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1 Fulminant Toxic Shock Syndrome: An Unusual Complication of Septic Abortion , Ahmed S El-agwany* and Mervat Ali El-Sersy
Endometritis and toxic shock syndrome associated with Clostridium sordellii have previously been reported after childbirth and after medical abortion. Clinical findings included tachycardia, hypotension, edema, hemoconcentration, profound leukocytosis, and absence of fever. We described a case of a young woman who developed Clostridium sordellii toxic shock syndrome after abortion surgically evacuated five days before admission. Although the patient was aggressively treated, death occurred <3 days after admission. Very early recognition of this disease can decrease the mortality associated with this rare disease.
2 Current Therapy of Hypercholesterolemia , Wilbert S. Aronow
Randomized, double-blind, placebo-controlled secondary prevention and primary prevention studies and observational studies have documented that statins reduce cardiovascular events in high-risk patients with hypercholesterolemia. The 2013 American College of Cardiology/American Heart Association guidelines on treatment of hypercholesterolemia support the use of statins in 4 major groups that will be discussed. The Expert Panel of these guidelines could find no data supporting the routine use of nonstatin drugs combined with statins to further reduce cardiovascular events. Since these guidelines were published, a double-blind, randomized trial of 18, 144 patients with an acute coronary syndrome demonstrated at 7-year follow-up that the incidence of cardiovascular events was 34.7% in patients randomized to simvastatin plus placebo versus 32.7% in patients randomized to simvastatin plus ezetimibe (hazard ratio = 0.936; p = 0.016). Proprotein convertase subtilisinkexin type 9 (PCSK9) inhibitors further lower serum low-density lipoprotein cholesterol by 50% to 70% in patients treated with statins and 4 phase 3 trials including more than 70, 000 patients are investigating whether these monoclonal antibodies to PCSK9 will lower cardiovascular events.
3 Effect of Folic Acid Adminsteration on Plasma Homocysteine Level in Preeclampsaia among Egyptian Population , Yasser Ibrahim Orief*1, Ahmed Samy El-agwany1 , Mohamed Mohamed El Sawy2 and Siham Atef Morsy1
Background: Hyperhomocysteinemia (HHC) appears to cause endothelial dysfunction through direct toxic and oxidative stress mechanisms. HHC was found to be seven times more common in women with history of severe preeclampsia. Objective: The aim of this study was to determine the effect of folic acid administration on the maternal serum homocysteine level in mild and severe pre-eclamptic cases between 28 and 32 weeks of gestation. Setting: The study was conducted on forty pre-eclamptic patients recruited from Elshatby Maternity University Hospital, Alexandria, Egypt over year 2012. Study design: The cases were subdivided into two groups; 20 mild and 20 severe pre-eclamptic cases. Each group was subdivided into two subgroups • Ten cases will take folic acid 5mg daily from 28 to 32 weeks. • Ten control cases (no folic acid administration). Results: The present study found that plasma homocysteine level was lowered after folic acid administration for both mild and severe cases. In the control group who did not receive folic acid, they had high homocysteine level . Conclusion: Folic acid can be administrated till the second trimester of pregnancy to decrease the risk of preeclampsia.
4 Unicornuate Uterus with NonCommunicating Non-Cavitated Rudimentary Uterine Horn: An Unusual Case with Adenomyosis Managed with Total Hysterectomy , Ahmed Samy El-Agwany* and Tamer Abdeldayem
A 45-year-old woman admitted to our hospital complaining of perimenopausal uterine bleeding not responding to medical treatment. Ultrasound evaluation revealed unicornuate uterus with adenomyosis and it was so difficult to see the distant small left rudimentary horn on ultrasound. The patient underwent laparotomy with total hysterectomy for both horns and was sent to pathologist that indicated adenomyosis and non-communicating non-cavitated left rudimentary horn.
5 Congenital vulvar Lymphangioma Circumscriptum: an Unusual Benign Pathology in Young Female , Ahmed Samy EL-Agwany* and Ahmed El-habashy
A female patient, aged 17 years, presented with papule-like condyloma of the labia majora. After major labiaectomy was performed, symptoms improved. Histology revealed lymphangioma circumscriptum of the vulva. Simple vulvectomy is an effective therapy for vulvar lymphangioma circumscriptum. It is a rare begning pathology that should be kept in mind in any vulval condylomatous lesion.
6 Morbidity and Mortality in the Surgical ICU: A Retrospective Audit in a Tertiary Care Center of a Developing Country , Delvene Soares*, Rizwan Sultan, Noman Shahzad and Hasnain Zafar
Introduction: Patients admitted to the surgical intensive care units (SICUs) pose a significant burden on both the health care services and the economy. In our institution and moreover in our part of the world, data concerning the morbidity and mortality in these patients is unknown. With an increasing number of patients admitted to the service, figures need to be calculated to establish guidelines and quality indicators. Objectives: This study aims to calculate the risk of infectious complications in the SICU, and to calculate the mortality rate and ratio. Materials and methods: This is a retrospective review of patients admitted to the SICU at the Aga Khan University Hospital from January 2010 to December 2014. Only adult general surgery and trauma patients were included. Data was collected about the types of morbidities, the mortality rate and different factors that affect this rate. The standardized mortality ratio (SMR) was also calculated. Results: A total of 243 patients were included. The mean age was 49 ± 18 years. ER admissions comprised of 89% of patients with 67% having planned ICU admission. The average length of ICU stay was 5.57 days. The mean APACHE II score was 19.59. Hospital/ventilator-associated pneumonia was seen in 33%, blood stream infections in 27%, central line infections in 4% and catheter-associated urinary tract infections in 13%. The mortality rate was 45.3%. Age, unplanned ICU admissions and non-trauma admissions were found to be significantly associated with mortality (P <0.05). The SMR was 1.81 for operative cases and 1.36 for non-operative cases. Conclusion: Our mortality rate and SMR is high when compared to international institutions – this could be due to the paucity of regional data for comparison. Our study highlights the benefit of a planned ICU admission and set criteria should be established to define which patients need critical care.
7 Retrograde autologous blood priming is an efficient technique for without, or minimally usage of blood infant cardiosurgery , E. Vârlan
Background: Both severities of cardiac surgery and technical features of extracorporeal circulation circuit demands blood transfusion from donors, which involves a number of risks for the patient, especially with low body weight. Priming of the cardiopulmonary bypass circuit with patients’ own blood [retrograde autologous priming (RAP)] is a technique used to limit haemodilution and reduce transfusion requirements. Methods: the study included 250 children (131 boys, 119 girls) with congenital heart disease, operated on heart under CPB, weighing less than 20kg (18.45 ± 2.15) and 3.4 ± 1.7 years average age, who were divided into experimental (125 children) and control group (125children). In the control group, conventional CPB was performed (supplementing the priming with red blood cells), while in study group CPB was started after RAP via aortic cannula with recuperation till 45 % of cristaloid “priming”. The hematocrit (Hct), lactate (Lac) levels at two perioperative time-points, and intraoperative and postoperative blood usage were recorded. There were no significant differences in CPB time, aortic cross-clamp time between groups. Results: No hospital lethality occurred in the study and no surgical hemostasis was performed. Blood loss accounted for 6.2 ml/kg /24h. Postoperative transfusion of homologous blood (erythrocyte mass) needed 73 children, that make up only 29, 2 % of the whole study group. Amongst children who received transfusion on pump, the number of packed red blood cells was less in the RAP group than that in the standard priming group intraoperatively and perioperatively (0.54 ± 0.17 vs. 1.48 ± 0.68 units, P = 0.03; 0.94 ± 0.54 vs. 1.69 ± 0.69 units, P = 0.15). There were no significant differences in CPB time, aortic clamp, and Lac value between the two groups (P>0.05). Length of ICU and hospial stay were similar. Conclusions: “priming”minimalisation and autologous blood priming, modified ultrafiltration (MUF) could diminish the necessity of perioperative blood transfusion in infant cardiac surgery.
8 Future Cardiac Events in Patients with Ischemic ECG Changes during Adenosine Infusion as a Myocardial Stress Agent and Normal Cardiac Scan , Amer H1 , Niaz K1 , Hatazawa J2 , Ahmed G3 , Samiri H1a, Alothman M1 , Alhammad M1 and Sheikh YM1
Background: We sought to determine the prognostic importance of adenosine-induced ischemic ECG changes in patients with normal SPECT myocardial perfusion images. Methods: We performed a retrospective analysis of 765 patients undergoing adenosine MPI between January 2013 and January 2015. Patients with baseline electrocardiographic (ECG) abnormalities and/or abnormal scan were excluded. Results: Overall, 67 patients (8.7%) had ischemic ECG changes during adenosine infusion in the form of ST depression of ≥1mm. Of these, 29 (43% [3.8% of all patients]) had normal MPI (positive (+) ECG group). An ageand sex-matched group of 108 patients with normal MPI without ECG changes served as control subjects (negative (-) ECG group). During a mean follow-up of 33.3 ± 6.1 months, patients in the +ECG group had no significantly more adverse cardiac events than those in the –ECG group. One (0.9%) patient within the negative ECG group had a nonfatal MI (0.7% annual event rate after a negative MPI). A case only was admitted due to heart failure in the (-) ECG group) that proved to be secondary to pulmonary cause and not of CAD. A case in this (+) ECG group admitted as a CAD that ruled out by coronary angiography. Conclusion: Patients with normal myocardial perfusion scintigraphy in whom ST-segment depression develops during adenosine stress test appear to be with no increased risk for future cardiac events compared with similar patients without ECG evidence of ischemia.
9 Congenital Syphilis Simulating Bone Neoplasm in 2-Month Old Infant – Case Report , Luciana Friedrich1 *, Júlia Lima Vieira2 , Cintia Junges3 , Veronica Indicatti Fiamenghi3 , Daniela Dias Morales3 and Jiseh Loss4
Introduction: Congenital Syphilis (CS) occurs through the transplacental transmission of Treponema pallidum in inadequately treated or non-treated pregnant women, and is capable of severe consequences such as miscarriage, preterm birth, congenital disease and/or neonatal death. CS has been showing an increasing incidence worldwide, with an increase of 208% from 2009 to 2015 in Brazil. Case report: 2-month old infant receives care in emergency service due to edema of right lower limb with pain in mobilization. X-ray with osteolytic lesion in distal fibula. Infant was sent to the Pediatrics Oncology clinic. Perinatal data: 7 prenatal appointments, negative serology at 10 and 30 weeks of gestation. End of pregnancy tests were not examined and tests for mother’s hospital admission were not requested. Mother undergone elective cesarean section at 38 weeks without complications. During the pediatric oncologist appointment, patient showed erythematous-squamous lesions in neck and other scar-like lesions in upper body. A new X-ray of lower limbs showed lesions in right fibula with periosteal reaction associated with aggressive osteolytic lesion compromising distal diaphysis, with cortical bone rupture and signs of pathological fracture, suggestive of eosinophilic granuloma. She was hospitalized for a lesion biopsy. Laboratory tests: hematocrit: 23.1 / hemoglobin 7.7 / leukocytes 10,130 (without left deviation) / platelets 638,000 / Negative Cytomegalovirus IgG and IgM and Toxoplasmosis IgG and IgM / VDRL 1:128. Congenital syphilis diagnosis with skin lesions, bone alterations and anemia. Lumbar puncture: glucose 55 / total proteins 26 / VDRL non reagent / 13 leukocytes (8% neutrophils; 84% monomorphonuclear; 8% macrophages) and 160 erythrocytes / negative VDRL and culture. X-ray of other long bones, ophthalmological evaluation and abdominal ultrasound without alterations. Patient was hospitalized for 14 days for treatment with Ceftriaxone 100mg/kg/day, due to the lack of Crystalline Penicillin in the hospital. She is now under outpatient follow-up. Discussion: CS is responsible for high rates of morbidity and mortality. The ongoing increase of cases of this pathology reflects a severe health issue and indicates failures in policies for the prevention of sexually transmitted diseases, with inadequate follow-up of prenatal and maternity protocols.
10 Elucidating the Origin of Milk Products on the Chinese Market Using Hydrogen and Oxygen Stable Isotope Technique , Jingyu Huang, Eyram Norgbey*, Philip Nti Nkrumah, Gloria Appiah-Sefahand Rainizafy Michel
Preference for foreign milk products is the cause of the economically motivated adulteration of milk products on the Chinese market. 42 milk samples from the United States of America, Canada, Southern China, Northern China, Australia and New Zealand were analyzed using δ2H and δ18O stable isotope technique to differentiate the origin of milk products. An isotope ratio mass spectrometer with a combination of a high-temperature conversion elemental analyzer, Thermo-Fisher was used. Statistical analysis was performed using one-way ANOVA. The study revealed δ2H and δ18O had a wide range of mean values: 13.86 to 22.25‰ and -82.86 to -28.5‰, respectively. There was a significant difference in the δ2H (n=7; F=20880, P=7.876E-43) and δ18O (n=7; F=1399.0; P=9.215E-29) composition of the milk samples from the different regions. It was observed that δ2H and δ18O composition is helpful in elucidating milk products from different regions on the Chinese market (P<0.05).
11 Procalcitonin Interest to Assess a Septic State Inducing the Death , N Sadeg1 , F Tarlier2 , L Veneau3 and H Belhadj Tahar1
For 90 cases, two groups were stratified by their final diagnosis: 33 of natural deaths and 57of violent deaths. There were no significant elevation of procalcitonin (PCT) in the group of violent deaths. We noted 6 elevations of PCT for deaths of natural origin (15.4%) and in 3 cases there was an evidence for an infectious context (recent anti-infectious treatments, chemotherapy in progress). Control of CRP performed on blood samples found initial elevations above 100 mg / L in 3 of the 6 cases (including 2 of 3 cases associated with an infectious context). There is no evidence of increased frequency of positive PCT for intermediate TPM (time post mortem), long TPM and undefined TPM. The PCT appears to remain stable over time and whatever the conservation conditions of the body. However given the size of some subgroups, it appears necessary to extend this study. The latter study found a PPV (positive predictive value) and clinical specificity of 100% for a cutoff set at 10 ng / L. By taking this threshold, we find no significant increase in cases of violent deaths.
12 Giant Ventral Hernia in a Pregnant Patient , Schroell R*, Kirkpatrick D, Phillips B and Wagner M
Large abdominal wall defects can occur as a result of temporary abdominal closure (TAC). TAC is used in critically ill patients where the abdominal wall cannot be closed due to intraabdominal hypertension, loss of domain (LOD), and other devastating abdominal conditions. Clinically, TAC is similar to giant ventral hernias (GVH) in that both have large facial defects. In the setting of pregnancy GVH is uncommon. In a meta-analysis of pregnant patients only five ventral hernias were described among nearly 33,000 patients [1]. Similarly, pregnancy in the setting of TAC is exceptionally rare. Our review of the literature did not identify other cases of TAC followed by a pregnancy. The literature does contain one case in which a pregnant woman suffered abdominal trauma and was managed with TAC [2]. In this report, we present the case of a woman who sustained penetrating abdominal trauma, received treatment with TAC, failed to return to clinic, then subsequently re-presented with a second trimester gestation.
13 Marijuana: Proposed Treatment in Trauma Patients , B Phillips*, B Keath, J Wu, M Hartmann,W Weber, J O’Connor, and J A Asensio
Background: A standardized treatment approach for trauma patients who test positive for marijuana/THC does not currently exist in the literature. Several medications are recommended to treat withdrawal and the cannabinoid hyperemesis syndrome. Methods: A literature search was conducted through Medline and PUBMED following PRISMA guidelines. Key phrases searched for included “marijuana treatment, trauma marijuana patients, and THC interactions with other medications”. Article selection was based on relevance, with focus on diagnosis and management of marijuana positive patients. All studies, regardless of publication date, were considered due to the paucity of published literature. Results: Of the 1853 studies identified, 24 were selected to have material relevant and useful to this review. Both retrospective and prospective reports were identified in order toclosely examine the relationship between marijuana use and Injury Severity Scores, hospital length of stay, and related hospital costs. Limitations: Limitations of this article are similar to all PRISMA-guided review articles: the dependence on previously published research and availability of references as outlined in our methodology. Conclusion: Patients experiencing marijuana withdrawal should be evaluated for divalproex to reduce marijuana cravings; nefazodone to decrease anxiety and muscle pain; and lofexidine to improve sleep as well as help address withdrawal related stress. Administration of benzodiazepines can be considered to limit aggression. Lorazepam and haloperidol have been shown to be effective for cannabinoid hyper emesis syndrome. All trauma patients should receive tobacco, alcohol, and drug screening, followed by reflex confirmatory blood testing to increase accuracy. Patients testing positive for marijuana should be individually addressed, since cannabis and cannabinoids have been found to alter anesthetic potency. In addition, all marijuana/THC patients should undergo counseling in an effort to reduce use and prevent further morbidity and use related complications.
14 Delayed Mesenteric Hematoma of the Sigmoid Colon Following Blunt Abdominal Trauma , M D Marieni, S J Shetty, D L Cornell, and B Phillips*
A 25-year-old Hispanic male was transferred to our level I trauma center after being ejected 40 feet from a motor vehicle crash. Once stabilized in the trauma bay, a computed tomography (CT) scan of the abdomen/pelvis with IV contrast revealed two AAST Organ Injury Scale grade III liver lacerations without contrast extravasation, bilateral pulmonary contusions, right posterior non-displaced fourth rib fracture, non-displaced right scapular body fracture, and bilateral anterior and posterior pelvic fractures [Figures 1–2]. A non-operative approach to the hepatic lacerations was chosen and the patient underwent closed reduction and percutaneous pinning of his posterior pelvic fractures as well as anterior external fixation of his bilateral pubic rami fractures.
15 Conservative Salvage of a Penetrating Grade IV Renal Injury with Extravasation , L Turco1 , J Wu 1 , S Leslie2 and B Phillips1
Penetrating abdominal injuries have traditionally been managed with surgical exploration. The recent trend in renal trauma is selective nonoperative management, even if laparotomy is performed for associated injuries. This case describes the salvage of a grade IV kidney injury secondary to gunshot wound. A large perinephric hematoma and associated hollow viscus injury were discovered on CT scan. The patient underwent laparotomy for colonic repair. The perinephric hematoma appeared non-pulsatile, nonexpanding, and not actively bleeding, and thus was not explored. The injured kidney healed and the patient did not require nephrectomy.
16 Women’s Socio-Economic Status as a Determinant of Utilization of Antenatal Care in Primary Health Centres: A Case Study of Nando Community, Anambra East Local Government Area, Nigeria , Okoronkwo Ijeoma1*, Adeyemo Florence2 , Nnamdi Nneka1,3, Ada Nwaneri1 and Chjkaoodili Ihudiebube1
The study examined the association between women’s status and utilisation of maternal health care services of primary health care centres in Anambra east L.G.A of Anambra state. Five objectives were developed. A cross sectional descriptive research design was used. The study population consisted of women of child bearing age (15-49 years) who had given birth in the last five years. A sample size of 500 participants was used after using the formula for estimating sample size from a finite population. However, only 482 copies of the questionnaire were returned, giving a response rate of 96.4%. The instrument for data collection was a questionnaire developed by the researchers based on literature review. Data were analysed using the statistical package for the social sciences (SPSS version 18). The major findings showed that 71.5% utilised ANC while 44.4% utilised delivery healthcare services; 40.2% of the women took decisions jointly with their husbands while 32.4% took decisions alone on utilisation of ANC. As regards utilisation of delivery care services, 39% took decisions alone while 36.5% took decisions jointly with their husbands on where to have their baby. There were statistical significant associations between women decision making autonomy women education, women economic status and utilization of maternal health services. However, the study showed no statistical significant association between occupational status and utilisation of maternal health care services. The study concluded that the factors that influence the utilisation of maternal health care services are women decision making autonomy, educational status and their economic status.
17 The Presentation of Misaligned Eyes in Children with Pervious Squint Surgery at Tripoli Eye Hospital , Amal El Bahi
Strabismus, is one of the most common ocular problems in children. It can be treated with conservative therapy such as glasses, prisms, patching and/or orthoptic exercises, with a majority of the cases eventually requiring correction with eye muscle surgery. The benefits of surgical correction include elimination of diplopia, restoration of binocular single vision, and improvement of cosmesis and psychosocial status. However, some reports in the past two decades have indicated the possibility of good surgical outcomes, and significant improvements of central and peripheral binocular visual function even in adult patients. The aim of this present study is to determine the prevalence of squinted eyes with previous squint surgery in patients attend the squint outpatient clinic.
18 The Influence from Sense of Coherence on Perceived Health after Prostatectomy A 5 Year Follow Up , Liselotte Jakobsson1 *, Petra Nilsson1 and Per Fransson2
The purpose of the study was to to describe which factors of health related quality of life were associated with a high sense of coherence in a 5 year perspective. The sense of coherence, SOC-scale, EORTC QLQ C-30 and PR 25 questionnaires were applied to a sample of 222 men at baseline and over 5 years following radical prostatectomy. Result showed significant association to SOC in psychological aspects (emotional and cognitive functioning, p=<0.00-0.04 respectively 0.04) and for hormone treatment related symptoms (i.e. manhood p=<0.05). High SOC was associated with quality of life (index) in the early post treatment period and to aspects of general functioning (role-, emotional- respectively cognitive) in year 3 and 5. High sense of coherence was interpreted to be a health resource for experiencing life quality connected to different aspects at different time points of the data collection. The result showed stability in SOC and QoL scoring over 5 years.
19 When Gingival Recession Is Rescued By Periodontal Plastic Surgery: A Clinical Case Report , Rahim O
Gingival recession is the most common mucogingival defect. It is characterized by the exposure of the tooth root surface resulting from displacement of the gingival margin below the cementoenamel junction. The denuded root surfaces compromise dental and gingival aesthetics with dentine hypersensitivity, caries proclivity, cervical abrasion and oral hygiene disability. When deciding root coverage, settled surgical techniques have been proposed and each procedure challenges to expand on limitations of the others. The purpose of this case report is to assess the esthetic correction of localized gingival recession using combined coronally positioned flap with connective tissue graft techniques. Long term evaluation, extended to two years after surgical treatment, is performed. The part of the prophylactic management to prevent potential future recessions is also enhanced. Significant increasing in keratinized and attached gingival tissues and reduction of height and width of recession were obtained. Gain of root coverage was 100% with great improvement in attachment level. Prevention of recession was accomplished and the results were stable after two years follow up. Patient-reported outcomes were satisfaction and esthetic appearance.
20 Hemodialysis Catheter-Related Sepsis , Badi H1 , Marhoum El Filali K1 , Oulad Lahcen A1 , Marih L1 , Sodqi M1 , Chakib A1 , Amouzoune M2 , Asad K2 , Mtioui N2 , Khayat S2 , Zamd M2 , Medkouri G2 , Benghanem Gharbi M2 , Ramdani B2 , Safir S3 and Habbal R3
Introduction: Hemodialysis (HD) patients are exposed to various complications. Infectious complications are the second leading cause of morbidity and mortality after cardiovascular complications. The aim of our study is to describe the clinical, paraclinical and bacteriological aspects of the HD catheter-related infection. Patients and methods: We carried out a retrospective study over a period of one year, involving 25 HDs patients hospitalized in the Department of Infectious Diseases, Cardiology and Nephrology of Ibn Rochd University Hospital Center in Casablanca. Results: The majority of these patients were male (72%) with an average age of 59 years. Twenty patients had a jugular catheter. Fever was the main symptom found in all patients, associated with sepsis signs in 88% of cases, while 12% of patients were classified as a septic shock. All patients had a biological infectious syndrome with leukocytosis and positive CRP. Peripheral and catheter-based blood cultures, and culture of the distal tip of the catheter were performed in all patients., allowing the determination of the causative germ in 72% of the cases. The most frequently isolated germs were Staphylococcus aureus (66.7%), Gram-negative bacilli (16.7%), coagulase-negative staphylococci (11.1%), and Candida sp (5.5%). All patients received a probabilistic antibiotherapy based on vancomycin and amikacin combination adapted to the renal function andthe antibiogram results thereafter. Six patients had associated endocarditis. The evolution was favourable in 76% of the patients. Six patients died. The main cause of death is the septic shock (3 cases). Conclusion: Vascular access in HD deserves special attention. The prevention of infectious complications in this category is based on compliance with hygiene rules and the temporary use of catheters and then the creation of native arteriovenous fistula.
21 Health Care from a Systems Thinking Perspective , Musfer Al-Shalawi
Highlight the systems thinking perspective inensuring quality health care. Transforming the healthcare delivery system, changing healthcare DESIGN, STRUCTURE AND processes to correct inherent structural deficiencies.
22 Evaluating the implementation potential of a transcultural tool for Tamil migrants with gestational diabetes mellitus living in Switzerland , Augustina Ewere Ayogbe, Helena Jenzer and Leila Sadeghi
Background: Gestational diabetes mellitus is a condition that affects many pregnancies and ethnicity appears to be a risk factor. Data indicate that approximately 18% of Tamil women are diagnosed with gestational diabetes mellitus. Today, approximately 50,000 of Tamils live in Switzerland. To date, there is no official tool available in Switzerland that considers the eating and physical activity habits of this migrant Tamil population living in Switzerland, while offering a quick overview of gestational diabetes mellitus and standard dietetics management procedures. The NutriGeD project led by Bern University of Applied Sciences in Switzerland aimed at closing this gap. The aim of this present study was to evaluate the implementation potential of the tools developed in the project NutriGeD for dietetic counseling before their wide scale launch in Swiss hospitals, clinics and private practices. Method: An online survey was developed and distributed to 50 recruited healthcare professionals working in the German speaking region of Switzerland from October – December 2016 (31% response rate). The transcultural tools were sent to participants together with the link to the online survey. The evaluation outcome was analysed using binary logistic regression and cross tabulation analysis with IBM SPSS version 24.0, 2016. Results: 94% (N=47) respondents believed that the transcultural tools had good potential for implementation in hospitals and private practices in Switzerland. A binary logistic regression analysis revealed that the age of participants had a good correlation (42.1%) on recommending the implementation potential of the transcultural tool. The participants with age group 34- 54 years old where the highest group to recommend the implementation potential of the transcultural tool and this was found to be statistically significant (p=0.05). 74% (34 out of 50) of the respondents clearly acknowledged the need for transcultural competence knowledge in healthcare practices. 80% (N =40) of the respondents agreed that the information presented in the counseling display folder was important and helpful while 60% (N= 30) agreed to the contents being clinically applicable. 90% (N=45) participants recommended the availability of the evaluated transcultural tools in healthcare settings in Switzerland. Conclusion: The availability in healthcare practice of the evaluated transcultural tools was greatly encouraged by the Swiss healthcare practitioners participating in the survey. While they confirmed the need for these transcultural tools, feed-backs for minor adjustments were given to finalize the tools before their official launch in practice. The developed materials will be made available for clinical visits, in both hospitals and private practices in Switzerland. The Migmapp© transcultural tool can serve as a good approach in assisting healthcare professionals in all fields, especially professionals who practice in areas associated with diet - related diseases or disorders associated with populations at risk.
23 Integrative Joint Organizational Platform of Chinese Medicine and Western Medicine in the Management on Recalcitrant Atopic Dermatitis , Chan Kam Tim Michael*1 and Yu Chau Leung Edwin2
An expert panel as a focus group on eczema comprises Chinese medicine practitioners (CMP) and Western medicine specialist (WMS) working based on an opinion sharing model under the established Integrative Joint Organizational Platform (IJOP). It is a program under the Hong Kong Association for Integrative of Chinese -Western Medicine, funded by the Innovation and Technology Commission. The aim is to provide a management framework assisting CMP – WMS collaboration and to layout examples for eczema integrated management. The following article provides details of the history of development of TCM in Hong Kong and the method and results of using this integrated platform for Chinese and Western Medicine collaboration for management of Atopic dermatitis.
24 Algorithm of Periorbital Area Rejuvenation , Åžeyda Atabay
Purpose: Representing the algorithm of periorbital area rejuvenation Materials: As part of the research, 1216 eyes of 608 patients were included. According to patients’ complaints and evaluating their situation, treatments were carried out as medical and surgical. Treatment was not applied to 75 patients that their request and the cure were not compromise. Patients were followed approximately 11,3 months (1-32 months). The study is evaluated according to patients’ reason of request, their general characteristics and the treatments that are applied. Findings: Age average of 608 patients who are applied to my clinic with the intent of periorbital area rejuvenation and enhancing eyelid deformity between the dates of March 2014-January 2017 is 38. 81,25% patients were female and 18,75% was male. 538 patients (88,5%) were applied medical treatment. 260 patients (42,8%) got surgical treatment and to 31,3% patients, combined treatment was applied. The treatment that I applied and the complaints of 89% patients harmonized with each other. 11% of patients were not treated since their complaints and their treatment request were not corresponded to each other. Result: The most important phase is pre-treatment to become successful in the treatment. First thing to do is listening and understanding the patient carefully, because the problem we observe and patient’s complaint may not be the same. In this case, no matter how successful the treatment is, we can not satisfy the patient. Sometimes, patient has unrealistic expectations. When such a patient like this is encountered, it must be kept away from him or her and the treatment should not be applied.
25 Severe Acneiform Facial Eruption: An Updated Prevention, Pathogenesis and Management , Chan Kam Tim Michael
Acne scarrings and papulopustular rosacea (PPR) are well documented cutaneous condition associated with major psychosocial morbidity. The burden of disease to the family and society is significant. A positive family history is a predictor. Inflammation involved an interplay of body inmate immunity and pro-inflammatory mediators, cytokines, neuropeptides and defence immune response to microbiomes results acneiform eruption. Modern research in molecular biology, neuroimmunology and clinical science enable the practicing physician to understand more about the pathogenesis of this complex skin disease and hence better therapeutic measures and management of the disease.
26 Using Marijuana to cure Marijuana Addiction , Kaufui V. Wong
Marijuana has been used medically to help relief neuropathic pain for some time now. Assistance in numbing or negating neuropathic pain is very commendable, but the ugly side of addiction (and associated negative consequences) tips the balance against the use of marijuana. The use of cannabidiol (CBD) rich marijuana, instead of tetrahydrocannabinol (THC) rich marijuana, to calm a person’s mind needs to be explored more. There is an assumption that a calm person (internally as well as outwardly) is less interested in getting a high from smoking marijuana because s/he is in a better condition to make a good decision. The appeal of using one kind of marijuana to cure marijuana addiction seems attractive to the addict. The concept seems whimsical at best, but scientific proof is plentiful in the literature regarding the basic reactions of THC and CBD.
27 How to Treat and Prevent Arterial Thrombosis with no Increased Bleeding from Accidents, Surgical Perations and other Invasive Procedures , Mark I M Noble
An enquiry into the lack of attention awarded to serotonin antagonism in the treatment of arterial thrombosis revealed that the mode of action of serotonin and its platelet receptor antagonists was upon thrombus growth, and not, as with antiplatelet drugs, upon the initiation of thrombosis at sites of damaged endothelium. This lack of effect could explain why this approach has been considered not to be effective. However under conditions of arterial stenosis in which there is platelet activation by increased shear stress, and during the growth phase of arterial thrombi, serotonin 5HT2A antagonism has been demonstrated to have great potentcy in dispersing thrombotic obstruction to blood flow. This mode of action, the lack of participation of serotonin in haemostasis, and the absence of serotonin in wounds accounts for the proven lack of effect of effect of pure specific 5HT2A antagonists (i.e., not ones with other actions) on operative bleeding and skin bleeding times. This lack of effect on haemostasis solves the dosing problem encountered by other anti-thrombotic drugs, with which drug concentration cannot be controlled with single fixed doses, leading to the association between increased antithrombotic efficacy and increased bleeding complications. Thus 5HT2A antagonism appears to be the preferred approach, from the point of view of safety and lack of bleeding risk, to thrombosis therapy in the context of traumatic accidents, surgical operations and invasive procedures such as angioplasty.
28 Nurse Leader Rounds: Effect on Nurse - Related Patient Satisfaction Scores on Two Post-Surgical Units in an Acute Care Facility , Angela Babaev
Background and Significance: The best possible inpatient experience is a priority for many hospitals in today’s model of healthcare delivery. Achieving and sustaining measurable success is a key challenge. Nurse leader rounds (NLR) has been revealed to be an effective improvement strategy in some hospitals. The purpose of this DNP project was to analyze the impact of implementing daily NLR on patient satisfaction (PS) scores in two postsurgical units at Mount Sinai Beth Israel (MSBI) hospital in New York. Methods: This study used descriptive comparison to analyze existing survey data before and after NLR was implemented. The study took place in an academic, urban, tertiary care hospital in two postsurgical units. Data were collected using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey reflecting questions to measure patient’s perceptions of care, specifically, assessing the nurse related communication to examine if there was a relationship between NLR and PS scores. Results: Patient perception data summarized in this study suggested that the implementation of NLR was associated with increased levels of patient satisfaction with communication (SC) with nurses following NLR in the inpatient setting on two post-surgical units. The results indicated significant difference between the pre and post scores of SC in nurse related questions referring to communication (Appendix A). Conclusion: Effective implementation of NLR can improve patient perception of care. Improvements in nurse communication impacted PS. Areas for improvement were to focus on patient self-management of care and medication education.
29 Cosmetic Allergen in the Past and Present , Hideo Nakayama1 , Tamotsu Ebihara2 and Ko-Ron Chen1
For almost 20 years after the end of World War II, many Japanese women were challenged by a dark secondary hyper pigmentation on their faces. The causation of this condition was unknown and incurable at the time. However this symptom became curable after a number of new cosmetic allergens were discovered through patch tests and as an aftermath, various cosmetics and soaps that eliminated all these allergens were put into production to be used exclusively for these patients. An international research project conducted by seven countries was set out to find out the new allergens and discover non-allergic cosmetic materials. Due to these efforts, two disastrous cosmetic primary sensitizers were banned and this helped to decrease allergic cosmetic dermatitis. Towards the end of the 20th century, the rate of positives among cosmetic sensitizers decreased to levels of 5% - 8% and have since maintained its rates into the 21th century. Currently, metal ions such as the likes of nickel have been identified as being the most common allergens found in cosmetics and cosmetic instruments. They often produce rosacea-like facial dermatitis and therefore allergen controlled soaps and cosmetics have been proved to be useful in recovering normal skin conditions.
30 Acquired Pure Red Cell Aplasia (Prca) Responding to Erythropoietin Therapy in HIV Disease , Rama Bhat1 , Raghavendra Rao2 , Savio D’Souza3 , Velagapudi Raja Mounika4 , Srikar Allada4 and Ruchee Khanna5
Acquired pure red cell aplasia (PRCA) is characterized by the presence of an acquired normochromic, normocytic, anemia associated with a complete disappearance of reticulocytes and erythroid precursors in the marrow and normal production of myeloid cells and platelets. Mediators of suppression [1].
31 The Presentation of Misaligned Eyes in Children with Pervious Squint Surgery at Tripoli Eye Hospital , Amal El Bahi
Strabismus, is one of the most common ocular problems in children. It can be treated with conservative therapy such as glasses, prisms, patching and/or orthoptic exercises, with a majority of the cases eventually requiring correction with eye muscle surgery. The benefits of surgical correction include elimination of diplopia, restoration of binocular single vision, and improvement of cosmesis and psychosocial status. However, some reports in the past two decades have indicated the possibility of good surgical outcomes, and significant improvements of central and peripheral binocular visual function even in adult patients. The aim of this present study is to determine the prevalence of squinted eyes with previous squint surgery in patients attend the squint outpatient clinic.
32 Formulation, Design and Development of Niosome Based Topical Gel for Skin Cancer , Sankha Bhattacharya1* and Bhupendra G.Prajapati2
Melanoma is the most dangerous type of skin cancer in which mostly damaged unpaired DNA starts mutating abnormally and staged an unprecedented proliferation of epithelial skin to form a malignant tumor. In epidemics of skin, pigment-forming melanocytes of basal cells start depleting and form uneven black or brown moles. Melanoma can further spread all over the body parts and could become hard to detect. In USA Melanoma kills an estimated 10,130 people annually. This challenge can be succumbed by using the certain anti-cancer drug. In this study design, cyclophosphamide were used as a model drug. But it has own limitation like mild to moderate use may cause severe cytopenia, hemorrhagic cystitis, neutropenia, alopecia and GI disturbance. This is a promising challenge, which is caused due to the increasing in plasma drug concentration above therapeutic level and due to no rate limiting steps involved in formulation design. In this study, we tried to modify drug release up to threefold and extended the release of drug by preparing and designing niosome based topical gel. In the presence of Dichloromethane, Span60 and cholesterol, the initial niosomes were prepared using vacuum evaporator. The optimum percentage drug entrapment efficacy, zeta potential, particle size was found to be 72.16%, 6.19mV, 1.67µm.Prepared niosomes were further characterized using TEM analyzer. The optimum batch of niosomes was selected and incorporated into topical gel preparation. Cold inversion method and Poloxamer -188 and HPMC as core polymers, were used to prepare cyclophosphamide niosome based topical gel. The formula was designed using Design expert 7.0.0 software and Box-Behnken Design model was selected. Almost all the evaluation parameters were studied and reported. The MTT shows good % cell growth inhibition by prepared niosome based gel against of A375 cell line. The drug release was extended up to 20th hours. Further as per ICH Q1A (R2), guideline 6 month stability studies were performed. The results were satisfactory and indicating a good formulation approach design was achieved for Melanoma treatment.
33 Knowledge, Attitude and Practice of Life Style Modification in the Management of Hypertension , Most Luthy Begum1 , Satya Prio Dhar2 , Arif Mahmud3 , Md. Firoz Abedin4 , Lobaba Sultana Lima5 , and Md Zahid Hasan Khan6
Background: Hypertension remains as one of the most important public health challenges Worldwide because of the associated morbidity, mortality, and the cost to the society. Despite the availability of safe and effective antihypertensive medications and the existence of clear treatment guidelines, hypertension is still inadequately controlled in a large proportion of patients worldwide. Unawareness of lifestyle modifications, and failure to apply these were one of the identified patient- related barriers to blood pressure control. Methodology: It was this cross sectional study was conducted to assess knowledge, attitude and practice of life style modification in the management of hypertension among 100 conveniently selected study subjects. Result: Mean±SD age of respondents was Average age of the patients was 36.96±13.04 years. More than half of the respondents (56%) passed SSC level of education. Almost 99% of the study subjects knew that smoking is associated with hypertension. About 94% respondent told excessive salt intake is bad for health. Almost all of them knew that excessive salt intake results high blood pressure. About 93% told that physical exercise has effect on blood pressure. Three-fourth of the study subjects told that physical exercise decrease cholesterol. About 40% took part physical exercise regularly. The study found levels of knowledge on non-drug control of hypertension was quite good but practice level was poor. Conclusion: Knowledge regarding hypertension is an important measure used for decreasing the prevalence of hypertension. Life style modification is the easiest way to prevent or control high pressure. The increase level of knowledge on life style changes will help to have desired intervention goal in people who are most motivated. This study was an attempt to assess knowledge, attitude and practice of life style modification in the management of hypertension.
