glands, vaginal mucosa, and G spot area. All partici-pants were evaluated with VHI and FSFI before and after the application in the 3rd, 6th, 9th and 12th months.Results: Elasticity, vaginal pH and humidity scores from VHI parameters significantly increased in the 3rd and 6th months after treat-ment (p < 0.001). In addition, significant increase in the score of the new parameter continued in the 9th month, as well (p < 0.05). Scores of orgasm, satisfaction and pain among FSFI parameters significantly increased in the 3rd and 6th months after treatment. Conclusion:Our B-SHOT technique may be a new practical rejuvenation protocol for genital rejuvenation, which is a low cost, safe, effective technique, prepared within a short time without the need for additional staff or laboratory and benefits from the regenerative effect of adipose derived mesenchymal stem cells in SVF. 231 Impact of COVID-19 on Daily Activities and Mental Health of All Ages , Suprakash Chaudhury and Tahoora Ali The COVID-19 pandemic is in a continual process of redefining daily lifestyle and habits of the average individual, as it progresses through its undulating phases. The public health recommendations and various government measures to curb the rampant transmission, have had adverse consequences. Labour markets, consumption patterns and economic activities, lifestyle patterns have been disrupted at an unprecedented scale. The predominant mental health issues that have been reported to be associated with the COVID-19 pandemic are stress, anxiety, depressive symptoms, insomnia, denial, anger and fear. COVID-19 may lead to increased risk of suicide due to the grief resulting from the loss of a loved one, the panic ensuing uncertainty of the future, the anxiety from financial turmoil, and the depression following social isolation. Cases of COVID-19 related suicides have been reported from Maharashtra, Uttar Pradesh, Assam, Kerala. Reports of suicide of health care workers, migrant labourers and those in quarantine centres are also reported 232 Leronlimab: Is it Just Another Monoclonal Antibody for COVID-19?   , Salim Surani, Pahnwat Taweesedt and Rahul Dadhwal Over the past 18 months, the world has been going through a roller coaster ride. Pandemic so far has taken more than 3 million lives globally and infected more than 160 million people [1]. Be-sides the health toll, there has been a significant economic toll. The race is on for the development of therapeutics and vaccines at a fast pace. With the Pfizer and Moderna Vaccine’s successful result, the race for developing the vaccine is at the fastest pace. Now with As-tra Zeneca, J&J, Cansino, Sinopharm, Sputnik, Bharat Pharmaceuti-cals, vaccines have been approved, to name a few [2]. According to the World Health Organization report on May 14th, 2021, there is 100 vaccine in clinical development and 184 vaccines in pre-clini-cal development for the COVID-19. The therapeutics have been go-ing fast, but the vaccine’s phenomenal success has overshadowed their success. Remdesivir, Tocilizumab, sarilumab, and steroids have shown the benefit, whereas the anticoagulation, ivermectin, colchicine data is still muddy. There have not been many drugs that have been suggested for immunosuppressed patients 233 Factors Influencing Neck Pain among Computer Users , Dr Md Harun-Or-Rashid, Dr Abul Hasnat Mohiuddin, Dr Md Arafat Hossin, Dr Aminul Islam, Dr Md Ashraful Alam and S M Imran Shoaib Introduction: Neck pain is a common problem for people who spend a great deal of time using computers. Computer based cus-tomer service work or call centre work is one of the most rapidly growing occupations in the world. Musculoskeletal disorders of the upper extremities and neck are the most common occupational health problem associated with this type of work. It has been stated that neck pain is the common occupational health problem (New guidance on using computers and preventing, 2003). Methodology: Cross sectional research in this study with 75 participants were collected from new life trauma centre at Rampura, Dhaka, Bangladesh and captured in Excel, using an SPSS 24.0 version programs.Results: The total participant of the study was 75. The age group was participant from 21 - 54 years. Mean 33 and (SD ± 8.599). Among the 75 participants 92% (n = 69) were Muslim and 5.3% (n = 4) were Hindu in religion and Christian were 2.7% (n = 2). Sec 234 Covid-19 and a Dissection of Health Care System in India   , Mohammad Owais China will be marked in the history books not for its technology or Ephemeral products it used to serve the world but the serious threat related to Covid-19 Pandemic. Almost every one of us is now familiar with the word Covid-19 and facts related to the disease be-cause of the lousy results it has shown over the couple of months, jeopardising the life of millions globally and crushing economy of masses. 235 Risk Factors for the Development of Bloodstream Infection in Patients Undergoing Haemodialysis in a Large Tertiary Hospital, Riyadh, Saudi Arabia   , Fahad Saleh Aldoghaim, Norah Saleh Alnasyan and Abdurahman Nasser Alodayani Introduction and Aim: Patients undergoing Haemodialysis are at high risk of developing bloodstream infection (BSI) because of their impaired immune defenses and repeated access of the bloodstream through vascular access sites. The major risk factor for the occurrence of haemodialysis-related BSI is the type of vascular access. The aim of this study was to evaluate the potential risk factors for the development of BSI in patients undergoing haemodialysis at Prince Sultan Medical Military City (PSMMC). Methodology: Risk factors for the development of BSI in patients undergoing Haemodialysis was investigated using a retrospective case-control study with 1:1 matching conducted between September 2017 and September 2019. Cases were matched to controls by gender, age, time on hemodialysis and diagnosis of diabetes mellitus. Data were systematically collected from patient electronic medical records. Logistic regression was used for statistical analysis. Results: The final study population included 120 patients (60 cases and 60 controls) were eligible to this study. There were no statis-tically significant differences between the two groups, except for the variables type of venous access and duration of venous access, where the p-value was ≤ 0.05. Multiple logistic analysis showed that type of venous access was an independent risk factor for occur-rence of BSI, where patients with a central venous catheters (CVC) were 7.75 times (CI 95%: 2.65 - 22.66) more likely to develop BSI compared with patients who had an arteriovenous fistulas (AVF). Gram-positive bacteria were the most prevalent microorganisms isolated from the case group. Conclusion: These findings emphasise the importance of specific measures for the insertion and maintenance of a CVC, particularly given that the number of patients that need haemodialysis treatment continues to grow in Saudi Arabia 236 The Impact of the COVID-19 Pandemic on University and College Students in New Jersey   , Julie Kalabalik-Hoganson As of May 2021, the COVID-19 pandemic has resulted in over 32 million cases and 574,679 deaths in the United States. In New Jer-sey alone, the number of cases have exceeded 1 million and deaths over 25,000 [1]. The pandemic has disrupted education systems for students of all ages across the globe. This mini review provides a summary of the published literature on the impact of COVID on university and college students in New Jersey. The search strategy included the MEDLINE database and MESH search terms were “covid-19 or coronavirus or 2019-ncov or sars-cov-2 or cov-19” and “university students or college students” and “New Jersey”. The following limiters were applied: English language and publication date January 1, 2020, to current date. The nine search results were focused on the themes of (1) mental health, (2) university accessibility services, communications, and internet connectivity, (3) age-ism and (4) alcohol consumption and sexual violence. 237 Actual Aspects of Medical and Social Expertise and Rehabilitation of Persons Injured at Work   , Bodrova Rezeda Akhmetovna, Ishteryakova Olga Alexandrovna, Iksanov Haidar Vazikhovich and Gilyazov Kamil Robertovich Occupational diseases (OD) that develop as a result of exposure of the employee to hazardous industrial factors, and accidents at work (industrial injuries) lead to disability and, as a result, to the need for material compensation for damage to health. According to the conclusion of the bureau of medical and social expertise, persons with occupational diseases and the consequences of accidents at work, accompanied by loss of occupational ability of work, including the definition of a disability group, are assigned insurance payments from the budget of the Social Insurance Fund of the Russian Federation. Considering the necessity of compensation pay-ments, disability due to occupational diseases and the consequences of industrial accidents is of great social importance. In the past 10 years, the rate of disability from OD in Tatarstan was 0.06 - 0.10 per 10,000 working-age population. At the same time, rather high rates of late diagnosis of OD were noted, indicating the low quality of periodic medical examinations. As a result, a significant proportion of patients undergo medical and social expertise (MSE) immediately after establishing a connection between the disease and the profession. In the structure of expenditures of the Social Insurance Fund (SIF) in the first place - payment of compensation for lost earnings (87 - 90% of funds). 10-13% is spent on the implementation of preventive measures and rehabilitation. The prior-ity place in the rehabilitation of persons injured at work belongs to the sanatorium-resort treatment (ST). With OD, rehabilitation at the expense of the SIF is currently carried out in the presence of persistent disability (moderate and pronounced manifestations of OD) after the conclusion of the MSE. For people who have suffered from severe accidents at work, immediately after the onset of industrial injuries, an early comprehensive rehabilitation program is implemented, including ST. In the Republic of Tatarstan, within the framework of this project, the costs of ST account for up to 44% of the funds spent on early rehabilitation. In 2015. during the implementation of the this project, 40% of the number of severe industrial injuries ended in full recovery and restoration of working capacity; since 2017 the growth of this indicator was recorded (more than 70% at present). In order to further optimize the expert 238 Assessment of Pancreatic Sizes in Patients with Diabetes Mellitus: An Ultrasound Based Study   , Iqra Ilyas Aims and Objectives: To evaluate the pancreatic size in diabetic patients and compare them with regular patients.Methodology: A prospective comparative study was conducted for six months, and 102 patients were included. Patients of type1DM, type2DM and control subjects were selected. The pancreas' ultrasound was performed on 27 healthy patients, 33 were with type 1 (Insulin-dependent diabetes mellitus), and 42 were type 2 (Non-insulin-dependent diabetes mellitus). Standard parameters of pan-creatic size such as pancreatic head, pancreatic body, and pancreatic tail have been measured. The statistical analysis was performed using MedCalc. Results: The results show that the mean age was 37 years in the control group, the mean age was 50 years in the NIDDM group, and the mean age was ten years in the IDDM group. 37% were women, and 63% were men in the control sample. Although 36.4% were females and 63.6% in the IDDM community were males. Fifty-two percent were women, and in the NIDDM, 47 percent were men.Conclusion: Pancreatic size shows a decrease in type1DM and type2DM as compared to the control group. T1DM shows more notice-able changes compared to T2DM 239 Nephrogenic Cholestatic Jaundice , Cholestasis due to liver metastasis is more common than primary liver carcinoma.Common cancers that metastasize to the liver are colorectal cancer followed by breast and pancreas, to the best of our knowledge very few malignancies can cause paraneoplastic cholestasis which are renal cell carcinoma followed by lymphoproliferative disease and cancer prostate.Stauffer syndrome is a paraneoplastic cholestasis due to renal cell carcinoma, commonly cause fever and cholestatic liver function in the absence of any metastatic involvement, treating renal cell carcinoma usually cures liver cholestasis.We present a patient with fever and advanced renal cell carcinoma in the absence of liver involvement.Due to end stage renal carcinoma and other comorbidity, patient and family opt to palliative management. 240 Why Acute Inflammatory Response Can Happen After Adenoviral Vector Vaccines; Is the Interleukin 6 the Secret and How Circumvent that, Is by Adding Polyethylene Glycol (PEG)? , Amr Ahmed, Hassan A Shora, Ahmed Mohamed and Simona IbrahimAfter one year of pandemic SARS COV2, which started in December 2019, it is still considered a health disaster in all nations. Despite vaccination efforts, the number of infected people increased, also the number of SARS COV2 variants increased. Certain vac-cinations are approved under Emergency Use Authorization, including those dependent on mRNA technology, like those developed by Pfizer-BioNTech and Moderna (FDA Emergency Use Authorization EUA), as well as those dependent on Adenovirus vectors, like those developed by AstraZeneca (covishield, AZD1222 vaccine. (ChAdOx1) (WHO permission) and Johnson and Johnson, (FDA sus-pended 13/4/2021 use FDA and CDC suggested the stop use of COVID-19 (Janssen & Janssen) vaccination when reviewing details of six U.S. case-rare and serious blood clot cases identified in vaccine-receiving individuals).The optimal vaccine will have a low sero prevalence of neutralizing antibodies against the viral vector and a low incidence of adverse events. The protection of non-human ad-enovirus vectors used in humans is a primary concern. Global efforts against covid-19 continue, and vaccine production has intensi-fied. Adenoviral vector vaccines induce an acute immunogenic response that varies according to the immune status of the individuals injected. The excipient used in the vaccine injection can either increase or decrease the severity of this acute immune response. For example, polyethylene glycol can decrease IL-6 while polysorbate 80 or EDTA can increase severity. In comparison to Americans or Asians, Africans have neutralizing antibodies against the chimpanzee adenoviral vector, which can result in a less acute immunogenic response (less adverse effects). Thus, it is necessary to administer ChAdox1 nCov2 to African populations in order to avoid the vac-cine's acute immunogenic impact in neutralizing antibodies existence (vaccine less effective). The question after discussing the acute immune response from adenovirus vectors (IL-6 is has a role) and Is adding polyethylene glycol to adenoviral vector vaccine lessen the vaccine adverse effects. 241 Treatment of Platelet Deficiency in a Cohort of Patients by a Combination of Melatonin and 5-Methoxytryptamine   , Carlo Pastore This paper seeks to demonstrate how melatonin and 5-methoxytryptamine can affect the blood value of platelets in patients with low platelets count. Five Patients with ndd platelet loss were examined. After 6 months in all patients given a combination of melato-nin and 5-methoxytryptamine, a significant increase in the value of platelets in hemochrome was observed 242 Quality Analysis of Water from Potable Trolley Venders by Using MPN Test in Vicinity of South Delhi Area   , Insha Jan and Shahnawaz Ahmad Wani Water is most abundant chemical in the human body and plays important role in the regulation and transport of nutrients and toxic wastes. Safe Drinking water is used for all types of domestic purposes, including drinking, food preparation and hygiene. This study was conducted on drinking water sold by drinking water trolley vendors to assess the extent of bacterial contamination from collected water samples. 5 drinking water vendors were found in the premises of Jamia Hamdard. After performing coliform pre-sumptive test, we found all the sample collected from trolly vendors were in the acceptable range. And only one sample that was collected from Loni Ghaziabad UP was in category C i.e. is unacceptable for drinking. Thus, conclude that water from trolley vendors is safe for drinking purposes and contain no contamination 243 Anxiety in Pregnancy and its Correlates: A Cross Sectional Study , Sharma R, Bhattarai G and Thapa P Introduction: Pregnancy increases the risk of various psychiatric symptoms including anxiety. Such symptoms can have negative consequences in pregnancy and post-partum. Adverse fetal outcome such as prematurity, low birth weight and post-partum psychi-atric issues in mother have been seen in women who suffer from psychiatric illness during pregnancy. Psychiatric disorders among pregnant women are still undiagnosed and untreated.In spite of the adverse consequences that pregnancy-related mental illnesses can induce, very few studies have identified psychiatric illnesses among this group of women in developing countries like Nepal. The aim of this study was to find out the prevalence and correlates of anxiety among pregnant women. Method: A cross-sectional, hospital based, descriptive study was conducted among 135 pregnant women attending Manipal Teach-ing Hospital, Pokhara (Nepal) antenatal clinic. Sociodemographic data and relevant clinical variables were collected using a prede-signed pro forma after obtaining informed written consent. The subjects were interviewed with Hit Insult Threaten, Scream (HITS) scale and Beck’s Anxiety Inventory (BAI). For the assessment of correlates, regression analysis was carried out. All statistical analyses were done using SPSS v 20.0. P values < 0.05 were considered significant.Result: The prevalence of anxiety in this sample was found to be 9.6%. Factors such as history of sub fertility, pregnancy-induced illnesses and presence of domestic violence were found to be statistically significant predictors of anxiety during pregnancy.Conclusion: Certain factors correlate with development of anxiety during pregnancy. Pregnant women with risk factors should be screened and diagnosed for timely treatment 244 A Case of Imported Non-falciparum Malaria   , Laura Costa, Inês Gonçalves, Dina Leal, Luísa Pinto and Francisco Gonçalves A 27 year old male, native of Angola, where he was diagnosed with malaria, presents in our emergency department with headache, fever and myalgias. A diagnosis of severe Plasmodium ovale malaria with probable persistent hepatic forms was confirmed. He was started on a quinine and doxycycline scheme, later changed to atovaquone/proguanil due to concerns for resistance. Primaquine therapy was also administered. Despite clinical improvement and persistent elimination of parasitemia the patient developed signifi-cant antimalarial side effects.Severe malaria can be associated with hemodynamic instability and serious organ dysfunction and requires prompt intravenous therapy. Malaria relapses are common with ovale parasites, which have dormant liver stage. Atovaquone/proguanil use is limited in endemic countries due to cost and resistance but can be used in developed countries for treatment of blood parasites. Anti-relapse therapy with primaquine is required for hynozoite elimination.Most antimalarial drugs have serious adverse reactions that should be monitored cautiously 245 Proteomic Analysis of K12 and VW Escherichia coli Strains Using Two-dimensional Gel Electrophoresis, Maldi-TOF/TOF Mass Spectrometry and Shotgun NanoLC-MS/MS , Kamal F Alblwei Escherichia coli is a bacteria that is found in the environment in most warm blooded animals. It is a harmful gram-negative bacte-ria that has been widely used in research and proteomics owing to its high rate of reproduction. Two strains of Escherichia coli were analysed using two different approaches in this experiment, the approaches were 2DE and MALDI TOF/TOF mass spectrometry, and these analysis also included SDS-PAGE with label having 1D shotgun with LC-MS/MS. A quick comparison between the 2DE gels indi-cated similarities in the molecular weights in the same position or in different positions. A total of 217 proteins were identified using the shotgun method out of which 35 were up regulated, 37 down regulated and 145 remained unchanged. Both the proteins false dis-covery rate and the peptide false discovery rate for the experiment were zero. It was clear from the results that shotgun proteomics is a more reliable and accurate method when compared to the 2-D method when conducting a comparison in proteomics studies 246 Using Public Health to Prevent Air-Borne Pandemics Rather than Medical Science Responding to Air-Borne Pandemics Bahman Zohuri , Using Public Health to Prevent Air-Borne Pandemics Rather than Medical Science Responding to Air-Borne Pandemics Bahman Zohuri The fight against the pandemic is not going well-but not for the reasons many people with political ideologies believe. With Presi-dent Biden Whitehouse in place, he is facing uphill battle July 4 vaccination goal of 70% of adults with at least one dose of COVID-19 vaccine arm injection, according to recent national news CNN analysis. But the administration continuous to push ahead with new and initiatives, and key players remain hopeful that the goal will be met. With Johnson and Johnson vaccine as a one-shot dose be-ing out of market for any medical reason, people need two shots of dose against COVID-19 virous. But, with new different variety of this pandemics coming out of United Kingdom and as recent one reported coming out of Vietnam, are we really protected, even if we complete the goal of 70% by 4th of July as Biden administration is targeting. Currently, 63% of adults in the US have received one dose of Covid-19 vaccine, and an average of about 371,000 adults were added to that total each day last week, according to data from the US Centers for Disease Control (CDC) and Prevention. But closer to 564,000 adults would need to initiate vaccination each day to reach Biden’s goal by July 4 -- a rate that the US has only consistently fallen behind in the past week or so. The holiday weekend might have delayed some data reporting, but daily vaccinations had dipped below the required pace a few times before this week. Another 18 million adults will need to receive at least one dose to reach 70%. At the current pace of vaccination, the US would hit about 68% of adults on July 4 -- falling short by about 6 million adults. The full 70% would be reached about two weeks later. Even so, 12 states have already met Biden’s goal: California, Connecticut, Hawaii, Massachusetts, Maryland, Maine, New Hampshire, New Jersey, New Mexico, Pennsylvania, Rhode Island, and Vermont. Eight others are on track to reach 70% of adults by July 4: Colorado, Delaware, Illinois, Minnesota, New York, Oregon, Virginia, and Washington, as well as Washington, DC. But three states -- Alabama, Louisiana, and Mississippi -- might not even vaccinate half of their adult residents with at least one dose by July 4 at their current pace. In this article we take a look at way where public health would enhance prevention of air born pandemics rather than just medical science such as full-vaccination target of entire population nation-wide and globally as well. 247 Ultrasound and CT Evaluation in Renal Failure     , Dr. Moscow Mani S A MBBS MD Background: Acute renal failure remains a vexing and significant clinical problem. Mortality from ARF is still elevated and has changed little over time despite technical advances in renal replacement therapy and supportive care, possibly because of increasing age and increasing co-morbidity of patients. Hospitalizations for ARF have dramatically increased in the past two decades. ARF may also be a precursor to ESRD as approximately 13% of patients with ARF proceed to ESRD over a 3-yr period.Methods: In this Prospective study, we analyzed 65 case histories of patients hospitalized with elevated serum creatinine. Ultra-sound echocity and CT attenuation values were noted.Results: In our series of 65 cases, 45 (69.2%) were males and 20 (30.8%) were females .Our study shows greater incidence of ARF among males than females. The maximum incidence of ARF in this series was found to be between 50 - 59 years. 15 patients (23.1%) presented with ARF in the 5th decade.•In our study, abdominal ultrasound was done in all the patients, 47 (72.3%) patients had normal size kidneys, 15 (23.07%) had small size kidneys, and 3 (4.61%) had large sized kidneys. In our study there was no significant correlation between renal length and serum creatinine levels.•There was a significant correlation between renal length and age group of the patient, wherein there was a slight decrease in the renal lengths in the forty and above age group patients.•In this series, when the cortical echogenicity was correlated with laboratory data, an overall significant correlation was found between cortical echogenicity and the serum creatinine levels.•In our study, sixty four patients had normal parenchymal attenuation value in both kidneys, except for one who had a obstruc-tive ureterolithiasis on the right side. Renal attenuationon the side with lithiasis was lower compared to the opposite kidney. However, in our study there was no significant correlation between renal parenchymal attenuation and serum creatinine levels.Conclusion: Our prospective study with 65 adult patients revealed that acute renal failure had a positive association with male gen-der and there was a gradual decrease in renal length with advancing age. The renal cortical echogenicity on ultrasound had a positive relation with serum creatinine levels and reflected the severity of the disease process. Non-enhanced computer tomography is a more sensitive modality in detecting other pathologies in the kidney, in particular renal and ureteric calculus. It also demonstrated a decrease in renal parenchymal attenuation in the obstructed kidney.The limited responses of the kidney to various pathological insults may well remain a limitation to specific sonographic diagnosis, even when accurate quantitative measurements by ultrasound become available. Sonographic characterization of tissue is at present an area of active research. Measurements of the degree of ab-normality and the definition of unique tissue signatures are the goals. 248 Delayed Spontaneous Pneumothorax in the COVID-19 Patient in the Highlander   , Sadaf Samrina, Kanwal Nimra, Sualeh Mohammad Asad and Iqbal Ratnani Covid-19 is a pandemic caused by SARS-Cov-2 primarily affecting the respiratory tract. However, there is scarce evidence of the association of a delayed spontaneous pneumothorax in a spontaneous breathing patient with covid-19. This report describes a pa-tient with covid-19 who developed spontaneous pneumothorax after 20 days during infection without any underlying pulmonary predisposing factors. Pneumothorax in these patients if treated promptly has no bearing on clinical outcome 249 Primary Osteosarcoma of Pulmonary Artery - A Case Report and Review of Literature   , Sarala Ravindran, Raja Norazah Raja Alam Shah and Pathmanathan Rajadurai Primary sarcomas of pulmonary artery are extremely rare, highly malignant tumours and primary osteosarcoma of pulmonary artery is even rarer. Most of the cases are often misdiagnosed as pulmonary thromboembolism and anticoagulated to no effect. We present a case of 38-year-old male initially treated for infection and pulmonary thromboembolism but did not respond to antibiotics and anticoagulative measures. Chest radiograph revealed multiple lung nodules. Excision of right main pulmonary artery mass and upper lobe lung nodules was performed and was proven to be an osteogenic sarcoma of primary pulmonary artery on histopathologi-cal examination 250 Impact of COVID-19 on Daily Activities and Mental Health of All Ages , Suprakash Chaudhury and Tahoora Ali The COVID-19 pandemic is in a continual process of redefining daily lifestyle and habits of the average individual, as it progresses through its undulating phases. The public health recommendations and various government measures to curb the rampant transmission, have had adverse consequences. Labour markets, consumption patterns and economic activities, lifestyle patterns have been disrupted at an unprecedented scale. The predominant mental health issues that have been reported to be associated with the COVID-19 pandemic are stress, anxiety, depressive symptoms, insomnia, denial, anger and fear. COVID-19 may lead to increased risk of suicide due to the grief resulting from the loss of a loved one, the panic ensuing uncertainty of the future, the anxiety from financial turmoil, and the depression following social isolation. Cases of COVID-19 related suicides have been reported from Maharashtra, Uttar Pradesh, Assam, Kerala. Reports of suicide of health care workers, migrant labourers and those in quarantine centres are also reported 251 Nanopulse Stimulation as a Possible Immunotherapy , Stephen J Beebe Nanopulse stimulation (NPS) presents a novel approach for cancer treatment. It applies high electric field pulses with ultrashort durations and fast rise-fall times, affecting the plasma membrane and intracellular structures and functions, inducing regulated cell death mechanisms that are immunogenic, eliminating tumors and their immunosuppressive tumor microenvironment, and activat- ing innate and adaptive immune mechanisms. This results in tumor ablation and in situ vaccination against rat liver and mouse breast cancer. Here I provide a general overview of this technology and some finer points of the pulsed power technology. 252 Post Covid 19 Impacts on Various Sectors , Manoj Kumar The effect of COVID-19 irrupts the social and financial existence of everybody. Coronavirus has adverse consequence on various areas of economy. In this paper, we broke down the major influenced territories like agribusiness, oils, fabricating industry, training and so on in light of COVID-19 pandemic. Because of limitation in versatility, the travel industry and flight area got influenced which contributes major in economy development. The current examination shows the general post effect of COVID-19 on different essen- tial and optional areas of economy. 253 Various Methods, Procedures and Tools for Improvement of Quality and Standards in Medical Sciences and Neurosciences   , PK Upadhyay, G Tiwary, K Upadhyay and U Kartikeya Quality in medical sciences and neurosciences is demand of the day. Any visiting patient want the assurance of good quality and standards of service before vouching for the service. Quality and standards are continuous processes. One has to learn from past defi- ciencies which is founds on different medical audits and then device new system or methods or processes to overcome the deficiency. Various methods to keep abreast the continued improvement in quality is described. Keywords: QualityTools; Quality Improvement, Quality Standards; Flow Charts; Cause and Effect Diagram (Fish Bone/Ishikawa Charts); Parito-charts (80:20 charts); Check-sheet; Control Charts; Histogram; Scattered Diagram; Brain Storming 254 Methods in Six Sigma Quality and the Application of this Concept in Medical Sciences and Neurosciences and Other Branches of Medical Institution and Health Care System   , PK Upadhyay, G Tiwary, K Upadhyay and U Kartikeya The concept of quality is as old as mankind [1,2]. Application of such concept in health care system was adopted in 18th and mainly 19th century [3,4]. Application of concept of six sigma to health care is one of the most modern of them. The application of this concept in medical and surgical sciences in Health care system is described to achieve optimal and up-to-date health care system. Keywords: Healthcare System; Six Sigma; Medical Science; Neuroscience; Champion; Belt; Black Belt; Brown Belt; Green Belt; Master Belt; DMAIC Method; DMADV Methods 255 Knowledge of Nurses about Human Milk and Milk Banking   , Pankaj Ray and Siba Thakali Exclusive breast feeding is recommended for first 6 months of life. Breast milk can be continued up-to 2 years and beyond as well. Unfortunately all mothers cannot breast feed their babies due to various causes related to mother and newborn. Breast milk can be stored and even donor milk can be used for feeding the newborns. For this purpose nurses should have information about human milk and its banking. The study aims to assess the nurse’s knowledge about human milk and its banking 256 Knowledge of Nurses about Human Milk and Milk Banking   , Pankaj Ray and Siba Thakali Exclusive breast feeding is recommended for first 6 months of life. Breast milk can be continued up-to 2 years and beyond as well. Unfortunately all mothers cannot breast feed their babies due to various causes related to mother and newborn. Breast milk can be stored and even donor milk can be used for feeding the newborns. For this purpose nurses should have information about human milk and its banking. The study aims to assess the nurse’s knowledge about human milk and its banking. Methods: Quantitative, non-experimental descriptive research approach was used to assess the knowledge of nurses about human milk and its banking that was conducted in a tertiary level hospital in Kathmandu Nepal. Knowledge was assessed using self- struc- tured questionnaire. Data was analyzed by descriptive and inferential statistical methods. Results: Study depicts that majority of nurses have adequate knowledge about human milk and milk banking. Conclusion: Despite the satisfactory knowledge of nurses, there should be provision of in service training and symposium at regular interval to keep update knowledge and efficient working. 257 Knowledge of Nurses about Human Milk and Milk Banking   , Pankaj Ray and Siba Thakali Exclusive breast feeding is recommended for first 6 months of life. Breast milk can be continued up-to 2 years and beyond as well. Unfortunately all mothers cannot breast feed their babies due to various causes related to mother and newborn. Breast milk can be stored and even donor milk can be used for feeding the newborns. For this purpose nurses should have information about human milk and its banking. The study aims to assess the nurse’s knowledge about human milk and its banking. Methods: Quantitative, non-experimental descriptive research approach was used to assess the knowledge of nurses about human milk and its banking that was conducted in a tertiary level hospital in Kathmandu Nepal. Knowledge was assessed using self- struc- tured questionnaire. Data was analyzed by descriptive and inferential statistical methods. Results: Study depicts that majority of nurses have adequate knowledge about human milk and milk banking. Conclusion: Despite the satisfactory knowledge of nurses, there should be provision of in service training and symposium at regular interval to keep update knowledge and efficient working. 258 Coronavirus Disease-19 Pandemic and Undergraduate Medical Students Teaching/Learning , Vakhtang Shoshiashvili Since the beginning of 2020 coronavirus disease-19 (COVID-19) pandemic caused by a novel coronavirus all aspects of life globally have been affected, including teaching/learning 259 Is the Primary Aetiology of Hypertension Unknown? Novel Views on Previous Assumptions , Andras Sikter and Christian Sonne Most details of primary hypertension are known, however, it is still unclear how and why the increased activity of angiotensin II and aldosterone cause developing primary hypertension seen worldwide. Here we hypothesize that primary hypertension is an age-related disease initiated by the acidification of the intracellular milieu. The renin-angiotensin-aldosterone system (RAAS), like many other hormones, work through feedback mechanisms, with aldosterone restoring pH and electrolyte changes produced by respiratory acidosis in targeted cardiovascular and kidney cells. High NaCl intake enhances the effect of aldosterone (salt-sensitive hypertension). By contrast, angiotensin II restores H+ and electrolyte abnormalities caused by metabolic acidosis in the targeted cells (salt-resistant hypertension). Aldosterone and angiotensin II decrease H+ concentration synergistically, but act antagonistically on Cl- to HCO3- concentrations. However, both hormones overcompensate acidosis and increase Na+ retention leading to increased circu- latory resistance, hypertension, and left-heart hypertrophy by a cascade of events. If this hypothesis is true, the cause of essential hy- pertension is chronic respiratory and metabolic acidosis and RAAS activation. Preventing age-related intracellular acidosis through a non-hormonal way could prevent pathophysiological blood pressure elevation. It is a challenge to mitigate pCO2 level permanently and we, therefore, recommend a salt mixture of KH2PO4 and other Mg2+, K+, Ca2+ and phosphate salts to relieve the withdrawal symp- toms in hypercapnia 260 Ocular Prosthesis: Face to New Look   , Janak Poudel, Archana Murthy and Premnath Krishnasamy Our eyes are the windows to our soul as well as the first features of the face to be noted. The human facial disfigurement related with loss of an eye can lead towards extensive levels of physical and emotional problems. The rehabilitation of an affected patient who has suffered the psychological trauma of an ocular loss requires a prosthesis which provides the most efficient cosmetic and useful end result. An ocular prosthesis is a simulation of human anatomy that uses the prosthetic materials to create an illusion of a normal healthy eye and surrounding tissue as well as to preserve the volume of eye socket. A custom made ocular prosthesis has many advantages as compared to stock shell ocular prosthesis. 261 Brief Review of Clinical Morphological and Therapeutic Profiles of the Hand and Wrist Osteoarticular Tuberculosis , Dan Nelu AnuÈ™ca and Raul Filip MureÈ™an Tuberculosis (TB) is an endemic disease known since the Paleolithic in animal species, even before it affected humans. Today it presents serious concerns for global health, being the second most infectious disease after malaria, causing the most deaths world- wide despite the remarkable progress made in recent decades in terms of screening, monitoring and therapeutic strategy. In 2017 there were 1.8 million deaths worldwide from tuberculosis, but we are witnessing a very topical reappearance [1,2]. There are sev- eral factors that contribute today to maintaining this status of global tuberculosis health problem with its recurrence in developed countries. These are: immigration from regions where the disease is endemic; increasing number of elderly people with debilitating diseases; increasing the number of immuno-compromised patients; the appearance of mycobacterium-multidrug-resistant strains; increasing drug, alcohol, unemployment, poverty and malnutrition abuse; the HIV epidemic, tuberculosis being often the first mani- festation of HIV infection; Extrapulmonary tuberculosis (TBEP) is more common in Asian and African countries, having today a fantastic increase from 7.6% in 1970 to 35 - 40% 262 Correlation of Length of Index Finger (2D) to Ring Finger (4D) Ratio (2D:4D) and Coronary Artery Disease - A Study in Male Population of South Rajasthan , Nehal Kukda and SK Verma Human index finger (2D), to ring finger(4D), 2D:4D ratio attract considerable research interest because they exhibit sexual di- morphism and are linked to several traits. The objective of the present study was to find 2D:4D, which could be used as a marker for predisposition to CAD as assessed by ECG, 2D-ECHO and coronary angiography. This study includes 100 male subjects; 50 subjects with CAD and 50 subjects without CAD of age between 30-80 years. Finger lengths were measured twice for both hands using digital calliper. The results were tabulated and subjected to statistical analysis. 2D and 4D ratio was found more in men with CAD which was statistically significant (P < 0.01), supporting a positive correlation between high 2D:4D and CAD in males. 263 Travel Medicine: Zika Virus , Efstathios Konstantinou Koutsostathis Zika virus belongs to the Flaviviridae family and was initially isolated in Uganda from a rhesus monkey in Zika forest in 1947. It was first identified in humans in Nigeria in 1968. It is directly linked to dengue fever, the West Nile virus and Japanese encephalitis. It is transmitted through the Aedes species mosquitoes, including the Asian tiger mosquito 264 The Hepatitis B with Delta Agent Problems of Therapy , ST Tobokalova, KA Nogoybaeva and JT Aitieva Thus, to date, the only approved etiotropic drug for viral hepatitis D is - peg IFN, which is combined with nucleoside analogues in the presence of an HBV viral load. According to systematic data for example, the use of humanized mice as a laboratory model made it possible to better understand the issues of hepatitis virus replication and integration D with host cells. As a result, researchers have developed several antiviral drugs aimed at different parts of the pathogenesis of HDV infection. Prenylation inhibitor-Lonafarnib, which blocks the exit of HDV particles from the cell; nucleic acid polymers (NAP) (REP2139Ca), an oligopeptide that mainly affects the penetration of the virus into the cell, and Myrcludex B- lipopeptide, preventing the formation of HDV RNA in initialized hepatocytes, undergoing various phases of testing in different countries 265 The Effect of the Transfer Matrix Applied to MIMO Systems in the Analysis of Cardiovascular Dynamics , Carlos Alvarez Picaza, Julián I Veglia, Ángel E Piacenza, Albert D Valdez, Paola L Schlesinger and Juan A Chiozza MIMO systems allow us to work in the state-space without restrictions. The use of the Modern Control Theory let to specify new behaviors of complex structures. We describe the dynamics of the cardiovascular system by finding the input-output relationships in the state-space of a functional cardiac model, based on state equations and controllability criteria of control theory. The use of the transfer matrix applied to dynamic systems with many inputs and outputs allows addressing the treatment of cardiovascular dynamics with a different perspective. Based on the controllability criteria of dynamic systems we present an alternative method of analyzing the state of the arterial wall as a function of compliance. The unit step response of the multiple-input multiple-output sys- tem model illustrates the damping effect of the arterial wall to the pulsatility of the heart. In addition to verifying that hypertensive patients have less inertia of blood flow, it established that the internal controllability of the system can be affected as a function of input-output correlations 266 A Systematic Literature Review of Tendency of Pathogenic Diseases in the Patients of Covid-19   , Syeda Hajra Batool The virus is comparable to the SARS-CoV-2 virus for several physical and pathogenic characteristics. The incidence of death and infection of seasonal influenza is lower than that of SARS-CoV-2.. The research aims to find out the tendency of the pathogenic dis- ease in the patients of covid-19 and also to highlight the major pathogenic diseases caused by Covid-19. Researcher as well started searching for electrification: Elsevier Science Direct, Taylor and Francis, Stringer, Scopus as well as Google Scholar, to evaluate the tendency of pathogenic diseases in the patients of COVID-19 investigation already identified in open access publications or online publications, dissertations, grey literature such as abstracts, peer-reviewed journals, and unpublished reports during the period started from 1900s to 2021. In this study, study selection and extraction, publications by year, analysis of data sources, publication by context, Citation analysis, publications by context, tendency of pathogenic diseases in the patients of Covid-19, statistical analysis of covid-19 associated/pathogenic diseases have been discussed in results section. The studies included with correlation between tendency of pathogenic diseases and Covid-19 patients were analyzed. The data on the tendency of pathogenic diseases in the pa- tients of COVID-19 were analyzed from all studies. The current research was dependent on the outcomes of the reporting studies. In order to undertake a descriptive data analysis and word frequency (keywords) have been analyzed. All statistical data were analyzed using Microsoft Excel. It is resulted that the Covid-19 patient not only affected one issue, but they also suffered from many other dis- eases like acute coronary artery diseases or cardiomyopathy cancer, chronic obstructive pulmonary disease (COPD) another chronic kidney disease, Sickle cell disease, weak immune system, pregnancy-related many serious issues, and many other viral and bacterial diseases 267 Compliances of Road Safety Practices and Associated Factors for Penalization against Traffic Offences among Commercial Motorcyclists: A Case of Dodoma City, Tanzania , Evaristus Peter Makota and Stephen Mathew Kibusi Accidents have been observed to hinder individual development and reduce national economic intensification against expecta- tions of Sustainable Development Goals (SDGs). The presence of users of motorcycles and the associated accidents incursion offer a unique challenge in view of inadequate work force, which is frequently lost. However, despite the effort taken by the Government in addressing road safety practices, compliance is still low and reasons for penalization against traffic offences among commercial mo- torcyclists is continued to worsen the situation, the current study aimed at assessing compliances and reasons for penalization so as to counteract the burden of road traffic injuries. Study involved two hundred fifty two participants randomly selected from registered parking points and the result showed that majority of the commercial motorcyclists had low compliances and most of them were penalized against traffic offences with a couple of reasons including riding without wearing helmet, drunken riding. The result also revealed that, riding experience, possession of license and awareness on speed limits shown closely association with penalization 268 Testing and Validation of the Questionnaire Identification of Professional Stress Syndrome in Health Workers (IPSSHM) , CÄƒtÄƒlina Croitoru , Vlada Furdui, Ana Leorda, Anatolie Baciu, Olga Bulat, Ludmila Ursu, Vasile DumitraÈ™ and Elena Ciobanu Introduction: Burnout is a common problem, especially in people whose professional activity is associated with communication with other people. At the WHO European Conference, it was mentioned that work-related stress is a significant problem for about a third of people in European Union countries. Materials and Methods: A descriptive study was performed. Specialty scientific papers on the indicators that reflect the stress and burnout were consulted for the elaboration of the working tool (IPSSHM questionnaire - for diagnosing the professional stress syn- drome in the health workers) and selecting the testing methodology. Results: A questionnaire, which includes two parts (general and special), was elaborated. The general part of the questionnaire (with ten items) allowed to collect personal social, professional, and married data about the respondent, regarding age, biological gender, family situation, living environment, activity environment, medical specialty, place/work institution, work experience, and informa- tion about a part-time job. The unique part of the questionnaire represents a set of 131 items, which characterize the respondent through the prism of six distinctive structural blocks: emotional-sentimental, behavioral block, cognitive block, communicative block, individual-semantic block, and neurophysiological block. The questions in the questionnaire were randomly ordered. The respon- dent selected the pre-set answers: Yes, No, I didn’t think/Differently. Each answer receives a score from 1 to 3, depending on the peculiarity of the question and block belonging. Cronbach’s alpha coefficient was 0.71. The results of the elaborated instrument were compared with the results of two standardized questionnaires (Maslach and Eysenck), which were conducted in parallel. Conclusion: The obtained results demonstrate the validity of the questionnaire and the possibility of its application identifying health workers’ burnout 269 Modern Methodological Approaches to Rehabilitation of Disabled Patients from Ischemic Heart Disease , Bodrova Reseda A, Iksanov Haydar V, Ishteryakova Olga A and Iunusova Endzhe R The article makes a detail review of goals, principles and stages of medical and social rehabilitation of people with disabilities due to coronary heart disease. The list, content, and level of rehabilitation measures carried out within the framework of an individual program of rehabilitation or habilitation of a disabled person are shown. Here is indicated the specific testing methods by using functional diagnostic tests that simulate various types of loads in life. The most important principles for assessing the rehabilitation potential and determining the rehabilitation prognosis had formulated. 270 Syncope as a Long Term Effect of Coronavirus (“Long Covid”) in an Afro Caribbean Patient: A Case Report , Felix Nunura, Edwin Tulloch-Reid, Ahmed Soliman, Safiya Weekes, Eldhose Basil, Daina Baugh and Ernest Madu While most persons with COVID-19 recover and return to normal health, some patients can have symptoms that can last for weeks or even months after recovery from acute illness. We describe an Afro Caribbean patient with symptoms of ‘long COVID’, and we posit that this condition may be related to a virus- or immune-mediated disruption of the autonomic nervous system resulting in a Vaso Vagal Syncope. 271 Non-Follow-Up of Pulmonary Tuberculosis Patients in Health Facilities and Associated Factors, Hoima, Uganda , Apolo Ayebale, Harriet Babikako, Joan N Kalyango, Jane Asiimwe, Hilda Nansikombi, Martin Nabwana, Alice Nakato and Achilles Katamba Introduction: The World Health Organization and Ministry of Health recommend monitoring of tuberculosis patients that are on treatment to assess for healing progress. Tuberculosis treatment success in Hoima district was only 68% in 2017 compared to the national target of 85%. About 55% of the smear positive tuberculosis patients remain positive at the end of two months of medica- tion. Failure to examine sputum at the end of 2 months during treatment reduces chances of early detection of treatment failure. Objective: The main objective of the study was to determine prevalence and factors associated with non-follow-up of pulmonary tuberculosis patients for the 2 months’ sputum examination in health facilities in Hoima, Uganda. Methods: We conducted a cross sectional study of 435 pulmonary tuberculosis patients’ records from 1st January 2017 to 31st De- cember 2018. The dependent variable was absence of 2 Months' sputum results and the independent variables included HIV status, directly observed treatment, facility location, facility ownership, distance and baseline sensitivity. The prevalence and it's 95% con- fidence interval was determined. Logistic regression was used to determine associated factors. Results: The prevalence of two months’ sputum non-follow-up was found to be 26.9% (95%CI = 7.0 - 64.4). The factors associated with sputum non-follow-up included: positive versus negative HIV status (aPR = 1.48, P < 0.001), not on versus being on directly ob- served treatment (aPR = 1.31 P = 0.002), rural versus urban health facilities (aPR = 1.79, P = 0.006), private versus government health facilities (aPR = 2.05, P = 0.015), distance > 5 km versus ≤ 5 km (aPR = 1.38, P = 0.021) and baseline tuberculosis drug sensitivity (aPR = 1.44, P = 0.318) which confounded health facility location. 272 What Went Wrong in Managing SARS-Cov-2 , Quirino Piacevoli1* and Ahsina Jahan In recent months, since the beginning of the pandemic, we have witnessed numerous debates on this issue, with very often diver- gent if not conflicting conclusions, with opinions with scientific content and many others with a naïve flavor. All this pseudo-in- tellectual-scientific cacophony one thing made us understand, that the pandemic has made us change our way of life. Many things will never be the same again 273 Lockdown - Can this Solve Our Problem? , Huang Wei Ling Today lockdown started in my city 27-05-2021, hospitals are full and every day the number of deaths increases even more. This city is located in the interior of the state of São Paulo, in Brazil, composed of 400,000 inhabitants and can be an example of what is happening in the world nowadays 274 Stereotactic Radiosurgery and Stereotactic Radiotherapy for Brain Tumors   , Enis Tinjak, Velda SmajlbegoviÄ‡, Nusret Salkica and Teufik Orahovac Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have become important treatment modalities for brain tumors. A technique that delivers a high dose of radiation, with effective use in patients with life-limiting diseases. Due to its specificity, the precision and direct visualization of the target during the delivery of the treatment is very important. The aim of this research article is to provide the safety and long-term efficacy of SRS and SRT. This research article, also, provides accuracy of the SRS treatment performed on linear accelerator and use of the trUpoint ARCH SRS system for patient imobilization 275 Clinical Outcome of Using Remdesivir in Bangladeshi Hospitalized Patients with Severe Coronavirus Disease (COVID-19)   , Md Azizul Islam, Mohammad Azizur Rahman, Mohammad Alimur Reza, Mohammad Jamil A Choudhury, KM Ashik Elahi, Mamun Al Mahtab and Sheikh Mohammad Fazle Akbar Background: Remdesivir is a broad-spectrum antiviral agent that is the first and only available therapeutic drug that has been ap- proved by several regulatory bodies for clinical use in the management of patients with severe COVID-19. Aim of this study was to evaluate the clinical outcome and safety of using Remdesivir in Bangladeshi hospitalized patients with severe COVID-19. Methods: We conducted a randomized, controlled, open level trial of intravenous Remdesivir in adult patients who are hospitalized with Covid-19. Patients were randomly assigned to receive standard of care therapy together with Remdesivir 200 mg on day 1 fol- lowed by Remdesivir 100 mg for next 4 days or standard of care therapy only. The primary clinical endpoint was duration of hospi- talization, defined by either discharge from the hospital or hospitalization for infection control purposes only. Results: A total of 60 patients were enrolled in the study after screening. Mean age of all the patients was 53.2 ± 12.7 and 83.3% were male. Results indicated that patients in the Remdesivir group had significantly shorter mean duration of hospitalization than control group (mean ± SD 7.3 ± 2.4, as compared to 10.8 ± 6.1; p-value: 0.013). In cox proportional hazard regression comparing time to clinical improvement (TTCI), we found statistically significant difference on day 11 (HR - 1.88; 95% CI - 1.03 - 3.36; p-value - 0.038) and day 14 (HR - 2.15; 95% CI - 1.22 - 3.81; p-value - 0.008) between two groups. There was no mortality or serious adverse events among all the patients in both groups. Conclusion: Remdesivir was proved to be beneficial to shorten the duration of hospitalization and time to clinical improvement in adult patients requiring supplemental oxygen therapy. A randomized placebo controlled clinical trial with larger sample size appears to be warranted to validate these important findings. 276 L-1β in Correlation to the Common Diabetic Complication , Emina Karahmet, Besim Prnjavorac, Tamer Bego, Neven MeseldÅ¾iÄ‡, Selma ImamoviÄ‡, Esma Karahmet, Farooq Sher, Lana LekiÄ‡ and Edin BegiÄ‡ The aim of this research study was to compare interleukin 1β (IL-1β) levels in participants with diabetes mellitus 2 (DM2) depending on the duration of disease and comorbidity. Methods: A total number of 150 participants were observed by two different ways. In a first observation, all participants were grouped into four different groups (A, B, C, K), with criteria duration of DMT2: A- less than 10, B- 10-20, C- 20-30 years of DMT2 duration. Second observation was conducted with criteria accompanied comorbidities of DMT2, and all participants were grouped into 5 different groups (1: DMT2+ polyneuropathy (PNP) + hypertension, 2: DMT2 + PNP, 3: DMT2 + hypertension, 4: DM, 5: control). Each group included 30 participants, except group A in first observation that included 60 participants. Control group included 30 healthy participants. An enzyme-linked immunosorbent assay (ELISA) was performed to measure IL-1β levels in each group. Results: In the first evaluation, IL-1β of the group C (98.43 pg/ml ± 5.72) was at a significantly lower level compared to group A 113.49 pg/mL ± 5.29 and B 114.53 pg/ml ± 5.69, and was not significantly different than control group K 98.88 pg/ml ± 14.42 (p = 0.002). IL-1β in group A was significantly different to group K, p = 0.0001, and group B was significantly different to group K, p = 0.003. IL-1β did not show a significant correlation with diabetic polyneuropathy. In the second evaluation, IL-1β (pg/ml) was significantly different in groups (p < 0.001) with average ranges per groups: group 1: 93.84, group 2: 63.76, group 3: 86.69, group 4: 69.42 and group 5: 47.97. Groups 1 and 2 were significantly different (40.09 vs. 27.29, p = 0.007), groups 1 and 5 were significantly different (45.97 vs. 22.03, p < 0.001) and groups 3 and 5 show significant difference between each other (38.96 vs. 22.94, p < 0.001). Conclusion: Hypertension has bigger impact to IL-1β ranges than diabetic neuropathy, but showed that hypertension and neuropathy are correlated and will probably be risk factors for the manifestation of another comorbidity in diabetic participants. 277 WBCs, Neutrophils to Lymphocytes, Monocytes to Lymphocytes and Platelets to Lymphocytes Ratios to Predict the Severity of Covid-19 Cases among Intensive Care Unit Patients   , Haytham Dahlwi, Rana Zaini and Mazen Almehmadi Introduction: On March 2020, the World Health Organization (WHO) introduced the disease of Coronavirus 2019 (COVID-19) as a pandemic disorder. Although Covid-19 has spread rapidly causing serious health problems and might lead to death no effective treatment has discovered yet, the detection of reliable and useful prognostic markers is helpful to predict the severity and prog- nosis among Covid-19 patients. Thus, the current study aimed to assess and compare the level of WBCs, lymphocytes, neutrophils, monocytes and platelets in Covid-19 patients and control group. This study also evaluated neutrophils to lymphocytes, monocytes to lymphocytes and platelets to lymphocytes ratio. Methods: This is a retrospective study included 385 participants 350 of which were confirmed COVID- 19 cases. Whereas the con- trol group include 35 healthy individuals. Results: The result of this study showed a significant increase in total WBCs count, significant low lymphocytes count and signifi- cant high neutrophil count in Covid-19 patients admitted in intensive care unit (ICU) compared to the control group. The result of this study also reported significantly (P < 0.0001) higher values for neutrophil-to-lymphocyte ratio (NLR), monocytes-to-lympho- cyte ratios (MLR) and platelet-to-lymphocyte ratio (PLR), in Covid-19 patients admitted in ICU. Conclusion: Based on the findings of this study, which revealed significant changes in a number of blood cells among Covid-19 patients admitted to ICU, it is suggested that level of WBCs, NLR, MLR and PLR can be use as a useful prediction marker to predict the severity of Covid-19 cases in ICU 278 Recurrent Pulmonary Tuberculosis in Low Prevalence Settings: Case Report from Louisiana   , Amit Barua, Joseph Hubble, Kathryn Yoo, Michael Lacassagne, John P Areno, Louis Trachtman and Juzar Ali Recurrence of Pulmonary tuberculosis (TB) after successful completion of supervised treatment may be due to relapse or rein- fection. Recurrence is common with an incidence rate of 2.26 per 100 person years over a mean follow up of 2.3 years. However, it is uncommon for an immunocompetent individual to experience multiple episodes of recurrences. We describe a 67yo, Human Im- munodeficiency Virus (HIV) seronegative man, seen in the public health system in Louisiana, USA with multiple relapses of TB due to drug susceptible MTB despite successful completion of guideline based direct observed treatment regimen in each episode. This case report highlights the need for increased awareness and recognition of risk factors contributing to the recurrence of TB even in countries with low prevalence of TB. Better understanding of the importance of drug penetration and action on varying mycobacte- rial populations within diseased lung tissue would also aid clinicians in the management of these relapses. 279 Infection Control Challenges in Dialysis Units in Developing Countries during COVID-19 Pandemic   , Ahmed Daoud, Mahmoud Mohammed and Karim Soliman The importance and strategies to implement infection control measures in dialysis units during COVID-19 pandemic have been discussed previously [1,2]. In this editorial, we would like to dis- cuss the limitations to implement the appropriate infection control measures in dialysis units in developing countries with limited re- sources and how to overcome them. These limitations include lim- ited availability of masks, limited spots in dialysis units in isolation hospitals for confirmed severe acute respiratory syndrome corona virus-2 (SARS-CoV2) infected cases, lack of clear plans to deal with suspected cases and limited availability of swabs 280 Colon Cancer: The Exclusion of Native Americans and Hispanics from Clinical Trials in the United States   , Yazzie GA, Yazzie GA1, Cayatineto HW1, Clyde CS1, Grunther B2 and de Soto JACayatineto HW, Clyde CS, Grunther B and de Soto JA Introduction: Each year there are 150,000 new cases of colon cancer in the United States. The chance of death for Hispanics and Native Americans who get colon cancer is much higher than whites even though both groups are much less likely to get colon cancer than whites. In this study, we look at the inclusion or exclusion of Hispanics and Native Americans from colon cancer clinical trials. Methods: In this retrospective study, 48 colon cancer clinical trials in the United States with an aggregate of 421,530 participants performed within the last ten years were selected at random. These clinical trials were evaluated for the inclusion and exclusion of minorities. Results: Though whites make up only 60.1% of the population they make up 89% of the colon cancer clinical trial participants. Af- rican Americans, and Hispanics who make up 13.4% and 18.5% of the population only made up 5.6% and 0.6% of the colon cancer clinical trial participants. Only two native Americans out of 421,530 colon cancer clinical trial participants could be identified. Conclusion: Colon Cancer Clinical trials have systematically excluded Hispanics and Native Americans while minimizing the partici- pation of African Americans. This may be directly related to the increased death rates seen in these groups and provides evidence for the non-generalizability of colon cancer clinical trials. 