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 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 232 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. 233 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. 234 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 235 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 236 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 237 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 238 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 239 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 240 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 241 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. 242 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% 243 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. 244 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 245 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. 246 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 247 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 248 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 249 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 250 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 251 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 252 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) 253 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. 254 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 255 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. 256 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 257 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. 258 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. 259 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 260 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 261 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. 262 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. 263 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 264 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. 265 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. 266 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. 267 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 268 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 269 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. 270 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 271 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 272 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 273 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 274 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 275 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 276 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 [ 277 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. 278 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 279 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 280 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. 281 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. 282 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 283 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 284 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. 285 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 286 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. 287 Acute Toe Ischemia in a Patient Receiving Ergotamine , W Skouri, O.Hentati, H Tounsi, W Garbouj, M Eleuch, J Ouali, R Amri. 288 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. 289 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. 290 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. 291 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. 292 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. 293 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. 294 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 295 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. 296 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 297 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. 298 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 299 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 300 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. 301 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. 302 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 303 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 304 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 305 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 306 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 307 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. 308 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 309 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 310 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 311 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. 312 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 313 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. 314 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 315 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 316 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. 317 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 318 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. 319 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%) 320 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. 321 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 322 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. 323 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 324 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? 325 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. 326 “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 327 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 328 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. 329 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 330 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 331 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 332 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. 333 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 334 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 335 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 336 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. 337 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 338 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 339 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 340 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. 341 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 342 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 343 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. 344 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. 345 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 346 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. 347 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. 348 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 349 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. 350 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 351 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 352 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. 353 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 354 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 355 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 356 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 357 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 358 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 359 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 360 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 361 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 362 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 363 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 364 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 365 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. 366 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. 367 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 368 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. 369 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. 370 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 371 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. 372 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 373 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. 374 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. 375 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.. 376 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) 377 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 378 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 379 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 380 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. 381 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. 382 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. 383 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 384 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 385 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. 386 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. 387 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) 388 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 389 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]. 390 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. 391 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. 392 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 393 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 394 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. 395 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 396 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 397 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 398 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 399 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. 400 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 401 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. 402 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 403 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. 404 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 405 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 406 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 407 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 408 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 409 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 410 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 411 When Pandemic is Over: We Need to Deal with Long Term Sequelae of COVID , Salim Surani and Pahnwat Taweesedt 412 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 413 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 414 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. 415 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 416 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 417   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. 418 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 419 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 420 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 421 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 422 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. 423 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 424 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. 425 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. 426 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 427 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 428 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 429 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. 430 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 431 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 432 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 433 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 434 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 435 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. 436 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. 437 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 438 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. 439 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 440 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. 441 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 442 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 443 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 444 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. 445 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. 446 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 447 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 448 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 449 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 450 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. 451 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 452 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 453 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. 454 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. 455 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 456 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 457 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 458 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. 459 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 460 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. 461 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 462 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 463 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 464 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. 465 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 466 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. 467 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 468 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 469 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. 470 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. 471 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 472 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 473 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 474 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 475 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 476 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. 477 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. 478 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 479 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 480 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 481 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. 482 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. 483 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 484 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 485 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 486 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. 487 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. 488 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 489 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 490 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. 491 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% 492 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. 493 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 494 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 495 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 496 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 497 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 498 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 499 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. 500 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. 501 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. 502 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 503 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 504 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 505 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. 506 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. 507 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 508 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. 509 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 510 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. 511 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 512 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 513 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 514 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. 515 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 516 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. 517 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. 518 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] 519 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. 520 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. 521 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 522 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 523 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. 524 Bisphosphonate Use in Childhood , Jomaa Olfa, Jguirim Mahbouba, Rim Klii, Ardhaoui Mahbouba, Bejia Ismail, Touzi Monji, Bergaoui Naceur 525 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 526 Indirect (Mirror) Laryngoscopy: Valuable Laryngological Skill Going into Extinction? , James E Toblh, Olusola A Sogebi, Taiwo O Adedejl and Theophilus O Esan 527 Morphological and Numerical Variations in WBC Distribution Pattern during Differential Count Estimation from Buffy Coat Smears , Tajalmas Anumon MG, Romi Sleeba and Deepa Revi 528 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. 529 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 530 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 531 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 532 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 533 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. 534 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. 535 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 536 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 537 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 538 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 539 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 540 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. 541 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. 542 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 543 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.