34 Halal Industrialization into Food Production-Global Perspective, Scientific Gaps & Proposed Solutions , R N A Khan*
Halal food is associated with billions of people so it’s logically easy to predict that any problem with-in halal food can give birth to serious food-crises with huge losses to economics, market, food-chain and energies along demand of huge shift of funds & food provision camps to cope it and cover up the need of food for halal industry-grade food user. If a food set up have some benefits then the same set up must have some drawbacks as well, especially when it’s not under scientific lines. Risk analysis & management as precautionary measuring tool are vital in case of halal industrialization. Moreover the past history response & set of behaviours told that the issues & crises associated to followers of Islamic ideologies, especially religious & sharia related matters usually turn disturbing & violent as well all around the globe, whenever some problem identified & arise with-in them. Wise approach is to see the drawbacks, gaps and their expected solution as crises management relief
35 Exploring the COMFORT Model for Complex Communication for Physiotherapists in Neurorehabilitation: A Critical Review , Selma Pelaez* and Michelle C Hall
Literature has evaluated the level of accomplishment of the Patient-centred care (PCC) model from physiotherapists working in Neurorehabilitation. Reviewing the literature has revealed a lack of kills, confidence and training by physiotherapists to communicate difficult or complex information, such as poor prognosis or shared goal- setting, leading patients and families to complain about the need for more empathy, encouragement for patients to foster autonomy and rapport with physiotherapists. This problem is not unique to physiotherapists in neurorehabilitation and can be found in other medical disciplines. Many frameworks have been designed in order to teach how to successfully lead communication in stressful situations. However, the COMFORT model, which is an acronym for seven key principles of effective communication, is a grounded framework based on PCC ideals. This study aims to review the evidence of the effectiveness of the COMFORT model used by other health care professionals (HCPs) to implement it for physiotherapists in neurorehabilitation to explore patients' multifactorial lives, break bad news (BBN) effectively, and manage the emotional labour implied in complex scenarios such as discharging or setting treatment goals. Numerous databases were electronically searched and through a critical realist approach, six studies that applied this communication framework in different medical specialities have been reviewed. Through the scope of the self-efficacy theory, the COMFORT model can be considered a suitable communication framework to be used by physiotherapists due to increasing their confidence, teaching how to approach the emotional dimension implied in neurorehabilitation and having the potential to change clinical practice. Recommendations are to conduct studies on physiotherapists working in Neurorehabilitation in order to display the effectiveness of the COMFORT curriculum but also, to design specific communication frameworks tailored for physiotherapists working in a challenging setting as neurorehabilitation.
36 Cradling Bias Occurrence and Purpose , Sharon J. Jones
Maternal cradling bias is the act of human females to tend to cradle newborns to the left side in the first few weeks of life. Many factors contributing to the occurrence of leftward cradling bias have been explored including handedness and hemispheric dominance, neural development in neonates, breast-feeding influences and early communicative acts [1-7]. Accepted best practices for developmental support for premature infants incorporate positioning and holding neonates in their protocols [8,9]. Questions as to what function leftward cradling serves and what impact it has on the developmental trajectory of the infant in the first few weeks of life is the subject of much research [1,10-13]. This paper will review the literature focusing on maternal cradling bias and explore implications on best practices for pediatric professionals.
37 Complex HCP as Sequelae of Severe TBI Case Presentation , Ramadan Shamseldien*, Mohammed Shoeb and Mohammed Mossa
Background: Post head injury HCP is not uncommon, its incidence up to 15% among all patients with TBI. The communicating type is more common in TBI than the noncommunicating type. In spite of being treatable sequelae of TBI but it may be complex one. Purpose: to report a case of complex hydrocephalus post sever TBI. Methods: Female child 6ys old presented at ER, after RTA 6months ago. GCS 7∕15, post traumatic epilepsy initial CT; brain edema. She suffering chest problems when she off MV and chest improved, CT brain; show HCP with Rt frontal hygroma, neurologically she has repeated fits and GCS 10∕15, conservative treatment. Not controlled follow up CT; disappeared hygroma and increased HCP. VP shunt inserted followed by immediate improvement. After discharge she get infection, readmitted managed conservatively , fever subside but conscious level not improved and fits not controlled , she developed distal shunt failure and CSF peritoneal pesudocyst. Distal revision was done followed by short period of improvement, then distal shunt failure and reformation of CSF peritoneal pesudocyst occurred. Lastly VA shunt was done followed by stabilization of the case improved conscious level and controlled fits and return normal activity. Results: the patient show neurological recovery from deep coma after proper management of post head injury HCP, and diversion to VA shunt instead VP shunt. Conclusion: Post head injury HCP possible cause of persistent altered neurological status. It's important to differentiating posttraumatic atrophy from posttraumatic hydrocephalus, and this need meticulous estimation of both radiological and clinical findings. Papilledema not always indicator of increased ICP.VA shunt is possible diversion with peritoneal CSF cyst formation.
38 Molecular Study of Cytomegalovirus Infection among Children with End Stage Renal Diseases Undergoing Dialysis, Pilot Study , Maysaa EL Sayed Zaki1 and Sameh Salama*2
Cytomegalovirus is considered as an opportunistic infection affecting immunocompromized patients. Children with end stage renal diseases requiring dialysis is among affected population by this virus. The aim of the present study was to detect and compare the seroprevalence of CMV and CMV antigen pp65 with real time polymerase chain reaction (PCR) among children with end stage renal diseases undergoing dialysis. The study is a prospective case - control study. The forty one patients included in the studied are registered in the hospital for regular dialysis waiting for renal transplantation. The study included forty one healthy controls with same age and gender distribution. Blood samples were obtained from studied children and subjected for determination of specific immunoglobulin M and G for CMV (IgM-CMV, IgG-CMV) by Elecys system and CMV-DNA determination by real time polymerase chain reaction (PCR) and for PP65 antigenaemia test by light diagnostic CMVpp65. CMV-IgM was significantly detected frequently (P=0.0001) in 12.2% of the patients and in 2.4% of the control children. Moreover, IgG-CMV was significantly more frequently detected in patients (P=0.0001) than in control (90.2%&31.7% respectively). CMV-DNA was significantly (P=0.0001) detected in 12 patients (29.3%) compared to the control (2.4%), while CMVpp65 was detected among 4 children (9.8%) compared to one child in the control group. The comparison between IgM-CMV and real time PCR revealed that 30.7% of positive samples by PCR had positive IgMCMV, while IgG-CMV was associated with 84.6% of positive PCR. CMVpp65 correctly identified all negative samples compared to PCR, while the majority of negative PCR was also negative for IgM-CMV (98.6%). Moreover, all negative children for CMVpp65 was also negative by PCR (100%) For the validity of different CMV markers, IgG-CMV was the most sensitive test (84.7%), CMVpp65 was the most specific test 100%. From this study we concluded that CMV is a common viral infection among children with end stage renal diseases requiring dialysis. The diagnostic performance of real time PCR is the gold standard technique in diagnosis of this infection. CMVpp65 antigenemia is a specific accurate test for laboratory diagnosis however, it lacks sensitivity. Specific IgG for CMV is good screening diagnostic test.
39 A Cross-Sectional Study to Investigate the Association between Physical Activity (PA) and Barriers among Tertiary Education Students in Hong Kong , H. K. Wong
Physical activity ties tight with our daily living. It defines as the bodily movement produced by skeletal muscles that involve energy expenditure [1]. According to WHO, it is recommended young adult should do at least 150-minute moderate to intensity PA or 75-minute aerobic vigorous to intensity PA throughout a week. The advantages of staying physically active have solid evidences supported. There, however, is a poor practice in PA in tertiary education students globally. It is stated that more than 80% of theadolescent population in the world is not enough physically active [1]. It is believed that students in Hong Kong are getting not enough physically active as well. Remedying this plight not only in the view of personal benefits but a global health issue. It, therefore, is a high time to investigate the relationship between perceived barriers and PA behavior among tertiary education students in Hong Kong.
40 Better Outcome in Laparoscopic Gastric Ulcer Perforation Than Laparotomy : Single Center Experience , Purnama Andriana1 and Rudiman Reno2
Each year gastric ulcer disease (PUD) affects 4 million people around the world. Complications are encountered in 10%-20% of these patients and 2%-14% of the ulcers will perforate [1]. Females account for more than half the cases, they are older and have more comorbidity than their male counterparts. Main etiologic factors include use of non-steroidal anti-inflammatory drugs (NSAIDs), steroids, smoking, Helicobacter pylori (H. pylori) and a diet high in salt. All these factors have in common that they affect acid secretion in the gastric mucosa. Defining the exact etiological factor in any given patient may often be difficult, as more than one risk factor may be present and they tend to interact [2]. While previous reports have shown a seasonal variation in the incidence of PPU, others have failed to find such a pattern [3].
41 Biometrics based Mobile Reminder for Mental Health Disorders , Ghada Al-Hudhud
Assistive mobile technologies are highly demanded in order to reduce care givers effort with low cost/free programs. In this context, and due to the aging/ mental health disorders, memory loss and the change in the interaction between cognitive disability and mental health conditions, using mobile mental health assistive applications would improve the employees’ performance. Hence, assistive mobile technology can be used to support people with mental health conditions to stay in their jobs and improve their productivity, in addition to assist remembering daily activities, order and organize them according to place and emotions. Emotion detection based mobile technologies are recently considered a revolution in building assistive mobile applications. This article introduces a Bio-reminder mobile application that will remind the person with his/her tasks based on matching with their biometrics associated with the given task. Biometrics includes heart rate monitoring measured by biosensors. In this paper, the proposed mobile application uses Fitbit to measure heart rate, calories burned in addition to GPS to report the location.
42 Transprk a no-touch Procedure to Refractive Surgery – Two Years Study , Antonio Carlos Centelhas
The TransPRK (Transepithelial Photo Refractive Keratectomy) by Amaris 750S a Schwind Thecnology Is a refractive procedure with no-contact surgery. Corneal epithelium is removed by the laser without manual interference.It brings more accurity and perfect deepithelization.
43 Reducing Reoccurence and Complications of Gc/Ct , Chioma Afoke
Gonococcal Neisseria (GC) and Chlamydia Trachomatis (CT) infections account for the largest number of reported cases of any infectious disease in the United States. The rates at which these infections occur are on the rise. Gonococcal Neisseria (GC) and Chlamydia trachomatis (CT) infections are also among the commonly curable sexually transmitted infections (STI)(California Department of Public Health, 2011). Though subsequent infections are preventable, reinfection rates are high [1]. As many as 20% of patients, especially females, reacquire GC or CT within six months after the initial positive test and treatment, and it is estimated that as many as 40% of adolescents get re-infeceted after an initial episode of GC and/or CT annually [2]. Chlamydia represents the most common reportable disease in the United States, and has comprised the largest proportion of all sexually transmitted infections (STIs) reported [3].
44 Prescription of Exercise in Older Adults, Physiotherapeutic Approach , Erika Cyrus Barker
Objectives • Identify the changes related to aging that must be taken into account for the prescription of the exercise • Define the appropriate functional assessmentsforthe prescription of the exercise in the older adult • Recognize the factors that influence the adherence to exercise by older adults • Describe according to the objectives the correct exercise prescription for older adults.
45 Challenges in Awake Craniotomy for Intrinsic Brain Tumors in Eloquent Cortex , Debabrata Mukhopadhyay1 , Asha Bakshi2 , A S Mathani2 , A K Verma2 and Anil Gurnani2
Introduction: Surgical treatment of brain tumors in the eloquent areas has high risk of functional impairment like speech or motor. These tumors represent a unique challenge as most of the patients have a higher risk of treatment related complications. A wake craniotomy is a useful surgical approach to help to identify and preserve functional areas in the brain and maximizes tumor removal and minimizes complications. Methods: Selected patients admitted with intrinsic brain tumor between from July, 2011 to August, 2016 in the eloquent area of brain like speech or motor area were chosen for awake craniotomy. A retrospective analysis was done. A preoperative assessment was also done. These patients were presented with seizure and or progressive neurological deficit like speech or motor. A standard anesthesia monitoring was done during surgery. Long acting local anesthesia (Bupivacaine) was used for scalp block. The surgeries were performed in a state of asleep-awake-asleep pattern, keeping the patients fully awake during tumor removal. Propofol and Fentanyl was used as anesthetic agents which was completely withdrawn prior to tumor removal. The speech and motor functions were closely monitored clinically by verbal commands during tumor resection. No brain mapping was performed due to lack of resources. All patients underwent noncontrast computed tomogram head in the first post-operative day. Results: A total of 35 patients were included in the study. The oldest patient was 55 years and youngest being 24 years (mean 36 years). 20 (57.14 %) were females and 15(42.85 %) males. 20 (57.14%) patients presented with predominantly seizure disorders and rest with progressive neurological deficit like speech or motor. 30 (85.71%) patients were discharged on second post-operative day. Complications were encountered in 4 (11.42 %) patients who developed brain swelling intraoperatively and 5(14.28 %) deteriorated neurologically in the immediate post-operative period however managed successfully and discharged in a week’s time. 5(14.28%) patients require ICU/ HDU care for different reasons. There was no mortality during the hospital stay. Histopathology revealed 25 (71.42 %) patients as low grade glioma, 8 (22.85%) as high grade glioma and 2 (5.71%) of them were metastases. Conclusion: A wake Craniotomy is a safe surgical management for intrinsic brain tumors in the eloquent cortex although surgery and anesthesia is a challenge. It offers great advantage towards disease outcome. However long follow up and more studies are required.
46 RegenerAge System: Therapeutic Effects of Combinatorial Biologics (Bioquantine®) and Spinal Cord Stimulation System on a Patient with Spinal Cord Section , Joel I. Osorio
As it has been previously demonstrated that coelectroporation of Xenopus laevis frog oocytes with normal cells and cancerous cell lines induces the expression of pluripotency markers, and in experimental murine model studies that Bioquantine® extract (purified from intraand extra-oocyte liquid phases of electroporated oocytes) showed potential as a treatment for a wide range of conditions as Squint, Spinal Cord Injury (SCI) and Cerebral Palsy among others.
47 Diabetes Reversal by Plant-Based Diet , Biswaroop Roy Chowdhury
Background: Diabetes causes a never-ending medicine and or insulin treatment for the diseased. Also, the patients are bound to follow a particular diet, with eliminating most of the sugary foods; that further deteriorates the quality of life. This gave way to the study, focused on diabetes cure without medicines and on rich fruits and vegetable diet. The clinical trial on 55 diabetes patients with a team of 6 medical associates was practiced for 3-days at Zorba, The Buddha, 10 - Tropical Drive, Ghitorni, New Delhi from 29th April to 1st May, 2016. The goal was to establish and observe the effects of plantbased diet on the sugar levels of the diabetes patients. These included both insulin-dependent and independent, diabetes type-1 and type-2 patients. The 3-days Residential Treatment Tour involved 55 subjects with different age groups and demographic profiles. The study considered participants from different countries to find out the global impact of the treatment. Objective Aim: The burden of the disease diabetes is rising globally. The aim of the research is to find out that on discontinuing the medicines and being on a particular plant-based diet, can high blood glucose levels in diabetes patients be normalized. Methodology Trial: Clinical trials were performed on diabetes patients for 3-days continuously. The sample size of the study was n=55 patients. Medicines were eliminated from the first day of the trial. Thereafter, following 3-days, the participants were kept on a prescribed plant-based diet. Both fasting and post-prandial readings were measured each day along with the weights of the participants. The subjects with varying diabetes history, age groups, type of diabetes, insulin dependency and demographic profiles were part of the trial. Findings of the Study Results: The study reported controlled blood glucose levels for 84% of patients and partially-controlled levels for 16% of patients. Those with controlled levels could attain a healthy blood glucose range without medicines and or insulin, along with the prescribed diet in 3-days. Those with partially controlled levels could attain a healthy blood glucose range with less than 50% of insulin than prescribed earlier. Among diabetes type-2 patients the study reported 100% results with all the patients maintaining a healthy blood glucose level. While among diabetes type-1 patients, 57% reported controlled blood glucose levels through the diet and zero-medications. Whereas, 43% reported healthy blood sugar levels through the diet and insulin reduction. In addition of the insulin-dependent group, 59% could completely drop their insulin requirements and 41% could reduce the requirement to at least 50%. The weight reduction for 55 patients in 3-days was reported as 1.14kgs of average weight loss per individual. Also, the patients had symptomatic relief from general fatigue and weaknesses .The plant-based diet proved to be beneficial with regards to energy and nutritional fulfillments. Future Scope Conclusion: Diabetes treatment has both health and economic burden on society. With reference to the present research, a new approach for the treatment of this considered life-style metabolic disability can be shaped. The plant-based diet has been found effective to cure and control diabetes, eliminating the medicine or insulin requirements. Further research on the subject matter can present a medicine-free-food-science based treatment for the disease. At the same time, this unique treatment approach will eliminate the risks of medicine side-effects. On the basis of this research, diabetes education can be developed for better understanding of the disease and better living for the diseased population.
48 Weightlifters - Need to Be Cautious Especially Having Pigment Dispersion Syndrome or Pigmentary Glaucoma , Shakun Gupta MS1* , ShwetaTripathi DNB1 , Alka Gupta DNB1 and Jyoti Gupta MS1
Weightlifter developed sudden diminution of vision after exercise with visual acuity in right eye (RE) HM and in left eye (LE) CF 1foot, Intraocular pressure (IOP) with Goldmann applanation tonometer (GAT) in both eyes were 34 mmHg with antiglaucoma medications. Slit lamp examination of both eyes showed edematous cornea, concave configuration of iris, semi dilated pupil, sluggishly reacting to light and pigment on corneal endothelium & on clear lens in RE, LE lens was clear. Gonioscopy showed open angle with increased pigmentation. Fundus examination showed cup disc ratio 0.8 in RE & 0.85 in LE. Anterior segment optical coherence tomography (ASOCT) confirmed concave configuration of iris. Patient was treated with antiglaucoma medications & peripheral iridotomy done with Nd: YAG in BE which decreased concave configuration of iris. Visual acuity improved to 6/6 in RE & 6/9 in LE. BE IOP with GAT 14 mmHg, Humphery visual field (HVF) 10-2 showed advanced field defects, Central corneal thickness 598µ, OCT showed retinal nerve fibre layer thickness in RE 75µ & 64µ in LE. Planned for trabeculectomy with MMC subsequently in BE. Conclusion: Weightlifters can need to remain cautious especially having Pigment dispersion syndrome or pigmentary glaucoma & should undergo regular ophthalmic checkup.
49 Study on the Performance of an Artificial Intelligence System for Image Based Analysis of Peripheral Blood Smears , Renu Ethirajan1 , Dheeraj Mundhra2 , Jaiprasad Rampure2 , Shreepad Potadar2 , Sukrit Mukherjee2 and Bharath Cheluvaraju2
In this study, we evaluate ShonitTM, an artificial intelligence (AI) system for automated analysis of images captured from peripheral blood smears, consisting of an automated digital microscope and a cloud based analysis platform. ShonitTM’s performance in classification of WBCs was evaluated by comparing ShonitTM’s results with haematologyanalysers and manual microscopy for manually stained smears. The study was carried out over 100 samples. The cases included both normal and abnormal samples, wherein the abnormal cases were from patients with one or more quantitative or qualitative flagging. All the smears were created using Hemaprep auto-smearer and stained using May Grunwald Giemsa stain. They were scanned and analysed by ShonitTM for WBC differentials under 40X magnification.WBC morphological classification by ShonitTM was verified by an experienced haemato-pathologist. Quantitative parameters were analysed by computing the mean absolute difference of the WBC DC values between ShonitTM and Sysmex XN3000, between ShonitTM and manual microscopy & between ShonitTM and Horiba ES 60. The mean absolute difference between WBC differential values of manual microscopy and ShonitTM were 7.67%, 5.93%, 4.58%, 2.69%, 0.44% for neutrophil, lymphocyte, monocyte, eosinophil and basophil respectively. The mean absolute difference between WBC differential values of Sysmex XN3000 and ShonitTM were 8.73%, 5.55%, 3.63%, 2.12%, 0.45% for neutrophil, lymphocyte, monocyte, eosinophil and basophil respectively. ShonitTM has proven to be effective in locating and examining WBCs. It saves time, accelerates the turnaround-time and increases productivity of pathologists. It has helped to overcome the time-consuming effort associated with traditional microscopy
50 An Unusual Cause of Myoglobinuria , Abhishek Dixit* , Sanjay Wagle, Deepa Usulumarty, Shrirang Bichu, Parag Tilve and Viswanath Billa
Rhabdomyolysis is characterized by the acute breakdown of skeletal muscle, resulting in the release of muscle cell contents like myoglobin, creatine phosphokinase (CK) and lactate dehydrogenase, which can lead to acute kidney injury in severe cases. A number of etiologies have been identified in acute rhabdomyolysis including hereditary and acquired of which drugs and trauma account for the majority of cases [1]. Physical therapy is frequently prescribed and generally considered safe for weakness; deconditioning and non - specific muscle aches. Rhabdomyolysis following a massage session is unheard of. However we report a rare case of rhabdomyolysis with acute kidney injury following an aggressive massage session.
51 Aromatherapy Versus Pharmaceutical Interventions for Dementia Related Behaviors Translating & Integrating Scholarship Practicum , Vanessa Veit
The elderly population is expected to double in the next thirty years increasing the number of individuals with the diagnosis of dementia. By proxy, dementia related behaviors such as agitation, anxiety and restless will also increase. Currently, pharmaceutical management of these behaviors include Ativan, Haldol and other psychotropic drugs which have side effects that place individuals at risk for falls and at times even aggravate the behaviors. Although, not widely researched, aromatherapy is a safe alternative to treating Dementia related behaviors. Research shows aromatherapy has a calming and relaxing effect which can be measured physiologically.
52 Procaryotic Diversity of a Remote Aviation Fuel-Polluted Lentic Ecosystem in Ibeno, Nigeria , Ime R Udotong1 , Mfoniso P Uko2* and Justina Ime R Udotong3
Ibeno in Akwa Ibom State is the operational base of Mobil Producing Nigeria Unlimited (MPNU), a subsidiary of Exxon Mobil in the Niger Delta region, Nigeria and it remains one of the most impacted communities by oil and gas exploration and production (O&G E&P) activities. Natural bodies of water (lotic and lentic systems) in the region receive recent petroleum hydrocarbon inputs almost daily due to oil spills and oily wastes discharges. This research was carried out to determine the prokaryotic diversity in a remote aviation fuel-contaminated lentic ecosystem after 15years of aviation fuel pollution using metagenomic approaches. Water samples from the polluted and a control (unpolluted) sites were collected using sterile 1-litre plastic bottles and transported to the laboratory in ice-packed cooler for analyses. ZR Fungal/Bacterial DNA MidiPrep™ (D6105) Extraction Kit was used to obtain community DNA of all microorganisms present in the water samples. The extracted DNA fragments were amplified by Polymerase chain reaction. The quantity of the amplified product was confirmed by agarose gel electrophoresis and bioinformatic analyses of the extracted fragments were carried out in the NCBI GenBank database using BLAST software. The analysis revealed the dominance of bacterial and archaeal communities in both the polluted and unpolluted water samples. The polluted sample had in composition 93.83% bacteria, followed by 3.43% archaea and 0.36% fungi; the control site sample revealed 58.05% bacteria, 39.69% fungi and 1.05% of archaea. Bacteria are the most dominant organisms in both the polluted and unpolluted ecosystem. These findings suggest that the conditions of the two water bodies are such that allow bacterial growth and proliferation otherwise the archaea would dominate if the conditions were harsh or at extremes.
53 The Role of Medicine in Population Control and Civilization Building from the Dawn of Civilization until the Present Time , Kevin Galalae
What I am about to say will make all doctors reconsider whether they will remain in the profession or look for a different one. It will also irrevocably change the way doctors practice medicine and how people in the general population view medicine. More importantly, it will forever alter the relationship between medicine and society. And last, it will change the profession and society in ways that we can scarcely fathom but that will greatly reduce the profession’s footprint and influence and greatly increase individual and general wellbeing.
54 Fractional Laser As Laser Assisted Drug Delivery of Triamcinolone Acetonide in Keloid , Zahra Ayu Lukita Sari1 *, Allin Marlina R1 and Yuli Kurniawati2
Background: Keloid is benign hyperplasia of dermal collagen which may or may not be preceded by injury in susceptible person. Keloids are refractory to treatment most of the times. Intralesional corticosteroid, topical retinoic acid, topical imiquimod cream, surgery, cryotherapy, laser, and silicon sheeting are mainly used for treatment. Fractional ablative laser is a new laser treatment modality that create numerous microscopic thermal injury zone controlled width, depth, and density that are surrounded by a reservoir of spared epidermal and dermal tissue, allowing of rapid repair of laser-induced thermal injury. Multiple studies demonstrate that laser pretreatment of the skin can increase the permeability and depth of penetration of topical drug molecules. Main observations: A boy, 12 years, scar that arise after burn scar 14 months ago. Scar was felt bigger and thickening also itching. Patient was diagnosed keloid and had been treated with same-session ablative fractional laser and topical triamcinolone acetonide after therapy. Patient had been treated 5 sessions with 3 weeks of interval. Successful of treatment was measured with reduction of keloid size and vancouver scar scale (VSS). Conclusions: Laser assisted drug delivery is an envolving technology with potentially broad clinical application. Ablative fractional laser treatment create vertical channels that might assist the delivery of drug into skin. Combination same-session therapy with ablative fractional laser and triamcinolone acetonide offer a good combination caused assisted delivery of drug.
55 Endoscopic Findings Related To Helicobacter Pylori , Alexandre Gomes1,2* and Thelma Larocca Skare1
Background: Studies with the latest technologies such as endoscopy with magnification and chromoendoscopy showed that various endoscopic aspects are clearly related to infection by Helicobacter pylori (Hp). The description of different patterns of erythema in gastric body under magnification of images revived interest in identifying these patterns by standard endoscopy. Aim: To validate the morphologic features of gastric mucosa to conventional gastroscopy Hprelated gastritis allowing predictability of their diagnosis as well as proper targeting biopsies. Methods: Prospective study of 339 consecutive patients with the standard videoendoscope image analysis were obtained, recorded and stored in a program database. These images were studied with respect to the presence or absence of HP, diagnosed by rapid urease test and/or by histological analysis. Were studied: a) normal mucosa appearance; b) mucosal nodularity; c) diffuse nonspecific erythemaor redness of antrum and body; d) mosaic pattern with focal area of hyperemia; e) erythema in streaks or bands (red streaks); f) raised erosions; g) flat erosions; h) fundic gland polyps. The main exclusion criteria were the use of drugs, Hp pre-treatment and other entities that could affect results. Results: Applying the exclusion criteria, were included 170 of the 339 patients, of which 52 (30.58%) were positive for Hp and 118 negative. On the positive findings, the most associated with infection were: antralnodularity (26.92%); raised erosion (15.38%) and mosaic pattern in the body (21,15%). On the negative group the normal appearance of the mucosa was 66.94%; red streaks in 9.32%; flat erosions 11.86%; and fundic gland polyps 11.86%. Conclusion: Endoscopic findings are useful in predicting the outcome, localization and targeting of biopsies in gastritis related to Helicobacter pylori infection.The most representative form of Hp related gastritis was the nodularity of the antralmucosa. Diffuse redness and mosaic pattern in the bodyare closely related to Hp infection.Raised erosions are suggestive but not specific to the infection. Normal-appearing forms, red streaks and fundic gland polyposis are related to the negativity of Helicobacter pylori infection. Flat erosions were not conclusive of the presence or absence of Hp.
56 The Impact of a Structured Balance Training Program on Elderly Adults , Chris King
Several viewpoints existed as to what is considered a fall. These viewpoints were developed based on the aspect of an individual’s involvement in a fall situation, knowledge level about falls, among other factors. A broad definition of a fall that has been widely accepted is “an event whereby an individual comes to rest on the ground or another lower level with or without a loss of consciousness” [1]. When referring to falls in more of a research typesetting, the researcher may have considered a fall, “an unexpected event in which the participants come to rest on the ground, floor, or lower level” [1]. Another proposed definition of a fall wasa “sudden unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force” [1].
57 Efficacy of a Meal Replacement Diet Plan Compared to a Food-based Diet Plan after a Period of Weight loss: a Randomized Controlled Trial , Vera Matta
Obesity is a chronic, complex, multifactorial disorder that has reached epidemic proportions in the United States [1]. Currently, an estimated 66% of the population is categorized as overweight or obese, and 32.2% obese [1,2]. Obesity is associated with an increased risk of morbidity and mortality secondary to complicating conditions that include heart disease, diabetes, cancer, asthma, sleep apnea, arthritis, reproductive complications, and psychological disturbances [3]. Moreover, obesity is associated with greater degrees of inflammation and oxidative stress, which have recently been shown to underlie many chronic conditions, from cardiovascular disease and cancer, to metabolic syndrome and nonalcoholic fatty liver disease, to neurodegenerative diseases, like Parkinson's disease [4,5-7]. Given the prevalence of obesity, its harmful consequences on human health, and the lack of effective treatment options, meal replacement diet plans represent a viable strategy for controlling weight and positively impacting health outcomes.
58 One Health – A New Paradigm in Fighting Infectious Diseases in West Africa , Koroma B M*1, Suluku R1 and Gogra A B1
Zoonotic infectious diseases have been an important concern to humankind for more than 10,000 years. Today, approximately 75% of newly emerging infectious diseases (EIDs) are zoonoses that result from various anthropogenic, genetic, ecologic, socioeconomic, and climatic factors. Zoonotic EIDs remain a major global concern, and such threats are expanding, especially in less developed regions. Current Ebola epidemic in West Africa is an extreme stark reminder of the role animal reservoirs play in public health, which reinforces the urgent need to operationalize a One Health approach. Building opportunities to overcome the challenges largely depends on four key capacity-building needs: (1) development of adequate science-based risk management policies, (2) skilled-personnel capacity building, (3) accredited veterinary and public health diagnostic laboratories with a shared database, and (4) improved use of existing natural resources and implementation. This paper highlights the key issues as building block for synthesis of the One Health approach to address the challenges and opportunities for tackling infectious diseases at the human, animal, and environment interface in low-resource settings. Health laboratory services are essential for the efficient delivery of quality and cost-effective healthcare. Training in laboratory services has long been a neglected part of the one health approach in countries like Sierra Leone. Njala University is actively working with other partners of Royal Netherlands Embassy (RNE) Post-Ebola Resilience Project, further reinforcing the One Health Concept by focusing on both human and animal health and its interface.
59 Comparative Study between IMF and Pure Conservation in Management of Condylar Head Fracture in Children , Majed Alharbi1 and Hamada Mahran2*
Background: The purpose of the present study was to compare IMF and pure conservation in management of condylar head fracture in children treated at the Department of Maxillofacial Surgery, Faculty of Medicine, Assiut University, Egypt, between 2011G - 2016G. Methods: Twenty four patients with condylar head fractures were included in this study, 14 males and 10 females ranging in ages from 5 – 15 years. They were divided into two equal groups. In group 1, twelve patients were treated by closed reduction for 2-3 weeks followed by physiotherapy, while group 2 patients were managed by pure conservation only for the same period. Outcome results on clinical and radiological parameters were evaluated during the follow up period. Results: In group 1, the maximum mouth opening after 2 months was ranged from 28-36 mm (average 32mm),while signs of development of ankylosis were reported in 3 patients. In group 2, the maximum interincisal opening was ranged from 28-37 mm (average 32.5mm) with absence of ankylosis. Pain in TMJ was noted in 3 cases of bilateral condylar head fractures of this group, but subsided gradually on the follow up. Conclusions: This study concluded that treatment of patients by closed reduction give satisfactory clinical results, though the condyle is not anatomically normal in radiographs. Whereas management of patients by pure conservation only without any surgical intervention showed excellent results clinically as well as radiographically. Perhaps a study conducted on larger number of patients with longer post operative follow up will throw more light on this subject.
60 Attempts at Repeated Cell Re-Constitution as Integral Developmental Dynamics of Cell Proliferation in Oncogenesis , Lawrence M. Agius
Performance re-characterization of pathway definition constitutes the defining elements of patterned response of the injured integral cell that individually defines the nature of biology of the cell clone and of the specific transformation event in oncogenesis. Determining parameters concern the patterns of response in the face of ongoing oncogenesis in terms that elusively create an autonomous response as systems biology pathways. It is within the further cooperative patterns of single cell integrity that oncogenesis defines a determined focality of response in terms that overall defines the primal proliferation and scatter of cells as induced by hepatocyte growth factor/MET activation.
61 The Prevalence of Refeeding Syndrome among Children with Severe Acute Malnutrition: An Observational Study in Kenyatta National Hospital, Kenya , Lilian Kerubo Okinyi
Background: Refeeding syndrome is a complication of severe acute malnutrition occurring during initial feeding because of electrolyte changes; mostly potassium, phosphorus and magnesium. The highest mortality in sam is observed between 48-72 hours of initiating feeds, the same time that refeeding syndrome occurs. Objectives: To establish prevalence of refeeding syndrome among children with sam in kenyatta national hospital, find out its associated factors and outcomes. Design: Observational study; Setting: Kenyatta national hospital paediatric wards Study Participants: Children 6-59 months diagnosed with severe acute malnutrition interventions: potassium, phosphorus and magnesium levels were measured at admission and repeated 48 hours after feed initiation. Anthropometric measurements, oedema, dehydration, HIV status, type of feed were evaluated and patients followed for outcomes. Main outcome measures: Recovery, persistence, undetermined, death. Results: Total of 160 children with sam recruited. Prevalence of refeeding syndrome was 21% (95% ci 15.2 to 28.4). refeeding syndrome was significantly associated with HIV (p=0.032). odds of refeeding syndrome increased six-fold with HIV infection (or=5.99, 95% ci 1.23 to 29.1) after age and sex adjustment of the 34 children who developed refeeding syndrome, 65% recovered with treatment, 3% died, 12% had persistently low electrolytes despite treatment while 20% were lost to follow up. Conclusion: Prevalence of refeeding syndrome in kenyatta national hospital among children admitted with sam was 21% with HIV being significantly associated with its development (p=0.032). The outcomes of those who developed refeeding syndrome were recovery (65%), mortality (3%), lost to follow up (20%) and persistence (12%).
62 The Role of Carbohydrate on Appetite Regulation , Aisha Alfituri
The physiological regulation of human appetite involves a complex interplay between signals originating from the gastrointestinal (GI) tract, liver and adipose tissue, and signals generated from the central nervous system (CNS). A great amount of studies have been conducted on this topic, and evidence has shown that the existence of carbohydrate in the GI tract plays an important role in the moderation of signaling and the regulation of appetite [1].
63 Diets and Risk of Cancer , Robert Skopec
A new study is providing further evidence about the potentially life-threatening danger of drinking soda on a daily basis. Large, long-running epidemiological studies have also concluded that there is indeed a link between the foods a person eats and his risk of colon cancer. During this process, the bacteria produce compounds such as secondary bile acids that have been shown to cause inflammation and cancer in lab studies. A study by the University of Aberdeen has found first time that a higher concentration of the molecules that breakdown omega-3 fatty acids is associated with a higher chance of survival from bowel cancer. Results showed that a higher proportion of omega-3 metabolising enzyme to omega-6 metabolising enzyme is associated with less spread of the tumor and a greater chance of survival for an individual patient. Cancer stem cells can be put into hibernation by a little-known drug diphenyleneiodonium (DPI) according to researchers from the University of Salford, UK. DPI effectively switches off the stem cancer cells, preventing their proliferation. It was showed that as the number of mutant KRAS copies increases, the tumor’s aggressiveness and ability to metastasize also increases. Disruption of endogenous protective mechanisms determines the evolution of cancer.
64 Severe Head Injury linked to Subsequent Development of Malignant Brain Tumour within a Short Period- A Case Report , Debabrata Mukhopadhyay1 , Geetu Malhotra2 and Asha Bakshi1
There have been a few case reports of head injury leading to brain tumour development in the same region as the brain injury. Here we report a case where the patient suffered a severe head injury with contusion. He recovered clinically with conservative management. Follow up Computed Tomography scan of the brain a month later showed complete resolution of the lesion. He subsequently developed malignant brain tumour in the same region as the original contusion within a very short period of 15 months. Head injury patients need close follow up especially when severe. The link between severity of head injury and malignant brain tumour development needs further evaluation. Role of anti-inflammatory agents for prevention of post traumatic brain tumours needs further exploration.
65 Safety And Preliminary Efficacy of Magnetic Stimulation of Pelvic Floor with Hifem Technology in Urinary Incontinence , Delgado Cidranes E1 * and Estrada Blanco2
Introduction: BTL EMSELLA™ utilizes High-Intensity Focused Electromagnetic technology (HIFEM) to cause deep pelvic floor muscles stimulation and restoration of the neuromuscular control. Key effectiveness is based on focused electromagnetic energy, in-depth penetration and stimulation of the entire pelvic floor area. A single BTL EMSELLA™ session brings thousands of supramaximal pelvic floor muscle contractions, which are extremely important in muscle reeducation of incontinent patients. Objective: Prospective study to evaluate the safety and preliminary effectiveness of the use of BTL EMSELLA magnetic stimulation in urinary incontinence. Method: Thirty-two patients with light and moderate urinary incontinence were recruited to perform 6 sessions of BTL EMSELLA during three weeks of initial treatment. Follow-up after three months. The patients received sessions lasting 28 minutes, completing the different treatment protocols. Initially the patients underwent a quality of life test before and after treatment, evaluation with advanced ultrasound using elastography to measure the initial tissue's elasticity and be able to compare after treatment, clinical functional evaluation and urodynamic test. Results: No adverse reactions were observed. All the patients finished the treatment sessions. Two patients reported increased pain after treatment in the first session corresponding to a VAS scale greater than 5 with duration greater than three hours. The treatment was highly satisfactory in 84,4% of the patients. After the first three months the improvement was maintained in 77% of the patients. No muscle injuries were observed. Elastographic changes and improvement of muscle tone were detected by advanced ultrasound (elastography) in 100% of patients. Conclusions: BTL EMSELLA is safe, well tolerated and effective for the treatment of mild and moderate urinary incontinence. The observed elastographic changes demonstrate the improvement of pelvic floor muscle tone after treatment. A reduction in the symptoms of urinary incontinence was demonstrated. Recommendations: Continue increasing the number of cases for research and increase the variables that we have decided to incorporate in the next research section such as MRI and pressure calculation.
66 Psychosocial Effects of Sexual Exploitation on Children , Zahra Salim Jessani
The happiest moment for parents in their life is to have a child whom they love, guide, protect and care for. Children are the blessing from the God and their protection is core responsibility. A child is recognized soon after their birth on sexual appearances, whether he is a boy or a girl. The term sexuality came into existence since life has evolved on earth. Although the world understands how sexual harassment poses a threat but, it is shrouded in secrecy either in the name of false piety or for intended personal revenge. Resultantly, the victim rarely files a complaint against the perpetrators of sexual exploitation. Many children face various issues throughout their way to maturity and the most prominent issue is sexual exploitation.