281 A Rare Presentation of Intraorbital Abducens Nerve Schwannoma Gaurav , Garg, Rukmendra Pratap Singh Warkade, Narendra Patidar, Ranu Gupta and Harshdeep Singh Gabba Schwannomas are slow-growing, well-defined, and pseudo-encapsulated arising from the Schwann cells of the peripheral nerves. Usually, schwannomas are presented intracranially. Intraorbital schwannomas’ incidence is as low as 1-2% of all orbital tumors. Ab- ducens nerve schwannoma in the orbit originating from the terminal branches which supply to the lateral rectus is extremely rare. A 45-year-old lady presented with painful proptosis of 10 mm with no extraocular muscle movement restriction. She underwent lateral orbitotomy with excision biopsy and was histopathologically diagnosed as schwannoma. On follow-up, she had total recovery of the abducens nerve 282 The informative value of several clinical-laboratory characteristics at the time of hospitalization in terms of prognosis of disease complication with COVID-19 patients td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;} , L Ratiani, T Sanikidze, G Ormotsadze, E Vashakidze, V Shoshiashvili, E Pachkoria, M Rurua, E Khuchua, L Gabunia, K Machavariani and T Megrelishvili The number of patients with COVID-19 is currently rapidly increasing globally. Most of the patients with COVID-19 have a favor- able prognosis, but some have rapidly progressed to severe and critical conditions with respiratory distress syndrome, coagulation dysfunction, multiple organ failure, etc. The purpose of our study was to identify early clinical-laboratory indicators of possible complications in COVID-19 patients. The information of a total of 106 patients with confirmed COVID-19 (the positive result of the nucleic acid test by real-time fluores- cence RT-PCR), who were admitted to First University Clinic of Tbilisi State Medical University (Georgia) (1.04.20-1.5.20), was col- lected. The clinical-laboratory data (saturation index, pH, hemoglobin, leukocytes (lymphocytes and neutrophils) and thrombocytes content, prothrombin, D-Dimer, CRP, LDH, AST, ALT, bilirubin, urea level in the blood, and CT-rate) were collected at the time of patient admission to the hospital. In accordance with the severity of the course of the disease during hospitalization, all patients were divided into two groups - without complications and with severe complications, when respiratory and other organs failure occur, requiring observation and treatment in intensive care units (ICU). Exploratory and confirmatory (K-mean Clustering, ANOVA, Xi2), data analysis methods were used to reveal the statistical reliabil- ity of the difference between the mean values of the parameters. To identify the optimal complex predictors of the risk of complica- tions, Binary Logistic Regression analysis and Receiver operating characteristic (ROC) curve analysis were performed. According to the results of the study, it was found that the prognostic criterion of further complications in patients with COVID-19, developed on the basis of a linear function of parameter values (saturation index, neutrophil count, and CT-Rate) at the moment of hospitalization is characterized by high accuracy. Also, the ways for further refining the complex prognostic criterion were identi- fied. In particular, the use of generalized nonlinear models with random effects in regression will allow to 1) increase the number of clinical- laboratory characteristics, 2) consider the effects of interaction between them, 3) to assess the level of uncertainty and its sources 283 Hesitancy, Perceptions and Attitudes towards COVID-19 Vaccination Programme among Health Care Workers in Tanzania   , Alen Kinyina and Sarah Mohamed Chamos Introduction: Development of a vaccine against the COVID-19 virus is considered successful preventive measure and the current hope over the fight against the present pandemic. However, the World Health Organization (WHO) acknowledged hesitancy as a threat towards the uptake of the vaccine. Objective: This study aims to explore the perception and attitudes of Health Care Workers (HCWs) and hesitancy towards the COVID 19 vaccination programme in Tanzania. Methods: We conducted a cross sectional qualitative study. In-depth interview was done to 153 respondents to explore their views, opinion and concerns toward the COVID-19 vaccine. This study used a thematic approach to analyze the data. Finally, syntheses and summaries were generated and key terms, phrases and expressions of the participants were used to support the findings. Results: HCWs understand that the vaccine are not effective by 100% however when they outweigh the risk of COVID-19 severity and vaccine risks, their choice is to get vaccinated. Due to uncertainty, insufficient information about safety and efficacy and few clini- cal trials some HCWs are delaying to make choice of decision to be vaccinated. Conclusion: HCWs in Tanzania are optimistic towards the COVID-19 vaccine and are ready to get vaccine. They perceive that regard- less of unknown and uncertainty about the vaccine, the risks of COVID-19 severity outweigh the risk of vaccine. Few of them feel they need more evidences and trials in order to be vaccinated 284 Perspectives of Physicians and Nurses Regarding End-of-Life Care at King Abdullah Medical City in Makkah: A Cross-Sectional Study , Naved Yousuf Hasan, Asiah Rugaan, Masood Iqbal and Sanaullah Bhatti End of life care decision is challenging. We assessed the perspectives of physicians and nurses in a tertiary care hospital by testing 19 statements. A total of 112 physicians and 188 nurses completed the survey. Both physicians and nurses agreed to 15 statements, disagreed to 2, and regarding statements 4 and 7, nurses were having a different opinion than physicians. In particular, nurses were more likely to agree while physicians disagree. According to our results, one reason for transferring sick patients to ICU is the fear of legal implications. Physicians and nurses both agreed that patients and families were encouraged to make timely and appropriate decisions about DNR and their religious beliefs greatly influence their views regarding EOLC decisions. Furthermore, physicians do talk about health care directives with patients and family members regularly. Nurses agreed that the patients with DNR status should always be treated in the intensive care unit if indicated. On the other hand, physicians do not want to treat DNR patients in ICU (P = 0.003). Similarly, nurses agreed that we routinely placed a religious assessment of the patients in patient charts and nurses/physicians know about it while physicians do not agree with that (P = 0.000). It is a single-center study, hence the generalization of its results is limited. We did not calculate the actual prac- tices of providing EOLC in our hospital. The possible confounding factors, such as age, gender, and ethnicity, have not been addressed in our survey. 285 Multiple Toy Magnets Ingestion; An Alarming Emergency td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;} , Mukhtar Mehboob, Manzoor Ahmed, Muhammad Zubair and Rubina Naz Ingestion of a foreign body in children inadvertent or intentional is a common emergency worldwide. A 2-year-old girl who ingested three magnets was presented with vomiting and generalized abdominal pain. Plain abdominal X-Ray revealed three oval shape toy magnets attached together in the upper abdomen. Exploratory laparotomy revealed two magnets in the stomach, which were evacuated. The third magnet was removed from 4th part of the duodenum. The perforation in the duodenum and posterior wall of stomach were repaired. The recovery of the patient was smooth. It was evident that body temperature and acidic & alkaline envi- ronment of intestine not hampered the magnetic properties. The magnetic forces exceed the tissue perfusion pressure of intestine lead to local necrosis and perforation 286 A Comprehensive Review on Functional Role and Additive Application of Lactoferrin , Barkha Binyameen, Muhammad Abdul Rahim, Waseem Khalid, Naqash Nasir, Saleem Ilyas, Fareed Afzal, Muhammad Rehan, Ravi Prakash Jha, Anwar Ali, Muhammad Zubair Khalid, Zahra Maqbool, Noman Aslam, Muhammad Safwan Siddique, Hamza Israr This review discusses the nutritional and biological properties of the LF. Lactoferrin [LF] is a multifunctional protein naturally present higher amount in milk and the lower amount is evaluated in rice and various secretions such as tears, saliva, pancreatic juice and bile. All existing non-animal LF expression systems have been improved from the point of view of their expression efficiency, purification procedure of target protein as well as the sophisticated cultivation, harvesting and biological activity. LF is used to activate humoral and cellular immune reactions. Therefore, it may be effective against COVID-19 and metabolic diseases. LF is an iron-binding glycoprotein that can be used to regulate iron absorption, also used as an antiviral and antibacterial agent in various food products. Furthermore, LF has been used for the formulation of infant feed and also used in pharmaceutical and nutraceutical industries. Moreover, LF is also used as an antioxidant and to protect against bacterial and viral infections. LF is very effective against many diseases caused by iron deficiency. Concluded that LF may inhibit iron absorption and can be used as a functional ingredient in many food products. 287 COVID19 Surge in India - What we Know so Far   , Raghavendra Tirupathi Govindaraju India is now facing a daunting task of battling the raging CO- VID-19 surge. It is second wave of infection that has rapidly sur- passed its first wave in 2020 in terms of the number of new cases and deaths per day. Rates in India trended down significantly during fall and winter with a complete drop in January. However, March and April had some large public gatherings of thousands of people due to religious activities and political rallies in sever- al states probably leading to dissemination of virus. The country has been recording more than 300,000 cases of COVID-19 per day since April 21, up from 100,000 per day on April 4. These numbers eclipse India’s previous highest number of new cases reported in a single day, at 97,860 cases on Sept 16, 2020. Fully opening up with unrestrained crowding, mass gatherings, large scale travel, and lack of personal protective measures such as masks, lack of a concrete national containment, surge and vaccination strategy have all contributed to this very preventable situation. Shortages of Medical oxygen, beds, pharmaceuticals like Remdesivir and To- cilizumab has made the situation even more challenging. Lack of preexisting vaccine procurement contracts are leading to short- ages of life saving vaccines at a critical time. 288 Effect of Magnetic Therapy on Clinical and Laboratory Parameters for the Patients Who have Undergone Pneumonia Caused by the New Coronavirus Infection , RA Bodrova, AD Zakamyrdina, IA Fakhrutdinov, AM Delyan, RR Mavzyutova and ER Yunusova The article is devoted to a comprehensive prospective clinical study of effectiveness of use of low-frequency magnetic therapy in medical rehabilitation of the patients with viral pneumonia in the convalescence phase by comparing it with a group of patients not receiving magnetic therapy in the rehabilitation program. The aim of this work is to study the effect of low-frequency magnetic therapy on improving the function of external respiration, on increasing the efficiency and shortening the rehabilitation period for patients with viral pneumonia in the phase of convalescence. The study included 200 patients (mean age 54.5 ± 5.2 years) who had experienced pneumonia caused by COVID-19. Group I (Main Group) consisted of 100 patients who received low-frequency magnetic therapy daily for 20 minutes on the background of a standard therapy beginning from 16-21 days after discharge from the hospital, a course of 15 procedures. Group II (Control Group) consisted of 100 patients who received low-frequency placebo magnetic therapy daily for 20 minutes beginning from the 16th to 21st days after discharge from the hospital, a course of 15 procedures. To determine the dynamic clinical and laboratory parameters and effectiveness of therapy in this study in accordance with the Temporary Clinical Recommendations of the Ministry of Health of Russia, the following were used: physical examination, pulse ox- imetry, rating scales: dyspnea scale mMRC (Modified Medical Research Council); Borg dyspnea scale, quality of life questionnaire (EQ-5D), and CBC [9] 289 Angiosarcoma of the Thyroid Gland with Bilateral Malignant Pleural Effusion: A Case Report with Review of the Literature , Vijaya Ganta, MD; Gail Nunlee- Bland, MD; Robert L. Copeland Jr., Ph.D Objective: Our objective is to report a case of angiosarcoma of the thyroid gland with bilateral malignant pleural effusion. Case Report: A 70-year-old African American woman with a medical history significant for Grave’s disease status post radioactive iodine ablation, and postablative hypothyroidism for 39 years, presented with progressive hoarseness of voice and dysphagia for one year. Physical exam revealed diffuse enlargement of the thyroid, no thyroid bruit or cervical lymphadenopathy. Thyroid func- tion tests TSH, FT3, and FT4 are normal and the thyroid peroxidase antibody was negative. The ultrasound of thyroid reported as a large thyroid gland with diffuse heterogeneity of the parenchyma with no clear-cut margins. The CT scan of the neck and chest with contrast reported as 7.5 x 5.1 cm thyroid mass with ill-defined margins surrounding the trachea, moderate bilateral pleural effusion, pulmonary vascular congestion, bibasilar atelectasis, and/or infiltrates. The fine needle aspiration of the thyroid under ultrasound guidance reported as angiosarcoma. Immunomarkers were positive for CD34 and CD31, and PAX-8, P53, and thyroglobulin reported as negative. Ultrasound guided pleural fluid aspiration analysis reported as angiosarcoma. Our Patient had total thyroidectomy with wide local excision. Pathology findings reported as high grade epithelioid angiosarcoma of the thyroid with tumor extension at surgical margins. The tumor cells showed strong CD31 immunopositivity, con- firming the diagnosis of angiosarcoma. TTF-1 immunostain highlights an entrapped thyroid follicle within the tumor. Our patient was started on radiation therapy 4 weeks after surgery followed by chemotherapy-Taxol. Unfortunately, our patient passed away within 4 months of diagnosis. 290 Cystic Fibrosis in Female Gender , Tiziana Ciarambino, Ombretta Para and Mauro Giordano MD PhD Abstract Introduction: Cystic fibrosis (CF) is a lethal autosomal recessive disease. It has been reported that females are diagnosed later than males (2) and have a significantly decreased survival. Methods: Clinical trials were identified by PubMed until June 30 2020. The search keywords were "sex, gender differences, cystic fibrosis”. Result: It has been suggested, that cystic fibrosis is diagnosed later in female children, because underdiagnosed. Unfortunately, cystic fibrosis determines airway inflammation and chronic respiratory infection, such as Pseudomonas aeruginosa. Different factors are related to these inflammations. However, mortality and cystic fibrosis–related diabetes (CFRD) prevalence were higher, in female subjects than males. Conclusion: Female subjects have significantly higher mortality than males, with about 4-year difference in median survival. How- ever, adolescent girls with CF have a greater emotional impact compared to boy. 291 COVID 19 in Liver Transplant Patient - Case Report , L Ratiani, V Shoshiashvili, E Vashakidze, M Rurua, E Pachkoria, E khuchua, L Gabunia and K Machavariani Abstract Coronavirus disease-2019 (COVID-19) caused by coronavirus 2 (SARS-CoV-2) infection is a global health problem; Severe CO- VID-19 can lead to multi-organ failure and may be associated with high mortality. The incidence and outcomes of COVID-19 in immu- nocompromised patients are a matter of debate, clinical presentation and management of liver injury in liver transplant patients with COVID -19 is unclear and may be an increasing challenge for the transplant centers. This is a Case report from Georgia that presents a case of COVID-19 in a patient with a liver transplant. Due to Corticosteroids and Antibiotic therapy, in parallel with continuing immunosuppressive drug full recovery was achieved. His maintenance immunosuppressive therapy includes calcineurin inhibitor (Cyclosporine) 75 mg BID, which was not ceased 292 Axion N and Photoluminescence , Ogluzdin VE A photoluminescence model is proposed that takes into account the role of axions, which are associated with the width of the photoluminescence spectra; the lifetime of axions has been estimated for a number of media 293 Study on the Effects of Sars-Cov-2 Infection on the Hematological and Biochemical Parameters and Clinicopathological Correlation in the Evolution of Covid-19 , Rakesh Holla A, Amit Sharma and Naveen Chawla Acta Scientific MEDICAL SCIENCES (ISSN: 2582-0931) Volume 5 Issue 10 October 2021 Study on the Effects of Sars-Cov-2 Infection on the Hematological and Biochemical Parameters and Clinicopathological Correlation in the Evolution of Covid-19 Rakesh Holla A1*, Amit Sharma2 and Naveen Chawla3 1Department of Pathology, 160 Military Hospital Silchar, Assam, India 2Consultant Pathologist, Sampurna Sodani Diagnostics Pvt. Ltd, Indore, Madhya Pradesh, India 3INHS Asvini Colaba, Mumbai, Maharashtra, India *Corresponding Author: Rakesh Holla A, Department of Pathology, 160 Military Hospital Silchar, Assam, India. Research Article Received: July 25, 2021 Published: September 18, 2021 © All rights are reserved by Rakesh Holla A., et al. Abstract The pandemic Covid-19 is caused by a single stranded RNA virus, SARS-CoV2 (Severe Acute Respiratory Syndrome Coronavirus 2). SARS CoV2 is one of the coronaviruses, primarily a respiratory infection with a significant impact on hematopoietic system and hemostasis. However, it is now learnt that Covid-19 also known to cause multisystem disorder with Kawasaki disease like fever in children. SARS-CoV-2 spreads via respiratory droplet and surface to human transmission via fomites where the virus can enter the mucus membrane of eyes, nose and mouth. Though asymptomatic/mild cases account for large number of cases, it is also postulated that the viral load is higher in pre-symptomatic cases compared to those with severe disease thereby making them most important overlooked viral shedders contributing to highly contagiousness of the infection. Therefore, early diagnosis of Covid-19 is critical for prevention and control of this pandemic and the clinical characteristics alone cannot define the diagnosis of Covid-19, especially for pre-symptomatic and asymptomatic patients. Nuclei acid detection based approaches have become a rapid and reliable technology for detection of virus, and amongst them real time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) is considered as the ‘Gold standard’ for the detection SARS-CoV-2. The real time RT-PCR has adequate sensitivity and high specificity in the diagnosis Covid-19 particularly the early infection. However, the important drawback with RT-PCR application is the risk of eliciting false-negative results which in the current pandemic can be perilous and a major impediment in the containment of outbreaks. It is reported that many ‘suspected’ cases with typical clinical characteristics of Covid-19 and diagnostic computed tomography (CT) images were not diagnosed with RT-PCR [15]. Thus, a nega- tive result does not exclude the possibility of Covid-19 infection entirely and therefore should not be used as the only criterion in the management of Covid-19 cases. We carried out a study to assess the effects of SARS-CoV-2 on the hematopoietic and biochemical profile which might provide for an alternative mechanism to diagnose Covid-19, particularly in hospital settings when patients are being evaluated in the Non-Covid zone of the hospital or in resource constraint settings where Nucleic Acid based tests are not readily available for the diagnosis of Covid-19. The study was carried out on individuals who were serving in an organization that generates physically fit and mentally robust individuals, thereby weeding out affection of any other confounding factors such as obesity, cardiovascular disease and other co-morbidities on the evolution of the disease. A total of 250 Covid-19 positive patients were evaluated hematologically and bio- chemically between June 2020 and October 2020. The Complete Blood Count (CBC) of the Covid-19 patients revealed normal Total Leukocyte Count (TLC) in more than 90% of patients, Leukocytopenia in less than 5% of patients, Leukocytosis in about 05% of cases and Thrombocytopenia in 5% of cases. It is pertinent to note that majority of the patients, particularly those presenting early in the course of the disease as pre-symptomatic illness, initially presented with Relative Lymphocytosis on days 2 to 3 post sampling that yielded a positive result for Covid-19. 294 Bisphosphonate Use in Childhood , Jomaa Olfa, Jguirim Mahbouba, Rim Klii, Ardhaoui Mahbouba, Bejia Ismail, Touzi Monji, Bergaoui Naceur 295 COVID-19 Pneumonia: Finding Clinical Solutions , Igor Klepikov The SARS-CoV-2 pandemic, despite the severity and tragedy of its manifestations, plays, oddly enough, a positive role for modern medicine. Some aspects of medical care have long required radical revision, and with the activation of the coronavirus, the need for new approaches and solutions has become more obvious, although old treatment stereotypes continue to determine the search strat- egy. Therefore, it is necessary to note the new facts and circum- stances that have accumulated during the current pandemic, as well as to assess them impartially and properly in order to make the necessary adjustments 296 Indirect (Mirror) Laryngoscopy: Valuable Laryngological Skill Going into Extinction? , James E Toblh, Olusola A Sogebi, Taiwo O Adedejl and Theophilus O Esan 297 Morphological and Numerical Variations in WBC Distribution Pattern during Differential Count Estimation from Buffy Coat Smears , Tajalmas Anumon MG, Romi Sleeba and Deepa Revi 298 In vitro Antiviral Activity of Bacopa monnieri (l.) Wettst Roots Methanolic Extract Against Dengue Virus Type 2 , Keerthy M, M Arya Lakshmi and B Ganga Rao Dengue is the most widely spread arthropod-transmitted viral diseases of human beings, approximately 390 million people are getting symptomatic infections annually and more than 2 billion people are living in risk conditions. Specified antiviral drug has not approved yet against dengue and in some countries restricted introduction of dengue vaccine is the only source. the only there is only limited introducti- on of a dengue vaccine in some countries. Bacopa monnieri (L.) Wettst plant frequently called as Brahmi and water hyssop, belongs to the family of Plantaginaceae. Bacopa monnieri (L.) Wettst is used as a medicine to cure various conditions including infections. In this study, determination of maximum non-toxic dose (MNTD) of the Bacopa monnieri (L.) Wettst was done against Vero E6 cells under in vitro conditions with the methanolic extract. The antiviral assay of Bacopa monnieri (L.) Wettst based on cytopathic effects (CPE) represented by degree of inhibition against DENV serotype 2 strain. Results showed that Bacopa monnieri (L.) Wettst had significant anti-dengue activity in Vero E6 cell lines by lowering the levels of cellular infection as well as virus output. It is done with the 50% effective concentrations for DENV 2 for Vero E6 cell lines. These results of this study by using MTT assay method, in which the Per- centage of inhibition in the presence of Bacopa monnieri methanolic extract for Anti DENV-2 activity was increased dose dependent manner from 1.56 to 100 μg in DENV-2 infected cell. The results indicated that Bacopa monnieri (L.) Wettst has a potentiality as an anti-viral agent against dengue infection for further development. 299 Dyslipidemia and Mortality in Young Patients Victims Of Cerebral Vascular Accident ,   Mohamed Lelouma Mansare, Kamadore Toure, Moustapha Ndiaye and Amadou Gallo Diop The risk of developing a vascular event attributable to dyslipidemia is correlated with the time of exposure to abnormally high levels of cholesterols in the blood. The occurrence of this event can compromise the survival of patients. The aim of this study was to determine the death rate among young patients hospitalized for Cerebral Vascular Accident in whom dyslipidemia had been obser- ved. The study was carried out for two years. Among the 609 cases of Cerebral Vascular Accident, 76 patients were between 16 and 45 years of age. They were grouped into two categories: those who presented with cerebral infarctions and those who presented with non-traumatic cerebral hemorrhages. Lipid profiles were analyzed. The cholesterol levels (C-g/l) with the following values (C-T≥2.4; C-LDL≥1.6; C-HDL <0.4 and Triglyce- rides≥1.5) were considered abnormal. The death rate was calculated by category of Cerebral Vascular Accident. Cerebral infarctions were the most predominant. The highest cumulative mortality rate (20/27) was observed in the age group of 36-45 years for the two Cerebral Vascular Accident categories. This age group corresponds to the economically productive popu- lation. HDL-c fraction dyslipidemia is not uncommon in young people. High rates of mortality were observed in young normally active patients who presented with dyslipidemia, sedentary lifestyle and obesity. Carrying out recommended sports activities can help to significantly reduce the occurrence of vascular events to the brain 300 COVID-19 and Alcohol - A Review , Supriya Garapati, Lakshmi Jyothi Tadi, Ariyanachi K and Pravin P Background: Alcohol use has been associated to a number of disorders, including SARS-CoV-2 infection since Alcohol can have a negative impact on the immune system through multiple pathophysiological mechanisms like reducing the number of T lymphocytes, favoring a pro-inflammatory status through an increased level of proinflammatory cytokines, such as tumor necrosis factor alfa (TNF α) and interleukins 1 and 6 (IL-1, IL-6), by decreasing the function, number of NK (Natural Killers) cells responsible for removing infected or malignant cells, disturbing the macrophage functions in the lung alveoli and damage to the respiratory ciliated cells which plays an essential role in filtering pathogenic microorganisms. It can also worsen mental and biological conditions, as well as pre- dispose to behaviour that increase the risk of infection and disease severity, though not necessarily sociopathic or violent behaviour. Another important factor is malnutrition secondary to excessive alcohol intake. Introduction: Alcohol misuse impairs both the innate and adaptive immune systems, potentially lowering resistance to the corona- virus SARS-CoV-2 and speeding up the onset of coronavirus illness (COVID-19). Alcohol use has been associated to several disorders, including SARS-CoV-2 infection since Alcohol can have a negative impact on the immune system through multiple pathophysiological mechanisms. Aims and Objectives • To review the relationship between Covid-19 and alcoholism • To learn about the illness signs of alcohol use in Covid-19 • To compare the mortality of alcoholics and non-alcoholics in the covid-19 population. • To learn about the effects of alcohol withdrawal in the aftermath of the pandemic. Methodology: Data was gathered from PubMed Central, Medscape, NCBI’s website, PMC, and BMJ journals, among other sources. The data on the relationship between alcohol and Covid-19 has been examined, analysed, and summarised in this publicatio 301 Explainable AI in Diabetes Prediction System , Dr. Jagreet Kaur, Suryakant and Kuldeep Kaur Use of AI in healthcare improves the industry services. Discovering patterns from data using ML improves the decision making process. It allows the industry specialist to make data-driven and fact-based decisions. The use of ML models in Healthcare is con- tinuously increasing but it proliferates the concerns of stakeholders due to complexity and black box functioning of ML models. Therefore Explainable AI approaches come into existence to make the ML model transparent and trustworthy. In this document a case study is represented in which the ML model is used to detect diabetes and for transparency Explainable AI approaches are defined to understand the AI system based on the concerns and queries [1] that would be raised by stakeholders. There are several approaches, libraries and packages that can be used to implement Explainable AI such as LIME [2], SHAP [3] etc. It allows the indus- try practitioner to use the right tools and approaches for making their AI system trustworthy and transparent 302 Knowledge, Acceptability, Enrollment, and willingness to support health insurance Program among traders in an Urban Community in Abia State , Prince Ezenwa Onyemachi, Nneka Chioma Okoronkwo and Chukwuemeka Ngozi Onyearugha Background: The desire to provide equitable access to healthcare delivery in Nigeria led the Federal Government of Nigeria to in- troduce National Health Insurance Scheme (NHIS). For this program to succeed, there must be adequate knowledge, acceptability, enrollment, and willingness to support national health insurance program among the masses. Objectives: To assess the knowledge and acceptability of health insurance among traders in Umuahia, Abia State, Nigeria. To assess their level of enrollment and suggested voluntary monetary contribution to a community-based health insurance program. Methods: This study took place in Umuahia, the capital city of Abia State, Nigeria. A pre-tested interviewer-administered question- naire was used to collect information on socio-demographic data and knowledge of health insurance from a group of traders selected by simple random sampling at an urban market. Following collection of data on baseline knowledge of health insurance, the Univer- sal health coverage and Community-based health insurance schemes were explained to respondents and responses were obtained. Results were analyzed using SPSS Version 24. Results: A total of 564 traders were interviewed out of which 39% were aware of national health insurance scheme. Amongst these group that are aware of the program, 68% knew about National Health Insurance scheme, while 27% were aware of only community- based health insurance. Only 5.3% of the traders were enrolled in a health insurance scheme. Following education and public enlight- enment on universal health coverage and community-based health insurance, over 80% of respondents believed health insurance was beneficial to achieving universal health coverage. Overall, 83.5% of respondents would be willing to support a community-based health insurance scheme if introduced in their communities. The mean amount suggested by respondents as monthly contribution to a community health insurance was nine hundred and twenty naira (N920.00) Conclusion: Awareness of health insurance, especially community health insurance is low. However, acceptability is high. It is im- perative that greater awareness be created in communities to enhance enrollment. Government subsidies will also be necessary to ensure sustainability 303 Leveraging the Power of High-throughput Technologies for Chromatographical Purification , Dilara BaÅŸ, Emre Burak Erkal, Ali Özhan Aytekin, Deniz Baycin Demirhan Abstract Therapeutic monoclonal antibodies (mAbs) are target-specific proteins used for patients especially suffering from cancer, autoim- mune, and inflammatory diseases. Due to the success rate of the mAbs, they are the fastest-growing sector in the biopharmaceutical industry. To be used for the therapeutic purposes, the monoclonal antibodies have to be high purity. A variety of different down- stream technologies have recently been evolved to provide high quality monoclonal antibody and biosimilar development with low cost in a shorter time. Recent advancements of high-throughput process (HTP) technology are employed for process development for saving time, investment, and cost. HTP allows running large number of experiments in a minimal scale. Incorporation of HTP technol- ogy with Design of Experiment (DoE) is systematic integration for effective and rapid screening of optimum experimental conditions. Development of purification process for mAbs requires the consideration of many different parameters including removal of im- purities and ready availability of raw materials for large-scale production. In this study, a downstream process was developed for one of the best-selling biosimilar mAb (TUR02) coupling HTP technology with DoE tools. TUR02 is an IgG1 which has a high tendency to aggregate. In order to develop protein A chromatography, firstly appropriate elution buffer had been selected using micro-volume columns. Large range of parameters were screened as buffer type (acetic acid, citric acid, sodium acetate), the concentration of buffer (10 mM-150 mM), and three different Protein A resins. Citric acid (10mM) at pH 3.5 was chosen as suitable elution buffer. A resin with base matrix of methacrylic polymer was chosen from the HTP study and a lab scale experiment with 1 ml column was done to prove the success of the scalability of the HTP technology. After protein A chromatography, HTP technology was applied to cation exchange chromatography to screen different conditions to be able to further decrease the impurity level. Flow through with over- loading mode was followed with the cation exchange screening. Concentration of sodium phosphate-based buffer (10 mM – 50 mM), working pH and comparison of strong and weak cation exchange resin were screened by coupling HTP technology and DoE tools. Strong cation exchange resin, 38 mM sodium phosphate and pH 4.5 were selected due to its impurity reduction strength. Scalability of the process was successfully proven using 1 ml pre-packed column. With these conditions, the aggregate and HCP levels were 0.52 and 612 and 0.32 and 234 for 0.1 ml and 1 ml columns, respectively. 304 A Rare Occurrence of Prader Will Syndrome in a 9-Month-Old Tanzanian Girl: A Case Report , Abdul Rafey Usmani, Zahra D Khan and Clement Kabakama Prader-Will syndrome is a disarray caused by a depletion or disruption of genes in the proximal arm of chromosome 15 or by maternal disomy in the proximal arm of chromosome 15. In sub-saharan Africa the prevalence of Prader will syndrome is estimated to be rare genetic disorder with a birth incidence of 1/10,000 to 1/30,000, and an estimated prevalence of approximately 10,000 to 20,000 living individuals in the United States and Globally it is estimated to be for almost 2% of the paediatric patients with the Prader Will syndrome. It affects males and females equally, as well as all races and ethnicities in Tanzania the epidemiology of Prader Will syndrome is not yet to be documented and thus We report the first case being presented in sub-sahara Africa. To Our Patient since before diagnosed with (PWS) was well till the age of two months when she gradually started increasing in weight with time, as days elapsed the patient was constantly gaining weight, 2.9 kg at birth to 14 kg at 7 months. This Case Report discuss about the Rare incidence of occurrence of Prader Will syndrome in Tanzania and its properly Diagnostic criteria interventions and treatment Management plan. 305 Low Back Pain and its Relationship with Working Period Among Commercial Flight Crews - An Evidence Based Case Report , Wawan Mulyawan, Fransiscus Januar Widjaja, Levina Chandra Khoe, Retno Wibawanti, Amilya Agustina and Syougie Abstract Flight crew has a work environment that can increase the risk of low back pain (LBP). The aim of this study is to find out whether the working period in commercial flight crews correlate with LBP. This study is an evidence-based case report, with literature search- ing conducted in the PubMed, Cochrane, and Ingenta databases. The inclusion criteria in the search were literatures with research subjects as crew members presenting LBP. Critical appraisal was carried out in accordance with the methods in the articles. After selecting literatures, we found three literatures based meet with the criteria. All articles use cross-sectional method. Only one study has the best quality, where the result of the study showed that there was no increase in the number of LBP sufferers within the 10-24 years of working period (Odds Ratio: 0.93 and 95% Confidence Interval: 0.78-1.03). These evidences are still insufficient to prove that the longer working period increases the risk of LBP in commercial flight crews, due to low level of evidence 306 Three Cases with Artifacts Presented in the Form of Intensive Diffuse Accumulation in the Liver and Spleen After Application of 99mTcMDP , Luljeta Abdullahu, Armend Jashari, Ylli Kaçiu and Naser Gjonbalaj Abstract The literature refers to various cases of non osseous uptake of 99mTc-MDP , and various examples are presented about radio- bio distribution problems of osteotropic radiopharmaceuticals, which may be unpredicted or altered, for which it is not it is always possible to conclude that this radiopharmaceutical (this agen t) can be absorbed in areas far from active bone formations where calcification is not present. Purpose: We report 3 cases with intensive diffuse uptake of 99mTc-MDP in the liver and spleen in patients with primary breast tumor, lung tumor and a suspected case of osteomyelitis, brought to our department, with the aim of detecting metastases in the skeleton respectively diagnosing the primary process to an adolescent's on left ankle. The aim is to interpret / refer to and discuss these cases with detected artifacts that exhibit difficulties in identifying soft tissue etiologies, organized according to the uptake mechanisms of 99mTc-MDP. Discussion: One of the impurities that can sometimes be observed in the eluent samples from the generators is Aluminium, in addi- tion to the reduced 99mTc hydrolysis process, also due to the excessive amount of Al3 which would cause the particles to form as a digestion "colloid" which, if injected, will be localized in the liver and spleen. Impression: In my experience almost 20 years ago, this is the first time I've had the chance to see such an artifact, such as intensive diffuse uptake of liver and spleen, along with the 99mTc-MDP accumulation on skeleton, until in the literature I had the opportunity to see and read about the various causes of this phenomenon, such as these presented cases, we would like to share this experience with you with presented facts. How much other artifacts like focal accumulation in the liver, lung, amyloidosis of the heart and un- usual or common accumulation in soft tissues and other organs outside bone tissue have been the most different 307 Determinants of Using the Modern Health Care in the Bagira Health Zone: Cases of Children Under 5 Years Old with Malaria , Eugène Kwamba, Christian Molima, Johanna Karemere, Safari Joseph Balegamire and Hermès Karemere AbstractIntroduction: Bagira Health area is characterized by a decline in the rate of use of curative health care between 2014 and 2018 while the prevalence of malaria was on the rise. This statement justifies the present study, which identified the specific determinants of the use of malaria-related children under 5 years in the Health area. Methodology: This is a cross- sectional analysis conducted in the Bagira Health area. An investigation was conducted with 303 households from the systematic, two-degree, systematized random sampling technique. The Data analysis used descriptive statistics and the Logit multinomial model. Results: The specific determinants identified in the use of health care in the case of malaria in the less than five years in the health area of Bagira are: the orphan parental status (19.70% of the probability of access to the public health center); the knowledge of antimalaria by parents (24% of the probability of access to public health cent e rs); follow-up at home (70.30% probability of use of the private health center) and the method of payment including the per-slice package (73.40% of the probability that private centers are used). Conclusion: The continued improvement of the quality of care, taking into account the determinants identified with a particular focus on the follow-up of sick children during and after treatment, should be strengthened in order to increase the use of curative care in Bagira. Keywords: Determinants; Health Services; Malaria; Logit Multinomial Model; Children Under 5 Years; South-Kivu; Democratic Re-public of Congo 308 Zinc Deficiency and Association with Cognitive Performance in School-aged Children: Peer Review , Gomaa F Salma Abstract In developing countries, micronutrient deficiencies are of major impact on children development. Zinc is among the micronutrient which is supposed to play an important role in children development, including both growth and cognitive performance. Although the evidence for the role of zinc in cognitive development though animals’ studies is proved, evidence from human studies is still not con-clusive. The association between dietary zinc status and cognitive functions through epidemiological studies, remains elusive. This review is summarizing current literature and epidemiological studies that investigated the association between zinc intake, through diet or supplement, zinc status (plasma/serum zinc concentration), and the different domains of cognitive functions in school-aged children 309 Effects of Artichoke and Bee Products on Body Weight Gain, Hot Flashes, and Insomnia during Menopause and Climacteric: A Systematic Review , Fabiola Mallon-Mercado, Mónica R Jaime-Fonseca and Patricia Vergara Aragón 310 The Effect of Spirituality on Adjustment to Chronic Disease during the Coronavirus Pandemic (COVID-19) , Reza Pourhosein Abstract Adjustment to chronic diseases is a fundamental strategy for patients' greater satisfaction with individual and social life, as well as to improve their level of performance and efficiency. In addition to causing biological disorders, these diseases cause problems and mental disorders for patients that reduce their resilience in life. Adaptation to chronic illness reduces abnormal psychological outcomes and increases their life satisfaction. Anxiety, stress and depression caused by chronic diseases in the context of the global corona outbreak, due to the frightening and mysterious nature of the virus, and its high mortality rate, have been added to the anxi- ety caused by chronic disease. Therefore, in order to adapt to chronic diseases in pandemic conditions, more efforts are needed and it is necessary to revise the traditional protocols and adapt them to the current conditions. Among the factors that are effective in reducing the psychological consequences of chronic diseases, spirituality plays an important role, which is described in this article. 311 Fetomaternal Outcome in Pregnancy with COVID-19 , Shruthi R, Niruby Rasendrakumar, Subashini S and Nidhi Sharma AbstractAims and Objectives: This study was to done to find the feto-maternal outcome when universal screening for COVID -19 was done in pregnancy. The effects of COVID-19 on placental histology and any evidence of vertical transplacental transmission were also investigated. Materials and Methods: A total of 850 pregnant women were screened from April 2020-July 2020 Eighty nine mothers were found positive for covid-19 with RTPCR. All pregnancies with covid 19 positive screen were admitted. 30 women were referred to labour room for intrapartum care and their feto maternal outcome was studied. Results: Covid -19 pregnancy is associated with miscarriages, preterm labour and intrauterine deaths. Placental lesions commonly observed are perivillous fibinous exudates, microthrombi and microinfracts. All newborns were covid negative tested by RT-PCR and hence transplacental transfer is not recorded in this preliminary report. Conclusion: The placenta acts as a barrier against transmission of COVID -19, though placental affection with microthrombi, infarcts and perivillous fibrosis were evident in almost all placenta in Pregnancy with Covid -19. 312 Knowledge of Nurses about Human Milk and Milk Banking , Pankaj Ray and Siba Thakali Abstract Exclusive breast feeding is recommended for first 6 months of life. Breast milk can be continued up-to 2 years and beyond as well. Unfortunately all mothers cannot breast feed their babies due to various causes related to mother and newborn. Breast milk can be stored and even donor milk can be used for feeding the newborns. For this purpose nurses should have information about human milk and its banking. The study aims to assess the nurse’s knowledge about human milk and its banking. Methods: Quantitative, non-experimental descriptive research approach was used to assess the knowledge of nurses about human milk and its banking that was conducted in a tertiary level hospital in Kathmandu Nepal. Knowledge was assessed using self- struc- tured questionnaire. Data was analyzed by descriptive and inferential statistical methods. Results: Study depicts that majority of nurses have adequate knowledge about human milk and milk banking. Conclusion: Despite the satisfactory knowledge of nurses, there should be provision of in service training and symposium at regular interval to keep update knowledge and efficient working 313 Knowledge of Nurses about Human Milk and Milk Banking , Pankaj Ray and Siba Thakali Abstract Exclusive breast feeding is recommended for first 6 months of life. Breast milk can be continued up-to 2 years and beyond as well. Unfortunately all mothers cannot breast feed their babies due to various causes related to mother and newborn. Breast milk can be stored and even donor milk can be used for feeding the newborns. For this purpose nurses should have information about human milk and its banking. The study aims to assess the nurse’s knowledge about human milk and its banking. Methods: Quantitative, non-experimental descriptive research approach was used to assess the knowledge of nurses about human milk and its banking that was conducted in a tertiary level hospital in Kathmandu Nepal. Knowledge was assessed using self- struc- tured questionnaire. Data was analyzed by descriptive and inferential statistical methods. Results: Study depicts that majority of nurses have adequate knowledge about human milk and milk banking. Conclusion: Despite the satisfactory knowledge of nurses, there should be provision of in service training and symposium at regular interval to keep update knowledge and efficient working. 314 Dose Exposure and Diagnostic Capability of Split Bolus Computed Tomography Urography (CTU): Comparison with Single Bolus Technique   , Clarissa Valle, Pietro Andrea Bonaffini, Maurizio Balbi, Francesca Invernizzi, Noemi Liggeri, Carlo Maria Ludovico Mondellini, Annalisa Pappini and Sandro Sironi Objectives: To compare CT urography (CTU) split bolus with standard protocol in terms of urinary tract opacification, parenchymal and vascular enhancement, and radiation dose exposure. To assess split bolus CTU diagnostic capability. Methods: Forty-eight patients (18-83 years) were retrospectively analysed: 24 (study group) performed a split-bolus CTU (com - bined nephrographic-excretory phase), 24 (control group) a single bolus protocol. On combined and portal venous phases, quantita- tive analysis of intraluminal opacification and parenchymal-vascular enhancement (HU) was achieved by placing regions of interest (ROI) in urinary tract, liver, spleen, kidneys, abdominal aorta and inferior vena cava. The corresponding mean HU values were com- pared between 2 groups. Qualitative analysis of urinary intraluminal opacification was performed by two radiologists using a four- point scale; inter-observer agreement was calculated. Radiation dose was calculated as Dose Length Product (DLP) and Computed Tomography Dose Index Volume (CTDIvol). The diagnostic capability was evaluated using a 2-point scale, using histology, imaging follow-up and endoscopy as reference standard. Results: The split-bolus protocol demonstrated lower mean urinary attenuation compared to the control group but no differences in quality of urinary tract opacification or in parenchymal-vascular enhancement. Mean DLP was lower (p = 0.045) in the study group (reduction of 37%). Split-bolus protocol answered the clinical question in 22/24 cases. Conclusions: With a comparable urinary tract opacification, parenchymal organs and vessels enhancement, split-bolus CTU results in a proper accuracy with a dose reduction of 37%, as compared to single-bolus protocols 315 Radiographical Evaluation of Alveolar Bone Resorption under Fixed Dental Bridge - Part II   , Jabbar Hussein Kamel and Faraed Dawood Salman Aims of the Study: Were evaluation of Alveolar Bone Resorption (ABR) under the fixed dental bridge (FDB) radiographically, along with considering the impact of variations like duration, the number of pontics, and the number of abutments, elaborating and ex - panding more about these variations. Materials and Methods: Forty (FDBs) were included from participants attending oral diagnosis and radiology department (Dentist- ry department)/Tishik International University. Each (FDB) was evaluated for the duration, the number of pontics, and the number of abutments. The orthopantomograph (OPG) was chosen as a radiographic technique to evaluate the (ABR), and measurements were done by the NewTom program. Results: Revealed highly significant associated level of (ABR) under (FDB) alongside duration and number of pontics, while the num- ber of abutments was found to play an insignificant vital role in ABR. Conclusion: FDB in conjunction with both variables (increasing number of pontics and duration more than five years) induce ABR, while the number of abutments does not considerably affect ABR 316 Oral Acute Toxicity of Ethanolic Extract of Rhizomes from Smilax domingensis Willd. in Cuba   , Ricardo Méndez, José González, Pilar A Soledispa, Enrique Gómez and Max Monan Smilax domingensis Willd. (Smilacaceae), also known as raíz de China and zarzaparrilla de la Tierra (Cuba), is a tropical American climbing shrub. The rhizome is widely used in medicine in manifold pharmacological activities. An evaluation was realized to deter- mine the oral acute toxicity from an ethanolic extract of rhizomes of this spice that grows in Cuba in 25 CD1 female rats using a dosage in 2000, 300, 50, 5 mg/kg. for 14 days, were evaluating the weight, feeding and the presence/absence of toxic symptoms, according to The Commission of European Communities (ECDO). Histopathological results in liver and kidneys revealed that at 2000 mg/Kg was observed necrosis, hyperplasia in Kupffer cells and glomerular hypertrophy. At 300, 50 and 5 mg/Kg were detected inflammation on hepatocytes by edema and dilatation on renal tubules. No mortality was produced at different dosage used in the experiments (2000, 300, 50 and 5 mg/Kg), however, histopathological analysis evidenced that on hepatic and renal tissues were causing alterations. 317 Improving Research Training Using Assignments for Family Medicine Residents in Saudi Arabia   , Mostafa Kofi, Saad Albattal, Ghada Alarfaj, Abood Al Abood, Abdelaziz Mansour Bin Alrasheed, Tarek Elsaid, Maha Moharram, Lamiaa Fiala and Ayman Afifi Setting: The family medicine training program at PSMMC in Riyadh is a major program with many years of experience in graduating residents of family medicine residency programs. The program is approved by the SCFHS. An average of 20-30 residents graduates each year from SCFHS’s training program. Residents in the Saudi family medicine program must complete research training as part of their residency training. However, Residents’ feedback emphasized the need for a change in the way research methods are taught. For this reason, assignment-based research training was designed to replace lecture-based training and to improve the research training experience. Methods: A Qualitative study in which a focus group of eight residents was included before and after implementation of research training change to assignment based. Results: Before implementation, there was an agreement that research training was considered a burden on residents and not a priority. Careless attitude was common among residents towards performance in the research requirement. There is an improved in commitment and seince of ownership for research after implementation of assignment-based research activities Conclusion: The use of assignment-based training in research training was effective in changing the perception of the residents towards research training as a requirement from the SCFHS 318 Improving Pediatric Vaccination During Covid19 Pandemic, in PHC, Riyadh, Saudi Arabia   , Medhat Maher, Abdelaziz AIRasheed, Abood Alabood, Azzam Alotaibi, Tarek Elsaid, Maha Bassim, Fawzyia Altassan, Tariq Alhajlah, Sultan Almutairi and Mostafa Kofi Background: Pediatric vaccination is mandatory program to control vaccine preventable diseases and in such cases that hinder its activity; in which conditions there is increased morbidity and mortality due to these vaccine preventable diseases [1]. Routine vac- cination of children must remain a priority even during the covid-19 pandemic. All countries could experience outbreaks of vaccine preventable diseases if uptake of routine vaccinations fall, undoing decades of progress. Vaccination has been one of the most effec- tive interventions in driving down infant mortality to historically low levels worldwide. For us at PHC, of the Family and Community Medicine Dept. PSMMC developed and promoted the vaccination of children uses the home visits pediatric vaccination, this work describes the success story of use of home visits pediatric vaccination to catch up vaccination coverage during the sever effects of COVID19 pandemic. Methods: The study aimed to System changes, so can the vaccination program to continue and catch up the vaccination coverage after severance due to the impact of Covid19 pandemic Developing new booking software in the hospital web site based on patient geographical distribution, age of the child and vaccination required. For the parents to log in and register their child Patient affair and nursing will access the web site and distribute the registry according to geographical area prepare the team who will visit patient at home to be consisted of Physician, nurse and nurse assistant Results: This graph shows that the number of vaccinated children at Alwazarat center has dropped significantly to zero starting from first week April 2020 (blue line), and stayed at the same level until first week of June 2020; which coincided with the start and peak period of OVID-19 pandemic. It also shows that the initiative of home vaccination was launched at second week of April (red line) and took off with more than 7 consecutive points during April through June 2020. Conclusions: System changes to Developing new booking software in the hospital web site based on patient geographical distribu- tion, age of the child and vaccination required to improve the patient access to care to log in and register their child. Integrated this program with healthcare team providers to facilitate the child home vaccination during Covid-19 pandemic and to allocate resources with continuity of care considering a safe procedure of vaccination at patient house, 319 CRISPER-CAS9 Utilization for HIV/AIDS Treatment   , Chouia Yassine and Amran Wafa 320 Proactive Improvement for Handling Patients with COVID 19 During the Pandemic, in PHC, Riyadh, Saudi Arabiat   , Medhat Maher Mohamed, Abdelaziz Al Rasheed, Abood Alabood, Azzam Alotaibi, Abuobieda Abdalrouf, Tarek Elsaid, Maha Bassim, Tariq Alhajlah, Sultan AlOtaibi, May Caria Quitan and Mostafa Kofi Background: Dealing with the surge of the COVID-19 pandemic patients in the health care facilities needs proper ways to effectively detect the patients with flu symptoms and prevent the transmission of the infection to the other patients and the health care work- ers in the same time. The fundamental aim of this project is. To improve early detection and management of Covid19 patients during covid19 pandemic Methods: Intervention: Failure Mode Effect Analysis, (FMEA) was used as a Methodology for improvement starting by Possible risk of transmission of infection during patient movement in Wazarat primary healthcare center Implemented change concepts in the form of: (1). Reduce unnecessary steps in patients suspected to have covid19. (2). Performing tasks parallel with the main process, (3). Smooth workflow in a step. (4). Eliminate hand-off failure. (5). Replace with a better value steps, based on outcome redesign the work process Results: Improve Average Pre consultation from 22 minute to 1 minute, Improve Average consultation from 17 to 4 minutes, before swabbing time improved from 7 to 2 minutes, Improved Pharmacy waiting time from 4 to 1, Patient journey improved from 50 to 8 minutes. Outcome results; outbreak infection rate between healthcare professionals Improved overall from 9.8% to 0.5%. Balancing results Overall staff satisfaction Improved from 24% to 85%. Conclusions: In situations of uncertainties like covid19 pandemic, urgent management of situation and interventions are needed. Proactive quality improvement tool like Failure mode and effect analysis and change management concept is recommended to im- prove 321 The Usefulness of Medicinal Herbs in the Treatment of Diseases   , Salem Mohamed Edrah and Dheba Mohammed Abobaker Medicinal plants as foodstuffs participants in diet are achieve- ment attractiveness to human everywhere in the world, because of occurrence of an enormous quantity of beneficial and safeties from constituents which every day are discovered by progressive performances or even by using it in treatments of several diseases or Alonso as traditional curative. Despite using synthetic drugs for treating diseases, the well-practiced data of herbal medicine is played very vital rules in this field, due to the side effects of syn- thetic products as drugs 322 Tetanus: The First Child Case Report from Hevi Pediatric Teaching Hospital at Kurdistan Region - Iraq   , Federica Buzzi, Nizar Bakir Yahya, Khalaf Hussein Gargary, Adel Hevan Al-Atroushy and Maiandi Stefano Background: Tetanus is a vaccine-preventable disease caused by a robust neurotoxin produced by the spore-forming bacterium Clostridium tetani. However, numerous cases continue to be reported in internationally published literature indicating that tetanus continues to be a substantial problem despite the existence of vaccines. In this case report, we describe the first case of tetanus at the Hevi Paediatric Teaching Hospital in Duhok, Iraq. Case Presentation: Our patient was a 13-year-old boy admitted to the emergency room for widespread spasms and difficulty swal- lowing and urinating. The patient was admitted to the paediatric intensive care unit for suspicion of tetanus. The WHO international guidelines for the treatment and care of tetanus were adopted. After 17 days of hospitalization, the patient was discharged without neurological sequelae. Treatment for tetanus patients is long, complex, and multidisciplinary. Conclusions: It is crucial to raise the awareness of tetanus and to vaccinate even the most vulnerable populations owing to the high costs of care and poor prognosis of patients with tetanus. In low- to middle-income countries such as Iraq, tetanus can impact overall healthcare management due to the complexity of patient care and high healthcare costs. 323 Penetrating Wounds of the Abdomen: Treatment in Times of Conflict at the Bangassou Regional University Hospital in the Central African Republic   , Doui Doumgba Antoine, Moute Jerry Martial, Ngboko Mirotiga Pétula Anicette and Piamale Germain Introduction: Wounds of the abdomen are traumas with rupture of the continuity of the abdominal wall. The circumstances of their occurring are varied but are often related to the increase in crime in civilian practice or during armed conflicts. Objective: to study the epidemiological, diagnostic and therapeutic aspects of penetrating wounds of the abdomen at the level of the general surgery department of the Bangassou Regional University Hospital in the south-east of the Central African Republic. Patients and methods: This is a descriptive retrospective study of cases of penetrating wounds of the abdomen recorded and treated during the period from May 12, 2017 to May 12, 2019 at the said CHU. Results: The series consisted of 84 patients and male subjects accounted for 88.1%. The sex ratio (M/F) was 7.4. The average age of patients was 30.4 years (± 12.7 years). Patients aged 14-23 years were more affected (39.29%). Nearly 2/3 of the victims were under 45 years of age. Many of the victims came from the area of the locality of Bangassou (44%) and Gambo (21%) which constituted the epicenter of armed conflict in the region. The injured were willingly unemployed (45.2%) followed by farmers (27.4%). The circumstances of the wounds were clashes during armed conflicts (51.2%) and criminal assaults (42.8%). The wounded had arrived under the guidance of a non-governmental organization (40.5 per cent) or their relatives (33.33 per cent). The average time to admission was 1.2 days. The firearm was the most incriminated vulnerable agent in 76.2% of cases. Wounds were mainly in the right hypochondrium (35.7%), the left iliac fright (17.9%) and the hypogastrium (17.9%). In 81% of cases these wounds were ponctiform. The diagnosis of penetration was based on signs of hemoperitoneum (57.1%) and peritoni- tis (27.4%). Abdominal wounds were associated with extra abdominal lesions in 17.8% of cases consisting of open fractures of limbs, bursa lesions and chest wounds. All the injured were operated on after brief medical resuscitation. A safe iso rhesus whole blood transfusion was useful in 55 injured (65.5%), including 30 in pre-operative and 15 intraoperatively. General anesthesia was used in all patients with orotracheal intubation. The first route was the median laparotomy above and sub umbilical. The lesions concerned the liver (37.1%), hail (29.8%), and colon (12.7%). In 5.8% of cases no lesions were found. The main surgical procedures performed were excision-suture of organs (50 cases) and resection-anastomosis (10 cases). 