67 Holistic Care during Delivery , Zahra Salim Jessani
Giving birth is a life-changing event. It is a crucial phenomenon in the women’s life. To be care, and to be cared for should be the motive for every health care professional’s mind. Good communication, support, clean and aseptic usage of equipment during compassion from staff, and having her wishes respected, can help her feel in control of what is happening and contribute to making birth a positive experience for the woman and her birth companion.
68 The Effectiveness of 2% Chlorhexidine Gel in Reducing Intracanal Bacterial Count , Vikram Lal*1 , Naghma Parveen2 and Ayesha Sajjad3
Background: Root canal treatment is normally prescribed to treat an infection, and as with all surgical procedures an aseptic technique is essential throughout. Even after complying with the best of the treatment regimes a root canal therapy can fail due to the presence of certain resistant, residual organisms. This study is all about clinical efficacy of 2% chlorhexidine gel in reducing intra canal bacterial count during RCT instrumentation. A total of 138 patients participated in this study. The sample included 69 male and 69 female patients. The mean age of the sample was 28.3 (SD = 4.16). The mean baseline bacterial count was 4.51 x 106 as compared to post medication count after 15 days which was 2.88 x 106 . Bacterial growth/ positive culture was found in only 29.7% of patients. Furthermore, effectiveness of CA(OH)2 /2% chlorhexidine gel as measured by 50% decrease in bacterial count was observed in 65.2% patients Conclusion: In conclusion, the results of CA (OH)2 /2% chlorhexidine gel in the present study was able to reduce bacterial count after 15 days. These results suggested that CHX gel might be more effective at curtailing bacteria, and thus be better suited as intra canal medication.
69 Analysis of Short Stature in Children , Shahid S1*, Hafsa2 , Aslam A3 , Arastu A4 , Ali Sheikh A5 , Abdul Samad S5 , Shaukat F6 , Zafar Ali J6 and Faisaluddin M1*
Growth is a continuous biologic process influenced by genetic, nutritional, environmental, and hormonal factors. Normal growth can occur only if the individual is healthy. Longitudinal growth assessment is essential in child care. Short stature can be promptly recognized only with accurate measurements of growth and critical analysis of growth data. The objective of this study was to assess the characteristics of patients referred to pediatric clinic because of short stature and determination of the etiology in tertiary care hospitals of Southeast Asia. This is a retrospective study of patients referred to a pediatric clinic with short stature during the period March 2015 to March 2018. After a proper detailed medical history, growth analysis and physical examination, followed by a radiological (bone age) and laboratory screening (complete blood count, urine and stool analysis and also thyroid function). Growth hormone stimulation tests were performed when indicated. Magnetic resonance imaging (MRI) of the pituitary was performed if required. As well, celiac screening and small bowel biopsy were performed when appropriate. During the period, two hundred and thirty eight patients were evaluated for short stature. Their age ranged from 3 years to 12 years. The male to female ratio was 1.3:1. The commonest etiology was genetic short stature found in 32 patients, while in the remaining patients, nutritional, endocrine, metabolic and other causes were noted. Short stature was a common referral. A wide variety of etiological diagnosis was noticed with genetic short stature being the commonest. A wide variety of endocrine causes were evident, with growth hormone deficiency, as a results of different etiologies, being the commonest
70 CIScoSI Study [Children Immunization Status and cases of Systemic Illness] , Shahid S1*, Bansal R3 , Aslam I4 , Faisaluddin M* , Islam M5 , Mithwani A6 , Sakib-uz-zaman M5 , Akbar Khan M7 , Zafar M7 , Mehtab A7 and Kaleem A8
To determine the immunization status of pediatric patients under age of 5 years visiting pediatric department of tertiary care hospitals in South East Asia. The aim of this study was to appreciate the awareness and implementation of vaccination in pediatric patients who came into pediatric outpatient Department with presenting complain other than routine vaccination. we can also know the count of patients who do not complete their vaccination after birth. we can differentiate between vaccinated and unvaccinated patients and incidence of severe disease in both groups. Immunization is a protective process which makes a person resistant to the harmful diseases prevailing in the community, typically by vaccine administration either orally or intravenously. It is proven for controlling and eliminating many threatening diseases from the community. WHO report that licensed vaccines are available for the prevention of many infectious diseases. After the implementation of effective immunization the rate of many infectious diseases have declined in many countries of the world. South-East Asia is far behind in the immunization coverage. An estimated total coverage is 56%-88% for a fully immunized child, which is variable between countries. Also the coverage is highest for BCG and lowest for Polio.
71 Tonsillar Inflammation, a Rare Cause of Bradycardia and Hypotension , Mohamad El Abdallah*, Naba Saeed, Asadullah Mahmood, Ameer Kambod, Cynthia Piko and Jonathan Zimmerman
Tonsillitis is a frequently encountered pathology in the outpatient setting, usually caused by viruses [1]. When bacterial, the most common causatory microbe is streptococcus group A [1]. Tonsillar and peritonsillar abscess (PTA) on the other hand are never viral, and are usually caused by streptococcus pyogenes, Streptococcus melleri, fusobacterium necrophorum and staphylococci [1,2]. The overall incidence of PTA is suggested to be 37/100,000 patients, with the highest incidence between ages 14-21 at 124/100,000 [3].
72 Varicella Infection May Cause Thrombosis: A Case Report , Ozgur Dagli1 *, Derya OZTURK ENGÄ°N1 , Seyfi OZYUREK1 , Asuman INAN1 , Nurgul Ceran1 and Refik DEMIRTUNC2
This case was presented due to development of DVT and pulmonary embolism after VZV infection and determination of Factor V Leiden mutation and activated protein C resistance. A 19-year old male patient presented with fever at the 10th day of varicella zoster virus (VZV) infection, and pruritic vesicopustular skin lesions and increased leukocyte and CRP levels. Acyclovir and ampicillin-sulbactam therapy were started. On the fourth day of hospitalization, left leg DVT and pulmonary embolism developed. Anticoagulant therapy was started. Tests revealed activated protein C resistance and Factor V Leiden mutation. The patient was discharged after the relief of symptoms with anticoagulant therapy. Thrombosis rarely develops in the course of VZV infection. It is essential to investigate the factors contributing to predisposition to thrombosis in patients with thrombosis.
73 Ixekizumab in the Management of Non-Selected Out Patients with Moderate to Severe Psoriasis -New Data and Personal Clinical Experience , Norbert Behnke
Introduction: Too many patients with moderate to severe psoriasis do not receive adequate treatment. This means a vast undersupply in the treatment of patients with psoriasis. Only biologics fulfill the whole range of the treatment of psoriasis – psoriasis does not affect only skin but the whole organism: It is a systemic disease! Between the biologics are evident differences concerning the effect. Discussion: Based on broad personal experience in the management of patients with moderate to severe psoriasis new data from clinical studies with ixekizumab are examined. This contains new data on long-term-efficacy of ixekizumab, effectiveness in special localizations (scalp psoriasis, nail psoriasis, palmoplantar psoriasis, genital psoriasis) as well as safely data and experience on patients switched to ixekizumab from other biologics. Personal clinical experience is based on >300 non-selected outpatients with moderate to severe psoriasis, >250 patients on biological therapies, > 50 patients with ixekizumab. Conclusions: Focusing on a relevant number of patients switched from secukinumab to ixekizumab due to first or secondary loss of efficacy significant differences between both IL-17A-inhibitors mainly in terms of efficacy and speed of therapeutic response are shown. Finally the correlation between PASI-90-/PASI-100 response and significant changes in DLQI are highlighted.
74 Assessment of Dietary Vitamin D, Vitamin K and Calcium Intake of Portuguese Women of Childbearing age living in Switzerland , Sofia Martins, Leila Sadeghi*, Katrin A. Kopf-Bolanz and Helena Jenzer
Background: The lack of sun plays a major role in vitamin D deficiency, particularly among vulnerable groups, including migrants and women. Vitamin D and calcium are crucial nutrients for optimal bone health, heart function and muscle contraction. Recent studies suggest that the two micronutrients alone do not appear to be as beneficial as when their intake is coupled with vitamin K. Therefore, it is necessary to prevent their deficiencies. To this date, we observe a deficit of culturally sensitive methods for assessing dietary intake. The aim of this study was to estimate the dietary vitamin D, vitamin K and calcium intake among Portuguese women of childbearing age living in Switzerland. Methodology: A food frequency questionnaire was developed and administrated. A comparative method, a 24-hour dietary recall, was applied twice, over two non-consecutive days. The same methodology was applied to and compared with two control groups: Portuguese women living in Portugal and Swiss women living in Switzerland. Data were analysed using Microsoft Excel® version 15.0, 2013, Nutritional. Software® version 1.32.44, 2012 and IBM SPSS®, version 24.0, 2016 for windows. Results: Portuguese in Switzerland had the lowest vitamin D intake (6.04 µg /day) from food. When dietary supplements were considered, significant differences were found between the Swiss (11.1 µg) and Portuguese groups (7.04 µg) (p = 0.004). Regarding vitamin K, the focus group had the lowest intake (102.20 µg/day). Concerning calcium, the Swiss group was the only one achieving the daily recommendations (1355.14 mg) and significant differences were found between the Swiss and the Portuguese groups (p < 0.001). Conclusion: In the present study the three participant groups had a deficient intake of vitamin D and only the Swiss group had an adequate calcium intake. Vitamin K intake did not seem to be a concern in terms of dietary deficiencies for all the groups of participants.
75 What we do not know about the psyche? , Reshetnikov Mikhail
In this paper, traditional views on the relationship between mental activity and the brain activity are reviewed, and the hypothesis of brain as the biological interface, which was suggested by the author in 2008, is developed. Approaches to research of the psyche in the areas of physiology, psychology, psychotherapy and psychiatry are summarised, and their implications to therapy of patients with mental disorders are analysed. Two models of mental disorders are suggested, which are based on clearer differentiation of organic (the brain-related) pathology and mental disorders as such, which result from informational non-material influence on the psyche as the informational system rather than on the brain. Difference between nervous and psychic functioning of the organism and the personality is outlined; mental activity is viewed as an acquired programmed function, which is formed in asocial informational environment. The question of aim of psychopharmacological influence is raised, as well as a number of other questions, which do not have unambiguous answers. The author substantiates the theory of the brain as the biological interface and outlines its historical prerequisites in the literature.
76 Complications and Nutrient Deficiencies after Bariatric Surgery: A general review , Hamed R Takruri1*, Seham M Abu Jadayil2 and Dima H Takruri3
Obesity is a major public health problem worldwide; approximately 600 million adults over 18 years old are obese. Changes in the lifestyle including diet and physical activity are main causes of overweight and obesity. Use of management methods including diet, physical activity and behavioral modifications has been found to be disappointing in the excessively obese population with weight regain problem. Hence, surgery, mainly bariatric surgery, is a choice in case of morbid obesity (where BMI is more than 40 or in case of diabetic patients with BMI of 35 or more). However, the substantial weight loss and improvements in co morbid conditions observed after bariatric surgery are not without health and nutritional risks. Bariatric procedures produce changes in the gastrointestinal anatomy and physiology, leading to changes in the quantity and quality of diet, which may result in nutrient deficiencies. The most common nutritional concerns following bariatric surgery are deficiencies of iron, vitamin B12, folic acid, vitamin D, calcium, and in some patients thiamin, vitamin A, zinc and selenium. In this review nutrient deficiencies after bariatric surgery are discussed.
77 Assessing the Prevalence of Hepatitis B Surface Antigen in the Northern Brong Ahafo Region of Ghana: Locus of Intervention Model , Paul Amo Kyeremeh MPH & DrPH
Background: Scarcely was found any data on the prevalence of hepatitis B surface antigen in the Brong-Ahafo Region of Ghana. This study was conducted in six traditional areas in the Northern Part of Brong-Ahafo Region, to ascertain prevalence of hepatitis B surface antigen among the respondents to recommend intervention strategies for control and prevention. Method of data gathering: The data was obtained from the department of Preventive Healthcare and Lifestyle Medicine at Valley View University Hospital, Techiman Campus. 444 respondents were assessed on the presence of hepatitis B surface antigen by community healthy health screening program. They were adults between 18 and 59 years old who were from Techiman, Nkoranza, Atebubu, Kwamedanso, Yeji and Kajiji traditional areas, all in the Brong-Ahafo Region, Ghana. The blood sample was collected by a finger prick. Sample population: There were 444 respondents: 198 (44.5%) males and 246 (55.4%) females. Study design: The study is basically cross seasonal. Limitations: This paper is to assess the prevalence of hepatitis B surface antigen among the respondents. Also, serum blood sample was not taken but the whole blood from a finger prick. This study is again limited to the causes and spread of hepatitis B surface antigen since such data could be obtained from peer review journals, textbooks, and qualitative, or clinical research. Results: Out of 444 respondents, 415(93.4%) were negative with hepatitis B surface antigen. 19 (4.2%) respondents tested positive. 10 (2.2%) males and 9 (2.0%) females respectively. Cumulatively, 4.2% of the sample populations were positive. Conclusion: education on the awareness, mode of transmission, effects and prevention of hepatitis B surface antigen are timely needed to save several thousand from poorer health outcome and mortalities in the Brong-Ahafo Region of Ghana.
78 Which Relevant Information do Preschoolers and Schoolers Perceive and Select for Imitating a Series of walking Movement? , Lazhar Labiadh*1 , Pauline Maillot2 and Sylvain Hanneton3
Imitation is commonly considered as a hierarchically organized mechanism. It is frequently used to explore various scientific fields but few works have studied how locomotion movements are imitated. The current study aims to investigate and expand the findings regarding which information children of different age groups select and integrate for performing a series of locomotion movements. One hundred and thirty children from 3.5 to 7.5 years of age were instructed to walk in step-alternating mode on and between obstacles in different imitation forms following gestural demonstration, and in a control condition following verbal instructions. The children’s performances were videotaped, coded in binary data, and then put into percentage. Results showed first, that all children performed the modeled walking movements, but did not necessarily do so with the same step-alternating mode or footedness and second, that the model helped the preschoolers to adopt his step-alternating mode and stabilized the schoolers from the age of 5.5-year-olds. These findings reveal that the age of 5.5 is crucial for imitating a walking task while overcoming the constraints of balance and propulsion.
79 Acrylamide in Algarrobine and the Recommendation of Daily Intake in the Population of Piura-Peru , Alfredo Lázaro Ludeña Gutiérrez1 , Deyvi David Cunguia Piedra2 and Ángel Alfredo Ludeña Escalante3
Objective: Quantify the recommended daily intake of algarrobine with acrylamide in the population of Piura-Peru. Methods: The raw material carob (Prosopis pallida), was cut, in a proportion 1 kg of locust bean chopped with 4 liters of water (1: 4), placed in a pot type perol on direct fire, after extracting the sugars from the carob, it is filtered, to then concentrate the sugars at a temperature of 103 to 105ºC. Samples of different soluble solids were analyzed in the algarrobin. To quantify acrylamide was performed by ion chromatography and mass spectrophotometry (LC-MS). To determine the amount of acrylamide consumption in the algarrobine, the per capita consumption of algarrobine (surveys) was determined. Results: One kilogram of carob was obtained 171.4 ml of algarrobin, with a density of 1.4 g / ml, a pH: 4.796, 4.26, 5.02 and 5.27 respectively, with a content of soluble solids of 77.07, 81.3, 74.98 and 82.6% respectively and a per-capita consumption of algarrobin of 0.17 lt / year / person. The content of acrylamide in the algarrobin was different in each sample: 303, 250, 83, 25 ug / kg respectively. Conclusions: The lower the presence of acrylamide in algarrobine, the greater the consumption of algarrobine.
80 Double- Chambered Left Ventricle and Abnormal Papillary Muscle Formation , Yasmin Hanfi1 * and Eva Nyktari2
Papillary muscles develop separately from mitral valve leaflet and chordae, they origin from myocardial ridge of the anterior wall and to the posterior wall of the left ventricle (LV). While chordae and mitral valve leaflets origin from a cushion tissue. The myocardial ridge gradually loosens from the ventricular wall and meanwhile the cushion tissue transforms into leaflet and chordae1. Abnormal papillary muscle formation may present a muscle bridge and divide the LV into two chambers. The most rare form is the superior inferior LV subdivision which our cases represent.
81 Impact of Alcohol Use and Drug Use on STD/HIV-Related Sexual Risk Behaviors among African American College Students , Jiangmin Xu1 * and Jingzhi Xu2
Objective: The study explored associations between alcohol use, drug use, as well as sexually transmitted disease (STD)/human immunodeficiency virus (HIV)-related sexual risk behaviors among African American college students. Participants: The study used data from 294 African American college students enrolled at Winston-Salem State University (WSSU). Methods: Participants completed a telephone interview and online self-report survey. A series of frequency analyses and regression analyses were used to examine how alcohol use and drug use interactively affect college students’ STD/HIV-related sexual risk behaviors. the college students had (p<0.001) after controlling for age and gender. However, no association was found between alcohol use and condom use. Results and findings: The findings indicate that alcohol use was positively associated with the number of sexual partners the college students had (p<0.001) after controlling for age and gender. However, no association was found between alcohol use and condom use. Conclusions: Our findings support the need for targeted STD/HIV prevention and emphasize the importance of reducing alcohol use among African American College students on campuses.
82 Questioning US Iodine and Fluoride Intake-Focus on Thyroid Cancer Treatment , Xu Chen
Thyroid nodules are very common among adults. One of the major reasons for this problem is iodine deficiency. Iodine is an important essential element for human body. It is not just for thyroid hormone synthesis, it is an anti-oxidant for the whole body. Currently, US iodine intake is questionable due to many reasons. Fast foods and processed foods are part of it. To make it worse, fluoride, a very toxic element to thyroid, is in municipal water to prevent tooth decay. This paper will be about a literature review in what to eat and how to cook to take in enough iodine to keep up thyroid health.
83 Normal Values of Left and Right Ventricular Tissue Doppler Imaging Myocardial Performance Index by Age and Gender , Anwar Ashraf M1, 2, Bakhsh Abeer3 *, Tunkle Ammar1 and Chamsi-Pasha Hassan1
The Myocardial Performance Index (MPI) is a validated modality for LV and RV assessment. Objective: This study evaluates the normal values of MPI by PWD and TDI in males and females across a wide age rage. Methods: MPI was measured for LV and RV using PWD and TDI in 99 healthy adults, of which 49 were women. Results: The sample was divided by age into: GI 17-44 years, GII 45-60 years, GIII 61-75 years and GIV >75 years. Mean LV PWD-MPI was 0.5 and LV TDI-MPI for septal/lateral walls 0.384/0.386. Mean LV PWD-MPI for males is [GI 0.53±0.18, GII 0.59±0.13, GIII 0.49±0.23, GIV 0.48±0.27] and females [GI 0.49±0.16, GII 0.54±0.17, GIII 0.45±0.10, GIV 0.47±0.08]. Mean LV TDI-MPI for septal and lateral in males are [GI 0.37/0.31, GII 0.36/0.36, GIII 0.46/0.39, GIV 0.36/0.36] and females [GI 0.37/0.36, GII 0.37/0.42, GIII 0.41/0.42, GIV 0.33/0.45]. There was an excellent correlation between LV TDI-MPI septal and lateral (0.38± 0.13 and 0.39± 0.13; R= 0.337; p= 0.001). There were no significant differences in LV TDI-MPI between males and females for the septal MPI (0.39± 0.15 vs. 0.37± 0.10; P= 0.46) and lower in males than females for the lateral MPI (0.36± 0.12 vs. 0.41± 0.13; p = 0.04). However, the reference value was higher for LV TDI-MPI septal/lateral in GIII 0.46/0.39. The correlation was not significant between LV PWD-MPI and LV TDI-MPI septal = 0.18; p value= 0.078, and between the LV PWD-MPI and LV TDI-MPI lateral = 0.13; p value= 0.22. The Mean RV PWD-MPI was 0.4±0.28. The RV PWD-MPI showed significant variation by age and gender for male/female [GI 0.35±0.23/0.27±0.22, GII 0.26±0.19/0.49±028, GIII 0.51±0.27/0.63±045, GVI 0.47±0.35/0.35±0.17]. The normal RV TDI-MPI was 0.39±0.12 with no significant differences between males and females (0.40± 0.28 and 0.40± 0.26; p = 0.99). Conclusion: The septal and lateral LV TDI-MPI is well correlated for all the groups in both genders. However, in GIII there is an increase in the LV TDI-MPI. There is significant variation in RV PWD-MPI by gender especially in the in GIII. This variation is not seen by TDI-MPI for the RV
84 Relationship between Information Deprivation on Food Security and Health Risks during Food Consumption in the Population of Piura (2018) , Adrian ColomerWinter1 , Ibai Aldebaran de Villasante Llaquet2 * and Alfredo Lazaro Ludeña Gutierrez2
The present research work is entitled "Relationship between information deprivation on food security and health risks during food consumption in the population of Piura (2018)." The report has been made due to the growing statistics of coronary metabolic diseases that are registered in Peru, and especially Piura, due to the deficient patterns of food consumption. It is for this reason that the perception of the risk that consumers have about food and the knowledge associated with the potential danger of developing diseases was analyzed.
85 Post-Stroke Spasticity (PSS) Setting Up a PSS Clinic: Experience and Results , Manjula Ricciardi
Stroke is a leading cause of long-term disability. As a consequence of stroke and associated upper motor neuron (UMN) syndrome, stroke survivors are often left with muscle over activity, including spasticity. Spasticity is characterized by over- activity in muscles after injury to the central nervous system. When left untreated, post-stroke spasticity (PSS) can lead to contractures, pain and deformity, involuntary movement, and greater functional impairments (eg, reduced mobility, self-care and dressing). Spasticity is a common symptom after stroke, arising in about 30% of patients, and usually occurs within the first few days or weeks [1]. However, the onset of spasticity is highly variable and can occur in the short- medium or long-term post-stroke period [2]. Post-stroke hemiparesis, together with abnormal muscle tone, is a major cause of morbidity and disability. Patients with poststroke spasticity often demonstrate recognizable antigravity postural patterns (Fig 1) characterized by shoulder adduction, elbow and wrist flexion in the upper limb, hip adduction, knee extension and ankle plantar flexion in the lower limb. This “hemiplegic” posture, which is thought to result from increased motor neuron activity in antigravity muscles, significantly interferes with body image, balance and gait. BoNT-A, one of the most potent biologic toxins known to man acts by blocking neuromuscular transmission via inhibiting acetylcholine release [3]. BoNT-A treatment in post-stroke upper and lower limb spasticity is a safe and effective procedure to decrease muscle tone and increase the range of motion. More recent studies are demonstrating the importance for the rehabilitation therapist intervention to work alongside the physician to create more positive and significant effects on active function [4]. Daily stretching exercise is the key for the long-lasting benefits. BoNT-A Injections, Ultrasound guided technique, performed by a Physician in combination with physiotherapy and outcomes measurements are used to improve upper and lower limb function in stroke patients with spasticity in the clinical setting [5]. We would like to share our experience on the benefit of the ultrasound guided technique to target the muscles and our results in setting up a spasticity clinic for post-stroke patients.
86 Comprehending and Ameliorating Medication Reconciliation in a Community Hospital , Asish Regmi* and John Pamula
Medication reconciliation is the process of creating the most accurate list possible off all medication patients is taking including drug name, doses, frequency and route, and comparing that list against the physician's admission, transfer and/or discharge order with a goal of providing correct medication to the patient at all transitions [1].
87 Social Logics in Reproduction Health , ANOUA Adou Serge Judicaël
The issue that underlies a worrying question of maternal and child health in Côte d'Ivoire is that of social logic. Social logic is perceived as "cultural constructions of actors with regard to morbidity that cause to adopt reproductive health care". Based on this understanding, the concept of social logic in reproductive health is similar to a paradigm that highlights the various factors that structure and organise sociological resistance to mothers' openness to healthy reproductive behaviours; that is, openness to change for sustainable reproductive health. Far from becoming and remaining a prisoner of blind culturalism with the social logic that generates the health of mothers, new-borns and children, practically-relevant questions are raised. Issues of "bad governance", socio-cultural representations and behaviours in conflict with modern epidemiological standards are addressed in a culturally-sensitive manner, an important issue for the provision of care focused on the needs of mothers seeking answers to health problems. Developing these original community characteristics helps to orient a reading list in a socioanthropological perspective with a view to explaining and understanding different problems encountered, experiences acquired by social actors during the implementation of antenatal, postnatal and family planning care. This context of building logic with regard to reproductive health care is key to identifying real bottlenecks in maternity services and achieving efficient management of maternal, new-born and child health care for the benefit of populations and actors in the public health sector.
88 Seven Chakras Karma and Tarot Cards for Overall Wellbeing , Jasmi Doshi Sarvaiya
Atma Namaste. I feel delighted to present this paper amongst the August gathering of healers and doctors. We all work on the same platform, either healing on physical, mental, emotional or spiritual level. Down the memory lane, as a child I remember going to doctorkaka in Sangli and procrastinating my problems, like my throat is swollen, won’t be able to breathe, etc. He used to listen to me calmly and then say, “Relax, it has happened to me previously”. And you are relieved. What did he do? He worked on our psychological level first and then on our physical level.
89 Use of Ultrasound-Assisted Liposuction for the Treatment of Breast Hypertrophy, Surgical Clinical Prospective Study on 45 Cases , Maria del Pilar Reyes2 and Gustavo H Leibaschoff*1
Breasts are a very important part of the woman's body. They have always been considered as a zone impregnated with sensuality and are inevitably associated with feminine harmony and beauty. There is No ideal breast size and beauty standards vary greatly from one person to another. In any case, the most important thing is that the woman feels at comfort with her breasts, that she feels in balance with her body and if that is not the case to seek a medical solution.
90 Onnetsu Therapy: Effects of Far Infrared and Terahertz Vibration for various Cancer, Rheumatoid Arthritis and Other Diseases , Kazuko Tatsumura-Hillyer
Onnetsu means comfortable heat. Dr Kazuko Onnetsu Therapy invented by Dr. Kazuko Tatsumura Hillyer emits from a special ceramic; 1) Precise 8-10μ of vibration of Infrared SunRay. 2) Vibration of Terahertz, and 3) various degrees of heat. When Onnetsuki is slid over the skin, healthy areas are comfortable, but IF deep tissue is cold, unhealthy or degenerated, “hot spot” is detected by the temperature sensation reported from the patient. Dr Kazuko’s Onnetsu Therapy is both a diagnostic and therapeutic. When this hot spot is effectively treated with Far-Infrared, Terahertz & Heat, Dr Kazuko Onnetsu Therapy, the hot sensation subsides and the Disease conditions improve. Dr. Kazuko’s protocol must be followed. Dr Kazuko Onnetsu Therapy is based on four historical and scientific facts. 1. NASA's finding regarding Far-Infrared vibration from Sun light 8-10μ only. Also, added is the specific Terahertz vibration: Healing vibration 2. Traditional Japanese Concept of the significance of Body Temperature; Raising Cold Temperature. 3. Immunology Theory by Dr. Toru Abo, balancing autonomic nervous system to improve condition of white cells; Raising Immunity. 4. Promoting four flows of Energy through acupuncture technique: blood, body fluid, Oxygen, Ki(Chi) Dr. Kazuko has taught her Onnetsu Therapy to MDs and health practitioners over the past decades all over the world: are practicing it in the hospitals and clinics. Clinical Trials have shown improvements on cases (including but not limited to) as arthritis, asthma, various cancers, diabetes, tuberculosis and various painful conditions. Clinical studies from Cuba and Peru will be presented.
91 Prevention and Management of Respiratory Diseases Including Lung Cancer Through Exercise Interventions , Manikonda Prakash Rao
The objective of the paper is to create awareness among people about alternative and complimentary methods to protect themselves from respiratory diseases like asthma, bronchitis, chronic obstructive lung disease, cancer etc. The following changes take place in airways as a result of Lung diseases 1) Inflammation: Is a physiological process and plays the role of immunological defense against infection, injury or allergy 2) Hyper secretion of mucus: is a major pathological feature of Airway diseases. It is the result of goblet cell hyperplasia in respiratory mucosa and is a prominent feature of inflammation. Acute inflammation is a defense process and where as Chronic inflammation is a disease process. Chronic Inflammation and mucus hyper secretion are a potential risk factors for an accelerated loss of lung function. It is a common feature in elderly.. The thick viscous mucus in the Lungs will be conducive to pathogens. Continued inflammation and mucus hyper Secretion may significantly contribute to transformation of normal cells into cancer cells ( often as a result of chemical , viral or radioactive damage to genes) 3) Broncospasm: is an additional factor in asthma patients. The three factors together cause breathlessness.
92 Migraine among Princess Nourah Bint Abdulrahman University Students in Riyadh, Saudi Arabia , Modhi Almuryidi, Hajar Alsaeed, Sarah Almahri, Aroob Almoagti* and Rawan Skair
Background: Migraine is a psych neurological disorder that represents a remarkable global and international health problem due to its frequency and substantial disability. Migraine is highly prevalent among university students and it is accompanied with impaired academic performance and limited daily activities. We aimed to determine the prevalence of migraine among PNU students. Objectives: To Estimate the prevalence of migraine among PNU students, in medical and other (non-health) colleges, to identify its common triggers, and assess its severity and effects on the students’ life. Materials and Methods: This is cross-sectional, questionnaire based study, of convenient sampling technique. 523 students out of 539 participated students were included. Participants who had two or more headaches in the last 3 months formed the headache group. Afterwards, two preliminary questions were applied to the headache group and participants with at least one affirmative response were asked to perform the validated ID-Migraine test. Results: The mean age of the participants was 20.97±1.6 years; 448/523 students (85.7%) were screened positive for headache. Migraine was detected among 234/523 of the students (45%); 17% were medical and 55% were non-health colleges. Lack of sleep 89.3%, stress74.8%, and menstruation 46.6% were the most triggering factors of migraine. This study showed significant association between migraine headache and studying in non-health colleges (P =0.001). In medical students, the median pain level was III (moderate) and Migraine Disability Assessment Score was I (little). Conclusion and Recommendations: The prevalence of migraine among PNU students was high compared to other studies. Further studies should be carried out by neurologist for more knowledge about migraine among students’ population.
93 Young Nulliparous Female with Continous Vaginal Bleeding: A Case of Atypical Endometrial Hyperplasia , Shaila Anwar* and Nabeela Shami
Mrs. XYZ 32 years of age, nulliparous presented in the OPD with complaint of continuous vaginal bleeding for 1 month. She had had Dx D & C twice previously for the same complaint one year ago. The two H/P reports showed Adenocarcinoma of the Uterus and repeat D & C one month later showed Secretory endometrium. Dilatation and curettage was done again on19. 03 2018 which showed Atypical Endometrial Hyperplasia (AEH). The couple was counseled and they opted for definitive treatment. TAH & BSO was done on 03.04 2018. Cut section showed thickened endometrium with no myometrium invasion. Conclusion: In patients with irregular or continuous bleeding P/V should be evaluated for AEH or Endometrial carcinoma.
94 Failure to Thrive: A Review for a Relationship between Coeliac Disease and Obesity , Chelsea Spackman
Objectives: The primary objective of this review was to provide a systematic review of the literature on the relationship between CD and obesity. Further, the reviewer had the purpose of conducting an investigation on this correlation, ranging from pediatrics to adults, in specific areas such as the mechanism of the two conditions and the nutritional interventions. The mechanism review involved finding any pathogenic and pathophysiological link between the two conditions and investigating the possible association in clinical evidence and manifestations and of the symptoms. As a result, the present research was designed to establish a paper that can effectively inform not only the public but health care providers, concerning the importance of proper and time-sensitive diagnosis. Methods: In order to achieve these objectives, the researcher conducted desk-based research, which involved a comprehensive review of numerous journal articles drawn from various publishers. The search strategy involved the use of both internal and external secondary sources of information obtained from Science Direct, PubMed, Journal of Paediatric Gastroenterology and Nutrition, The American Journal of Clinical Nutrition, and The European Journal of Clinical Nutrition, among others. Moreover, the search strategy also considered the mechanistic pathology, functional physiology, and human intervention. Results: The key pathophysiological findings indicated that CD and obesity have a connection in the context of the predisposing factors, which are genetic, environmental and immunological factors. Further, the two conditions also show connection in the aspects of human nutritional interventions, where the intervention for CD was established to involve a GFD, however, some patients have been recorded as becoming obese once they start the treatment process. Conclusion: Conclusively, it was important establishing a link between obesity and CD based on the clinical implications of the findings, as well as the general healthcare field; where, the present paper points out for the proper diagnosis of both conditions, whether the symptoms are atypical or not. Hence, it was important to provide a precise nutritional intervention for future patients, which may involve an introduction of a GFD before diagnosis, and strict follow-up and education for the patients on the importance
95 Improving Pain Management Knowledge Among Nurses , Lucia Amendano
Pain is the most commonly presented symptom among patients who are admitted to the emergency department. Unfortunately, many barriers to pain management exist thereby impacting emergency department patient care and outcomes, specifically regarding inadequate pain assessment, reassessment, and documentation. Thus, the quality improvement project aimed to increase emergency department nurses knowledge of pain management and utilization of pain assessment guidelines, resources, and policies. By nurses having sufficient education, they can provide timely and efficient care to support patient outcomes, improve patient comfort, and improve patient satisfaction. The Knowledge and Attitudes Survey Regarding Pain was utilized to conduct a pre and post-test assessment to measure emergency department nurses’ knowledge of pain management [1]. The results of the quality improvement project showed that nurses lacked adequate pain management knowledge, 45.45% of participants responded incorrectly to knowledge questions about pain before the intervention. However, after the project implementation, the results of the data analysis showed a statistically significant mean increase of 23.91% from pre-intervention (65.65%) to post-intervention (89.56%) after eight weeks of project implementation. This quality improvement project will provide a basis for future studies in improving nurses’ pain management knowledge.
96 Cancer Therapies: Quantum-level Contribution of Ayurveda and Yoga Highlighted Significant Health Tech Data Exchange in Harvard meet , Sudhanva Char
This is an account of the main deliberations of the International Conference on Integrative Medicine – Role of Yoga and Ayurveda in the Management of Cancer and Palliative Care held at Harvard Medical School’s Joseph Martin Conference Center, June 22-24, 2018. The Conference was unique in the annals of integrative medicine with professionals from different modalities like allopathy, ayurveda, yoga, and related fields coming together, and in the process leaving behind their respective professional silos, and examining seriously the prospects of borrowing best practices from other modalities in health care. Comparative performance-effectiveness and cost-effectiveness too were considered. The aim, inter alia, of the meet was one of highlighting the capabilities of Ayurveda and Yoga techniques and thereby help them gain more currency as efficient, if not sounder means to deploy against cancer and other grave threats to wellness. A caveat: This is a synopsis of the proceedings and covers just a digest of presentations and discussions about Ayurvedic and yogic treatment of cancer per se. There were other valuable presentations which however did not directly deal with treatment of cancer, and so they are not enumerated here. The exception to this caveat has been the inaugural session in which some presentations were generic too. For all details the reader is advised to contact one of the organizers: Indo-US Health Initiatives, (email: info@indoushealth.com), or the platform paper presenters.
97 An Opportunities of Stem Cells in Cancer Therapy , Hamid Hussain
Due to the uniqueness of the biological structures of stem cells, and having special properties, such as remarkable affinity and migrating to cancers cell, producing and pouring bioactive factors, as well as theimmunosuppression characteristics, all make stem cells ready to playing extensive role in tumor targeting process. Applications of preclinical stem cells in cancer therapies witnessed significant progress and have lots of promises. Recently stem cell therapy in cancers management revealed several advantages, opportunities, and potential challenges.
98 Graphic Communication of Scientific Research , Serena Ghezzi
Scientific communication is going through a new era, thus researchers have to revalue communication importance: not only divulgation, due to its social impact and implications, but even communication between scientists. Graphics is a language able to increase attention, understanding and memorization. It engage people to overcome noises of other communications. To know and to handle graphic language rules allows a higher quality communication.
99 Is it Possible to Prescribe Right Drug for Every Patient? , Brahma D Sharma, PhD
Around the world, doctors prescribe drugs by trial and error. After determining the diagnosis, a doctor prescribes one of the drugs from several ‘suitable’ drugs. When the drug creates unbearable side effects, another drug is often prescribed to address them. If the side effects are severe or the patient is not responding to the drug, another drug is selected with the hope that it may be the ‘right one’. Trial and error prescribing of drugs is frustrating and costly practice of medicine.
100 Tramadol & Sports , Dr. Sherif Azmy Rizkalla
Tramadol hydrochloride is the full name: is a centrally acting opioid analgesic used to treat moderate to moderately severe pain”. It’s sold under a range of brand names .It works on the brain and nervous system to reduce pain and is a medium to strong pain killer, this is not what people take for a headache. Instead it’s used for chronic and acute pain relief. As an opiate it can be addictive. Indeed as well as correct use it is also abused. By some measures prescription drugs, including Tramadol, are abused in greater quantities in the US than illegal drugs from heroin to cocaine etc.
101 A Case Study of Efficacy of Homoeopathic Medicines in Case of Infertility Due to Uterine Fibroid without any Surgical Procedure , Rahul Singh
This case study is about the efficacy of Homoeopathic medicines in treating the infertility caused due to Uterine Fibroid, which is a most common pelvic tumor in women. Day by day, case of uterine Fibroids are increasing, where they are causing difficulty in conceive or leading to miscarriages. Lower abdominal pain, irregular menstruation and abnormal uterine bleeding are other common symptoms. While conventional medicine does not offer any satisfactory treatment except surgical removal of Myomas (Myomectomy) or in extreme condition, complete removal of Uterus (hysterectomy), Homoeopathy is a good alternative for the treatment of Myomas. At, Care 'N' Cure Homoeopathic Health center, Delhi, we have treated and still treating many cases of uterine fibroids by homoeopathic medicines for last more than 13 years. Out of them, around 70% have shown very good results. Most of them were referred for surgery by other doctors, but well selected homoeopathic medicine and proper counseling, leads the complete disappearance of fibroids. Duration of treatment varied from case to case depending on the size and total numbers of Myomas. Outcome of our study on uterine fibroid is very encouraging. Some of the patients who were childless due to large and multiple uterine fibroid got conceived with the help of homoeopathy. These results are very encouraging and giving us the more confidence to work in the field of infertility
102 The Growing Popularity of Alternative Medicine Approaches , Ron Neer
In the United States, the most popular thing to do when encountering a health issue is to go see your primary doctor and follow their recommendation. Now more than ever, people in the United States and abroad are seeking second opinions, considering alternative methods in combination with conventional methods, or forgoing conventional methods all together.
103 Invitro Cytotoxicity and Glucose Uptake Activity of Mushroom Pleurotus Eous in Methanol Extract Using L-6 Cell Line , K Shoba1 and S Krishnakumari2 *
The aim of the present study is to evaluate the cytotoxicity and glucose uptake activity of methanolic extract of pleurotus eous mushroom using L6 cell lines. An MTT assay is a colorimetric assay based on assessing the cell metabolic activityThe results showed that the extracts did not confer any cytotoxicity. The effects were observed in treated cells up to 6.25 mg/ml extract as measured with MTT. Also the mushroom extracts shows better glucose uptake potential. The results were compared with Insulin a standard antidiabetic drug. Insulin enhance the glucose uptake upto 97.8%. The L6 cell lines enhance the glucose uptake by 57.4% at 65µg concentration.
104 Artificial Heart Oxygenator of Blood Energyically Autonomous , Luigi Antonio Pezone
The artificial heart of man, proposed in this patent deposit, closes the circle of sustainable energy based on the only physical principle possible in every remote corner of the Earth: the bypass of the force of gravity and of the elastic pressure of the air that it can be realized everywhere, even in the man's chest, using pumps with the double supply separated until to the impeller, which science, industrialists and world legislators pretend to ignore in order not to admit that they have wronged the entire industrial and economic development. Everything would have been simpler, cleaner and cheaper if this invention had taken place a hundred years earlier, as it could have been. The artificial human heart is the miniaturized version of the autoclave system, already reduced, to make it enter the wells' shirts, to purify the water producing energy. Entering the chest of the man to purify the blood producing the energy needed by the brain is not much different from expected for the wells. They serve two mini parallel autoclave systems that replace the right and left atria ventricles. The two pumps that feed them, with the double supply separated until o the impeller, allowing the balance of the hydrostatic thrust in suction and delivery, allow to get the blood coming from the systemic circulation in the mini autoclave on the right and the one coming from the lungs in that left, bypassing the compressed air pressure. This system works autonomously because the mini autoclave ejects at the same instant the quantity of blood equal to the one that enters, due to the principle of impenetrability of the bodies, through a mini pump used as a turbine connected to a direct current generator. The energy spent by the pump motor is about a tenth of the energy produced by the generator. This allows us to have enough energy available to produce the amount of compressed air necessary to the autoclave and the management of an electronic control unit that with a three-word voice command: "rest, normal, fast" manages the flow and the blood pressure according to the physical activity that it carries out. Although it is the air pressure that circulates the blood in the pump used as a turbine, since the circulation is one-way, apart from air solubilized in the blood with purifying effects, there is no other consumption of compressed air because it is exploited statically and not even electricity to produce it. Although it is the air pressure that circulates the blood in the pump used as a turbine, since the circulation is one-way, apart from the solubilized air in the blood with purifying effects, there is no other consumption of compressed air and electric energy. As published on http://www.spawhe.eu, this solution was found by myself after many years spent trying to improve the purification systems of water and air and many patents filed in vain. However, the study served to ascertain that world science has identified single and incomplete scientific principles, which used singly have polluted and warmed the planet. Only with the invention of the pumps with the double power supply separated to the impeller, the undersigned has found the key of the problem. In fact, through it, the dynamic fluid used cold between water and air, especially compressed, would have produced energy protecting the environment, consuming only moderate wear of materials, with low operating temperatures, and air pressures used statically, which would circulate the incompressible liquid. This is the true principle of terrestrial energy that, unfortunately, has not been legislated by world science, which still ignores it, hoping that in addition to myself, no one notices it. Too late. They would have to admit their mistakes, before this energy, despite their silences, also entered the human heart.
105 Is Homeopathy Heplful In Autism? , Kavita R. Chandak
Child psychology is really a big mystery. It is quite difficult to understand the mood of the child even when he has no psychological upsets. Just think how difficult is to understand a child suffering from autism. It is a rare variety of developmental disorder seen in early childhood. The child is unable to respond as he doesn’t understand it. Odd behavior, disorder of language and cannot learn etiquettes’ are the classic features of autism. It is also associated with emotional disorder like showing anger or fear suddenly without any particular cause. These children can be hypoactive or hyperactive. The child does not like to speak even a word, he just cries loudly for hours if he is hungry or thirsty. The child is very obstinate, if his demands are not met, he just cry and roll down on the floor. When he starts crying he cannot be stopped for hours together and is very destructive and throws things around. In few cases, disliking for clothes is there, they want to throw away the wearing. These children cannot distinguish between right or wrong habits for example if the child is thirsty he would drink water straight from the tap. Sometime the child may go out of home and wander here and there without any purpose; he has his own world and does not like to play with other children. He is physically restless, always doing something, cannot sit at one place. They utter something which cannot be understood.
106 The Visual Arts and how Advanced Mathematics Affects Human Consciousness , Nydia J. Gutierrez
Computational Modeling and Advanced Mathematics: How it affects the encoding of memory in the brain. Computational modeling and advanced mathematical models defined the visual cognitive hierarchy that connects to human intelligence and creative thinking. The influential of human intelligence and the brain provides concretes images that neuroscience creates spatial abstraction and cultural creative thinking. The genes and the environment affects’ the plasticity and neuroplasticity of the human brain. The creative cognitive genome affects human intelligence. This stimulates the reconstruction and the plasticity of the brain. Consciousness is recreated by the momentum of time. And this affects the experiences of the events and frequency. The generation of consciousness and brain activity. The neural mechanism that retrieves consciousness and the significant of brain anatomy. Computational modeling and advanced mathematics affects the encoding and decoding of consciousness and memory. Therefore, it is true that advanced mathematics and computational analysis affects the encoding of memory in the human brain. The Encoding of Consciousness and Mathematics in the Human Brain. Encoding and Consciousness comes in many ways and visual mathematic patterns. It is the refraction to our human intelligence and creative thinking. It recreates our personal memories and it encodes the mind mapping abstraction as an algorithm. Perhaps, the mind is our biggest treasure and it recreates memories and experiences. Neuroscience provides findings and it chooses consciousness. What we recreate is not an illusion but a brain algorithm that happens through numerical figures. It is the surroundings of the impossible. Moreover, the possibility of a thinking pattern that helps believes our soul. Our language is not only based on neurons although it recognizes sound and it merges in the Broca’s area and the cerebral cortex. It is recognition of brilliance and creative thinking.
107 Effects of Restricted use of Modern Technology before Bed - Time on Psychological and Athletic Performance among University Athletes , N Aarthi* and Jeykar T Lazarus
Sleep plays a vital role in good health and well-being throughout our life. Getting enough sleep at the right times can help protect our mental health, quality of life and safety. In children and teens sleep also helps in growth and development. Getting enough quality sleep at right times help us function well throughout the day [1]. People who are sleep-deficient are less productive at work, colleges and especially in the sports they practice. After several nights of losing sleep our ability to function suffers [2].Lack of sleep may lead to micro sleep. Micro sleep refers to brief moments of sleep that occur when you are normally awake.
108 Integrative Maternity Health Care – The only logical way forward , Kathy Fray
In 2014-2015 I was the founding director of a global inaugural conference on Integrative Maternity Healthcare that was a groundbreaking and revolutionary symposium, held in Auckland New Zealand, which promoted a cross-discipline exchange of progressive research, innovative knowledge, enlightened experience and radical ideas; all in a medically professional and universally holistic environment of visionary open-mindedness.
109 Alternative Medicine: Doubtful Treatment or a Powerful Healing Force , Major Roger Haw Boon Hong
Alternative medicine is an approach to healing used in place of conventional medicine. Complementary medicine, on the other hand, is used together with conventional medicine. For example, if a special diet is used to treat cancer in place of surgery recommended by a conventional doctor, the diet would serve as an alternative therapy. However, if a special diet were used to combat high cholesterol levels in a patient with heart disease, in addition to coronary artery bypass surgery, the diet would serve as a complementary therapy. Since the same therapy can serve as either complementary or alternative, the various therapies outside the domain of conventional medicine are often grouped together under the term CAM (complementary and alternative medicine) therapies. The increasing interest in alternative medicine, which attempts to treat a patient‟s body, mind, and spirit, can be viewed as a measure of the spiritual hunger in our high-tech society. The desire within the medical community to integrate treatments for a patient’s spiritual needs as well as physical needs is validating the importance of pastoral care in the hospital setting. Perhaps an approach to healing that makes use of the strengths of both conventional medicine and alternative medicine would enable a person to experience the best of both medical worlds. The forms of alternative medicine with scientific backing could be used to maintain health and increase physical fitness, while conventional medicine could be used to accurately diagnose and eradicate disease. Certain cautions, however, should be observed.
110 Medical Cannabis for Autism Spectrum Disorder, is it an option? , Joseph Rosado MD, MBA
Objective: A literature review was conducted to evaluate the validity of medical cannabis as an adjunctive treatment in the management of individuals with Autism Spectrum Disorders. Background: Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Since there is no medical test to diagnose the disorders, the provider must listen to the parent/ caretaker and look at the child’s behavior and development to make a diagnosis. Unfortunately, many children do not receive a final diagnosis until much older. A deficiency in the endocannabinoid system in the body is considered as the reason for many disorders and recent researchers’ state that it might help in the treatment of autism. The chronic neuroinflammation can be eased with the help of the antioxidants which are present in the cannabis plant. The theory of Clinical Endocannabinoid Deficiency (CED) was based on the concept that many brain disorders are associated with neurotransmitter deficiencies, affecting acetylcholine in Alzheimer's disease, dopamine in Parkinsonian Syndromes, serotonin and norepinephrine in depression, and that a comparable deficiency in endocannabinoid levels might be manifest similarly in certain disorders that display predictable clinical features as sequelae of this deficiency. Design/Methods: A literature review was conducted of the National Center for Biotechnology Information, U.S. National Library of Medicine PubMed from 2012-2018 specific to the topic of medical cannabis and autism spectrum disorder. Conclusion: This literature review supports the feasibility of cannabis based medicine as a promising treatment option in children with ASD. Based on the promising results, it is recommended that large, double blind, placebo controlled cross-over trials be launched in jurisdictions where medical cannabis can be studied without limitations from the federal government.
111 Prevalence and Related Risk Factors of Low Back Pain among Nurses Working in Intensive Care Units , Manal E Fareed1 * and Hasnaa E Shabaan2
Studies have shown that low back pain is a common health problem among hospital nurses especially those working in Intensive Care Units. However, prevalence and the related risk factors in intensive care units needs to be widely investigated. The aims: of this study were to identify prevalence of low back pain and determine its related risk factors among nurses working in Intensive Care Units. Subjects: A purposive sample of all nurses who worked in intensive care units and meet the inclusion criteria. Setting: The study was conducted at four intensive care units of Menoufia University hospital. Tools of the study: Two tools were utilized for data collection as follow; Tool I: Interviewing questionnaire and Tool II: Observational checklist. Results: The prevalence of low back pain among studied nurses was 85%. The most important and preventable risk factors for low back pain among studied nurses were higher body mass index, more average working hours/day, not enough working space, lower compliance of nurses with proper body mechanics and range of motion exercises during work. Conclusion: prevalence of low back pain among nurses working in intensive care units was high. There were multi interrlatrelatede risk factors for low back pain among studied nurses: work, patients and personnel related factors. Recommendations: Periodic and continuous in-services training for nurses working in intensive care units on preventing and coping strategies for low back pain should be implemented.
112 Radiation Protection in Nuclear Medicine in Eastern Province, KSA , Akbar Algallaf
In nuclear medicine, radiopharmaceuticals are administered to the patient either for the production of diagnostic images or with the intention to treat using the emitted radiation from the radiopharmaceutical. The increased use of PET-imaging causes a need for new planning of radiation protection. In radionuclide therapy, the activities are higher and the radionuclides used are often different from those used in diagnostic nuclear medicine and constitute a greater radiation protection problem. In both diagnostic and therapeutic nuclear medicine, the patient becomes a source of radiation not only for him/herself but also for staff, caregivers and the general public. All categories of staff members involved in nuclear medicine must have good knowledge of radiation protection. This is vital for patient safety as well as for the staff's own security, for caregivers and the general public.
113 Forensic Endodontics , Aditi Jain* and Subhasree Chaudhuri
Each human tooth is distinct in itself, which makes dental identification in forensic odontology an integral part of forensic studies. Identification of charred bodies or persons burnt beyond recognition, is next to impossible and endodontics has a very important role to play here, as, in such cases, identification is done with the help of the distinctive nature of human teeth and the study of roots, root canal anatomy and biomaterials with the help of advances in endodontic imaging, researches and practice.
114 Investigation of Possible Immunomodulatory Effects of Resveratrol as an Add-on Therapy in a Murine Model of Ovalbumin-Induced Bronchial Asthma , Rania Hamed Shalaby *1, 2, Waleed Barakat Al Bahoty1 , Amany Abd El-Rahim Abdin1 and Mohamed Nabih Abd Al – Rahman1
Background: Bronchial asthma is a cause of significant morbidity and mortality with increasing prevalence worldwide. Although corticosteroids are routinely used in management of bronchial asthma either for long term therapy or control of acute attacks, but unfortunately they have limitations due to their diverse side effects. Resveratrol, a natural polyphenol, exhibits a wide range of biological and pharmacological activities, such as anticarcinogenesis, cardiovascular protection, and anti-inflammatory effects. Thus it is of much interest to investigate possible immunomodulatory effects of resveratrol in bronchial asthma representing a new mechanism that has not yet been fully elucidated. Methods: This experiment was performed on 50 albino mice divided in 5 equal groups. The normal control group (group I) received a veheicle of saline. The Ova-untreated group (group II); received ovalbumin (OVA) via two I.P. injections in days 0 and 14 in a dose of 100 µg and challenged with an intranasal (I.N.) dose of 50 µg OVA in days 14, 25, 26&27. The OVA- challenged group treated by Resveratrol (group III) in a dose of 30 mg/kg given by oral gavage 1 h. before challenge in days 14, 25, 26 & 27. The OVA- challenged group treated by Dexamethasone (group IV) in a dose of 2.5 mg/kg by intraperitoneal injection (I.P) 1 h. before challenge in days 14, 25, 26&27. OVA- challenged group treated by dexamethasone and resveratrol (group V) in the same dose regimen. At the end of experiment in the 28th day (24 hours after the last challenge in the 27thday), serum was analyzed for total IgE (TIgE) levels and bronchoalveolar lavage (BAL) was investigated for inflammatory cell count. The lung tissues were examined for histopathology score and immunohistochemistry for TLR2, CD4 and CD8. Results: The untreated group of asthma model showed a significant increase in serum level of TIgE, the number of total inflammatory cells, inflammatory score and the number of positive TLR2, CD4+ and CD8+ when compared to normal group. The treatment by both of resveratrol and dexamethasone was better than treatment with resveratrol alone as it showed significant decrease in the whole studied parameters. Conclusion:We demonstrated the immunomodulatory effect of resveratrol preclinical in bronchial asthma induced model via suppression of TLR2, CD4 and CD8 expression. We could suggest using resveratrol as add- on therapy with dexamethasone to achieve more efficacies in management of bronchial asthma. However, this should be verified in further clinical studies.
115 The Effect of Perioperative Warming Measures for Major Abdominal Surgery on Postoperative Hypothermia , Ahmed Farag El-Kased1 *, Amal El-Sayed Shehata2 , HananRamzy Atalla3 , Mohamed Sabry Amar4 and Shaimaa Adel Mohamed5
Aim of the study: was to determine the effect of perioperative warming measures for major abdominal surgery on postoperative hypothermia. Setting: The current study was conducted in operating room at Emergency Hospital of Menoufia University, Menoufia Governorate. Subjects: A purposive sample consists of 100 adult patients undergoing major abdominal surgery were randomly divided and assigned alternatively into two equal groups; 50 for each group. Tools: Three tools were used for data collection. Structured interview questionnaire: knowledge assessment sheet, perioperative assessment sheet, and shivering scale. Results: There was a highly significant difference between study and control groups regarding mean perioperative temperature at all times of interval of measurements p<0.001.Also there was a highly significant difference between study and control groups concerning postoperative shiveringP<0.001. Conclusions: Usage of perioperative warming measures for major abdominal surgery has a positive effect on the prevention of postoperative hypothermia and shivering. Recommendations: All staff of surgical nurses should be encouraged to be familial with perioperative warming measures and use these measures in order to maintain perioperative normothermia and prevent postoperative hypothermia.
116 Pure Red Cell Aplasia Secondary to Parvovirus B19 Infection in HIV Positive Patients. Clinical and Seroepidemiological Description and Observations in a Third Hospital Level in Colombia , Martínez Rosado LL
Objective: Describe the clinical and seroepidemiological characteristics and the impact on morbidity and mortality and health costs of patients infected with HIV and red cell aplasia and positive serology for Parvovirus B 19. Methodology: Descriptive and retrospective study, of the clinical and seroepidemiological characteristics of cases of aplasia of the red series without affecting hematimetric indices in HIV positive patients with positive serology to Parvovirus B19, were descripted in an hospitalization service in the period from April 2016 to April 2017. Serum samples from the 16 patients enrolled for the study were analyzed by IgG and IgM type antibodies using the enzyme immunoassay technique. Other causes of anemia, such as: iron-deficiency anemia, invasive fungal infection were ruled out. Results: A total of 16 cases were documented, 11 men (69%) and 5 women (31%) with an average age of 40.7 and 44.4 years respectively, 5 of the 16 patients (31.25%) had positive IgM levels (distributed among 3 men and 2 women) without IgG activity documented in the same sample and 4 of these 5 patients were without treatment for their HIV (80%), none of the patients received regular treatment for HIV. The average in grams per deciliter of hemoglobin and hematocrit at the time of sampling was 8.92 g / dl and 28.6 g / dl respectively, the average of CD4 cell count was 115 for the male population and 187.2 for the female population, the average viral load was 515,483 and 369,390 copies / ml for men and women respectively. No patient received adjuvant treatment directed at the pure red anemia demonstrated. Conclusion: Persistent parvovirus B19 infections in human immunodeficiency virus type 1 infected patients have been reported. The two viruses could share common target cells. The co-infection by Parvovirus B19 is associated with longer days of hospital stay, costs and complications such as nosocomial infections and need of poly transfusions.
117 Smart Skirting Board: Snoezelen System in Alzheimer , Joaquim Parra Marujo JP
Alzheimer’s disease is the most common cause of dementia in old people. We used the Smart Skirting Board® (SSB®) that integrates, among other things, a Snoezelen system, a laser system, music, video and aromas for multisensory and cognitive stimulation. The SSB® allows a non-pharmacological intervention, and the brain stimulation is achieved, improving the elderly person’s attention span, memory, mood, verbal skills and concentration and helping them to relax and offering an atmosphere of security and mental and physical relaxation. Based on a study that was conducted, the smart skirting board as a therapeutic tool, contributed significantly to the improvement of the quality of life of the elderly with psychomotor deficits and particularly those showing signs of Alzheimer's.
118 The Role of Genetics Mutation in Gene Tgm5 in Induce Acral Peeling Skin Syndrome , Shahin Asadi1 *, Hossein Amjadi2 and Mahsa Jamali2
APS syndrome is a skin-related genetic disorder characterized by painless skin lesions from the upper layer of the skin. In addition to the above, sometimes peeling of the skin in the arms and legs also occurs. Skin peeling usually appears at birth, but can begin in childhood or later in life. APS syndrome is caused by the mutation of the TGM5 gene, which is based on the long arm of chromosome 15 as 15q15.2.
119 Patient Dropout from Opioid Substitution Treatment , Akhtar S*, Sellman D and Adamson S
Opioid Substitution Treatment (OST) is an established treatment for opioid dependence. In New Zealand, OST programs are regulated by the Ministry of Health (2014) and Methadone and Buprenorphine/Naloxone (Suboxone) are the primary medications. Retention on OST is a key indicator for stabilisation of patients with opioid dependence. The purpose of the present research was to study dropout rates and identify factors associated with the dropout of patients from OST at the Community Alcohol and Drug Service (CADS), Hamilton, from 1st January 2013 to 30th April 2014. A retrospective clinical audit of patients on OST was conducted. There were 150 patients on OST in Hamilton under the CADS team during the period of study. Nine patients dropped out during the study period. Sixty-four patients were randomly selected from the remaining 141 patients who remained on treatment as a comparison group and for the study sample to be approximately half of the overall population of 150 patients. File review was conducted and potential predictors of dropout were identified. Thirty-five independent variables were selected and dropout was the dependent variable. The statistical programme SPSS22 was used to analyse the data. Fisher’s exact test was used and four variables were identified as being associated with dropout: history of intravenous drug use; (Fisher’s exact p = 0.05); history of lifetime imprisonment (Fisher’s exact p =0.05); other medications prescribed, (Fisher’s exact p = 0.04); and opioid type prescribed during the study, i.e. methadone or Suboxone. Patients on Suboxone dropped out more than those on methadone, (Fisher’s exact p = 0.00). The overall dropout rate was 6%, which was less than the rates of 15-85% found in previous studies. The limitations of the study were that it was retrospective and the number of dropouts was small. Furthermore, only patient factors associated with dropout were included in the study and service factors were not included.
120 China’s New Directives on Nutraceuticals and Hong Kong Experience , Ping-Chung LEUNG1,2
Nutraceuticals could be food or health supplements with vaguely described functional value. Inspite of the obvious uncertain health benefits, consumers maintain a blind trust. With the rising concern of healthy aging because of the explosion of the elderly population, health supplements have become ever popular. In Asia, Traditional Herbal Medicine is commonly used in nutraceuticals and China must be one of the greatest producers. Since 2015, the China FDA has issued a series of recommendations for the production of nutraceuticals which have been granted a new unique description of “Food Supplements with specific clinical use”, and instructions on their production and evaluation are subsequently given. Clinical trials with the evidence-based principles are definite requirements. Evidence-based production of nutraceuticals with specific clinical indications would follow the standard procedures of quality control; biological and pharmacological evaluation; followed by the provision of clinical evidences. Hong Kong has been following such directions of developing health supplements. Brief descriptions will be given followed with the example of a cardiovascular tonic. With such clear change of policy on the production of health supplements which is also in line with the recommendations of the European Union, one could expect a continuous supply of efficacious nutraceuticals which could be registered for marketing as proprietary drug or health supplements.
121 Compression Fracture Induce Severe Pain Treated by Caloripuncture: A Case Report , Hsin-Hua Li1 , Wei-Jen Chen1,2*
Fractures are common diseases that the continuity of the bone is broken. It could occur when the physical force exerted on the bone is stronger than the bone itself. There are many types of fractures, and vertebral compression fracture is one of the most common type which is generally occurs in the spongy bone in the spine and happens from a fall from a standing height or less, but without major trauma such as a motor vehicle accident [1]. Vertebral compression fractures usually occur in the mid-thoracic or thoracolumbar transition zone of the spine. Vertebral compression fracture is common in the elderly. But there is still no ideal treatment for this disease [2].
122 Myasthenia Cardiomyopathy Silent Myocarditis Unveiled by Cardiovascular Magnetic Resonance , Yasmin Hanfi1 , Dominique Auger1 , Dudley J Pennell*1 and FMedSci1,2
In myastheniagravis (MG) patients, heart muscle is one of the autoimmune targets. The presentation of cardiac involvement with MG varies and may include myocarditis. Beyond comprehensive left ventricular volume and ejection fraction quantification, cardiovascular magnetic resonance (CMR) provides incomparable non-invasive tissue characterisation. Hence, CMR in MG may allow early detection of subclinical myocarditis or evaluation of remote myocardial damage by late gadolinium enhancement technique.We present the first case of cardiac involvement of immune-mediated myocarditis imaged by CMR in MG.
123 Suicidal Ideation and Attempt among Alcohol use Disorder Patients Attending Addiction Clinic at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia , Mohammed Negussie1 *, Solomon Teferra2 and Charlotte Hanlon3
Background: Alcohol is one of commonly used psychoactive substances. Harmful use of alcohol results in a cluster of behavioral and physical symptoms known as Alcohol use disorder. WHO suggests that harmful use of alcohol to be an individual risk factor for suicidal behavior, accounting for 25-50% of all suicides linked to alcohol and other substance. Many studies were done on alcohol and suicidal ideation and attempt. Most of these studies suggest that alcohol have association with suicidal ideation and attempt. But there are studies with no association between alcohol use disorder and suicidal ideation and attempt. Objective: To assess the prevalence of suicidal ideation and attempt among alcohol use disorder patients attending addiction clinic at Amanuel Mental Specialized Hospital (AMSH). It also determines the association of alcohol use disorder and suicidal ideation and attempt. Method: This was a hospital based cross-sectional study, that include 120 patients of age above and equal 18 years. Data were collected by using ASSIST 3.1 (Alcohol, Smoking and Substance Involvement Screening Test), to assess alcohol use disorder, CSSRS (Colombia suicide severity rating scale) to assesssuicidal ideation and attempt, and PHQ-9 (patient health questioners-9) to assess the depression and severity of depressive symptoms. Chi square and binary logistic regression was used to assess factor relation. Result: The overall prevalence of suicide ideation and attempt among alcohol use disorder patients was 30.6% for the past month and 31.7% for past year of time of data collection. Suicide attempt was 14.9% and 13.3% respectively. Older age was associated significantly with suicidal ideation and attempt (X2 =6.128, P=0.047). Alcohol use disorder had no association with suicidal ideation and attempt for both past month (OR = 0.827; 95% CI 0.116, 5.914) (P = 0.850) and the past year (OR=1.360; 95% CI 0.122,15.165) (P=0.803) of data collection. Major depressive disorder was significantly associated with alcohol use disorder (P=0.047). Conclusion: Suicide ideation and attempt was significantly associated with advancement of age among alcohol use disorder patients. Alcohol use disorder has no association with suicide ideation and attempt among the respondents. Alcohol use disorder and major depressive disorder was significantly associated with and could lead to suicidal ideation and attempt indirectly. Recommendation: Further researches on alcohol use disorder, depression and suicide are necessary to assess the relationship each character.
124 Psychiatric Patients Boarding at the Emergency Department: Length of Stay and Consequences , Huma Iram
Objectives: In this research audit we look at the length of stay for psychiatric patents boarding at the emergency room at Hamad General Hospital which is the largest government hospital in the state of Qatar. We also looked at other parameters like, the number of psychiatric patients who leave the ER against medical advice of their own will, whether they return afterwards within a week or not, and also, how many of the boarding patents were treated and discharged without being transferred to the psychiatry hospital. Significant Findings: It was found that out of the 357 boarding patents, only 95 (26.6%) spent less than 12 hours in the ED, and a cumulative of 115 patents spent more than 24 hours in the ED. What was also found was that from the 65 patents discharged y the psychiatry liaison team only 3 returned to the ED within 1 week. Principal Recommendations: To find a safer alternative to patients boarding in the emergency room, in the form of increased in patent beds in Psychiatry, increased flow to community services in additon to adequuate staffing and ER resources including staff and doctors to care for the boarding patents. Conclusion: After reviewing the national mental health strategy, as mentioned in the introduction as well, it is deemed that a need of 319 psychiatric beds is present in the state of Qatar currently. The mental health strategy also highlights plans for expansion of psychiatric services in all the various disciplines like community and home care as well, in order to reduce the number of patents boarding in the ER which goes in line with the recommendations that are produced through this audit.
125 Mindfulness and Ubuntu: Foundations for Inner Health , Heather Greaves
Presented here are thoughts of inner health, mindfulness, and Ubuntu. Inner health for this purpose is a state of well-being and abiding peace; and not the absence of mental health diagnosis. Mindfulness as a concept is ubiquitous, and ever increasing numbers of children, youth and adults practice this ancient tradition. Ubuntu is a cooperative way of living, anchored in the understanding of the interconnectedness of humans and nature. The African philosophy, Ubuntu, recognizes that each person has unique gifts; the person embedded in community enriches herself and community.
126 Neuroprosthetic Devices: i-HAND , Mustafo Mingbaev
Millions of people are paralyzed or have suffered an amputation. Although these people can still see the object they may want to reach, for example a glass of wine, and can still process in their brains the specific commands to pursue this goal, the action cannot be completed due to, for example, a spinal cord injury or due to the fact that the arm has been amputated. Given that in most cases the brain of these persons is intact, the possibility of reading brain signals would allow the development of Neuroprosthetic devices, such as a robot arm that is driven by neural activity. These technological and scientific advances connect the amputee more intimately with their prosthetic limb, meaning we can now focus more on how the prosthesis is embodied. In other words, to what extent does the prosthetic limb feel like part of the biological body? Does your brain treat it as such? We have a good understanding of how our body is mapped in our brain. Both our motor cortex – the movement control centre, if you like – and the somatosensory cortex where we process a wide range of touch sensations are organisedsomatotopically. This means each area of our body corresponds to a specific area of the primary motor and sensory cortices. Importantly, this mapping does not disappear after the loss of a limb. This means we have an opportunity to connect prostheses, through muscles and peripheral nerves, to the parts of the brain that would have controlled and sensed the biological body part. But it may also allow us to measure embodiment, how successfully the brain accepts the prosthesis as part of the body. Ultimately this line of research, bringing together cognitive neuroscience and biomedical engineering, is not only important for designing better prostheses. It is a unique window for understanding how our brain creates and maintains the image of our bodies – mechanisms that apply equally to amputees and non-amputees.
127 The Role of “Doctor-Industry Dyad” in Decreasing Health Care Expenditures , Asma BAAZAOUI*1 , Abdelfatteh TRIKI2
This paper presents an assessment of the doctor-industry relationship effect on generic drug prescription, and attempts to help policy makers and generic producers to establish more efficient programs when promoting generic drugs as a cost saving measure in healthcare provision. We followed a qualitative approach, using methodological and information sources triangulation in order to explore the current situation. The research findings end up with a clear framework to evaluate the impact of such relationship on improving the management and control of healthcare costs.
128 Detection of Melanoma Skin Cancer with Deep Neural Networks , Grism Patel, Pooja Ranawade and Yuling Yan*
Detection of skin cancer involves several steps of examinations first being visual diagnosis that is followed by dermoscopic analysis, a biopsy, and histopathological examination. The classification of skin lesions in the first step is critical and challenging as classes vary by minute appearance in skin lesions. Deep convolutional neural networks (CNNs) have great potential in multicategory image-based classification by considering coarse-to-fine image features. This study aims to demonstrate how to classify skin lesions, in particular, melanoma, using CNN trained on data sets with disease labels. We developed and trained our own CNN model using a subset of the images from International Skin Imaging Collaboration (ISIC) Dermoscopic Archive. To test the performance of the proposed model, we used a different subset of images from the same archive as the test set. Our model is trained to classify images into two categories: malignant melanoma and nevus and is shown to achieve excellent classification results with high test accuracy (91.16%) and high performance as measured by various metrics. Our study demonstrated the potential of using deep neural networks to assist early detection of melanoma and thereby improve the patient survival rate from this aggressive skin cancer
129 An Unusual Case: The Importance of Wrist Arthritis in Post-Polio Sequelae , Mahmut Altuntas
Joint pain and accompanyings welling is the most common complaint in clinical practice. In this cases, the important thing is to determine the underlyingetiology and to give appropriatet reatment. The most common cause of most joint disease observed in the form of acutemono arthritis is gout and calcium pyrophosphate crystal storage disease. The prevalence of gout disease peaks among the ages of 40 to 50. The causes of increased prevalenceare advanced age, the use of diuretics for obesity and hypertension, trauma and excessive alcohol consumption.1Gout is 5 times more common in males. The gout attack occurs most often in the first metatarso falangialsingle joint in the ankle.
130 The Results of the Examination of Patients with eczema in Greece , Salavoura Katerina*, Laliotou Nikoleta and Xatzis Dimitrios
Atopic dermatitis or atopic eczema is the most frequent skin disease of childhood. It is characterized by a chronic recurrent inflammation of the skin accompanied by disturbing itching. The etiology is complex including the genetic defects of the epidermic barrier and of the innate immunity as well as environmental factors. Diagnosis is based on clinical criteria and laboratory investigation is supportive of the atopic predisposition being not always relative to the disease severity and natural history. Eczema is usually the first manifestation of the atopic symptoms starting the so called ‘atopic march’, being followed by allergic rhinitis and asthma.
131 Mucuna Flagellipes Chronic Diet Consumption Improves Exploratory Behaviour and Body Weight in Mice , Aduema W1 *, Akunneh-Wariso, C2 and Vidona WB3
The use of Mucunaflagellipes in recent time has been on the increase as a result of its speculated therapeutic effect mostly on the protein level of the body. And owing to the fact that there are no detailed reports on Mucunaflagellipes on its effect on neurobehavioral parameters, this work is therefore intended to investigate the possible effects of this herb on the exploratory behavior and body weight in Swiss white mice. Twenty (20) mice of mixed sex were randomly divided in to two groups of ten mice each. Group 1 served as the control, while group 2 received the Mucunaflagellipes diet. The feeding lasted for 31 days. The open field maze task was used to assess exploratory behavior. All mice were allowed free access to clean drinking water. Daily food intake, water intake and body weight change were measured. Data were analyzed using the statistical tools (one way ANOVA and student t-test).The results showed that the Mucunaflagellipes diet fed mice had significantly increased (p<0.01; p<0.05) line crossings, close arm duration and stretch attend posture (SAP) compared to control. There was an increase in food intake and water intake (p<0.001 and p<0.01) compared to control. However, the body weight change was statistically higher but not significant when compared to the control group. Therefore, consumption of Mucunaflagellipes improves exploratory behavior and body weight in mice. These may be has a result of an unknown phytochemical compound present in Mucunaflagellipes.
132 A Guide to Selecting a Measurement Tool for Quality of Life Assessment , Veronica McInerney1,5*, Eileen Mannion2 , Anusha Moses1 , Kate Molony3 and Dympna Waldron2, 4
Modern approaches to patient treatment and personalized medicine increasingly recognize the importance of the patient’s quality of life outcome. The art of assessing and using quality of life information in routine practice remains a challenge and poses a stumbling block for clinicians. This critical review of the literature identifies useful measures to minimize those challenges and guide nurses and researchers in selecting the correct tool for measuring quality of life in their clinical setting.
133 Childhood Obesity: Risk Factors and Preventive Measures , Shubhangi Gaikwad
The obesity epidemic has grown worldwide in both the developed and developing countries. We are the “present” of the era with ever increasing growth of obesity; the coming generation is our “future”. Future of obesity largely depends on how we are handling it in present. Overweight and obesity prevailing in children has multiple causes from genetic factor, hormonal imbalance to environmental factors, lifestyle preferences and cultural practice. Keeping apart the hormonal, genetic and any physiological causes of obesity which are not in direct control, the remaining factors such as lifestyle, environment and cultural background which can be modulate to help eliminating percentage of existing and future obesity. Evidences have suggested that the major cause of obesity is imbalance between food habits and physical activity. Additional factors as per the recent researches show that excessive use of smart phones has increased the overweight issues and also increases the anxiety among the user. Childhood obesity has maximum chances to develop into adulthood obesity. Therefore, to eradicate the future obesity, there is need to increase the awareness of do's & don'ts to prevent obesity and also the educate common people to know about the pros & cons of obesity. This paper is inclined towards the various risk factors of childhood obesity, and also pointing some preventive and educational measure to avoid obesity in the future.
134 Chronic Hydrocephalus of Adults: Prospective Study Regarding 50 cases from January 2011 to January 2018 in the Department of Neurosurgery CHU Mustapha Algiers , Bekralas H1 , Bouallag M1 , Chitti M1 , Habchi N1,2, Boulaouad W1 and Djaafer M1 *
From January 2011 to January 2018, 50 adult patients (average age of 68,5 year) with chronic hydrocephalus were followed in the department of neurosurgery of Mustapha PACHA’s hospital. Our long-term follow-up revealed that male’s gender predominated and the clinic were dominated by gait disorders more mental disorders and urinary incontinence.The management of adult’s chronic hydrocephalus is mainly based on early diagnosis, ventricular- peritoneal shunt (VPS) and the clinical and radiological following.
135 Spinal Cord Compression Secondary to Extramedullary Hematopoiese in a Patient with a Beta-Thalassemia , Bekralas H1 *, Bouallag M1 , Khalfi Kh1 , Habchi N1,2, Chitti M1 , Boulaouad W1 and Djaafer M1 *
Extramedullary hematopoiesis (EMH) is a rare cause of spinal cord compression (SCC). EMH represents the growth of blood cells outside of the bone marrow and occurs in a variety of hematologic illnesses, including various types of anemia and myeloproliferative disorders. Although EMH usually occurs in the liver, spleen, and lymph nodes, it may also occur within the spinal canal. When this occurs, the mass effect can compress the spinal cord, potentially leading to the development of neurological deficits. We present a case of SCC secondary to EMH. Our patient is a 26-year-old male with beta-thalassemia who presented with both upper thoracic and lower extremity symptoms of spinal cord compression. This report illustrates the importance of considering EMH in the differential diagnosis of SCC, even in the absence of signs of its most common etiologies.
136 Cystic Meningiomas: Report of Four Cases , Bouallag M1 *, Bekralas H1 ,Chitti M1 , Habchi N1,2, Boulaouad W1 and Djaafer M1 *
Although intra cranial meningiomas are usually solid tumors, some are associated with confusing cysts. So, computed tomography scan and conventional magnetic resonance imaging may not easily differentiate these lesions from other tumors frequently associated with cystic or necrotic component as gliomas or metastasis. We report four cases of cystic meningioma in which the diagnosis was not suspected preoperatively because of short clinical history and rapid neurological deterioration. However, a cystic component on imaging studies confused the diagnosis of meningioma with other cyst lesions. Although some authors report that hemorrhage is rare in meningioma, one of our cases was associated with hemorrhage and was histologically grade I meningioma. Total removal of cystic meningioma was our goal and histopathological examination was important to establish the diagnosis after surgery.
137 Smart Health Management with Ancient Wisdom , Chye-Tee GOH
Health management is an important global issue in the light of aging population and prevailing chronic illnesses. Other than trauma and accidents, many illnesses typically evolve over a long period of time from healthy to sub-optima health and eventually seriously ill state. Many of these cases slowly becoming chronic and have to rely on conventional medicines to control symptoms over along period of time. Others developed into acute and critical cases requiring costly and severe measures such as surgeries, radio and chemo therapies thus subjecting patients to increasing risk of side effects and longer period of rehabilitation.
138 A Review on the Antimicrobial Activity of Propolis and its Synergy with Other Antimicrobial Compounds , Ruth Smith
The alarming increase in the development of drug resistant microbes and the decrease in the efficacy of numerous antibiotics have led to the rise in patient mortality and morbidity affecting various fields of medicine. To combat this development and or the improvement of drugs are paramount. Natural products have long been utilized in the treatment of diseases showing broad spectrum of activity against a wide range of pathogens. In this study, the potential application of propolis to combat drug resistant microbes is reviewed, highlighting the presence and diversity of bioactive compounds with focus on its antimicrobial activity against a number of drug resistant microbes and its synergistic properties with other antimicrobial compounds. It is hoped that this study would enable researchers to continue to analyse propolis compounds and its interactions with other antimicrobial compounds which ultimately paves the way for new drug development.
139 Early Intervention Proposal Assisting Special Needs Children and Empowering Families , Ashraf Abd El- Ghafar Saad
Statistics: A survey carried out by the World Bank in Egypt, Jordan and Yemen estimated that between 5% and 10% of children under age 18 have at least one type of disability; many of these children face health, educational, social and psychological problems [World Bank, 2004]. A community-based study carried out in Jeddah, Saudi Arabia, found that speech, motor or mental disabilities were most common.