324 Viral Hepatitis B Seroprevalence Among Pregnant Women in Tlemcen   , H Brahimi and DJ Bacha The epidemiology of viral hepatitis B in pregnancy is not precisely known in Algeria, although it is of primary importance to health planners and program managers. The objective of this study was to assess the prevalence of these infections in the population of pregnant women. This is a prospective longitudinal study carried out at the level of the mother-child specialized hospital and mo- ther-child protection centers in the region of Tlemcen. This study lasted 30 months (January 2013 to June 2015), and recruited 2165 pregnant women. The seroprevalence of HBs Ag in pregnant women was 1.8%. The mean maternal age of HBs Ag positive patients was 30.38 ± 5.9 years, with the most affected age group of 30-39 years with 51.28%. There was no statistically significant association between age or socio-demographic factors (level of education, marital status, surgical procedures, previous hospitalization, previous transfusions, dental care, history of sexually transmitted infections or scarifications, gestational age) and HBs Ag status. On the other hand, other socio demographic factors such as parity (P = 0.014), professional activity (P = 0.031), history of jaundice (P = 0.014), mode of delivery (P = 0.012), piercing (P = 0.034), intravenous drug addiction (P = 0.005), vagrancy (P = 0.02), and family history of hepatitis B (P < 0.001) were associated with HBsAg carriage. Chronic mutant carriers (87.2%) vs. 12.8% chronic wild-type. These results encourage the screening of viral hepatitis B in pregnant women in order to prevent vertical transmission of this virus. These results encourage screening for viral hepatitis B in pregnant women in order to prevent vertical transmission of this virus 325 Huge Adrenocortical Carcinoma: Case Report and Literature Review   , Maatougui Jasser, Raboudi Mehdi, Ben Rejeb Nedhir, Besrour Chayma, Gargouri Faten, Ramzi Khiari, Ouertani Haroun and Ghozzi Samir Adrenocortical carcinoma is a rare entity. We report a case of a 47-year-old male with abdominal pain. without classical tumor symptoms. Computed tomography revealed a left adrenal mass measuring 17 cm. Hormonal evaluation was negative. Open left adre- nalectomy was performed by sub-costal approach. Diagnosis of adrenocortical carcinoma was established by pathology. Metastatic workup was negative. The patient has been followed regularly with no recurrence for one year. Adrenocortical carcinoma is a chal- lenge. Surgery is the main treatment 326 The Use of Ultrasound in the Placement of Totally Implantable Veinous Access Ports (TIVAP) for Chemotherapy   , EL Bouazzaoui Abderrahim, Jabrane Marouane, Touzani Soumaya, Houari Nawfal, Maaroufi Mustapha, Tsigbe Wisdom Kwasi, Boukatta Brahim and Kanjaa Nabil Introduction: There is an increasing demand for Totally Implantable Intravenous Access Ports (TIVAP), mainly to facilitate the ini- tiation of intravenous chemotherapy. Ultrasound guidance during venipunctures for the placement of these TIVAP catheters is a good technique that is highly recommendable for Practicians. We present a prospective study for the placement of TIVAP using Ul- trasound-guided percutaneous approach in 288 patients. The objective of this study is to demonstrate the contribution of Ultrasound guidance in making the procedure for the placement of these devices a safe one and also to study the complications that may arise from the placement of these intravenous devices. Patients and Methods: This is a prospective study over a period of 7 years from January 2015 until July 2021 carried out in the A4 multipurpose anesthesia-intensive care unit of the CHU Hassan II in Fez. All the TIVAP were inserted under Ultrasound guidance. The parameters studied were: the sex of the patient, age, the cancer to be treated, the puncture site, the side of the puncture, the ultra- sound technique, the per- and post-operative complications that occurred during or after the placement of the intravenous device. Results: The study includes 288 Totally Implantable Venous Access Ports (TIVAP) placed in 288 patients of which 52.7% male and 47.2% female. The reasons for chemotherapy were diverse. Ultrasound exploration of the veins was systematic in all patients before starting the implantation procedure. Two cases of venous thrombosis were incidentally diagnosed during these preoperative explo- rations. Venipuncture was performed at the axillary area in 67.70% of cases, against 31.5% of cases at the internal jugular area, and in the end 1.05% of cases of these punctures were at the femoral area. The ultrasound technique for venipuncture was in the ultra- sound plane in 71.18% of cases, compared with 28.81% of venipunctures performed outside the ultrasound plane. Venipuncture was obtained during the first trial in 100% of cases. We did not observe any case of pneumothorax, arterial puncture or hematoma. The duration of the TIVAP procedure varied between 45 and 90 minutes depending on the case. Four cases of aberrant path of the TIVAP catheter were observed on the chest X-rays;which was systematically taken at the end of the insertion procedures. These aberrant paths were subsequently corrected via endovascular route by interventional radiology. In the long term, we noted one case of extra- vasation of the chemotherapy product, two cases of surgical site infection and one case of catheter exposure. Discussion and Conclusion: The use of ultrasound decreases the risk of pleural damage and the formation of pneumothorax. Ultra- sound guidance also decreases the risk of hematoma by reducing the number of punctures and avoiding arterial punctures. Ultra- sound exploration also helps to verify the anatomical location of the vein, its permeability and the presence or absence of deep vein thrombosis. Thus, the use of ultrasound makes the procedure for inserting TIVAP a safe and secured one 327 A New Method of Eustress by Physiological Activation of the Hypothalamic-Pituitary System of the Body   , Leonid Tell and Sergey Lysenkov The stress response system is a vital aspect of the dynamics of an individual’s health/illness at the physical, psychological and so- cial levels. This extremely complex self-regulating system includes many causal factors, non-linearities and time delays. The underlying physiological response to stress involves three main mechanisms: the autonomic nervous system, the hormonal system, and the im- mune response system. To create a model of mild stress (in our understanding, eustress) seemed very important and at the same time such stress should be beneficial for the body [1-3]. We pro- pose a method of physiological influence on the vegetative-hor- monal system. We believe that eustress is a physiological condition and necessary for maintaining health. 328 Nutcracker Syndrome   , Adel Ekladious Nutcracker Syndrome is a rare condition that presents with variable non-specific symptoms and signs including loin pain, chronic pain syndrome, macroscopic and microscopic haematuria, orthostatic albuminuria, occasionally varicocele, infrequently chronic re- nal failure. As a result, these patients are often treated as pyelonephritis or diagnosed with benign orthostatic albuminuria. They may also be subject further investigation with cystoscopy by urology. It is not uncommon for these patients to be labelled with chronic pain syndrome, functional pain syndrome or fibromyalgia, with significant morbidity involving chronic pain poorly controlled with analgesia. We present a 29-year-old medical student with chronic pain, who was given a diagnosis of fibromyalgia. Following recurrent presentations to emergency department with left loin pain and intermittent haematuria, the patient was admitted under urology for further investigation. Doppler ultrasound, CT, and MRI showed compression of the Left Renal Vein (LRV) between superior mesen - teric artery and adnominal aorta confirming the diagnosis of nutcracker syndrome. The patient opted for endovascular therapy with left renal vein stenting that resulted in resolution of all symptoms. Although nutcracker syndrome is a rare condition, a low threshold to discuss radiological findings with a senior radiologist is required to exclude nutcracker syndrome once common causes of haematuria and loin pain have been ruled out. Failure to diagnose Nutcracker in a timely manner can lead to serious complication and irreversible kidney injury6 329 A Rare Case of Kimura Disease in A Black African   , Biram Codou Fall, Assane Sall, El hadji Daouda Niang, Bamba Diaw, Ahmadou Gaye, Aly Salane, Aichetou Fall and Souhaibou Ndongo Introduction: Kimura disease or eosinophilic lymphogranuloma is a very rare condition. It occurs almost exclusively in patients of Far Eastern origin, but more rarely in Caucasians. It has not been described in black Africans. We report a case. Observation: The patient was 66 years old, a farmer, not known to be a smoker, referred by an ENT specialist for investigation of a swelling of the left parotid region, evolving for 9 years, progressively increasing in volume, painless, accompanied by inflammatory episodes. The clinical examination revealed a patient in good general condition, apyretic, with normo colored conjunctiva. On inspec- tion, there was a swelling of the left parotid region without inflammatory signs of the skin. On palpation, there was a swelling of firm consistency, poorly limited, painless, not flapping, mobile in relation to the superficial and deep planes, measuring approximately 7cm in long axis. Palpation of the contralateral submaxillary region showed a smaller soft mass with a 3 cm long axis. Dermatological examination revealed prurigo. A cervicofacial CT scan showed an enlarged right parotid gland with irregular contours infiltrating the subcutaneous fatty tissue externally, without visualization of lithiasis or bone lysis. The biopsy of the accessory salivary glands revealed a grade 1 chronic sialadenitis. The biological workup was normal except for a major hypereosinophilia of 4400. However, the systematic search for proteinuria was negative. The patient underwent a total right parotidectomy. Anatomopathological study of the specimen concluded to a Kimura disease. Oral corticosteroid therapy was instituted with a good evolution. Conclusion: Kimura’s disease is a rare condition, which usually affects Japanese men. It is characterized by subcutaneous nodules predominantly on the head and neck. The prognosis of the disease remains good 330 COVID-19 Severity and Serum Level of Procalcitonin: A Systematic Review   , Mohamed Awny Abdelhamid Abouhemda Objective: To review the serum level of procalcitonin in relation to COVID-19 severity. Data Sources: All articles published between 2003 and 2021 were subjected to a comprehensive search of MEDLINE (PubMed, Med- scape, Science Direct, EMF-Portal) and the Internet. Study Selection: English-language reports of procalcitonin and COVID-19 were chosen for this study. The initial search yielded 127 articles, 51 of which met the requirements for inclusion. Data Extraction: Articles that did not include procalcitonin or COVID-19 in the title or abstract were excluded from the study. Data on methodology was collected by 26 independent investigators. Data Synthesis: Structured reviews were used to make comparisons, with the results tallied. COVID-19 mortality-related risk factors have been studied in 21 studies, while PCT level has been studied in 30 studies in relation to COVID-19 severity. Findings: As of 2020, Egypt’s total number of COVID-19 patients is predicted to be in the range of 710–5241 patients. Dyspnea, diabetes mel- litus, lymphopenia, elevated CRP, ESR, ferritin, ALT, AST, low albumin, increased D-dimer, and the presence of CT chest abnormalities might all be used as predictors for COVID-19 severity. Most prior investigations discovered a statistically highly significant relationship between serum procalcitonin levels and COVID-19 severity (p0.001). Conclusion: Demographic, clinical, haematological, biochemical, and imaging data, as well as dyspnea, diabetes mellitus, obesity, smoking, lymphopenia, elevated CRP, ESR, ferritin, ALT, AST, low albumin, increased D-dimer, and the presence of CT chest findings, were found to be predictors of COVID-19 severity in this study. These aspects should be given extra attention, and more evaluations should be done to look into the underlying processes of these effects. PCT may also serve as a predictor of disease severity and aid in identifying the severity of COVID-19 patients. Serial PCT measurements may also be helpful in predicting prognosis. Additional research is needed to better understand the methods by which more PCT is produced and released in SARSCoV-2 patients 331 Phytochemical Examination and Antibacterial Activities of Thyme Leaves and their Use with Goat's Milk as a Traditional Remedy   , Dheba Mohammed Abobaker, Salem Mohamed Edrah, Sarah Jarood, Hanan Alnade and Wesam A Kollab Plants are a source of a great abundance of drugs including several groups such as antimicrobials, anticancer, antispasmodics, etc. A large number of the plants are own antibiotic characteristics in conventional usage and are also utilised widely by the tribal people extensive. Objectives: Thyme is one of the vital plants around the world because it contains various essential secondary metabolites which are considered as bioactive ingredients for the remedy of several diseases. The present study aimed to a qualitative and quantita - tive phytochemical screening of RE, preparation of a boiled mixture of thyme leaves and goat’s milk TMGT as a traditional drug, and examination of the biological activity of each of RE and TMGT against some sorts of pathogenic bacteria. Methodology: Preparation of Thyme-Milk Goat’s Treatment (TMGT): where fresh wild thyme leaves were added to fresh goat’s milk, and mixed very well, followed by added virgin olives oil with well mixing, and boiled a while, a thick, yellowish-oily liquid {Thyme- Milk Goat’s Treatment (TMGT)} was obtained. Preparation of Thyme Aqueous Raw Extract (RE): Where a coarsely fine powdered of thyme leaves was extracted with appropri- ated solvent by using soxhlet extractor apparatus. Results: Percentage Yields: The percentage yields of RE were 89%, while the pH for RE and TGMT were 6.7 and 7.3, individually, and the acid value of raw goat’s milk was 6.7g. Preliminary Phytochemical Screening: The preliminary phytochemical screening of thyme aqueous crude extract revealed the presence of plentiful amounts of bioactive ingredients, which are tannins, phenols, Fats and Fixed oils, Amino acids alkaloid, flavo- noids and steroids and triterpenoids. Quantitative Phytochemical Investigation: The percentage yields obtained from the leaves regarding quantitative phytochemical investigation were 81, 72 and 90 % for Flavonoids Alkaloids and Saponins, separately. Antibacterial: The thyme aqueous raw extract (RE) was tested against each of the bacterial; Escherichia coli, Staphylococcus au- reus, Lactobacillus, Streptococcus pneumonia and Staphylococcus aureus, were revealed 19, 20, 21, 19 and 23 mm, correspondingly. However, the TMGT showed 23, 22, 25, 24 and 25 mm consistently. 332 Awareness of Emergency Nursing Staff about Emergency Operations Plan in a Tertiary Care Hospital in Riyadh, Saudi Arabia   , Faisal Alasmari, Abdulaziz Albuhairy, Jean Bail and Steven Parrillo, Maher Alsakkak and Mostafa Kofi This paper offers a project to assess nurses’ disaster readiness in the Prince Sultan Military Medical City emergency department. The study aims to determine the level of awareness of the concept of the EOP and preparedness among emergency department nurses for a large-scale disaster. With the hospital implementing an emergency operation plan, it is unclear whether emergency department nurses are conversant with it. An extensive literature review discussing incident command systems, regulations and standards, disasters in Saudi Arabia, and preparedness has been conducted in this paper. Data was collected using survey question- naires developed by the Qualtrics platform and distributed to a sample of nurses in the department. The project outcomes will help outline areas that need improvement. Findings show that ED nurses have a lack of knowledge about disaster preparation. They need educational, practical, and awareness programs to cultivate their confront disasters’ competencies. Some recommendations have been presented to the Major Disaster Response Unit (MDRU) to perform and provide additional educational and training approaches for the ED nurses about the EOP and disaster response 333 Genital Infection Risk Profile in Post-menopausal Women with Type 2 Diabetes Mellitus on Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors   , Gentile S, Guarino G, Della Corte T, Satta E, Pipicelli AMV, Romano C, Alfarone C, Lamberti R, Di Maio A and Strollo F Background: patients with type 2 diabetes mellitus (T2DM) often discontinue Sodium-Glucose Cotransporter-2-inhibitors (SGLT2- Is) despite high efficacy and safety due to genital infection (GI). Aim of the study: to assess real-life GI risk profile in post-menopausal T2DM patients educated on strict hygiene-based prevention practices (SHBPPs) due to their intrinsic GI susceptibility. Methods: 721 post-menopausal T2DM patients willing to follow SHBPPs were randomly assigned to three different SGLT2-Is (inter- vention group, IG, n=318) or other drugs (control group, CG, n=403) for three- months. Before and after treatment, they underwent routine lab tests and completed a specific questionnaire. Results: GIs more often occurred (9.6 %; p < 0.001) among IG women non-adhering to SHBPPs (41.5%) vs. the 2.9% of adhering ones. Conversely CG women had superimposable GI rates (2.7% vs. 3.1%, respectively, p n.s.) whether or not adhering to SHBPPs (51.4 vs. 49.6%, respectively, p n.s.). The typical profile of women on SGLT2-Is at higher risk for GIs included (i) poor adherence to SHBPPs, (ii) older age, (iii) higher BMI, (iv) poor glucose control as witnessed by high HbA1c levels, and (v) antihypertensive drug utilization. Conclusion: physicians should consider the importance of strict hygiene control in their post-menopausal T2DM patients undergo- ing SGLT2-I treatment and thus utilize better-focused education strategies in that specific subgroup to prevent or rehabilitate from repeated GIs 334 Biomedical Waste Disposal Practices in a Tertiary Level Hospital – An Effort to Bridge the Gap Between Policy and Reality   , Prerna Gupta and SK Verma Objectives: The objectives of the study were to evaluate the infrastructural setup for Bio-medical waste (BMW) handling, segrega- tion and mutilation at the point generation of the waste and to identify the shortcomings in the execution of the same in a tertiary level hospital in Udaipur, Rajasthan (India) in the month of September and October, 2021 with the help of a standard checklist with 22 questions and scoring out of 22. Background: Establishing policies and ensuring its effective execution in a hospital are two completely different goals to achieve, when it comes to biomedical waste (BMW) handling, segregation and mutilation. The careless handling of BMW has a potential to become a major health hazard affecting community especially health workers. This study is a critical reminder that the protocols for BMW handling should be followed efficiently and in a strictly monitored environment to achieve the ideal management of BMW. There is always an enormous scope to know about the challenges faced in day to day execution of biomedical waste disposal. Methods: The cross-sectional study was conducted quantitatively among 17 specialties and 5 clinical labs in a tertiary level hospital in Udaipur, Rajasthan (India) in the month of September, 2021 to October, 2021.The approach followed in this study was that, a stan- dard checklist of 22 questions was prepared keeping in mind the regulations related to BMW. Each response appropriate according to Bio-Medical Waste (Management and Handling) Rules, 2016 was denoted in scoring as 1, otherwise as 0. So, the scoring was done out of 22. Data was further interpreted by graphs and percentages, and the outcomes were subsequently analyzed. Results: Results included major problems such as- failure of mutilation of intact needles, failure to follow color coding, uncovered bins, poor hygiene, absence of particular color coded bins, unattended blood bags and failure to segregate in few of the places. Among the poorest scoring specialty includes Neurology outpatient department (OPD), COVID OPD (swab sample collection room), Dialysis treatment room, Neuroscience semi deluxe ward and sample collection room. Conclusion: This is an example of a study conducted to evaluate the condition of hospital waste management in a tertiary level hos- pital. There is a further scope to study about the knowledge and practices of BMW Management among health workers to identify where these shortcomings in the execution stem from. Further, studies like this should be conducted in large numbers among health care workers and tertiary level hospitals to know the real status of BMW disposal system in order to improve the quality of waste management. 335 Anterior Cervical Discectomy, Corpectomy with MRI Compatible Titanium Plate and Screw Fixation Under Neurophysiological Monitoring, Experience of 27 Years   , PK Upadhyay, G Tiwary, G sharma, K upadhyay and Kritika U 115 cases operated by the senior author in 27 years utilizing neurophysiological monitoring, using anterior cervical discectomy and corpectomy and immediate fixation using MRI compatible titanium screw and plate under Neurophysiological monitoring of somato sensory evoked potential and motor evoked potential, which helped immensely in preventing damage to neural structure and improving results, both for spinal surgeon and the patients 336 On Distinction of Organocarbamate and Organophosphorous Pesticide Poisoning at Point of Care: A Timely Highlight , Sumanpreet Kaur and Dibyajyoti Banerjee Pesticides are one of the irreplaceable requirements in the field of agriculture [1]. In developing countries like India, where the pri- mary source of income is agriculture, the use of pesticides can’t be actually prohibited. Pesticides help to overcome the break out of pest attacks and fulfil the population’s food needs. But, the disad- vantages of the use of pesticides can’t be ignored too 337 Prevalence of Secondary Caries Around Posterior Restoration   , Jabbar Hussein Kamel and Faraed Dawood Salman Abstract Background: Secondary caries is defined as lesions at the margins of existing restorations and is considered as a major reason for their replacement which, if it is left undiagnosed it may lead to loss of vitality of a tooth with many factors contributing to it. Aims of the Study: The present study aims to determine the prevalence of secondary caries around posterior restorations in patients attending Tishik Dental Hospital University in Erbil city/Iraq. Methods: A descriptive study was conducted among 61 patients with a total of 113 posterior restorations that are older than one year. Information regarding the presence or absence of secondary caries was noted with the age of the restoration, their types are based upon an extension of the restoration and the restoration material being used either amalgam or composite. Statistical analysis was done using a t-test for difference and a chi-square test for relations. Result: Prevalence of secondary caries was found to be (53%) among the understudy patients, restorations in the lower arch showed the highest prevalence, class II restorations had the highest prevalence, Amalgam restorations had a higher occurrence of secondary caries more than composite restoration, which had an age average of less than five years. Conclusion: Restorations located in the mandible, especially the first molars, showed the highest prevalence of secondary caries, restorations involving the occlusal with the proximal margins had the highest prevalence, their occurrence was highest in restora- tions being in a period of less than five years 338 Lumbo Sacral Fixation After umbosacral Decompression for Disc and Spondilotic Changes Along with Instability and Stabilization with MRI Compatible Titanium Pedical Screw and Rods Fixation Under Neurophysiological Monitoring to Reduce Morbidity and Complication, An Experience of 30 Years   , PK Upadhyay, G Tiwary, K Upadhyay and Kritika U Abstract 130 cases operated by the senior author in 30 years utilizing neurophysiological monitoring, using lumbosacral discectomy and decompression for canal stenosis and destabilization by immediate fixation using MRI compatible titanium pedicle rods and screw under intraoperative Neurophysiological monitoring of somato sensory evoked potential and motor evoked potential, which helped immensely in preventing damage to neural structure and decreasing the chances of mortality and morbidity for patients and confi- dence and reliable method for neuro-spinal surgeon. Keywords: Lombo Sacral; Pedicle Screws and Rods; MRI Compatible; Titanium Screw and Rods; Intraoperative Neurophysiological Monitoring; SSEP, MEP; SEP 339 A Study on Clinicopathological Features of Covid-19 Among Vaccinated and Non-vaccinated People     , Rakesh Holla A, Amit Sharma and Naveen Chawla Abstract Introduction: The World Health Organisation declared Covid-19 outbreak by SARS-CoV-2 as a global Public Health Emergency of International Concern under the International Health Regulations on 30 January 2020 and was then further characterized as a pan- demic on 11 March 2020. The pandemic has since then swept the globe as an unprecedented event causing widespread disruption and mayhem in terms of economic upheaval and health care ruin, dredging up the fragility of health services and public health sys- tems worldwide. The Government of India (GoI) introduced new vaccines for mass vaccination against SARS-CoV-2 with the intent to keep the menace of the virus pandemic at bay and included Covishield (the name employed in India for the Oxford-AstraZeneca vaccine), a non-replicating, adenovirus vector vaccine carrying a recombinant spike protein of SARS-CoV-2. The situation in India in the April and May months of 2021 mandated a unified and comprehensive response by everyone at the helm when the country was struck by the second wave of Covid-19. An observational study was carried out to assess the course and the effects of SARS-CoV2 on the biochemical and haematological profile of Covid-19 patients and to draw comparisons between the vaccinated and non- vaccinated groups of people. Method: The study was carried out at two different locations in India for two different groups of population, one vaccinated against Covid-19 by two doses of Covishield vaccine while the other group which was not being vaccinated against Covid-19. The non-vacci- nated group comprised entirely of civilian population at Bihta, state of Bihar in India who were referred by the government medical hospital to a Covid hospital established by the Indian Army. The vaccinated group comprised of those vaccinated against Covid-19 with two doses, atleast 28 days apart, of Covishield vaccine. A total of 138 Covid-19 patients, 78 covid-19 patients of non-vaccinated group and 60 Covid-19 patients of vaccinated group were studied between 01 May 2021 and 31 July 2021. The patients were evalu- ated in terms of clinical presentation, haematological and biochemical laboratory parameters including inflammatory markers and mortality rates. Result: The study reveals that the vaccinated cohort with breakthrough infections following Covid-19 vaccination with two doses of Covishield Vaccine had only mild symptoms and no deaths being reported while the non-vaccinated cohort presented with moderate to severe Covid-19, deranged laboratory parameters and increased mortality rate. Conclusion: The study clearly demonstrates that Covid-19 vaccination with two doses of Covishield vaccine, offers significant pro- tection against severe infections and death from Covid-19. While the study highlights the importance of Covid-19 vaccination particu- larly amongst the high risk groups such as those with co-morbid conditions including obesity, diabetes mellitus, hypertension, etc., it also emphasizes the need for observing Covid appropriate behaviour such as social distancing, frequent hand hygiene and wearing of face mask as breakthrough infections were noted amongst the vaccinated cohort in this study for want of such measures in the milieu. Keywords: SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2); Covid-19 Vaccination; Covishield Vaccine; Break- through Infections; Neutrophil Lymphocyte Ratio; Delta Variant; Inflammatory Markers 340 Case Report: Foramen Magnum Meningioma in a Patient with 29 Weeks of Gestation     , Hamna Afridi and Naila Nasr Malik Abstract Meningiomas are central nervous system (CNS) tumors which are extra-axial and originates from the arachnoid cells of the dura matter. They have annual incidence of 6/100,000, most commonly they present during the fifth and sixth decades of life but rarely in childhood [1-3]. Meningiomas are usually benign, slow growing tumors that occur frequently in female gender and African ethnic- ity. The female/male ratio is 2:1 and the incidence of meningiomas in post-menopausal women treated with hormone replacement therapy has increased [3-5]. 341 Prostate Cancer Awareness and Knowledge Among Men Residents in Al-Madinah Al-Munawarah, Saudi Arabia: A Surveillance Study     , Zakaria Eltahir, Alahmadi E, Mushal Alahmadi, Mohammed F Alahmadi and Moneira A Mansour Abstract Background: Prostate cancer is a major health problem that affects a high percentage of populations on the local and global level, ranked globally as the fifth men cause of mortality. In Saudi Arabia prostate cancer incidence is estimated at about 6.6%. Lack of knowledge about the disease and the nature of its routine clinical examination in any community can contribute to patients being arrived late to seek medical care. We have used scientific research engines to explore studies on prostate cancer that discuss and assess knowledge in our local community of Al-Madinah, unfortunately, no studies have been conducted in Al-Madinah region up to the time of conducting this work. Therefore, this study aimed to assess the awareness and knowledge of prostate cancer among the local population of Al-Madinah region. Methodology: A cross-sectional study was conducted and self-designed questionnaire was generated and distributed containing multiple choice questions in order to asses and evaluate the level of awareness and knowledge among the population of Al-Madinah region. The IBM® SPSS® software platform version no. 21.0 was used by applying the Chi-Square test in order to compare the mul- tiple variables in the study. Results: 502 participants have successfully completed the questionnaire. The results showed that 63% of the participants think that the prostate is a disease, 91% of the participants have never been examined by an urologist in their lifetime and 59% of the partici- pants have obtained their information about the disease via internet. Conclusion: The population of Al-Madinah region showed a moderate level of awareness on prostate cancer, but this level of knowl- edge has not been reflected the impact uptake of prostate cancer screening among participants. It is suggested that actions need be taken by the relevant authority to influence the uptake of prostate cancer screening in order to minimize the burden of the disease on the local community and probably within the whole country. Indeed, this will improve the quality of life and it would have a good reflection on the economy. 342 Intravenous Leiomyomatosis of the Uterus: Case Report   , Jellouli MA and Mathis J Intravenous leiomyomatosis (IVL) is a benign and rare pathology, characterized by intravenous proliferation of a histologically benign smooth muscle cell. It can result in systematic complications, especially cardiac, with threatening outcomes if remained un- treated. Intravenous leiomyomatosis (IVL) is probably underestimated, due to a likely easily missed diagnosis. Introduction: We present a case of an intravenous leiomyomatosis without extra-pelvic involvement, with a brief review of this pathology. Case Report: A total hysterectomy and bilateral oophorectomy was planned in a 50-year-old woman was because of recurrent pelvic pain with uterus myxomatosis detected in ultrasound. During the surgery, intravenous leiomyomatosis diagnosis was not suspected. Pathological analysis confirmed the unexpected diagnosis. Later, other imaging exams were performed without detecting any extra- pelvic localization. The patient remained with no evidence of disease after 2 years of follow-up. Conclusion: Although Intravenous leiomyomatosis is rare, it can cause serious complications. Early diagnosis followed by an appro- priate treatment (Hysterectomy and oophorectomy or anti-estrogens therapy) are necessary to patient outcome. Further exams and long-term follow-up is needed to exclude systemic metastasis or recurrences 343 A Case of Post-reconstruction Dermatitis of the Breast   , Elia Rosi, Maria Thais Fastame, Antonella Di Cesare and Francesca Prignano A 51-year-old woman was referred to our dermatologic clinic for the evaluation of a 2-week itchy skin rash. Her medical history was significant for left breast carcinoma, which had been treated whit a unilateral mastectomy and lymph node dissection 3 years prior to this current examination 344 Vascular Purpura: A Cohort Study of 73 Patients   , Mekki Sahar, Damak Chifa, Frikha Faten, Mouna Snoussi, Raida Ben Salah, Yosra Bouattour, Sameh Marzouk and Zouhir Bahloul Abstract Purpura are red-brown lesions caused by localized haemorrhage into the skin. Vascular causes of purpura may be the result of inflammation, vascular fragility, or microvascular occlusion leading to local ischaemia, and it is most commonly associated with small vessel disease affecting the superficial vessels of the dermis. This article provides the experience of an internal medicine department about purpura with vascular causes. Case Presentation: It was a retrospective study including 73 patients with palpable purpura hospitalized in the internal medicine department of the Hedi Chaker University Hospital of Sfax during the period between 1996 and 2020. Our population consisted of 27 men (36.9%) and 46 women (63%). The average age of the patients was 43.7 years with extremes ranging from 14 to 90 years. Systemic diseases were the most frequent aetiology, found in 26 cases (35.6%), Henoch-Schoenlein pur- pura (HSP) was the most frequent systemic disease found (16 cases), 7 patients were diagnosed with Sjögren’s syndrome (SS). Other autoimmune diseases were found: systemic lupus erythematosus (2 cases), eosinophilic granulomatosis with polyangiitis (1 case). An infectious cause was found in 12 cases (16.4%): hepatitis (7 cases), post streptococcal (2 cases), post-meningococcal (1 case), cytomegalovirus infection (1 case) and parvovirus B19 (1 case). In 20 cases (27.4%), the aetiology of purpura was unknown. Skin biopsies were performed in 49 patients, showed leukocytoclastic vasculitis in 32 cases (43.8%). In terms of therapy, bed rest was recommended for all patients. Colchicine was prescribed in 6 cases. Corticosteroid therapy was prescribed in 20 patients, associated in 3 cases with immunosuppressive treatment. The evolution of PV was favorable in the major- ity of cases with regression of lesions in 47 cases (64.3%) 345 Evaluation of the S.T.O.N.E Score to Predict the Outcomes of Flexible Ureteroscopy for Urinary Stones   , Maatougui Jasser, Raboudi Mehdi, Ben Rejeb Nedhir, Khiari Ramzi and Ghozzi Samir Abstract Over the years, several nomograms have been developed to predict the rate of no fragments after surgery for urinary stones. The objective of this work is to evaluate the S.T.O.N.E score to predict of the effectiveness of flexible ureteroscopy for urolithiasis. The S.T.O.N.E score evaluates 5 parameters: S (Size): size, T (Topography): location, O (Obstruction): obstruction, N (Number), calculation number, E (Evaluation of Hounsfield Unit) computation density in Hounsfield unit. A score of 1 to 3 points is assigned to each parameter. Between January 2015 and December 2019, 92 interventions were performed. The S.T.O.N.E score was calculated retrospectively for each patient and correlated with the absence of residual fragment 3 months after flexible ureteroscopy (SFR: Stone Free Rate). We tried to determine the threshold value of this score through the analysis of the receiver operator curve. The average S.T.O.N.E Score was 9.94. The Stone free rate was 81%. After statistical analysis, the area below the ROC curve was 0.73 IC-95% [0.624; 0.836]. In our study, a threshold of 10 or less was associated with an SFR of 59.3%. In comparison, a preoperative S.T.O.N.E Score strictly greater than 10 was associated with a significantly low stone free rate of 39.3%, p = 0.003. In light of our results, the S.T.O.N.E score seems to be an easy, reliable and reproducible tool to predict the outcome of a flexible ureteroscopy 346 The Key Aspects of BRCA1 Interactome for Novel Breast Cancer Therapies   , Raji Sundararajan and Ignacio G Camarillo Abstract In Feb 2021, World Health Organization (WHO) announced that breast cancer overtook lung cancer as the #1 cancer in the world. With over 2 million new cases and over 600,000 deaths in 2020, breast cancer is the most common cancer of women worldwide. About 10% of the breast cancer is familial (or hereditary), caused by mutations of Breast Cancer Susceptibility gene 1, commonly known as BRCA1. Located in chromosome 17, this gene has multiple functions, interactions, pathways and direct and indirect binding partners, contributing to the various hall marks of cancer, including cell cycle and other. It interacts with several genes and proteins and these interactions are studied using String diagrams. The goal is to obtain better insights of the various key aspects of these in- teractions and utilize them towards novel breast cancer therapies for familial breast cancer treatments 347 Bacteriological Quality of Commonly Dispensed Non-prescription Drugs (Tablets) Sold in Patent Medicine Stores   , Nwachukwu O Ndubuisi, Ezeagwula Divine, Onyeagba A Reginald, Unegbu N Valentine and Owanta I Julie Commonly consumed nonprescription oral dosage forms (tables) dispensed from Patent Medicine Stores are subject to unrestrict- ed handling and potential contamination by microorganisms. We determined the bacteriological quality of tablets sold from patent medicine stores in Umuahia, Nigeria. A total of 113 items of 24 registered tablet brands were purchased. They were investigated for total bacterial count and presence of specified microorganisms using standard microbiological methods. Out of 113 items, 84(74.3%) tablets were free of microbial contamination while 14(12.4%) had bacterial counts <102 cfu/ml. Only 2(1.8%) tablets exceeded the specified bacterial limit of >2x103 cfu/ml. None of the blister-packed tablets had bacterial growth on them. All the tablets dispensed (“counted”) from large containers were contaminated by aerobic bacteria. The commonly encountered bacterial contaminants were Staphylococcus aureus and Bacillus species. Folic acid and Magnesium trisilicate were the most contaminated tablets. The tablets in blister packs were of excellent bacteriological quality 348 The Assessment and Impact of Online Classes Among Undergraduate Medical Student's During COVID-19 Pandemic of the Republic of Kyrgyzstan - An Online Survey   , Nawaid Hussain Khan, Chaitenya Verma, Kenan Gumustekin, Haider Ali1, Mirza Masroor Ali Beg, Kudaibergen Osmonaliev, Faisal Amin and Ahmet Sanic 349 Pancreatic Pseudotumour in Seronegative Autoimmune Pancreatitis: A Rare case in the Caribbean   , Elizabeth Guelmo-Daisley, Shiva Sarwan, Ariadne Saunders and Osei Fraser Abstract Background: Autoimmune pancreatitis (AIP) is commonly found in Asia and Japan but its incidence in most of the western world is yet to be determined. There are two histologically distinct forms of the disease: type 1 and type 2 AIP. AIP may appear clinically and radiologically similar to pancreatic adenocarcinoma, but with fundamentally different treatment strategies. Case Presentation: A non-alcoholic 42-year-old female with no medical issues presented with painless and progressive clinical and biochemical obstructive jaundice. Initial focused hepatobiliary ultrasound excluded cholelithiasis, and CECT and MRI abdomen with contrast/MRCP imaging of the biliary tree was highly suggestive of a pancreatic head neoplasm. Her Ca 19.9 levels were elevated and her IgG4 serology was normal. A pancreaticoduodenectomy was done. Histological examination of the specimen revealed nil evidence of pancreatic adenocarcinoma, but a robust lymphoplasmacytic inflammatory infiltrate with storiform fibrosis in keeping with autoimmune pancreatitis. Discussion: Despite the existence of and adherence to robust AIP international guidelines, pancreatic pseudotumours represent a distinct clinical entity that is difficult to distinguish from pancreatic adenocarcinoma based on clinical, radiological and serological investigations. Thus, the incidence of patients having unnecessary surgery for AIP due to misdiagnosis remains around 9.9%, with the inherent associated morbidity [1]. 350 The Need of Integrated Tools for the Study of Occupational Exposure to Allergens     , Maria Concetta D’Ovidio, Pasquale Capone, Andrea Lancia, Paola Melis, Giovanna Tranfo, Carlo Grandi and Isabella Annesi-Maesano Abstract The workplaces represent an important source of exposure to a variety of biological, chemical and physical agents. The aim of this paper is to investigate the topic of allergens in occupational settings, promoting the practice of human biomonitoring, which is now mostly used for environmental exposure to chemical agents in the management of occupational allergies. We conducted a search on the websites of international institutions and/or associations focusing on allergens potentially relevant in workplaces. Allergy-related biomonitoring and biomarkers were included, and data on work-related allergic diseases available on the Italian Workers’ Compensation Authority (INAIL) data bank were collected in cumulative years 2014-2019. Both biological- and chemical-derived allergens found in industry and services, as well as in agriculture, may induce respiratory and cutaneous effects, resulting in work-related diseases. The number of cases confirmed in cumulative years 2014-2019, included 97 cases of allergic rhinitis unspecified, 409 cases of predominantly allergic asthma diseases, 916 cases of allergic contact dermatitis and 10 cases of allergic urticaria. The number of cases of allergic rhinitis unspecified was the same in both industry and services and agriculture, while the majority of cases of predominantly allergic asthma were found in industry and services (276) with respect to agriculture (129). The survey and/or notification of work-related allergy cases, jointly with data from environmental monitoring, human biomoni- toring, specific biomarkers, individual sensitization and health surveillance practice play a key role in the building of a network aimed at improving preventive measures in the field of occupational allergies 351 Acute Kidney Injury in Patients With Covid 19 in Ivory Coast (West Africa) Intensive Care Unit     , Landry Kohou-koné, Servais Saï, Joseph Kouadio Kouamé, Antoine Kouamé, Judith Bouh Sogbéti Diomandé, Sarah N’daw, Stéphane Adingra, Cédric Doh, Lossan Kra and Narcisse Boua Abstract Background: To describe the epidemiological profile, risk factors and evolutionary aspects of patients who contracted acute renal dysfunction during their stay in a covid 19 critical care unit in Ivory Coast (West Africa). Methods: Observational and cross-sectional study of four months (From May 1 to September 1, 2020) carried out in the intensive care unit of the infectious and tropical diseases department of Treichville University Hospital (Abidjan-Ivory Coast). All patients with a positive RT-PCR test were included. They were then categorized into two groups: the “AKI-CoV-2” group for patients who had devel- oped acute renal failure (AKI); the “non-AKI-CoV-2” group concerning patients who didn’t developed acute renal failure during their stay in intensive care. The diagnosis and classification of AKI were based on the 2012 KDIGO recommendations. Results: The prevalence of AKI was 26.5%. Regarding co-morbidities, there were no significant differences between the two groups apart from the arterial hypertension mainly found in the “AKI-CoV-2” group (p< 0.001). The majority of patients were at KDIGO 1 (58.97%) at the time of diagnosis. The average time to onset of acute renal failure was 3.2 days. There was a statistical difference between the two populations when compared for the need for mechanical ventilation, vasopressor amines and blood trasfusion requirement, with the AKI group requiring all this as opposed to the non-AKI group. Mortality was higher in the “AKI-CoV-2” group (81.6%, p < 0.001). Conclusion: AKI complicating covid 19 is responsible for excess mortality with mechanical ventilation, the use of vasopressors and arterial hypertension as a risk factor. 352 Majoon Supari Paak - A Polyherbal Unani Formulation Used in the Management of Sayalan al-Rahim (Leucorrhoea)   , Fouzia Bashir, Jamal Akhtar, Nighat Anjum and Shah Alam Abstract The Unani Medicine (Greek medicine) is a broad system of medicine, which specifically deals with a variety of states of wellbeing and disease. It deals in prevention of disease so that it can be checked in early stages and also helps to restore the function of body. This System of medicine is one of the oldest conventional systems of medicine, which has its root from the time of Hippocrates (460 - 377 BC). In modern medicine, Leucorrhoea is described as a thick discharge from vagina which is whitish, or yellowish in colour. It is commonly a non-pathological symptom which occurs after inflammation of the vagina or cervix. In Unani system of medicine, the modern counterpart name for leucorrhoea is Sayalan al-Rahim. A huge number of drugs, either single or compound formulations, have been described for the management of Sayalan al-Rahim. Majoon Supari Paak is a polyherbal Unani formulation that contains twenty-five herbal ingredients, of which Foful (Areca catechu) is the main ingredient along with Zafran (Crocus sativus), Darchini (Cin- namomum zeylenicum), Zanjabeel (Zingiber officinalis), Qaranfal (Cinnamomum verum) and many more. The medicine has been used to treat leucorrhoea, as a uterine tonic and also to treat infertility along with different gynaecological disorders. The ingredients have been considered to perform as an antioxidant, anti-inflammatory, and boost fertility. Scientific researches of the above-mentioned constituents have also reinforced their beneficial anti-inflammatory, astringent, and antiseptic properties 353 A Case of Papillary Edema Revealing a Cerebral Abscess with Toxoplasma gondii, at the Maurice Ophthalmological Clinic   , Maxime Dantouma Sovogui, Mohamed Cherif, Christophe Zoumanigui and Fodé Amara Traore 354 A Case of Papillary Edema Revealing a Cerebral Abscess with Toxoplasma gondii, at the Maurice Ophthalmological Clinic , Maxime Dantouma Sovogui, Mohamed Cherif, Christophe Zoumanigui and Fodé Amara Traore Abstract Objective: To describe the ophthalmologic manifestations in the setting of a Toxoplasma gondii brain abscess revealed by papillary edema at the Maurice ophthalmologic clinic in Guinea. Because of its gravity Patient and Observation: We report here the case of a 17-year-old female student diagnosed with Toxoplasma gondii brain abscess revealed by papillary edema. The symptomatology was dominated by: visual blurring, headache, vomiting, lethargy and left hemi- paresis. Stage II papillary edema has been found in fundoscopy. The patient was managed in collaboration with the neurosurgery and tropical infectious diseases departments. She benefited from: Acetazolamide 250 mg, Dexamethasone 4 mg, Cotrimoxazole and Paracetamol. A relay was conducted namely: Cortancyl 20 mg, cotrimoxazole 960 mg and Acetazolamide. An optical correction has been introduced. The evolution was marked by an improvement in the clinical condition with decreased abscess on computed tomo- graphy. Continued treatment was observed for two (2) months in a row. Conclusion: When faced with papillary edema associated with headache and projectile vomiting in an infectious context, a Toxoplas- ma gondii brain abscess should be suspected until proven otherwise. The positive diagnosis is based on the bundles of clinical and imaging arguments for which the ophthalmologist plays an important role. In this patient, papillary edema was suggestive of the underlying pathology and prompted us to do more investigation. 355 Enhancing Qualitative Research to Postgraduates Through Training   , Thuledi Makua Abstract The purpose of this paper was to explore and develop the knowledge of the postgraduate researchers registered in masters and doctoral degree programmes at various universities. A Participatory Action Research as an empowering approach was used and twenty government employees were invited from Kwa Mhlanga area, in Mpumalanga Province, South Africa to voluntarily participate over a period of sixteen-weeks of contact sessions. Through interviews the participants verbalized their frustrations and needs for research skills. The lessons learnt from the project were communicated through participants self-reporting. Thematic analysis re- vealed that (1) participants do not have formal opportunities for research training from the basic training institutions and employer, and (2) not understanding what research is from basic education, participants do not have courage to register for research studies at tertiary institutions. The project enhanced the participants’ knowledge and understanding of qualitative research methodology in the way that they reflected it through diverse choices 356 The Fingerprint Pattern of People of Bosso Local Government Area of Niger State, Nigeria   , Isah MC Abstract This study is aimed at surveying fingerprint pattern of people living in Bosso, Pai and Kodo communities of Bosso Local Govern- ment Area of Niger state, which can be helpful in resource management for Niger State of Nigeria. The samples were grouped into Bosso, Pai, Kodo and Bosso Local Government Area as a whole. The communities were visited for data collection. The fingerprints were captured using Digital persona 4500 sdk 4500 sdk fingerprint scanner. The collected fingerprints were tabulated in Microsoft excel 2010 and represented in percentile of occurrence of the fingerprint patterns for each group. The types of fingerprint patterns captured include; Ulnar Loop, Radial Loop, Plain Arch, Tented Arch, Plain Whorl, Double Loop Whorl and Central Pocket Whorl. There was no Accidental Whorl fingerprint pattern among the population of Bosso Local Government Area of Niger State 357 Morphological Study of the Quadrate Lobe of the Liver   , Seye C, Mar NB and Ndiaye AB Abstract Objective: The objective of this study is to determine the morphological variations of the quadrate lobe, to propose the criteria that make it possible to define the presence or not of the quadrate lobe, the aspects defining the notion of fusion of the quadrate lobe with the right lobe or the left lobe. This study also looks for the different shapes of the quadrate lobe as well as the existence and frequency of fissures within this lobe. This study will improve anatomical knowledge and diagnosis of liver tumors located in this liver segment. Material and Methods: This study was carried out in the necropsy room of the Bichat pavilion of the Aristide Le Dantec University Hospital in Dakar. It involved 39 livers of indigenous adult Senegalese cadaveric subjects whose cause of death was neither liver di- sease nor liver trauma. On each liver collected, rinsed with water, we observed and then photographed the external characteristics of the quadrate lobe including its presence, its limits, its seat, its shape, the presence of furrows. Results: Of the 39 livers studied, we noted no cases of absence of the quadrate lobe. However, there were 16 cases of complete pre- sence without fusion or 41.03% of cases and 23 cases of presence with fusion or 58.97%. We noticed the absence of total fusion of the lobe with the right lobe and 6 cases of fused quadrate lobe with both the left and right lobe. We noticed the predominance of the rectangular shape with 68% of cases, followed by the ovoid shape with 25% of cases. The square shape was observed in only two cases. Six cases (15%) of fissure of the quadrate lobe are noted of which 4 were transverse and 2 were oblique. No antero-posterior cracks were observed. Conclusion: The quadrate lobe was always present. It is most often partially fused with the right lobe, or the left lobe or both. Com- plete fusions are done with the left lobe. The quadrate lobe does not reflect its name in its shape which is rectangular in the majority of cases. The presence of fissures in its surface is not uncommon. These data contribute to the improvement of anatomical knowledge of the quadrate lobe in the management of liver pathologies 358 Evaluation of Knowledge and Awareness of Medical and Dental Professions About Mucormycosis Associated with Covid 19: A Questionnaire Survey , Avineet Kaur, Harnoor Singh Sandhu, Sonampreet K Dhillon, Aron Sarwal, Iqra Khilji and Shalika Bhagat Abstract Aim: The study was done to assess the knowledge and awareness of medical and dental professions about Mucormycosis associated with Covid 19. Materials and Methods: A prospective questionnaire survey was done on 200 medical and dental professionals. Medical profes- sional’s knowledge and awareness about Mucormycosis associated with Covid 19 was evaluated. Result: In medical group 61 were males and 39 females whereas in dental group 32 were males and 68 were females. The difference was statistically significant (P < 0.008). The age group was 34 for 25-30 years and 66 for 31-40 years in medical group and 46 and 54 respectively in dental group. The difference was not statistically significant (p-0.11). 57 were graduates and 43 participants were postgraduates in medical group. In dental group 69 were graduates and 31 were post graduate among 100 participants in each group. The response to knowledge about steroids responsible for fungal infections was statistically significant in both groups (p-0.041). The awareness response among the study population was significant for appearance of mucamycosis during first wave and prolonged headache another symptomatic factor for fungal mucormycosis was insignificant. 359 Esthetic Management of Dental Fluorosis: A Minimally Invasive Approach , Asma Nakhli, Farah Chaouali, Marwa Amara, Sarra Nasri, Zohra Nouira, Belhassan Harzallah, Mounir Cherif and Dalenda Hadyaoui Abstract Fluoride is known to be beneficial to teeth. However, when they are exposed to excessively, especially in children during odonto- genesis, it can lead to fluorosis. Fluorosis is a condition defined by a hypo-mineralization of the enamel characterized by coloration, which can turn into cavities and leads to an unsightly aesthetic appearance. In Tunisia, fluorosis is a real scourge that affects certain regions where drinking-water contains excessive fluorine. The manage- ment of these patients differs depending on the extent of the damage. In this article, we will describe the minimally invasive manage- ment of a case with severe fluorosis 360 What does it Mean Natural Forces within us that are the True Healers of the Disease? , Huang Wei Ling The belief that only medicines are capable of curing diseases, after the implementation of the Flexner report in 1913, in which both doctors and patients have the belief in their hearts that only the medicines manufactured by the pharmaceutical industry are scientific and can cure diseases is the purpose of this article [1,2] 361 Identification of Rare Bombay Phenotype by Immunohematology Workup: A Case Report     , Prem Kumar Essgir and Nanda Kishore P Abstract Abbreviation Introduction: Rare Bombay phenotype was first reported in Bombay, India by Bhende and Bhatia in 1952. Bombay phenotype is characterized by absence of H, A and B antigens on red cells and in secretions, while plasma contains anti A, anti B and anti H. Geneti- cally Bombay Oh phenotype individuals are termed as homozygous hh/sese. Keywords: Bombay Blood Group, ABO RhD, Column Agglutination Technology, Saliva Testing, Immunohematology, Direct Coombs Test, Indirect Coombs Test Methodology: Blood grouping (ABO and RhD) was done in our blood bank by semi-automated Column Agglutination Technology (CAT) as well as Tube agglutination method and performed Adsorption Inhibition Test using saliva (tube method) for confirming secretor status. Results: A young 21years male voluntary donor donated blood at our blood bank. The ABO Grouping and RhD typing with serum grouping Indicated Bombay Oh RhD Positive group. Further tests done were: Direct Coombs Test/Indirect Coombs Test by 3 cell panel and Adsorption Inhibition Test by using saliva, which confirmed the Bombay blood group. Conclusion: To identify Bombay Oh Blood group we recommend complete immunohematology workup (Blood Group: Forward and Reverse with Auto control) using standardised agglutination technologies combined with saliva testing for secretary status (with controls). 362 On the Problem of Demarcation of Health and Disease   , Vadim Rozin Abstract Today, the undoubted successes of medicine are side by side with the negative consequences of its triumphant march. It is becom- ing more and more clear that not only medicine, but also a number of other practices is responsible for human health, that without a radical revision of the concepts of “health” and “disease”, further development of “health science” is hardly possible. Health and illness are not natural biologically phenomena (natural states of the body and psyche), but rather complex artifacts caused by both modern cultural discourses (concepts, worldviews, knowledge) and, to no less extent, social institutions and technologies. It is important to cultivate a new understanding of health, which implies not only medical care, but also the work of a person on himself, the develop- ment of individual concepts of health, the subordination of the work of recovery and maintenance of health to the general context of a correct life 363 Prevalence of Left Ventricular Hypertrophy in Chronic Hemodialysis Patients of Military Hospital Mohamed V in Rabat   , Don Carleone Sanama B, Aatif Taoufiq, Driss El Kabbaj, Fatimazahra Fikrat, Ilyasse Asfalou and Aatif Benyass Abstract Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in hemodialysis. Left ventricular hyper- trophy (LVH) is an independent factor of cardiovascular morbidity and mortality. Its frequency is 60 to 80% in chronic hemodialysis patients. Keywords: Left Ventricular Hypertrophy (LVH); Hemodialysis; Cardiovascular Complications; HMIMV Objective: Determine the prevalence of LVH for more adequate cardiovascular management of our patients. Results: The size of our sample was 38 patients, of which 50% were men and 50% were women, for a sex ratio of 1. The mean age was 60.21 ± 16.864. The mean length of time on dialysis was 106.53 ± 72.72. Diabetic nephropathy was the most common in 31.6% of cases. Arterial hypertension was the 2nd CVRF present in 42.1% of cases. 94.7% were on AVF dialysis, and 71.1% had distal AVF. Predialytic hypertension was present in 57.9% of patients. The mean PPID was 4.55 ± 1.25. The mean dry weight was 65.73 ± 11.5. 8 patients (21.1%). The frequency of LVH was 31.6% with a female predominance. Concentric LVH was most common in 23.7% of cases; 36.8% had a concentric remodeling. The mean LVMI was 92.80 ± 28.87 with a maximum LVMI of 164.4 g/m2. 31.6% of patients had Hemoglobin <10 g/dl and the mean PRU was 72.94 ± 6.45. Conclusion: LVH is very common in chronic hemodialysis patients. Its prevalence is 31.6% in our series. Its early diagnosis by 2D echocardiography must be done systematically. And its multidisciplinary management is important in order to reduce cardiovascular morbidity and mortality. Methods: Observational and analytical cross-sectional study, carried out over a period of six months (February to July 2020), at the Hemodialysis Center of the HMIMV in Rabat. The study population consisted of chronic hemodialysis patients of both sexes, affiliated to the center, placed on conventional hemodialysis for more than three (3) months, and who had received pulsed and continuous Doppler echocardiography 2D. Demographic and clinical-biological data were collected from patient records, supplemented by ques- tioning and listed on a pre-established operating sheet. LVH was defined as LV mass indexed to the body surface or LVMI (g/m2): ≥95 in women and ≥115 in men; The echocardiography was performed by the same operator, within 24 hours of the last dialysis session and data was collected via EchoPac software. The analysis was carried out with SPSS 20.0 software and written with Microsoft Office Word 2013 364 Buried Penis - A Hidden Problem in Obese Children   , Ab Ahad Wani, Aamir Shafi, Haseeb Mohammad and Shams UL Bari 365 Evaluation Of Autonomy in Chronic Hemodialysis, at the Military Hospital of Rabat in Morocco: About 38 Cases   , Don Carléone Sanama B, Montasser Ibrahim D, EL Kabbaj D and Mrini S Abstract Introduction: The Measure of autonomy loss has required special attention since the sixties: initially with the Katz scale based on activities of daily living (ADL), and the Lawton scale based on activities of domestic life still called instrumental activities of daily living (IADL). It evolved in the eighties with the WHO classification, which served as the basis for developing the SMAF (Functional Autonomy Measurement System) score used in Canada. It has 29 functions divided into 5 areas (ADL, IADL, mobility, communication, mental functions), with a total score varying from 0 to 87. In France, it is the AGGIR grid that is used and includes 06 GIR. Objective: Evaluate autonomy in chronic hemodialysis, to improve its overall management. Material and Methods: Prospective observational study carried out from 12 to 26 December 2019, at the Hemodialysis Center of Mohamed V Military Training Hospital in Rabat, Morocco, which included all chronic hemodialysis of both sexes. The SMAF evalua- tion grid was completed based on information collected from the patient, his entourage, and completed with the data of his medical file. The grade rating scale used ranged from 0 to 3: 0=Total autonomy, 0.5=Difficulty, 1=Stimulation/Supervision, 2=Partial help, 3= Total dependence. The data processing was done with Microsoft Excel 2013. Results: We had 47% men and 53% women (sex ratio M/F: 0.9); of which 39% were aged 65 and over. The average age was 59 years ± 18.9. 