140 Etiological Hypotheses and Facts of Acute Pneumonia , Klepikov Igor
Modern AP concepts are focused exclusively on the infectious nature of the disease and the presence of certain pathogens. This belief determines the principles of treatment, the lack of effectiveness of which remains a concern of health professionals. The article presents a fragment of the study devoted to the etiology of АP. 994 children aged 4 months to 14 years with various forms of so-called community-acquired pneumonia were examined and treated. Bacteriological examination of the material from the inflammation zone was carried out in 542 patients. Experiments on modeling АP and its pleural complications were performed on 44 animals. The obtained results and critical analysis of the literature data and scientific facts allow us to consider bacteria only as one of the etiological elements of АP, which is not mandatory in all cases of the disease. Scientifically based revision of existing ideas about the causes and mechanisms of AP development leads to the need for a radical change in the principles of treatment and is a strategic direction in solving the problem.
141 Pathomorphology of Myocardium in the Neuroleptic Cardiomyopathy: Impact of Age Factor , Volkov V P
By a morphometric method of research and calculation of Cohen’s coefficient the force of impact of an age factor on pathomorphological changes of heart at the tissue and cellular levels of his organization at development of a neuroleptic cardiomyopathy was determined. It is established that at patients of different age crucial importance plays not an age factor, but side cardiotoxic effect of antipsychotics leading finally to development of the neuroleptic cardiomyopathy.
142 Educational Actions for a Developing Learning in Student’s Medicine , José Ramón Valdés Utrera1 , Jesús Cuéllar Álvarez2 *, Annia Vizcaíno Escobar3 and Melva García Martínez4
Background: the purpose of this paper is to present some educational actions aimed at the effective achievement of a communicative style by teachers in the local Cuban context. Objective: proposing educational actions for a developing learning in student’s medicine. Methods: a cross-sectional descriptive study, carried out in the period between October 2018 and March 2019, with student’s medicine in the town of Santa Clara, Cuba. Theoretical methods are used systemic, historical-logical and analytical-synthetic; as well as empirical ones: documentary analysis, questionnaire to students, interview to experts; and the descriptive method. Results: it was found that in the teaching-learning process from the student’s medicine, features of the rote teaching are used and have difficulties in the communication. Conclusions: the existing needs in the students stimulated the authors to propose educational actions to achieve a communicative and motivating developer learning in adolescent students.
143 Acupuncture Treats and Preserves Mental and Emotional Health , Susie Hayes
Both energetic medicine (acupuncture) and allopathic medicine recognize more and more the effect of the mental and emotions in physiology. We live in times full of fear, worry, stress, depression, anxiety and exhaustion. Often these emotions contribute to or even cause the patient’s illness. Moreover, the pervasive use of moodstabilizing drugs further complicates diagnosis and treatment. Energetic medicine inherently explains the impact of emotional imbalance on overall health. Now more than ever, it is imperative to understand how to include the emotions in the diagnosis and to incorporate the mental in the treatment for all patients.
144 Acupuncture Treatment for Headaches and Pain , Rabit Sadiku
Acupuncture is a medical science that deals the study and recording the information to the organism in the specific points. The Acupuncture Points help us also in the treatments and diagnostic. The number of the Acupuncture points in our body is 361 points. Only ear-auriculo has more than 200 points. Stimulation of these points helps to relieve the pain. Treatments are so effective and all natural. Migraine is the disease with psycho motoric origin.
145 Shift Work Disorder - Prevalence & Burden of Illness in Healthcare Providers of India , Dharmik Vora*, Sanjay Mehta and Shashank Patil
Background: The proportion of shift workers in the society has taken a big leap in the last 2 decades or so. Thus, the epidemiological significance of shift work disorder (SWD) can no longer be ignored. Emergency Physicians & nurses almost always work in shifts and are an important subset of the population whose health and wellbeing directly and indirectly impacts the morbidity and mortality of the rest of the population. It is thus important to understand the magnitude of the problem in this population. Several studies describe a high incidence of SWD and psychosomatic complaints in EP. The main objective of this study is to examine the prevalence of symptoms of SWD; contribution of demographics, working hours, shift work, morningness/eveningness & sleep hygiene practices to occurrence of SWD, related health & occupational hazards and job satisfaction in a random sample of Emergency Physicians & nurses of India. Methods: A cross sectional survey of nurses and doctors working in emergency departments of at least 12 major urban hospitals across India was conducted during October 2016 – March 2017. Peer validated questionnaire with standard scales, descriptive & objective questions was emailed only to individuals who were known to be working in Emergency departments as nurses and doctors. This convenience-sample of email addresses was obtained through personal and professional contacts of the researcher. Those who volunteered responses were included in the study. No identifying information was collected. Those who reported diagnosed sleeping disorders were excluded from the analysis. For analysis, responses were divided into 2 groups – those who reported symptoms of SWD and those who did not. With aid of a professional biostatistician, these 2 groups were then compared for unique characteristics and statistically significant variables using t test, chi square test, odds ratio and logistic regression Results: Prevalence of symptoms indicative of SWD in a random sample of emergency medicine physicians and nurses in India ranges from 13-27% and was significantly (p=0.048) higher in those who did shift work and night shift work depending on the method of assessment. Women have 3 times higher risk than men. More than half (51%) the number of Emergency medicine physicians and nurses in the study suffer sleep disturbances due to work timings. This group may develop SWD in the future, pending due intervention. SWD is strongly (p<0.02) associated with bad sleep hygiene and excessive daytime sleepiness. The presence of symptoms of SWD also leads to poor job satisfaction. (p<0.05). Majority (60%) report preference for shifts that start later in the day
146 Modern View on the Mechanism of "Thought" Formation and Its Implementation "Program" At the Supramolecular Level , Bitsoev Vladimir Dodtievich
The paper considers one of the most important problems of modern medicine: corrective and guiding function of cardiovascular system in all manifestations of vital activity of an organism at the supramolecular level. A "thought" and its implementation "program" simultaneously appear in the left ventricle of the heart. In author's opinion, when a child is born, a place in the information bank of the biosphere is allocated for the constant receipt and storage of data on his or her vital activities, until the death. The author managed to discover a mechanism of information feed forward and feedback between an organism and the biosphere.
147 Saponins and Flavonoids from Ludwigia leptocarpa (Nutt) Hara (Onagraceae): Isolation, Characterization, Antibacterial and Antioxidant Activities , Florence Déclaire Mabou1 ,*, Jean-de-Dieu Tamokou2 , David Ngnokam1 , Dominique Harakat3 and Laurence VoutquenneNazabadioko4
Diarrhea continues to be one of the most common causes of morbidity and mortality among infants and children in developing countries. The most common microorganisms responsible for diarrhoeal diseases are Vibrio cholerae, Escherichia coli and Shigella spp. The present study aims to evaluate the antibacterial and antioxidant activities of extracts and compounds from Ludwigia leptocarpa, a plant traditionally used for its vermifugal, anti-dysenteric and antimicrobial properties. The MeOH extract was prepared by maceration from dried whole plant and successively extracted with ethyl acetate and n-butanol to obtain EtOAc and n-BuOH extracts respectively. The column chromatography of the EtOAc and n-BuOH extracts followed by purification of different fractions led to the isolation of six known compounds. Structures of isolated compounds were assigned on the basis of spectra analysis, and by comparison with those from the literature. The antioxidant activity was evaluated by the 1,1-diphenyl-2-picrylhydrazyl (DPPH) and trolox equivalent antioxidant capacity (TEAC) assays. The antibacterial activity was assessed by performing minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) against the strains of Gram-positive bacterium, Staphylococcus aureus (a major cause of community and hospital-associated infection), and Gram-negative multi-drug resistant bacteria, Vibrio cholerae (causative agent of cholera) and Shigella flexneri (causative agent of shigellosis). All of the extracts showed different degrees of antioxidant and antibacterial activities. Compounds 2, 3 and 6 displayed the largest antibacterial and antioxidant properties which were in some cases equal or higher than those of reference drugs. The overall results of the present study shows that L. leptocarpa has potentials as a source of natural anti-diarrhoeal and anti-free radical products, given further investigations.
148 Weight Evaluation and Serum Indices Effect of Potash Administration on the Uterus of Pregnant Wistar Rat , Vidona WB1 * and Aduema W2
Potash known as potassium carbonate (K2 CO3 ) is a mixture of salt with other components including impurities which coexist in mineral and salt is highly consumed in various forms by pregnant women. The aim of this research is to evaluate the weight and serum indices of potash on the uterus of pregnant wistar rat with the specific objectives of determining the effect of potash on the progesterone and estrogen level and weight index of pregnant wistar rat. A total of Twenty-five albino Wistar rat with weights ranging from (180-300g) were used and allocated into five groups of five animals each (4 females and a male) designated as groups 1, 2, 3, 4, and 5. The experimental groups 2, 3, 4, and 5 were administered different doses of potash. The animals were allowed for a period of one week for acclimatization under normal temperature (270C -300C) which they were being feed with normal feed (grower’s mash) and water ad libitum for one (1) week. Administration of potash were through the oral route. Group 1 served as the control group and was administered distilled water only. Group 2 received 300mg/kg of potash plus feed and water was given ad libitum for 7 days after detection of pregnancy. Group 3 received 600mg/kg of potash plus feed and water was given ad libitum. Group 4 received 900mg/kg of potash plus feed and water was given ad libitum. Group 5 received 1200mg/kg of potash plus feed and water was given ad libitum. After analysis from histological procedures, the progesterone and estrogen level of pregnant wistar rat were evaluated and observed that treatment with potash induced changes. However, the level of progesterone activities increased in the test groups (2, 3, and 5) when compared to the control group. As for estrogen level, the increased level was observed to be progressive in the test groups, with the highest seen with the 1200mg/kg group as well as the physical activity of the wistar rats. At the end of the study, the results showed that Potash alters progesterone and estrogen level as well as the physical activity of the wistar rats.
149 Ayurveda and Veganism (Some of the Most Significant Cases of Healing Among My Patients) , Isabel Arizmendi
Creating My Protocol After developing a personal protocol that combines, in addition to herbal and Ayurveda remedies,a vegan diet based on the predominant Dosha and blood type, may I present some of my most significant cases of healing among my patients:
150 Emotional Well Being with Daoism and Chinese Medicine , Kim McLaren
What has become apparent in clinical practice is the amount of people who are struggling with emotional pain and lack of direction, contentment or purpose in their life. Taoism, Buddhism which was part of Chinese Medicine history have developed tools, concepts and beliefs in the understanding of self and emotional well-being, which can give people a more compassionate view with the complexities of life for themselves and others. What is alarming is the amount of people on medication for depression and anxiety, which has increased considerably over the last few years. Cognitive Behavioural Therapy (CBT), self- help books and mindful meditation incorporate principles of Daoism and Buddhism in there techniques and theories.
151 Intranuclear Inclusions in Cerebellar Golgi Cells of Patients with Cerebellar Tumors , Orlando J Castejón
Fibrillar Intranuclear inclusions are described in cerebellar Golgi cells of three patients with cerebellar tumors. Cortical biopsies taken during neurosurgical treatment were immediately processed for transmission electron microscopy. The intranuclear inclusion appears as a straight rodlet up to 3 um in length and from 0.4 um in width, immersed in the nucleoplasm and without topographic relationship with the nucleolus. This rodletshows a periodic or crystalloid structure formed by dense bands 9.2 nm thick, separated by clear spaces of 5.4 nm in width (Fig. 2), and in some regions displays a lattice or crystalloid appearance produced by oblique superposition of the dense bands. The findings are discussed in relationship with intranuclear inclusion found in viral and central neurodegeneraive diseases.
152 Impact of Dietary Protein intake, Lean Body Mass percentage, Body Mass Index, Physical activity on Urinary Creatine and Urinary Creatinine excretion in a TeamSport , Nabeela Mansuri1 * and Ramlal Moorjani2
Background: Creatine and Creatinine plays a role in muscle function. Urinary creatine and urinary creatinine concentration was measured in order to see significance in monitoring athlete and athlete’s performance. Objective: Evaluate association of dietary protein intake, Lean Body Mass (LBM) percentage, Body Mass Index (BMI) and physical activity on urinary creatine, urinary creatinine concentration in different team sports [cricket players (C), basketball players (B) and football players (F)]. Methodology: A total of 62 players from different team sports - C (n-20), B (n-17) and F (n-25) age of 18-30 years participated. Post training urine samples was analyzed. Using Jaffe's reaction, urinary creatinine was obtained and Urinary creatine is obtained by difference in the creatinine present before and after heating with acid solution. 24 hour dietary recall was taken to find athletes protein intake. LBM were taken using Body Impedence Analysis (BIA machine). Data were analysed using SPSS (Statistical Package for Social Sciences Version 16.0). Findings: Pearson bivariate correlation (2-tailed) was used to find the relationship between BMI, LBM, total dietary protein intake per day, dietary protein, duration of practice with urine creatinine and creatine level. Positive correlation between urinary creatine and total dietary protein intake per day, dietary protein according to body weight per day was found (p<0.001), (p<0.005) respectively. Negative correlation between urinary creatinine and dietary protein according to body weight per day and duration of practice per day was found (p<0.001), (p<0.005) respectively. Urinary creatine mean (SD) values- C group 78.63 ± 27.17, B group 102.65 ± 38 and F group 169.60±41.58. Urinary creatinine mean (SD) values- C group 46.60 ± 37.23,B group 84.88 ± 48.27 and F group 70.40±44.083. Conclusion & Significance: Significant increase was seen in urinary creatine excretion with respect to dietary protein per day, dietary protein according to body weight per day. Urinary creatine excretion is more in football players followed by basketball players. Significant decline was seen in urinary creatinine excretion with respect to increase dietary protein according to body weight per day and increase duration of practice. Urinary Creatine excretion is more in basketball players followed by football players Urinary creatine and urinary creatinine excretion depends on sports-type, duration of sports and protein consumption.
153 Elderly Food and Nutrition , Gaurav Popli
Ageing (and related diseases) may be described as a process which results from impaired immunological, genetic, neurological or endocrinological functions. Oxidative mechanisms may play an important role in the ageing process. It is important, therefore, to emphasize the relationship between health and nutrition in the elderly [1].
154 Nurse in the Process of Preventing Domestic Violence , Tomasz Iwanski
The problem of domestic violence occurs in all societies and cultures. For many years it’s been regarded as an important social issue especially in Western Europe. At that time, international organizations created plenty of documents advising the member States of the European Union, to take changes in law and practice in order to raise the effectiveness of combat with domestic violence and to provide victims of violence with assistance and effective interaction for domestic violence perpetrators. Up to this day in Poland, domestic violence was not seen as a purely pathological phenomenon. Initially, the problem was marginalized and silenced, because families with a domestic violence problem carefully hid these facts, especially in contact with health care system. Therefore, it was necessary to determine the role of nurses as people of first contact with the patient, which in the event of diagnosis of symptoms which indicate violence can take an appropriate diagnose and therapeutic measures which would lead to the prevention of domestic Violence. The main objective was to determine the level of knowledge of professionally active nurses and students of nursing connected with the problem of domestic Violence (279 active nurses and 281 students of nursing). The author used a questionnaire. Conclusion & Significance: both groups of respondents did not recognize the long-term effects of domestic Violence, they well recognize factors influencing the Violence development. Respondents experienced Violence in their families, and problem of Violence is often found in work of nurses and students’ private environment. Both groups rated their knowledge at the secondary level. Nurses and students perceive a nurse as a person who can prevent domestic violence and have their place in an interdisciplinary team.
155 Study Educational for the Prevention of Suicidal Methods in Adolescents , Jesús Cuéllar Álvarez1 *, José Ramón Valdés Utrera2 , Liset Perdomo Blanco3 , Vivian Margarita Guerra Morales4 and Dunia Mercedes Ferrer Lozano5
Background: The adolescent suicidal intent in the county of Villa Clara and their incidence in the municipality of Santa demand of assuming a detailed analysis to prevent suicide. Objective: To prevent the suicidal methods educationally in adolescents. Methods: A study of traverse descriptive type was used. The study population conformed to for 20 adolescents. The main variables were: age, sex, used methods, family operation and educational method that it was obtained starting from an applied survey and the contained data in the clinical histories of the patients. Results: It was corroborated that the suicidal intents in the adolescence were associated with soft and hard methods where they were the ingestion of medications and the hanging. Conclusions: In educational methods with adolescents, a dysfunction with a high total prevalence of 52,7 % prevailed with the use of soft methods from pills and the use of hard methods such as hanging
156 Radiofrequency in Musculoskeletal Pain , Soheil Mansour Sohani
Radiofrequency energy is acclaimed by thousands of patients and high level sports people for its therapeutic benefits. Its energy is a high frequency current, ranging between 300 KHz and 1 MHz it accelerates “natural regeneration” in the biological tissue. The low level of energy means it is totally non-invasive and 100% natural for the human body.Studies over more than thirty years have shown that the therapeutic effects stimulate natural tissue reconstruction and pain relief.In the 300 KHz – 1 MHz frequency range, the C Gabriel Research team highlights the Permeability of cellular membranes by analyzing several types of biological tissue for their Study “The dielectric properties of Biological tissues”.
157 To be in Good Health , Samlee Plianbangchang
All people, rich and poor, would like to be in good health, not being ill or getting sick, movable to where they like to go, and able to work as desired. When people were not sick or ill, and they seem to be in good health, they should also have satisfaction with the quality of their life at a certain level.
158 Regional Anesthesia and the Adolescent Opioid Epidemic , Halpern LM1 *, Kogan CJ2 and Michels PE3
Rationale: The legitimate use of prescription opioids in high school seniors increases the risk of future misuse after high school by 33%. Medial patellofemoral ligament reconstruction (MPFLR) is an operation to correct recurrent patellar instability occurring primarily in teenagers with joint hyperlaxity. MPFLR is associated with the extensive use of prescription opioids for significant postoperative pain and prolonged recovery. The hypothesis of this study is that the addition of a single injection proximal sciatic nerve block would significantly reduce opioid requirements and pain scores in adolescents undergoing MPFLR with an adductor canal continuous peripheral nerve block (CPNB). Objectives: The primary end-point of the study is cumulative post-operative opioid consumption (mg/kg morphine equivalents) while hospitalized after MPFLR between the two groups. Findings: We retrospectively compared 25 patients who received an adductor canal CPNB with a single injection proximal sciatic nerve block (Group A/S) and 23 patients who received only an adductor canal CPNB (Group A). Morphine consumption was less than half in group A/S compared to Group A. Eighty-eight percent of patients in Group A/S did not require opioids on the DOS. Maximum and mean pain scores on DOS and POD 1 were significantly lower in Group A/S than Group A. Conclusions: This study suggests the addition of a proximal sciatic nerve block to the adductor canal CPNB significantly reduces opioid requirements and pain scores in the first 24-32 hours after MPFLR in adolescent patients and supports a randomized clinical trial to confirm these findings.
159 The Role of Cardiomyocyte Apoptosis in the Pathogenesis of Neuroleptic Cardiomyopathy , Volkov V P
In the presented mini-review of the literature the role of cardiomyocyte apoptosis in the pathogenesis of neuroleptic cardiomyopathy is considered. Despite the insufficient development of the issue and the scarcity of literature data, various ways of negative influence on the heart of the side effect of cardiotoxic antipsychotic drugs leading to a decrease in myocardial mass due to the death of cardiomyocytes by apoptosis are convincingly shown, which initiates the process of heart remodeling with the subsequent development of myocardial dysfunction and progression of heart failure.
160 Bartonellosis a Rare Cause of a Splenic Cyst , Mohanned Omer Abass¹, Nassir Alhaboob², SiddigFadul Mohamed³, AM El Hassan4 and Elwalid Mohamed Elamin5,6
Background: Bartonellosis comprises infections caused by the emerging pathogens in the genus Bartonella. B henselae is the cause of cat scratch disease. Most of the cases present with the typical self-limited regional lymphadenitis. Isolated splenic involvement is very rare. Here we present a case of splenic cyst which was found to be due to Bartonella Henselae. The case: A 30 years old, previously healthy female presented with non-specific poorly localized abdominal pain for 2 months. Her condition was not associated with any gastrointestinal symptoms or fever. She had close contact with pets (dogs and cats). Physical examination was only positive for a palpable spleen of about 6 cm below the costal margin. Abdominal U/S and CT showed a loculated splenic cyst in the lower pole with wall calcification. Blood tests were unremarkable. A provisional diagnosis of Hydatid cyst was made and the patient received albendazole tabs and planned for splenectomy. Splenectomy was done and histopathological examination of the spleen revealed collection of black small filaments that stain positive for Bartonella Henselae, associated with marked vascularity. Patient run an uneventful postoperative course and was prescribed oral erythromycin for 3 weeks. Conclusion: Bartonellosis is rare in immunocompetent patients and isolated splenic involvement is even extremely rare. The case presented here represents this atypical presentation of this rare disease.
161 Personnel Policy and Practice: Sustainable Management of Pharmacy, Pharmacists and Pharmaceuticals and How to Bridge the Gap in Human Resources for Health , Abdeen Mustafa Omer
Worldwide there are different systems for providing pharmacy services. Most countries have some element of state assistance, either for all patients or selected groups such as children, and some private provisions. Medicines are financed either through cost sharing or full private. The role of the private services is therefore much more significant. Nationally, there is a mismatch between the numbers of pharmacists and where are they worked, and the demand for pharmacy services. The position is exacerbated locally where in some areas of poor; there is a real need for pharmacy services, which is not being met and where pharmacists have little spare capacity. Various changes within the health-care system require serious attention be given to the pharmacy human resources need. In order to stem the brain drain of pharmacists, it is, however, necessary to have accurate information regarding the reasons that make the pharmacists emigrate to the private sector. Such knowledge is an essential in making of informed decisions regarding the retention of qualified, skilled pharmacists in the public sector for long time. There are currently 3000 pharmacists registered with the Sudan Medical Council of whom only 10% are working with the government. The pharmacist: population ratio indicates there is one pharmacist for every 11,433 inhabitants in Sudan, compared to the World Health Organisation (WHO) average for industrialised countries of one pharmacist for 2,300 inhabitants. The situation is particularly problematic in the Southern states where there is no pharmacist at all. The distribution of pharmacists indicates the majority are concentrated in Khartoum state. When population figures are taken into consideration all states except Khartoum and Gezira states are under served compared to the WHO average. This mal-distribution requires serious action as majority of the population is served in the public sector. This study reveals the low incentives, poor working conditions, job dissatisfaction and lack of professional development programmes as main reasons for the immigration to the private-sector. The objective of this communication is to highlight and provide an overview of the reasons that lead to the immigration of the public sector pharmacists to the private-sector in Sudan. The survey has been carried out in September 2014. Data gathered by the questionnaires were analysed using Statistical Package for Social Sciences (SPSS) version 12.0 for windows. The result have been evaluated and tabulated in this study. The data presented in this theme can be considered as nucleus information for executing research and development for pharmacists and pharmacy. More measures must be introduced to attract pharmacists into the public sector. The emerging crisis in pharmacy human resources requires significant additional effort to gather knowledge and dependable data that can inform reasonable, effective, and coordinated responses from government, industry, and professional associations.
162 Recurrent Varicocele Associated With Congestion Pelvic Syndrome , Arlindo Lemos
Left Renal Vein compression, entitled as Nutcracker Syndrome, usually is described as cause of Pelvic Congestion once the difficult of drainage of the left kidney deviate vein flow to Gonadal vein developing Pelvic varices in women, and Varicocele in men. Recurrence of Varicocele is described to be between 1 to 35%, dependent on the surgical technique used to repair it. Among the cause of recurrent varicocele, include surgical technique failure, low Body Mass Index, venous plexus variation (persistence of branched spermatic veins), and venous compression. In this study, the authors present 2 cases of recurrent varicocele in young men caused by pelvic congestion due to the Left Renal Vein (LRV) and Left Common Iliac Vein (LCIV) compression, treated by endovascular techniques with good results. In the Literature there are few papers relating the association of both syndromes. Authors discuss of the association of recurrent varicocele and pelvic congestion, and also suggest a routine investigation of it in this recurrence.
163 Hyper-Vitaminosis D , Cristiane Ferreira*, Irfan Khan, Amit Badshah and Parag Singhal
Vitamin D is a group of fat-soluble molecules responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and multiple other biological effects [1]. High levels of 25(OH) vitamin D can therefore cause refractory hypercalcemia. Suboptimal levels of serum Vitamin D are a global healthcare issue. Recently, Vitamin D has increasingly been recognised to have healthcare benefits beyond Calcium metabolism and bone health. As a result, Vitamin D status assessment and over-thecounter consumption has exponentially increased. However indiscriminate consumption can lead to hypervitaminosis D and its associated complication. This report reviews a case of a patient with hypercalcaemia and Acute Kidney injury as result of Vitamin D intoxication.
164 E. coli Causing De Novo Bile Duct Stone Association Revisited , Jeremy Lee Kay Hock1 * and Stephen Chang Kin Yong2,3
The finding of a common bile duct (CBD) stone after living donor liver transplant (LDLT) is a rare occurrence. We report a case of a post-transplant patient who was admitted for gastroenteritis caused by Escherichia coli (E.coli). Three weeks later, following the acute episode, he developed a CBD stone.We hypothesize that ascending infection by E.coli in immunocompromised patients plays a role in the pathogenesis of CBD stone formation.
165 Hip Arthroscopic Portals: A New Approach through Accessory Portals Established Within 3cm around Anterolateral Portal , Kiran Kumar Shah
Background: This new technique an approach through accessory portals established within 3cm around anterolateral portal has more advantageous aspect than any other approach taken during hip arthroscopy. Through this new approach injury to labrum, articular cartilage, neurovascular structures is avoided completely along with that this new approach makes the procedure easy and convenient. Aim: To prove that accessory portals established within 3cm around anterolateral portal makes the procedure and instrumentation facilitation easy and injury to anatomical structure and NVS can be avoided completely. Methods and materials: Anterolateral portal being the safest is established first and in relation to it within 3cm accessory portals are established as many as per need. Results: Every year an average of 40 patients undergo hip arthroscopy and in all cases our approach is through this new technique of accessory portals established within 3cm around anterolateral portal. Conclusion: The accessory portals we establish not only makes the hip arthroscopy easy but also help us avoid use of fluoroscopy and prolonged traction. The visualization within the hip joint of anatomical structure is more precise and accurate, and injury to anatomical structures and NVS is avoided completely
166 Steroid Vs My Special Preparation for Osteoarthritis , Kiran Kumar Shah
Introduction: In osteoarthritis most surgeons prefer setriod namely triamcinolone or methyl prednisolone for Intra-Articular injection but its efficacy is very limited, source can be proved from various article review. But I prefer my special preparation which consists of combination of triamcinolone hexacetonide or hydrocortisone or methyl prednisolone plus vit.B1 plus vit.B12 plus lidocaine plus normal saline. In my clinical practice as Orthopaedic Surgeon I have given IA for 15 cases of OA. Their follow-up was made at 2 weeks, then at 1 month for three consecutive months, then at 6 months, then finally at 2 months. After one single shot of my special preparation patient was pain free for over 1 year in which 15 days physiotherapy course was included in 1st 2 week after IA. All 15 cases were known cases of DM-2 with HTN and age between 49 to79 Discussion: Since all patients had comorbid conditions and already under lots of drugs for DM and HTN, so my special preparation for OA, does not include any oral meds just single shot of my preparation. This puts patients in favorable state and puts patients in no risk or harm from long term analgesic use. Conclusion: My special preparation single shot is superior and cost effective in comparison to other steroid repetitive use. It use help avoid long term analgesic use and its complications in patients with DM and HTN as their renal function and Heart function are always at risk.
167 A Comparative Study of Emotional and Behavioral Problems among Children with and Without Learning Disabilities , Syedda Maheen Abid Ali1 * and Ruhi Khalid2
The study explored the relationship between emotional and behavioral problems and learning disability by comparing children with and without learning disabilities.it was hypothesized that both comparison groups will be different on emotional and behavioral problems and there will be gender differences too. Purposive sampling was done to recruit cases for the learning disabilities group. Sample consisted of students (both boys and girls) from private schools of lahore, studying in grades 3, 4, 5. A matched sample of children without learning disabilities was selected to constitute the comparison group. Learning disabilities diagnostic inventory (hammill & bryant, 1998) and child behavior checklist (achenbach, 1991) were used to assess the variables. Descriptive analysis of data, t-test and multiple analysis of variance were carried out to test the proposed hypotheses. The results revealed that groups of children with and without learning disabilities differ significantly across almost all emotional and behavioral problems. The findings of the study also showed gender differences on different emotional and behavioral problems.
168 Efficacy of Systemic and Inhaled Corticosteroid Therapy for Patients with Community-Acquired Pneumonia: An Evidence-Based Case Report , Fahreza Akbar Siregar1 and Gurmeet Singh2
Background: Community-acquired pneumonia (CAP) is one of the top leading causes of morbidity and mortality worldwide. CAP also becomes the sixth most prevalent cause of overall mortality in adults. Corticosteroids are known to be the most potent anti-inflammatory drugs and have physiologic rationale for their use in patients with infection. Its efficacy in the treatment of CAP is still debatable. Objective: This study aims to evaluate the efficacy and clinical outcomes of systemic and inhaled steroid therapy for patients with community-acquired pneumonia. Methods: We used four databases for literature searching process, Pubmed, EBSCO, ProQuest, and Science Direct, which selected articles are those therapeutic studies with relevant clinical question and met the inclusion-exclusion criteria. Critical appraisal was performed by assessed its validity, importance, and applicability based on Oxford Center of Evidenced-Based Medicine 2011. Results: Three retrieved articles feature cohort studies. Two studies conducted systemic steroid therapy research which other conducted inhaled steroid. Two of three articles show steroid therapy was associated with lower mortality and shorter clinical stability. Conclusion: We suggested that steroid therapy, both systemic and inhaled steroids help hasten clinical recovery, prevent pneumoniarelated complication, lower mortality, and reduction in the duration of mechanical ventilation and length of hospital stay.
169 TEVAR- Thoracic Endovascular Stent Graft , Snezana Medakovic
Surgical care, respectively health care started with the first step in hospital us patient and client. All people who working in hospital where is surgical dominant medical branch, it will tell you that it is the only exact part of medicine, for this opinion have the simple explanation, medical team see problem and try to find the best solution for patient.
170 The Role and Experience of Sudan in Assisting To Develop and Implement National Drug Policies , Abdeen Mustafa Omer
The strategy of price liberalisation and privatisation had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatisation policy, the government introduced radical changes in the pharmacy regulations. The 2001 Pharmacy and Poisons Act and its provisions established the Federal Pharmacy and Poison Board (FPPB). All the authorities of the implementation of Pharmacy and Poisons Act were given to this board. This article provides an overview of the impact of the pharmaceutical regulations on the quality of medicines on the Sudanese market from the perspective of the pharmacists working with drug importing companies. The information necessary to conduct the evaluation was collected from 30 pharmacists who are the owners or shareholders in medicines’ importing companies. The participants were selected randomly. 89% of respondents considered the medicines on the Sudanese market are generally of good quality. The design of the research itself may be considered inadequate with regard to selection process. However, the authors believe it provides enough evidence, and the current pharmaceutical regulations have some loopholes. The Pharmacy, Poisons, Cosmetics and Medical Devices Act-2001 and its regulation should be enforced. The overall set-up including the Act itself needs to be revised. The emerging crisis in pharmacy human resources requires significant additional effort to gather knowledge and dependable data that can inform reasonable, effective, and coordinated responses from government, industry, and professional associations. Furthermore research should be carried out to understand the scope, magnitude directions of the migratory flows, within and outside the country, as well as the characteristics and skills of the emigrated pharmacists.
171 Full Ceramic Aesthetic Applications: 3 Case Reports , Merve AYDEMÄ°R* and Serdar Baglar
One of the most important issue of today’s dentistry is the preservation of tooth structure. Following biomimetic principles, employing minimally invasive applications and adhesive technologies are of paramount importance for successful restorations. Ceramics are materials that allow minimally invasive approach in the anterior region. As ceramic materials develop and patients demand for aesthetic restorations goes up, practitioners must keep up with the material science. The authors suggest guidance to the practitioner in selecting the proper all-ceramic systems for crowns when faced with different aesthetic desires. In this article, three cases of full ceramic restorations were obtained by different production techniques are presented.
172 Brief, Aerobic-surge Exercises for Effective Weight Loss: a Randomized, Controlled Trial , F Buck Willis1 * and Sarah A Curran2
Background: Obesity is a growing disease and a consistently effective protocol is needed to reduce this epidemic. The purpose of this study was to determine if a frequent, brief (2-minute) high intensity aerobic exercise (≥75% max HR) was effective in reducing subjects’ weight (BMI) and girth sizes. Methods: A randomized, controlled trial lasting 60 days was conducted at three sites and forty-six subjects completed this study (mean age 39 ± 8 and BMI 32 ±2). The Experimental group was shown how to make movements such as riding a stationary bicycle or lifting dumbbells into an ‘Aerobic-surge’ exercise at or above 75% of calculated maximum heart rate. Control subjects were simply told to “exercise more.” No dietary changes were made for either group. The dependent variables were changes in weight and ‘body summation’ of 10 girth measurements. A 2x2 ANOVA was used to calculate differences. A post-hoc analysis of changes in BMI was also calculated. Results: There was a significant difference between groups (P<0.0001). The mean change of the groups were as follows: Experimental (N=23) mean reductions = -18.lbs and -18.7” vs. Control (N=23) mean changes = +1.3.lbs and +1.3.” Conclusion: The repeated, brief (2-minute) aerobic-surge exercise protocol, performed 4.2 times/day was effective in reducing subjects’ weight and body circumferences. Isolated tests of body composition showed that change were primarily in body fat. This could be a tool in reducing the obesity epidemic. The Aerobic-surge exercise was effective without a dietary changes. Retrospectively Registered Trial: ISRCTN 17326333.
173 Impedance Therapy in Rehabilitation of Degenerative Disc Disease Randomized Clinical Trial , Kostka P1 and Ziakova E2 *
Aim: The aim of this work is to investigate the effects of Impedance Therapy (IT) in the treatment of degenerative disc disease by confirming the presence of the "disc grow-up" (DGU) phenomenon. Method: The set consisted of 55 patients with DDD with an average age of 51.3 years divided into two groups – the experimental group and control group. The experimental group consisted of 29 patients with an average age of 56.7 years. The control group consisted of 26 patients with an average age of 45.8 years. Results: In the experimental group of patients with DDD, who received IT, the DGU phenomenon with a success rate of 76% was observed, with an average increase in the volume of the intervertebral disc of 31% (p <0.000). In the control group of patients receiving standard electrotherapy, the DGU phenomenon was not proven – the DDD progressed normally with a mean volume reduction of 15% (p <0.000). Conclusions: Degenerative disc disease as a disease of modern civilization is treatable. It can be concluded that the theory, that degenerative disc changes are irreversible has been overcome by the impact of impedance therapy.
174 A Review of Nasal Polyps , Eyad Zein Aldean
Nasal polyps (NP) are one of the most common inflammatory lesions of the nose, affecting up to 4% of the population. Their etiology remains unclear, but they are known to have associations with allergy, asthma, infection, cystic fibrosis, and aspirin sensitivity. However, the underlying mechanisms interlinking these pathologic conditions to NP formation remain unclear. Also strong genetic factors are implicated in the pathogenesis of NP, but genetic and molecular alterations required for its development and progression are still unclear. They present with nasal obstruction, anosmia, rhinorrhea, post nasal drip, and less commonly facial pain. Management of polyposis involves a combination of medical therapy and surgery. There is good evidence for the use of corticosteroids (systemic and topical) both as primary treatment and as postoperative prophylaxis against recurrence. Surgical treatment has been refined significantly over the past twenty years with the advent of endoscopic sinus surgery and, in general, is reserved for cases refractory to medical treatment. Recurrence of the polyposis is common with severe disease recurring in up to ten percent of patients. In this talk I will present the newer treatment options available for better control and possibly cure of the disease.
175 Hepatic Peliosis Associated with a Paraganglioma , Mahbuba Shirin
Peliosis of the liver and spleen is a rare benign condition characterized by dilatation of sinusoidal blood-filled spaces. The imageology of hepatic peliosis resembles hepatocellular carcinoma, hepatic metastases and hemangioma. We report a case of hepatic peliosis imitating metastases on CT. The patient was 26-year-old man who previously had a splenectomy and retroperitoneal paraganglioma surgically removed. Peliosis must be considered a potential differential diagnosis of hypodense foci of the liver seen on CT
176 Methanol Poisoning Important Differential in a Refractory Metabolic Acidosis with A Diabetic Patient Suspecting Ketoacidosis: A Case Report , U K Mallick1 , S M Hossain Shahid2 , Mohammad Asaduzzaman3 , Aflatun Asha4 , Sayem Mohammad Farhad5 , Supta Bardhan6 , Nahin Siddique7 , Nahid Sarker8 , Omar Faruq9 and Ashikur Rahman10
The incidence of methanol intoxication is less common in Bangladeshi population. Early and aggressive management with bicarbonate, ethanol and hemodialysis in patients having significant toxicity will decrease mortality and improve patient’s outcome. Our experience of SLED in haemodynamically unstable patient with inotrpic support may improve outcome. Case presentation: A-45 years old male bussinessman, diabetic and hypertensive was admited into cabin with history of restlessness, blurring of vision and breathlessness 1 day. Inspite of conservative treatment after 10 hours his general condition gradually detoriated, so he shifted to ICU and kept in mechanical ventilator. His laboratory results showed a severe high anion gap metabolic acidosis not corrected by sodibicarb and adequatefluid resuscitation. His neurological codition of patient was detoriating and MRI of brain showed bilateral putamenal lesion suspecting methanol intoxication. After conservative treatment, his general condition was deteriorated and acidosis was not corrected rather than he developed acute kidney injury so haemodialysis (SLED) was started after taking nephrology consultation. After giving 3 sessions of SLED, metabolic acidosis was corrected with normalization of renal function. His vital signs stabilized and he was extubated subsequently. After six months in a follow-up patient complained total blindness and fundal photography showed bilateral optic atrophy. Conclusions: We conclude that in case of severe metabolic acidosis, methanol intoxication always should kept in mind in a patient of Diabetes Mellitus suspecting DKA .Early initiation of haemodialysis is very effective to reverse renal and metabolic abnormalities inspite of haemodymis unstability. Metabolic improvements do not equal to healing the patient, especially permanent neurological deficit like blindness may persit.
177 Medium Definition Liposuction , Giuliano Borille
Medium Definition Liposuction is an alternative liposuction approach, without the need of external energy device (such as LASER or VASER), that avoids the eventual stigmata of some cases of High Definition liposuction. This approach uncovers the abdominal muscle outlines by enhancing the superficial muscle anatomy and topography, creating an athletic, natural look. The ideal patient should have the Body Fat Index (BFI) of 18% or less with abdominal muscle hypertrophy. 50 patients underwent Medium Definition Liposuction (2016-2018) and were evaluated by the authors according Strasse Aesthetic Outcome Scale 1.
178 Gravity Syndrome , Raja TOUNSI
Extension of Einstein's hypothesis "The agent Na + acts constantly on the circulatory rotation of the neurons, which accentuates the operational deficiency of the cellular rhythm in normal state, the agent Ca acts on the bone system and indirectly on the cardiac rhythm. This relativity provokes the law of body weight with respect to atmospheric deficiency."
179 Morphologic Variations of end Trunks of M1 Segment of Middle Cerebral Artery , Valvita Reçi* and Sadi Bexheti
Introduction: The middle cerebral artery is divided into four segments: proximal M1, insular M2, opercular M3 and cortical M4. M1 extends from the bifurcation point of ACI at ACA and ACM to the insula threshold, laterally from chiasma opticum, laterally from tractus opticus and caudally from trigonum olfactorium, directed laterally, dorsally and rostrally. Early division of the M1 segment into the final trunk is possible at any of the first points of the limb insulae. Material and methods: The study of the micromorphological and morphometric characteristics of the M1 segment was performed in 25 brain (50 ACM preparations) obtained from autopsy of both sexes of different ages without pathological changes. For the removal of the brain from the skull we used the usual technique of obduction. Results: This segment was arch-shaped, in 32 (64%) arteries, rarely S-shaped, in 12 (24%) arteries, much less straight alignment, in 6 (12%) arteries. The average length of the M1 segment of the S shape was 20.6 ± 3.31mm, with a 19.8 mm 4.41mm arch shape, while the straight shape was 16.9 ± 3.62mm. The average S-shaped diameter was 2.7 ± 0.51 mm, arched 2.6 ± 0.47 mm, straight form 2.6 ± 0.36 mm. Variations of M1 branching were: common in 38 cases, early branching in 12 cases, joint trunk with cortical branch in 9 cases, lateral cortical branch in 21 cases, final bifurcation in 24 cases, final trifurcation in 13 cases, duplication in 1 case and M1 accessory in just 1 case. Conclusion: True bifurcation refers to the division of the M1 segment into two final trunks. In cases where the strong joint cortical branch trunk divides from segment M1, while dividing into two terminal trunk immediately after ACM knee formation, it is described as false branching of M1 segment into three terminal branches.
180 Ayurveda: The Sanjeevni of Modern Life , Rupinder Kaur
The current era has thrown many challenges for humankind primarily lifestyle diseases. It has happened because modern man has divorced himself from the age-old ideas of oral health traditions enumerated in Ayurveda. Some verbal and textual resources exist to guide people on maintaining good health. It describes it under three cardinal headings: Vata, Pitta and Kapha that are the three Doshas of the body. Perfect harmony between these three Doshas leads to optimal health while an imbalance in Tridosha leads to diseases. This review describes various seasons (Ritu), proper food intake as well as regulated daily activities. There is a shift of understanding from good health to total wellness of the being from an appropriate method of consuming food to sexual wellness. It is a comprehensive construct of how Ayurveda helps in holistic coexistence with nature.
181 Drinking Water and Public Health Risk , Carina Harkin
Drinking water is a social determinant to disease, a powerful determinant of health and also promotes socioeconomic development, yet public health is failing to protect the public with poor drinking water quality posing a threat to public health. Major sources of ground and surface contamination are landfill and human sewerage. Irish Water has consecutively failed to meet safety standards for bromate, nickel, nitrite, copper, pesticides, arsenic, fluoride, lead, trihalomethanes (THM). Regardless of where public opinion lies in relation to the addition of hexafluorosilicic acid to drinking water as a public health measure, it is found in Irish drinking water in illegal and unsafe amounts hence by definition poses a risk to public health. The EU Drinking Water Directive does not contain standards for microplastics. Existing drinking water treatment and wastewater treatment processes are inadequate at removing persistent toxic substances (PTS) from water. Bottled water can contain endocrine disrupting chemicals (EDCs), heavy metals, pesticides, persistent toxic substances and even gastrointestinal microbes. The following review article refers to Irish drinking public drinking water supplies however the issues reflect those of many first-world countries.
182 Exploring Motivational Interviewing as a Technique for Physical Activity Promotion on an Acute Medical Unit Setting – A Qualitative Study , YN Ajanah*, B Scammel and Ivan Le Jeune
Research Question: Could the self-perceived physical activity levels of acute in-patients be improved by offering motivational interviews prior to discharge from the Acute Medical Unit: A Qualitative Study. Aims: To explore how the patients on an acute medical unit perceive Motivational Interviewing (MI) as a method of encouraging physical activity (PA) for them, in relation to any change in their perceived involvement in PA after 6-8 weeks and to explore patients’ feedback of motivational interview and their preferences as to its technique and manner of delivery to them. Methods: Participants were recruited from an acute medical admissions unit. Eligibility criteria was patients’ ability to walk 10m on the flat ground, with or without an aid and identified as being close to discharge by ward staff. Participants answered the Global Physical activity Questionnaire (GPAQ), following which they were offered MI by their bed side. 6-8weeks later, participants answered the same questionnaire and participated in a semi-structured interview, which was verbatim transcribed and analysed using an inductive thematic analysis. Ethical approval was gained from the London - Brighton & Sussex Research Ethics Committee and Local Human Research Authority (REC reference 18/LO/0496). Results: 7 out of 10 participants found MI, helpful at improving their participation in PA. Although certain barriers were identified that limited PA participation such as perceived fears, concerns and misconceptions of PA, where participants expressed preference for these barriers to be tackled individually in conjunction with motivational interview techniques. Conclusions: MI is a feasible method of encouraging PA, which could be impactful on the PA participation of the patients on an AMU. Future studies may consider combining approaches towards tackling perceived barriers in conjunction with MI when delivering this intervention to the patients in this setting
183 Grow Factors in Ampoules , Paulo Roberto Lisa Sanchez
Growth factors are a set of substances, in general proteins that together with hormones and neurotransmitters, play a fundamental role in intercellular communication. The main function is cell cycle control. Iniciante mitosis, maintaining proliferation and cell survival, migration, differentiation, and apoptosis.
184 Free Amino Acids in the Diagnosis and Treatment of Pathology the Hepatobiliary System (Review) , I I Nefyodov*, AJ Karakosh, MA Alufaini, PA Karavay and NL Karavay
A mini-review of literature data on the mechanisms of formation of the stock of free amino acids and their derivatives in liver pathology and methods for correcting metabolic imbalance.    
185 Primary Side Sclerosis, Case Report and Bibliographic Review , Miranda Nava Gabriel and Garc�­a Garc�­a Luis Gilberto
Introduction: Primary lateral sclerosis is a rare disease that involves the upper motor neuron, producing a bulbospinal spasticity. The course of the disease is insidious and progressive, usually beginning with the lower extremities, and subsequently becoming a tetrapyramidal syndrome. Being a rare disease, the diagnosis in most cases is exclusion, having to study the patient extensively, in a clinical manner, including a thorough clinical history, laboratory and with relevant cabinet studies. Clinical Case: This is a male patient who started his clinical picture about a year ago with weakness in the left pelvic limb, later accompanied by pain and paraesthesia, manifesting the same symptoms later in the contralateral leg and upper left limb. Currently, hypoesthesia of the index and middle toes of the right foot is added, moderate tremor in the left arm, with overlapping of the middle finger over the ring of said hand. He has an inability to lift light objects for short periods of time, as well as fatigue in short periods of time when performing daily activities, which greatly limits his daily life. Conclusions: Motor neuron diseases are divided into two groups, and in the case studied, the upper motor neuron is exclusively affected. Being a rare disease, with a low incidence, multiple differential diagnoses will be considered before concluding this, considering a diagnosis of exclusion. The natural history of the disease will always have a bleak outcome, with a poor prognosis for life and function, despite the measures taken to modify its course.
186 Characterization of Smoking in Adolescents from the Medical Sciences in Cuba , Jesús Cuéllar Álvarez, Leonardo Manuel León Ledesma, Lidia Esther and Abrahantes Hernández
Background: The characterization in adolescent’s smokers as prevention from the medical sciences is one of the lines of the work team in the consultation of Ceasing Tobacco. Objective: To characterize of smoking in adolescents from the medical sciences in Cuba. The investigation embraced one period from January 2019 to September 2019. Method: A descriptive study of traverse court was used. Registered to 41 students for sampling intentional non probabilistic, of an universe of 80 adolescent students. It was used empiric methods; clinical histories, interviews structured and the questionnaire. Results: The male sex prevailed, where 51,2 % of the active smoking adolescents was understood between the 13 and 15 years of age, 78 % of these they began to smoke between the 12 and 15 years. Conclusion: Of why the most frequent rea
187 Lean Management" - A Method of Improving Change Management in Healthcare Organizations , Joanna Jasinska
The aim of this article is to present selected ways of developing the management in medical institutions in Poland with the help of Lean Management. The author concentrates on processes of changes in clinical hospitals which include: dealing with special tasks in healthcare system, diversity of tasks, medical technology, diversity of relationships with the surrounding, financing from few different sources, limits of resources (especially public ones). The article leads to a conclusion that Lean Management should be a way of thinking.
188 Ankylosing Spondylitis-A review on Drug Promotion through the Ages , Suhasishray
The diagnosis of ankylosing spondylitis is often delayed due to ambiguous clinical manifestations and strict diagnostic criteria. However, imaging techniques such as magnetic resonance imaging have been found effective for the early diagnosis of nonradiographic sacroilitis. New tumor necrosis factor alpha (TNF-α) inhibitors have good efficacy for patients with persistently high disease activity despite conventional nonsteroidal anti-inflammatory drug treatment which are effective in low diseases cores. Thus, early diagnosis and aggressive treatments are essential for ankylosing spondylitis patients. Though the disease can be stayed with conventional DMARDs and NSAIDs in low score diseases, in high score diseases TNF-α inhibitors are more effective. In this review, we discuss new diagnostic criteria for ankylosing spondylitis, administration methods of TNF-α inhibitors, comparative review between conve
189 Loss of Information Associated with the Perceptomotor Cognitive Domain: Praxis , Jair Rodrigues Neyra, Rafael Santos da Costa and Thiago RS Moura *
We have proposed a random walk model to model perceptomotor cognitive domain damage in patients with neurocognitive disorders (NDs). The random walk model with truncated Lorentz memory profile. We have reported that memory damage has an impact on random walkers' praxis and, consequently, on the global diffusive process, fractal dimension and information loss, and it is the major impact on information loss. We have found two diffusive regimes: the ordinary and the superdiffusive. We have observed two superdiffusion regions separated by a region with ordinary diffusion regime: one in the anti-persistence region and one in the persistence region. These regions are characterized by diffusion level curves, invariant curves of scale variations in the Lorentz distribution. In the anti-persistence region, we found a greater variation in entropy, for example, greater loss of praxis-related information than in the persistence region. Therefore, when memory impairment is accompanied by observation of anti-persistent behavior, there are greater losses of information related to the perceptomotor domain of random walkers.
190 Food is the Cause and the Cure for the Obesity Epidemic , F Buck Willis* and Sheri M Brackman
Recent evidence has shown that consuming food products which cause inflammatory or leukocyte reactions are significant causes of weight gain, while eating natural foods has been shown to elevate basal metabolic rates necessary for weight loss. The obesity epidemic continues to rise because the causes of this disease are not being successfully identified and counteracted. In 2016 the World Health Organization (WHO) estimated that over 900 million adults are categorical obese (Body Mass Index > 30) and that another 340 million children are overweight or obese. This is a curable disease, however obesity now causes more deaths globally, more than being malnourished (starving). It is estimated that in the USA (2019) over 131 million adults are obese (40% US population) and the British NIH completed and exhaustive study of patient admissions in 2019 showing that “the majority of adults in England were overweight or obese.” The British obese population exceeds an additional 13.4 million adults were obese (BMI > 30). The purpose of this manuscript is to identify the evidence-based protocols designed for identifying the causes of the obesity and for determining an effective treatment of this disease.
191 Using Three Analysis Methods: Time-Series, Spatial, And Frequency-Domain to Analyze and Forecast Key Diabetes Biomedical Variables (GH-Method: MathPhysical Medicine) , Gerald C Hsu
This paper describes the author’s application of Time-Series Analysis, Spatial Analysis, and Frequency-Domain Analysis (including wave theory, Candlestick charting, segmentation pattern analysis) to analyze and forecast certain biomedical key variables of type 2 diabetes (T2D) conditions. The dataset is provided by the author, who uses his own type 2 diabetes metabolic conditions control, as a case study via the “math-physical medicine” approach of a nontraditional methodology in medical research.
192 Some Controversial Nutrition-Associated Aspects of Decompensation of Oncology and Diabetes Mellitus , Elena Drozdova
Today, 422,000,000 people are suffering from diabetes throughout the world (according to World Health Organization). Diabetes mellitus in turn is the course of death of 1,600,000 people per year
193 Using GH-Method: Math-Physical Medicine to Conduct Segmentation Analysis to Investigate the Impact of Weather Temperatures on Glucose (Both FPG And PPG)     ,  Gerald C Hsu
This paper is based on big data collected from a period of 1,420daysfrom 6/1/2015 to 4/21/2019 with a total of 4,260 data, including highest ambient temperature (weather) of each day in degree Fahrenheit (°F), fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) in mg/dL. The dataset is provided by the author, who uses his own type 2 diabetes metabolic conditions control, as a case study via the “math-physical medicine” approach of a non-traditional methodology in medical research.
194 Spread of Respiratory Viruses: Temperature and Physical Environment. Temperature Control May Exploit Virus Hypo-Thermolabity; A Possibile, Immediate Solution for COVID-19 , Giovanni Belcaro*, Umberto Cornelli, Maria Rosaria Cesarone, Beatrice Feragalli, Ezio Bombardelli and Mark Dugall
Bronchial-Tracheal surface cells work at a specific temperature range. At this range (37-38 C°) their response to viruses and bacteria tend to be optimal and mucus tends to have the specific grade of fluidity to contrast infections [1, 2]. With a decrease of 3-4 C° or more, these cells may be less protected, less active and not ready to fight infections. Most viruses may work (and replicate) only at lower temperatures (i.e. 34-35°C).
195 Importance of Screening Colonoscopy for Colorectal Cancer among Inflammatory Bowel Disease Patients in Qatar , Nasrein Mohamed Elkomy*, Rafie Yakoob, Khalid Mohsin A Al-Ejji, Saad Rashid Mohamed Al-Kaabi, Khaleel Sultan, Prem Chandra and Ahmed Elnajjar
Since 1920, inflammatory bowel disease (IBD) has been linked to increased incidence and mortality from colorectal adenocarcinoma (CRC). Several studies have found that screening colonoscopy reduced CRC mortality and improved survival in IBD patients. However, there are little or no data about the prevalence of CRC/Dysplasia in Qatar detected by screening colonoscopy and weather the Qatar gastroenterologists adhere to the international guidelines. Thus, the focus of the present study was to examine the rate of CRC and dysplasia in IBD patients who underwent a screening colonoscopy. The sample consisted of 153 patients who were diagnosed and treated for IBD. The results of the study showed high incidence rate of CRC/Dysplasia among IBD patients and it was also found that the gastroenterologists in Qatar did not strictly adhere to the international guidelines in relation to the time of first screening colonoscopy of IBD patients.
196 From Jungian Attitude-Types to a Comprehensive Model of Diseases , Marco Balenci
This review discusses the pair of opposites named introversion and extraversion by Swiss psychiatrist Carl Gustav Jung in its biological foundation and psychosomatic implications. Jung’s typology was the reference for Elida Evans’ book on cancer in 1926, which would be the basis of American psycho-oncology and of a holistic approach to cancer patients. It is shown that introversion and extraversion have been widely used in psychology and psychiatry, even without any reference to Jung. Moreover, these concepts have been used for somatic illnesses. In 1990, independently of each other, George A. Bonanno and Jerome L. Singer of Yale University (USA) and Marco Balenci of Sapienza University of Rome (Italy) conceived two similar comprehensive models of diseases - both in their physical and psychic aspects - based on the psychophysical balance of opposite attitudes. Persistent dualism in Western medicine may explain the lack of development of these models. Actually, this kind of model derives from a holistic view, which was advocated by George L. Engel in the United States, giving relevance to biopsychosocial factors. Despite the increasing discoveries of psychoneuroimmunology and developmental psychobiology can provide a new scientific impetus to the individual-as-a-whole, this perspective still has greater convergence with Eastern medicine.
197 Decrease in Covid-19 Contagiousness: Virucidals Control the Presence of Covid in Saliva and Salivary Glands , Giovanni Belcaro*, Umberto Cornelli, Maria Rosaria Cesarone, Beatrice Feragalli, Roberto Cotellese, Ezio Bombardelli, Mark Dugall, Marcello Corsi, Lars Rosenkvist and Sandeep Shah
Summary: This pilot study evaluated the effects of some virucidals in vivo (using the RT-PCR swab test) to evaluate the presence of COVID in the mouth saliva. With this model, if an asymptomatic subject is positive (in the mouth saliva, the first incubating medium), virucidals can be used, i.e., for a week, and the positivity re-evaluated to define the direct killing power of the virucidal. Results: A progressive decrease in positivity in the swab samples was observed. Virucidals produced disappearance of positivity in most subjects at 3 and 7 days. All virucidals used in this pilot registry resulted effective. The pharmaceutical form seems to be important to assure persisting traces of the virucidal in the mouth. The gummy Phyrorelief CC possibly produced the longest action (>3 hours) due to its slower release. These preliminary observations indicate a significant effect of virucidals on the viral contamination of the mouth (the first incubator) with a relatively simple, cost-effective model. The lower presence of a virus charge or its decrease may significantly reduce contagiousness of most of these patients and possibly, the spread of viral material. The effects on the evolution of COVID-19 on single patients is, unpredictable with this model but virucidals may assume a significant community value in preventing and controlling spreading.
198 Hurdles and Stumbling Blocks on Efforts of Prevention and Halting New HIV Infections by 2030: A Review of Southern Africa Region , Moses Mncwabe
Since the discovery of Human Immunodeficiency Virus (HIV) an infection that causes Acquired Immune Deficiency Syndrome (AIDS) four decades ago, there have been numerous global conferences where governments and heads of states made commitments to end the spread and provide mechanisms to mitigate the socioeconomic effects of advanced HIV [1]. However, these commitments have not been fully implemented as by 2019, the advanced HIV continued to be the leading cause of death among young women of reproductive age of 15-49 years globally. Despite political commitments, an estimated 6000 new HIV infections per week continue to occur among the age group of 15 and 24. These new incidences of HIV makes it near impossible for the international community to meet its commitment of fewer than 500,000 new HIV infections by 2020 [1]. On the positive side, there has been recognition that advanced HIV is not only a health issue but a development phenomenon. To this end, there have been multifaceted interventions such as increased number of girls enrolled in primary and secondary schools globally. Other development relates to more numbers of women in political leadership, improvement on pieces of legislation, increased investment in vaccines and noticeable uptake of antiretroviral treatment (ART) for people infected with HIV. By end of 2019, there were over 24 million people globally that were on treatment, of which more than 13 million were women aged 15 years and over [1]. However, there are formidable hurdles that make halting new HIV infections by 2030 as per the Sustainable Development Goals (SDGs) a difficult task. In the midst of progress and difficult challenges, the international community ought to reflect on Mandela's assertion that “…I have discovered the secret that after climbing a great hill, one only finds that there are many more hills to climb”[2]. These daunting hurdles include lack of political will, multiple concurrent sexual partnerships, transactional sexual relations, stigma, isolation and exclusion as well as poverty-migration and HIV, co-infection of Tuberculosis (TB) and HIV. The combination of these hurdles make the possibility of meeting the internationally agreed upon SDGs target of having zero new HIV infections a greater challenge to achieve, unless complacency is addressed head-on and the issues raised in this review are reprioritized.
199 Thrombo-Prophylaxis Prevents Thrombotic Events in Home-Managed Covid Patients a Registry Study , G Belcaro, M Corsi, GB Agus, MR Cesarone, U Cornelli, R Cotellese and Feragalli B
This pilot registry analyzes data from subjects with COVID-19 infection and mild symptoms, followed and treated at home. Antithrombotic prophylaxis was used in all subjects. A comparison was made with comparable cases that had not used prophylaxis. A control group (36 subjects) without prophylaxis was compared to a prophylaxis group (67 subjects using LMWH and 35 using defibrotide). At two weeks, there were no DVTs or thrombotic disease in the prophylaxis groups. Also, the evolution of the main respiratory symptoms was significantly better in the prophylaxis groups (p<0.05). No patients went to ITU: 4 out of 36 patients in the comparative group went briefly to hospitals. In subjects, using LMWH 1 went to hospital as in the defibrotide group. None was put in ventilation. D-dimer values were fluctuating and not usable to define the presence of a thrombotic condition. This aspect is under further evaluation. No significant side effects were observed. Conclusions: Antithrombotic prophylaxis should be started as soon as possible (home patients) and used during all the high-risk conditions. The importance of venous thromboembolism in medical patients with severe respiratory disease (as COVID), even in the early phases, has been stressed and it is well known; it cannot be considered a new observation and requires adequate, immediate prophylaxis.
200 Hemorrhagiparous Thrombocytic Dystrophy (Bernard-Soulier Syndrome): A Case Report of a Rare Bleeding Syndrome , Yaser Khalid, Neethi Dasu*, Herman Suga, Debashis Reja, Kirti Dasu, Amy Polansky, Keith Brown and Richard Gordon
Bleeding syndromes, such as Bernard-Soulier Syndrome (BSS), are extremely rare with an incidence of 1 in 1,000,000 persons. Very few cases (approximately a hundred) have been reported in the literature. However, it is very important to quickly recognize this condition as soon as possible before life-threatening complications occur. Here, we present a case of a 25-yr-old with chronic thrombocytopenia who was found to have BSS on peripheral blood smear prior to a routine dental procedure. Rare disorders, such as BSS, need to be on the differential diagnosis for physicians because missing this condition could have led to catastrophic side effects, such as uncontrolled bleeding for our patient. She was transferred to a tertiary care center for her procedure to be managed for potential bleeding complications.
201 Clinical Manifestations and Radiological Characteristics on Rosai-Dorfman Disease: A Retrospective Observational Study , ST LI, ZF Xu*, LW Huang and AZ Pan*
Background and Objective: Rosai-Dorfman disease (RDD) are usually misdiagnosed because of rarity and nonspecific clinical and radiological features. The aim of our study is to explore the clinical and imaging characteristics of RDD to improve diagnostic accuracy. Methods: Clinical and imaging data in 10 patients with RDD were retrospectively analyzed. 7 patients were underwent CT scanning and 3 patients were underwent MR examination. Results: 8 (8/10) patients presented with painless enlarged lymph nodes (LNs) or mass. 3 cases were involved with LNs, 5 cases were involved with extra-nodal tissues, and the remaining 2 cases were involved with LNs and extra-nodal tissue simultaneously. In enhanced CT images, enlarged LNs displayed mild or moderate enhancement, and 2 cases showed heterogeneous ring-enhancement. MR features of 3 patients with extra-nodal RDD, 2 cases showed a mass located in the subcutaneous and anterior abdominal wall respectively, and 1 case showed an intracranial mass. Besides, all lesions showed high signal foci on DWI images, and were characterized by marked heterogeneous enhancement with blurred edge. The dural/fascia tail sign and dilated blood vessels could be seen around all the lesions on enhanced MRI. Radiological features of 2 cases with LN and extranodal tissue involved, one case presented with the swelling and thickening of pharyngeal lymphoid ring and nasopharynx, meanwhile with enlarged LNs in bilateral submandibular area, neck and abdominal cavity, and also companied with osteolytic lesion in right proximal humerus. All these LNs displayed mild and moderate enhancement on CT images. Another case showed enlarged LNs in bilateral neck accompanied with soft tissue mass in the sinuses. Conclusions: RDD occurred commonly in young and middle-aged men and presented with painless enlarged LNs or mass.RDD had a huge diversity of imaging findings, which varied with different location. The radiological features, such as small patches of high signal foci in the masses on DWI images, heterogeneous enhancement and blood vessels around the masses, are helpful in diagnosis of extranodal RDD.
202 Recurrent Breast Cancer?Hyperbaric Oxygen Therapy , Malcolm R Hooper
Primary Diagnosis: Breast Cancer (2005). Past Treatment included Chemotherapy, Radiation Therapy. Current Medical: Recurrent Breast Cancer, Metastatic ER positive, Recurrent HER2 negative breast cancer, Oesophageal stricture. Currently taking Tamoxifen.
203 A Mnemonic for Neck Triangles , Badr M I Abdulrauf
Anatomical Neck Triangles are imaginary to some extent. Their significance to many surgical specialties is invaluable. Among all basic Medical sciences subjects, Anatomy is most prone to be forgotten. None of the other subjects has the amount of mnemonics described or invented compared to it. Junior year’s students of Medical schools need to memorize anatomy with no or very little knowledge of its clinical applications. Relatively speaking, that can be quite cumbersome for them compared to those who are already involved in surgical residency training program, when anatomy knowledge is concerned. Surgeons who specialize or exclusively work in a selected anatomic region, they become experts and famous in their field and in that particular operation, mostly because they subconsciously become oriented to that region’s anatomy. However, those who work on various anatomical areas frequently need to refresh their anatomy knowledge. Mnemonics therefore are helpful for various level medical professionals. The Neck represents a relatively limited transition zone or passage of various tissue structures besides great vessels and nerves between Head, Chest and Upper extremities, very much like a three-way connector. Unless the concept of Neck triangles was there, it would have been very difficult to discuss or communicate about neck related procedures. The theory of simulating Neck triangles to a Bird like creature was long thought and utilized by the author. Here we are describing and sharing this imaginary mnemonic to help in the ability of recalling and drawing those triangles. An analogy of a flying Bat is used.
204 Virucidals Control the Presence of Covid in Mouth/Saliva , Giovanni Belcaro*, Ezio Bombardelli, Umberto Cornelli, Maria Rosaria Cesarone, Roberto Cotellese, Mark Dugall, Marcello Corsi, Beatrice Feragalli and Lars Rosenkvist
Summary: This pilot study evaluated the effects of some virucidals in vivo (RT-PCR swab test) to define the presence of COVID in the mouth saliva. With this model, if an asymptomatic subject is positive (in the mouth saliva, the first incubating medium), virucidals may be used and the positivity can re-evaluated to define their viral killing power. Results: A progressive decrease in positivity in the swab samples was observed. Virucidals’ produced disappearance of positivity in most subjects at 3 days. All virucidals used in this pilot registry resulted effective. The pharmaceutical form seems to be important to assure persisting traces of the virucidal in the mouth. Phyrorelief possibly produced the longest action (>3 hours) due to its slower release. These observations indicate a significant effect of virucidals on the viral contamination of the mouth with a simple, cost-effective model. The lower presence of a virus charge may reduce contagiousness of most patients and possibly, the spread of viral material from the mouth. The effects on the evolution of COVID-19 on single patients is, unknown but virucidals may assume a significant community value in controlling spreading.
205 Virucidals Control the Presence of Covid in Mouth/Saliva , Giovanni Belcaro*, Ezio Bombardelli, Umberto Cornelli, Maria Rosaria Cesarone, Roberto Cotellese, Mark Dugall, Marcello Corsi, Beatrice Feragalli and Lars Rosenkvist
Summary: This pilot study evaluated the effects of some virucidals in vivo (RT-PCR swab test) to define the presence of COVID in the mouth saliva. With this model, if an asymptomatic subject is positive (in the mouth saliva, the first incubating medium), virucidals may be used and the positivity can re-evaluated to define their viral killing power. Results: A progressive decrease in positivity in the swab samples was observed. Virucidals’ produced disappearance of positivity in most subjects at 3 days. All virucidals used in this pilot registry resulted effective. The pharmaceutical form seems to be important to assure persisting traces of the virucidal in the mouth. Phyrorelief possibly produced the longest action (>3 hours) due to its slower release. These observations indicate a significant effect of virucidals on the viral contamination of the mouth with a simple, cost-effective model. The lower presence of a virus charge may reduce contagiousness of most patients and possibly, the spread of viral material from the mouth. The effects on the evolution of COVID-19 on single patients is, unknown but virucidals may assume a significant community value in controlling spreading.
206 Guesstimate Probable Partial Recovery of Pancreatic Beta Cells Using Calculations of Annualized Fasting Plasma Glucose Decreased Amount (GH-Method: mathphysical medicine) , Gerald C Hsu
In this paper, the author describes his hypothesis on the probable partial self-recovery of some insulin regeneration capability of pancreatic beta cells on a type 2 diabetes (T2D) patient via his collected data of fasting plasma glucose (FPG) and body weight during the period of 1/1/2014 to 11/2/2019.
207 Policy Review Dubai Health Authority? COVID-19 Rapid Response-Review , Fatma Bin Shabib and Immanuel Azaad Moonesar*
Dubai Health Authority (DHA) is the entity regulating the healthcare sector in the Emirate of Dubai, ensuring high quality and safe healthcare services delivery to the population. The World Health Organization (WHO) declared COVID-19 a pandemic on the 11th of March 2020, indicating to the world that further infection spread is very likely, and alerting countries that they should be ready for possible widespread community transmission. The first case of COVID-19 in the United Arab Emirates was confirmed on 29th of January 2020; since then, the number of cases has continued to grow exponentially. As of 8th of July 2020 (end of the day), 53,045 cases of coronavirus have been confirmed with a death toll of 327 cases. The UAE has conducted over 3,720,000 COVID-19 tests among UAE citizens and residents over the past four months, in line with the government’s plans to strengthen virus screening to contain the spread of COVID-19. There were vital UAE policies, laws, regulations, and decrees that have been announced for immediate implementation to limit the spread of COVID- 19, to prevent panic and to ensure the overall food, nutrition, and well-being are provided. The UAE is amongst the World’s Top 10 for COVID-19 Treatment Efficiency and in the World’s Top 20 for the implementation of COVID-19 Safety measures. The UAE’s mission is to work towards resuming life after COVID-19 and enter into the recovery phases. This policy research paper will discuss the Dubai Health Authority’s rapid response initiatives towards combating the control and spread of COVID-19 and future policy implications and recommendations. The underlying factors and policy options will be discussed in terms of governance, finance, and delivery. 
208 Nodular Fasciitis: A Tumor with Misnomer! , Badr M I Abdulrauf* and Jamal A Ilyas
Nodular fasciitis is a peculiar a tumor in its clinical presentation and cytological appearance, owing to its similarity with soft tissue sarcoma. It is a rare benign neoplasm most commonly occurring in the upper extremity. Meanwhile it is selflimiting reactive process mimicking malignant lesion composed of Fibroblasts and Myoblasts. Here we are reporting two cases in the hand, with varied clinical presentation, were treated with complete surgical excision and pathologically confirmed to be Nodular Fasciitis. The term Nodular Fasciitis although pathologically is indicative of an inflammatory process, clinically it seems to be misleading since “Fasciitis” usually denotes an acute serious soft tissue infection. As per literature, this benign tumor is often described as pseudo-sarcomatous, yet its title gives no hint of such a concern. After dealing with the presented cases and the literature review it is evident that, diagnosing this specific lesion on basis of clinical picture, MRI or fine needle aspiration is very unlikely. Most cases will end up having surgical excision due to its frequently alarming presentation.
209 Autism & Hyperbaric Oxygen Therapy , Malcolm R Hooper
Young DC age 7 - high functioning autism, non-social, non-verbal. Cytokine Testing pre-HBOT.
210 Variations in Essential Elements After Malignant Transformation of Kidney Epithelial Tubular Cells , Maria Helena Bellini*, Alexandre Luiz de Souza, Fabio Ferreira da Silva, Sabine N Guilhen, Rafael Vicente de Padua Ferreira, Leandro Goulart de Araujo, Joao Ezequiel de Oliveira and Julio Takehiro Marumo
Cell line-based research is a valuable tool for the study of cancer physiopathology and the discovery of new drugs for use in clinical practice. In this study, inductively coupled plasma mass spectrometry (ICP-MS) was used to estimate Ca, Co, Cu, Fe, K, Mg, Mn, Na, P, S, Se, and Zn in epithelial tubular cells (HK-2) and kidney tumor cells (Caki-1 cells). The most relevant difference was a decrease in the contents of Ca, Cu, Fe, K, Mg, Mn, Na, P, S, and Zn. A significant accumulation of Co was also detected in Caki-1 cells. The fold change variation of each element concentration between HK-2 and Caki-1 cells was Ca (��?0.40), Co (1.37), Cu (��?0.68), Fe (��?0.56), K (��?0.40), Mg (��?0.41), Mn (-0.54), Na (��?0.33), P (��?0.31), S (��?0.26), and Zn (��?0.73). These findings indicate that the elements mainly affect the metabolic pathways of epithelial kidney cells. Thus, our findings open a new avenue for RCC target therapy.
211 Inhibition of Reverse Transcriptase as A Clue for Curing RNA Viral Infections , Shimon Shatzmiller*, Ludmila Buzhansky, Inbal Lapidot, Galina Zats and Rami Krieger
Scientists provide evidence showing that delayed chain discontinuation is a plausible mechanism of action of Remdesivir. This mechanism was described previously in the context of reverse transcriptase (RT) inhibition of human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus
212 The Kawasaki-like syndrome in children- a further development of COVID 19? , Shimon Shatzmiller* Galina Zats, Inbal Lapidot, Ludmila Buzhansky and Rami Krieger
At first, we thought COVID-19 was not affecting children, and now we are dealing with a troubling issue where we have about 100 cases of childhood inflammatory disease that appear to be the virus, “Cuomo said in a statement.” New York is leading this investigation and we recommend all hospitals and providers Medicine prioritize diagnostic tests for each child who presents with symptoms of this disease [1].
213 pplication of Multi-Layer Perceptron Classification Model to Predict the Professional Direction of Sports Undergraduates Through Personality Traits , Cheng Hua* and Wang Dandan
Background & Aims: Personality traits play a stable and intrinsic role in the process of sport undergraduates coping with the multiple stresses of classroom academic performance and maintaining extracurricular sport. The purpose of this study is to determine the correlation of multilayer perceptron (MLP)models in predicting gender status and major choice among sport undergraduates. Method: Personality surveys based on the classic Eysenck questionnaire was carried out and MLPs feedforward neural networks with back propagation algorithm were processed by SPSS and cross-validated among the 332 undergraduates. Descriptive analyses and T tests were used to analyze the personality traits of the overall participating subjects. MLP models the original scores of items in the Eysenck Personality Scale were set as covariates, and "gender" and "major" was set to be the predicted output, respectively. Choose the best predictive models from all models. Results: The personality characteristics of subjects were more extroverted (t =20.838, p =0.000) and more neurotic (t =4.892, p =0.000) and unlikely to be psychotic (t =-0.321, p =0.749). The test outcomes are credible suggested by the Lie score (t =-17.679, p =0.000). The top four items that play an important role in predicting the gender are: N67, N28, E22, E1. The most important items of the E and N dimension scales in the "professional" prediction model are in turn: E85, E1 & N66, N28. Conclusions:The type of the personality model is ENql, meaning extroverted, neurotic, unlikely psychotic and trusted in the personality characteristics. The application of MLP prediction models is to help undergraduates in choosing their major more easily.
214 Survival Analysis of Multiple Myeloma Cancer (MMC) Using the Cox-Proportional Hazard Model , Lohuwa Mamudu*, Chris P Tsokos and Otunuga Oluwaseun E
Though multiple myeloma cancer (MMC) remains incurable, research into improving the therapeutic strategy has increased dramatically in recent years. But it is unclear if sustained improvements have been achieved. We studied the survival times of 48 patients diagnosed and treated with alkylating agents. The semi-parametric Cox proportional hazard model was employed to examine the survival probability taking into account the sixteen risk factors presumed to be contributing to the survival times. A careful and rigorous assessment of the risk factors based on the AIC of the stepwise selection technique revealed seven risk factors, and one interaction term are statistically significantly contributing to the survival times. They are blood urea nitrogen (BUN)/serum creatinine, white blood cells (WBC), Bence Jone protein in the urine (BJPU), fractures, proteinuria, gender, platelets, and the interaction of infections and serum calcium. The final Cox-PH model was well-validated and satisfied the key assumptions. The identified risk factors are rank according to the prognostic effect on the survival time based on the hazard ratio. Blood urea nitrogen (BUN)/serum creatinine was the greatest prognostic factor (most contributing factor, and highly negatively related to the MMC deaths or survival times), followed by white blood cells (WBC), and normal platelet was found to be the minimum prognostic factor (least contributing factor to MMC death or survival times). This study offers prognostic and therapeutic significance for further enhancement in the treatment strategy of the multiple myeloma cancer disease.
215 Essential Elements as Biomarkers of Metastatic Renal Cell Carcinoma , Maria Helena Bellini*, Alexandre Luiz de Souza , Fabio Ferreira da Silva, Sabine N Guilhen, Rafael Vicente de Padua Ferreira , Jo�£o Ezequiel de Oliveira and Julio Takehiro Marumo
Renal cell carcinoma (RCC) represents 3% of human malignant tumors and approximately 90% of malignant renal neoplasms. Despite great therapeutic advances in the last decade, metastatic RCC (mRCC) is still considered an incurable disease. In this study, we examined the potential of essential elements as biomarkers of mRCC using an orthotropic metastatic mouse model. Frozen lung and plasma samples from healthy and mRCC-induced mice were lyophilized, digested, and analyzed using inductively coupled plasma mass spectrometry. In metastatic lungs, a significant increase in Ca concentration (268%) was observed, whereas a significant decrease in Cu (23.2%), Fe (17.4%), Mn (38.8%), and Na (11.7%) was observed. The plasma of mRCC-induced mice showed decreased concentrations of Mn (53%), Na (19.7%) and Zn (49,50%) and increased levels of Ca (53%), Cu (39.5%), Our findings revealed marked differences in the concentrations of essential elements in the lung and plasma of the metastatic mouse model. The circulating levels of Ca, Cu, Mn, Na, and Zn could be utilized as diagnostic and therapeutic response biomarkers.
216 Effect of Dietary Intake of Supplement Fertylor15 Containing Astaxanthin and Other Compounds on Human Sperm: In Vivo and In Vitro Study , Guido Ambrosini, Alessandra Andrisani, Gabriella Don� , Chiara Sabbadin, Elena Tibaldi, Anna Maria Brunati, Claudia Radu, Eugenio Ragazzi, Decio Armanini and Luciana Bordin*
Chronic stress and endocrine disorders that result from environmental pollution, reactive oxygen species (ROS), and genetic abnormalities, are responsible of the idiopathic infertility. The aim of this study was to investigate the effect of a daily intake of supplement containing astaxanthin (Asta), known to ameliorate sperm viability in in vitro conditions, and other elements, on semen quality. Sperm from 34 volunteers were analyzed before (T0 ) and after (T1 ) 30 days of intake of supplement containing Asta, zinc, selenium, arginine, vitamins C and E, Coenzyme Q10 and folic acid. Semen parameters (sperm concentration, motility, morphology) and biochemical properties (rafts shifting, tyrosine phosphorylation (Tyr-P) and acrosome reaction (AR)) were evaluated. In additional 18 volunteers, Asta, all other components or both were analyzed also in in vitro conditions. Results show an improvement of sperm quality with a decrease of membrane-bound IgG. The percentages of cells achieving capacitation and AR were increased (28±8 to 52±10%, p<0.0001, and 24±5 to 46±7%, p<0.0001, respectively). The in vitro study assessed that Asta and other compounds had a synergistic positive effect on all the biochemical parameters, with no sperm DNA fragmentation. In conclusion, this dietary intake would be helpful in the treatment of no-complicated idiopathic infertility
217 Hybrid Reconstruction of the Upper Lip Following Major Cancer Resections , Badr M I Abdulrauf FRCSC
Major defects of the Upper lip due to cancer surgery are relatively less common compared to Lower lip. Standard techniques such as Karapandzic’s are capable of reconstructing up to fifty percent of the lip otherwise, microstomia and oral incompetence may result. The Upper lip has few aesthetic characteristic details due to the philtrum, its columns and cupid’s bows. Here we are proposing incorporation of an Abbe Flap to reconstruct the central unit of Upper lip, associated with Karapandzik flaps from both sides. Use of a Lip sharing concept has an additional advantage of producing harmony to the reconstructed region, and avoidance of crowding phenomena to the Lower lip.