10% were totally dependent for at least one IADL, and 26% had full autonomy in all areas. 15% used help for at least one IADL; 26% were supervised to manage their budget. 32% had memory difficulties, 40% had motor impairment and 26% mental impairment. 5% of patients aged 65 and over needed help with at least one ADL. 47% of men aged 65 and over needed help with at least one ADL, compared with 53% of women in the same age group. The total SMAF score ranged from 0 to 41.5. Discussion: We chose the SMAF score because it allows for a comprehensive and multidimensional assessment of patient autonomy from other scores. In Quebec, Choinière in 2010 had 6% of patients aged 65 and over who required help for at least one ADL (2); which is consistent with the data from our study. In France, a study done in 2016 by P. Gervais., et al. on 207 residents of an EHPAD in the Dordogne, comparing SMAF and AGGIR scores, found the following results: 24% had a disability for IADL; 22% mental disability, and 24% motor disability. This data is less than ours. Conclusion: Evaluation of autonomy in chronic hemodialysis is essential, for adequate and comprehensive management to improve quality of life. In our series, 26% had total autonomy in all areas. Dialysis itself would decrease autonomy over the years, it’s the in- terest in establishing an autonomy score before dialysis and reassessing it regularly 366 Difficulty and Obstacle in the Management of an Tracheoesophageal Fistula by Accidental Inhalation of a Foreign Body (Chicken Bone), in a 16-month-old Infant at the Amissa Bongo Regional Hospital Center in Franceville   , Ngakani Offobo Silvère, Aseke Kundulunga Jean Albert, Nyamatsiengui Hilaire and François Ondo Ndong Abstract The inhalation of foreign bodies is a frequent, poorly listed and multifactorial situation. It may be accidental or voluntary. Through this observation in 16-month-old infants, we try to show that foreign workers can present an immediate danger. The Tracheoesopha- geal fistula is a medical-surgical emergency that requires multidisciplinary management involving clinicians, radiologists, surgeons and endoscopists. Lack of adequate equipment can lead to death 367 Concepts of Healing , Edward F Block This work addresses the concepts that surround what com- prises healing modalities in these days and times. The concepts discussed do not involve those of surgery. There are three major thrusts in the origin of healing concepts that have been developed over the ages. The more advanced Eastern concepts first originat- ed in the sub-continent of India and were later transfered to the area that is now known as China. All Eastern concepts began devel- opment some 4000 years ago and eventually yielded a comprehen- sive treatment system that lasted into modern times. The Western concepts originated in Europe and progressed much more slowly than those in the East. In all cases, most of what would be known as medicines were for the most part derived from herbal sources with a minority from mineral of animal sources 368 Case Report: Bilateral Acute Anterior Uveitis with Hypopion in Children: About One Case at Yaounde Application and Reference of the Armed Forces Hospital   , Nomo AF, Koki G, Aboubakar H, Mvilongo TC, Akono Zoua ME, Ndjock NJ, Biangoup P, Epée E and Bella AL Abstract Introduction: Uveitis is defined as inflammation of the uveal tract which includes iris, ciliary body, and choroid. the presentation of uveitis in children is often “silent”, with few warning signs, and few functional complaints on the part of the children, frequently leading to significant diagnostic delays causing poor vision or even blindness We report a case of recurrent bilateral acute anterior uveitis with hypopion in a young boy of 11-year-old that posing a problem of etiological diagnosis. Medical Observation: The patient consulted for a reduced in bilateral visual acuity which had progressed for 5 days. He reported three past episodes of bilateral acute hypopion anterior uveitis separated by approximately 8 months each. On ophthalmologic ex- amination far visual acuity was 4/10 in both eyes, mild conjunctival hyperemia, ciliary injection with fine retrodeskemetic precipi- tates not granulomatous, a hypopion and 3+ Tyndall in anterior chamber in both eyes. Intraocular pressure was normal (07 mmHg) in both eyes. After dilation, there was 2+ anterior hyalitis but the rest of the fundus was normal. The diagnosis of recurrent bilateral acute anterior uveitis with hypopion non-granulomatous and non-hypertensive was made. An aetiological assessment included in- fectious assessment and dosage of HLA B27 was done. No aetiology was found in this patient. Most uveitis in children are idiopathic but Juvenile idiopathic arthritis has been described as the primary aetiology of anterior uveitis in children.. The management of uve- itis consisted of local and general steroidal anti-inflammatory drugs and cycloplegics. After a follow-up of six months, the evolution was favorable. Conclusion: Uveitis are rare pathologies in children but not diagnosed and untreated, can cause serious sequelae such as blindness 369 Maculopathy and Posterior Reversible Encephalopathy Syndrome Presumably Associated with Tacrolimus   , Muñoz A, Martínez MT, Rojas P and Carvajal C Abstract Tacrolimus is an immunosuppressant drug used in solid organ transplantation to reduce rejection rates and to prevent graft ver- sus host disease (GVHD) in haematopoietic stem cell transplantation (HSCT). Tacrolimus is a fungal metabolite produced by Strepto- myces tsukubaenis. It works as a calcineurin inhibitor reducing interleukine-2 (IL-2) production and activation of T cells [1]. Along with cyclosporine and other calcineurin inhibitors, tacrolimus is associated with posterior reversible encephalopathy syndrome (PRES) [2], optic neuropathy and only a few cases reported in the literature of maculopathy. About one-third of patients who develop PRES can present visual impairment, most of them fully recover after drug suspension, although there have been partial recovery cases reported [3]. 370 Is Genetics Implicated in the Causation of Autism?   , Samashaptak, Pratnoja Das, Sukanti Bhattacharyya and Tarun Kumar Datta Abstract Autism is a neurodevelopmental disorder first introduced by Kanner in 1943. Presently, a group of disorders collectively is consid- ered to be ‘Autism Spectrum Disorder’ which is an outcome of complex interaction between genes and the environment. In this investigation, authors considered the historical development of genetic study that revealed the secret of genes responsible for autism. They noted that synapse-related risk genes and susceptibility genes affecting transcription and chromatin-remodelling pathways have an important role behind the mechanism of the disease. But there are environmental factors also. Currently 40%-80% of autism cases are related to some risk genes, but epigenetic, particularly environmental modifiers, like advanced age of father, gestational complications and infections, prenatal exposure to anti- convulsants, or paucity of oestrogen in developmental brain are also playing fundamental roles in heterogeneity of manifestations. Till date, hundreds of genes have been recognized along with the environmental factors but how they interact to manifest the disease is still unknown due to complexities in interaction and overlap between different neuro-psychiatric disorders. Presence of second level modifiers has made the situation more multifaceted. However, advancements in sequencing technology, analyzing software, and expansion of databases have made the study of genetic modifiers possible. Going through the works by various scientists across the globe over the last 75 years, authors have identified a number of chro- mosomes, multitudes of gene loci, many genetic overlaps, and myriads of modifiers - endocrinal, environmental, and epigenetic. But, at the same time they have warned that though genes play a pivotal role, the other factors also need to be considered and studied in detail with proper attention and finally synthesis all the information reasonably to discover the root cause of autism 371 Headache and Covid-19: Experience from the Covid-Centre at the University Clinic of Neurology in Skopje   , Popovska H, Petrov I, Kiteva-Trencevska G, Popovski N and Filipovic D Abstract Introduction: Corona virus infectious disease 2019, (Corona virus disease-19, Covid-19), commonly is manifested with severe re- spiratory syndrome and interstitial pneumonia. Beside these respiratory symptoms, the clinical spectrum of the disease consists of neurological symptoms. A headache is one of them. Aim: The aim of this study is to determine the cumulative prevalence of a headache in patients with Covid-19, that were hospitalized at the Clinic of neurology in Skopje, from November 2020 to the end of March 2021. This study also aimed to determine the cumula- tive prevalence of patients with positive outcome and successful rehabilitation and, on the other side, the prevalence of the patients with poor outcome. Methods and Materials: The data was extracted from HIS system (electronic data base for outpatient clinic and hospitalized pa- tients in our Clinic). In the study were included 437 patients, hospitalized in the Covid –centre. We have calculated the cumulative prevalence of headache in these patients. Additionally, we have determined the prevalence of headache in patients with good and with poor outcome of the disease. Results: Headache was found in 44 patients out of 437, with confirmed Covid-19 infection. The estimated cumulative prevalence is 10.06%. The patients with headache had more favorable outcome of the COVID-19 infection (37 patients out of 270 with favorable outcome has complained of a headache in the early stage of the disease, and only 4 patients out of 120 with fatal outcome, had a headache (P = .002058, (P < .05)). Three patients, who have complained of a headache, out of 47, were transferred to another medi- cal institution. Conclusion: Headache is a common symptom among patients with infectious diseases, whether it is a part of the general infectious syndrome or it is a sign of a direct cerebral affection. The headache could be a predictive symptom for more favorable outcome of this infectious disease. 372 Place of Atropine and Vasoactive Drugs in Hemodynamic and Rhythmic Complications of Cervical Spine Trauma   , SM Medjadi, L Cherfi, H Brahimi and N Taleb Bendiab Abstract Objectives: The aim of this work is to demonstrate the importance of the earliest atropine’s introduction and vasoactive drugs as preventive therapy for the occurrence of hemodynamic and rhythmic complications, which most often severely hamper the progno- sis of cervical spine trauma patients. Patients and Methods: Exhaustive descriptive-type study with prospective collection, carried out over a period of three and a half years at the level of several structures of the Tlemcen University Hospital, namely medico-surgical emergencies, multipurpose re- suscitation and neurosurgery departments. It focuses on cervical spine trauma patients treated from the scene of the accident to the neurosurgery and/or medico-surgical intensive care unit at Tlemcen University Hospital. All were admitted for cervical spine trauma, whatever the level reached, whatever the mechanism of the accident, whatever the treatment decision, with or without neu- rological lesions, with or without signs of seriousness on admission and over 16 years of age. Results: The initial management in intensive care and in a dechocking unit for vegetative disorders was indicated on admission in 25% of patients. Cardiac arrest recovered in three patients on admission to medico-surgical emergencies. An injection of Atropine® on admission was performed in 18.75% of patients, but also vasoconstrictor drugs in 15.62%. A combination of vasoactive drugs and Atropine® were required in 7.81% of our patients; 33 of them had hemodynamic disturbances and 20 were in collapse requiring the use of vasoconstrictor drugs. Conclusion: Our study allowed us to study and analyze the main hemodynamic and rhythmic changes occurring during cervical spine trauma. Survival was 7 ± 3.71 days for the patients who had bradycardia, and 29 ± 6.13 days for those who had kept a normal heart rhythm (P = 0.000). Maintaining a stable heart rate and hemodynamic state upon admission remains the primary care physi- cian’s priority in order to increase the chances of survival for this type of patient 373 The Toxicity and Abortifacient Studies of Commelina benghalensis Leaves and Stalk in Wistar Rats   , Chioma Njideka Adeyemi, Joseph Oloro and Clement Olusoji Ajayi Abstract Scope of this paper is of Pharmacological relevance. Introduction: The use of plants as a natural medicine has been attached to the culture of different ethnic groups and is practiced worldwide. Thus called traditional medicine, plays a vital role in today’s health-care services. These plants of medicinal value, could be cultivated, wild, weeds and vegetables. Commelina benghalensis Linn is a common invasive weed found around homes, roadside, gardens and farmlands. It is a perennial plant with upward growing stalk, commonly used for self-induced abortion amongst other numerous ethnopharmacological uses in parts of Uganda and the world at large. Abortion is common among females despite the fact that it is illegal and immoral. Self- induced abortions could lead to mortalities because of inadequacies of self-medication whether of traditional or conventional drugs. Medicinal plants have been used as aborti- facients with some cases multiple organ system failures. Objectives: This research, studied the acute-toxicity and the potential abortifacient activities of extracts of Commelina benghalensis Linn. leaves and stalk in female Wistar rats. Literature reveals that there has been no research done on the plants abortifacient claims. Materials and Methods: The plant was collected, authenticated, dried, powdered and extracted with n-hexane, ethyl acetate, etha- nol and water. The acute oral toxicity test was carried out on female Wistar rats, then median lethal dose (LD50 ) of the extract from each plant part were determined in vivo using OECD (Organization for Economic Co-operation and Development) guidelines with help of AOT (Acute Oral Toxicity), 425 software. The extracts were thereafter concentrated in vacuo and tested in the animals at 100, 200, and 400 mg/kg doses in the pregnant rats Results: The acute toxicity test showed LD50 greater than 5000 mg/kg. There was no observable toxicity symptom including respi- ratory distress, salivation, weight loss, dull eyes, diarrhoea and change in the appearance of fur in rats. Extracts of C. benghalensis showed abortifacient activity (33.33-100.00%) at 100 - 400 mg/kg with a significant reduction in the number of live foetus compared to the normal group. Conclusion: There was no observation of any adverse effect or clinical toxicity symptoms in the treated Wistar rats. At the dose of 100 mg/kg body weight of rat, the stalk decoction extract of C. benghalensis Linn was found to have the highest abortifacient activity (100% efficacy) when compared with the leaves extracts 374 Status of Infectious Urolithiasis and Multi-resistant Bacteria Extended Spectrum β-lactamase in Algeria   , Berrahal M Abstract Introduction: We wanted to take stock of the new microbio-epidemiological trend of mixed urolithiasis infected or colonized by multi-resistant germs including multi-resistant enterobacteria bacteria extended spectrum β-lactamase and others. Materials and Methods: Assess the impact of the microbiological study of the microbiological study (phenotypic and molecular) of pyelic urine and/or stone compared to standard urineculture (ECBU). Results: 114 (03%) had an infected (or colonized) stone. Preoperative ECBU was 90% negative compared at the culture of urine pye- lique and stone with 22% Proteus mirabilis, 15% Staphylococcus aureus, 11% K. pneumoniae and others emerging species. Antibiotic resistance detected in the stone and pyelic urine analysis: 60% of E. coli and 40% of K. pneumoniae resistant to Cefazolin (CIIG) with 60% resistance to ciprofloxacin in E. coli and 20% in K. pneumoniae. we had five extended spectrum β-lactamase strain: tow Entero- bacter cloacae complex (ECC) and three K. pneumoniae. Conclusion: Mixed infectious urolithiasis can be a real public health problem because, pathogenic germs sometimes alarmist due to their resistance to antibiotics and their etiopathogens or virulences and can be life-threatening for patients with additional costs, especially hospital and social care 375 Health and Healthcare as Infinite Games ,   Neil E Grunberg and Erin S Barry Abstract “Life is a game” and health and healthcare should be seen as infinite, not finite, games. To succeed at infinite games requires an understanding of what is meant by infinite games as well as the willingness to embrace this mindset. Infinite games are continuous without a designated beginning or ending and do not have referees or judges, specified outcomes, or observers in the same way as finite games. Individuals and organizations that have an infinite game mindset are stronger and benefit because they are always learning and growing with no designated end at which point one stops trying, contributing, or participating. Five essential practices to embrace and operate with an infinite mindset are described as they relate to health and healthcare: (1) Advance a just cause; (2) Build trusting teams; (3) Study their worthy rivals; (4) Prepare for existential flexibility; and (5) Demonstrate the courage to lead. If health is perceived as an infinite game, then health-enhancing, injury-avoiding, and disease-preventing behaviors are more likely to be regular and consistent aspects of daily life. Similarly, if healthcare is perceived as an infinite game, then patients and practitioners will more likely focus on health-promotion best practices, injury and illness prevention, education about and encouragement to en- gage in behaviors and cognitions related to wellness. 376 Postoperative Problems Following Surgical Corrections for Spastic Equinovarus Deformities   , Mikio Muraoka, Koshiro Imai, Shin Watanabe and Yasuharu Kinjo Abstract Objective: Surgical corrections are effective for severe spastic equinovarus deformities, but postoperative problems may occur over time. The present study examined postoperative problems and differentiated the proper surgical procedures. Keywords: Equinovarus; Curling Toe; Stroke; Brain Injury; Spasticity; Surgery Results: Pes calcaneus deformities occurred postoperatively in 4 feet undergoing a combination of Achilles tendon Z-plasty and TP tendon transfer, and required revision surgery. Of the 9 feet with curling toes, 4 underwent flexor elongations for curling toes, and 3 of these required flexor tenotomies or additional elongations; 5 feet in which the flexor tendons were released required no further surgery. Conclusion: Achilles tendon elongation following Z plasty often causes overcorrection of pes calcaneus when the transferred TP ten- don works too strongly. In contrast, overcorrection does not seem to occur when fractional tendinous elongation of Achilles tendon and TA tendon transfer are combined. Surgeons should consider whether elongations for curling toes are appropriate to perform during the first surgery because subsequent operations are often required. Materials and Methods: We studied 12 feet of 11 patients with severe equinovarus deformities resulting from stroke or brain in- jury that were corrected surgically. Achilles tendons elongation after Z-plasty (n = 7) or fractional tendinous elongation (n = 5) was performed. Tendon transfers were performed using the tibialis anterior (TA) (n = 7) or tibialis posterior (TP) (n = 5) tendon. Flexor hallucis longus (FHL), flexor digitorum longus (FDL), or flexor digitorum brevis (FDB) tendons were released or elongated for 9 feet with curling toes 377 Quality of HIV Counselling Services Offered in Public Health Facilities in Kampala, Uganda   , Victo Kyobutungi, Anthony Ssebagereka, Christine T Begumisa, Christine Muhumuza, Collins Atuheire and Joseph KB Matovu Background: HIV counselling is increasingly available in public health facilities in Uganda. Counselling is an entry point into care, treatment and support services of many HIV/AIDS prevention programs. Quality of HCT services have significant role on prognosis of HIV patients. This study assessed the quality of HIV counselling services offered in public health facilities in Kampala by review- ing adherence to the HIV Counselling and Testing (HCT) policy guidelines, content of counselling information offered to clients and health facility amenities. Methods: This was a cross-sectional study utilizing quantitative methods of data collection. Quality of HIV counseling was defined in accordance with adherence to the HCT guidelines, offering ‘good’ content of counsel- ling information and health facilities having adequate amenities. We used principal component analysis to obtain and reveal current composite scores of the variables. Data were summarized into frequencies and proportions using STATA, version 13.0. Scores below 70% were considered as ‘poor’ quality. Results: In this study, 74 health workers offering HIV counselling services at five public health facilities were interviewed. The study revealed that quality of HIV counselling at the five public health facilities was ‘poor’ as 74% of the health workers offered ‘poor’ qual- ity HIV counselling and only one out of five health facilities was found to have adequate amenities. Majority (74.3%) of the health workers were found not to adhere to HCT guidelines. In addition, 67.6% of the health workers offered ‘poor’ content of counseling information. Conclusion: Overall quality of HIV counselling was found to be poor. Improvements should be focused on mentorship programs for all health workers involved in HIV counselling. Provision of modest space for counselling is also required so as to ensure privacy dur- ing counselling sessions. 378 Evaluation of Biofilm Production and Antibiotic Resistance Pattern Between Biofilm Producing and Non-biofilm Producing Isolates of Staphylococcus aureus   , Naziya Salim, Baijayanti Mishra and Deepa Revi Abstract Staphylococcus aureus is a common cause of nosocomial infection and biofilm is one of its important virulence factors. Biofilm is a group of microorganisms enclosed in a self-produced exopolysaccharide matrix. S. aureus biofilms have been extensively involved in several chronic untreatable and medical implants related infections. The treatment of biofilm infections is laborious and challenging. On this account, the study was undertaken to detect the biofilm production capacity and antibiotic susceptibility pattern in Staphy- lococcus aureus derived from various clinical samples. A total 100 S. aureus strains were isolated from various clinical samples and tested for production of biofilm using three methods namely Congo Red Agar Plate method (CRA), Microtiter Plate Method (MTP) and Tube Method (TM). Antibiotic susceptibility comparison between biofilm producers and non-producers were also performed by modified Kirby Bauer’s disc diffusion method. The results showed better correlation between MTP and TM when compared to CRA method. Of the 100 S. aureus strains 6% were strong biofilm producers, 11% were moderate, 47% were weak positive, and 36% were negative by MTP while 56% were strong positive, 26% were moderate positive and 18% were negative for biofilm by TM. The CRA method showed that only 8% were strong positive, 3% were moderate and rest all were negative for biofilm production. None of the S. aureus isolates was resistant to glycopeptides (Vancomycin). The resistance exhibited by S. aureus to penicillin, ciprofloxacin and erythromycin resistant was 100%, 70% and 62% respectively. The antibiotic resistant rate (biofilm producers v/s non producers) for penicillin (64% v/s 36%), erythromycin (38% v/s 24%), and ciprofloxacin (48% v/s 22%) revealed that biofilm producers were more resistant to all the tested antibiotics. 379 Interrelationship Between Thrombosis and COVID-19   , Malerba Mario, Barbieri Mariangela, Mondini Lucrezia, Ruggero Luca, Trotta Liliana and Ragnoli Beatrice Abstract Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus SARS-CoV-2. In March 2020, the World Health Orga- nization officially declared it as pandemic viral infection. Clinical manifestations include fever, dyspnea, cough, but can evolve into acute respiratory distress syndrome (ARDS), and COVID-associated-coagulopathy (CAC). The hypercoagulation state is based on an interaction between thrombosis and inflammation. The so-called CAC represents a key aspect in the genesis of organ damage from SARS-CoV-2. The prothrombotic status in COVID-19 disease cgan be explained by the increase of coagulation, levels of D dimer, lym- phocytes, fibrinogen, IL-6 and prothrombin time, that are important laboratory parameters which indicate the COVID-19 and VTE severity. The main characteristic of immune-thrombosis is the interaction between haemostasis and the innate immune system. The vas- cular damage in COVID-19 is induced by the endocytosis of SARS-CoV-2 in the host cells, which leads to pyroptosis. This status is a consequence of the direct virus-induced endothelial damage, leukocyte and cytokine-mediated activation of the platelets, release of TF and NETosis, intensified by activation of the complement system. In this review, the aim is providing an overview of the current knowledge on pathogenic mechanisms of thrombosis in different disease states that may occur in COVID-19 and informing on new areas of research. 380 Evaluation of Effluent Management at the Gynco Obstetric and Pediatric Hospital of DOUALA   , Séverin Mbog Mbog, Françoise Christelle Biyong, Dieudonné Bitondo, Dieudonné Adiogo, Patrice Polmbaye Ngoko and Tania Mboute Nzekou Abstract The study on the evaluation of the effluent management of HGOPED was carried out between. March and July 2021, with the aim of proposing an appropriate management method. Methodology: To complete this evaluation, we made an inventory of the source’s pollutants associated with wastewater mapping, to highlight the non-compliance of the mode management, we carried out a diagnosis through a checklist, Ishikawa and Pareto. Then the determination of the pollutant removal rate in the laboratory followed by a questionnaire with residents. Results: The results on the management of HGOPED effluents enabled us to highlight the non-compliance of the wastewater treat- ment steps and the most important causes (methods to 33.33%, material at 33.33% and financial resources at 16%). Residents also complain foul odors and the sensitivity of the receiving environment has shown us that diseases the most recurrent water problems are malaria at 37.6%; 24.8% typhoid; 12.8% of amoeba and scabies. All this is due to the lack of potable water. The result of labora- tory analyzes revealed apart from SS (intermediate 23 mg/l, downstream 30mg/l) and intermediate COD (368 mg/l) i.e., 20 mg/l, 250 mg/l respectively. which were high due to the excessive presence of chemicals in the water. The slaughter rate of all physical and chemical parameters met MINEPDED discharge standards. The initial environmental analysis enabled us to highlight the significant environmental aspects that arise, among other things, from the activities carried out in the anatomy-pathology department. 381 Proposal for Use of Saliva IgA and IgG to Monitor the Potential of Intranasal COVID-19 Booster Vaccines   , Yuji Aoki Now that great effectiveness of intramuscular delivery of messenger RNA vaccines against COVID-19 has been proven, it becomes one of critical issues to maintain the immune potency. Intranasal vaccination has an advantage of easy self-administration but some difficulties in the vaccine formulation for effective mucosal immunization. The potency of the COVID-19 booster vaccination could be monitored even at home by SARS-CoV-2 specific IgA (as local immunity) and IgG (as systemic immunity) in the saliva. Such a safe and feasible strategy to boost the immunity is proposed, especially for vulnerable people, when the COVID-19 booster vaccination is beginning 382 Neuraxial Anesthesia for Covid-19 Parturients   , Vakhtang Shoshiashvili, Levan Ratiani, Ketevan Machavariani and Ekaterine Khuchua This is a retrospective non-randomized study in which the clinical experience of neuroaxial anesthesia of 44 cases for COVID-19 parturients is presented. All parturients were with mild or no symptoms of COVID-19. Neuroaxial anesthesia (labor epidural and spinal for cesarean section) provided with keeping of infection safety for personnel and patients. No complications had been seen. Neuroaxial anesthesia for parturients with non-sever COVID-19 is safe and can be provided with same indications as for non-infected parturients 383 Impact of COVID-19 Pandemic on Congenital Hypothyroidism, Review of Neonatal Screening in Some States   , Luljeta Abdullahu, Violeta Grajçevci-Uka, Vjollca Dedushaj-Fazliu, Neshet Rizvanolli, Idriz Geqari, Rame Miftari, Drita Rizvanolli, Naser Gjonbalaj and Fitore Murati Objective: The purpose of this work was to present some cases diagnosed with congenital hypothyroidism during a certain period of critical condition of covid 19 pandemic brought to our Department. Methods: Data were extracted from retrospective analysis of patients diagnosed with congenital hypothyroidism brought to the De- partment of Nuclear Medicine for thyroid scan in order to detect the location of the thyroid tissue of the newly discovered newborn with congenital hypothyroidism. Results: During the period April 17 to August 29, 2020, 5 newborns were diagnosed with congenital hypothyroidism. Clinical evalu- ation of patients was performed, performing additional routine examinations at all times according to the clinical and diagnostic route. All cases came with results from thyroid hormone testing samples with TSH> 100. In our ward the patient undergoes ul- trasonography and thyroid scan. The mean age of diagnosis was 25.5 days. Ectopic sublingual glands were found in three patients with ultrasonography and thyroid scan was confirmed in three patients. One patient with ultrasonography alone was suspected of hypoplasia of the thyroid gland, while with thyroid scan in two patients, one after starting replacement therapy and scintigraphy was done without this information and we gained weak fixation of radionuclide at the level of the newborn neck, where is suspected in the absence of thyroid gland tissue, and in the other case we had poor fixation consistent with ultrasound. We in one patient had thyroid gland deficiency. 384 The Omicron Variant of SARS CoV-2: One More Mutation in the Ongoing Pandemic   , Urvansh Mehta and SK Verma Newer variant of concern of SARS CoV-2, the Omicron variant is causing a lot of panic and confusion due to rapid transmissibility and infectivity. Lack of data and clinical evidence is still a pertinent problem. As with the evolving face of the pandemic, newer muta- tions come with new set of challenges. This review tries to summarise the variant’s origin and infectivity and how vaccines can even- tually help in curbing the spread. However despite low rate of hospitalisation and lower mortality rate, this is still the early phase of the current wave and it won’t take much time before the pandemic is again as devastating as it was earlier. 385 The Other Side of the Coin of COVID-19: Development of Molecular and Genetic Sectors in Developing Countries as Exemplified by BANGAVAX® from Bangladesh   , Mamun Al Mahtab, Md. Sharfuddin Ahmed, Sitesh Chandra Bachar, Kakon Nag, Naznin Sultana, Md. Abdur Rahim, Ritesh Bachar, Nipa Bain, Musarrat Mahtab, Mohammad Helal Uddin and Sheikh Mohammad Fazle Akbar The world has been in pandemic situation after the outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019. Relevant disease COVID-19 has devastated the world ever since, causing more than 5 million of deaths and still counting. The challenging epidemiology and pathogenesis of SARS-CoV-2 and COVID-19 along with emergence of new variants of the virus have jeopardized the entire health care delivery systems of almost all countries of the world. In the meantime, several drugs have been repurposed for treatment of COVID-19, however, the management of COVID-19 is still limited to a type of symptomatic management schedules, as no antiviral drug capable of eradicating SARS-CoV-2 could be established. In addition to conventional pre- ventive measures to combat further propagation of SARS-CoV-2, several vaccine candidates have been developed. Billions of people have been vaccinated to protect from acquisition of SARS-CoV-2, however, the magic vaccine is yet to be explored that may provide effective HERD IMMUNITY to the society. In these circumstances, the major challenge of the mankind is to get real insights about the virus, SARS-CoV-2 and the disease, COVID-19 as well as initiate program for better management of future devastation. This review will provide a comprehensive outline regarding the virus and diseases that induced this pandemic with a new home-work to prevent such pandemic in future, especially in the context of developing and resource-constrained countries 386 The Level of Socio-psychological Adaptation and Emotional Status of Graduate Students and Teachers in Conditions of Covid-isolation   , Abaskalova Nadezhda Pavlovna, Aizman Nina Igorevna and Aizman Roman Idelevich The relevance of our research is due to the problems of distance education in modern conditions during COVID-19 isolation. The online survey was chosen as the research method for collecting data. It was noted that the level of anxiety and conflict among school teachers increased, health disorders manifested themselves, professional burnout was revealed. The insufficient level of competence of school teachers in the field of information technologies requires psychological and pedagogical support of their work to reduce the level of maladjustment in the mode of distance education. Parents and teachers noted an increase in aggressiveness, anxiety, sleep disorders, exacerbation of chronic diseases in schoolchildren. The school psychologist in this situation did not have the opportunity to personally communicate with the child, and remote communication did not give the desired result. Deterioration of psychological health affected the ability to assimilate educational material and academic performance. It is necessary to select specific technologies and teaching methods in the distance education system in the current situation and develop a system for the prevention of psycho- logical health disorders. 387 Cardiovascular Changes in COVID19   , Zmitrukevich Andrei Stanislavovich The COVID19 pandemic has become a new challenge for doctors and patients. Cardiovascular changes often accompany the disease caused by the SARS-CoV-2 virus. Many researchers are proving the connection of COVID-19 with myocardial damage. Acute myocarditis (acute inflammatory cardiomyopathy) can be caused by direct or indirect exposure to the SARS-CoV-2 virus. The effect of COVID-19 on atherosclerosis of blood vessels, primarily coronary, is also known. SARS-CoV-2 can cause endothelial dysfunction, an independent factor in the development of myocardial and cerebral infarction. Disseminated endotheliopathy caused by COVID-19 triggers a hyperinflammatory reaction and hypercoagulation, resulting in vascular thrombosis and thromboembolism. Many cases of various types of heart rhythm disturbances in COVID-19 have been described, including exposure to antiviral and other drugs. Most of the direct and indirect mechanisms of action of SARS-CoV-2 on the host lead to hypertension or hypotension. Troponin level research should be considered an ally and essential diagnostic and prognostic assistance in providing medical care worldwide in the context of COVID-19 388 Distance learning in times of Covid-19: importance, strengths and limitations - Case of the Regional School of Public Health of the Catholic University of Bukavu in Democratic Republic of Congo   , Hermès Karemere and Samuel Makali The outbreak of Covid-19 has limited travel around the world, even for visiting teachers, including those from the Catholic Uni- versity of Bukavu in the Democratic Republic of Congo. Faced with the digital divide in this country, a distance learning model was designed and tested between May and July 2020 to allow access to two courses (Policy, organization, structures and regulation of health systems as well as Planning, implementation, monitoring and health evaluation) to 38 students enrolled in a master’s degree in public health at the regional school of public health in Bukavu. The implementation of this model was documented, and a survey was conducted among the 38 students who participated in both courses to evaluate this distance learning model. The results of this study present the model using mainly email and the WhatsApp network, describe the complete course flow, the challenges encoun- tered, the adaptations introduced to the distance learning model of these two courses. Remotely, courses in the form of a PowerPoint with narration were transmitted gradually to the students in a WhatsApp group and by email; discussions in the group were orga- nized under the moderation of the teacher ; the students’ questions were centralized by the assistant and answers were formulated by the teacher either through voice messages on WhatsApp or using an illustrative PowerPoint with narration; daily assignments were systematically given to students for pedagogical support of their application and to attest to their effective participation in the courses. The study shows that in a situation of digital divide and confinement, it is possible to adapt distance learning models to ensure knowledge transfer. 389 Plastics and Our Lysosome: The Modulator of Hepatic Health   , Eshika Bindal, Kiran Gill, Parul Garg, Rajasri Bhattacharyya and Dibyajyoti Banerjee Alcohol has been known for a long to cause a spectrum of liver diseases [1]. Nevertheless, in the absence of alcoholism, a similar illness is reported. It is known as nonalcoholic fatty liver disease (NAFLD). NAFLD is increasing at a tremendous rate [2]. Scientists are showing that plastic leaks out can cause such disease [3]. It is seen that Bisphenol A and Bisphenol F (the two plastic leak outs) cause lysosomal dysfunction [4-6]. Lysosomal dysfunction can cause lipid accumulation in the cell as it regulates cellular lipid catabolism [7]. Therefore, Bisphenol A and Bisphenol F induced lysosomal dysfunction can result in lipid accumulation in the liver. So, Bisphenol A and Bisphenol F exposure can get lipid accumula - tion in the liver, which can cause NFALD. This can happen in the absence of alcoholism 390 Impact of Health Indicators and Socio-Economic Inequalities on Greek Population’s Health Level in Relation to Causes   , Mentis Isidoros The present work deals with the change in the health indicators in Greece over time and the socio-economic factors that cause health inequality, focusing on the economic crisis. At the same time, it is attempted to explain the causal parameters-mechanisms of provoking the abovementioned inequalities and to propose interventions to reduce their intensity in the context of a more fair socio-economic policy. GOOGLE SCHOLAR has been sought in order to analyze the term «health» through health indicators and to investigate the epidemiological understanding of the disease and its domestic prevalence, through socio-economic indicators. In addition, statistical data were extracted from the Eurostat database and processed diagrammatically to record an average level of health and long-term inherited domestic health inequalities. Through the aforementioned methodology, the author recorded the evolution of health indicators of the Greek population (healthy life years, life expectancy , infant mortality , population with long-term disease, health problem and activity limitation), the negative impact of the economic crisis on their level and their association with socio-economic factors (income-education-urbanization) that have a long-lasting effect on the classification of the health of the domestic population, causing health inequalities. The domestic health level, through the use of health indicators, recording its long-term grading, had been heavily hit by the onset of the economic crisis and in combination with the change in socio-economic indicators, has highlighted the importance of the latter in the health of individuals and the wider community and by adopting the proposed policy of stigmatizing the intensity of the inequalities caused, the differentiations can be eliminated (or at least mitigated) and social balance can be achieved 391 The Bugaboo Cancer     , Edward F Block 392 The Bugaboo Cancer   , Edward F Block I am really very much disappointed in the American Medical As- sociation as their members are more concerned with their profits than they are about the health of the populace. However, it is easy to understand as the members have made it such that they obtain the greatest profit from the mostly unnecessary surgeries that they perform. This article does not address the control that the AMA has over all aspects of what is their greatest money-maker: surgery for cancer. Instead, this article is about how you may learn to take control of your own efforts at maintaining your health and not be subject to the bugaboo cancer. It is not the fact that cancer does occur, it is the fact that you ignore it until the cancer becomes a problem! 393 Mortality by Traffic Accident in Mahajanga, Concerned and Predisposing Factors   , Tohaina DV, Rasamimanana NG, Habib N, Randrianirina HH, Razanatiana BE and Tiandaza DO Road accidents currently represent one of the most serious problems for the community on a national and global scale. They are the leading cause of death for children and young people aged 5 to 29, and the number of road deaths continues to rise. This is a cross-sectional study carried out in Mahajanga over a period of 2 years, during the years 2016 and 2017. The aim is to identify the deceased victims, and determine the factors favoring fatal road accidents in the Boeny region. Of 1209 victims of traffic accidents during this period, 69 had died, with a mortality rate of 5, 70%. They had an average age of 29.49 years, predominantly male (78.2%). Pedestrians (n = 33; 47.82%) and motorcyclists (n = 17; 24.63%) were the most affected. Most accidents occurred in built- up areas (63.8%), but those outside built-up areas were the most serious. In 98.55% of cases, these accidents were related to human factors, occurring during the day between 6 a.m. and 5 p.m. (60.8%). The vehicle- pedestrian (43.48%) and vehicle-vehicle (21.74%) type collision were the most encountered mechanism, involving mainly motorcycle (31.88%), minibus (23.19%) and off-road cars (20.29%). In 40.6% of the cases, the victims died on the spot, 18.8% during their transport to the hospital, and 40.6% after their arrival at the hospital. The lesions that caused these deaths were dominated by severe polytrauma (88.4%) and severe head trauma (31.8%). The education of road users, the establishment of a good road safety policy and the adoption of responsible behavior with strict respect for the highway code among vehicle drivers will help to reduce this scourge 394 Your Enteric Nervous System     , Edward F Block IV It seems that the majority of those that call themselves as a “medical scientist” do not actually know about what is the Enteric Nervous System (ENS). This fact completely baffles my beingness as the ENS is, after the Central Nervous System, one of the most im- portant aspects of the nervous elements within your entire physi- cal body. The following material is offered in the attempt to assist your efforts in recognizing this very important fact of life! 395 Developing Standard Operating Procedures for Supply Chains to Support Neglected Tropical Disease Mass Drug Administration in an Endemic Country: Lessons Learned in Senegal   , Ndeye Astou Badiane, Boubacar Diop, Sylla Thiam, Ndeye Mbacke, Seynabou Ndour and Elizabeth Wilskie Neglected Tropical Diseases affect more than 1 billion people and remain a major public health problem. Many efforts are being made to combat these diseases to improve the situation of endemic countries on a large scale. One of the main strategies is the use of preventive chemotherapy through mass drug distribution. Effective supply chain management requires to develop and align to standard operating procedures (SOPs). The World Health Organization and the technical experts of the Neglected Tropical Diseases Supply Chain Forum have defined 11 SOPs. Senegal, in col- laboration with PATH, revised the SOPs to adapt them to the country’s needs and context. World Health Organization and various health stakeholders in Senegal organised the SOP manual around seven steps: (1) review of the existing SOP manual, (2) adaptation of the manual to the country’s context, (3) development of the SOP manual, (4) develop- ment of the twelfth SOP on pharmacovigilance, (5) validation of the SOPs, (6) response to and submission of the World Health Orga- nization questionnaire on the review process, (7) and dissemination of the manual. Developing SOPs for neglected tropical disease drug supply chain management was a major step towards ensuring availability of high-quality drugs in target areas across the country during mass drug administration. However, to achieve effective drug manage- ment in the next distribution campaign, additional efforts are needed, including the development of management tools and training manuals, training of drug distributors, and dissemination of SOPs to all levels of the health system 396 New-onset Anosmia Among COVID-19 Suspected Patients in a Tertiary Care Hospital, Cairo, Egypt   , Nora Tarek Ibrahim, Hossam Attia Mohammed, Hazem Naguib Awad, Mohammed Elsayed and Ahmed Elshehawy Introduction: The COVID-19 pandemic was caused by the SARS-CoV2 virus, which was first reported in Wuhan, China in late 2019 and has quickly spread to 213 countries and territories. As we race to get a better understanding of its pathology and how to manage it, a few trends have been noticed. Among these is the anecdotal finding of patients reporting sudden loss of smell and taste as one of the preliminary, and sometimes only, symptom Aim: This study aims to describe the characteristics of patients that present with new onset anosmia during the COVID-19 pandemic. Methods: Sample will target patients that present to the Emergency COVID-19 clinic at Ahmed Maher Teaching Hospital. The study data will be collected by data collection forms filled out by the researchers. All adult patients presenting to the COVID-19 Emergency clinic with new onset anosmia within a two-month period will be included. Results: Out of total 81 participants from whom data was collected, 15 cases had diminished sense of smell as preliminary symptom, and 6 cases had only that at time of swab., 38.5% of all positive patients had their olfactory function affected as preliminary symptom. Thus, we can say that almost one in three positive patients displays a diminished sense of smell as a preliminary symptom. The mean duration of anosmia was 9.4 ± 10.4 days in cases with anosmia who were confirmed by PCR to be positive, as compared to 10.74 ± 9.39 in cases with anosmia who showed negative results; without significant difference (P = 0.660). Duration was < 7 days for 55% (11/20), 7-14 days for 20% (4/20), and > 14 days for 25% (5/20). Conclusion: While anosmia has been proven to be an anecdotal finding in COVID-19 positive patients, the presence of new onset anosmia in patients during the COVID-19 era cannot be fully explained by the SARS- CoV-2 virus. However, as healthcare workers, wearing full PPE while dealing with anosmia patients is recommended, as anosmia could be a preliminary symptom and this could prevent infection. 397 Vulnerability of the Katana Health Zone in the Democratic Republic of the Congo: A Resilience Strategy to Malaria Treatment in Healthcare Facilities from 2014 to 2018   , Hermès Karemere, Nadine Muhune, Rosine Bigirimana and Samuel Makali Synopsis Introduction: The Katana Rural Health Zone has experienced several events, including looting of health centers, the stoppage of funding, or the instability of nursing staff, which could have hampered the functioning of its health structures. These structures continued to function in this unfavourable context, thus showing themselves to be resilient. The objective of this study is, on the one hand, to understand whether the various events that have occurred in the Katana Health Zone partly explain the sustainability of malaria and, on the other hand, to identify the different adaptation mechanisms put in place to facilitate the resilience of the Health Zone in the face of these events in the treatment of malaria. Methods: The methodology applied approach uses a case study using mixed methods (qualitative and quantitative) for data collec- tion. The study covers the period from 2014 to 2018 and is based on the identification of events that have occurred in the Katana health zone, the analysis of the evolution of cases and deaths linked to malaria, and perceptions of key actors on the nature of the events and their link with the number of cases. The study used a document review and individual interviews targeting 8 key players. Results: The main destabilising events identified are linked to the management of human resources, the use of health services, the disruption of funding, the availability of curative or preventive inputs, community participation, and security and safety issues. infra- structure. The trend in the development of new cases of malaria is similar for all age groups. Death, on the other hand, evolves in a different way. The health services continued to provide care thanks to the coping mechanisms developed. Conclusion: The study demonstrates the precariousness of a health system heavily dependent on humanitarian aid, the termination of which can generate dysfunction with effects on mortality, including infant mortality; the weak involvement of the government in supporting structures confronted with the effects of disasters such as the earthquake and looting; the poverty of the population, making it inaccessible to health care despite the drop in prices; and the resilience of health centres following the establishment of endogenous adaptation mechanisms 398 ACR, SLICC, EULAR: Which Sensitivities in the Diagnosis of Lupus?   , Nada Jnyah, Chaimae Soltani, Basmat Amal Chouhani, Ghita El Bardai, Nadia Kabbali and Tarik Sqalli Houssaini Introduction: The American College of Rheumatology (ACR), the Systemic Lupus International Clinics (SLICC) group and the Euro- pean Alliance of Associations for Rheumatology (EULAR) are three classifications for diagnosing systemic lupus erythematosus with different sensitivities and specificities. Purpose of the study: Our purpose is to compare the sensitivity of these scores in the diagnosis of lupus to adopt the most relevant classification in our daily practice. Materials and Methods: We conducted a prospective descriptive and analytical study including renal biopsies objectifying a lupus nephritis. These biopsies were performed in the nephrology department of the University hospital center Hassan II of Fes, from Ja- nuary 2010 to January 2021 to compare the sensitivity of these scores. Biopsies made during a relapse were excluded. Patient data was collected from records and computerized management software. Socio-demographic, clinical-biological and immunological data were processed by the SPSS software. The reference test of the calculation of sensitivity considered the decision of the medical staff, which is a daily meeting in the nephrology department, it aims to discuss the files of patients hospitalized and seen during the guard by doctors in training. This meeting is held under the aegis of four professors of nephrology, two of them are associate professors and two assistants. The decision of the medical staff to define lupus patients is based on a bundle of clinical biological, immunological, and pathological arguments. Results Achieved: We collected 183 patients with an average age of 38.4 years with a standard deviation of 12.9 [17-76 years]. One hundred and sixty-seven (167) patients (91.3%) of the sample studied validate 4 out of 11 criteria of the ACR, with a sensitivity of 97%. For SLICC, 163 patients (89%) meet 4 out of 17 criteria, compared to 155 patients (84.7%) for EULAR. Thus, the sensitivity is 97% for the ACR, 96% for the SLICC and 93% for the EULAR classification with positive predictive values of 87.7%, 86.3% and 89% respectively. The changes made by SLICC, and EULAR classification allowed to obtain 90 patients (49.2%) and 126 patients (68.9%) meeting the joint criterion respectively compared to 37 (20.2%) only for ACR. Following these same changes, 35 patients (19.1%) meet the neu- rological criterion of SLICC compared to 25 (13.7%) for ACR and EULAR. Conclusion: The EULAR classification loses its sensitivity but gains its predictive value 399 Impact of Circulating miRNAs in Cutaneous T-cell Lymphoma Diagnosis: miR-146a and miR-26a as Promising Diagnostic Biomarkers   , Marianna Papadaki, Christina Piperi, Georgia Damoraki and Evangelia Papadavid Background: The diagnosis of early-stage Mycosis Fungoides (MF) can be very challenging due to overlapping clinicopathologic findings with reactive and inflammatory dermatoses. The aim of this study was to investigate whether selective peripheral blood mi- croRNAs, are involved in CTCL pathogenesis and canbe used as potential diagnostic biomarkers to differentiate inflammatory diseases from early MF. Methods: The expression of miR-148a, miR-338-3p, miR-26a, miR-146a and miR-451 was evaluated in the serum of early MF pa- tients (Ν = 15) using RT-PCR and also measured in skin biopsies (Ν = 10) and CTCL cell lines (My-La and Seax). Results: Our data showed that miR-26a and miR-146a were significantly upregulated (P < 0.001) in early MF patients compared to controls and could be utilized to differentiate inflammatory skin diseases from early-stage MF. Of importance, miR-451 which has a tumor suppressor role in other hematologic malignancies, was overexpressed inMF. Conclusions: Altogether these data indicate that liquid biopsy may detect upregulation of specific microRNAs (miR-26a and miR- 146a)inearly-stageMFandpresentareliablenon-invasivediagnostictechnique. The correlation of liquid biopsy with histological data from the skin biopsy indicates that it may be further used as a supplementary tool to the established criteria for the differential diag- nosis of early MF stages from inflammatory skindiseases 400 Potential Nucleotides of CD38 are Causing the Aggregation of Platelets     , Mazhar Mushtaq Objective: To elucidate the platelets aggregating effects of CD38 produced nucleotides. Introduction: The production of cADPR and NAADP has been demonstrated in various cells in different tissues. Their primary physi- ological response is to elicit an increase in intracellular calcium. Platelets, like other cells, are also calcium dependent on producing their physiological response, normal aggregation. Materials and Methods: The Platelet's aggregating effect was studied in thermomax microplate reader. Calcium measurements were carried out using Fura 2-AM loaded platelets subjected to PTI in a magnetically stirred cuvette at 37 °C with proper excitation wavelengths. cADPR and NAADP assay were performed using a fluorescence reader. Thrombin and ADP were used as physiological agonist along with cADPR and NAADP. Values of the result were expressed as mean and were considered statistically significant if p < 0.05. Result: By using Thrombin and ADP, we were able to delineate the pathway of cADPR and NAADP and their response to releasing calcium from the intracellular organelles. The use of specific inhibitors in the paths of these nucleotides enabled us to deduce that cADPR is upstream to that of NAADP. 401 An International Consensus for the Value of the Electrocardiographic QT Interval   , Breijo Márquez For many authors, the electrical cardiac systole includes from the beginning of the Q wave (or beginning of the R wave if there is no Q wave) to the ending of the T wave, wherever the descending branch of the T wave reaches the isoelectric line of the ECG. For many others, to which we belong, the electrical cardiac sys- tole must also include the P wave. In any case, it is imperative to measure waves, intervals and electrocardiographic segments in all cases. In order of calculating the different lengths of these ECG enti- ties, many different calculation formulas have been proposed, be- ing the most known and used those of Bazett[1] and Fridericia [2]. It is fair to say that, before Bazzet, L.M. Taran and N. Szilagyi [3] were the true pioneers in the description of the formula, as Cobos M.A. and García Rubira J.C. have written in their magnificent work [4] 402 The Consequences of Traditional Treatments on Bone Fractures. Study About 92 Cases Recorded in Bangui, Central Africa Republic   , Doui Doumgba Antoine, Issa Mapouka Pierre Alfred, Dibertbekoi Nouganga Emmanuel, Ngboko Mirotiga Pétula Anicette, Nabia Don Rodrigue and Tékpa Bertrand Jean de Dieu Objective: To describe the complications observed in patients suffering from a limb fracture treated by a traditional method at home before being admitted to hospital. Patients and Method: This was a prospective descriptive study, carried out in the orthopedic-trauma department of the CHU Com- munautaire of Bangui from January 1 to December 31, 2015. Patients included in the follow-up department had Limb fractures treat- ed by the traditional method and presenting a complication. These patients should indicate their consent and provide information on the traditional treatment received. Those who had undergone mixed treatment, those who were not consenting and those who pre- sented no complications were excluded. The study was conducted during consultations, and hospitalization. Each patient included was asked about the traditional product used, the stages in the treatment of the fracture. A survey form was used to collect the data and included variables such as age, sex, profession, provenance, type of fracture, product used, reasons for this choice, method used, duration of treatment and course of treatment. The data collected was analyzed using the Epi info 2012 software. Results: The mean age of the patients was 45.4 years (range 14 and 73 years). Male subjects made up75% of the sample. The Sex ratio was 3. According to the profession, the farmers were the most numerous with a proportion of 22.8%. In 58.7% of the cases, the injured came from within the country. The average consultation time was 4 months. Fractures were common in the leg (32.6%), the femur (27.2%) and the humerus (16.3%). Most fractures (79.3%) were closed. The traditional means used were mainly vegetable leaves (31.5%), tree bark (17.4%) and wild onions (9.8%). These products were used in 62% of cases by application to the fracture site followed by a bandage. In 66.3% of the cases, the fractures were not reduced before treatment and not immobilized in 57.6% of the cases. In the 42.4% of cases the fractures were immobilized and, the immobilization materials were pieces of wood (17.4%), braided Chinese bamboo (16.3%) and bark of wood (8, 7%). The products were renewed every5 to 7 days in 75% of the cases. Vi - cious calluses (31.3%), non-union (25.2%) and joint stiffness (14%) were the main complications. Confidence (55.4%) motivated the choice of this treatment. 