218 Germicidal (Bactericidal) Power of Phytorelief (On Group A-Hemolytic Streptococcus) a Concept, Pilot Registry     , Giovanni Belcaro*, Umberto Cornelli, Maria Rosaria Cesarone, Roberto Cotellese, Mark Dugall, Ezio Bombardelli, Marcello Corsi and David Cox
This concept, pilot study evaluated the effects of some bactericidal products in vivo to evaluate the presence of Group A β-hemolytic streptococcus (GAS) in throat swabs. With this model, if an asymptomatic subject is swab-positive, bactericidal products can be used (i.e., for 3 to 7 days) and the positivity re-evaluated to define the direct killing power of the product. Results: A progressive decrease in positivity in the swab samples was observed. Bactericidal products (Phytorelief, in 2 formulations, baicalin, rifampin and benzydamine produced the disappearance of positivity in most subjects at 3-7 days. All oral bactericidal used in this pilot registry resulted effective in killing bacteria in >85% of cases. The pharmaceutical form (gummy, slow release lozenges) of Phytorelief seems to be important to assure persisting traces of the bactericidal/virucidal in the mouth. Phytorelief lozenges in 2 formulations, possibly, produced the longest action (>3 hours) due to the slower release of the substances (mainly pomegranate and ginger) in the product. Conclusions: These preliminary observations indicate a significant effect on Group A β-hemolytic streptococcus as previously seen on the viral contamination of the mouth (in COVID-positive subjects) with a relatively simple, cost-effective human model. The lower presence of a bacterial and virus charge (load) and its decrease may reduce contagiousness of most of these patients and possibly, the spread of bacterial/viral material from the mouth. The effects on the evolution of infections on single patients is, at the moment, not fully predictable with this model but oral bactericidal and virucidals may assume a significant community value in preventing and controlling spreading.
219 The Alteration of Teaching Tendency in View of the Corona Crisis, the Use of Electronic Communication Technology , Shimon Shatzmiller*, Rami Krieger and Inbal Lapidot
We got to a crossroads; we got from what we assumed was normal; things suddenly turned upside down. One of our main tasks now - for those of us who are not infected (yet ?), not working on the front line and not facing other economic or housing difficulties - is to understand this moment, what it may require of us and what may make it possible [1, 2].
220 The validity of myocardial perfusion using 99mTc-Tetrofosmin gated single-photon emission tomography (gSPECT) in the detection of coronary artery disease in different stages of chronic kidney disease , Khaled Elsaban*, Hijji AlSakhri , Yehea AlZahrani, Tohamy ElKholy and Hamzeh Aladwan
Background: Patients with advanced chronic kidney disease (CKD), subjected to hemodialysis (H.D.), May not manifest chest pain with severe coronary artery disease (CAD). Aim of the study: Study the value of radionuclide myocardial perfusion using gated single-photon emission tomography (gSPECT) in recognition of the frequency and risk factors of CAD in different stages of CKD patients. Patients and Methods: the current study divided 133 CKD patients (pts) into three groups according to CKD stage: 43 cases in stage 3, 43 in stage 4, and 47 in stage 5. Each stage included asymptomatic and symptomatic subgroups. The present study recorded the clinical evaluation, laboratory data (in the form of complete blood picture, fasting blood glucose and glycosylated hemoglobin (HbA1c), lipid profile, serum calcium and phosphorus, C-reactive protein [CRP]), together with imaging tests (Dipyridamole stress-rest gSPECT/C.T., coronary C.T. angiography and LVM index by echocardiography) for all patients. Results: the study included ninety-nine asymptomatic and 34 symptomatic patients. CKD 3 included 33 asymptomatic and ten symptomatic, CKD 4 included 33, and 10, while CKD5 included 33 and 14, respectively. The asymptomatic group presented forty-eight cases (48.5%) abnormal gSPECT (19 fixed and 29 reversible defects). Eleven of this abnormal gSPECT were in CKD3, thirteen in CKD 4, and twenty-four in CKD 5, with a statistically higher prevalence of abnormality in CKD5 (P 4) was dependent first of all on age, which consequently revealed the substantial role of D.M., LVH, and elevated CRP. Conclusion: stress-rest gSPECT is essential in the revealing of CAD in different stages of CKD, even in low-risk patients. High-risk CKD patients for CAD are those with D.M., LVH, and high CRP
221 Spinal Cord Stimulation inpatient with Tethered Cord syndrome: A Case Report , Simonova Jana, Komanova Blanka, Pataky Frantisek, Hudak Vladimir, Simon Robert* and Cuchrac Luks
Background: Neuromodulation techniques are an important part of the chronic refractory neuropathic pain treatment. Their effectiveness is insufficiently documented in patients with tethered cord syndrome. Case Description: We present the case of a 32-year-old woman with a history of myelomeningocele repair, followed by a detethering surgery complicated with cerebral fluid leakage. Her intractable pain in her left leg and low back was successfully treated with spinal cord stimulation. Pain intensity decreased from 8/10 to 1-2/10 on her visual analogue scale without regular analgesic intake and her quality of life improved significantly. Conclusions: A review of the literature documents only three case reports of similar efficacy of spinal cord stimulation in the treatment of pain in adult patients with tethered cord syndrome.
222 Prognostic factors related to angina frequency and health-related quality of life during the recovery period in patients with acute myocardial infarction: A follow-up study     , Sheng-Shiung Huang, Heng-Hsin Tung, Kevin Kau and Shiow-Luan Tsay
Background and Objective: Angina frequency (AF) and health-related quality of life (HRQoL) are important outcomes of acute myocardial infarction (AMI) survivors. The aim of this study was to identify the specific characteristics related to the changes of AF and HRQoL among AMI patients after treatment. Methods: We performed a prospective cohort study of 102 AMI patients in Taiwan. Data were collected at baseline and 1 month (T2), 3 months (T3), and 6 months (T4) after treatment. AF was assessed using the Seattle Angina Questionnaire (SAQ). The HRQoL was evaluated with the 12-Item Short-Form Health Survey (SF-12). The generalized estimating equation (GEE) model explored the prognostic factors related to the changes in AF and HRQoL. Results: Patients who received PCI had a reduction of the changes in AF compared with those in non-PCI group from baseline to T2 (B: -15.70, p < 0.05), T3 (B: -21.50, p < 0.05) and T4 (B: -22.91, p < 0.05). Occlusive vessels negatively associated with the changes in physical HRQoL from baseline to T3 (B: -11.44, p < 0.001) and T4 (B: -11.53, p < 0.05). Patients who had longer hospital stay (B: 0.86, p < 0.001) and jobs (B: 5.88, p < 0.05) showed better physical HRQoL from baseline to T3. Patients who were older (B: -4.56, p < 0.05) and unemployment (B: -6.86, p < 0.05) reported worse mental HRQoL. Conclusion: Higher risk AMI patients such as PCI therapy, older age, and occlusive vessels would take care carefully for promoting HRQoL and AF
223 Medical Investigations in Autism Spectrum Disorders. A critical review of the everyday practice , Elena Martinez-Cayuelas*, Sonia Milkova-Ivanova, Beatriz Moreno-Vinues, Maria Rodrigo-Moreno, Rebeca Losada-Del Pozo and Teresa Gavela-Perez
Objectives: To evaluate the outcome of medical examination in a population of children with autism spectrum disorders (ASD) and to describe its usefulness. Study design: In this cross-sectional study, we evaluated the records of 122 patients with ASD to analyze their clinical course, medical investigation and outcomes. Results: A total of 122 patients with ASD were included (0-18 years). Regarding the additional investigations, none of them has proved to have a high diagnostic yield in the absence of specific clinical features except from next generation sequencing (NGS), which showed a higher efficiency in comparison with the other genetic tests performed. Conclusions: Clinical context should be the main determining factor for the execution of additional medical investigations in children with diagnosis of ASD. Nevertheless, given its high yield, NGS would be indicated from the beginning in children with ASD as part of the etiological diagnosis
224 Development of Higher-Level Intellectual Skills through Interactive Group Work: Perspectives between Students and Educators , Florence Mei Fung WONG
Nursing education nurtures students to have adequate competence in managing current patient care with complex and sophisticated technology in healthcare service. Interdisciplinary collaboration is important for maintaining high quality and safe patient care. Small group work is effective for enhancing students’ theoretical knowledge and training in various skills. However, there is inadequate knowledge on how students develop higher-level intellectual skills to benefit their sense of collaboration through small group work. The aim of this study was to understand how undergraduate nurse students develop higher-level intellectual skills through small group work based on nurse students and educators’ learning and teaching experiences, respectively. This study was the secondary analysis of a qualitative study with 13 students and 10 educators using semi-structured group interviews with digital audio recording at a professional educational institution. Four skills were derived as main themes, including interpersonal communication, critical thinking, problem solving, and creativity, which enhance collaborative abilities. All skills were developed through interactive learning while working in a group. A theoretical framework was developed to illustrate the relationships among these skills through interactive group work. Interpersonal communication is the most important skill to be closely linked with other identified skills to enhance students’ interdisciplinary collaboration for a higher quality and more cost-effective care. The results will increase educators’ awareness in facilitating the development of these skills through interactive group activities.
225 Phytochemicals in Cereals and their Potential Health Benefits-A Review , Remya Mohanraj
Edible seeds of Poaceae are referred to as cereals. A lot of cereals have been the staple food for human populations from time immemorial and have been a significant source of energy and nutrients. Their consumption has always been linked to a wide array of health benefits that could be attributed to the rich amount of phytochemicals harbored in them. This review attempts to present a summary of the various phytochemicals present in cereals and their potential health benefits. This review has been compiled using information from various sources including scientific publications. Citations have been provided to credit the sources.
226 Preventive Cancer Screening: A Strategy to Reduce U.S. Healthcare Costs , Nicholas B Jennings and Howard J Eng
The Agency for Healthcare Research and Quality (AHRQ) estimated that the direct medical costs for cancer in the United States (U.S.) in 2014 was $87.3 billion, and it is projected that the cost to the U.S. taxpayer will rise to $173 billion in 2020 [1, 2]. In addition to the financial cost, cancer is the second leading cause of death in the U.S. [3]. Increasing access to and uptake of preventive cancer screenings could significantly reduce the burden of death and the cost of treating cancer in the U.S. We conduct a literature review to summarize knowledge about preventive cancer screenings in the U.S. including the burden of disease that currently exists in the population, the benefits of receiving preventive cancer screenings, the factors that act as barriers or predictors to receiving preventive care, cost effectiveness of selected preventive services, and the exploration of ways to increase the uptake of preventive services. Increasing preventive cancer screenings in the U.S. is an effective strategy to reduce health care costs.
227 An Immune-modulating Diet Maintains Food Intake during Cancer Chemotherapy , Naoki Nakaya*, Kentaro Nakamura*, Hidekazu Tonouchi, Yasutaka Senpuku, Mami Muramatsu, Yoko Takemasa , Ayako Izumi , Aya Tsuchiya , Seiko Ota , Itaru Sato Keita Koizumi and Hideo Nakajima
An immune-modulating diet (IMD), an enteral diet enriched with immunonutrition and whey-hydrolyzed peptides, has been shown to bring an improvement of prognosis by suppressing inflammation after surgery or under stress. In this study, we have experimentally and clinically examined the effect of the IMD in cancer chemotherapy. In experiments using colorectal cancer cell-transplanted mice, the mice fed with the IMD in combination with anti-cancer agent significantly tended to maintain plasma body weight excluding tumor, and to reduce plasma interleukin-6 (IL-6) levels compared with the control group. Furthermore, normal mice fed with the IMD elevated the level of plasma ghrelin, in particular acyl ghrelin. An clinical trial for a patient with malignant lymphoma revealed that the acyl/desacyl ghrelin ratio and total calorie intake was increased when the patient was supplemented with the IMD in conjunction with chemotherapy. These results suggested that the supplementation of the IMD during cancer chemotherapy might enable to maintain the food intake of the patients through elevating plasma acyl ghrelin levels.
228 Spinopelvic Anatomic Parameters Prediction Model of NSLBP based on open dataset , Cheng Hua*, Wang Ping, Yu Qing, Yao Baoyuan, Zhang Xiaoshuang and Zheng Xuemei
Objective: The purpose of this study is to perform analysis through the low back pain open data set to predict the incidence of non-specific chronic low back pain (NSLBP) to obtain a more accurate and convenient sagittal spinopelvic parameter model. Methods: The logistic regression analysis and multilayer perceptron (MLP) algorithm is used to construct a NSLBP prediction model based on the parameters of the spinopelvic parameters from open data source. Results: Degree of spondylolisthesis (DS), Pelvic radius (PR), Sacral slope (SS), Pelvic tilt (PT) are four predictors screened out by regression analysis that have significant predictive power for the risk of NSLBP. The overall accuracy of the equation prediction model is 85.8%.The MLP network algorithm determines that DS is the most powerful predictor of NSLBP through more precise modeling. The model has good predictive ability of 95.2% of accuracy. Conclusions: MLP models play a more accurate role in the construction of predictive models. Computer science is playing a greater role in helping precision medicine clinical research.
229 21st Century Transplantation: A rational utopia? , Felix Cantarovich
In his Utopia, Thomas More describes a generous conception of medicine. The current reality of organ transplants, with the drama of organ shortages, waiting lists, and patient mortality, requires a conceptual review. For the success of this request, the need of parts of the human body, live or after death is essential. Without organ donation, there are no transplants. The importance of non-enrichment at any level through organ and tissue transplants has been pointed out, significantly, by monotheistic churches and the World Health Organization (WHO). The value recently given to non-cognitive factors, as well as individual behaviour in community actions, when searching for social benefits has also been discussed. This essay proposes ways to change the present critical reality. Our analysis considers education and economic aspects to be of greater significance for changing social donation behaviour
230 Limits and Possibilities of Orthodontic Treatment of Patients with Skeletal Forms of Sagittal Anomalies , NV Popova*, OI Arsenina and АV Popova
The need to develop and improve methods of diagnos is and treatment of patients with deformities of the jaws is determined primarily by the frequency of it prevalence. Dental anomalies occur in 33.7 - 49% of those examined. To improve the effectiveness of orthodontic treatment of patients with skeletal forms of sagittal anomalies of occlusion of the dentition, it is necessary to conduct additional methods of examination, computer modeling of treatment results, drawing up a comprehensive treatment plan. Clinical case. Patient 33 years old. Skeletal III class, Mesial occlusion of dental arches, Narrow upper jaw, Tooth crowding, periodontal problems, gingival loss. After additional diagnostic methods, computer simulation of treatment was performed, various treatment options were considered.
231 Investigating Workplace Safety Programs in a Chemical Industry in Africa , Samukelisiwe Euphrasia Mabele and Muhammad Ehsanul Hoque*
Safety is a critical component in any organisation. The purpose of this study was to investigate the safety culture of a chemical industry in Africa. This was a cross-sectional study conducted among 124 employees from South Africa, Ghana, Nigeria, Kenya and Zimbabwe. Data were collected using self-administered questionnaire via online programme (QuestionPro). The majority of the respondents were satisfied with the overall organisational culture, workplace condition and the support provided by management to ensure employee safety within the organisation. The respondents attested to a positive safety climate, although some felt that it would be of benefit to recognise and reward safety performance. Employee awareness of ImproChem’s safety standards and the level of compliance were also satisfactory. More focus can be directed to increasing individual hazard recognition and elimination to ensure “No harm to anyone ever”.
232 Evaluation of Public Health Mass Campaign: Hesitancy and Event Ratios Method , Martin Ndinakie Yakum*
Several public health interventions administer drugs and vaccines to large number of people for preemptive or reactive intervention. These vaccines and drugs were developed in very narrow conditions in clinical trials and we therefore have to continuously monitor the efficacy in the field. This paper proposes a method to evaluate the efficacy in the field using data collected from the intervention coverage survey and surveillance. The design is closely related to cohort prospective studies except that the sample size is not fixed upfront and the measure of association not affected by the population denominator. It uses two new terms: hesitancy ratio denoted β, which is the ratio of the target that does to receive the intervention to the target that received it; event ratio is denoted by α is the ratio of health event or disease being prevented absolute incidence in the intervention group to that is in control group. It further shows that risk ratio (RR) can be calculated from these two parameters by taking their products. i.e. RR = α β. This method is therefore called Hesitancy and Event Ratios (HER) Method. We can conclude that this method is scientifically sound and can be used in the evaluation of public health intervention in the field. We recommend that this method be included in routine monitoring of programs for efficacy evaluation.
233 Getting it Right First Time in Trauma Clinic: How a Pandemic Improved Service Provision for Orthopaedic Patients , Jamie Hind*, Gur Aziz Singh Sidhu, Amit Kotecha, Christos Kitsis and Neil Ashwood
Introduction: The 2019 coronavirus outbreak (COVID-19) fast became a global pandemic. In the United Kingdom, guidlines were introduced to help control the spread of this virus. Hospitals made significant changes to accommodate for the change in demand. Orthopaedic trauma services needed to remain, however, the management of orthopaedic trauma needed modifying to comply with government and hospital guidelines. Method: Queens’s hospital, Burton, is a level III trauma unit. The orthopaedic department manages upper and lower limb trauma as well as head and chest and spine trauma. Injured patients can be referred to the orthopaedic team from the community or from the Major and Minor Emergency Department. To accommodate new guidelines, the orthopaedic department introduced a ‘virtual clinic’ and a ‘trauma clinic’. The virtual clinic took place in the morning and discussed referrals from the day before. The ‘trauma clinic’ followed on from the virtual clinic and lasted the remainder of the day. Results: The intervention introduced to Queens’s hospital was beneficial for patients, staff and for the hospital. It improved waiting times, reduced the time patients spent in hospital, reduced the number of hospital attendees and enhanced knowledge of common orthopaedic injuries for staffing involved in reviewing and managing these injuries. Conclusion: For our department, these changes improved service provision, staff education and patient safety. These benefits could be seen in other trusts if a similar method of managing trauma patients was introduced.
234 Double Headed?-Primary Giant Intracranial Melanoma , Kian Waleed*, Alguayn Farouq, Adam A Sharb, Shalata Walid, Yakobson Alexander and Abed Abo-Quider
A16 years old male admitted to the hospital complaining of headache, loss of vision and swelling of the upper part of the scalp. With four months’ history of headache, weightloss, gradual loss of vision and rapidly growing mass on his scalp. His past medical history was unremarkable.
235 Exceptional Design for an Adult Oral Health Screening Program, Qatar , Najat Abdrabbo Alyafei* and Sara Gibreel
Introduction: As a result of an increased life expectancy and reduced fertility, it is anticipated that by 2050 about half of the world’s population will be aged 60 years and above. This increased longevity has posed a challenge of adding health to life as progressive improvements in older people’s health that translate to longevity may be stalled. Physiological aging is usually associated with multiple chronic diseases, frailty, polypharmacy, and the loss of dependency and autonomy for daily living activities. Besides, reduced dexterity, impaired vision, and lower tactile associated with physiological aging pose an increased risk to oral hygiene. Furthermore, older adults, especially those with cognitive impairment, have more compromised oral health. Aims and Objectives: The aim of this heuristic designed project is to screen all adult patients, including those with a history of chronic diseases living and seeking dental services at the public sectors and other sectors in Qatar. To improve the treatment of oral health diseases, the overall oral health of older adults, and to develop a data repository of oral diseases in the elderly population under one national umbrella for the first time in Qatar. Project Design: This project is consisting of two tests, pre-test, and post-test design. The use of this design will allow us to understand the oral health challenges in Qatar. This screening’s expected outcome will reveal the critical factors and challenges that affect the oral health logistic system. It will also help in improving and identifying all oral health problems. Help in testing whether Qatar’s older population’s oral health screen effectively reduces the risk of poor oral health among this group. Oral health screening will be implemented as a regular intervention that will be delivered using the Oral Health Assessment Tool (OHAT) such as tongue, lips, saliva, dental pain, natural teeth, gums and oral tissue, and dentures. Expected Outcomes: The project is anticipated to support the practical application and real operational status of healthcare settings. Besides, it is anticipated that this project will optimize the chances for maximum impact once the program is implemented. Furthermore, it is expected that the project will include an essential part for decision making, evaluation, and justifications and will also hold key evaluation features for program impact and monitoring. Another expected outcome of this project is its ability to document programs effectively and identify significant opportunities for improvement with collected data. Finally, it is expected that this project will result in a model outline that will be implemented in both Qatar and across the globe to help merge the public sector and other sectors’ dental health data on a national level. Recommendation: Since the number of adults with a history of chronic diseases and have oral conditions is still unknown in Qatar due to the lack of a database, the authors recommend this project to help in building the background and database to assist dental practitioners, and policymakers develop specific and targeted programs that will support and provide treatment for the targeted population to improve the quality of life.
236 Q Kidney Risk Calculator- Useful Tool in Hospitals and Community , Alinda Sze Fung Chiu
A kidney health check was conducted over a day in two private hospitals (Peninsula Private Hospital and Beleura Hospital) in 2017. 243 participants enrolled in this study. The study population were mobile inpatients, members from the public and health workers (nurses, doctors, allied health workers and administrative staff). Method: A Q risk calculator was used to assess the risk of developing moderate and severe chronic kidney disease (eGFR < 60 mls/min) and end stage renal failure over the next 5 years. All participants consented prior to being involved in the study. Results: The majority was aged 65 to 75 years old (aged population). 18% of the participants were diabetic, 18% had cardiovascular disease, 37% were hypertensive, 5% were smokers, 28% of the participants were overweight and obesity was seen in 25%. Diabetic females are five times higher risk than non-diabetic females in developing chronic kidney disease stage 3 and 4. Male diabetics are three times more at risk than non-diabetic men in developing moderate to severe chronic kidney disease. However diabetic men are five times higher risk than normoglycaemic men in progressing into end stage renal failure Females with cardiovascular disease are five times higher risk than women with no cardiovascular disease in developing moderate to severe chronic kidney disease. Men with cardiovascular disease are three times higher risk than men with no cardiovascular disease in developing moderate to severe chronic kidney disease. Hypertensive women are ten times higher risk than normotensive women in developing moderate to severe chronic kidney disease. Interestingly hypertensive men are four times higher risk than normotensive male in developing end stage renal failure Obese men are three times higher risk than normal weight men in developing moderate to severe chronic kidney disease. Underweight females are three times at risk than normal weight females in developing moderate and severe chronic kidney disease. Summary: Qrisk questionaire is a quick and easy tool to assess risk of developing chronic kidney disease. Participants with diabetes, hypertension and cardiovascular disease have a higher risk of developing moderate and severe chronic kidney disease over the next 5 years. Overweight (body mass index 25 to 29.99), obese patients (body mass index more than 30) and interestingly underweight females with body mass index 18.5 or less have a higher risk of developing moderate and severe chronic kidney disease.
237 Scholastic and Cognitive Achievement Following Adenotonsillectomy in Children with Obstructive Sleep Apnea , Gomaa MA*, Mamdouh H, Khalaf Z, Abd El-hakeem WH and Zaky EA
Objective: To evaluate the effect of adenotonsillectomy (AT), in children with Obstructive Sleep Apnea (OSA), on the cognitive and scholastic achievement. Study Design: Prospective study Sitting: Tertiary care hospital (Minia university hospital) Subjects and Methods: 50 children were selected, complaining of symptoms of (OSA) and seeking adenotonsillectomy compared to another control group of 50 children without symptoms of OSA. The study sample were subjected to clinical evaluation where hypertrophied palatine tonsils and Adenoid were the cause of OSA. Polysomnography, audiological evaluation were done and All 50 children underwent a battery of neurocognitive tests including process-oriented intelligence scales (Stanford Binet Intelligence scale and Illinois Test of psycholinguistic ability) pre and post adenotonsillectomy to reveal the effect of (AT) on the cognitive and scholastic achievement of those children. Results: Children with OSA had lower scores in neurocognitive tests (Illinois test and Stanford Binet intelligent scale), as well as. In Academic performance in comparison to the control group. After 8 months from AT, the children with OSA demonstrated highly significant improvement in IQ, Mental age, auditory perceptual assessment (APA), PLA of VSM (Visual sequential memory), AA (Auditory association) VA (Visual association), AC (Auditory closure), VC (Visual closure), GC (Grammatic closure) and SB (Sound Blending). Conclusions: School performance and Neurocognitive functions are worsened in children with Adenotonsillar hypertrophy, this effect is reversible as improvement occurred after their removal.
238 Combined with Targeted Therapy Intensively Modulated Radiotherapy for Inoperable Giant Cell Sacral Tumor��?Three - Year Follow-up of a Rare Borderline Tumor with Literature Review , Lena Marinova*, Radoslav Georgiev and Kremena Petrova
Giant cell bone tumors are rare benign, locally aggressive neoplasms, involving predominantly young patients. In a 26-year-old patient with inoperable sacral giant cell tumor, definitive intensive-modulated radiotherapy (IMRT) up to total dose 64Gy with daily dose 2 Gy was performed. After 3 years of diagnosis and complex treatment (radiotherapy and targeted therapy) the patient is asymptomatic, with achieved local tumor control, without distant metastases and without dynamics in terms of bone recalcification. Radiotherapy is an alternative to surgery for axial bone localizations with a high risk of unacceptable postoperative deformities.
239 Plant-derived stimulants and psychoactive substances ��? social and economic aspects , Barbara Sawicka*, Olutosin A Otekunrin, Dominika Skiba, Bernadetta Bienia and Marek ��wintal
An analysis of the drug market was carried out, in the context of changing patterns of drug use, cultural and social factors as well as economic and links with wider crime. The drug markets remain one of the most profitable areas of economic activity of organized criminal groups. The impact of the drug market on society is enormous and goes beyond the immediate effects of their use. It involves participation in other types of criminal activity and terrorism, impact on legally operating companies and the economy, the burden on public institutions and corruption, as well as the impact on the whole society and its health. Globalization and technological development has accelerated the pace of changes taking place on the drug market. Geographically, this type of activity focuses on several existing for a long time, but also on new markets. Changes in this area pose a challenge for entities undertaking actions in response to problems related to the functioning of the drug markets, including those indirectly resulting from them. A detailed analysis of the conditions for growing the most common types of stimulants has also been made and the key information on this subject is presented in the following work.
240 Hypofractionated External Beam Irradiation with Single HDR Iridium 192 Boost in the Treatment of intermediate and High Risk Prostate Cancer Patients Initial acute and late side effects , James Fontanesi*, Jeffrey Schock, Sity Girgis, Fadi Eliya, William K Johnston III, Gregory McIntosh, William McDevitt, Victoria Williams, Giovanni R Fontanesi , Karen Roszczewski and Misbah Gulam
Purpose: Dose escalation has been shown to improve biochemical outcome in the treatment of prostate cancer. The use of precision radiotherapy whether using IMRT, proton’s or other appropriate means have been utilized in an effort to reduce side effects while engaging in dose escalation. However, it is well known that best way to ensure precision delivery of radiation is with the use of brachytherapy. In prostate cancer the use of HDR brachytherapy exploits the low α/β ratios. We sought to evaluate our combination of moderate hypofractionated external beam irradiation with a single HDR boost in terms of acute/late toxicity in patients with intermediate and high risk prostate cancer. Method: 69 patients whose age range from 49 to 83 (med = 69 y.o.) years old were offered treatment utilizing the combination of moderate hypofractionated external beam irradiation and single HDR boost. The external beam irradiation consists of 17 fractions of 250 cGy per fraction, which using BED evaluation most closely approximated our previous more conventionally delivered external beam (23 fractions/200 cGy per fraction) irradiation in this setting. All patients were treated with either 3D conformal or IMRT; within 2 weeks of completion of external beam irradiation a single 1500 cGy iridium 192 implant was delivered. Our dose constraints have been previously published but our stated goal was to delivered 98% of the dose to the prostate treatment volume identified by ultrasound. 29 patients received ADT at the discretion of the treating Urology team. Follow up has been maintained on all patients and has ranged from 11 to 53 months (median 37 months). Results: Assessment of acute / late toxicity was assessed using the RTOG/EORTC criteria. Overall 36/69 (52%) developed ACUTE GI toxicity. 49% developed Gr I/II while two patients developed Gr III. 14.5% reported late GI toxicity, all were GR I / II. Without surprise 98% reported acute GU toxicity. Of these 67/69 had Gr I/II with a single patient reporting GR III. However, after 6 months only 8 (11.5%) had persistent GR I/II issues. An additional patient went on to develop GR III toxicity. Conclusion: While further follow up will be required before definitive statements can be made regarding the oncologic effectiveness of this treatment combination, the early toxicity profiles are very encouraging. We continue to offer this treatment regimen for select intermediate/high risk prostate cancer patients.
241 Combined treatment modalities in wet AMD , Mitova Daniela
Introduction: ÐÐ�?D is a disease of social significance and an increasing incidence. The patients with wet AMD need a life-long treatment in order to sustain useful vision. The Anti-VEGF treatment does not ameliorate the dry component of the disease. That’s why an alternative treatment is highly needed. Aim: To propose an alternative treatment as an adjunct to the standard of care in an attempt to prolong treatment-free intervals, to ameliorate the degenerative process and to suppress tachyphylaxis. Methods: Nanosecond laser (2RT, Ellex) was used as an adjunct to Anti-VEGF treatment in the first group of patients and Triamcynolon subtenonially and Anti-VEGF in the second group. Patients were followed with visual acuity, FA, FAF, OCT, Angio-OCT. Results: 20 patients were followed in the first group-AntiVEGF+2RT. Improvement of BCVA was achieved in 85% (1 to 3 lines on Snellen). In the follow-up-4 months of treatment-free period was maintained in 6 patient; 2 patients had 12 months of treatment free period; 6 patients had 6 months of treatment-free intervals. Ten patients were followed in the 2nd group. Improvement or stabilization of visual acuity and up to 6 months treatment-free intervals were achieved. Amelioration of degenerative cysts in 2/3 of the patients. Conclusion: The combined treatment of wet AMD with Anti-VEGF and 2RT or Anti-VEGF and Triamcynolone subtenonially can ameliorate the degenerative process by tissue stimulation, and suppression of inflammation. It also shows the potential to elongate treatment-free intervals and diminish tachifilaxis.
242 Insufficient Sleep Correlates with the Natural Environment, Health Behaviors, and Selected Causes of Death , Ray M Merrill
Objective: To estimate the prevalence of insufficient sleep in the contiguous US and show how insufficient sleep correlates with selected natural environment factors, health behaviors, and causes of death. Design: An ecologic study design was used with measurements for each variable on the county level. Setting: A total of 3,108 counties in the contiguous US. Measures: Measurements were on the county level, which included altitude, sunlight, ambient air temperature, PM2.5, and precipitation, and selected health behaviors and causes of death. Results: Higher altitude is associated with better sleep, but this association is explained by lower average daily fine particulate matter, maximum air temperature, and precipitation at higher altitude. Improved sleep duration correlates with less air pollution, moderate sleeping temperatures, and less precipitation, which likely correlates with better health behaviors. Sufficient sleep may further improve by lower tobacco smoking, obesity, physical inactivity, and better diet. After accounting for the environmental and health behavior variables, insufficient sleep no longer had a direct effect on the causes of death, except for injury and motor vehicle accidents. Conclusions: Better sleep duration occurs at lower altitude and in places where there is less average daily fine particulate matter, more moderate maximum air temperature, and lower precipitation. Better sleep duration also correlates with less tobacco smoking, obesity and physical inactivity, and better diet. After accounting for the environmental and health behavior variables, insufficient sleep continues to have a direct influence on death, except rates associated with injury and motor vehicle accidents.
243 Overview of Cold Atmospheric Plasma in Wounds Treatment , Souad Mahmoud AL-OKLA*, Nasser Salim Al Nazwani and Fatin Abduljalil Al-Mudarris
Cold atmospheric plasma (CAP), a room temperate ionised gas, known as the fourth state of matter is an ionised gas and can be produced from argon, helium, nitrogen, oxygen or air at atmospheric pressure and low temperatures. CAP has become a new promising way for many biomedical applications, such as disinfection, cancer treatment, root canal treatment, wound healing, and other medical applications. Among these applications, investigations of plasma for skin wound healing have gained huge success both in vitro and in vivo experiments without any known significant negative effects on healthy tissues. The development of CAP devices has led to novel therapeutic strategies in wound healing, tissue regeneration and skin infection management. CAP consists of a mixture of multitude of active components such as charged particles, electric field, UV radiation, and reactive gas species which can act synergistically. CAP has lately been recognized as an alternative approach in medicine for sterilization of wounds by its antiseptic effects and promotion of wound healing by stimulation of cell proliferation and migration of wound related skin cells. With respect to CAP applications in medicine, this review focuses particularly on the potential of CAP and the known molecular basis for this action. We summarize the available literature on the plasma devices developed for wound healing, the current in vivo and in vitro use of CAP, and the mechanism behind it as well as the biosafety issues.
244 Implementation of Clinical Algorithms for Take-Home Naloxone and Buprenorphine/ Naloxone in Emergency Rooms: SuboxED Project Evaluation , Annie Talbot*, Rania Khemiri, A�¯ssata Sako, Luc Londei-Leduc, Christine Robin, Suzanne Marcotte, Gueni�¨vre Therrien, Genevi�¨ve Goulet, Genevi�¨ve Beaudet-Hillman , Christine Ouellette, Suzanne Brissette, Marcel Martin, Polina Titova and Pierre Lauzon
Introduction: Emergency departments (EDs) are often the first point of care for people at risk of opioid-related overdose, an issue on the rise in Canada. Dispensing take-home naloxone (THN) and/or initiating opioid agonist treatment (OAT) in the ED can help prevent overdose. Methods: The SuboxED (CC-BY-NC-SA) project evaluated the implementation of a clinical algorithm for dispensing THN and prescribing buprenorphine/naloxone (B/n) in three EDs in the province of Québec. We performed a retrospective review of ED electronic medical records flagged as “at risk of opioid overdose (ROO).” This study included an implementation process from April 1, 2018 to April 30, 2019, and an evaluation of the project implementation for eligible patients from May 1 to December 31, 2019. We also administered satisfaction surveys to medical teams and patients. Results: A total of 877 (36.2%) patient records were included in the analysis. Of these, 62% had a confirmed diagnostic of opioid use disorder (OUD) and 70.8% met eligibility criteria for naloxone prescription. However, only 7.7 % were given a prescription or take-home naloxone in the ED, and 12.4 % were initiated on B/n in the ED or in the community after the ED visit. Seven patients and 125 health care providers from EDs, clinics, and retail pharmacies completed the survey. Conclusion: The SuboxED project demonstrated the feasibility of implementing a clinical algorithm for dispensing THN and initiating B/n in the ED, and of evaluating its efficacy in the 6 months following implantation. In addition to advocating for free access to THN in EDs, scaling up the uptake of the algorithm in EDs is the next challenge.
245 Knowledge, Attitudes and Practices of Diabetes Amongst Diabetes Patients at A Primary Health Care Centre in Durban, South Africa , Akm Monjurul Hoque*, ME Hoque, Sandhia Singh, Yugeshin Chinnasamy and Maariyah Hoque
Background: Diabetes Mellitus (DM) is considered a major public health problem in South Africa and Globally. The condition is not well-managed globally and in SA. The most important known intervention for prevention and management of DM is lifestyle modification which depends largely on the knowledge, attitude and practices of DM patients and general population. The objective of the study was to investigate the knowledge, attitudes, and practices on diabetes among DM patients. Method: This was a cross-sectional prospective study conducted on diabetic patients attending a primary health care centre in South Africa between January to June 2018. Students t-test and ANOVA tests were conducted to find the mean difference of the knowledge, attitude, and practice scores among the demographic variables. Pearson’s correlation test was conducted to find the relationship between Knowledge, attitudes, and practice towards DM. All statistical tests were performed using two-sided tests at the 0.05 level of significance. Results: Most of the respondents were over the age of 45 years (87%), female (74%), had no education (58%) and unemployed (52%). Results showed that DM patients had poor level of knowledge, had better positive attitudes towards DM and the respondents were practicing positively towards the management of DM. DM patients in the age group of 46-55 years were practicing better towards DM compared to patients from age group of 25-35 years. It was also found that those had no income practiced significantly better than those earning >R3001 per month (p<0.05). It was found that knowledge was moderately positively correlated with practice towards DM (p<0.05). Conclusion: The knowledge and practice levels of lifestyle modifications and control of type 2 diabetes mellitus patients attending KwaDabeka Community Health Centre were generally poor. Nevertheless, majority of these patients have positive attitude toward healthy lifestyle habits which could potentially be harnessed and translated into healthy lifestyle practices. Health education intervention through Health Care Workers might improve the knowledge, attitudes and practices of the DM patients regarding DM.
246 Knowledge, Attitude and Behavior Towards Oral Health Care Among Parents/Caregivers of Children with Disabilities in Qatar , Najat Abdrabbo Alyafei*, Bushra Naaz Fathima Jaleel and Tintu Mathew
Background: Parents/ caregivers oral health knowledge, attitude and behaviors can either facilitate or hinder their child’s oral health care or oral heath promoting behaviors. The perspective of parents/caregivers has a significant bearing on the oral health, particularly for the disabled children. Objective: To assess the knowledge, attitude and behavior towards oral health care among of parents/ caregivers of children with disabilities and to evaluate the association between education level and oral health knowledge, attitude and behaviors. Methods: This cross-sectional, questionnaire based, descriptive study was carried out among parents/ caregivers of children with disabilities, who attended 8 Special Needs schools in Doha, Qatar. Data was analyzed using Spearman’s test and Kruskal-Wallis test. Results: Majority of the parents/caregivers knew that oral health affects general health and recognized that inadequate tooth brushing caused tooth decay. The mean knowledge, attitude and behavior scores were 7.81, 3.61 and 2.91 respectively. Highly significant correlation was found between parents’/ caregivers’ knowledge and attitude (p<. 001) as well as parents’/caregivers’ knowledge and behavior (p<. 004). Knowledge, attitude and behavior scores were significantly associated with education level. Conclusion: Parents/caregivers of children with disabilities possess good oral health knowledge, very positive attitude and favorable behavior towards their child’s oral health. Education plays an essential role in shaping their knowledge, behavior and attitude with regard to their child’s oral health care and should be taken into consideration while designing Oral Health Promotion programs.
247 Why, Now, Just Before the Vaccine Arrives, are Experts Worried? , Shimon Shatzmiller
Vaccines based on mRNA have been known for years to be the most effective for influenza [1]. The technology allows the use of CRISPR and quick and efficient adaptation to situations of different strains of the virus that bring about the different diseases [2].