403 Epidemiological Profile of Glomerular Nephropathies in the Oran Region West Algeria   , F Zerdoumi, M Medjamia, S Boudani and K Djoudad Introduction: Early identification of kidney disease is an essential step in optimizing management. To this end, we present to you the anatomo-clinical description of the main nephropathies of our department during the interval from 01.09.2017 to 28.02.2021. Material and Methods: 180 renal biopsies were performed during this interval. Our study is prospective and descriptive. It relates to the study of the frequency, and the anatomo-clinical specificity of nephropathies. Any adult patient over 16 years old with kidney disease was included in the study; descriptive analysis was done by Microsoft Excel2010. Results: Average age 33.94 ± 15.06 years with overall male to female ratio 1.12. Among primary nephropathies, lipoid nephrosis dominates (33.33% including 25% MCD and 8.33% FSGS) followed by MGN (10%), IgA nephropathy (5.55%), DPGN (2.77%), Cres- centic GN (2.21%), CIN (2.22%) and AIN (1.6%). For secondary nephropathies, lupus nephropathy dominates (20%) followed by AA amyloidosis (3.33%). Nephrotic syndrome (74%) represents the most frequent reason for renal biopsy. Histologically, with regard to the low chronicity index compared to 00 globally sclerotic glomeruli (75%) and absence of interstitial fibrosis (77%). Discussion and Conclusion: In comparison with the data from the African Registry of the main glomerular nephropathies (Plos one 2016; 11 (5); e0152203), the Nephrotic syndrome remains the main reason for renal biopsy and the transition observed in Tunisia [1] (little amyloidosis and DPGN) matches our results with however a predominance of lipoid nephrosis 404 Basic Nature of Three States of Water Explained by “Multi Molecule Theory”   , Satyavarapu Naga Parameswara Gupta This is a vital result. We know the three main states of H2 O, viz., ice, water and vapour. What is the reason for this change of state? What is the inherrant nature the inter molecular attraction forces? These questions were not thought off earlier. On what factor that makes H 2 O to change its state. Of course, temperature is the common answer. We plunged into a more fundamental aspect i.e., inter molecular attraction forces and intermolecular distances. We took a distance factor (DF) = 1 which represents inter molecular distances in a drop of contaminated water. And keeping the original molecular structure same changed all the inter molecular distances proportionally with different values of DFs... We wrote macros in Visual Basic for Excel to find the inter molecular hits that would happen for that DF from the excel sheet where all the calculations were done. We plotted addresses of colliding molecules in a designated area in the worksheet. We took screen shots of that area for that value of DF value and shown these plots Inter Molecular Hits in this paper. We observe that number of inter molecule hits is decreasing from all the pairs hitting each other to no hitting pair depending on inter molecular distances. We can visualize very clearly for DF 0.02 to 0.08 the state will be ice, for DF 9 to 300 the state will be water and for DF 5000 to 10000 the state will be vapour. There are many MIXED intermediate states 405 Misinformation and COVID Vaccine Hesitancy: The Viral Threat to COVID Vaccine Efficacy   , Moki Chris Usani Not long after the corona virus introduced itself in Wuhan, China, with all the subtlety and finesse of a bull in a China shop, efforts towards creating and distributing a vaccine reached fever pitch. In fact, just a few months after the World Health Organization (WHO) declared COVID-19 a pandemic (on March 11, 2020), two major pharmaceutical and biotech giants: Pfizer (in partnership with BioNTech) and Moderna, Inc., announced their success follow- ing the primary efficacy analyses of their phase 3 COVID-19 vaccine trials 406 Clinical Characteristics of Patients Diagnosed with COVID-19 in a Tertiary Hospital in Cali, Colombia       , Mónica Chávez Vivas, José Rafael Tovar Cuevas, Antonio José Tascón, Lina María Ibañez Correa and Armando Lucumí Moreno 407 Availability of Health Services in the Health Facilities of the Congolese National Police in North Kivu Province       , Woolf Kapiteni, Éric Mafuta, Bienfait Mwarabu, Philippe Mulenga1, Oscar Luboya and Albert Mwembo Tambwe Introduction: The Democratic Republic of Congo (DRC) is facing challenges in implementing Universal Health Coverage due to gaps in its health system, particularly in terms of service delivery. The objective of this study was to identify the services available in the health facilities of the Congolese National Police in North Kivu Province (NKP). Methods: This is a descriptive cross-sectional study carried out in the North Kivu Province of the DRC over a period of 3 months from 01 December 2019 to 29 February 2020. The study involved ten health facilities (HF) of the Congolese National Police (CNP) in North Kivu Province. No sample size was determined a priori in this study. Data on the availability of care services, basic equipment in the general outpatient department, basic infrastructure to meet the needs of patients in health facilities and the availability of tracer drugs were collected by observation and interviews with health facility managers, seizures and analyzed with Microsoft Excel 2016 software. An average availability score of HF with the item was calculated and expressed as a percentage. Results: All HF of Congolese National Police in NKP organize curative care for children under 5 years of age and pregnant women, STI diagnosis or treatment services, noncommunicable disease diagnosis and management services, and minor surgery. About a third offer caesarean section, organizes the blood group analysis service and major surgery. One tenth organizes preventive care for children under 5 years of age and pregnant women, provides antiretroviral treatment and has communication equipment. No HF of CNP in NKP organizes an emergency and intensive care department, nutritional management, diagnostic confirmation services or the prescription of treatment, nor the provision of services or follow-up of tuberculosis treatment. None has a computer with internet connection, nor an ambulance on duty. Conclusion: HF of Congolese National Police in North Kivu province have shortcomings in the provision of care, the availability of services, medical equipment and essential medicines. The results of this study suggest that efforts must be made to improve the provision of care for police populations as well as their dependencies in terms of service provision and equipment. 408 Management of Accidental Traumatic Digestive Perforation After Ingestion of Medicinal Plant Indigenat, About 4 Cases, at the Amissa Bongo Regional Hospital Center in Franceville Gabon     , Ngakani Offobo Silvère, Aseke Kundulunga J Albert, Choua Ochiemi and François Ondo Ndong Digestive perforations are common in our region. Accidental digestive perforations occurring in traditional practitioners become recurrent and are a public health problem. Prolonged stays in the indigenate cause serious visceral lesions. The authors report four cases of perforations after ingestion of medicinal plants to the indigenate. The objective was to study the causal agent, the clinic, the paraclinical and the therapeutic strategy. 409 Incidence and Risk Factors for Re-exploration Following Off Pump Coronary Artery Bypass Grafting     , Anirudh Mathur, O P Yadava, Vikas Ahlawat, Anirban Kundu and Amita Yadav Re-exploration post to the cardiac surgery is a troublesome complication. There is an enigma of rare reported data about the ef- fect of re-exploration after off-pump coronary artery bypass grafting (OPCABG). We here represent our institutional experience on re-exploration following OPCABG with follow up of 5 years. In the present study total of 1852 OPCABG were performed at tertiary multi-super specialty care center. Out of these patients, 22 (1.18%) were re-explored in the operation room and were included in this study. The medical records of these patients were retrospectively reviewed. The results showed that the most common cause of re-exploration was bleeding and the most common site of bleeding was general ooze. The mean time to re-exploration was 10.6 ± 5.76 (Hours, mean ± SD), and the Hospital Mortality of 2/22 cases was observed with 5 year follow up mortality of 7/22 cases. The observations, add the preliminary data in the literature for overall incidence (1.18%) of re-exploration with most common site of the bleeding that was generalized ooze (n = 12). Summarizing the delaying re-exploration increases the three-fold risk in mortal- ity and morbidity. This study suggests that a strategy of reducing the incidence of re-exploration, like the use of minimally invasive surgery and early re-exploration with the judicial use of products, maintaining Operation theatre temperature should be used to improve outcomes after re-exploration following OPCABG. The need for re-exploration is surely not totally alleviated by using off pump coronary artery revascularization strategies. As there is lake of data reported in literature with the rate of incidence, effect of timing and associated risk factors of re-exploration after OPCABG. Minimally invasive surgery can be suggested as option to improve outcome after re-exploration for off pump CABG. Since, Re-exploration after off pump CABG is not associated with high mortality as per our study in contrast to other data reported in literature. Delaying the re-exploration is associated with increased drain out. The recommendable stanchion of minimizing the incidence of re-exploration after OPCAB should be judicial hemostasis during primary surgery and adequate core temperature management. Minimally invasive surgery is suggested choice to improve outcome after re- exploration for off pump CABG 410 Chronic Non-communicable Diseases: Risk Factors, Disease Burden, Mortalities and Control     , Ravi Kant Upadhyay Present review article described major NCDs, its causes, symptoms, complications, medication and prevention. This article ex- plains major non communicable disease and complications of various CVDs i.e. strokes, arterial diseases, stress, alcoholism, narcot- ics, hypertension, cancer and blood pressure and other life style diseases. NCDs do clinical, mental, physical impairments in users, and these become either permanent or temporary. But most of them impose residual disability/chronic impairment and non revers- ible, non measurable pathological alterations. This article filters out important causes of NCDs like imbalances in diet structure, living facility, social awareness, cleanliness, and hospital care and medicine availability. There is a rising trend of alcoholic, narcotics and drug abuse in school going young population. Dietary patterns and physical disabilities are not normal and people are coming under extravagant consumerism. Today NCDs are major killer of people and there is an urgent need to make long term plan to aware, coun- sel and provide regular treatment to the sufferers. For quick action social, community, clinical-legal and treatment methods must include in planning and implement them across the world. 411 The Psychological Effect of Virtual Learning on Mothers During the Pandemic with their Children     , Areej Mohammed Alabdulsalam, Mezoun Almohaimeed, Mostafa Kofi, Dakhel Fahad Almubarak, Abdulelah Mutlaq Alotaibi, Raghad Sulaiman Alkahmous and Rakan Ziyad M Alotaibi Background: Pandemic outbreak causes various effects on different parts of our lives: the learning process. One of the ways to continue education is virtual learning which replaces traditional ways. It is a mixture method between face-to-face teaching and an online approach [1]. Aim: To improve mothers’ mental health who deal with their children during virtual learning during a pandemic. Method: A cross-sectional study was undertaken at Riyadh’s Prince Sultan Military Medical City’s Al-Wazarat healthcare center. During the outbreak, three hundred eight mothers were given a self-administered questionnaire that assessed sociodemographic variables, homeschooling data, and the Hospital Anxiety and Depression Scale (HADS). Results: A total of 308 mothers participated, and the vast majority 292 (98%) of them were Saudi. Almost all 306 (99.4%) of the par- ticipants reported spending time with their children during online learning. Class room-based schooling was the preferred school- ing style by 209 (68.08%) of the mothers. In addition, 43 (14%) were borderline anxiety, and a similar percentage was borderline depression. The prevalence of anxiety and depression was 191 (62%) and 222 (72.1%), respectively. Multivariate logistic regression showed that classroom-based schooling was the significant risk factor for anxiety and depression with OR=86.761, 95%CI (30.467- 247.067), and 53.005 95%CI (14.855-189.128), respectively, and a P-value of <0.001. Conclusion: Depression and anxiety were highly prevalent among mothers with children in homeschooling during the COVID-19 pandemic. Class room-based schooling was the only significant risk factor for anxiety and depression. At the same time, old age was a significant protective factor from depression among the participated mothers. This study highlights the recognition of the impor- tance of mental health screening among women who have children studying online. Recommendation: Measures need to be implemented to decrease the prevalence of depression and anxiety among mothers who take care of their children during online learning, such as decreasing the number of mothers’ working hours and asking the father to support the mother and helping them during educational processes. 412 Challenges Faced by Elderly During Covid-19 Pandemic: An Overview   , Sumanth S Hiremath While in developed nations the adult who is 65 years or above is considered to be elderly. There would be around 2 billion people belonging to the old age segment across the world by 2050. The rise in the ageing population poses a number of challenges and this pandemic has increased the number of challenges. Several studies have been done for assessing the impact of the pandemic on overall health of elderly which is much more as compared to the others. Studies from across the globe show that risk of the pandemic is much more in elderly. Elders are specifically influenced by the social vulnerability, especially during the lockdown or quarantine. They felt lonely, anxious and uncertain which give rise to insomnia and depressive disorders. Many elderly people live alone because their children maybe working in some other city or country 413 COVID-19. Is it Still Pandemic or Endemic? What is its Future in 2022?     , Salim Surani and Minahil Saleem The SARS-CoV2 or severe respiratory syndrome Cov2 or COVID-19, since its origin in the wet seafood market in Wuhan, China, in late 2019, has taken the world by storm affecting almost 467 million people globally, with 6,089,773 people being succumbed to this disease worldwide [1]. In 2020, scientists focused on antiviral therapy, vaccines, and the role of repurposing medications. The vaccine came as a winner, hands down, with the Pfizer vaccine for COVID-19 making its way in late 2020. This was followed by several vaccines such as Moderna, AstraZeneca, Sinovac, Sputnik, Sinopharm, to name a few. As the vaccine supply was emerging, so was the disparity. In the initial phase, the developed country vaccination rate was far higher than the developing countries [2] 414 The Conscious and Unconscious Minds     , Edward F Block   It has come to my attention that some needed clarification concerning realms of awareness and consciousness would be very helpful for planning any future research efforts related to just what comprises conscious and unconscious mentation. During the development of the human fetus during gestation, two activity poles develop that have been named as the Vegetal Pole and the Animal Pole. The Animal Pole eventually becomes the Central Nervous System (CNS) and the Vegetal Pole eventually becomes the Enteric Nervous System (ENS). The vegetal pole develops at breakneck speed while the animal pole develops at a more sedate pace. The various elements of the ENS are the control system for the unconscious coordination of the various functional activities of the entire physical body. Whereas the CNS is the control system for consciously directed muscular activity and conscious mentation dedicated to the planned co-ordination of that directed muscular activity 415 A More Modern Understanding of Traditional Chinese Meditation     , Edward F Block This article is an attempt to bring the Traditional Chinese Medicine (TCM) paradigm into the modern age. The entirety of TCM was formulated over many thousands of years in the area of the world that is now known as China. This achievement was very useful in the care of human beings that were not able to deal with adverse events that cause sickness. TCM and the tenets of the philosophy that arose from Chinese medical practice were created in a time considerably long before the 1930’s. The 1930’s may be considered as the era when modern medicine really began to came of age due to advances in many aspects of science and technology. 416 Small Bowel Obstruction Secondary to an Internal Hernia Through the Pouch of Douglas: A Case Report and Review of the Literature     , Elizabeth Guelmo-Daisley   Background: Internal hernias are an uncommon cause of small bowel obstruction. These are caused by the protrusion of viscera through defects in the mesentery or peritoneum. Pouch of Douglas hernias are an exceedingly rare type of internal hernia. As such, there are no standard guidelines for management. Case Presentation: An elderly female presented with small bowel obstruction in the virgin abdomen, was found to have a recto uterine cul-de-sac or pouch of Douglas hernia via a computer tomography (CT) scan. Open reduction of the hernia followed by herniotomy was the method used to treat this patient. Conclusion: Pouch of Douglas hernias are a rare type of internal hernia. It may be due to a congenital defect in the peritoneum or due to an acquired defect usually secondary to previous pelvic procedures. It may be identified via computer tomography (CT) and the definitive management is surgical due to the high risk of strangulation. Herniotomy or widening of the hernia defect, which decreases the risk of incarceration and strangulation, appears to be a valid method of definitive management of hernias within the Pouch of Douglas 417 Functional Prognosis of Open Patella Fractures Treated by Guying at Yopougon University Hospital: Study of 16 Cases       , Feigoudozoui Hermann Victoire, Soumaro Kanate Daouda and Boka Eva Rebecca Abstract Objective: To describe the factors that influence the functional outcome of surgical treatment of open patella fractures. Method: A retrospective study for 5 years (January 2016 - December 2021) included records of open patella fractures. Treatment was exclusively surgical by guying. The minimum follow-up period was 6 months. The results were evaluated according to the Casta- ing score. Results: Sixteen patients with 16 open patella fractures were selected, including two women. The mean age was 38.7 years (ex- tremes: 26 and 64). According to the Gustillo classification, there were two type IIIA injuries. According to the Ricard-Moulay clas- sification, two fractures were classified as type III. All fractures were treated by guying and were cured at recoil. Four fractures were complicated by infection of the surgical site. Two cases of knee stiffness were also remained. Functional results were good in 12 cases according to the Castaing score. Conclusion: Two main clinical elements may affect the functional prognosis: skin opening and comminution of the fracture line 418 Periprosthetic Surgical Preparation of Total Edentulous at CHU-CNOS De Bamako     , Ahmed BA, IB Bengaly, A Konate, Diaby A, IH Sidibe, MD Diallo and A Camara Oral health and general health are intimately linked and dependent in humans. The complete disappearance of the teeth leads to the loss of proprioceptive control systems, modification of the entire tissue system, and therefore great psychological fragility. Pre- prosthetic surgery consists of restoring the osteo mucosal tissues to allow the placement of a prosthesis. The Objective: Was to assess the need for pre-surgical prosthetic preparation of the total edentum at the CHU-CNOS in Bamako. Method and Materials: This was a descriptive prospective study spanning a period of 08 months (from January 1 to August 31, 2018). Patients admitted to the removable prosthesis department for a consultation diagnosed with edentulousness constituted the study population. We carried out an exhaustive recruitment of the total edentulous people received in the department for the completed removable prosthesis who agreed to participate in the study. Data were collected using an individual survey sheet and analyzed with SPSS ver- sion20.0 software. Result: A total of 50 patients were registered including 14 men or 28% and 36 women or 72%. The sex ratio was 0.38 in favor of women. The 60 to 69 age group was the most represented with 19% and the average age was 56 years. The demand for prosthetic restoration for aesthetic and functional purposes represented the reasons for consultation in 46%, 44% of cases and pain in 10% of cases the most expressed concern by patients. Oral hygiene was 64% average, 20% good and 16% poor. Tooth extraction represented 70% of cases, without surgery 20% of cases and osteotomy 10% of cases as a pre-surgical prosthetic treatment. The ridge was poorly resorbed at 40%, moderately resorbed at 30%, highly resorbed at 20% and the negative ridge at 10%, 50% of patients did not wear a prosthesis, 34% of patients wore partial removable prostheses and 16% wore full removable dentures. Of our patients 66% had normal brakes, 22% had short brakes and 12% had wide brakes. Conclusion: This study made it possible to highlight the real needs for pre-surgical prosthetic preparation. Among these needs, mul- tiple tooth extraction remains the most common pre-prosthetic surgery. 419 Epidemiological, Immuno-virological and Evolutionary Profiles of Men who have Sex with Men with HIV/AIDS Followed in Niamey/Niger   , Gado AM, Ayouba Tinni I, Daou M, MoussaSaley S, Yacouba N, Souley C, Boulama Malam BM, Kossi Odjo Dogbé YZ and Adehossi E Background: Since the beginning of the HIV epidemic, MSM(Men Who Have Sex with Men)has been disproportionately affected. In Niger, data on MSM with HIV are not available. In order to strengthen preventive strategies, it would be essential to determine the profile of HIV-positive MSM patients. Objective: The aim of this study was to determine the prevalence, the immunological and evolutionary profiles of MSM living with HIV followed in Niamey. Materials and Methods: This is a retrospective cross-sectional study based on the use of files of HIV-positive MSM followed up in the 3 centers of Niamey (Cedav, ATC and NHN) over a period of 13 years, from 2007 to 2020; on 65 cases. Results: We identified 4601 patients living with HIV at the time of our study, including 65 MSM cases, i.e. a prevalence of 1.41%. The average age of the patients was 30.57 ± 8.453 with extremes of 18 to 66 years. The age range of 25 to 35 years represented 32 (49.2%) of our patients. Single people represented 49 (75.4%) of our patients. Thus, 21 (32.3%) of our patients had a higher level (32.3%) and 15 (23.1%) patients were bisexual. All the 65 (100%) patients were HIV-1 infected. The mean CD4 count at initiation was 382.95 ± 263.974 and 34 (52.3%) of the patients had a CD4 count between 200 and 500/mmᶾ at initiation. No patients had viral load testing at initiation. So, 56 (86.2%) patients had a favorable course. Conclusion: MSM have been a highly vulnerable segment of the population to HIV infection since the 1980s. Behavioral change, regular screening and condom use are weapons to control the spread of this disease 420 Prevalence of Vitamin B12 and Folic Acid Deficiency in Patients with Severe Mental Disorders Admitted to Acute Psychiatric Unit and Review of the Literature     , Casares-Ruíz M, Rodríguez-Sosa JT, Hernández-Fleitas JL, Alonso-Ortiz MB, Santana-del Pino A, Andrès E, Lorenzo-Villalba N   Introduction: Diet is increasingly recognized as a potentially modifiable factor influencing the development and treatment of psyc- hiatric disorders. Vitamin B12 and folic acid deficiencies may have a significant causal contribution in the development and mental illnesses exacerbations. Objectives: The main objective was to study the prevalence of vitamin B12 and folic acid deficiency in a group of psychiatric inpa- tients and to compare it with another cohort of Internal Medicine department. Also, a review of other nutritional epidemiological studies of psychiatric inpatients is carried out. Methods: We conducted a cross-sectional descriptive study evaluating the prevalence of vitamin B12 and folic acid deficiency in newly psychiatric patients aged 18 years or more admitted to the acute hospitalization unit. Patients presenting a serum creatinine ≥2 mg/dL, advanced chronic liver disease, cognitive impairment, discharged or deceased with 48 hours after hospital admission were excluded. Matched controls were obtained from Internal Medicine department. Deficiency was considered with plasmatic levels lower to 200 pg/ml and 2.76 ng/ml for vitamin B12 and folic acid, respectively. Results: 140 patients were included in the study, 70 patients of the Psychiatric unit and 70 patients of the Internal Medicine depart- ment. In total, 8 patients (11.4%) ofthepsychiatriccohorthad vitamin B12 deficiency while folic acid deficiency was found in 27 (38.6%). The prevalence of these deficiencies obtained in the Internal Medicine cohort was identical. Mean values of cobalamin in controls were significantly higher than in psychiatric patients (p = 0.0381). Low folate levels were significantly associated with alcohol con- sumption and a correlation between elevated folate levels with age, female sex, and food disorder (n = 2) was obtained. Conclusions: Vitamin B12 and folic acid deficiencies are prevalent among psychiatric inpatients, and there were no differences with respect to patients admitted to Internal Medicine department. The combined deficiency was more prevalent in the psychiatric inpa- tients than in patients from Internal Medicine department 421 Pyramids: The Influence of Form on the Environment     , Konstantin G Korotkov Abstract Objectives: The purpose of this study was to explore the possibility of the influence of several ancient and contemporary pyramids on the environment. Methods: The Bio-Well device with a specially designed Environment Energy Sensor called the “Sputnik” was used to monitor the environment's parameters, allowing us to study geo-active zones. Results: The energy parameter of the Sputnik sensor signal at all the pyramidal complexes was significantly higher than at the hotels nearby. Conclusions: Results confirm the hypothesis that pyramids may influence the surrounding environment and hence, people being around. 422 Relationship between Airway Management and Duration of Mechanical Ventilation in Cervical Spine Trauma       , Sidi Mohammed Medjadi and L Cherfi Objectives: The aim of this work is to study the relationship between the early airway management and duration of mechanical ventilation, in the context of improving the prognosis of cervical spine trauma patients. Patients and Methods: Exhaustive descriptive-type study with prospective collection, carried out over a period of three and a half years at the level of several structures of Tlemcen University Hospital, namely the medical and surgical emergencies, multipurpose resuscitation and neurosurgery departments. It focuses on cervical spine trauma patients treated from the accident scene to the neu- rosurgery and/or medico-surgical resuscitation departments of Tlemcen University Hospital. All admitted for cervical spine trauma, whatever the level reached; the mechanism of the accident; the therapeutic decision (surgical or orthopedic), with or without neu- rological lesions and over 16 years old. Results: Orotracheal intubation was performed in 32.81% of the 128 patients identified in our study, it should be noted that two patients arrived already intubated. 25% were intubated in the first day and 3.1% in the second day. The last patient to be intubated, was on the 16th day following his hospitalization. The ventilatory parameters were regulated in such a way as to have a SPo2 > 90%. The sedation of our patients in the intensive care units was ensured by the combination of Midazolam and Fentanyl with an electric syringe, and maintained until clinical and radiological improvement. All were sedated and placed on mechanical ventilation. Of all intubated patients, 7.81% received a tracheostomy while in hospital. The median survival is 3 ± 5.47 days in the group of patients who have been intubated and 74 ± 1.42 days in the group who have not been. Conclusion: It is concluded that the occurrence of infectious broncho pulmonary complications in 31% of intubated patients (13/42 intubated) was correlated with the duration of hospitalization of our cervical spine trauma patients at Tlemcen University Hospital, establishing thus skip a statistically significant relationship between them (P = 0.000). Keywords: Cervical Spine Trauma; Airway Management; Mechanical Ventilation; Infectious Respiratory; Length of Hospitalization 423 Prevalence of Compliance on Asthma Action Plan Among Asthmatic Children in PSMMC and Associated Factors with Good and Poor Compliance     , Mohammed Saud Alshammari, Tarek Elsaid, Mashael Albargawi and Mostafa Ahmed Kofi Background: Asthma is the most common long-term condition in children, and impact the quality of life of children and their par- ents. A Written Asthma Action Plan is a set of written instructions kept by patients or their caregivers to help with asthma manage- ment. The current study is to assess the prevalence of compliance to asthma action plans among asthmatic children in prince sultan military medical city and the associated factors with good and poor compliance. Methods: A quantitative observational descriptive cross-sectional study among Saudi parents having asthmatic children aged 6- 12 years and followed up in PSMMC. Data were collected by a questionnaire developed and validated by the study authors to fulfill the study objectives. Parents who accepted to participate were given a written asthma action plan and it was explained to them, and they were informed that their contact number is needed to follow up with them after 6 months to check for compliance. Consent were obtained from all participants in this study, confidentiality is ensured and participants’ information are used for this study and will not be disclosed, IRB approval from research. Ethics committee was obtained and permitted to conduct the study. Data were analyzed by using Statistical Package for Social Studies (SPSS 22; IBM Corp., New York, NY, USA). Results: A total of 366 parents with asthmatic children participated in the current study, 52.2% of the children were males with a mean age of 8.70(±2.04) years. The compliance to asthma action plan was significantly correlated with gender(males were more compliant to the asthma action plan compared to females at 66.7% vs. 33.3%, respectively), the number of children in the family, and compliance (the number of children in compliance families was significantly lower than non-compliant ones at 4.57(±2.66) vs. 5.69(±1.89). A positive significant (P < 0.001) association between each of fathers' and mothers' educational level, economic status, and having a sibling with asthma, and compliance to the asthma action plan was reported. Conclusion: The compliance rate to asthma action plan reported in the current study among parents with asthmatic children aged 6-12 years at 13.93% is considered very poor. The compliance rate was positively significantly associated with the educational level and economic status of the participants 424   Diagnosis and Characterization by Using NMR, FT-IR, HPLC and G C Spectroscopies for Flaxseeds (Brown Variety) Oil Content from Libya     , Hawa Alsadi and Salem Mohamed Edrah Objectives: Extraction of oil from Linum u. seeds, investigating, characterizing of this oil by using chemical and extensive spectro- scopic methodologies. Methods: The oil constituents were isolated by using the Soxhlet Apparatus Extractor in n-hexane as a solvent, and diagnosis, char- acterization by the Gas Chromatography Technique (GC), High-Performance Liquid Chromatography (HPLC), FTIR, H1, C13 NMR, Oil Thermal Analysis (DSC) and Determination of Solid Fat Content (SFC %). Results: The percentage yield of oil content of Linum u. was 39%. The Physiochemical Properties, the acid value was 4.4 mg/g, Free Fatty Acid content (FFA %) free oleic acid was 2.2%, the average molecular weight value was 848 and the density of oil ranged from 0.89 g/cm3. According to triacylglycerols profiles (TAG)s in the oil were polyunsaturated of OLL with 17.45%, LnLnLn with 20.65 - 21.44%, OLnLn with 8.18 - 8.84%, PLLn with 6.72%, PLnLn with 7.97%. Whereas the FTIR Spectrum results of the presence of the functional groups of triacylglycerols were peaks at 3010- 3020, 2927-924, 1743-1743, 1462-1463, 1376-1377, 1238-1250, 1100-1110, and 722-721 cm-1. Thermal Transition Properties for quality of the Linum u. oil after melting in the Differential Scanning Calorimetric were showed a simple thermo-gram. While the obtained results from the p NMR analysis of the Solid Fat Contents were decreased when the temperature increased until it reaches room temperature 250C, which means that the oil contains higher un- saturated fatty acid 89.5% more than the saturated fatty acid 10.5%. Whereas by H1 and C13 NMR chemical shifts were observed that there were no significant differences between the Linum u. oil from Libya and Linum u. oil from Canada, and where both oils contain triacylglycerol TAG in which the NMR chemical shifts were consistent. Accordingly, the H1 NMR spectrum shows the chemical shift at 0.868-0.986 ppm and 0.5 ppm referred to the methylene group, respectively, and the terminal methyl group which is between 1.25- 1.343 ppm and 1.0 ppm, and for the methylene 2.005 ppm and 2.0 ppm, the acyl groups were at 5.253-5.39 ppm and 5.2 ppm. As well as the methylene groups of glyceryl were at 4.281-4.308 ppm and 4.5 ppm. In addition, the C13 NMR spectrum shows the main signals assignment at 172.76-173.17ppm refers to the carbon atom of the carbonyl group, and the signals at 127.12-131.92 ppm refer to the unsaturated carbon atoms 62.09-68.92 ppm due to the glyceryl carbon atoms, and were the methylene carbon atoms were further distinguished into those adjacent to one double bond, saturated at 29.0-29.7 ppm. As well, the results obtained by Gas Chromatogra- phy (G C) were 89.4% for unsaturated fatty acid and 10.1% for saturated fatty acid. And the unsaturated fatty acids present in the oil are dominated by 55% linoleic acid (C18.3), 15.9% linoleic acid and 17.8% oleic acid. Meanwhile, saturation fatty acids, present in the Linum u. oil consisted of 5.3% Palmitic acid (C16:0) and 4.4% Stearic acid (C18:0). The HPLC results showed that LnLnLn (21%) was dominated by triacylglycerols. Conclusion: The findings of the study revealed that Linum u. oil has the potential uses as a source of pharmaceutical for treating diseases. Therefore flaxseed plants can be further assayed for pharmacological preparations 425 Risks and Uncertainties in Photobiological Measurements     , Yun Zhang The risks and uncertainties in photobiological measurements have attracted more attention. Positive and negative effects of optical radiation on the visual analyzer, skin and psychophysiological functions of the human body have been established. Herein,standardized the quantities of optical radiation in 5 systems. Additionally, photobiological quantities and the traceability of their measurements were investigated. The risks and uncertainties of photobiological measurements were analyzed with the example of weighted radiance (LB). Combining the influence of optical radiation on human body, the map of safety intervals was creatively proposed, and the connection between uncertainty and photobiological measurement has been established. 426 Management of Abdominal Gunshot Wounds of Ballistic Trauma at Somine DOLO Hospital of Mopti     , Brehima Traore, Pierre Coulibaly, Djibril Traore, Modibo Coulibaly, Soumaila Sagara, Oumar Guindo, Abdoulaye Traore, Dramane Cisse, Kiffery Ibrahim Keita, Fode Mory, Keita, Dramane Samake, David T Thera, Aly Guindo, Aly Boubacar Diallo, Seydou Mariko and Adegue Pierre Togo Background: Abdominal gunshot wounds are common in areas of armed conflict. Mali a west African country has been going through a security crisis since 2012, which has led to an avalanche of wounds. The management of these wounds calls for multidisciplinary expertise due to their complexity. The aim of this work was to describe the clinical, epidemiological, surgical and therapeutic characteristics of abdominal gunshot wounds. Patients and Methods: This was a prospective study January 1, 2019 to December 31, 2019) on 1601 trauma received in emergency and general surgery departments of the Sominé DOLO Hospital of Mopti. The study involved all patients who had a gunshot wound to the abdomen during the study period. Data were entered into Excel and analyzed using SPSS (Statistical Package for Social Sciences) version 20 software. Results: A total of 27 cases (10.8%) of visceral gunshot wounds were recorded out of the 250 cases of ballistic wounds recorded during the study period. Intestinal perforation was the most common abdominal lesion, 11/27 cases (40.7%). The most surgical process performed was the ileo-ileal anastomosis resection with 9/27 cases (33.3%). The evolution was favorable in 22/27 (81.5%) of cases however was noted some cases of infectious complication and 2/27 cases of death (7.4%). Conclusion: Abdominal gunshot wounds are common in areas of armed conflict with intestinal perforation as the most common abdominal wound 427 Evaluation of Biochemical Markers of Hemophagocytotic Lymphohistocytosis with Severity and Outcome of Dengue Fever     , Tarun Betha, Ajit Tambolkar, Vihita Kulkarni-Nivargi, Arun Bahulikar and Deepak Phalgune   Background: The aim of the present study was to identify an association between biochemical markers of hemophagocytic lymphohistiocytosis such as serum ferritin, serum triglycerides, serum fibrinogen and serum lactate dehydrogenase with the severity of dengue fever and disease outcome. Material and Methods: Ninety patients aged ≥ 18 years with dengue fever confirmed with a serology- dengue non-structural protein 1 antigen-positive were included for this prospective observational study. The patients underwent tests that included serum ferritin, serum triglycerides, serum lactate dehydrogenase, and serum fibrinogen. The primary outcome measure was to find an association of serum triglycerides, serum lactate dehydrogenase,, serum ferritin and serum fibrinogen with the severity of dengue disease. Results: The median serum ferritin (870.0 ng/mL Vs 95.0 ng/mL), the mean serum lactate dehydrogenase (235 ± 36 U/l Vs 192 ± 24 U/l) and mean serum triglyceride (230 ± 33 mg/dL Vs 192 ± 24 mg/dL) were significantly higher in severe dengue fever patients as compared to dengue fever patients. The mean fibrinogen was 180 ± 45 mg/dL and 197 ± 46 mg/dL in severe dengue fever patients and dengue fever patients respectively (p-value = 0.149). Conclusions: Serum ferritin, serum lactate dehydrogenase and serum triglyceride levels were found to have a significant association with dengue disease severity. 428 Green Chemistry: Phyto-antibiotics, A Green Antibiotics, Isolated from Medicinal Plant of West Bengal Targeting Multi-drug Resistant Bacteria     , Sanatan Das, Sankalita Datta, Madhumita Dey, Kousik Poria and Asit Kumar Chakraborty Today green chemistry approaches have been introduced to reduced toxicity and environmental pollution. Interestingly, use of huge synthetic antibiotics caused generation of drug resistant bacteria with increased generation and amplification of mdr genes (bla, amp, tet, str, aph, aac, cat) and transposons (IS5, IS30, IS110 etc) in large plasmids. We coined the green antibiotics word to introduce phyto-chemicals that inhibited bacteria with specificity similar to synthetic drugs. Ideally plants secret anti-metabolites to retard the growth of microorganisms and thus a good source for new drug development. We explored the isolation and characterization of six organic plant extracts from medicinal plants of West Bengal. In truth, Taxol, Artiminisin, Etoposide and Camptothecin are well documented phyto-drugs used as anti-cancer and anti-parasitic drugs 429 Recent Trends in Nano-Drug Delivery Systems for Breast, Prostate, Brain, and Other Cancers       , Kinnera K, Kevin Sneed and Yashwant V Pathak Nano delivery system as well as Nano medicine is new initiative; however, it develops pharmaceutical science increasingly. Nanotechnology has several benefits to treat many chronic health issues, especially, cancer by target-oriented delivery of appropriate medicines. This assignment was about reviewing the existing literature on the Nano medicine and Nano drug delivery system, in context of different toes of cancer. It has discussed various nano particles that are considered for cancer treatment such as polymers, liposome, dendrimers, protein nano particles, and cellulose. It has provided information about both organic and inorganic nano particles. The findings have shown that in case of nano-drug delivery of cancer, lipid, dendrimers, polymers, and liposome highlighted promising results. This review presents update summary of recent trends within NDDS and nanomedicine by comprehensive scrutiny of application and delivery of nanoparticles by improving efficacy of old and novel drugs. Lastly, it has provided short information on future of NDDS and nanomedicine based on the collected information. That information indicates that since nanotechnology is increasing day-by-day, it has an emerging future. Additionally, researchers have the chance to develop effective treatment solution with help of nanomedicine. This is a literature review which covers various aspects of recent trends in nano drug delivery systems with focus on selected cancers. 430 Hypertension and the Interior Ion-milieu. Can we Overcome Hypertension with Regulated Breathing?     , Andras Sikter The author presents a new model for age-associated diseases through a hypothesized pathogenesis of hypertension. Preservation or restoration of the constancy of each original cell-specific intracellular ion-pattern is essential for upholding cellular identity and integrity. The ageing background is intracellular acidosis: low-grade respiratory acidosis elevates the intracellular HCO 3 - /Cl - gradient and induces metabolic syndrome, while low-grade metabolic acidosis causes exhausting buffer syndrome (EBS) with a decreased intracellular HCO 3 - /Cl - rate. The former elicits higher aldosterone levels to restore the original ion-pattern by NHE-1 (natrium-hydrogen exchange) mechanism located in the membrane of vascular smooth muscle cells (VSMCs) and by retaining NaCl. The fault of ion-status restoration leads to Salt-sensitive hypertension through cascades of events. The ion-pattern changes in EBS elicit angiotensin II levels elevation through the renin-angiotensin system, which tries to eliminate intracellular changes via NBCn1 (natrium-bicarbonate cotransporter). However, it leads to a dead-end, and Salt-resistant hypertension develops. Hypertension occurs because restoring the original intracellular ion-pattern in VSMCs by aldosterone and angiotensin II fails. These hormonal counter- regulations lead to Na + retention and alkaline overcompensation in the VSMCs. There may be several explanations for the failure, but hypertension would not develop if the intracellular ion-milieu were initially neutral or slightly alkaline. Regulated breathing could overcome hypertension 431 Medicare’s 30-days Readmission Rule in the United States: A Review and Recommendations       , Iqbal Ratnani, Annum Faisal, Parisa Aijaz, Samia Nadeem and Salim Surani   This review intends to explain the Center for Medicare and Medicaid Services (CMS) 30-days unplanned readmission rule under its Hospital Reduction Readmission Program (HRRP). In this article, we will briefly define this rule with its intent, origin, impact on patients, hospitals, and staff/managers. In other words, we will describe who, what, when, where, why, and how this rule applies. We would also make some recommendations in this regard 432 Why is there a Fear of Coronavirus?   Published: April 25, 2022; Volume 6 Issue 5: 168-172.   , Igor Klepikov It has been more than two years since the SARS-CoV-2 pandemic swept the world. During this time, not only vaccines were created to protect against this infection, but also vaccination of the population of many countries was started, followed by the preservation of the effect by the introduction of booster doses. Preventive measures have been expanded through the introduction of unprecedented quarantine measures. After a long implementation of such unusual preventive measures, it would seem that it is already possible to get rid of the feeling of fear and uncertainty before the trouble that has arisen. However, the surrounding reality shows that there has not been a complete reduction in tension due to the pandemic, and the fear of the danger of a disease with an uncertain outcome has not decreased even among passionate followers of protective measures 433 Gummy Smile Treatment Perception by Laypersons     , Abdalla Samir Nouh Background and Objectives: A gummy smile is excessive gingival display, and it can cause harassment for many people. Gummy smile can be caused by many factors such as jaw growth problems, incorrect bite, and hyperactive or short upper lip. The aim of this study is to determine the esthetic perception of gummy smile laypersons. It shows the most appropriate patient opinions and proper treatment plans to reach the maximum patient satisfaction. Materials and Methods: The current study was performed on 20 gummy smile cases photos treated by lip filler injections and orthodontic intrusion with average vertical facial patterns, divided into two groups which included 10 for each group. The sample photos contained 20 cases only to avoid layperson confusion. Cases were selected in the average age of 2530 years. Those of missing, misaligned or extracted teeth, having visible crowns on smiling, and facial asymmetries were excluded from the study. A questionnaire for each group was sent to 50 laypersons, but 43 laypersons responded, to evaluate their satisfaction by the smile as in Figs.1-3. Laypersons didn’t know which group treated either by filler injections or by orthodontic intrusion, to avoid any preferable treatment bias and to get accurate results. Results: Satisfaction with filler treatment attained the highest percentage, followed by satisfaction with orthodontic treatment and satisfaction with both groups, while not being satisfied represented the lowest percentage. Conclusion: Filler injections were rated the highest patient satisfaction due to the harmonically balance between soft tissues of the face after lip filling, in cases of well aligned teeth, if the teeth are maligned so orthodontic treatment came the first choice to align teeth as well as to fix gummy smile by intrusion 434 Management of the Droppings of Laying Hens of the "Large Poultry Farm" of the AECAM Common Initiative Group (CIG) of Mendong and Proposal of a Treatment System     , Severin Mbog Mbog, Dieudonne Bitondo, Jean Paul Lekefack, Innocent Ndoh Mbue and Simon Aneck Patamaken A Study on the management of the poultry manure at the “Large poultry farm” of the AECAM Common Initiative Group (CIG) of Mendong was carried out from June to December 2014, with the aim to propose a treatment system. The methodology consisted of documentary research, interviews to collect information relative to the management of faeces from the poultry farm. The identification and characterization of the potential impacts of this management on the environment was done by using the Léopold’s matrix, Fecteau’s grid and direct observations. The analysis of the current situation helped to propose a treatment system which aims both at: mitigating the harmfulness of faeces by reducing the content of harmful substances and improving the valorization of these waste. The results obtained show that the faeces produced are of two types namely; droppings and liquid manure, with a bi-weekly production quantities estimated at 52 140 ± 1 191 liters of droppings and 98 700 ± 3 371 liters of liquid manure. In addition to the lack of training and sensitization of the personnel in charge of these wastes, the collection and treatment tools are faulty. These leads to the disposal of dropping and poultry manure in neighboring water courses, bad odor spread and the loss of the esthetic view of the area. Meanwhile, 10% of the local populations and some members of the staff of the farm say that the management of the effluents is good, 52% find it bad. Regarding the potential impacts on the environment, the management of these wastes presents risks for the environment and the health due to the inadequacy identified in the field. These include; air pollution risks, deterioration of the quality of surface and underground water, soil pollution, fauna, flora and human intoxication. In general, the collection and transportation have less impact on environment as compared to storage and treatment of the droppings. A drying system by “non-planted bed” was designed and proposed for the poultry farm. The cost for its implementation is estimated at 29,000,000 Fcfa (twenty-nine million Fcfa). 435 Knowledge Attitude and Practice Towards Patients with Chronic Low Back Pain Among the Physiotherapist Clinical Practice at Dhaka City - A Cross Sectional Study     , Nafisa Tahera, Shamema Bari, Mohd Harun-Or-Rashid, Abul Hasnat Mohiuddin and Bijoya Sarkar Introduction: Low back pain is one of the top foremost causes of disability worldwide. Most cases of acute low back pain progress to chronic low back pain when recuperation takes more than three months. This is due to psychosocial factors, brain structural change and also the neurochemical changes which lead to change in the central mechanism of the brain. The management approach of chronic low back pain has evolved from the biomedical to the biopsychosocial come up to in order to consider the psychosocial factors during assessment and management of patients with chronic low back pain. The multidisciplinary team and biopsychosocial draw near are currently recommended in managing patients with chronic low back pain in order to gain best possible results for pa- tients. Their knowledge of the neurophysiology of pain and their attitudes and practice about patients with pain is equally important in influential the appropriate approach in the management of patients with chronic low back pain. Objective: The objective of this study was to evaluate Knowledge, attitude and practice towards patients with chronic low back pain among the physiotherapist clinical practice in Dhaka city of Bangladesh. Methodology: Cross sectional research with 105 participants among the target population of this study is male and female enthusi- astically grace with presence in Dhaka city of Bangladesh. On the other hand the study population was those congregation inclusion/ exclusion criteria and KAP study of chronic low back pain. Data was collected through a well structured NPQ for knowledge and HC- PAIRS for attitude and practice questionnaire prepared by the interviewer and approved by the examination board. Baseline informa- tion was collected through interviewer-administered questionnaire through face to face interview. Data were numerically coded and captured in Excel, using an SPSS 16.0 version 436 Management of Hypercholesterolaemia for Cardiovascular Risk Reduction: A Malaysian Perspective     , Jeyamalar Rajadurai, Wan Azman Wan Ahmad, Hapizah Nawawi, Choo Gim Hooi, Ng Wai Kiat, Rosli Mohd Ali, Al Fazir Omar, Sazzli Kasim and David Quek Kwang Leng Cardiovascular disease (CVD) is a major health problem worldwide. Primary preventive population-based strategies aimed at improving global cardiovascular (CV) health is being advocated universally. In addition, specific CV risk factors need to be addressed. This paper focusses on the management of hypercholesterolaemia from a Malaysian perspective and also discusses the newer lipid lowering agents. In individuals at low and intermediate CV risk, lifestyle modification alone may suffice. This encompasses a prag- matic and healthy diet, weight management and increased physical activity. In individuals at high and very high CV risk however, in addition to lifestyle modification, drug therapy is almost always necessary to achieve the target Low Density Lipoprotein Cholesterol (LDL-C) levels which have been shown to improve CV outcomes. In clinical trials, very low LDL-C levels (< 1.4 mmol/l) have been shown to retard progression and sometimes even result in regression of atherosclerotic plaques. Statins are the first-line drugs be- cause there is robust data that they are both effective and safe. Such low target LDL-C levels (< 1.4 mmol/l) however are sometimes not achievable despite maximally tolerated statin therapy and lifestyle modification. The addition of ezetimibe and/or Proprotein convertase subtilisin/kexin type 9 Inhibitors (PCSK9-i) to statins may be necessary to achieve these targets. 437 Bisphenol A and Melamine: The Toxins of the Modern Civilization   , Nitish Rai and Dibyajyoti Banerjee Bisphenol-A is one of the most common chemicals produced in the highest volume worldwide with over 6 billion pounds produc- tion annually [1]. It is a synthetic chemical used in the manufactur- ing of polysulfone, polycarbonate, polyacrylate, epoxy resins, flame retardant tetrabromobisphenol-A and polyvinyl chloride plastics [2]. The polymers like polycarbonate and epoxy resins are dan- gerously associated with food items as they are used in food con- tainers, reusable plastic bottles, baby feeders, dinner wares and internal coating of packaged food cans [3]. Today, the use of these polymers is not only limited to food industry but has extended to medical and dental devices, building materials, thermal papers, sunglasses, CD-ROM etc [2]. The production and usage have been so high that Bisphenol A is now ubiquitously present in the envi- ronment and a study has estimated that over 90% of people have considerable levels of Bisphenol A in the body [4] 438 Protective Effects of Manuka Honey Against Diazinon Induced Hepatorenal Toxicity in Adult Male Rats     , Mohsen Ali Khormi, Moustafa Hussein Roshdy Elnaggar and Mansour Attia Al-Hazmi Manuka honey is mono-floral honey produced by Manuka myrtle tree. MH has anti-inflammatory, anti-bacterial, anticancer, wound healing and other benefits. This experimental study aimed to monitor Diazinon administration effects on liver and kidney of adult male Albino rats and protective value of 6 weeks administration of MH against effects of Diazinon and mechanism of their actions. Forty rats weighing 180-220 g divided into four groups (10 rats each): Group I (control group): rats received 0.2 mg/kg corn oil, daily for 6 weeks. Group II (DZN group): rats orally administrated 50 mg/kg DZN in corn oil, daily for 6 weeks. Group III (MH group): rats orally administrated 1.5 g/kg MH daily for 6 weeks. Group IV (DZN + MH group): rats orally administrated 50 mg/kg DZN and 1.5 g/kg MH, daily for 6 weeks. After six weeks, blood samples collected from retro-orbital venous plexus. Serum samples used to determine levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin, creatinine, blood urea nitrogen (BUN), total protein (TP), albumin (ALB), glucose, triglycerides (TG), total cholesterol (CHO), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c) very-low- density lipoprotein cholesterol (VLDL-c), creatinine kinase (CK) and lactate dehydrogenase (LDH). After blood sampling, livers and kidneys isolated, fixed in 10% buffered formalin and examined under light microscope. DZN led to hyperglycemia, increased in serum levels of triglyceride, CHO, LDL-C, VLDL-C, AST, ALT, ALP, GGT, creatinine, Blood urea nitrogen, CK and LDH but significant decreased in total proteins and albumin. Administration of MH led to improvement of blood glucose, lipid profile, liver function tests and kidney function tests, Tissue destructive enzymes. These improvements were confirmed histologically by examination of hepatic and renal tissues. In conclusions, DZN had hepatotoxicity and renal toxicity that improved by Manuka honey administration for 6 weeks. 439 Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: A New Kid on the Block     , Suganya Karikalan and Salim Surani Around 29.5 million people in the United States over the age of 30 years suffer from mild to severe Obstructive Sleep Apnea. Positive Airway Pressure (PAP) remains the mainstay of treatment of OSA. Despite being the gold standard treatment for many years, the compliance rate for the PAP devise remains low. Other modes of treatment such as the use of Mandibular Devices, surgery for relieving the obstruction, and weight reduction surgeries carry high morbidity and mortality. The new evolving Upper Airway Stimulation therapy – Hypoglossal Nerve stimulation opens new and alternate pathways of treatment approach to OSA. This opinion- minireview explores two new devices, the INSIGHT MEDICAL SYSTEMS DEVICE, and the eXciteOSA device 440 Surgery for Chronic Glaucoma by the Technique of Non-perforating Deep Sclerectomy at the Bartimée Ophthalmological Clinic: About 50 Cases   , Sovogui Maxime Dantouma, Balde Ramata, Zoumanigui Christophe, Grovogui Moriba Marcelin, Vonor Kokou and Mermoud Andre Abstract Purpose: Contribute to improving the management of Primary Open Angle Glaucoma. Patients and Methods: This was a prospective descriptive study of 6 months. Patients included in the operative report register. Were not included, as patients did not consent and those operated on but followed elsewhere. Our variables were sociodemographic, clinical, therapeutic and evolutionary. Results: The mean age was 45.20 ± 14 years, sex ratio 1.21. The most frequent comorbidity was arterial hypertension 54.76%. Preoperative visual acuity was <1/10 in the right eye in 71.43% and between 1-2/10 in the left eye in 57.14%. Fundus glaucomatous excavation was the most common lesion, 92.5% in the right eye and 85.7% in the left eye. Intraocular pressure was normal in 52.3% in the right eye and in 71.4% in the left eye, the visual field was impaired in 85.71% in the right eye and in 88.1% in the left eye. ‘left eye. The surgical act was performed by the same surgeon in 100% of cases. On D25 postoperative, visual acuity without correction was ≥3/10 in 67.85% in the right eye and in 68.18% in the left eye; the Intraocular Pressure was between 9-21 mm Hg in 96.43% of cases in the right eye and in 95.45% of cases in the left eye; there were no complications in 100% of cases. Vision was unimproved in 52.0%. Conclusion: Deep non-perforating sclerectomy allows a lasting reduction of intraocular pressure with the formation of filtration 441 Utilization of Infographics for Breast Cancer Awareness: Another Look     , Asefeh Kardgar and Raji Sundararajan Breast cancer is the most frequent malignancy among women worldwide. It affects about one in every eight women at some point in their lives. In the U.S., women younger than forty-five years old account for about nine percent of all affected individuals. Breast cancer in young females is more likely to be inherited than breast cancer in aged females, and if it is diagnosed late, there will be progression of the disease, and it will be more invasive and harder to treat. Several young women are unaware of their breast cancer risk or how to reduce it. For this, more awareness of the disease is needed. Towards this, in this research, utilization of infographics is reviewed. It compares various infographics used for breast cancer awareness. It is also of practical interest to evaluate the parameters and factors that can improve the effectiveness of the breast cancer infographics and know why we need to design a new infographic for breast cancer and what the characteristics should be. Hence, the current study also suggests designing an infographic related to the early diagnosis of breast cancer awareness. The early diagnosis-based breast cancer infographic will educate and/or enhance their previous knowledge the women, especially those at higher risk, about examining the symptoms, like lump formation, excessive secretions from the nipples, and pain. The novel infographic should be a combination of motion and static infographics (such as interactive infographics) that will present the breast examination video from time to time in a short video clip with background audio. The pink or blue color scheme, pictures, icons, logos, and fewer words should be used to design a new infographic. As a result, the current study focuses on the potential for increasing health awareness about breast cancer to influence early diagnostic strategies adherence favorably. 442 Management of Limb Lesions of Ballistic Trauma at Sominé DOLO Hospital of Mopti     , Brehima Traore, Djibril Traore, Modibo Coulibaly, Soumaila Sagara, Oumar Guindo, Abdoulaye Traore, Dramane Cisse, Pierre Coulibaly, Kiffery Ibrahim Keita, Fode Mory Keita, Dramane Samaké8, David T Théra, Aly Guindo, Aly Diallo and Adegue P Togo Background: Mali is a west African country which has been going through armed conflict, insecurity and socio-political instability since 2012. This multidimensional crisis has led to an avalanche of violence with health repercussions, including ballistic trauma to limps. Sominé DOLO hospital is a second reference hospital located in the center of Mali where the war wounded are referred. The objective of this work was to describe the characteristics and the management of limb lesions du to ballistic trauma. Patients and Methods: This was a prospective study from January 1 to December 31, 2019 in the surgery department. Our study focused on 170 limb-injured patients out of the 250 patients admitted to the emergency department for ballistic trauma. The study population consisted of patients of all ages presenting a ballistic injury to the limbs. Data was captured and analyzed on Epi-info 7.2.4.0. Proportions and means were calculated for qualitative and quantitative variables, respectively. Results: Out of the 250 cases of ballistic lesions, 170 cases (68%) of limb injuries were found. The average age was 41 years. The sex-ratio was 9. Isolated wounds without fracture were the most frequently lesions in the limbs, 108 cases (63.5%) followed by fractures 62 cases (36.5%). Out of the 179 cases, surgery was performed twice in 83.6%. Patients with open fractures accounted for 54 (31.8%) and had been operated on more than 3 times. We resorted to orthopedic treatment, 30 cases (48.4%) received a plaster splint, 14 (22.6%) an external fixator and in 6 cases (9.7%) limb amputation was performed. The evolution was favorable in 90.8% of cases, however some cases of complications was noted such as surgical site infection (6.3%) and 5 cases of death (2.9%). Conclusion: It appears that the majority of patients affected by ballistic trauma to the limbs were civilians with a predominance of the male sex. Lesions of the lower limbs were the most frequent. Surgical trimming and delayed closure well conducted reduced the risk of complications. Keywords: Armed Conflict; Limbs Lesions; Surgical Management 443 Allergic Rhinitis and Atopy: The Causative Role of Aeroallergens: A Review     , G Shyam, R Chandana, G Anusha Reddy, M Asimuddin and Kaiser Jamil Abstract The prevalence of Allergic Rhinitis (AR) has increased globally in recent times from 10 to 20% which can further deteriorate to atopy affecting adults and children equally. The main causative agents include aeroallergens which produce symptoms, not only like sneezing, itching, and nasal congestion, but also affecting the quality of life (QoL) and disturbed sleep. This review evaluates the risk parameters of allergic rhinitis which generally occur due to indoor and environmental aeroallergens, these interact with the host’s immune system to increases the production of specific immunoglobins like IgE. These specific IgE antibodies bind to high-affinity IgE receptors on mast cells and basophils and trigger a sequence of events leading to allergic rhinitis, chronic rhinitis, and atopy. The propensity to produce IgE to allergens is referred as Atopy. This article examines the mechanism of the causative agents leading to the disease, with regards to the potential differences in health care and allergic rhinitis. The diagnoses, pathophysiology and subsequent treatment of the disease impacts an economic burden on the patients, further, co-morbidities associated with AR impose additional financial burden and can have a negative impact on the QoL of the patients. Hence this article observes the economic burden due to AR which is estimated at 10-40% of the country’s economic burden. This review further highlights on improving the well-being of the patients through better diagnosis and utilizing currently available treatment options for Allergic rhinitis. 444 Protective Effect of Arabian Balsam (Commiphora gileadensis) Against Hepatorenal Toxicity of Diazinon in Male Rats     , Mohsen Ali Khormi, Moustafa Hussein Roshdy Elnaggar and Mansour Attia Al-Hazmi The aim of the present study was to assess the protective effect of the Arabian Balsam (Commiphora gileadensis) against the hepatorenal toxicity of Diazinon (DZN) on adult male albino rats. Forty male albino rats weighing 180-220 g were divided into four equal groups as follows: Group I (control group): untreated group that received 0.2 mg/kg of corn oil, daily for 6 weeks. Group II (DZN group): orally administrated 50 mg/kg of DZN in corn oil, daily for 6 weeks. Group III (Balsam group): orally administrated Arabian balsam 500 mg/kg daily for 6 weeks. Group IV (Balsam + DZN group): orally administrated 500 mg/kg balsam + 50 mg/kg DZN, daily for 6 weeks. After six weeks, blood samples were collected from retro-orbital venous plexus. Serum samples used to determine levels of liver and kidney functions. After blood sampling, livers and kidneys were isolated and fixed in 10% buffered formalin and then were processed and stained with Hematoxylin and Eosin stain and examined under light microscope. DZN administration caused significant decrease in final body weights, total proteins, albumin and high density lipoprotein cholesterol but significant increase in triglyceride, total cholesterol, low density lipoprotein cholesterol, very low density lipoprotein cholesterol, aspartate amino- transferase, alanine, aminotransferase, alkaline phosphatase, gamma glutamyl transferase, creatinine and urea nitrogen, creatinine kinase and lactate dehydrogenase enzymes compared with control and Balsam treated groups. Balsam administration led to significant decrease in blood glucose level versus control and DZN groups. In balsam + DZN group led to improvement of lipid profile, liver function tests, kidney function tests and tissue destructive enzymes. These improvements were confirmed histologically. In conclusion, DZN caused hepatorenal toxicity in rats that was improved by Arabian Balsam administration for 6 weeks. In conclusion, DZN led to hyperglycemia, dyslipidemia, alteration of liver and kidney function tests increased in tissue destructive markers as CK and LDH. Administration of balsam led to improvement of measured parameters. These improvements were confirmed histologically. In conclusion, DZN caused hepatorenal toxicity in rats that was improved by Arabian Balsam administration for 6 weeks. 445 Protective Effect of Arabian Balsam (Commiphora gileadensis) Against Hepatorenal Toxicity of Diazinon in Male Rats     , Mohsen Ali Khormi, Moustafa Hussein Roshdy Elnaggar and Mansour Attia Al-Hazmi Abstract The aim of the present study was to assess the protective effect of the Arabian Balsam (Commiphora gileadensis) against the hepatorenal toxicity of Diazinon (DZN) on adult male albino rats. Forty male albino rats weighing 180-220 g were divided into four equal groups as follows: Group I (control group): untreated group that received 0.2 mg/kg of corn oil, daily for 6 weeks. Group II (DZN group): orally administrated 50 mg/kg of DZN in corn oil, daily for 6 weeks. Group III (Balsam group): orally administrated Arabian balsam 500 mg/kg daily for 6 weeks. Group IV (Balsam + DZN group): orally administrated 500 mg/kg balsam + 50 mg/kg DZN, daily for 6 weeks. After six weeks, blood samples were collected from retro-orbital venous plexus. Serum samples used to determine levels of liver and kidney functions. After blood sampling, livers and kidneys were isolated and fixed in 10% buffered formalin and then were processed and stained with Hematoxylin and Eosin stain and examined under light microscope. DZN administration caused significant decrease in final body weights, total proteins, albumin and high density lipoprotein cholesterol but significant increase in triglyceride, total cholesterol, low density lipoprotein cholesterol, very low density lipoprotein cholesterol, aspartate amino- transferase, alanine, aminotransferase, alkaline phosphatase, gamma glutamyl transferase, creatinine and urea nitrogen, creatinine kinase and lactate dehydrogenase enzymes compared with control and Balsam treated groups. Balsam administration led to significant decrease in blood glucose level versus control and DZN groups. In balsam + DZN group led to improvement of lipid profile, liver function tests, kidney function tests and tissue destructive enzymes. These improvements were confirmed histologically. In conclusion, DZN caused hepatorenal toxicity in rats that was improved by Arabian Balsam administration for 6 weeks. In conclusion, DZN led to hyperglycemia, dyslipidemia, alteration of liver and kidney function tests increased in tissue destructive markers as CK and LDH. Administration of balsam led to improvement of measured parameters. These improvements were confirmed histologically. In conclusion, DZN caused hepatorenal toxicity in rats that was improved by Arabian Balsam administration for 6 weeks 446 Evaluation of Educational Environment: Perceptions of Preclinical and Clinical Year Medical Students from Malaysia     , Kye Mon Min Swe, Chan Choong Foong and Vinod Pallath Abstract Background: Educational environment of an education institution is where teaching and learning activities occur. Educational environment plays an important role in academic achievements, satisfaction and successes of student and it is a major determinant of developing effective learning. Aims: The aims of the study were to determine the perceptions of educational environment among all medical students at and to compare these perceptions between pre-clinical and clinical year students. Settings and Design: This cross-sectional study involved all medical students (from Year 1 to Year 5) of University Tunku Abdul Rahman. Year 1 and Year 2 were pre-clinical years and Year 3 to Year 5 were clinical years. Methods and Material: Dundee Ready Educational Environment Measure (DREEM) was used to determine the educational environment. Statistical analysis used: SPSS 26 was used to analyse the data. Analysis of variance was used to compare the mean scores of the domains of DREEM. Results: Two-hundred-and-seven (n = 207) students responded to the questionnaires. Perceptions of medical students on educational environment showed that there were more positive than negative aspects (M = 123.41). Highest rated item was item 2; “The teachers are knowledgeable” (M = 3.43) and lowest rated item was item 27; “I am able to memorize all I need” (M = 1.27). Meanwhile, upon comparison, pre-clinical year students were more satisfied than clinical year students did in all the five domains of DREEM. In addition, social self-perception (Domain 5) in pre-clinical years was significantly greater than clinical years. Conclusion: This study identified strengths and areas for improvement of the educational environment at UTAR. Strengths should be maintained to continue satisfying learning needs of the medical students. It was recommended that educational environment related with social life of clinical year students should be monitored closely. 447 Prevalence and Risk Factors of Thrombocytopenia in a Medical Intensive Care Unit in Egypt     , Ahmad M Hassaneen 448 Covid-19 Infection Among Asymptomatic and Symptomatic Patients in Kuwait     , Huda Al-Ghareeb and Asma AlKandari Objective: Discuss the importance of early transmission control at the onset of an epidemic with special reference to healthcare workers in Covid-19 centers. Summarize the clinical characteristic if fined for Covid -19 patients attending the Covid -19 centers. Discuss the implication for design of diagnostic strategies for HCWs at risk of COVID-19. Aim: To assess the prevalence of asymptomatic individuals in this outbreak and to describe the clinical presentation of patients with mild and moderate Covid-19. To estimate the asymptomatic ratio- the percentage of carriers with no symptoms will improve understanding of COVID-19 transmission and the spectrum of disease it causes, providing insight into epidemic spread 449 Covid-19 Infection Among Asymptomatic and Symptomatic Patients in Kuwait     , Huda Al-Ghareeb and Asma AlKandari Abstract Objective: Discuss the importance of early transmission control at the onset of an epidemic with special reference to healthcare workers in Covid-19 centers. Summarize the clinical characteristic if fined for Covid -19 patients attending the Covid -19 centers. Discuss the implication for design of diagnostic strategies for HCWs at risk of COVID-19. Aim: To assess the prevalence of asymptomatic individuals in this outbreak and to describe the clinical presentation of patients with mild and moderate Covid-19. To estimate the asymptomatic ratio- the percentage of carriers with no symptoms will improve understanding of COVID-19 transmission and the spectrum of disease it causes, providing insight into epidemic spread 450 Investigation of High-Mobility Group Box 1 Protein Levels in Gastrointestinal Malignities       , Hanim Seval SavaS, Hulya Cicek, Mustafa Yildirim and Huseyin Gurbuz Cancer is a serious health problem that is common in humans and its development is quite complex. Protein-coding genes, tumor suppressor genes, and some biomarkers responsible for the growth, differentiation, and metastasis of cancer cells are used in the diagnosis and treatment of cancer patients. Gastrointestinal cancers are the most common cancers worldwide and cause more deaths than any other type of cancer. The poor prognosis of patients diagnosed with gastrointestinal cancer has made primary prevention a potentially attractive approach. Despite improved diagnosis and treatment methods, survival rates are low. Therefore, early diagnosis and treatment of cancer are important. High Mobility Group Box 1 (HMGB1), an important biomarker in cancers, regulates DNA and transcription. HMGB1 plays a role in cancer progression, angiogenesis, and metastasis development. Plasma samples were used in this case-control study involving 68 gastrointestinal cancer patients and 40 healthy controls. HMGB1 was measured by the ELISA method. There was a significant relationship between the patient and control groups in terms of HMGB1 level. It was determined that 98.5% sensitivity, 90% specificity, and 19.31 values could distinguish the patient and control groups. There is no significant difference in HMGB1 levels among gastrointestinal malignancy groups. We found evidence of a significant association between HMGB1 protein and all gastrointestinal cancers. Since results suggest that HMGB1 may play an important role in cancer diagnosis, studies on this marker should be increased. 451 Self-healing   , Edward F Block This article is titled as Self-Healing. Self-Healing occurs all of the time as it is a quite natural body process. However, it seems that very few human beings, if any, understand this natural process. In putting forth my knowledge and understanding of the natural processes of just what comprises “Healing” of the human physical body components, there is quite a bit of background information that will need to be explained first. The concepts put forth are not of the usual sort and will require a considerable amount of rumination to occur before any real learning path for you becomes evident. This is due for the most part because of the actual and real nature of just what comprises healing in any form, according to my personal understanding. I am still learning. The purpose, then, of this work is to aid you the seeking individual in your journey towards knowledge and understanding of just what the evolution of animate organisms has given to us as human beings for ensuring that we continue and thrive within the Biosphere of the Earth 452 COVID-19 Infection in a Patient with Paroxysmal Nocturnal Hemoglobinuria   , Khaleduzzaman HM and Mishu Nafisa Jabin Severe acute respiratory syndrome coronavirus 2 (SARS COV-2) activate and enhances complement mediated cell destruction through membrane attack complex (MAC) formation (Ting Gao, 2020) [6]. In paroxysmal nocturnal hemoglobinuria (PNH) there is deficiency of complement regulatory proteins (CD55 and CD59) which enhances the red blood cells (RBC) to lysis by MAC (Rother, 2005) [3]. SARS COV-2 causes complement activation on the other hand individuals with PNH is vulnerable to complement mediated destruction of RBC. In PNH when massive hemolysis occur hemosiderin become deposited in renal tubule causing acute renal tubular necrosis (ATN). If it is diagnosed and treated early it may be reversible but if remain untreated it may progress to chronic kidney disease (CKD) as occur in this patient (Hussain S, 2013) [1]. Individual with PNH when superadded with COVID-19 infection it should be treated with extreme caution to prevent multiple complications 453 University Support for International Students Entering Canadian Universities     , M Shalima Sulthana and C Nagaraju Acta Scientific MEDICAL SCIENCES (ISSN: 2582-0931) Volume 6 Issue 6 June 2022 University Support for International Students Entering Canadian Universities M Shalima Sulthana* and C Nagaraju Department of CSE, Yogivemana Engineering College of YV University, India *Corresponding Author: M Shalima Sulthana, Department of CSE, Yogivemana Engineering College of YV University, India. Review Article Received: August 30, 2021 Published: May 11, 2022 © All rights are reserved by M Shalima Sulthana and C Nagaraju. Abstract This is a literature review of programs offered by universities to international students taking degrees as part of their entry requi- rements for residency in Canada. Canada lacks the population to sustain its labour markets, due to low domestic birth rates. Over the past decade, federal and provincial governments partnered with post-secondary institutions to develop immigration programs that attract international students. They come to Canada with high expectations of ready access to job markets and many have professio- nal credentials and work experience from their home country. The purpose of this article is to explore ways universities operating in Canada can improve their educational contributions for international students who face numerous barriers as they transition into a new country. Through provision of effective social, psychological, and academic preparation, universities facilitate the transition from entry to the country to the job market. The literature reveals examples of university initiatives and programs that provide international students with accurate information and support early in their entry to Canada such as orientation, support services for information, sense making, and preparation for their education degrees. The student’s academic success hinges on sufficient English language skills to participate fully in the education experience and to enter the job market. University faculty and staff design new curriculum for inclusiveness, informality, and social interaction, an unfamiliar classroom to most international students. Although universities have a history of multi-cultural education and diversity policies, more is needed to strengthen inclusiveness. This requires faculty and staff who are keenly aware of the challenges facing international students. While enormous efforts by government and universities resulted in graduation of international students and successful entry into the job market, additional research is essential. The future of the Canadian economy rests upon easier entry of international students to jobs through university programs 454 A Multi-country Analysis of the Treatment Options for Late-life Depression in Geriatric Patients     , Chamanthi Konidala, Kevin Sneed and Yashwant Pathak Abstract In many countries around the world, the geriatric population is still one group that lacks proper healthcare. Further, the prevalence of mental illnesses, like late-life depression, grows in the elderly as costs of care, family separation, and inexistence of government support increases. Despite these circumstances, the geriatric population seems to be growing day by day. The purpose of this paper is to bring awareness to late-life depression present in the elderly population. The main body of the paper is separated based on the different countries that were discussed (China, India, and the United States). The different cultural beliefs each country contains were identified. These differences brought attention to how late-life depression may be prevalent in the different countries. Lastly, with the cultural differences in mind, various treatment options were proposed to aid the geriatric population in each country. As the paper progressed, it was clear to see that cultural differences truly affected which therapies certain elderly individuals will be the most responsive to. Thus, there is no one true winner in the many solutions given. As a result, future research on this subject may be on identifying a proper treatment that could work universally with cultural beliefs in mind 455 Awareness and Practices of Traffic Police on Prevention of Respiratory Problems in Kathmandu     , Sneha Katuwal, Apsara Pandey and Devaka Kumari Acharya Abstract Introduction: Respiratory problems are major cause of morbidity and mortality worldwide. Outdoor air pollution has become a major environmental risk to public health. Traffic police expose more to polluted air that increases the risk of respiratory problems and affect to their health. Aim: This study aims to find out the awareness and practice regarding prevention of respiratory problems among traffic police in Kathmandu. Methods: This study used a descriptive cross-sectional design. Data were collected through structured self- administered questionnaire from 102 traffic police working in five traffic police stations of Kathmandu using the non-probability purposive sampling technique. Data were analyzed by using descriptive statistics. Chi-square and correlation were used to measure the association between level of awareness regarding prevention of respiratory problems and different variables. Results: The study found that the mean age of the traffic police was 28.8 ± 5.29 years, 77.5% were police constable, and mean work experience was 6.28 ± 4.30 years with mean duty hours per day was 13.62 ± 2.40 hours. Only 65.3% and 39.6% had knowledge about bronchial asthma and chronic bronchitis respectively as effects of outdoor air pollution on the respiratory system. Likewise, 85.3% had said implementation of strict traffic rules regarding reducing of air pollution for prevention of respiratory problems. Similarly, almost all (91.2%) of them had said anti-pollution face mask as most suitable for protecting from inhalation of polluted air. Similarly, 100.0% traffic police had used mask during duty hour whereas only 54.9% face masks the whole time during duty hours. Only 22.5% had implemented strict traffic laws to vehicles regarding air pollution, 10.8% had rotation of duty area to prevent respiratory problems due to air pollution and 9.8% had done routine health check-ups. More than half of the traffic police (51.0%) had an inadequate level of awareness and (56.7%) had an inadequate level of practice on the prevention of respiratory problems. There was a positive correlation between level of awareness and level of practice (r = 0.334, p = 0.001). Conclusion and Recommendation: This study concluded that traffic police have inadequate awareness and practice regarding the prevention of respiratory problems. It is recommended to conduct regular health awareness programs and training regarding prevention of air pollution-related respiratory problems among traffic police by concerned authorities. 456 Relapse Processes are Important in Modelling Drug Epidemic     , Alexander Yu Tang and Maurice HT Ling   Global drug epidemic is an important public health issue. Mathematical modelling is vital for gaining insights, which may inform policymaking. Several modelling studies fail to adequately address relapse, which includes rapid relapse into heavy or light drug use, and relapse after extended sobriety. Here, we study the impact of relapses by incorporating relapse processes into an existing 6-compartment model. Our results show that the proportions of drug users are higher with relapse processes than that without relapse processes; yet, the proportion of rehabilitation is lower with relapse than without relapse. This highlights the importance of relapse processes in modelling drug epidemic 457 Laparoscopic Findings in Patients with Secondary Infertility   , Shamim Akhtar, Zill E Huma, Naila Nasr Malik, Humaira Bibi1, Asma Amin Baig and Shazia Zulfiqar Objective: To see the common findings in diagnostic laparoscopy in patients with secondary infertility. Place and Duration: This is a retrospective cross sectional study of 70 patients with secondary infertility. Diagnostic laparoscopies were performed at Health care center (pvt) Ltd, Peshawar from July 2020 to September 2021. Background: Infertility is very painful condition. It causes psychological stress, social disgrace and affects quality of life of a couple. In Pakistan prevalence of infertility is 22%. Secondary infertility contributes its major proportion. There are different causes of it. In majority of cases it is because of some pelvic pathology. Diagnostic Laparoscopy is a good tool for diagnosing and treating the pelvic pathologies. Material and Methods: Laparoscopy was performed after taking informed consent of all patients who had at least previous one confirmed pregnancy irrespective of outcome and had normal semen analysis. Females with midline abdominal scar were excluded. Pelvic findings were noted. Percentages, frequencies of findings and mean for age were calculated. Data Analysis was done on SPSS. Results: In this study laparoscopy was done in 70 patients with secondary infertility. Mean age of presentation was 29.1 yrs and mean duration of infertility 6.34 yrs. 16 patients had tubal factor and 10 had PCO. Fibroid uterus, pelvic adhesions, endometriosis and PID were seen in 6,5,4 and 3 patients respectively. 26 patients had normal pelvic findings 458 Coping Strategies and Distress in Patients and Caregivers Dealing with Neurocognitive Disorders     , Maria Devita, Erika Ruffino, Pasquale Anselmi, Daniela Mapelli, Michela Sarlo, Giuseppe Sergi and Alessandra Coin Abstract Background and Aims: Quality of life (QoL) is described as the individual’s perception of life in relation to the cultural context and value system in which they live, and their objectives, expectations and interests. The aim of the present study is to investigate the perceptions of QoL on the part of patients with Mild Cognitive Impairment (MCI) or mild dementia and on the part of their caregivers, by examining how they are influenced by factors such as anosognosia, coping strategies, perceived stress and caregiver burden. Methods: QoL was assessed in a sample of 30 patients with MCI or mild dementia and their caregivers using the QoL-AD. Other variables were measured with the AQ-D, PSS-10, COPE-NVI-25 and CBI instruments. We also assessed patients’ levels of cognitive impairment with the MMSE. Results: Patients’ QoL ratings were significantly higher than those of their respective caregivers. Patients’ perceptions of QoL were predicted by their caregiver’s avoidance coping strategy (β = -0.591, p < 0.01), whereas the caregivers’ perceptions of QoL were predicted by their perceived stress levels (β = -0.567, p < 0.01), the patient’s transcendent orientation (β = -0.369, p < 0.05) and the caregiver’s positive attitude coping strategy (β = 0.312, p < 0.05). Conclusions: This study shows that perception of QoL is mostly influenced by coping strategies and perceived stress, and that caregivers’ dysfunctional coping strategies can affect patients’ perceptions of QoL. Our data also highlight the crucial role of the caregiver in the treatment of neurocognitive disorders 459 Evaluation Study: Epidemiological Trends of COVID 19     , Yarmaliza, Teungku Nih Farisni, Fitriani, Fitrah Reynaldi, Zakiyuddin, Veni Nella Syahputri and Rinaldy Coronavirus Disease or COVID-19 is still a concern around the world. The latest COVID-19 case situation is still showing a fairly high number or case, so the potential for transmission is great. there is still a great deal of contention encompassing it. As indicated by Brian Mahoney from the Related Press, Ron Artest is sending off a that will be shown the occurrence in this whole interestingly during Kickoff. Consequently, we drove an overview of studies associated with Covid 19, which were comprehensively applied in mid 2020 to the farthest furthest reaches of August 2020. As of recently, conclusive treatment for Coronavirus has not been found, patients with Coronavirus are just given supportive treatment. The method used in this research is a literature study, which is a study whose research object is in the form of library works, either in the form of scientific journals, books, articles in the mass media, as well as statistical data so as to describe the epidemiological trend of COVID 19. The purpose of writing this article is to knowing the distribution trend of COVID-19, which is still a pandemic issue. 460 Success Rate of Smoking Quitting in those who Attends Smoking Cessation Clinic: A Cross Sectional Study     , Abdulhakam Falemban and Mostafa Kofi Abstract Background: Different cessation rates have been reported from various smoking cessation clinics. There is limited and contradicting available data about smoking cessation rate in Saudi Arabia. Objectives: To objectively and accurately measure the cessation rate, and subsequently the effectiveness, of smoking cessation clinics. Subjects and Methods: Cross-sectional observational study was carried out at the smoking cessation clinic, Ministry of Health, Makkah city. It included a sample of smokers enrolled in the national Saudi tobacco control program and followed regularly with an anti-smoking clinic at least for 3 months despite the form of treatment (either cognitive behavioral therapy or pharmaceutical). A self-administered Arabic validated questionnaire was used in this study. It includes two main sections: the demographic data of the participants, and the factors and the determinants that faced the participants in the smoking cessation process. Results: A total of 340 smokers were included in this study. Most of them (77.4%) were males. Their age ranged between 18 and 66 years with an arithmetic mean of 37.9 and standard deviation of 12.1 years. Almost one-quarter of the participants (27.4%) had succeeded to quit smoking. Determination and purposefulness was the main reason for successful smoking cessation (53.8%), followed by following anti-smoking program (21.5%) and using anti-smoking therapy (10.8%). Starting smoking after age of 20 years (p = 0.001), smoking 10 cigarettes or less per day (p<0.001) and frequent trying to quit smoking (p<0.001) were significant determinants for successful smoking cessation 461 Real Life Experience of Combining Atezolizumab (Immunotherapy) and Bevacizumab (Antiangiogenic Agent) in Patients with Unresectable Hepatocellular Carcinoma in Bangladesh     , Mamun Al Mahtab, Musarrat Mahtab, Proshikha Saha and Sheikh Mohammad Fazle Akbar Abstract Introduction: In a global, phase 3, multi-center,open label clinical trial combination of atezolizumab and bevacizumab has yielded encouraging results, including better survival benefit and safety in patients with unresectable hepatocellular carcinoma. Methods: We conducted a real-life observational study in small number of Bangladeshi patents with unresectable HCC on the background of decompensated liver cirrhosis. Results: We had 6 patients in our study and the patients took the drugs in diverse number of cycles. One of the patients who took six cycles of the drugs have been surviving for about 15 months. Atezolizumab and bevacizumab combination proved to be safe during 48 hours of follow up, however, long-term follow up had not been possible for all patients due to their unavailability after administration. Conclusion: Atezolizumab and bevacizumab combination seem to have encouraging outcome with approved dosage and administration, however, clinical study with larger cohort should be accomplished in Bangladesh to properly assess its possible usage in Bangladeshi patients 462 Evaluation of a Chromogenic Medium for the Identification and Isolation of MRSA     , Ede Tyrell, Lorenzo Richards, Tanesha Mentore, Shemuel Ben Lewi and Nazara Roach Abstract Abbreviations ATCC: American Type Culture Collection; CA-MRS: Community Acquired Methicillin-Resistant Staphylococcus aureus; CDC: Center for Disease Control; CLSI: Clinical Laboratory Standards Institute; FDA: Food and Drug Administration; FN: False Negative; FP: False Positive; HA-MRSA: Hospital Acquired Methicillin-Resistant Staphylococcus aureus; LTCF: Long Term Care Facilities; MHA: Introduction: We sought to evaluate the screening ability of the chromogenic medium, HardyCHROMTM MRSA, for the identification of Methicillin Resistant Staphylococcus aureus (MRSA) from clinical specimens at 24 hours and 48 hours of incubation. Materials and Methods: 100 Staphylococcus aureus isolates were obtained from 162 non-repetitive clinical specimens which included: pus aspirates, blood cultures, urine; ear, wound and vaginal swabs. Stool specimens were excluded due to the possible interference of commensals. Suspected isolates of S. aureus were confirmed using Mannitol Salt Agar (MSA) and the coagulase test. Two methods were compared for the detection of MRSA: (1) The Reference method -Kirby-Bauer disk diffusion method with a 30 (μg) cefoxitin disk on Mueller Hinton Agar (MHA) and (2) The Test method – observation of HardyCHROM™ MRSA after 24 and 48 hours. For the Reference method, a zone diameter of ≤21 mm was an indication that the isolate was MRSA, while ≥22 mm was identified as Methicillin Sensitive Staphylococcus aureus (MSSA). Pink to magenta colonies on HardyCHROM™ MRSA were interpreted as MRSA. No growth after 48 hours was documented as MSSA. Results: A total of 100 Staphylococcus aureus isolates, obtained from 162 non-repetitive clinical specimens were processed. The specimens were mainly pus aspirates (36%), blood cultures (27%) and wound swabs (13%). After 24 hours, the sensitivity, specificity, PPV and NPV of HardyCHROM™ MRSA were 96.9%, 5.6%, 64.6% and 50.0% respectively. At 48 hours, the sensitivity, specificity, PPV and NPV of HardyCHROM™ MRSA were 96.9%, 0%, 63.3% and 0%, respectively. Using McNemar’s test, to compare the two tests, a significant difference (p value <0.05) was found at 24 hours and 48 hours incubation Conclusions: We concluded that because of the high sensitivity of HardyCHROM™ MRSA, this medium would be effective in the screening of patients or staff to identify persons with an MRSA infection or those carrying MRSA 463 Peculiarities of Scoliosis of Black Children and Adolescents     , Ngo Yamben Marie-Ange, Muluem Kennedy, Guifo Marc-Leroy, Mbono Betoko Ritha Carole, Bat Rebecca, Nana Chunteng Theophile, Nseme Etouckey Eric, Batchom Daudet, Manga Alexandre and Handy Eone Daniel Abstract Introduction: Scoliosis is a pediatric pathology characterized by a deformation of the spine exerting a twist around its axis. Its expression is variable and multifactorial. When they are severe, they can become disabling and therefore justify appropriate care. However, the African literature is scarce on the subject. Objective: The objective of our work was to draw up the epidemiological, radio-clinical and evolutionary profile of scoliosis in black children and to highlight their singularities. Patients and Methods: We conducted a retrospective descriptive and analytical study over a 10-year period including all patients aged 0 to 17 years with scoliosis at the NCRPD. Results: We collected 69 cases with a female predominance. The prevalence of scoliosis in children was 0.4% and that of adolescents was 4.2%. The average age was 4.88 years for children and 15.16 years for adolescents. The average time of the 1st consultation was one year for children and 3 years for adolescents. They were severe and very severe (Cobb angle > 35°) in 76.8% of cases and symptomatic in 78.3% of cases with gibbosities of up to 6 cm in children and 11 cm in adolescents. 5 risk factors for severity were identified in the black subject. Conclusion: Despite much work on the subject, more targeted epidemiological research is needed to improve the prevention and management of this disabling condition. 464 Place of the Third Person in the Informed Consent in Orthopedic and Trauma Surgery of Young Adults at the Yaoundé Emergency Center     , Ngo Yamben Marie-Ange, Nseme Etouckey Eric, Metogo Mbengono Junette, Jemea Bonaventure, Ngongang Franck Olivier, Muluem Kennedy, Batchom Daudet and Ze Minkande Jacqueline Abstract Introduction: Consent is defined as the willingness to commit one’s person or property or both. A third party means any person who has not been a party to it, or who has not been represented, and therefore a person who is not a member of two persons. A third party may intervene in decision-making when the patient cannot consent or with the patient. The consent given by the patient is qualified as «free», it must not be under physical or moral coercion either by the doctor or by a third party. Objective: The purpose of our work was to determine the frequency of recourse to a third party by patients with orthopedic or traumatological surgical indication at the Yaoundé Emergency Center in order to assess the impact on the doctor-patient relationship. Methodology: A cross-sectional and prospective study was conducted at the Yaoundé Emergency Center from November 2020 to June 2021; i.e. a period of 08 months. This included was any person who had had orthopaedic or trauma surgery whose consent had been given by a third party. The maintenance of the selected patients was done in the post-operative period in the hospital ward. The data was collected using a pre-designed data sheet and then analyzed using SPSS version 25.0 software. Results: The average age of our patients was 29.3 ± 5.9 years with extremes of 16 and 44 years. The majority were married (53.3%) with at least a secondary level of education in 88.5% of cases. The proportion of patients who used a third party was 72.8%. The third parties most in demand were spouses (48.4%) and family members (35.0%). The consent given by these third parties was done simultaneously with the patients. In 14.7% of cases, third parties intervened alone to agree to the intervention. Conclusion: Patients used third parties in three-quarters of the cases in the consent process. Also, the communication between the Doctor and his patient must be extended, to a certain extent but always under the seal of medical confidentiality, a third person whose approval is as important as that of the patient himself in our context 465 Case Report on Bilateral Microlithiasis with Left Staghorn Lithiasis     , Chakir Y Abstract The lithiasis pathology is frequent and recurrent, it most often affects the upper urinary tract, several types of stones exist. The most frequent are calcium oxalate stones (70%). In this case a bilateral renal lithiasis with a left coralliform lithiasis the surgeon in front of a diagnostic and therapeutic dilemma. We report a case of a 39-year-old patient with no particular pathological history who presented bilateral lithiasis (with a 10cm left staghorn microlithiasis) responsible for major bilateral ureter hydronephrosis, who progressed well under surgical treatment. We discuss the modalities of management in front of staghorn lithiasis 466 Evaluation of Hemophilic Arthropathy in Children in Algiers Center     , Akretche N and Nemmar R Abstract Hemophilia is a hematological disease responsible for hemarthrosis starting from the age of learning to walk. In severe forms, these hemarthrosis are at the origin of hemophilic arthropathy that can lead to a loss of autonomy. The clinical and radiological eva- luation of this arthropathy must be supplemented by a functional evaluation which will determine the impact of the disorders on the performance of activities of daily living and guide the therapeutic decision. The aim of the present work was to evaluate hemophilic joints clinically, radiologically, and functionally in patients with hemophilic arthropathy. Our study concerned 43 patients with mean age of 9.17 +/-6.26 a total of 67 affected joints were assessed clinically by the Ped- net score, radiologically by the Pettersson score and the functional FISH score. The knees are the most common joints followed by the eblows and ankles. There was a highly significant correlation between Pednet clinical score and Pettersson radiological score (P<0.00001, r = 0.769) and between Pednet clinical score and FISH functional score (r = 0.03 and P = 0.023).Given the signifiant correlation between these scores,these scores can be extremely useful in clinical practice to detect early joint damage and guide therapeutic management. 467 Assessment of Salt Intake Markers Among Hypertensives Patients Attending Primary Care Clinic of a Nigerian Tertiary Hospital , Ayodapo Abayomi Olusola1; Adeagbo Adedayo Olutunji; Omosanya Olusegun Emmanuel; Monsudi Kehinde Fasasi; Olukokun Taiwo A and Olagbemide Olanrewaju JoelIntroduction: The development of hypertension has been linked to dietary sodium, hence, a low-sodium diet in conjunction with hypertensive medications has been widely recommended in getting optimum blood pressure control. Therefore, this study assesses salt intake among hypertensive patient using dietary salt markers. Method: This quasi-experimental study investigated the salt taste threshold, overnight urine collection for sodium estimation and its relationship with dietary salt intake among 564 adult hypertensive (282 each in study and control group) attending Family Medicine Clinic of Federal Teaching Hospital, Ido-Ekiti (FETHI), Ekiti State. Respondents in the study group were taught and shown in practical terms the recommended daily salt consumption. Salt solutions were used to measure the salt taste thresholds (STT) which is the ability of respondents to discern the taste of salt in graded solutions of sodium chloride using single-blinded forced stimulus drop technique. Urinary sodium was estimated from overnight urine collection which was a low-burden alternative to the 24 hour urinary sodium excretion (USE). Result: The baseline mean urinary sodium excretion ( mmol/l) and mean salt taste threshold ( mmol/l) was high in both the study and control group (210.4 ± 57.2 vs 214.0 ± 62.2; 47.3 ± 19.7 vs 49.7 ± 20.0). Post intervention, there was a statistically significant reduction (p < 0.05) in the mean USE and mean STT among the study group (199.4 ± 48.4 and 42.9 ± 17.7). A direct relationship between STT and USE was found and the fact that either of the two variables could serve as a marker to estimate individuals and population salt intake. Conclusion: The dietary salt intake among hypertensive adults was high as evident by salt taste threshold and urinary sodium excretion. Educating patient through practical demonstration on quantity of recommended salt intake will help to combat the increasing burden of uncontrolled hypertension. 468 Developing a New, Improved Yoga Medicine Treatment for Asthma , Sangeethalaxmi MJ and Alex HankeyBronchial asthma afflicts many millions of people worldwide, with over 4% of young adults found to be taking asthma medication in multinational studies. Prescribed medication may alleviate symptoms but does not cure. The complementary system of Yoga medicine has developed Yoga practice modules that improve symptoms, but are cumbersome, and lead to high dropout rates. Here we report the development of a new, shorter Yoga module that achieved zero dropouts over a ninety-day randomized controlled trial. All Yoga breathing exercises could be done standing or sitting in a chair, making it suitable not just for young adults but for all ages. 469 Perceptions and Preferences Toward GLP-1 Receptor Agonists in Type 2 Diabetes Management in Saudi Arabia: A Cross-sectional, Two-arm Study , Abdulrahman Alshaikh; Hussein Elbadawi; Mohammed Aleissa; Fahad Alsabaan; Fatima Alslail; Hajer Almudaiheem; Saud Alsifri and Emad R Issakackgrounds and Objectives: The preferences of patients for oral GLP-1 RA treatments, particularly in KSA, have not yet been sufficiently studied. In order to add to the body of knowledge already available in this field, the current study sought to determine the acceptance and preference of various GLP-1 RA formulations (weekly injectable vs. daily oral) among T2DM patients in KSA as well as to investigate how doctors who treat T2DM patients there felt about GLP-1RAs. Methods: The current cross-sectional two-arm (patients-arm and physicians-arm) study was carried out all over KSA using an online survey. Two online surveys were used, one for each arm. The analyses were carried out on 700 T2DM cases and 400 physicians (150 diabetes specialists and 250 general practitioners) who completed the surveys. The primary outcome measure in the patients-arm was the preference for oral GLP-1RA or injectable GLP-1RA. For the physicians-arm, the primary outcome measure was the right time of GLP-1RA prescription or delay. Results: Out of the 700 patient respondents, 588 (84.0%) prefer the daily oral formula of GLP-1RA, while 112 (16.0%) prefer the once-weekly subcutaneous formula. About 40.2% of those who prefer the injectable formula perceive that the injectable formula is more effective, 30.3% reported that it is more convenient for them, and 28.6% stated that they take too many oral medications. On the other hand, reasons for preference for oral formula were perception of injections as a ‘last resort’ treatment (23.0%), fear of injection (20.2%), fear of hypoglycemia (19.2%), convenience (19.0%), and poor communication with physicians (18.5%). Out of the 400 physicians, 340 (85.0%) were delayed in the prescription of GLP-1RAs for their patients, and only 60 (15.0%) prescribed GLP-1RAs at the right time. Among different criteria of respondents, only specialty affects this delay (Table 2). Interestingly, the delay is only among the general physician group (73.%) of those who delay. Reasons behind hesitance differ among groups (p-value < 0.0001), among those who delay prescription of GLP-1RAs, were injectable (72.6%, followed by time constraints (20.3%), and unavailability (7.1%). However, in those who did not delay, they perceived that the reasons behind hesitance were time constraints (45.0%), followed by unavailability (33.3%), and being injectable (21.7%). Conclusions: In conclusion, the preference for the oral form of GLP-1RAs is self-evident in this two-arm study among patients and physicians. That can help to tackle the problem of underutilization of this group when they are indicated. 470 The Fascinating Chronicle of Uroscopy: From the Era of Qarurah and Matula to the Microscope, Sidra ; Sana Kauser Ateeque Ahmed; Tasfiya Hakeem Ansari; Abid Ali Ansari; Azizur Rahman and Aumir Rasool Objective: The objective of the present study is to elucidate the evolution of thoughts on urine inspection from antiquity to the present day. Data Source: The classical Unani literature like Liber Ragius, Canon of Medicine, Liber continens, Treasure of Khwarazamshah, etc. and the ancient literature of other traditional medicines like Ayurveda were prime sources of data. Additional sources were translations and summaries of the said classical books and scholarly articles written on the topic of urine. For recent advancements in uroscopy, browsing of PubMed, Google Scholar, data science, and other trusted websites was carried out. Review Methods: Plentiful resources were frequently looked up and aided in the selection of topics for discussion in this review. With this intent, bibliographic research on the various classical literature was thoroughly sought out. In this regard, the classical literature of various traditional medicines was of immense help. Moreover, browsing of trusted websites was carried out by searching for complementary and alternative treatments for uroscopy and urinalysis. Conclusion: Uroscopy has a long, colourful, and interesting history. The earliest evidence of urine inspection can be found in Babylonian, Sumerian, and Ayurvedic writings. Correspondingly, uroscopy has been practised for over 6,000 years. However, with the invention of the microscope, urinalysis became a valuable diagnostic tool in clinical practices. So essentially, urine represents a mirror image of the body’s states, such as health and disease. Besides, Urinalysis has been evolving since antiquity to the present day, from time to time. 471 “Klinefelters Syndrome” Presenting with Deep Neck Fascial Infection with Uncontrolled Diabetes - A Case Report , Gautam T, Amith KP; Deeepa Kamath G; KSN Siva Bharani and Kiran HY Klinefelter syndrome is chromosomal abnormality seen in males, linked with hypergonadotrophic hypogonadism with increased risk to metabolic syndromes; usually diabetes and cardiovascular diseases (CVD). Diabetes is a prevalent metabolic disorder which compromises the individual’s immunity and makes them vulnerable to infection. Oro-fascial infections in the maxillofacial region are very frequently diagnosed in Diabetes Mellitus patients with uncontrolled glycaemic levels. Delay in treatment can cause spread into various Oro-fascial spaces which could be fatal. Prompt surgical treatment with medical management should be strictly undertaken. Here we discuss a patient with klinefelter syndrome reported with potential deep neck space infection with uncontrolled glycaemic index, both surgical and medical management been discussed for the same. 472 Antioxidant Properties of Nine Commonly Used Medicinal Plants in Arabs Region, Abuelgassim Omer AbuelgassimThe present study was conducted to investigate the total phenolics, total flavonoid, and Trolox equivalent antioxidant capacity of 9 commonly used medicinal plants and herbs among Arabs nation namely, Trachyspermum ammi (Apiaceae) seeds, Ferula assa-foeti- da (Apiaceae) dried latex, Elettaria cardamomum (Zingiberaceae) fruit 1, Senna alexandrina (Caesalpinioideae) Leguminosae leaves, Adenium obesum (Apocynaceae) leaves, Elettaria cardamomum (Zingiberaceae) fruit 2, Trigonella foenum-graecum (Leguminosae) seeds, Lepidium sativum (Brassicaceae) seeds, Ziziphus spina-christi (Rhamnaceae) fruit, and Nigella sativa (Ranunculaceae) seeds. The methanol extract of each plant was obtained by dissolving 2g of plant powder in 20 ml methanol-water (4:1v/v) to overnight at room temperature. The supernatants were concentrated by using a rotary evaporator. Residues of each extract were dissolved in distilled water and the final volume was recorded. A serial dilution of 10, 100, 1000, and 5000 were made. The mean values of the total phenolics content were 535.24 ± 70.68, 150.28 ± 36.89, 69.05 ± 14.18, 1358.7 ± 118.88, 605.83 ± 117.67, 228.28 ± 53.8, 2171.57 ± 296.2, 726.65 ± 130.73, 702.63 ± 32.93, and 132.4 ± 30.77 (mg GAE/100g) in T. ammi, F. assa- foetida, E.cardamomum1, S. alexandrina, A. obesum, E.cardamomum2, T. foenum- graecum, L. sativum, Z. spina-christi and N. sativa respectively, whereas the mean values of the total flavonoid content were 143.96 ± 6.44,0.0, 9.16 ± 3.14,761.66 ± 14.71, 210.09 ± 7.61,12.83 ± 0.88, 347 ± 60.15,94.84 ± 10.04, 94.07 ± 6.26, and 30.49 ± 0.33 ( mg QE/100g) respectively. The determined scaveng- ing activity against ABTS radical of the aqueous methanolic extracts of T. ammi, F. assa- foetida, E. cardamomum1, S. alexandrina, A. obesum, E. cardamomum2, T. foenum- graecum, L. sativum, Z. spina-christi and N. sativa were 1271.32 ± 273.35, 234.89 ± 42.2, 135 ± 21.45, 2551.83 ± 305.35, 2101.1 ± 298.97,794.9 ± 175.72, 794.73 ± 149.49, 2219.74 ± 382.12, 3093.11 ± 445.93, and 483.07 ± 98.17 (μmole TEAC/100g) respectively. Among studied plants T. foenum-graecum showed the highest phenolic content (2171.57 ± 296.2 mg GAE/100g) whereas S. alexandrina showed the highest total flavonoid content (761.66 ± 14.71 mg QE/100g). The highest IC50s were noticed in T. ammi, S. alexandrina, Z. spina-christi, and A. obesum extracts (100.035 ± 19.38, 583.38 ± 45.11, 666.87 ± 79.62 and 720.51 ± 92.24μg respectively). The hydromethanolic extracts of T. foenum-graecum, S. alexandrina, A. obesum, L. sativum and Z. spina-christi showed a significant antioxidant property, further research is ongoing to identify their bioactive compounds, in par- ticular phenolic acids. Our findings suggest the possibility of applying T. foenum-graecum, S. alexandrina, A. obesum, L. sativum and Z. spina-christi in food and/or pharmaceutical industries. 473 Dietary Pattern, Lifestyle, Anthropometric Indices and Prevalence of Hypertension among Undergraduate Students in Farm Practical Year of the Federal University of Agriculture, Abeokuta, Nigeria, Oyinbolaji A Ajetunmobi,, Ibiyemi O Olayiwola, Ebenezer P JohnBackground: In the past few years the aetiology of hypertension has been linked to a variety of dietary, body size and lifestyle vari- ables. Objective: To assess the dietary pattern, lifestyle, anthropometric indices and prevalence of hypertension among undergraduate students at the Federal University of Agriculture, Abeokuta, Nigeria, during their active period of on-farm work doing their farm practical year. Methods: A cross-sectional descriptive study among 320 students was determined by stratified random sampling and colleges by purposive sampling technique. A sphygmomanometer was used to measure blood pressure. Food data were obtained through a food frequency questionnaire, anthropometric and lifestyle were collected using a standard structure questionnaire used to collect weight, height, physical activity and other risk factors. Results: Our findings revealed that the majority of 70.6% are within age 21-25, 79.4% live off-camp, The BMI categorized as normal had 69.5%, 14.5% were overweight, 11% were underweight and 5% were obese. 90% WC were not at risk, 88.4% WHR were accept- able and 90% WHtR were not at risk. In addition, 69.5% undergo high physical activity. Also, the majority consume high sodium and low potassium, The energy intake was between 1789.14 – 1985.54 kcal/day. A significant relationship was established between sex, BMI, WHtR and prevalence of hypertension using (p < 0.05). Conclusion: The study revealed that the prevalence of hypertension is higher in male than female, also obesity and people who have a very high risk of WHtR has a higher magnitude of hypertension. More so, an increase in body size variable had a relative increase in blood pressure variable 474 Clinical Case Report Acute Management of Deep Vein Thrombosis with Pulmonary Thromboembolism in A 16-Year-Old Patient, Vallejo Chaves Saul, Molano Milton, Ramirez GermanDeep vein thrombosis represents 0.05% of hospitalizations in pediatrics, with a similar predilection between male and female; and higher incidence in newborns and adolescents. We present the case of a 1 6-year-old female patient, treated at the Fourth Level Clinic, Colombia, with a history of pain in the left lower limb of five days of evolution, located in the thigh and radiated to the entire leg, with increased volume and paresthesias, making it impossible for her to ambulate. The performance of a venous Doppler ultra- sound of the left lower limb revealed: common, superficial, deep femoral veins and popliteal vein with absence of compressibility, dilated, with presence of heterogeneous echogenic material inside and without flow to the Doppler study, image that corresponds to thrombus that extends from the proximal end to the middle end of the leg, the study confirmed deep vein thrombosis. Assessed by vascular surgery who considers has indication of thromboaspiration protocol both pulmonary and lower limbs by phlebography of lower limb, cavograph filter vena cava, thoracic phlebography (pulmonary) thrombo aspiration - thromboembolectomy of abdominal vessels, pulmonary vessels and vessels of the lower left limbs which is performed without complications. It progressed satisfactorily and treatment was continued on an outpatient basis. This case aims to generate scientific knowledge in health personnel who work with children and adolescents to guide them not to automatically rule out deep vein thrombosis in pediatric patients as a differential diagnosis and thus provide adequate and early treatment avoiding complications that could become fatal. 475 The Promising Future of Using Microalgae as Lamp that More Effective Alternative than Trees to Absorb Carbon Dioxide , Dina Yousif MohammedAlgae are autotrophic microorganisms found all over the world, especially in water bodies, whether fresh or salty in rivers as well as in seas and oceans. They consider the base of the food web in a biological system, and provide energy for all levels of the food cycle. They adapt to environments dominated by viscosity and form of single, multicellular. Its size is verity between a few micrometers to hundred micrometers, that able to perform the process of photosynthesis which, consider basic process of life on Earth just like plants, except that algae do not have roots, stems and leaves, in addition to absent the flowers and they produce nearly half of the amount of oxygen in the atmosphere absorbing at the same time carbon dioxide for their growth. 476 Management of a Volvulus of the Sigmoid Colon at the Somine Dolo Hospital in Mopti About a Case , Djibril Traore; Keïta IK; Traoré B; Coulibaly M; Maïga A; Cissé D; Sanogo S; Guindo A; Thera TD; Couulibaly P; Guindo O and Togo APWe report a case of spontaneous devolvulation of the sigmoid colon in a patient following a delay in preparation for medical and surgical management. The aim of this work was to bear witness to the precariousness of health coverage in certain areas of our country that have suffered from military and community crises (Djénné, Bandigara, Koro, etc....). This was a clinical observation where the signs were dominated by a passage of faecal matter and flatus, vomiting, abdominal pain and air fluid levels. Erect X-ray abdomen helped in confirmed the diagnostis The patient during his preparation had made a spontaneous devolvulation followed by a complete remission of the clinical symptoms. He returned 3 monts later with the same symptomatology following which the emergency medical-surgical treatment was based on resuscitation measures and laparotomy with resection of the sigmoid colon followed by colorectal anastomosis, termino-terminal. 477 Clinical Case of Autonomic Dysfunction in a Young Patient with Exogenous Constitutional Obesity , Gulova ShG; Кurnikova IA; Zhuravleva АS; Klimenko AS and Danilina NOThe article describes a clinical case of progressive obesity with early development of complications and cardiometabolic risk in a 19-year-old patient with an analysis of the course features and identification of the most likely factors that cause these features. Particular attention was paid to the analysis of heart rate variability indicators in relation to the age and phenotype of the patient. Authors accessed prognostic significance of these indicators in a personalized approach to the patient. Both metabolic and regulatory disorders were diagnosed in the patient, which indicate the tension of regulatory mechanisms, which in the near future may lead to maladjustment of the body, an increase in the risk of developing other concomitant diseases and, first of all, an increase in the risk of early development of cardiovascular diseases. 478 Neuroprotective Effect of Monodora myristica on the Lead-induced Injury of the Cerebral Cortex of Male Wistar Rats , Orish CN; Valentine Chidozie Amasiatu and Chidi U BetrandBackground: Lead (Pb) is one of the most common environmental toxicants, exposure to which can cause significant neurotoxicity and an associated decline in brain function. Plant-derived products with antioxidants activity are useful in reducing lead-induced neurotoxicity. This study investigated neuroprotective and antioxidant properties of the aqueous Monodora myristica against lead-induced neurotoxicity in male Wistar rats. Methods: Six groups of six weight-matched animals each, were used for the study. Group 1 (normal control) was treated with deionized water and group 2 (toxic control) with lead acetate at the doses of 50 mg/kg b.wt, whereas group 3 received M. myristica 40 mg/kg only, groups 4,5, and 6 were simultaneously treated with lead (50 mg/kg b.wt), and 40 mg/kg, 80 mg/kg, and 160 mg/kg of M. myristica respectively. The treatment was administered orally for 42 days. Their biochemical and histopathological investigations were carried out following animal sacrifice at the end of the study period. The neuroprotective effect of M. myristica was assessed by measuring redox status (malondialdehyde), enzymatic antioxidant activities (Superoxide dismutase, Catalase, Glutathione peroxidase and glutathione reductase) and histopathology of the cerebral cortex. Results: The increase in the malondialdehyde, the decrease in the activity of antioxidant enzymes (Catalase, Glutathione peroxidase and reductase), and the altered histology of the brain induced neurotoxicity by lead acetate were mitigated in the brain of rats treated with M. myristica. Conclusion: Aqueous M. myristica has a neuroprotective role against lead-induced neurotoxicity probably mediated through its antioxidant properties. 479 Muscular Cysticercosis - Radiological Diagnosis , Gustavo Bunemer Citrangulo de Paula; Márcio Luís Duarte and Daniel de Almeida PiresCysticercosis is an infectious disease caused by ingesting the eggs of the tapeworm. The central nervous system is the most important primary site of infection, and the disease can present with solitary or multiple space-occupying lesions. It is known that muscular cysticercosis is not common, and further studies should be carried out to recognize and diagnose this parasite. Treatment can be clinical or surgical depending on each case. The muscular form has been a casual finding in radiological exams, demonstrating specific characteristics. 480 Comparative Analysis of Dural Substitute Autologous Versus Semisynthetic Collagen-based Dura Graft , Faizan Fuzail; Muhammad Mehran Mouzam; Aamna Bibi and Watiba DanishObjective: The aim of present study is to evaluate the success rate and safety of both auto-grafts and collagen based semi synthetic grafts in patients with dura defects. Study Design: A prospective comparative study was conducted at the neurosurgery departments of different hospital in Peshawar . Methodology: Patients were divided into two groups; A (autologous graft) and B (semi-synthetic graft). Dura graft autologous was applied in one group of patients with supratentorial brain surgery. Fascia lata was used, harvested from the lateral thigh, 3 to 5 cm long incision at the junction of the upper and middle one-third of the upper leg. A bone flap was implanted in the subcutaneous region in the abdominal part. Perioperative antibiotics were given to all the patients, and surgical drains placed intraoperatively were removed after 24 hours of surgery. In the second group, semi-synthetic dura grafts of 2.5x2.5 cm and 5x5 cm 7.5 cm x 7.5 cm sizes were used. Statistical analysis was performed using SPSS version v.20. Student’s t-test (t-test) was performed for the two groups to compare categorical variables, and the data were considered statistically significant at p > 0.05. Results: In this study 72 patients of both genders were recruited. We observed that Semi-synthetic collagen matrix had less surgical time. The mean difference of surgical duration was observed as 40 minutes. However, both groups reported statistically significant differences in terms of surgical duration (< 0.001). No case of infection was reported in both group. The overall mortality ratio was 12%. Two male deaths were recorded due to cardiovascular disorders, while one death of a 42-year male was also recorded. Conclusion: Based on the above findings, it may be concluded that using a semi-synthetic collagen substitute for dura repair is a simple, safe, and effective alternative to the autologous graft for dura repair in dura defects. 481 Prevalence and Pattern of Uncorrected Refractive Errors among School Aged Children in a Semi-Urban Community of Northern Nigeria , Samuel Chibueze Osuji; Eunice Ifeyinwa Agwa and Francis OnyekwereObjective: This study aimed to determine the prevalence of uncorrected refractive errors among school aged children in a Semiurban community of Rantya, Jos, Northern Nigeria. Methods: A cross-sectional study was employed where a total of 350 children of ages 11 to 19 years, were conveniently sampled. Visual acuity was assessed monocularly using Snellen’s chart at 6 metres testing distance. Uncorrected refractive error was defined as an unaided distance visual acuity of 6/9 or less which improved with pinhole. With ethical considerations observed, Ophthalmoscopy was done to rule out pathologies, while Retinoscopy and subjective refraction were also performed to establish refractive anomalies. Data obtained was analyzed using Statistical Package for Social Science (SPSS Ver.16), and tested using descriptive statistic. P-Value of 0.05 or < was taken to be significant. Results: Out of the 350 participants examined, comprising of 156 (44.6%) males and 194 (55.4%) females, 78 persons presented with uncorrected refractive errors, puting the overall prevalence of uncorrected refractive errors to 22.3%. Among these persons with uncorrected refractive errors, females 50(64.1%) were more than males 28 (35.9%), and this was not statistically significant (p = 0.123). The age range of 14 - 16 (n = 37, 47.4%) had the highest proportion of uncorrected refractive errors but it was not also statistically significant (p > 0.05). The pattern of uncorrected refractive errors showed that Myopia was the most prevalent uncorrected refractive error with 35 (44.9%) persons, while compound Astigmatism with 5(6.4%) persons was the least. About 272 (77.7%) of the study population were Emmetropic with visual acuity of 6/9 and above while 78 (22.3%) of participants had uncorrected refractive errors with visual acuity of 6/12 or less which improved to 0.9% when presented with pin hole. Conclusion: Since most children with uncorrected refractive error are asymptomatic, screening helps in early diagnosis and timely intervention through vision screening is advocated. 482 Causes and Magnitudes of Visual Impairment among Children Attending Clinic in Abak, Southern Nigeria , Samuel Chibueze Osuji; Kingsley Nosayaba Bazuaye and Gertrude Ebele EjidikeObjective: This study was aimed to determine the causes and magnitudes of visual impairment among children attending eye clinics in a Sub-urban Hospital, Abak, Southern Nigeria. Methods: This was a prospective study where a convenience sampling technique was employed to sample a total of 200 children consisting of 97(48.5%) males and 103(51.5%) females and within the age range of 6 to 17 years. With ethical consent obtained from parents and guardians, data was collected on subjects’ history, presenting and best-corrected visual acuities, internal and external ocular conditions. Instruments used involved Snellen’s Visual Acuity (VA) Chart, Trial Lens Case (to assess the presenting VA and best-corrected VA), Keeler Direct Ophthalmoscope, and Slit lamp bio-microscope (for internal and external eye examination). Data collected were analyzed using the descriptive statistics and Chi-square inferential statistics of Statistical Package for Social Science (SPSS) Version 25. Results: Out of the 200 children examined, there were abnormalities detected in 105 (52.5%) children, while 95 (47.5%) of them did not present any determined abnormality. The major causes of visual impairment were refractive errors [32 (16.0%)], congenital cataract [25 (12.5%)], and optic nerve atrophy [12 (6.0%)]. The least cause was traumatic cataract (2.0%). Although there was higher occurrence of refractive errors in males [19 (9.5%)] than females [13 (6.5%)], congenital cataract occurred more in females [17 (8.5)], than males [8 (4.0%)]. The magnitudes were moderate [43(21.5%)], Blindness [22(11.0%)], Severe [9(4.5%)]. Gender and age were not statistically significant. Conclusion: This study showed refractive error as the major cause of visual impairment among children between the ages of 6 to 17 years in Abak and with a significant magnitude leading to blindness. Therefore, early detection and prevention of visual impairment among children through regular eye screening is advocated. 483 Misuse of the Drug Acenocoumarol in a Population of 250 Inhabitants with Non-valvular Atrial Fibrillation Assessed in a Region of Southeaster of Spain , FR Breijo-MarquezSpain is one of the few countries in Europe that still prescribes Acenocoumarol, similar to warfarin. So much so that primary care physicians are not allowed to prescribe other anticoagulants that are more effective and less bothersome for the patient when taking the digital INR test. The study was performed in a primary care health system and secondary category hospitals. We were setting in a population of 250 inhabitants in southeastern Spain (Number of patients to be treated is sufficient) with non-valvular atrial fibrillation and Acenocoumarol takers. The follow-up time was 12 months. The statistical study was limited to an "observational/descriptive" study, taking into account the variations and lability of the INR value (International Normalized Ratio), whose figures universally considered – regardless of the type of cardiovascular pathology – have been proposed to be between 2-3, in a maximum term of one determination every 28 days, regardless of the figures obtained concerning previous ones. Given that the vast majority of Acenocoumarol intake occurs in elderly patients – over 65 years of age – and that these individuals are usually subject to a polymedication regimen, the medications taken by each of them were a fundamental reason for the assessment. As fundamental conclusions in this clinical study, we must say that: The endpoint. In time between INR determination and last intake of food and medication are not being correct; they tend to be anarchic INR determinations and when it is most convenient; research regarding drugs taken concomitantly with Acenocoumarol practically does not exist. 484 School Operational Room Guidance for Reopening Primary and Secondary Schools During COVID-19 Pandemic Kuwait Experience , Huda Al-GhareebObjective: To explain the actions of Ministry Of Health leaders that was taken for the reopening of primary and secondary schools during Covid-19 pandemic under different interventions that create stable school environments associated with academic achievement and parent’s confidence. To explore the role of operation rooms in each six-education districts and how the decisions was applied about the protective strategies in schools and when school closures might be necessary. Background: The spread of COVID-19 all over the world caused by the transmission of severe acute respiratory syndrome cornonavirus2 (SARS.CoV.2) has led to a temporary closure of schools, universities and replaced by distance learning to prevent further transmission and potential spread in school setting. Schools are an important part of the infrastructure of communities. They provide safe, supportive learning environments for children, adolescents, and staff [1]. The Ministry Of Education in Kuwait government decided to temporarily close all schools as part of national lockdown mitigation strategies to prevent Covid-19 transmission and replace it by distant learning which created a set of challenges and difficulties. Reopening of schools after relaxation of restriction is another challenge with many new standard operating procedures put in place [2]. The online learning with E-learning tools have become a panacea for this unprecedented global pandemic [2] and online teaching required many different skills and competencies than traditional teaching [3]. Excessive screen time is well known to be associated with poor sleep, sedentary habits, mental health problems and physical health issues [4]. Remote learning exacerbated existing educational inequalities, was determined to the educational attainment of students of all ages, and worsened the growing mental crisis among children and adults [5]. Prolonged school closure can affect children’s development and psychological well-being as well as cause several unwanted economic effects. We should force on the learning recovery process from assessing learning consequences during school closures, ensuring their socio-emotional wellbeing and taking measures to address disparities through remedial approaches [6]. Evidence indicates that restoration of functioning of the education system, as it was in pre-Covid times as early as possible appear prudent [7]. Reopening the full time schools safely for all elementary school children should be a top national priority [8]. UNESCO established a framework for reopening schools that mainly centered on “contextualization and continuous adaptation” [9]. Ministry Of Health in all countries recommends schools plan, prepare, and respond using CDC guidance as best practice recommendations to inform their efforts to slow the spread of COVID-19 and protect the health and safety of their school communities [10]. Maintaining safe school operation or reopening schools after closure require many considerations, but if done well can promote public health [11]. One of the main concerns with the full reopening of school transmissions leading to large outbreaks, with onward transmission to household members and potentially into the wider community [12]. Reopening school building for the 2021-2022 school year was the most complex decisions to make from leaders in Ministry Of Education and Ministry Of Health in Kuwait. These decisions were more difficult by the lack of definitive evidence about transmission in children or about protective measures in limiting spread of COVID-19 infection. The Ministry Of Education in Kuwait took a measured step towards reopening schools between 29 Sept 2021 to 23 June 2022, They allow the school to remain open and safe with appropriate implementation of multi-layered mitigation measures where students participation remain essential. They allow students to go back to school with alternating classes by splitting students in two groups, each attending lessons during half of the week in the governmental schools including (preschool, primary, middle and high school), while reopening of private schools was earlier including either splitting the students in two groups or using bubble one. To overcome any challenges, MOH provide a strategic plan guidance to support the education school leaders in this difficult time by managing COVID-19 in the school and endorsing control measures with safety legislation. Reopening Primary and Secondary schools during COVID-19 infection implemented between 26 Sept 2021 to 23 June 2022 in Kuwait included five components: The design and delivery of operation rooms, the role of Ministry Of Health physicians in operation rooms, the role Ministry Of Education staff in operation rooms, operation room’s closure strategy and the monthly reports. 485 Follow-up of Critically Ill COVID-19 Patients After ICU Discharge , Laura Costa; Elisabete Coelho; José Martins; Marina Costa; Anabela Mesquita and Luís LencastreIntroduction: Severe COVID-19 survivors may experience decreased health-related quality of life, as well as physical and psychological disability after discharge. This study aimed to characterize the impact on the quality of life of severe COVID-19 patients admitted to a single Portuguese Intensive Care Unit (ICU). Methods: Retrospective case series of 119 consecutive patients with laboratory-confirmed COVID-19 admitted to ICU from January to December 2020, in whom a EuroQol five-dimension five level (EQ-5D-5L) was used to access self-perceived quality of life. Demographic and clinical data were collected. Results: Average ICU mortality was 40%. 51 patients undertook a EQ-5D-5L telephone survey, approximately 12 months after ICU discharge. A moderate impairment was identified in 43% of the patients and extreme impairment in 25% of the patients. Problems related to anxiety/depression were more frequently reported. Discussion: Assessment of health-related quality of life has increasingly been recognised as crucial in severe COVID-19 survivors. Our study results are in line with available evidence in these patients, showing impairment in different aspects of quality of life, particularly those concerning pain/discomfort and anxiety disorders. The later were the most frequently reported in our analysis. Conclusion: Health-related quality of life is negatively affected in severe COVID-19 survivors. An organized approach to manage the post-acute phase is needed to improve long-term outcomes. 486 Smoking Cessation and Prevention Principles , Efstathios Konstantinou KoutsostathisThe multiple correlations between smoking and diseases that relate to the entire range of internal medicine have been known for decades. Various alternatives have been proposed, including nicotine patches and gum, and bupropion pills. Other alternatives used are acupuncture and sleep therapy. References to the electronic cigarette or e-cigarette date back to 2004, when Hon Lik first developed it in China. It is atomiser that looks like a conventional cigarette, but differs in that it contains a mixture of glycerol, propylene glycol, fragrances and possibly nicotine in quantities of 1.6-1.9 mg/device. It is generally believed that it is a form of smoking that is safer than the conventional one. Even though there has been a limited number of experimental and epidemiological studies conducted and the results in some cases are contradictory, it seems that this view is not far from the truth given that, to date, the adverse events of e-cigarettes are significantly fewer than those of conventional cigarettes. However, the potential health risks reported include airway irritation, cardiovascular burden and fatty liver infiltration. In addition, strict specifications are not always followed during the manufacturing of e-cigarettes. As a result, apart from very small quantities of nicotine, they also contain carcinogens and metals that could theoretically impact one’s health. 487 Observation of a Case of Autoimmune Anti-rach Myasthenia Gravis: Clinical Aspect and Management at the West Guyanese General Pediatrics Department , Bangoura K; Diallo FB; Diallo ML; Camara SH; Conde I and Kouyate MThe objectives of this observation were to describe the elements of the positive diagnosis and to evaluate the evolution under treatment of a case of myasthenia gravis antis rach autoimmune in a 17-year-old girl who had made several visits to the emergency room for walking disorder on background. weight loss and physical asthenia. Myasthenia gravis is an autoimmune disease of the neuromuscular junction which preferentially affects young women and the elderly and whose incidence is tending to increase. Fluctuating oculo-facio-bulbar paresis of varying severity is common. Remissions and exacerbations are typical. The disease is caused by autoantibodies directed against acetylcholine receptors or more rarely against a specific muscle kinase. The therapeutic objective, mainly based on observational studies, is that of a remission which is obtained by continuous collaborative work between the attending physician and the specialized center, by the combination of symptomatic drugs (anticholinesterases) and immunomodulators/suppressants (prednisone and azathioprine), or even other alternative treatments. Complementary examinations aim to confirm the diagnosis and to look for associated pathologies (1/10 to a thymoma or an associated autoimmune disease). The assessment includes immunological assays for autoantibodies, mainly anti-RACh or anti-MuSK antibodies, electromyography and repeated nerve simulations, thoracic imaging (75% of patients have thymic hyperplasia and 15% thymoma). A Tensilon pharmacological test, performed in a hospital setting, can confirm the diagnosis. 488 Oservational Study of Two Cases of Macrophagic Activation Syndrome in the General Pediatric Department of the Marc Jacquet Melun Hospital Center , Bangoura K1; Diallo FB; Diallo ML; Camara SH; Conde I and Kouyate MMacrophage activation syndrome is a pathology whose diagnosis is difficult because of its rarity, its clinical variability and the absence of a specific diagnostic test. However, the delay in diagnosis weighs its prognosis. This syndrome can be primary in children or secondary to various infections at any age. Viral infections by herpes virus (especially Epstein Barr and cytomegalovirus), by intracellular germs but also by pyogenic bacteria or with neoplasia (mainly lymphoma) and certain autoimmune diseases (lupus and still) [1]. It is characterized by a set of non-specific clinical and biological signs but the association of which should suggest the diagnosis and lead to a cytological or histological examination to confirm it. In this observation, our objectives were to reduce the time to diagnosis and review our decision tree in the case of fever in children. This was a single-center retrospective study of cases diagnosed with macrophage activation syndrome hospitalized in the general pediatrics department for 10 years. Diagnosis was based on clinical and paraclinical examination of suspected cases of macrophage activation syndrome with case selection criteria. For both patients, we calculated the macrophage activation syndrome score established by the Saint Antoine team. On admission and at diagnosis. Patient 1 presented 5 criteria according to Henter while patient 2 presented only 4 for the diagnosis of macrophage activation syndrome. However, these criteria experienced a temporal dispersion. The diagnoses were evoked by the clinical and paraclinical aspect. However, in the absence of hemophagocytosis, the differential diagnosis is made with other diseases and is often difficult. 489 “Hematuria in Hemophilia” - A One Year Study , Suresh Hanagavadi; Chanda Varshini Sindhiya and Thippeswamy MTRHematuria is the excretion of red blood cells in the urine. There are various causes of hematuria which includes renal, postrenal, hematologic and vascular. These vary with age, sex, race, risk factors, personal and family history. Recently it was noticed that one of the cause of hematuria was coagulopathy like hemophilia. A prospective study of 50 hemophilia cases done from January 2021 to January 2022 on clinically diagnosed cases of hemophilia who came for evaluation of hematuria to Hematology unit, Department of Pathology, JJMMC and Karnataka hemophilia society, Davangere, Karnataka, India. In 50 hemophilia cases, 12 cases having hematuria were studied for aetiology, prevalence and management. 490 Epidemiological, Clinical and Therapeutic Aspects of Sexual Abuse in Children and Adolescents at KAMSAR Hospital, Guinea , Condé Ibrahima; Hyjazi Marie Elisabeth; Diallo Fatoumata Binta; Kouyaté Mustapha; Cherif Mahamoud Sama; Camara Abdoulaye and Traoré AmadouIntroduction: The incidence of rape and sexual abuse among children is constantly increasing in the world and particularly in Guinea. The objective of this study was to describe the epidemiological, clinical, and therapeutic aspects of sexually abused children admitted to Kamsar Hospital. Patients and Methods: It was a prospective cross-sectional, study on the sexual abuse of all minors victims admitted at the Kamsar hospital and the incident evaluation was carried out by a multidisciplinary team made up of gynecologists and pediatricians from January to December 2020. Results: Out of a total of 29 cases of sexual abuse recorded and treated at the Kamsar hospital, 24(82.75%.) cases were minors. The victims were aged 4-10 years (41.66%) and 11-16 years (58.34%). Children were abused at the family’s house (54.17%) and mostly between 1 p.m.-5 p.m. (58.17%)often by someone known to the victim (71.84%).The sexual contact (genito-genital) was about 58.3%, the sexual contact with fingers was 12.5%, the genito-anal contact was 12.5% and 1 case of touching (4.35%).Almost all the children presented sexual trauma (99.67%) with different locations: a hymenal (79.16%), anal (16.67%) and extra genital (8.33%). Mutism was present in 99.17% of cases. Preventive antibiotic therapy was used in 100%; preventive antiretroviral (ARV) was used in 58.33%; local antiseptic was used in (54.17%), analgesic was used in 79.17%. Emergency contraception (Levonorgestel) was used in 12.5% of cases. Conclusion: Sexual violence among children and adolescents remains a reality at the Kamsar hospital; this phenomenon includes both sexes with a female dominance. 491 A Case of Primitive Open Angle Glaucoma Conversion of an Isolated Ocular Hypertonia , Akono Zoua M; Mvilongo C; Nomo Arlette; Nanfack N Chantal; Epée E and Omgbwa Eballe AIntroduction: Conversion of isolated ocular hypertonia to glaucoma is rare. We report one case, after 03 years of follow-up. Observation: This is a 56-year-old female patient, with a history of high blood pressure, who came to consult for headaches evolving for 02 years. The initial ophthalmological examination showed corrected intraocular pressures of 27 mmHg and 30 mmHg respectively. Gonioscopy was normal in both eyes. At the back of the eye were vertical papillary excavations of 0.2 in both eyes. Initial automated visual field examination (Octopus) was normal, as was OCT of the optic nerve. Simple monitoring was advocated. The persistence 6 months later of hypertonia at 31 mmHg on the right and 26 mmHg on the left, with visual fields and OCT of the normal optic nerves, motivated the prescription of Carteolol 2% eye drops. The control carried out 3 years after the initial diagnosis, showed glaucomatous lesions to the visual and OCT fields of the optic nerve. The diagnosis of primary open-angle glaucoma was retained. 492 Clinical Aspects of Central Retinal Vein Occlusion at Yaounde Central Hospital , Akono Zoua ME; Mvilongo TC; Nanfack C; Nomo; Dombou Nguena B; Dohvoma VA; Epee E; Omgbwa and Ebana VIntroduction: Our work aimed to research the clinical profile of patients diagnosed with retinal vein occlusion, at the ophthalmology department of the Central Hospital of Yaoundé. Materials and Methods: This is a documentary and descriptive study, conducted over a period from 02 January 2015 to 30 October 2020 at the ophthalmology department of the Central Hospital of Yaoundé, over a period of 05 years. Results: We collected 15 files out of 17962 patients consulted, or 17 eyes with retinal vein occlusion which made a prevalence of 0.09%. The median age of patients was 62 years. The sex ratio was 4 males to 11 females or 0.36. High blood pressure was found in 9 patients, or 60%. Four patients (23.53%) had severely reduced initial visual acuity, consistent with blindness. Retinal hemorrhages were found in all patients. Three patients (17.64%) had macular oedema. Conclusion: Central retinal vein occlusions are rare and serious conditions in older females. High blood pressure is the most common comorbidity. 493 Differences in Image Quality Between Different Deep Learning Algorithms in Chest CT Scans , Faizan Fuzail; Muhammad Mehran Mouzam; Aamna Bibi; Saud Ur Rehman and Tayba BatoolBackground: Lately, however, deep learning reconstruction (DLR) technologies have emerged as a viable technical option for reducing radiation dose because they can effectively reconstruct images developed at a low radiation dose to create clear and interpretable images for diagnostic and clinical use. Objectives: This study explores the possibility of using DLR algorithms in healthcare imaging by comparing image quality between vendor-specific DLR algorithms like TrueFidelityTM and vendor-non-specific DLRs to improve the diagnostic quality of ultra-low-dose CT scans in lung imaging. Methods: The study involved studying past CT scans of 50 patients who had undergone CT scans between January and February of 2021. Two reconstructed images for each patient were submitted to experienced radiographers from whom reconstruction details had been hidden for qualitative assessment. The assessors rated the images on a scale of 1 to 4 for the noise, resolution, and distortion properties and gave their preferred choice between the two images for each case. Quantitatively, one experienced radiographer assessed the signal-to-noise ratio (SNR) and Edge-Rise-Distance (ERD) for each image. Results: Non-tuberculous lung diseases, precisely, were the main, accounting for 62% (n = 31). The other conditions included atelectasis (12%, n = 6), pneumonia including COVID-19 (18%, N = 9), and active tuberculosis (8%, n = 4). For subjective noise, TrueFidelityTM scored higher than ClariCT.AI. On the qualitative noise assessment scale, the former scored 3.72, whereas the latter scored an average of 3.22. On resolution, whereas TrueFidelityTM had a score of 3.66, ClariCT.AI recorded an average score of 3.49. In terms of Image distortion, TrueFidelityTM had a score of 3.46, while ClariCT.AI recorded an average score of 3.51. the average preference rate for TrueFidelityTM was 72%, while for ClariCT.AI was 28%. Quantitatively, whereas the SNR for TrueFidelityTM was 22.65 ± 2.84, that for ClariCT.AI was 25.95 ± 5.82. While the ERD for TrueFidelityTM was 0.97 ± 0.19, that for ClariCT.AI was 1.48 ± 0.19. This study confirmed that vendor-specific DLR algorithms were generally more effective at delivering quality images, confirming the need to develop more specific DLR for the different CT scanners available in the market. 494 The Red Blood Cell Not Only for Colour Identity but with Complex Material Properties , Raphael Chinweike Okolo; Silas A Ufelle; Peter U Achukwu and Emmanuel S NgwuThe red blood cells are biconcave disc in shape, flattened and depressed in the center. The shape with its high surface area to volume (SAPV) ratio helps to accelerate diffusion of gases. The red cell membrane consists of bilayers of proteins and lipids which are rich in the glycosphingolipids that reside on the red blood cells and serve as the major determinants for the discovery of blood groups that are of major importance in blood group serology, paternity dispute and in transfusion medicine. Not only that, the membrane proteins carry the various blood group antigens, transporting ions, endothelial cells as signaling receptors and adhesive properties. This makes the red blood cells possible not to experience protein synthesis and for that no viral attack on them. The red blood cell abnormalities are being regulated by three constitutive characteristics namely, the geometry of the cell that is the cell surface to volume ratio, cytoplasm viscosity powered by intracellular haemoglobin concentration and membrane deformability. This review highlights on the importance of the red blood cell in our diagnosis and also its importance in study of red blood cell morphology to assist in the classification of numerous disease condition which can be treated with mere blood film microscopy. 495 Correlation Between Hematological and Serological Parameters in Dengue Fever Patients , Abin Varghese and Vanamala AlwarAccording to the World Health Organisation, dengue is endemic in more than 100 countries. there are an estimated 390 million or more cases of dengue annually worldwide, and 40% of the world population. Understanding the pathophysiology of dengue virus infection along with an early diagnosis of dengue fever with the aid of laboratory parameters and clinical evaluation helps in the management of dengue fever. The objective of this study was to analyze the hematological parameters which will help in the early diagnosis of dengue syndromes. Most patients are clinically asymptomatic. However severe dengue fever may cause increased vascular permeability with vascular leakage, hemoconcentration, hypovolemic shock, and bleeding manifestations due to thrombocytopenia. The parameters studied were hemoglobin concentration, total leucocyte count, differential leucocyte count, platelet count, and Leishman-stained peripheral smear examination. In our study, out of 100 dengue-positive patients proven by the ELISA method; the common laboratory finding was thrombocytopenia (97%). Leucopenia was found in only 13% of patients and 18% of patients had relative lymphocytosis. Of 100 patients 81% of patients showed the presence of reactive lymphocytes. Also noted was a raised hematocrit in 21% of patients. The correlation of dengue IgM antibody with hematological parameters was studied. The severity of thrombocytopenia depends inversely on the titre of antibody level in the patient. 496 HIV in Ukraine: Operational Program , Benabdellah AMore than 6 million people have been displaced across the border since the Russian invasion of Ukraine began. The European Union Council has adopted a Temporary Protection Directive that provides an adequate response by granting the right to immediate protection, including the right to receive medical assistance: Access to medical care for Ukrainian refugees living with HIV. 497 Multiplex Methodologies in the Study of Occupational Allergies Due to Animal and Plant-derived Allergens Exposure , Maria Concetta D’Ovidio; Pasquale Capone; Andrea Lancia; Paola Melis; Ornella De Pità; Elvira Macale; Francesca dé Donato; Manuela De Sario; Paola Michelozzi; Stefania Massari; Annarita Wirz; Roberto Moccaldi; Carlo Grandi and Renato ArianoBackground: The air quality guidelines published by WHO in 2021 underlines the need to study multipollutant exposures to investigate additive, synergistic or antagonistic effects of air pollutants including pollens. An important research area concerns the study of action mechanisms and the advanced methodologies for the evaluation of such exposure. Multiplex methodologies are important tools that can improve the study of health responses followed exposure to agents from different sources and in particular in the research involving allergy. The use of multiplex methods can define the individual allergic profile, addressing the investigation of the action mechanisms and the identification of new biomarkers. The aim of this paper is to promote the use of innovative methodologies applied to occupational allergies, showing the results obtained with two multiplex systems. Methods: A total of 43 workers enrolled in an animal research facility and 105 patients were screened with two multiplex methods (ImmunoCap ISAC and ALEX) to evaluate allergic reactivity towards about 100-300 allergens. Results: The results obtained with ImmunoCap ISAC evidenced a higher reactivity for plant allergens, while ALEX methodology showed that the pollens were the allergens with the higher IgE values. These results highlight the role of plant allergens, in particular pollen, able to interact with chemical agents, as well as with several factors such as microclimate and meteorological variables. Pollen exposure is also affected by the ongoing climate change as well as by anthropic factors such as occupants in indoor settings. Conclusion: The multiplex methodologies may be applied on biological and environmental matrices to improve the knowledge of the action mechanisms of allergies. The identification of novel biomarkers using multiplex methodologies is a further opportunity in the study of occupational allergies. 498 Strategies to Improve Safety Culture in the Hospitals , Iqbal Ratnani and Salim SuraniThis article addresses potential minefields of patient safety in healthcare organizations across the globe, particularly in the post-COVID era. This paper also suggests strategies at ground level to ensure a proper safety environment for staff as well as for patients. This article encompasses and addresses domains about patient safety and suggestions to provide a positive and viable working environment 499 Zebrafish: A Powerful Tool in Drug Discovery and Development , Neeraj VermaAnimal models are non-human animal species which may be used to recognize unique biological methods and to acquire informations which could offer a perception into working of different organisms. Animal models are crucial tool for addressing essential scientific questions on illnesses and for the development of new therapeutic approaches. Among the various version organisms, the zebrafish (Danio rerio) is one of the leading models to look at developmental biology, most cancers, toxicology, drug discovery, and molecular genetics. The zebrafish has been used as a good opportunity vertebrate model for the study of human skeletal illnesses, because of its genetic manipulation, excessive fecundity, outside fertilization, transparency of hastily growing embryos, and occasional renovation fee. 500 The Problem of Blood Transfusion in Bangui, Central African Republic , Ngouyombo Ange Donatien; Pamatika Christian MauKler; Doui Doumgba Antoine and Le Faou AlainObjectives: Describe the problems related to the supply and use of blood products in Bangui, Central African Republic Methods: It was a cross-sectional study, conducted from 1 August to 1 October 2013 in three public hospitals in Bangui, on the practical modalities of blood transfusion in patients whose clinical condition required blood transfusion. Results: 300 patients were included, of which 169 (56.3%) were female (sex ratio = 0.77). The mean age of the patients was 30.5 years (range: 5 months and 64 years). The main indications for transfusion were medical (70% of cases), gynecological or obstetrical (19% of cases) and surgical (11% of cases). Whole blood was used in all patients. The transfused volume was 500 ml in 64.4% of cases. In 75% of cases, the transfused blood came from voluntary donors. The transport of the blood bags to hospitals was provided by a relative of the patient. The time interval between prescription and blood transfusion was reasonable for the Pediatric Complex hospital closer to the national blood transfusion center compared to the other two hospitals where it could take more than an hour. Determination of blood group and Rhesus factor prior to blood transfusion was only performed in 189 patients (63%). A single blood bag (500 ml) was transfused in 196 (64.4%) patients and in 48.7% of cases transfusions were done with O + blood. Only 25 patients (8.3%) were tested for compatibility in the patient’s bed. Conclusions: To ensure transfusion safety, the authors recommend strengthening the capacity of the CNTS in equipment and logistical means for the preparation of products and blood distribution, decentralization of blood product storage and recycling of blood transfusion safety practitioners. 501 Practice of Childhood Immunization Among Mothers in Umueze, Osisiomangwa Local Government Area, Abia State, Nigeria , Uwa N Onwuchekwa; Prince Ezenwa Ndubueze Onyemachi; Isaiah Abali; Ajere Grace Chimkamnele; Chidi-Esike Obinna Ugonna and Ukanwa Ebere AnnBackground: Childhood immunization is an effective public health initiative aimed at reducing the burden of vaccine preventable diseases (VPDs) and deaths among children, particularly under-fives. It averts an estimated 2.5 million deaths per year in all age groups from VPD. Childhood immunization is an act of inducing immunity to a child by applying a vaccine that almost guarantees protection from many major diseases. Objective: To determine the practice of childhood immunization among mothers in Umueze in OsisiomaNgwa Local Government Area of Abia State. Methods and Materials: A cross-sectional study performed in Umueze Community in OsisiomaNgwa Local Government Area in ABA, Abia State, Nigeria. Self/interviewer questionnaires were administered to 470 women for the study. Result: A total of 470 women selected by systematic sampling methods with non-response rate of 40 (8.0%). Mean age was 34 ± ,8.246. Three hundred and fifty (81.4%) believe that there was benefit of immunization as it prevented child from diseases, 340 (79.1%) believed that immunization was free, 330 (76.7%) believed that lack of centres was the cause of reduced child immunization, 350 (81.4%) started immunizing their children after birth, 138 (32.1%) mothers give their children all the immunization, while 278 (64.7%) women had good practice of immunization. The relationship between the sociodemographic variables and level of practice of immunization were statistically significant, marital status (95% Cl: 1.164 - 541.451), odd ratio; -3.223, p = 0.04, Number of living children (95% Cl:2.025 - 61.784), odd ratio; - 2.415, p = 0.006. Conclusion: Childhood Immunization is an inevitable practice that every family should be involved in, and mothers should always see to the completion of their children’s Immunization, in order to avert impending dangers which can result from it. 502 Safety Requirements Elicitation Method for Medical Devices Using FRAM , Shuichiro YamamotoBackground: As medical devices attached to human body shall be safe, it is important to elicit safety requirements for medical devices. So far, the risk driven approaches are used to derive safety requirements specification. We are trying to elicit safety requirements by the success conditions of medical device functions and operations which are clarified by describing the Functional Resonance Analysis Method (FRAM) diagram. Method: Firstly, interactions of medical device functions and its human operations are described by FRAM diagram. Secondly, the success conditions of functions are identified. Finally, safety requirements of the medical device are elicited for the identified conditions. Results: The approach is applied to elicit safety requirements of an insulin pump system. The safety requirements have been elicited by describing the FRAM diagram for the insulin pump system. The result showed the applicability of the method to elicit safety requirements. Conclusion: The proposed approach is effective to elicit safety requirements for medical devices from the success conditions of functions identified by using FRAM. 503 Trace Elements and Bone Metabolism , Efstathios KoutsostathisOsteoporosis: Osteoporosis is a systemic disease that affects the skeleton and is characterised by reduced bone mass and deterioration of the bone structure. The direct consequence is increase in bone fragility, resulting in fractures even with little mechanical force. It is the most common complication of metabolic bone diseases. Simply put, osteoporosis is a systemic disease marked by increased incidence of fractures [1,2]. Osteoporosis is roughly divided into idiopathic and secondary. Idiopathic osteoporosis is further divided into type I and type II osteoporosis. These two types were previously known as postmenopausal and senile osteoporosis respectively [3]. 504 Serum Prostate-Specific Antigen (PSA) Level is a Biomarker for Prostate Adenocarcinoma Grade, Tumour Volume and Histologic Prognostic Indicators , Grace Ferguson; Luke Gilligan; Caitlyn Keogh and Paul H HartelWhile serum PSA has limited specificity for prostate cancer detection, and its appropriate clinical application remains a topic of debate, it has been shown to correlate with cancer grade and some measures of tumour volume. We sought to replicate these findings and also establish the utility of PSA as a potential biomarker for prognostic indicators in patients with needle biopsies positive for prostate adenocarcinoma. Following clinical audit CoPath electronic archive search using keywords ‘prostate’ and ‘adenocarcinoma,’ anonymized reports from 43 clinical audit needle biopsies positive for prostate adenocarcinoma from 2015 through 2022 were reviewed. Data on primary and secondary tumour grade, histologic Gleason score, Grade group, tumour volume, perineural invasion and extraprostatic extension were reviewed with associated PSA levels. Patients with cancers that fell into Grade groups 1 and 2 (Gleason 3+3 and 3+4), had an average PSA level of 10.55 ng/ml, while those in higher Grade groups 3, 4 and 5 (Gleason 4+3, 4+4, 4+5, 5+4 and 5+5), had an average PSA of 26.09 ng/ml. Patients with higher tumour volume (> = 60% of biopsy tissue containing tumour) had an average PSA level of 22.98 ng/ml, while patients with lower tumour volume ( 505 The Surgical Closure of Neglected Ulnar Deficiency of the Hand; Unclassified Phenomenon “Ulnar Cleft Hand” , Tolgay ŞatanaCleft hand classified as central deficiencies of the hand. We present a patient who had cleft hand between the fourth and fifth ray at ulnar side which was not be classified in current classification of congenital hand deformities neither in central cleft hand anomalies nor ulnar deficiencies. Eventually we defined it as ulnar cleft hand. Twenty-six years old man examination revealed fifth ray of the hand was divided from carpometacarpal joint to ulnar sides about forty-five degrees. The fifth fingers rotated to dorsoradial from Metacarpophalengeal joint about ninety degrees. Little finger was hypoplastic and hypotenar side of the hand completely divided therefore the palm was narrow and shallow. Range of motion of distal and proximal interphalangeal joint was limited by ankylosis. The aims of the surgery are to improve grasping function, to keep the palmar continuity and obtain acceptable cosmesis. The cleft closure was performed with volar and dorsal skin flaps. Fifth metacarp released from flexor carpi ulnaris tendon, capsule and muscles. FCU was transferred distal of ulnar carpal bone, which seemed triquetro-hamate coalition bone. We defined this deformity as ulnar cleft hand. It is indisputable that treatment of congenital deformities before development ends will provide acceptable and more successful outcomes. At older ages, treatment of such rare hand deformities should be planned in stages with functional outcomes in mind according to patient’s needs while cosmetic appearance should be tackled at the second stage. 506 Diarrhea of Bacterial and Parasitic Origin in Children in the Pediatric Department of the ANAIM Hospital in Kamsar Guinea , Condé Ibrahima; Diallo Fatoumata Binta; Kouyaté Mustapha; Hyzazi Mari Elisabeth; and Traoré AmadouIntroduction: Diarrhea is one of the leading causes of illness and death in children under 5 years of age in developing countries. The etiologies are varied and depend on the living conditions. The aim of our study was to describe the causative germs by performing stool culture and examination of stool, in order to help set up a targeted intervention and provide an early warning for more effective response measures. Method: This was a prospective cross-sectional study of descriptive type, conducted over a 12-month period from January 1 to December 31, 2018 in the pediatric department of ANAIM Hospital in Kamsar. We included all children hospitalized for acute diarrhea and who had undergone coproculture and stool parasitology before any treatment. Results: Out of a total of 1223 admissions, 293 cases of acute diarrhea were hospitalized in the pediatric ward of Kamsar, the average age was 22±8 months, the associated pathologies were malaria (86.60%), severe acute malnutrition (11.95%), acute otitis (9.55%). The bacteria found were E. coli (1.71%), Klebsiella (1.02 %,), Salmonella (0.34%), shygella (0.34%) and listeria monocytogene (0.34). The intestinal parasites found were amoebae (3.75%), giardia (3.75%), roundworms (0.34%) and trichomonas (0.34%). Conclusion: Diarrhea is an important cause of morbidity in children in the pediatric department of the hospital of Kamsar. The germs found were dominated by E. coli, Klebsiella, amoebae and giardia. 507 Results of Testing for Viral Hepatitis B and C in the Kyrgyz Republic, 2008 -2021 , Tobokalova Saparbu T; Aitieva Jyldyz T; Zairova Gulzada M and Saydykova Altynai A Introduction: Testing and early detection of hepatitis B and C infection determine indications for the services of prevention and treatment and are a key component for effective response to the epidemic of these infections. The Aim of the Study: Analysis of the state early detection of viral hepatitis B and C in Kyrgyzstan to develop a mass testing program as a stage towards eliminating the epidemic of blood-borne viral hepatitis in the country. Materials and Methods: State Reporting Forms No. 1 “Report on infectious and parasitic disease” for 2008–2021 were reviewed. The data was processed by Epi Info 3.8.1 Results” The Kyrgyz Republic belongs to countries with high incidence of viral hepatitis B and C. The incidence of acute and chronic viralhepatitis B in 2021 amounted to 29.2 per 100,000 population, and hepatitis C -10.8. Based on the results of testing by some healthcare organizations, the hepatitis B virus infection of the population ofvaries from 4.6% to 7.3% and hepatitis C - from 3.1% to 7.7%. Data of official statistics (Department of Disease Prevention and State Sanitary-Epidemiologic Surveillance and the Centre of Electronic Healthcare) on theprevalence of acute and chronic hepatitis B and C differ considerably. Thereis no information about the exact number of patients with all forms of hepatitisВ and C, cirrhosis and liver cancer in their outcome. Conclusions: To ensure the access of patients with chronic viral hepatitis and cirrhosis in their outcome to the services of diagnostics, highly effective methods of treatment and preventionit is needed to conduct a phased mass testing of the adult population for viral hepatitis B and C in order to determine the true number of such patients. 508 Bronchial Variations in the Lower Left Lung Lobe: About 17 Anatomical Injection-corrosion Pieces , Karim Yacouba Garba; Ndeye Bigue Mar; Ainina Ndiaye; Magaye Gaye; Cheikh Seye; Mamadou Ndiaye; Issa Dior Seck; Jean Marc Ndoye; Abdoulaye Ndiaye and Assane NdiayeIntroduction: There are many anatomical variations in the bronchial distribution of the lower left lung lobe. The control of its variations offers a better guarantee for safe and controlled removal surgery. The objective of this work was to study the bronchial distribution of the lower left lung lobe, to specify its variations and their surgical implications. Methods: Thus, we operated 17 broncho-arterial moldings made from heart-lung blocks treated by injection-corrosion. Results: Our results were as follows: the lower lobar bronchus was present in 100% of cases and measured 0.65 cm on average. It ended by giving the apical and basal bronchi. The apical bronchus ended in 64.70% of cases with a bifurcation and in 35.30% with a trifurcation. As for the basal bronchus, it is 1.1 cm long. It gave successively the ventro-paracardiac trunk (TVPC) which bifurcated in 88.23% of cases in baso-medial and baso-ventral bronchi; the baso-lateral bronchus which was typical in 58,82% of cases; and ended with the baso-terminal bronchus in our cases. Conclusion: This distribution presents many variations which must be taken into account for a quality excision. 509 Prophylaxis of Atrial Fibrillation After Isolated On-pump Coronary Artery Bypass Surgery with Postoperative Intravenous Magnesium Sulfate Supplementation , Elona Dado; Edvin Dado; Juna Musa; Juliana Karanxha; Elizana Zaimi Petrela; Edlira Horjeti; Mrunal Teja Chinthapalli; Fjolla Hyseni; Syeda Salima Sultana; Blina Abdullahu; Mohammad Abubaker Siddique; Efrosina Kajo and Arghyadeep GangulyObjective: Atrial fibrillation (AF) is the most common arrhythmia complicating cardiac surgery and carries a high risk for significant morbidity and mortality in short and long term. Its prophylaxis remains crucial to improve outcomes. The role of magnesium administration in preventing the occurrence of AF after isolated bypass surgery is not well established. Variations of dose, timing and mode of administration have been proposed. The purpose of this study was to investigate the efficacy of 4-day postoperative intravenous magnesium supplementation on the incidence of postoperative AF. Methods: We performed a prospective, randomized, placebo-controlled clinical study on 200 consecutive patients who underwent initial, elective, isolated on-pump coronary artery bypass surgery, to assess the role of magnesium sulfate administration for postoperative AF prevention. Patients in the treatment group received 10.3 mmol of magnesium sulfate in 100 mL of saline solution infused intravenously over 2 hours once daily for 4 consecutive days, starting immediately after surgery. There were no significant differences in the preoperative characteristics of patients. Results: The incidence of postoperative AF was 18% in the magnesium-treated group compared with 35% in the control group (p 0.006). Absence of magnesium administration, magnesium serum levels less 2 mg/dl, age over 65, decreased ejection fraction, increased aortic cross clamping and cardiopulmonary bypass time were identified as independent risk factors for the development of AF on the multivariate logistic regression analysis. The duration of AF in the magnesium treated patients was longer than in the control group. There was a significantly higher presence of risk factors in the magnesium treated patients who developed AF compared with those who developed AF in the control group. Conclusion: Our study indicates that postoperative 4-day supplementation of magnesium sulfate is helpful in reducing the incidence of AF after coronary surgery. For older patients, patients with reduced EF, patients with longer cardiopulmonary bypass and aortic cross clamping times, magnesium supplementation alone is inadequate for the prophylaxis of postoperative AF. The longer duration of AF and the increased presence of risk factors in the magnesium treated patients who developed AF, supports the rationale that magnesium therapy is efficacious in the prevention of the subset of postoperative AF that is transitory and self-limited. Important advantages of magnesium therapy include the high safety profile and utility in identifying patients with the subset of AF that carries a higher risk of morbidity and mortality. 510 Therapeutic Approach to Depression and Cardiovascular Diseases in a Hospital Setting at the Mustapha University Hospital Center of Algiers in Algeria , Issack Biyong; Leila Akhrouf; Lidawouwè Ahloma and Guido BondolfiIntroduction: Ischemic heart disease and depression are inseparable conditions, with increasing incidence and prevalence with the aging of the population. When combined, they reduce quality of life, and require long-term care and exorbitant cost for care. Activation of stress pathways has often been indexed as a neurochemical mechanism that links depression and ischemic heart disease. Anxiety resulting from cardiac involvement, the complexity of treatment and repeated hospitalizations facilitate the onset of depressive syndrome. Untreated depression can be a risk factor for heart disease over time. Early detection and treatment of depression is recommended in patients with ischemic heart disease. Methods: We conducted a case study reported in a cardiology department of the University Hospital of Algiers, as part of the consultations of the liaison psychiatry. We included patients regardless of age, sex, origin, hospitalized for cardiovascular pathologies. The parameters studied were sociodemographic data: age, sex, marital status, cardiovascular risk factors as well as clinical signs, diagnosis of hospitalization and the existence of anxiety and/or depression. Our comprehensive psychiatric assessments with psychiatric history, mental examination with structured interviews according to DSM-5 and also the passing of questionnaires: Beck Depression Inventory-(IDB-13) "PHQ-9: Patient Heath Questionnaire" to inpatients in the cardiology department as mentioned above. Results: Of the two selected cases followed for cardiovascular pathologies mainly coronary syndrome on the one hand and myocardial infarction on the other hand in the cardiology department of the University Hospital of Algiers. We have seen that depression would explain this cardiovascular event although this subject, young woman of 25 years mentioned in case N ° 1 and without cardiovascular risk factors identified on the one hand and on the other hand with all the cardiovascular risks of making a myocardial infarction despite effective revascularization. For the 2nd case of this 42-year-old man, the management was longer and complicated by a recurrent, resistant major depression. Treatment of comorbidity has made it possible to eliminate the risk of mortality through the intervention of psychiatry in conjunction with the appropriate treatment of this depression. Conclusion: At the end of this study we can conclude that depression and cardiovascular disease are inseparable and linked to each other. The follow-up must be multidisciplinary, early detection of depression using scales such as the PHQ-9 in cardiac patients could reduce the risk of occurrence of depression but also its complications, reduce the cost and duration of hospitalization this promoting the survival and well-being of our patients. SSRIs and particularly Sertraline, Citalopram and Escitalopram are the recommended first-line pharmacological treatment for the management of depression in coronary patients. Non-pharmacological treatment involves cognitive-behavioral psychotherapy and cardiovascular rehabilitation or even repetitive transcranial magnetic stimulation (rTMS) in some severe or resistant depressions. 511 Effect of Cinnamon (Cinnamommum verum J. Presl.) on Blood Lipids, Fibrinogen, Fibrinolysis, and Total Antioxidant Status in Patients with Ischemic Heart Disease , Surendra Kumar Verma; Vartika Jain and SS Katewaackground: Spices and condiments are reported to possess many health-beneficial activities. Cinnamon (Cinnamommum verum J. Presl.) is a well-known spice used in preparation of many cuisines and sweet dishes. Several scientific studies have reported its protective role in modification of risk factors associated with cardio-vascular diseases. Traditional medicine also recommends its use for treatment of heart disease. In view of all this, its bark powder was evaluated for its effect on blood lipids, fibrinolysis, fibrinogen and total antioxidant status in patients with ischemic heart disease. Methods: Forty individuals (50-70 years) with ischemic heart disease were selected for the study and divided into two groups of twenty each. Group I (Treated) received 3 g Cinnamon powder in two divided doses while Group II (Placebo) received matched placebo capsules for four weeks. Blood samples were collected initially and at the end of four weeks for analysis of lipid profile, fibrinogen, fibrinolytic activity and total antioxidant status. Results: Administration of Cinnamon significantly (p < 0.001) reduced atherogenic lipids without significant alteration in HDL-cholesterol. A statistically significant enhancement in Plasma fibrinolytic activity (p < 0.001) and serum total antioxidant status (p < 0.05) was observed at the end of the study. The placebo group however did not show significant alteration in these parameters. It was tolerated well without any untoward effects. Conclusion: Four weeks supplementation of Cinnamon (1.5g twice daily) to patients having ischemic heart disease favorably affects various lipid parameters, fibrinolytic activity and total antioxidant status in a statistically significant manner. 512 Impact of COVID-19 on Renal Dysfunction , Israa Hashim SaadoonCoronavirus Disease-2019 (COVID-19) may cause different degrees of renal impairment [1]. One of the studies conducted on hemodialysis patients and infected with COVID-19 revealed that there was no difference between patients regarding the presence or absence of diabetes mellitus and hypertension, but the effect of COVID-19 on the kidney increased with increasing the age [2]. 513 Phytochemical Screening and Antibacterial Activity of Oil Extracted from the Seeds of the Corandia Savitam Plant , Hanan Soheal Alnade; Selima Ali Al-Mabrook; Fatimh Mustafa Meelad and Salem Mohamed EdrahThe Corandia Savitam plant has been known since ancient times because of its preventive and curative benefits against diseases, as well as its various uses in flavouring foods. And likewise, because includes beneficial and desirable effects that provide bioactive antimicrobial potential. In this study, the qualitatively phytochemical screening results of the Aqueous-Ethanolic and n-hexane oily extracts indicated that tannins, phenols, saponins, cardiac glycoside, carbohydrates and terpenoids were present in very high concentrations, while phlobatannins, alkaloids, flavonoids, proteins, quinines and oxalate were present in a moderate concentration in its oily extracts. While the quantitative results of the oil extractive revealed that the value yields for each of the oil aqueous-ethanolic and n-Hexane extracts of Coriandrum Sativum seed were 56.4 and 70.6%. Consequently, the best quantity of extractive value oil crop was the oil extracted by an n-Hexane solvent which was higher than the extractive value crop of oil extracted by water-alcohol as a solvent. Whereas, for each of tannins, alkaloids, flavonoids and saponins were 43.0, 57.2, 63.4 and 74.3% respectively. However, the results of the biological activity of the bout oil extracts of the Coriander Sativum plant seed were as follows: The Aqueous-Ethanolic oil extract against each of Escherichia Coli, Salmonella typhi, Staphylococcus aureus and Klebsiella 15, 13, 14 and 17 mm, correspondingly, even though the n-Hexane oil extract was 16, 15, 12 and 13 mm, respectively. Thus, in compression of these results. Furthermore, when comparing these results with the effects of antibiotics. 514 Investigation of Distribution of PKD1, PKD2 and GANAB Genes in Autosomal Dominant Polycystic Kidney Patients in Turkish Population , Mujgan Ozdemir Erdogan; Başak Gogus; Handan Yildiz; Sinan Kazan; Serdar Ceylaner; Alper Emre Kurt; Sena Ulu and Muhsin ElmasObjectıve: Mutational screening of the PKD1 and PKD2 genes, which are known to be associated with the severity of the disease, and the GANAB gene, which is a strong candidate gene, which is thought to be involved in the genetic basis of ADPKD, were performed in 16 cases admitted with the indication of autosomal dominant polycystic kidney disease (ADPKD). Materıals and Methods: A total of 16 cases who were diagnosed with ADPKD and met the criteria were evaluated. After DNA isolation from peripheral blood samples of the case group, PCR was performed with primers designed specifically for PKD1, PKD2 and GANAB genes. In this study, targeted resequencing method was applied by using MiSeq (Illumina, San Diego, CA) system for mutation screening of the aforementioned genes. In the analysis of detected variants, in silico analyzes, database searches and literature reviews were performed. For this, Varsome, Polyphen2, HGMD-Public, PubMed, Google search, Clinvar, EXAC and 1,000 Genomes studies were used. Results: As a result of the sequence analysis of PKD1, PKD2 and GANAB genes from 16 cases diagnosed with ADPKD, at least one of the 3 genes analyzed for all patients and at least one disease-related variant was detected. The changes found are all heterozygous changes. Six PKD1 polymorphism were found in 4 patients. In 11 of 16 patients, 14 different variants for the PKD1 gene (2 frameshifts, 5 missense, 3 nonsense, 1spilice region and 3 synonyms) were detected. In 6 of 16 patients, 6 different variants (3 nonsense, 1 missense, 2 synonyms) were detected for the PKD2 gene with a pathogenic effect. As a result of the GANAB gene sequence analysis, 6 different variants (1 missense, 3 synonyms and 2 noncoding) were determined for 5 patients. Of the 27 non-polymorphic variants detected for these 3 genes, 5 are novel mutations that have not been reported before. Of these 5 mutations, 3 were found in the PKD1 gene, and 1 in each of the PKD2 and GANAB genes. While 6 of these mutations in 16 patients are de novo (fresh mutation), 10 of them have autosomal dominant inheritance. Conclusıon: Our study results shed light on the genotype-phenotype correlation, the effect of genotype on clinical progression, and mutations not previously reported in the literature. In addition, our study results support that the GANAB gene is a strong candidate gene that plays a role in the genetic basis of ADPKD. It is recommended that similar studies be conducted with patient groups with a higher number of patients. 515 Low Antibacterial Potency of Ceftriaxone Brands in Mbarara Municipality, Uganda , Anthony SsebagerekaIntroduction: Antibiotic therapy has for a long time been a critical aspect of health care. Ceftriaxone is widely used for empirical antibacterial therapy among Healthcare facilities in Uganda. Antibacterial potency of ceftriaxone is the relative measure that compares doses of different brands required to produce the same bactericidal effect. Reports of widely differing antibiotic activity and clinical outcomes for ceftriaxone brands, from medical professionals, has raised many questions about their potency. The study aim was to determine the relative potency of the different ceftriaxone brands compared to the innovator brand. Methods: Eleven Ceftriaxone brands on the market were obtained from the pharmacies and drug shops in Mbarara Municipality, including two brands obtained from the public hospital supply chain. Broth macro-dilution technique were used to determine the MIC (Minimum inhibitory concentration) and consequently, the MBC (Minimum Bactericidal Concentration) for each ceftriaxone brand against Escherichia coli (representative of gram negative bacteria) and Staphylococcus aureus (a representative of gram positive bacteria). Thereafter, the potency ratio (MBC of Innovator brand: MBC of a given ceftriaxone brand) was calculated. Results: Generally, all the brands were found to be unreasonably less potent than the innovator (reference) brand. However, two brands had the lowest potency ratios (0.25% and 0.5%, respectively against Escherichia coli and 5% against Staphylococcus aureus), while the innovator brand and one other brand were the most potent brands (50% against Staphylococcus aureus and 100% against Escherichia coli), exhibiting the lowest MBCs. The two brands supplied in the public hospital, had percentage potency ratios of 10% and 40%, respectively against Staphylococcus aureus and 10% and 2.5%, respectively against Escherichia coli. Conclusion: The ceftriaxone brands exhibited widely varying antibacterial activity with inferior bactericidal properties compared to the reference brand. Most of the ceftriaxone brands were largely bacteriostatic rather than bactericidal. In addition, the generic brands generally exhibited much lower potency against Staphylococcus aureus than Escherichia coli when compared with the reference brand. Further investigations ought to focus on quantification of the Active ingredient, chemical purity, and in-vivo activity of ceftriaxone brands, as well as monitor and assess efficacies and potencies for medicines especially antibiotics. 516 Economic Burden of Using Conventional Syringes and Budget Impact of Introducing Safety Syringes in Emergency Departments Across University Hospitals in Egypt , Ismail G; Rashed H; Abdel Aziz S; Zaki M; Bassyouni R; Girgis S; Mohamed A; Ahmad A; Elzamarany E; Higazi A; Gala S; Bayan N and Abdelghaffar HBackground: Needlestick injuries (NSIs) represent a serious health problem among health care workers (HCWs) mainly nurses as they are associated with a high risk of infection with blood-borne pathogens including hepatitis B virus, hepatitis C virus, and human immunodeficiency virus which are associated with significant clinical, economic, psychological and societal burdens. Safety syringes were shown to minimize the rate of NSIs and accordingly reduce the associated burdens as well as improve the quality of life of HCWs. Objectives: The main objectives of this study were to assess the economic burden of NSIs in the emergency departments of University hospitals from a societal perspective and to estimate the budget impact of introducing safety syringes to the university hospitals across Egypt. Methodology: This was a cross-sectional observational study where data were collected from 76 nurses from eight university hospitals using a self-administered survey, including 30 questions. The economic burden of NSI was estimated by developing a population-based model, using a hybrid top-down, bottom-up approach. A budget impact analysis was performed to evaluate the impact of introducing safety syringes on a payer budget over a 3-month time horizon. The analysis included the direct cost of NSI associated with both conventional and safety syringes. Results: The study revealed that, with an average NSI rate of 1.3 events per nurse over 3 months and a total cost of EGP 1,773 per nurse, The total economic burden of NSIs associated with conventional syringes usage was estimated to be EGP 11.3 million per 3 months. In addition to the economic burden of NSIs, 70% of the nurses reported experiencing psychological and societal impact associated with NSIs. The budget impact analysis revealed a cost-saving of EGP 4.2 million per three months with the introduction of safety syringes as compared to conventional syringes. Conclusion: Results of the current study suggest that using conventional syringes is associated with high clinical and economic burden while the switch to safety syringes in the University hospitals in Egypt can lead to cost savings by reducing the total number of NSIs. 517 New Biomarkers in Oncology in the COVID-19 Era , Kristina Krpina; Miroslav Samarzija1 and Lara BaticicCancer is one of the most frequently diagnosed diseases with increasing incidence worldwide. The treatment of cancer requires a multidisciplinary methodology due to the complexity of the disease, the therapeutic possibilities of personalized medicine and the peculiarities of carcinogenesis, which is essential for the selection of an appropriate therapy [1]. Extensive evidence has been published on the molecular background of cancer development and progression, which can help tailor therapy to individual patients and improve their survival prognosis. Drug-specific therapeutic methodologies for cancer have contributed to substantial enhancements in overall survival and general quality of life for patients. However, there remains a pronounced need to expand personalization of treatments based on genetic and epigenetic tumor profiles in order to maximize quality and efficiency while limiting cytotoxicity of the oncological treatment. Early detection, accurate diagnosis, and treatment monitoring of cancer with specific markers and targeted molecular testing can be of great benefit to cancer patients [2] 518 Glycemic Control of Type 2 Diabetics and Associated Depressive Disorders Spectrum - Descriptive Comparative Study in Ismailia City - Egypt , Seham A Ibrahim; Hassan A Shora; Ashraf Eltantawy and Ismail DahshanBackground: Depressive disorders are highly prevalent in the general population worldwide. Evidence suggests a longitudinal reciprocal bi-directional relationship between depression and type 2 diabetes. This study aimed at detecting the relationship between glycemic control and the spectrum of depressive disorders among patients with type II diabetes attending the health insurance outpatient clinics of medical complex, Ismailia city between January and March 2022, Ismailia city, Egypt. Methods: This study recruited 105 patients with type II diabetes randomly selected from patients attending the specialized endocrinology and diabetes center clinics in the medical complex, health insurance Ismailia city and matched on a regular basis with another 105 non-diabetic individuals randomly selected from new patients attending for general medical checkup and covered in the comprehensive medical insurance pilot run currently in Egypt. Brief medical history and examination was carried out for all participants including, duration of type 2 DM diagnosis, presence of diabetic complications, and smoking status, and BMI recording, followed by interview for self-completion of the “Beck Depression inventory II scale”. A venous blood sample, in a non-fasting state, was drawn for measuring HbA1C% from all participants. Results: The mean HbA1c% in diabetic group was 8.7% + 2.1, compared with 5.3 + 0.44 in non-diabetic group. Assessment of prevalence and the grades of depression in the two study groups, showed a highly statistically significant difference between the two groups with 55 subjects representing 52.4% in the diabetic group, compared with 11 subjects, representing 10.5% in the non-diabetic group. The grades of severity of depression between the two groups showed also a highly statistically significant difference with 33.3%, 15.2%, and 3.8% respectively for mild, moderate, and severe depression in the diabetic group, compared with 8.6%, 1.9%, and 0% respectively for mild, moderate, and severe depression in the non-diabetic group. High statistically significant difference in Beck ‘depression inventory Score (BDI-II) was shown between the two groups with mean score of 14.2 + 7.6 in the diabetic group, compared with 9.8 + 3.3 in the non-diabetic group. A linear positive correlation was shown between HbA1c%, and BDI-II score in all of the study participants. In the diabetic group a moderate positive correlation was shown between BDI-II and HbA1c% with r coefficient 0.37 that was highly statistically significant (P < 0.001). The results of binary regression analysis model for prediction of depression, showed among several independent factors selected, that smoking, and presence of diabetic complications were statistically significant predictors (P = 0.016, and 0.013, respectively), and glycemic control (HbA1c%) was highly statistically significant predictor (P < 0.001). Conclusion: In this study, poor glycemic control reflected in high glycosylated hemoglobin percent (HbA1c%), was shown to be closely related to higher percentages of all grades of depressive disorders as assessed by BDI-II scale (Beck Depression inventory II scale) when comparing type 2 diabetic and non-diabetic patients, and among the type 2 diabetic patients. A positive linear correlation was shown between the glycemic control level and BDI-II scale score. Glycemic control was shown to be the strongest predictor of depressive disorders, followed by presence of diabetic complications, and smoking. 519 Knowledge and Adherence to Traffic Regulations and Their Impact Among Female Drivers in Saudi Arabia , Renad A Alsalem; Fay S Algarfan; Reem M Almohaimeed; Samar M Almufleh; G Elhesaiwi; Huny Bakry and Lamiaa FialaBackground: Road traffic crashes are a real public health problem. It is the leading cause of mortality among young adults, causing the deaths of 1.35 million people. Females in Saudi are novice in vehicle driving exposing them to the road traffic crashes. Aim: This study aims to assess the knowledge and adherence of female drivers in Saudi Arabia regarding the traffic regulations, and the impact of road traffic crashes. Methods: This is a cross-sectional study design, analytic type. The sample size is calculated to be 384 female drivers. The convenient sampling technique is used to recruit the female drivers. The study was conducted from October to April 2022. Data were collected using a questionnaire designed and validated by the researchers. Results: Knowledge and adherence questions were coded then categorized into good and poor. Only 32.1% of the females were found to have good knowledge of traffic regulations, while 60.1% of the females had good adherence. Conclusion: This study revealed most of the participants have poor knowledge, while most of them have good adherence to traffic regulations that they know. 520 Influence of Climate Change on Mental Health - A Review , KG Sruthi2014 was declared by the US Meteorological Department as the hottest year in the world. Climate change is a worldwide problem that affects both physical health and mental health. The rise in temperature leads to anger and droughts due to climate change can lead to farmers’ suicide. Increased problems of climate change can lead to anxiety and depression. A decrease in agricultural practices causes an economic burden to the families which causes mental health problems like anxiety and post-traumatic stress disorder. There is a growing global view of the need to reduce carbon emissions per person over the coming decades and bridge the inequalities between rich and poor countries. The plantation of trees and saplings can reduce stress and promote a sense of well-being. This article discusses the influence of climate change on mental health and measures taken to mitigate the same 521 "Covid-19 - Post-Covid Syndrome" Pandemic: High Risks for Pregnant Women , Krashenyuk AIThe article discusses the mechanism of the disease "Covid-19 - Postcovid Syndrome". The mechanisms of pathogenesis of this disease in pregnant women are affected. The most proven mechanisms of the pathogenesis of the disease and the most correct methods of treatment according to the literature data are investigated. In comparative terms, the advantage of the "System Method of Leeching" in comparison with the proposed methods of treatment is shown. The possibility of monotherapy with medical leeches (hirudotherapy) of this disease and recommendations for pregnant women at risk of the disease are shown. 522 Combined Case Finding Strategies for Pulmonary Tuberculosis in Kampala City: A Cost Effectiveness Analysis , Anthony Ssebagereka; Kyobutungi Victo; Stevens Kisaka and Juliet N SekandiObjective: This study aims to evaluate the cost-effectiveness of a combination of three strategies compared to Passive Case Finding (PCF) alone for TB case identification among high-risk communities in Kampala from provider’s perspective. Design: This was a cost effectiveness analysis where cost data and yield of TB cases for PCF alone and a combination of Passive Case Finding (PCF), Enhanced case finding strategies (ECF) and Household Contact Investigation (HCI) were collected among adults in highly-congested areas of Kampala. The main outcome was Incremental Cost Effectiveness Ratio representing the cost to detect an additional TB case identified. Results: Based on Uganda TB program data, 4,755 pulmonary TB cases from 12,298 presumptive TB cases were identified through PCF alone in Kampala. The average cost for every presumptive tuberculosis case identified through PCF alone and PCF+HCI+ECF was US$895.80 and US$4909.90 respectively. The cost of detecting one additional TB case was US\$8211.80 using PCF, ECF, and HCI compared to using PCF only. The Incremental Cost Effectiveness Ratio (ICER) was most sensitive to number of household contacts screened, number of TB cases identified through ECF and probability of having chronic cough. Conclusion: The proportion of TB case yield of the combined strategies (PCF, ECF, and HCI) was twice as high as PCF alone. However, this was costlier making it less cost-effective compared to PCF alone based on the set threshold of twice Uganda’s gross domestic product. 523 Evaluation of the Relationship Between Serum Level of Vitamin D3 and Endothelial Function Tests in Patients with Migraine Headache , Mohammadreza Rezvani Valuklolaee; Zahra Mirzaasgari; Fatemeh Afrashteh; Roya Ghafoury and Rayan RajabiIntroduction: Migraine is a severe headache type and has a negative effect on quality of life. Studies have confirmed the presence of vitamin D receptors in different regions of the human brain and the relation between vitamin D deficiency and neurologic disorders. Here we evaluated the association between migraine features and serum vitamin D levels. Method: In this case analytical study, we included patients who were referred to the General Neurology Clinic from march 2020 to march 2021 with these criteria: Over 18 years of age, having a diagnosis of migraine with at least 3 attacks per month. Exclusion criteria included risk of vascular diseases including a history of heart attack or stroke, diabetes, hypertension, smoking, peripheral vascular disease, patients using statins, and patients who were in the acute migraine attack phase. Flow mediated dilation (FMD) of the brachial artery depending on the blood flow and carotid intima-media thickness (IMT) score were measured for the participants. Results: The correlation coefficient between FMD and IMT values was r = -0.428 (p = 0.003). This association was not notable in migraine patients with aura (p = 0.065) but in the group of patients without aura, the results were significant (r = 0.379, p = 0.025). FMD and IMT were not associated with serum vitamin D level in all patients (p = 0.802 and p = 0.785 respectively). Conclusion: We did not found a correlation between serum vitamin D level and FMD or IMT in migraine. FMD and IMT were correlated with each other only in patients without aura. Further studies are needed to investigate the role of vitamin D level in migraine features. 524 The Study of Quality of Life Among Medical Students in Universiti Tunku Abdul Rahman During the COVID-19 Pandemic , Xin LP; Boon YC; Jit LT; Wan HT; Soe YN; Swe KMM and Phyu HPIntroduction: Maintaining a good quality of life is an important component when studying medicine. However, the COVID-19 pandemic has brought a negative impact on the quality of life among medical students. Thus, studies need to be done to assess their quality of life and to generate effective measurements to overcome this issue. Objectives: To describe the socio-demographic profile of the UTAR MBBS students, to determine the prevalence of the quantity of life among respondents, and to determine the association between quality of life and the sociodemographic characteristics among respondents. Methods: A cross-sectional study was conducted among medical students at Universiti Tunku Abdul Rahman using the WHOQOL-BREF instrument [44]. Results: A total of 151 students participated in this study, with (63.6%) females and (36.4%) males of mean age between 21-25 years. Among all respondents, 23.2% were year 1 students, 25.2% year 2, 5.9% year 3, 17.2% year 4 and 18.5% year 5 students. The environmental domain has the highest mean score (74.95) among all domains of quality and life. In general, Year 2 students, living in a house or apartment, students living with families, students of M40 household income, and students without the presence of congenital disease showed a higher score of quality of life in the environmental domain. Conclusions: The overall quality of life of medical students in UTAR was good, indicating that they were not affected much by the pandemic. However, it is still advised to continuously monitor and support students during the pandemic, to further improve their quality of life. 525 Epidemiology of Accessory Renal Vessels Among Patients with Hydronephrosis in Albania , Bilbil Hoxha; Ervin Toçi; Enver Roshi; Fjolla Hyseni; Edlira Horjeti; Guri Hyseni and Breta KotorriPurpose: This study aimed to shed light on the prevalence and epidemiology of aberrant renal vessels in a group of patients diagnosed with hydronephrosis in Albania. Material and Methods: This is a case-series study of 81 patients diagnosed with hydronephrosis and showing up at the Urology Service of the University Hospital Center "Mother Teresa", in Tirana, during the years 2010-2014. All patients were examined in order to confirm the hydronephrosis diagnosis and to potentially detect the presence of aberrant renal vessels. Basic socio-demographic data were collected and the chi square test was used to assess their distribution among patients with and without aberrant renal vessels. Results: The mean age of participating patients was 27.7 years ± 13.78 years, 51.9% males, 53.1% residing in urban areas, 42% unemployed. The patients came all over the country as demonstrated by the distribution of them according to country’s prefectures. The overall prevalence of aberrant vessels in patients with hydronephrosis was 42%, the prevalence of aberrant renal arteries was 29.6%, and the prevalence of aberrant renal veins was 18.5%. About 32% of patients with hydronephrosis had one type of aberrant renal vessel (artery or vein) and 9.9% had both types of aberrant renal vessel (both artery and vein). In 9.9% of cases aberrant vessels were located in the right kidney, in 30.9% of the participants they were located in the left kidney and in 1.2% of all participants the aberrant vessels were present in it both kidneys simultaneously (bilateral). No significant differences in the prevalence of aberrant renal vessels were detected by gender, age and place of residence of participants. Conclusions: The epidemiology of aberrant renal vessels among patients with hydronephrosis in Albania is comparable to literature reports. The epidemiology of accessory renal vessels can help professionals in the field to suspect and seek evidence of these structures in their patients, since these health conditions are quite frequent and could interfere with the relevant surgical procedures. 526 Urinary Adiponectin as a Predictor of Carotid Atherosclerosis in Metabolic Syndrome in Type 2 Diabetics , Ismail Dahashan; Hassan Shora; Nada Hosni and Seham IbrahimPlasma adiponectin has been established as a marker for cardiometabolic syndrome in type 2 diabetics. This study aimed for evaluating urinary adiponectin uAPN and plasma adiponectin concentration as a biomarker of cardiometabolic risk linked to carotid atherosclerosis in type 2 diabetic paients. Subjects and methods total 220 participants were included in the study who were attending Diabetes outpatient clinic in Ismailia Medical complex in June 2021 to December 2021. They were divided into four groups: Group 1 (n = 55): included healthy individuals without cardiometabolic syndrome. Group 2 (n = 55): included non-diabetic subjects with cardiometabolic syndrome. Group 3 (n = 55): included diabetic patients without cardiometabolic syndrome. Group 4 (n = 55): included diabetic patients with cardiometabolic syndrome. Cardiometabolic syndrome was diagnosed based on the IDF and revised NCEP ATP III criteria that conditioned the presence of elevated waist circumference (WC) in addition to two of the following: elevated triglycerides, decreased high density lipoprotein (HDL), elevated fating blood glucose (FBG) (or diagnosed as type 2 diabetes), and elevated blood pressure (or being on antihypertensive treatment) to diagnose cardiometabolic syndrome. Venous blood samples were drawn from all participants and analyzed for both urinary and plasma adiponectin and other investigations according to standard methods. Carotid Ultrasonography was performed for all of the study participants to estimate the carotid plaque score (CPS). All laboratory investigations were done according to standard methods. Results: Urinary adiponectin concentration was increased in all three study groups: ng/mg creatinine,7 ± 2.7,6.6 ± 2.9,9.3 ± 3.9 vs 4.6 ± 2.1 in control group, respectively. It is strongly statistically positively associated with all components of cardiometabolic syndrome Whereas carotid plaque score was also increased in all study groups. Furthermore, uAPN cutoff value 6.2ng/mg creatinine predicts carotid plaque score with high sensitivity and specificity, 85.8% and 82.2% respectively. Conclusion: Urinary and plasma adiponectin may be useful biomarkers for prediction of cardiometabolic risk and atherosclerosis in type 2 diabetic patients and may represent helpful tools for primary and secondary prevention strategies of cardiovascular disease in metabolic syndrome in type 2 diabetic patients. 527 Neonatal Bilateral Herpetic Keratitis Treated with Ribavirin Eye Drops at the Yaounde Gyneco-Obstetric And Pediatric Hospital: About A Case , Nomo AF; Akono Zoua ME; Nanfack Ngoune C; Mvilongo Tsimi C; Nguepnang V; Malla Eyebe G; Dega A; Koki G; Epée E; Omgbwa Eballe A and Bella ALIntroduction: Herpetic keratitis is inflammation of the cornea caused by herpes simplex viruses 1 and 2 (HSV-1 and HSV-2). HSV-2 keratitis is almost only encountered in neonatal infections causing amblyopia or even blindness. The mode of per-partum contamination during passage through the genital canal is very often recurrent. We report the case of a 33-day-old infant who presented with bilateral neonatal herpetic keratitis and which poses a therapeutical and prognostical problem. Medical Observation: We reported the case of a 33-day-old infant, born to a primiparous mother by septic delivery at home, who presented with neonatal bilateral herpetic keratitis at two weeks of life without systemic involvement treated with ribavirin eye drops. The evolution was marked by the improvement of symptomatology with the disappearance of corneal opacities. Conclusion: If not treated early, neonatal herpetic keratitis can lead to serious eye damage and even systemic lesions. New molecules such as ribavirin eye drops are proving their worth in the management of herpetic keratitis. 528 Modern Didactic Problems of Acute Inflammation of Lung Tissue , Igor KlepikovAcute pneumonia (AP) is one of the oldest nosologies known to medicine, which for many centuries has rightfully been attributed to severe diseases with high mortality. For most of its history, the search for ways to help patients with AP has been conducted empirically, but this disease has never been included in the category of contagious and did not pose a danger to others 529 Music Therapy in Preterm Infants: Which One is Better Active or Passive? , María de los Angeles Livengood de SanabriaPreterm newborns present multiple complications due to their immaturity, for several years multiple methods have been used that help conventional therapy, among the most used is music therapy, this can be done in different modalities and has multiple benefits, for what is intended to review the scientific literature to evaluate them and see if they present any differences and which one has more advantages 530 The Daily Profile of Blood Pressure in Patients with CKD of Various Stages , Daminova KM; Abduqodirova ShA and Xusanxojaeva FTAll patients conducted an explanation about monitoring the level of blood pressure in the form of self-control to assess its influence on the development of CKD, and also determined intrauditive and long-term variability (LTV). Due to the study, the presence of arterial hypertension is recorded as a risk factor for the progression of chronic kidney disease in the absence of clinical manifestations, the data indicate the need to study arterial hypertension as a risk factor for the development and progression of CKD during the initial examination of patients. In the early diagnosis of risk factors, normalization of the level of HTN, and the achievement of target blood pressure numbers is more effective. 531 “Diffusion” and The Basic Nature of Intermolecular Attraction Forces , Satyavarapu Naga Parameswara Gupta; Kiron Koti Shesha Manikya Satyavarapu and Satyavarapu Subba Vamsi Krishna Here in this paper, we show that the primary reason for this diffusion is the intermolecular attraction forces due to Newtonian gravitational attraction forces acting in a combined way which are the vectorial sum of all the attraction forces acting on molecules as defined as SITA forces Multi Molecule Theory. Some pairs of molecules hit each other, bounce like rubber balls, and diffuse because of these SITA forces. Here some of the molecules are going to higher distances from the hitting centers. Earlier we formulated and showed the three states of matter similarly. Here we took a Nano-drop-let of contaminated water as a container. We are calculating inter-molecular attraction forces between molecules and finding the movements of molecules due to the attraction by all the other molecules at the molecular level. 532 Assessment of Practice of Household Solid Waste Disposal in Eziama, Aba North Local Government Area, (Lga) Abia State, Nigeria , Akwuruoha Emmanuel Maduabuchi; Ibe U Ibe; Prince Ezenwa Ndubueze Onyemachi; Ohanaka Njideka Jane; Ekezie Stella Chioma; Onu Ruth and Minadoki David MinadokiBackground: Solid waste can be described as unwanted materials generated from households and municipal services in our daily activities in homes, agricultural, and livestock activities and in industries. They include garbage or kitchen waste, paper, empty cans, broken bottles, glass, iron scraps, plastic, etc. These are dry refuse as opposed to wet or liquid refuse (sewage) constituting of human faeces, urine, effluents from bath and kitchen. If not properly disposed of will lead to offensive conditions such as bad smells, breeding of flies, and spread of infectious diseases, fire outbreak and injuries especially to children playing around. Waste management is the process of collecting, transporting, processing or disposing and monitoring of waste materials. Objective: Assessment of Practice of Household solid waste disposal in Eziama, Aba North Local Government Area. Abia State, Nigeria. Materials and Methods: A cross-sectional study performed in Eziama Community in Aba North Local Government Area in ABA, Abia State, Nigeria. Self-administered semi-structured questionnaires were administered to 465 household heads for the study. Result: A total of 465 household heads were selected by systematic sampling methods with response rate of 450 (97.6%). Mean age was 35 ± 6.421. Level of good practice on waste management is 206 (45.8%) and is low. The relationship between the sociodemographic variables (age group, marital status and level of education) and level of practice of solid waste management was statistically significant, marital status at p value of 533 Determination of Pathogenic Bacteria Isolated from Post-Operative Wound Infections and Their Antibiotic Resistance Pattern: A Hospital-Based Cross-Sectional Study , Ishaq Hossion; Md Shahin Mahmud; Md Aoulad Hosen; Md Saiduzzaman; Fatema Tuj Zohora; Md Khaled Hossain; Md Shajedur Rahman and Nazmi Ara RumiPostoperative wound infections in surgical patients after surgeries, as well as the emergence and spread of drug-resistant strains, have been identified as a key challenge in the medical field and also can cause mortality, morbidity and economic burden. Therefore, this study investigated some common aerobic pathogenic isolates and their antibiotic sensitivity pattern in patients with post-surgical wound infections in a territory hospital in Dinajpur, Bangladesh. Bacteriological analysis was performed on wound swab samples collected from 15 patients with a medical assessment of post-surgical wound infections at Dinajpur Medical College. Wound swabs were collected from different surgical wound during dressing and inoculated on Nutrient agar, MacConkey agar, EMB agar, Blood agar, Cetrimide agar, and Mannitol Salt agar for isolation and identification of Escherichia coli, Pseudomonas spp. and Staphylococcus spp. The modified Kirby-Bauer disk diffusion technique was utilized for antibiotic sensitivity tests. Out of 15 samples, 10 (66.67%) samples were positive, of which 4 were male and 6 were female patients with age ranged from 15- ≥50 years. A high predominance of aerobic bacteria was observed and Staphylococcus spp. (42.11%), E. coli (31.58%) and Pseudomonas spp. (26.31%) were predominantly identified. The highest number of the positive case found in the age group ≥50 (40%) and the lowest positive cases were found in the age group 15-30 (10%) respectively. Among 19 bacterial isolates, higher growth of isolates (52.63%) were found in the age above ≥50, whereas the lowest growth of isolates was found in the age group 15-30 (5.27%) respectively. Sequencing the 16S rRNA gene, E. coli was identified with a 1466 bp PCR band. Gram-positive bacteria were susceptible to Cloxacillin 7/8 (87.5%) and Gentamicin 6/8 (75%), whereas, Gram-negative isolates were most effective to Ofloxacin, Ciprofloxacin, Gentamicin and Amikacin 5/5 (100%). Hence, the most predominant bacteria in post-operative wound infection were Staphylococcus spp. and E. coli. The antibiotic sensitivity tests revealed that numerous and multi-drug resistant bacteria are involved in post-operative wound infection. Therefore, routine microbiological investigation of wound specimens and antibiotic susceptibility testing will be advised by the clinicians in treating wound infections. 534 The Key Role of Exercise Trainings in Decreasing Diseases Related to Lack of Mobility , Keyvan Ahmadi DehrashidDue to the change of Life-style and the industrialization of societies, diseases caused by reduced mobility have increased. One of these diseases is obesity, which itself can be the origin of many other diseases. In general, adults who have a body mass index (BMI) between 25 and 29.9 are classified as overweight; Adults who have a body mass index of 30 or higher are considered obese. The number of overweight and obese people has increased dramatically in the last two decades. It has been observed that a high percentage of urban residents are overweight. In the research conducted in connection with obesity, it has been observed that obesity not only makes a person susceptible to insulin resistance and diabetes, but also by creating lipid disorders such as high levels of LDL, VLDL, cholesterol and triglycerides, makes a person vulnerable to cardiovascular diseases. 535 Giant Right Inguinoscrotal Hernia: A Case Report , Francesco Esposito; Dorin Sacrieru, Marco Del Prete and Alexandre CortesA 69-year-old patient presented a giant right inguinal-scrotal mass for over ten years. The clinical examination and a CT-Scan confirmed the presence of a giant inguonoscrotal hernia containing the last ileal loops, caecum and the right colon. After a careful pre-operative cardio-respiratory evaluation, the surgery was proposed. Through an inguinal-scrotal incision, the hernia sac and its contents were largely released and reintegrated into the abdomen. Reparation using a polypropylene mesh according to the Lichtenstein technique was finally performed. The postoperative course was uneventful. The patient was discharged after three days and one year later, no recurrence was found. This case report shows that in patients with good cardio-respiratory function, Lichtenstein technique with mesh reinforcing remains the best treatment. 536 A Comprehensive Survey Report on Women Health Care Problems at the age Group of 18-30 Years , Sabnaz Kazi; Nandan Sarkar; Sourav De; Soma Das; Vijayalakshmi P; Sanjay Dey and Sajal Kumar JhaWomen go through major physiological changes throughout their lives, leading to differences in health concerns for varying age groups. During times of physiological change, women are facing many issues such as depression, anxiety and eating disorders, fertility, avoiding STDs and practicing safe birth control gain importance. We have performed this survey on women health issues at this age group (18-30), the behavioural changes are greatly seen compared to other age group in terms of hormonal changes, depending on busy life schedule, peer pressure, less sleeping, weakness due to menstrual cycles, improper food habits etc. So, these were the factors to be concern which leads us to do enquiry on these topics and go to root of cause of the disease. Also, we did enquiry on the medication they were using for their health issues and the side effects of the medications and checked cause of the adverse events happening. 537 Syndromatic Pulmonary Lymphangioleiomyomatosis , Cristhian Manuel VelásquezLymphangioleiomyomatosis (LAM) is a rare disease that predominantly affects women, especially those of childbearing age. It occurs sporadically or is associated with tuberous sclerosis complex. The case of a 25-year-old female patient is presented, with a clinical history of fever and dry cough for one month evolution, as well as facial cutaneous angiofibromas, Shagreen patches on the neck and shoulders and Koenen nail tumors on the feet. 538 Ultrasound-Guided Cervical Plexus Block for Thyroidectomy: About 05 Cases at Sominé Dolo Hospital in Mopti , MS Kamissoko; K Soumano; A Traore; L Dienta; M Shabani; B Traore; S Coulibaly and D TraoreLocal or regional anesthesia has long been recognized as a useful anesthetic option for thyroidectomy. This block was relatively confidential before the arrival of ultrasound. In our study, they were a series of five patients operated for thyroidectomy under bibloc of the intermediate and superficial cervical plexus associated with skin infiltration of the incision site. Conversion to general anaesthesia was required to control bleeding plus sedation with 05 mg midazolam for discomfort, verbal contact was maintained with patients and surgery was uneventful in the other cases. Cervical plexus block is a technique that can be used for thyroidectomy. 539 Diabetes Prevalence and Associated Factors in the Adult Population Aged 25-64 in the Humbo Districts of Woliata Zone , amson Abebe; Wondimagegn Paulos and Rea TschoppBackground: The burden of disease caused by NCDs is quickly growing in emerging nations, with substantial social, economic, and health repercussions. However, data on the prevalence of diabetes and related variables among adults aged 25-64 years in Ethiopia, particularly in drought-stricken areas, is limited. The goal of this study is to find out how common diabetes is and what variables contribute to it in the middle-aged population. Methods: From January to February 2020, a community-based cross-sectional survey was undertaken among adults aged 25-64 years in Humbo district, southern Ethiopia. 587 people were chosen using a multi-stage sampling process. Weight, height, and fasting blood glucose levels were all measured. To enter data into a computer, Epi Data version 3.1 was utilized, which was subsequently exported to SPSS version 20 for analysis. Descriptive statistics and bivariate and multivariate logistic regression analyses were performed, and statistical significance was determined at a p-value of less than 0.05. Results: Diabetes was found in 5.9% of the research participants (95 percent CI: 3.8-7.8). Age 45-54 (AOR = 4.80, 1.25, 18.32), physical inactivity (AOR = 5.33, 1.37, 20.72), family history of diabetes mellitus (AOR = 6.34, 95 percent CI: 2.43, 16.55), and obesity (AOR = 3.26, 95 percent CI: 1.43, 7.42) were all significantly associated with diabetes, according to multivariable logistic regression. Conclusion: The findings demonstrated the need for implementing educational public policies to encourage population behavior changes in order to prevent and control diabetes. 540 Fulminant Emphysematous Hepatitis Mimicking Liver Abscess in a Diabetic Patient , Saurabh Gupta; SK Verma; KR Sharma and John PunnoseEmphysematous hepatitis is a rapidly progressive infection of liver which has a high fatality. It is mostly seen in immunocompromised patients with a radiological appearance like emphysematous pyelonephritis but distinguished by histopathlogy and CT/MRI scans. There is limited data in medical literature regarding the causative organisms, pathogenesis and management of this condition. Despite treatment by broad spectrum antibiotics and surgical care, it may end in fatality as in the present case. 541 Impact of the High Risk Pregnancy Approach (HRPA) on Maternal Mortality in Low Income Countries , Atemkeng TF; Fouogue J; Donfack JH; Fondop J; Banga NDD; Djam A; Fouedjio J; Mbu RE and Leke JIA high-risk pregnancy (G.A.R.E.) is one where one or more factors expose the mother and/or fetus to a very high probability of morbidity or mortality before, during or after delivery. The best management of this type of pregnancy requires scrupulous compliance with the so-called G.A.R.E. approach, which is an essentially preventive method. To assess the impact of the G.A.R.E. approach on maternal mortality in order to determine whether this approach can significantly reduce current maternal death rates, a prospective and analytical study was conducted at the Central Hospital of Yaoundé over a period of 10 months, from February to November 1998. During the study, 96 parturient were received and followed up until postpartum, in the G.A.R.E. service and 2647 deliveries were also registered at the Main Maternity Hospital, for a total of 2743 deliveries. Greater multiparity was the most encountered risk, at 29.17%. Complications from abortion were the most common causes of death at 28.57%. The successful application of the GARE approach could reduce the maternal mortality ratio by up to 53.57 per cent. 542 Oncogenic Characteristics, Functional Partners and Protein Structure Variations in Isolated MDM2 Gene among Liver Cancer Patients in UCTH, Calabar, Nigeria , Sunday Cecilia James; Kooffreh Mary E; Umoyen John A; Ubi Godwin M; Agbor Reagan B; Ekerette Emmanuel E and Ekpenyong Blessing B This research investigated the oncogenic properties and protein structure variations of mutations in the mouse double minutes 2 (MDM2) gene implicated in liver cancer patients in the University of Calabar Teaching Hospital, Calabar. Forty five liver cancer patients and fifty controls were recruited for the study. Blood samples were collected for molecular analysis. DNA was isolated from the blood samples of all the subjects and sequenced for the presence of MDM2 gene mutation. The chromatogram was decoded into nucleotide sequences using Chromas Pro and later translated to protein sequences. Bioinformatics tools were used to unveil the oncogenic characteristics, functional partners of MDM2 gene/protein interactions and the MDM2 protein structure variations. The result revealed significant differences in oncogenic characteristics as molecular weights, theoretical isoelectric points, total number of atoms, size of gene, G-C content, extinction coefficient, estimated half- life, instability index, aliphatic index, total positively and negatively charged amino acids and hydropathicity of the MDM2 gene for both patient and control group isolates. The results of MDM2 gene oncology /protein interactions revealed strong relationship and interactions with functional partners of major genes and proteins such as MDM4, TP53, TP57, RLP11, EP300, UPST and CDKN2A proteins. Results of secondary protein structures for the MDM2 gene isolates showed variations in the percentage distribution of alpha helices, beta sheets, extended strands and random coil. The tertiary protein structure further revealed the double mouse shape of the gene which accounts for the name mouse double minutes 2 gene. Knowledge of the oncogenic characteristics of the mutated and non-mutated MDM2 gene and the variations that exist in the protein structure characteristics can play a major significant role in the design and development of therapy for liver cancer disease and further help to unmasked the genetic factors and interactions that trigger the loss of functions and deviant expressivity of the mutated MDM2 gene among patients. Hence, the findings of this study serve as baseline information for further studies on the genetic etiology of the disease. 543 Probiotics in the Era of Diabetes, is it a Hope or a Hype; Narrative Review of Literature , Dakhel Fahad Almubarak; Alanoud Abdulaziz Alharkan and Mostafa KofiDiabetes is a metabolic disorder that is characterized by inadequate insulin secretion by pancreas or the lack in ability of the present insulin to function properly. Hence, diabetes forms a fertile media for several diseases and represents a greater risk on human-being health. Over decades, several strategies for management of diabetes have been tried by specialists, of which medical, herbal, and even live style modification has been tried. Although diabetes mellitus represents a global growing epidemic disease, Till the moment there is no absolute solution at molecular level that targeting the disease. It’s well known that commensal bacteria have an un-neglectable role in bode metabolism since infancy both in healthy and diseased patients. On a clinical base when we studied beneficial role of probiotics at cellular level in animals. It was proved in many studies the beneficial role of probiotic for people with DM; nevertheless, further prospective interventional research, mostly using human models, are required to fully understand the impact of probiotic use in diabetic patients. Indeed, we need to test the probability of probiotics usage in the outpatient clinic. As Based on our reliable understanding the beneficial role of probiotics in patients with diabetes mellites specially at the level of cell, both in clinical trials and animal studies, in addition to their excellent tolerability. Also, probiotics have proved their ability to decrease insulin and fasting blood glucose level in diabetic patients in a preclinical setting and in human trials. Recently, probiotics are used in a multiple diseases like inflammation, allergic reactions, and autoimmune diseases. However, the heterogeneity in these studies is high. For example, species used, the dose of probiotic used, and the magnitude of efficacy. In our review, we focused on reviewing the relation between probiotics and troubled metabolism of our body sugar. 544 Effective Natural Products BioChaga and BioDihydroquercetin to Safe Assistance to the Body at all Stages of COVID-19 Viral Infection , O UsolcevaThe rapid outbreak of coronavirus infection is a global public health problem worldwide. In a pandemic, the issue of creating effective antiviral drugs for the treatment of a new coronavirus infection is most acute. The issue of prevention is also acute. Each of us would like to know what he can do to protect his body from the threat of coronavirus infection. So far, effective treatments have not yet been developed. The scarcity of clinically proven drugs has contributed to the fact that natural products have received increasing attention due to their low toxicity and lack of side effects. 545 Prevalence of Heart Failure and Frequency of its Risk Factors Among Heart Failure Patients: A Study in the Internal Medicine Ward of Mirwais Regional Hospital , Asadullah Zerak; Mohammad Sami Hayat; Ihsanullah Darmal and Ahmad KhanHeart failure is a global problem that is associated with significant morbidity, mortality, and healthcare expenditures worldwide. This study aimed to identify the prevalence of heart failure and the frequency of its different risk factors among heart failure patients in Mirwais Regional Hospital in Kandahar, Afghanistan. This study is a hospital-based cross-sectional study, and data is collected from heart failure patient populations by a standard questionnaire. A total of 1623 patients were admitted to the internal medicine ward of Mirwais Regional Hospital during the study period, and 114 patients had heart failure. Hence, its prevalence is 7%. Of these 114 patients, 50.1% were male, the remaining 49.9% were female. Research is limited on the incidence of heart failure in Afghanistan. It is essential to conduct region-centric research on the prevalence of heart failure to make evidence-based strategies to decrease the burden of heart failure in the country. 546 Prevalence of Diabetic Foot and Risk Factors Among Diabetic Patients in PHC, PSMMC, Riyadh, KSA 2019-2020 , Ahmed Alsomali; Sultan Alturki; Hussam Alzahrani and Mostafa Kofi Introduction: Diabetic foot is a common complication among individuals with diabetes, characterized by the development of ulcers, infections, and amputation. In a study conducted at the Prince Sultan Military Medical City in Saudi Arabia, a cross-sectional research was conducted to determine the characteristics, prevalence, and risk factors of diabetic foot in diabetic patients attending a primary healthcare center and diabetes clinic. A sample of 300 patients was sampled using a comprehensive sampling technique and data collected from medical records. The results showed that the prevalence of diabetic foot in the study population was 15.8%. Risk factors for diabetic foot included older age, duration of diabetes, peripheral neuropathy, and peripheral arterial disease. In addition, the results showed that the prevalence of peripheral neuropathy was 89.3%, and the prevalence of peripheral arterial disease was 35.4%. These findings highlight the need for prevention and early intervention for diabetic foot in this population, as well as the importance of screening for peripheral neuropathy and peripheral arterial disease in diabetic patients. Further research is needed to understand the specific risk factors for diabetic foot in the Arab population and to develop appropriate prevention and management strategies.Top of Form Methods: In the Prince Sultan Military Medical City, family medicine and community Centre in Riyadh (KSA), a cross-sectional research was conducted among diabetic patients who were visiting the PHC, Diabetics clinic. The participants were from Saudi Arabia. The purpose of the research was to determine the characteristics of Dm foot in PSMMC, as well as the prevalence of Dm foot in PSMMC and the risk factors associated with Dm foot in PSMMC. Results: Dm foot is associated with neuropathy with a p-value of 0.004, which is statistically significant. No other risk factors are associated with Dm foot in Riyadh this is due to the low number of people with Dm foot in the area. Chi-square test cannot be done for Changes in sleep risk factor because no participant with both normal and Dm foot mentioned it as a risk factor. They all do not experience changes in sleep. Conclusion: There is a high prevalence of risk factors for diabetic foot problems, which has led to an increase in the frequency of these complications and calls for primary and secondary preventive programs to reduce morbidity and death in addition to the economic cost of the complications. When treating diabetic patients, it is important to take additional precautions, such as releasing pressure on the nerves in the lower extremities. 547 Co-enzyme Q-10 and its Effect on Periodontal Disease and Oral Cancer: A Systematic Review Article , Faraed Dawood Salman; Aya Jabbar Hussein and Jabbar Hussein KamelBackground: To combat the excess production of free radicals in periodontal disease, antioxidant medications are employed. Free radicals (FRs) and reactive oxygen species (ROS) are the major contaminants that Co-Q10 primarily effectively removes in order to perform its intercellular antioxidant function, this study is aimed to: Analyze the results of using perio Q gel (coenzyme Q10) intravenously only. As an additional step in the treatment of patients with chronic periodontitis in conjunction to scaling and root planning on the periodontal clinical criteria. Examine which of the various treatment modalities improved clinical periodontal markers more at 3 and 6 weeks. Materials and Methods: Clinical periodontal markers like the Plaque Index (PI), Gingival Index (GI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD), and Relative Attachment Level (RAL) were evaluated at the first visit, 3 weeks, and 6 weeks. Results: When compared to the SRP group, the clinical parameters PPD and RAL of the combination group significantly decreased, according to intergroup analysis. In all groups, the reduction in PI, GI, BOP, PPD, and RAL across the three visits was highly significant when intra-group analysis was performed. Conclusion: By using the gel in addition to scaling and root planning rather than only scaling and root planning alone, the clinical periodontal parameters improved more significantly. The ability to employ the gel as the only substance to support common periodontitis treatment methods. In the periodontal treatment phase, the clinical metrics considerably improved, showing that CoQ10 expands treatment possibilities by enhancing the host response to disease activity. All living things possess the lipid-soluble endogenous antioxidant coenzyme Q10. Coenzyme Q10 may be a therapy for periodontitis, according to the pharmacology of the substance. To establish its precise function in the treatment of periodontitis, including both as an adjuvant and a primary therapeutic agent, as well as the right dosage, efficacy, and bioavailability, more research is required. 548 Pulse Immunomodulatory Mesotherapy of Psoriasis , Zavadsky VNPulse immunomodulatory mesotherapy (PIMT) for mild and moderate forms of psoriasis is described. A suspension of a prolonged-acting glucocorticoid in a mini-dose - betamethasone 7 mg (or triamcinolone 40 mg) - is diluted with a saline solution of sodium chloride, 10-15 mg of methotrexate is added as an injection solution, and this mixture of drugs is injected intradermally into the lesions 1 time per month. The effectiveness of PIMT in psoriasis, which is an immune-dependent chronic disease, has been shown. PIMT is a convenient alternative to local corticosteroids - for the treatment of adults, adolescents and partly children. With a mild course of psoriasis, PIMT has a sufficient and pathogenetic effect. Advantages of PIMT: treatment is carried out no more than 1 time per month, simultaneously; the effect is manifested from the first days, stable; relapses become less frequent and weaker; the total dose of glucocorticoid with PIMT is no more (even less) than required with external corticosteroid therapy; the safety of PIMT is ensured by an acceptable fixed dose of the drug and its reliable natural decrease. Quality of life is improving (service and management are higher): the "ointment dependence" has been eliminated, the procedures are rare, not burdensome; temporary disability is reduced, hospitalization is not required. There is an economic benefit. 549 Considerations in Medical Academic Writings , Iqbal Ratnani; Saleem A Zaidi; Anam Mithwani; Justyn Mahanger and Salim SuraniThis paper provides an overview on how to write an academic writing piece with a step-by-step process for completion, as expected in academia, and is intended to support the crafting of scientific papers, written by physicians, nurses, and other allied healthcare personnel in the broader medical field. This article is written to guide new writers through the essential considerations for writing scientific manuscripts, such as identifying the targeted audience, purpose, and devising a strategy before starting a written piece, as well as incorporating organizational layout, flow, style, and presentation. 550 Contribution of Radiological Imaging in the Management of Cervical Spine Trauma , Sidi Mohammed MedjadiObjectives: The main objective of our work is to study the contribution of radiological imaging in the diagnosis and therapeutic decision in traumatized patients of the cervical spine. Materials and Methods: We conducted an exhaustive descriptive-type study with prospective collection, carried out over a period of three and a half years at the level of several structures of the University Hospital of Tlemcen, namely the emergency service, multipurpose intensive care and neurosurgery departments. It focused on cervical spine trauma patients treated from the scene of the accident to the neurosurgery and / or medical-surgical resuscitation departments. All patients admitted for cervical spine trauma, whether superior (C0-C2), inferior (C3-C7) or mixed, whatever the mechanism of the accident, whatever the treatment decision, with or without neurological lesions, with or without signs of seriousness on admission and over 16 years of age. Results: The majority of the injured (n = 107) benefited from a CT scan of the cervical spine at the University Hospital of Tlemcen (83.59%) upon admission, while 7.81% (n = 10) did so privately. 8.59% (n = 11) had their CT examination a few days after their hospitalization in the Neurosurgery department (7 at the central radiology unit of the university hospital of Tlemcen and 4 in an external radiology structure). The CT scan allowed us to accurately diagnose the osteoarticular lesion and to guide our therapeutic conduct. Of the 21 patients who presented spinal cord compression, 15 were of bone origin (11.71%), 4 of disc origin (3.12%) and two others of mixed origin (1.6%). A single vascular lesion of the vertebral artery was recorded during the study (1.6%). The damage to the recorded ligaments represented 7.81% with a frequency of ligament rupture of the order of 4.7% and a frequency of ligament elongation of the order of 3.12%. Spinal cord edema and intraspinal hematoma were successively around 6.25% and 2.34%. Conclusion: In the acute phase of the trauma, it retains performance inferior to that of CS in the detection of minor bone lesions, but equivalent to dynamic maneuvers to search for instabilities of ligament origin access to the machine and the cost are far superior. In addition, the indication will have to be very carefully weighed in polytrauma patients because of the difficulties of monitoring during this sometimes very long examination and the need to use equipment resistant to magnetic fields (respirator, etc.). The scanner therefore remains the most effective technique for detecting but also formally eliminating a traumatic lesion. 551 Non-invasive Predictive AI Coronary Angiography , TP Abdualimov and AG ObrezanA novel approach to diagnosing coronary artery disease was proposed. A model for diagnosing coronary heart disease was designed using neural network analysis and allow to reveal transient myocardial ischemia, pathology of the main coronary arteries. The aim of the study was to compare the accuracy of the trained neural network model on the input structured data (sex and age, cholesterol levels, presence of chronic diseases, hereditary factors, lifestyle and etc.) and ECG images with the results of traditional coronary angiography. The proposed diagnostic model was proved to be reliable and highly sensitive for 1500150 cases. The model was compared with the traditional diagnostic methods of transient myocardial ischemia (24-hour Holter monitoring, treadmill test), where the presented diagnostic model was considered to be significantly effective. The accuracy of forecasts was assessed and justified by the cardiologists supervising patients with ACS on a daily basis. The study also presents a new method of sample extrapolation using generative adversarial networks allowing to exceed the volume of observations used in classical meta-analyses. 552 Clinical Suspicion Refuted by Laboratory Tests , Mariana-Alis NeagoeMedical laboratory tests complement the medical check-up, playing an essential role in establishing a correct diagnosis. They confirm or refute certain suspicions of the disease. Depending on the specific clinical context of each patient, the physician will recommend medical laboratory tests, from routine tests to tests specific to certain conditions. We present the case of a 73-year-old female patient, who presented to the medical office for fatigue arising from moderate exertion and breathing difficulties. Following the pulmonology check-up, it was decided to carry out a thoracic-pulmonary computer tomography (CT) which revealed fine bilateral infrahilar bronchiectasis and a voluminous round-oval process with axial dimensions of 39/26 mm located at the level of the prevascular space. It was decided to perform an anterior mediastinal puncture and the histopathological test revealed an aspect compatible with the diagnosis of type A thymoma. Considering the relationship between myasthenia gravis and tumours of the thymic gland, the diagnosis of myasthenia gravis was suspected. Medical laboratory tests refuted the existence of anti-acetylcholine receptor antibodies. Anti-acetylcholine receptor antibodies are present in 80% of patients with generalized myasthenia gravis, which means that there are no current criteria for this diagnosis. Medical laboratory tests can be the first line of detection of unusual events thus facilitating the establishment of an etiological diagnosis of suspicion or certainty. Laboratory diagnosis plays an essential role in the correct clinical decision as well as in the optimal treatment for each patient. 553 Acute Myocardial Infarction in Young , Imran Ahmed Khan and Anoop Kumar SinghCoronary artery disease (CAD) once thought a problem of old age, now seen among young adults too. There are several examples of young celebrities and sportspersons who succumb during their live performance due to Acute Myocardial Infarction (AMI). Although there has been a dramatic decrease in the burden of CAD over the past few decades, this favorable trend has not been found among young adults, more so among younger women [1,2]. This trend highlights the importance of improving all levels of prevention among young individuals as their risk factor profiles and prognosis may differ from that of their older counterparts [3]. Furthermore, consequences of AMI in the young carries larger economic and social impact given the higher number of productive years of life lost. These points need further exploration and research. 554 The Use of Transcranial Magnetotherapy for the Correction of the Psycho-Emotional State of Patients with Post-Covid Syndrome , RA Bodrova; AM Delyan; ER Yunusova and RO ChaikovskyThe article is devoted to a comprehensive prospective clinical study of effectiveness of use transcranial magnetotherapy for the correction of the psycho-emotional state of patients with post-covid syndrome.by comparing it with a group of patients not receiving magnetic therapy in the rehabilitation program. The aim of this work is to study the effect of transcranial magnetotherapy on the effectiveness of the use of low-frequency magnetic therapy in the complex medical rehabilitation of patients with pneumonia caused by COVID-19 in the convalescence phase. For an objective assessment of the dynamics of the state of all patients at the stage of registration of the subject of the study and the collection of primary information and after the completion of courses of treatment in patients of the main and control groups, a control assessment of the quality of life of patients was carried out according to the EQ-5D scale, the Spielberger-Khanin personal anxiety scale (State-Trate Anxiety Inventory , STAI), the Beck depression scale, the WAM questionnaire (well-being, activity, mood). Results and Discussion: assessing of the quality of life according to the EQ-5D questionnaire, positive dynamics was noted in the main group - an improvement in the quality of life by 30%, a decrease in anxiety by 28% and depression by 35%. Assessment of the quality of life according to the EQ-5D questionnaire, anxiety and depression in the control group showed a less pronounced positive dynamics of indicators. Conclusion: application of low-frequency magnetic therapy in the complex rehabilitation of patients, who have had pneumonia caused by the new coronavirus infection, improves the function of external respiration of the patients, which is confirmed by a decrease in the severity of anxiety on the Spielberger-Khanin scale, decrease of depression on the Beck scale reducing asthenoneurotic syndrome, improving the general well-being of patients, increasing tolerance to physical activity, normalizing the psycho-emotional status and, as a result, restoring activity in everyday life and improving the quality of life of patients. 555 Chronic Granulomatous Colitis Due to Tuberculosis, Case Report , Diego J Alvis-Peña; Carlos H Calderón-Franco; Jaime G Muñoz-Cerón; Santiago E Campbell-Silva; María P Alvis-Peña; S Peña-Mazabel; Ángel U Ávila-Rosales; Edgar Figueroa-López and SANDRA ITZEL HERNANDEZ OLVERAChronic granulomatous colitis secondary to tuberculosis is an unusual manifestation of extrapulmonary tuberculosis, this pathological entity is difficult to diagnose because most of its symptoms are nonspecific, resulting in a late diagnosis and treatment, considering that the disease is curable and preventable. Case: 42-year-old man with abdominal pain of intensity 6/10. Physical examination revealed superficial and deep palpation pain in the right iliac fossa, without signs of peritoneal irritation. Paraclinical tests showed no signs of local or disseminated infection, but the histopathological study reported chronic colitis due to mycobacterium tuberculosis. Discussion: intestinal tuberculosis is the sixth cause of extra pulmonary infection, located in most opportunities in the ileocecal region, the clinical manifestations are fever, fatigue, weight loss and abdominal pain, management is done with anti-tuberculosis drugs for an average period of 6 months, with subsequent clinical improvement and endoscopic remission. 556 Rat Spinal Cord Development , Maksimovich NYe; Bon EI; Nosovich MA; Khrapovitskaya KA and Portonenko AMThe study of the central nervous system is one of the promising scientific areas. A lot of dissertations are devoted to this topic. The rat is an important object in the study of the spinal cord in the normal state and in pathology. It is important to clearly understand the stages of development and morphology of the spinal cord of the rat in order to extrapolate information in the experiment. Below will be presented information about the development of the spinal cord of rats. 557 Community’s Mask Wearing Practice and its associated Undesirable Side Effects Among Iraqi Population Group in COVID-19 Era , Aya Jabbar Hussein; Faraed D Salman; Manar Jabbar Hussein; Marwa Jabbar Hussein; Ahmed Jabbar Hussein and Jabbar Hussein KamelAssessing the principles, knowledge, attitude, and compliance of the Iraqi population group with regard to mask use; raising awareness and accountability, counseling them on the value of wearing masks, and researching the most common negative effects of mask use among them. Materials and Methods: 1205 responses to an online survey with a cross-sectional design were gathered from healthy Iraqi backgrounds, ranging in age from 11 to 65 and with varying levels of education. The survey was divided into 5 components that were relevant to the major goals and objectives of the research. Gender differences were expressed as frequencies and percentages using the chi-squared fisher exact test, with statistical significance set at p