248 Complications Versus Lawsuits , Badr M I Abdulrauf, MD FRCSC
Not every medical claim or lawsuit is necessarily result of a complication or a malpractice. This is especially true in Plastic surgery practice.
249 Successful Reduction of SARS-CoV-2 Viral Load by Photodynamic Therapy (PDT) Verified by QPCRâ?A Novel Approach in Treating Patients in Early Infection Stages , Hans Michael Weber*, Yasaman Zandi Mehran, Armin Orthaber, Hadi Hosseini Saadat, Robert Weber and Matthias Wojcik
Background: The Covid-19 pandemic is affecting Global Health and the world‘s economy dramatically since early 2020. After a temporary slowdown in summer 2020 the infection numbers and death rates have been increasing again in recent months leading to various restrictions of social and economic life in many countries. Latest developments of new vaccinations seem to be promising; however large-scale production and worldwide distribution logistics take time while questions such as length of immune protection, long-term side-effects etc. are remaining unclear at this point. Furthermore, vaccination is a preventive approach and not a therapy for acutely infected patients. Thus, there are still therapies needed to help people with Covid-19 Infections. The objective of this study was to evaluate if Photodynamic Therapy (PDT) with Riboflavin and a specially designed light treatment kit would be able to fill this gap and to help people in early stages of infection. This may lead to a relief of the hospitals and intensive care stations. Methods: This study was made up of two groups with 20 patients each with the experiment (verum) group receiving Photodynamic Therapy and daily testing and a control group receiving conventional care plus testing. All patients in both groups had positive Covid-19 test results at the beginning of the study being in an early infection stage with mild symptoms like fever, dry cough, headache, hard breathing, fatigue etc. QPCR tests with CT-viral load were performed on day 1, 2, 3, 4, 5 and 7 in the experiment group and on day 1, 3, 5 and 7 in the control group. Results: All 20 patients in the experiment group showed significant improvement in clinical symptoms and viral load assessment within the 5 days of PDT treatment. 14 out of 20 patients had a negative QPCR test after 5 days of treatment with PDT while the other 6 patients also showed significantly reduced viral load. 20 patients in the control group with conventional care were tested 3 times within 5 days and no significant improvement could be seen clinically or in viral load assessment. Conclusion: In this primary study the potential of Photodynamic Therapy (PDT) against SARS-CoV-2 could be shown in early infections stages. PDT proved to be successful in improving clinical symptoms, lowering viral loads and in preventing hospitalisation and intensive care treatments. This treatment is easy to perform, cost effective and can be done at home. It can be used for prevention after contact with infected people or in case of positive testing but also in early cases with mild to moderate clinical symptoms.
250 Lamivudine Revisited: Long-Term Treatment of Relatively Low-Viremic Hepatitis B Patients on Higher-Dose Lamivudine , Brianna Shinn, Christopher Cao, Christopher Roth, Nathaniel Brown and Hie-Won Hann*
Hepatitis B virus (HBV) is a significant global health problem with more than 350 million people chronically infected. Currently it is believed that HBV is responsible for 50% of hepatocellular carcinoma (HCC) worldwide [1-3]. While a cure for HBV is still needed, several oral drugs that suppress viral replication exist. In the United States, six nucleos(t)ide analogues that have been approved at different time periods include lamivudine (1998), adefovir (2002), entecavir (2005), telbivudine (2006), tenofovir disoproxil fumarate (2008) and tenofovir alafenamide (2016).
251 A Studentsâ? Health Centre Design for Qatar , Najat Abdrabbo Alyafei
Introduction: School health services have the purpose of ensuring that all students are ready to learn by ascertaining that they are in good health. More than 2.3 billion school-aged children have been reported to spend a third of their days in the school environment1. Such findings underscore the need to establish school health centers (SHCs) that exclusively promote students’ physical, social, and psychological health of school children, yet currently non-existent in the State of Qatar. Aim: The present paper aims to propose the establishment of SHCs in Qatar, and to envision the impact of these comprehensively and uniquely designed Student Health Care Centers (SHCs) for school children health and wellbeing in Qatar. Student’s Health Center Design: Qatar prioritizes student’s health as part of its high-quality health care services. Qatar’s student health will benefit from establishment of comprehensive school health center services. Recommendation: This paper presents an SHC design that may be used in the State of Qatar. Identical SHC design may be applied in other countries also to improve the health, and quality of life among school children by creating a platform for rendering multidisciplinary health care services and health promotion to school children.
252 eNOS 894T allele can Contribute to Endothelial Dysfunction but not QT Interval Prolongation in Dialytic Patients     , Jessica L. F. Andrade, Guilherme B. Nogueira, Maria H. Bellini, Frederico Mancuso, JoÃ?£o P. Kleine, Ismael D. C. G. Silva, Giovana R. Punaro, Elisa M. S. Higa
Background: Cardiovascular complications are common in chronic kidney disease (CKD) patients. Endothelial nitric oxide synthase (eNOS) is very important for the homeostasis of the cardiovascular system, and its gene polymorphism at position 894 (G>T) has not been investigated with QTc interval in patients on dialysis. Objective: This study evaluated the association of the 894G>T polymorphism with QTc prolongation and endothelial dysfunction risk in dialysis patients. Methods: Predialysis blood samples were collected for eNOS gene polymorphism, nitric oxide (NO), thiobarbituric acid reactive substances (TBARS), total antioxidant, asymmetric dimethylarginine (ADMA) and L-arginine, and 12-lead electrocardiograms were analyzed in these patients. Statistics were based on continuous and categorical variables using Fisher’s exact or Chi-square or one-way ANOVA or KruskalWallis tests. The results were considered significant when P < 0.05. Results: The study showed that the GG genotype was prevalent, with 54% of patients, followed by 41% GT and 6% TT, and the genotypic distribution was not associated with QTc prolongation. Furthermore, patients with the T allele showed increased ADMA, L-arginine and peroxidation lipid levels with reduced NO synthesis. Conclusion: Our study showed a lack of association between QTc interval and eNOS polymorphism; however, it was found that patients with the T allele had a greater risk of developing endothelial dysfunction by ADMA, which could contribute to future cardiovascular complications and worsening of CKD.
253 A Political-Health Emergency: Ending Social Tragedy of Organ Shortage , Felix Cantarovich
The transplantation of organs and tissues became a medical reality in the 1950s. Fundamentally, it generated the possibility, never achieved except by haemodialysis in the case of the kidney, to solve end-stage organ failure.
254 I have the floor: Naturopathy or Naturosophy? , Alexandros Senarelis Sinaris
The problem is embedded archetype information within the infinite potentiality of the cosmos. So does any human pathology, syndrome, disease, and unhealthy lifestyle. But this potentiality in our days shows an alarming increase. The COVID 19 pandemic is a good example. A single-cell organism, equipped with an unseen -for the naked eye- protein (SARS-CoV-2 S), has created a worldwide pandemonium. All of a sudden, from a “zoonotic” animal origin (and not an artificial one) virus, our external environment and internal ecosystem are in jeopardy. A black cloud of fear, confusion, disorder, madness, insecurity, agony, illness and death is swirling like the perfect storm around us. And all these frightening “bat-terfly effects” from a tiny, invisible intruder. However, if you see the whole phenomenon from a different perspective (anamorphosis), sometimes from something big, one can understand the offset powers of something small; the abstract notions of size, level, symmetry and balance (equilibrium). The more we zoom into the complex world of the problem, our microscope-like attitude enlarges it. As a result, we get absorbed and, one by one, become coalesced, making it bigger and bigger. But the truth is that a minuscule virus is inside a big world, and not a big world inside a tiny virus. And this world is not a beautiful place. It is not a moral, righteous, reasonable creation of angels.
255 Post-Operative Nasal Obstruction: Comparison between External and Endoscopic Dacryocystorhinostomy     , Youval Slovik, Waleed Kian* Tova Monos, Melanie Zemel, Moshe Puterman, Erez Tzumi and Farouq Alguayn, Sabri El-Saied*
Objectives: The objectives of this study is to compare between endoscopic and external dacryocystorhinostomy (DCR) procedures with regards to both objective and subjective parameters, i.e., incidence of long term post-operative nasal obstruction and patientreported quality of life. Study Design: Prospective study Setting: Tertiary Care University Hospital Participants: Study population included 24 patients undergoing either endoscopic or external DCR with bicanalicular silicone, at the Department of Otorhinolaryngology and Head and Neck Surgery in (removed for blind peer review 1). Main outcome and measure: Changes in nasal resistance was determined by anterior rhinomanometry, and quality of life was assessed by mini rhinoconjuctivitis quality of life questionnaire (MRLQ). Results: Post-operative nasal resistance was significantly increased upon both endoscopic and external DCR (p=0.04); this outcome was temporary and returned to normal after stent removal. Quality of life (QOL) exhibited a significant bimodal improvement in both groups 3 months after the operation (p=0.03), as well as after stent removal (p=0.01). Conclusions: While endoscopic and external DCR with silicone tube stenting both lead to an improvement in quality of life, a significant temporary objective nasal obstruction occurs, more prominently after the endoscopic procedure. Pending future studies, this observed discrepancy may be an appropriate matter to convey to prospective patients prior to choice of procedure.
256 Frequency and characteristics of thyroid dysfunction in pregnant women ? screening of 547 women in Bulgaria , Anna-Maria Borissovа, Boyana Trifonova, Ludmila Ivanova , Lilia Dakovska , Eugenia Mihailova and Mircho Vukov
The Recommendations of the European Thyroid Association’2014 have been widespread among the medical community for many years. In them as well as in the latest Recommendations of the American Thyroid Association’2017 the first recommendation is related to the development of population-based reference limits based on data from the local population. he aim is to study the current functional thyroid status in pregnant Bulgarian women and to carefully assess in the light of modern understandings the specific diagnostic and therapeutic approach for our population. Material and Methods: The study was conducted as a cross-sectional multicenter population-based study, which included 547 pregnant women, mean age 30 ± 5 years. Fasting morning venous blood (TSH, FT4, TPOAb - determined by ECLIA method) and fresh morning urine sample (to determine urine iodine concentration) was taken, ultrasound examination of the thyroid gland was performed. Results: Based on the accepted cut-off for TSH according to the Recommendations of ETA’2014, the studied pregnant women were divided into six groups: Subclinical and Clinical hypothyroidism; Subclinical and Clinical hyperthyroidism; Euthyroid; Low T4 syndrome. Almost 2/3 of pregnant women have TSH < 2.5 mIU / L. Undiagnosed hypothyroidism is present in 121 pregnant women (22%), which is a bad feature of our health system. The data were analyzed in two TSH cut-offs (ETA’2014 and ATA’2017) and it was found that the increase in TSH cut-off for the first trimester did not change the absolute number of undiagnosed and untreated pregnant women with Clinical hypothyroidism, increasing 2.5 times its relative share, from 25.6% reaching 63.3% of all undiagnosed cases of hypothyroidism. Conclusion: Increasing the cut-off of TSH would unrealistically calm and neglect the follow-up of the pregnant women which is very dangerous. Efforts should focus on early screening for verbally identified risk factors. Of course, it is necessary to develop a national standard for TSH, which would serve more accurately to assess the thyroid status of pregnant women in the Bulgarian population
257 Does Cervicogenic Headache Result in the Presence of Neural Tension, and Does this Affect the Position and Mobility of Atlas? , Rob Sillevis*, Eric Shamus and Karen Wyss
Background: Cervicogenic headaches (CGH) can be the result of dysfunction of the upper cervical spine. Due to the soft tissue connection between muscle, cervical fascia, and dura, this region might contribute to the development of CGH. Objective: Evaluate if subjects with CGH have neural tension signs. The secondary objective was to investigate if a correlation between the position and mobility of atlas and cervicogenic headaches exists. Methods: 60 Subjects were recruited. Self-reported outcome measures, passive neck flexion rotation test, upper limb tension test (ULTT), slump test, and straight leg raise test (SLR) were assessed. Results: There was a significant difference in atlanto-axial rotation to the right with p=0.025. There was no statistical significance in left rotation. There was no significant relationship between CGH, ULTT, slump and SLR with P>0.05. Atlas position was significantly related to CGH with P<0.001, and position of the atlas was significantly related to atlanto-axial motion with p<0.001. Discussion: There is a direct relationship between the position and mobility of atlas and CGH. Fascial connections between structures could result in dural tension and should be considered when managing patients with CGH. The use of the ULTT, Slump test, and SLR test does not appear to be beneficial in identifying those with CGH.
258 Factors Associated with Biofilm Persistence on Different Surfaces, Spread and Pathogenicity , Effiok Warrie William Egwari Louis Osayenum*, Olasehinde Grace Iyabo, Akinnola Olayemi Oluseun, and Kilani Adetunji Musbau
The conglomeration of microbial life on a self-produced extracellular polysaccharide (EPS) matrix for mutual co-existence and protection against external aggression and adverse environmental conditions best describe biofilms. This community of microorganisms confers a number of survival and nutritional benefits to members while at the same time portend great ecological and health concern. Biofilms can form on virtually any surface; terrestrial, aquatic, plants, animals and on medical devices and implants. The ability of biofilms to disperse from the parental stalk ensures continuous survival and spread within their ecological niche. Biofilm organisms therefore possess unique survival mechanisms over their plancktonic form and have contributed to our understanding of the mechanisms of pathogenicity of infectious microorganisms. This review highlights trends in the understanding of biofilms and emphasized their health significance.
259 An Exploratory Qualitative Study of Parentsâ? Views on a School Oral Health Program , Dr. Najat Abdrabbo Alyafei, Dr. Bushra Naaz Fathima Jaleel
Introduction: School-based oral health programs enhance the oral health knowledge, practices and attitudes of children by employing oral health education, promotion, prevention, treatment and/or referral services to reduce the prevalence of oral diseases among school children. Periodic evaluation of School Oral Health Programs is essential to assess the impact of the program, its effectiveness, acceptability and to promote quality improvement. Objective: To explore the parents’ views on Asnani (My Teeth) School Oral Health Program. Materials and Methods: This descriptive, exploratory, cross sectional study was conducted among parents of children in public primary schools of Qatar, who had participated in Asnani (My Teeth) School Oral Health Program. Primary data on parents’ views, experiences, opinions and suggestions towards Asnani School Oral Health Program was obtained utilizing open-ended questionnaires. Thematic analysis was employed for the organization of the rich descriptive data, while deriving at themes which convey the explicit and implicit interpretation of the data collected. Results: Qualitative responses from 359 parents revealed five principal themes i.e. Perceived value, Reinforcement of Oral Health Education and Promotion, Frequent dental check-ups, Continuity of care and Additional school-based activities. Conclusion: Perceptions of parents regarding the Asnani School Oral Health Program disclosed in this study provide valuable insights about their acceptability of this school based oral health program. The results are also encouraging as the parents realize the importance of oral health for their children and recommended need for reinforcement of the oral health education and promotion.
260 Nasal Myiasis: A Neglect State , Delwar AHM*, Mazumder JA, Rashid MS, Mustafa MG and Swamy KB
Background: Nasal myiasis is a parasitic condition of human being and animal species in which nose and paranasal sinuses infested by Diptera Larvae of Chrysomya albiceps and Oestrus ovis group of flies. It is rare and sporadic, usually occurs in adults, the elderly, debilitated poor, and neglected patients suffering from chronic Sinonasal diseases. Methods: A cohort retrospective study of 11 cases in the Department of Otolaryngology and Head-Neck Surgery, Comilla Medical College Hospital, Cumilla, Bangladesh from 01 July 2016 to 31 June 2020. Results: Incidence of nasal myiasis out of total admitted in the inpatient department was 0.03%. Of them, the female was 10 (90.91%), the male 01 (9.09%) (P-value <0.001), age range 35-70 years, the adult was 09 (81.82%), and the elderly 02 (18.18%) (P-value <0.001). The left nostril exhibited 08 (72.73%), and right nostril 03 (27.27%) (P-value <0.05). Social class showed poor was 08 (72.73%), and lower middle class to working 03 (27.27%) (P value< 0.05), villagers was 09 (81.82%), and slum dwellers 02 (18.18%) (P-value <0.001), Sinonasal mass was 07 (63.64%), and atrophic rhinitis 04 (36.36%) (P-value <0.001), Sinonasal malignancy was 06 (85.71%), and benign 01 (14.29%) (P-value <0.001). Conservative traditional treatment was 07 (63.64%), and endoscopic removal 04 (36.36%) (P-value <0.001), recovery without complication was 10 (90.91%), and complication occurred in 01 (9.09%) (P value<.001). Conclusion: Nasal myiasis is a progression of other disease processes of the nose and paranasal sinuses of adults and the elderly in a low socioeconomic group of people. They need extra care medical services to overcome it.
261 Cancer Treatment with Per Os Administered Methotrexate , Kazuo Maeda
As new anticancer agents are tried cancer treatment, the author remembered complete remission of choriocarcinoma and metastases with methotrexate (MTX) administered within some months, to get normal uterine pregnancy and usual life, thus wondered non-sergical MTX treatment of human common cancer, and several cancer treatments in Pubmed and NIH reports with success.
262 Effects of Flavonoids from Scutellaria Baicalensis Georgi Stems and Leaves on Learning and Memory Ability of APP/PS1 Transgenic Mice , Ding Shengkai, Miao Hong, Gao Yang, Guo Qing*, Shang Yazhen*
Introduction: APP/PS1 transgenic mice are established natively AD-like animal model. The present study used this animal model to study the effects of stems and leaves flavonoids from Scutellaria baicalensis Georgi (SSF) on APP/PS1 transgenic mice learning and memory ability with Morris water maze, jumping platform, dark box and shuttle box test. The results demonstrated that SSF markedly improve the learning and memory ability in APP/PS1 transgenic mice, and the four behavioral tests of Morris water maze, jumping platform, dark box and shuttle box are also suitable methods for evaluating the learning and memory ability of animals. Objective: To study the effects of SSF on the learning and memory ability in APP/PS1 transgenic mice by several behavioral experiment methods. Methods: APP/PS1 transgenic mice were randomly divided into model group and three doses of SSF treated groups. While, the same period C57BL/6J mice were used as the control group. The APP/PS1 transgenic mice in the drug group were given continuous daily and orally administration of 50, 100 and 200 mg/kg SSF for 77 days. On the day 51 of administration, four behavioral experimental methods, including Morris water maze, jumping platform, dark box and shuttle box were supplied to test the learning and memory ability of all mice and continually administered SSF during the test. Results: Compared with the control group, Morris water maze test found that model group mice had a significant longer latency to find the hidden platform, shortened swimming time in the target quadrant, and reduced number of crossing platforms (P<0.05, P<0.01). The detection of jumping platform and dark box showed that the latencies of the model group for jumping off the platform and entering the dark box were significantly shortened, and error times received by electric shocks was significantly increased (P<0.05, P<0.01). The shuttle box test reported that the number of active avoidance in the model group was significantly decreased, while the times of passive avoidance and non-response were significantly increased (P<0.05, P< 0.01). However, the three doses of SSF markedly shortened or prolonged the latency of APP/PS1 transgenic mice to find the hidden platform, jump off the platform and enter the dark box, as well as reduce the errors times of electric shock (P<0.05, P<0.01). Conclusion: SSF can improve the learning and memory impairment of APP/PS1 mice by different behavioral test.
263 Apocrine Breast Carcinoma - Pathohistological And Immunohistochemical Analysis, Prognosis and Complex Treatment     , Lena Marinova*, Snezhinka Vicheva and Dorothea Malinova
Apocrine breast cancer (ABC) is a rarely diagnosed pathomorphological subtype of invasive ductal carcinoma of the breast. We present a clinical case of apocrine breast cancer in a 36-year-old woman. A left-sided breast-preserving surgery (quadrantectomy am blok with underlying muscle fascia) and axillary lymph dissection at all three levels were performed. The complex treatment is continued with adjuvant chemotherapy, followed by radiotherapy of the left mammary gland. The pathomorphological and immunohistochemical characteristics of apocrine breast cancer, the prognosis and the necessary complex treatment are discussed. Immunohistochemical (IHC) analysis of apocrine carcinoma cells reported a characteristic steroid receptor profile with negative IHC expression for estrogen and progesterone receptors and positive for androgen receptors. ABC is prognostically similar to invasive ductal carcinoma / NOS. Apocrine breast cancer needs to be classified as a separate nosological unit, due to growing evidence of a different hormonal profile with different clinical behavior following androgen deprivation therapy.
264 Alzheimer Plaques visualized by in situ DNA Hybridization with Molecular Beacons specific for Borrelia? a novel histomorphologic application , Alan B. MacDonald
Background: This case describes a novel application of Molecular Beacons, which are a patented technology, for the detection of DNA in tissue sections from an infectious microbe, namely Borrelia burgdorferi, the etiologic agent of Lyme borreliosis. A 65-year-old man with Alzheimer’s disease and previously well documented spinal fluid neuroborreliosis eight years prior to death is the subject of this report. Neuroborreliosis in its tertiary from has been linked to some cases of Alzheimer’s disease (1. -4.) Findings: Molecular beacons designed from the flagellin b open reading frame (BBO 147) of Borrelia burgdorferi, strain B31 demonstrated positive fluorescein signals indicating successful probe hybridization with discrete 4 sharply demarcated rounded foci within tissue slides from autopsy hippocampus. Conclusions: Molecular beacons, carefully designed to hybridize only with the DNA of a target pathogen (after a comprehensive search of the entire human genome to confer probe specificity) are powerful molecular interrogators for evidence of tissue infection. The implications of the application are far reaching in the study of neurodegenerative diseases which might (like General Paresis and Tabes Dorsalis) be sequelae of chronic bacterial infection in the central nervous system.
265 A Nerve Sparing Procedure for Posterior Access Thoracolumbar Fracture Surgery , Nissim Ohana, Dimitri Sheinis and Daniel Benharroch
Background: Treatment of thoracolumbar fractures often requires surgery, but there is no consensus as to the preferred method. The results of a nuanced surgical procedure use a posterior approach and aimed at preserving the integrity of the neural elements. Methods: The files of 14 patients who underwent surgery for complex thoracolumbar fractures at a single tertiary hospital during a four-year period were reviewed. During a single-stage procedure, performed via a posterior approach, a titanium mesh cage was inserted into the vertebral cavity using a maneuver which protected the nerve roots. Outcome measures included neurological status, sagittal profile of the spine, spinal stability, height restoration and decompression. Results: Seven patients presented with Type A fractures according to the AOSpine classification, three of them with two simultaneous fractures. One patient suffered from a type B fracture and three patients from type C fractures. While most patients displayed a preserved neurological status, three were paraplegic on admission (Frankel grade A). The suggested procedure has allowed for direct canal decompression and has resulted in immediate stability and optimal height restitution. The spinal profile has also improved. Conclusion: The nerve sparing procedure offered considerable benefits to the patients. Additionally, the technique may be applied also to fractures above and below the T11-L2 segment, and to patients with Frankel grade A lesion.
266 Pathohistological and Immunohistochemical Analysis of Primary Invasive Ductal Breast Carcinoma with Signet-Ring Cell Differentiation- Differential Diagnosis, Prognosis and Complex Treatment     , Lena Marinova*, Bistra Yordanova, Nikolay Evgeniev, Dorothea Malinova
Primary signet ring cell carcinoma (PSRCC) of the breast is a rarely diagnosed neoplasm. We present a 76-year-old woman with a tumor formation in the left mammary gland, who has been self-medicating for a year. Pathohistological and immunohistochemical analysis proved rare primary invasive ductal carcinoma with focal (over 90%) signet ring cell differentiation, size 4 cm / 3.5 cm / 2 cm, moderately differentiated (G2). Complex oncological treatment, including radical mastectomy with axillary dissection, 6 courses of systemic adjuvant chemotherapy, radiotherapy of the chest wall and regional lymph nodes with TD 46 Gy and antiestrogenic hormone therapy, was performed. The diagnosis and the differential diagnosis of this rare tumor require precise pathohistological and immunohistochemical analysis. The prognosis and complex treatment depend on the clinical stage, hormonal and HER2 status. In locally advanced PSRCC of the breast with moderately differentiation, the combination of surgery, systemic chemotherapy, postoperative radiotherapy and antiestrogenic hormone therapy achieves long-term local tumor control without distant metastases for nearly two years.
267 SARS-CoV-2 Pandemic in Algeria , Samir Djemli*, Abdelkrim Tahraoui, Mabrouk Boussena, Samia Messikh, Faiza Rouag, Ines Refes, Ibtissem Chouba, Mohamed Kouadria and Rouya Memouni
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a recently discovered coronavirus. The majority of people with COVID-19 will only experience mild or moderate symptoms and will recover without special treatment [1]
268 The new â?New York Mutationâ�? â�?�? the new form of the Devi , Shimon Shatzamiller*, Inbal Lapidot, Galina Zats, Rami Krieger
In New York we see a first case of a more contagious virus strain than someone infected, with no known travel history, tested positive for the new version of COVID-19
269 Diagnostic Value of FTIR Spectroscopy, Metabolomic Screening and Molecular Genetics in Saliva for Early Detection of Oral Squamous Cell Carcinoma (OSCC) , Kalpani Senevirathna, Nadeeka U Jayawardana, Ruwan D Jayasinghe, Bimalka Seneviratne* and AG Unil Perera*
Oral cavity cancer (OCC) has become a prevalent malignancy worldwide. Despite, the current developments of diagnoses and therapies, the 5-year survival rate has persisted at a dismal of 50% in recent decades. Histopathological evaluation remains the golden standard method for cancer detection. However, in some cases the histopathological assessment may not be able to give a definitive diagnosis due to pitfalls in the interpretation of biopsy samples. There are well identified benign conditions in the oral cavity that could mimic malignancy. Hence, it is a timely approach to understand the utility of other emerging techniques which could be used in conjunction with the histopathological assessment. Attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy has been employed extensively to diagnose various diseases by determining the chemical and molecular alterations. As a cost-effective, minimally invasive or non-invasive and label-free, bio spectroscopic technique this could be developed into an excellent diagnostic tool in the years to come. Besides this, OCC is known to alter the composition of metabolites in saliva. Analysis of the metabolomics in saliva of OCC patients could provide additional information that would be useful to establish a panel of biomarkers with regard to early detection. Furthermore, the rising epidemiological significance underlines the requirement of a better understanding of molecular mechanisms and the recognition of extrapolative tumor markers. Thus, gene expression analysis plays a vital role in identifying those genes related to the progression of this disease. In here, we review the potential applications of FTIR analysis in disease detection and metabolomics in verifying FTIR spectral data. Moreover, the genetic and epigenetic anomalies in OSCC will be briefly discussed along with the salivary biomarkers enabling the detection of this disease.
270 Gender Differences and Trends of Self-Rated Health in Population Aged 25-64 years from 1988 to 2017 , Gafarov VV, Panov DO, Gromova EA, Krymov EA, Gagulin IV1,2 and Gafarova AV
The aim: To determine gender differences in the dynamic of self-rated health in an open population of 25-64 years over a long-term period - 29 years in Russia / Siberia (Novosibirsk). Methods: Within the framework of the screening in 1988-89 under the WHO MONICA-psychosocial (MOPSY) program (n=1676, 49.5% males, mean age 44.1±0.4 years), MOPSY screening in 1994-95 (n=1527, 43% males, mean age 44.85 ± 0.4 years), in 2003-2005 under the international project HAPIEE (n=1650, 34.9% males, mean age 54.25±0.2 years), in 2013-2016 (n=975, 43.8% males, mean age 34.5±0,4 years) and 2016-2017 (n=663, 41.3% years 51.95±0.32 years) within the framework of the budgetary theme No. AAAA-A17-117112850280-2, random representative samples of men and women in one of districts in Novosibirsk were examined. Self-rated health was assessed using the questionnaire “Knowledge and attitude towards own’s health”. Results: The proportion of people with negative self-reported health in the open population was extremely high in 1988. The share of women who consider themselves healthy was 13.7%, men - 37.9%. Gender differences increased with age. Only 10.5% of women and 29.7% of men had no complaints about their health. In 2013, there was an increase in positive health estimation among males and females and a decrease in the frequency of complaints, especially in female part of the population - by 2-2.5 times. The favorable trend which began in 2013 continued in 2017, when men and women more often self-esteemed own health status as “good” compared to earlier periods of observation. The proportion of women believed that taking comprehensive care of their health rose to 15% by 2017, equaling that of men. With the exception of 2013, women were more likely than men to report that “taking care of their health is not enough”, although by 2017 this proportion had dropped to 20%. Conclusions: Sex differences in self-rated health increase with age, but the frequency of health complaints increases proportionally in men and women. There were found favorable tendencies in the decrease in the frequency of negative assessments of health, especially in female population. Further research is required to determine the stability of this trend.
271 Risk Factors of Breast Cancer Among Western Algerian Women Under 40 yearsâ�?�? old     , HS Bensaber, DJ Bicout, AM Bensnouci, A Comez, FZ El KÃ?©bir and Y Chebloune*
Background: The frequency of patients developing Breast Cancer (BC) among all other types of cancers exceeds 35% in Western Algeria. The main objective here was to determine which risk factors were associated with this high frequency of BC occurrence in young adult women (<40 years old) in Western Algeria. Methods: A BC case-control study matching with the woman age was conducted. The total number of participants was 484 women from Western Algeria. Inclusion criteria were BC and age <40 and women older than 40 or without documented BC were excluded. Results: Univariable analysis showed that i) there was an increased risk of BC; OR = 1.77 [1.06 to 2.93] in married women using oral contraception drugs; ii) in contrast there was a lesser risk; OR = 0.43 [0.28 to 0.65] of BC in multiparous compared to nulliparous women; iii) similarly there was a lesser risk; OR = 0.45 [0.26 to 0.76] of BC in married, divorced and widowed women compared to single women. Multivariable analysis showed a higher risk; OR = 2.34 [1.05 to 5.22] of BC in non-breastfeeding than lactating women. Conclusion: The use of oral contraception drugs, nulliparity, lack of breastfeeding and the single unmarried status are risk factors associated with increased BC in young adult women (<40) from Western Algeria.
272 Stuttering and Smoking Frequency: A Longitudinal Analysis of Adolescence and Young Adults , Molly M Jacobs
Purpose: Previous research exploring the association between stuttering and cigarette smoking has been confounded by failure to control for confounding factors, improper empirical specification and inadequate data. Due to these and other limitations, previous studies have found no association between stuttering and smoking. This study examines the relationship using a longitudinal sample of adolescents and young adults controlling for previous smoking, alcohol consumption and mood disorders. Methods: Regression analyses utilizes the Longitudinal Survey of Adolescent to Adult Health—a panel study following a cohort of 12 to 17-year-olds into adulthood with four repeated interviews—to assess the relationship between adult smoking frequency and stuttering controlling for age, demographic and parental characteristics, depression, anxiety and adolescent smoking and alcohol consumption. Results: Stuttering is highly predictive of adult smoking frequency, even after controlling for alcohol use, early-life smoking habits and mood disorders. The high correlation between smoking and age consumption suggest that patterns smoking begin in adolescence and continue into adulthood. Conclusion: Findings indicate that, all else held constant, individuals who stutter smoke more frequently than their fluent counterparts. Stress relief, social inclusivity or belongingness could induce individuals who stuttering to use smoking as a form of social capital or to facilitate inclusivity
273 The Behaviours, Positions and Importance of the Church and Traditional Birth Attendants (TBAs) in Combating HIV and AIDS in Rural Nigeria , Anthony Wovisike Umetor
Since the beginning of the current pandemic both academic and public commentators have described the expansion of Covid-19, and its effects, as exceptional and indeed unprecedented. None could therefore be blamed for the overcrowded hospitals, lack of planning and preparation that have resulted. But there is in fact little new in this pandemic, neither its expansive effects or the struggle for containment while developing vaccines. It’s a history seen time and again. We just forget, each time, what we experience and the lessons should have resulted.
274 Central Nervous System Involvement is Associated with Ibrutinib-Induced Severe Hyperleukocytosis and Controlled by the Combination of Intrathecal Chemotherapy in Chronic Lymphocytic Leukemia: A Case Report , Ke Wang, Zheng Yan, Junfeng Chu, Shuang Zhao, Haiying Wang, Yanyan Liu*
Central nervous system involvement (CNSi) is a rare complication of chronic lymphocytic leukemia (CLL) with a very poor prognosis. Its diagnosis, predictive factors, and standard treatment remain elusive. Ibrutinib, an oral inhibitor of Bruton’s tyrosine kinase, has been approved to treat CLL, yet little is known of its effect on the occurrence and management of CNSi. Here, we report, for the first time, an elderly CLL patient with secondary CNSi following ibrutinib-induced severe hyperleukocytosis, characterized by subcutaneous lesions and unmutated IgHV gene. Ibrutinib combined with intrathecal chemotherapy induced a prompt and durable remission of CNSi. This case indicates that severe hyperleukocytosis caused by ibrutinib is associated with the emergence of CNSi, and a combined treatment with intrathecal chemotherapy is effective and safe in the treatment of CLL patient with CNSi.
275 Effect of Virucidals On the Presence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Saliva     , Richard Stanton, Anuradha Kulasekaran*, Oluwajoba Adegoke, Graca Coutinho, Jonathan Adcock and David Thomas
We read with interest the article by Belcaro G et.al. about the effect of virucidals on the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in saliva [1]. We would like to raise major concerns on several aspects of this pilot study, including clinical methodological limitations, the use of real-time reverse transcription polymerase chain reaction (rRT-PCR) analysis of saliva, and the interpretations and conclusions drawn from the data
276 Efficacious Dendritic Cell Based Immunotherapy for Advanced Solid Tumors: Three Case Studies , Chandan R Bora, Ileana Nordet Carrera, Fidel S Rampersad , Andrea M Richardson and Pramod S Dhembare*
Background and Aims: Dendritic cell (DC)-based immunotherapy is promising as a viable tool in cancer treatment. Dendritic cell (DC)-based vaccination can provoke antitumor T cell responses in vivo. These case studies examined feasibility and outcome of DC-based tumor vaccination for patients with advanced cancers. This approach has been used mostly in patients in the presence of defined tumor antigens. Experimental Design: Accessible tumor tissue was disrupted into single cell suspensions. Autologous DCs were prepared from adherent peripheral blood mononuclear cells and cultured in granulocyte macrophage colony-stimulating factor, interleukin and autologous plasma. Tumor cells and DCs were co-cultured in the presence of polyethylene glycol to generate the fusions. Fusion cells were quantified by determining the percentage of cells that co-express tumor and DC markers. Patients were vaccinated with three doses of DC (10 X 106 ) were administered after every 2 weeks’ intervals and assessed weekly for toxicity, and tumor response was assessed at 3 months after completion of vaccination. Results: Vaccination was well tolerated. No physical signs of autoimmunity were detected. There was no evidence of significant toxicity from vaccine or adjuvant. There was increased expression of T helper type 1 cytokines. Vaccination resulted in a significant reduction in the level of prostate-specific antigen (PSA) in the prostate cancer patient. Disease was stable upto 6 months in cases of breast and cervical cancer patients. Conclusion: DC-based vaccination can stimulate an antitumoral T cell response in patients with various cancers. This data indicates that vaccination with autologous tumor-pulsed DCs generated from peripheral blood is safe and can induce tumorspecific cellular cytotoxicity. Clinical responses are achievable, even in patients with advanced disease.
277 Short-Term Effect of Reduction in Forced Vital Capacity After Diving Exposure , Cheng Hua
To discuss whether there is relationship between short-term and long-time attenuation effects of ventilation caused by diving activity. The ventilation observed before and after hyperbaric exposure for 20min by case-control experiments. Participants of the experimental group (EG) stayed for 20min under 12-m underwater and the control group (CG) stayed in hyperbaric chamber under pressure of 2.2ATA. Immediate effects of pulmonary ventilation detected by the Spirometer and compared by paired T test to reveal the different caused by environmental pressure. The Vital Capacity (VC) rises while the Minute Ventilation (MV), Maximal Voluntary Ventilation (MVV) decreases after the exposure for 20min in both groups. The Forced Vital Capacity (FVC) is detected decreased significantly in EG (t=1.21, P =0.25) while it slightly increased in CG (t=-0.42, P =0.68). The ratio of Forced Expiratory Volume in one second to VC (FEV1.0/VC %) increase in EG (t=-0.73, P=0.48) while decrease in CG (t=0.42, P=0.17). The Ratio of FEV1.0 to FVC (FEV1.0 %) values increase obviously in EG (t=-1.48, P =0.16) and a bit in CG (t=-0.23, P =0.82). High pressure is the common factor in both groups that leads the changes in the same trend in VC, MV and MVV. Extra factors as immersion effect, loading of diving equipment and low temperature underwater, would encounter EG participants. Instant reduced effects of FVC under diving exposure in the study are quite consistent with the long-term cumulative effect of professional divers in previous research, which illustrated even small depth of short-range diving exercise have definite influences on ventilation.
278 Control Study of Short-Term Aftereffect in Diving Exposure Related Pulmonary Ventilation Function     , Hua CHENG
Objective: Ventilation attenuation often happened in professional divers due to long-term cumulative effects in diving exercises. By case-control experiments, we observed the immediate effects of pulmonary ventilation before and after the exposure of 12m-depth underwater for 20 min to discuss the relationships between the short-term and long-time effects caused by diving environment. Methods: Participants were randomly assigned into the Experimental Group (EG) who stayed for 20 min under 12-m water environment or the Control Group (CG) who stayed in hyperbaric chamber under the pressure of 2.2ATA. Pulmonary ventilation function parameters including VC, FVC, MVV and MV were detected respectively before and after hyperbaric exposure by the Spirometer. Immediate effects of pulmonary ventilation before and after diving were compared by paired t test to reveal the different influence caused by environmental pressure. Results: The value of VC appears to rise while the MV, MVV were detected decreased after the exposure of 2.2ATA of environment pressure for 20min in the two groups. VC increased more significantly in the CG (t=-1.26, p=0.23) after hyperbaric exposure, that leads to the FEV1.0%t (=FEV1.0/VC %) increase in EG (t=-0.73, p=0.48) while decrease in CG (t=0.42, p=0.17). The same trend in VC, MV and MVV after high pressure exposure in the two groups mainly due to the effect of common factors –the pressure. In addition to the impact of the pressure itself, EG members also face diving related immersion effect, influence of diving equipment load and water under low temperature. The FVC is detected decreased in EG (t=1.21, P =0.25) while it increased in CG (t=-0.42, P =0.68) , but the differences are not significant and couldn’t affect the measured FEV1.0% (=FEV1.0/FVC %) values showed both increasing in EG (t=-1.48, P =0.16) and in CG (t=-0.23, P =0.82). The expiratory flow rate including PEF, FEF25-75, MEF75, MEF50 increased in EG (t are -0.72, -0.69, -0.87 and -0.36 respectively with P all greater than 0.05) while decreased in CG (t are 1.67, 0.50, 1.53 and 0.71 respectively with P all greater than 0.05). MEF25 is the expiratory flow index of not affected by respiratory muscle force and the measured values of MEF25 increased in the EG (t=-0.68, P =0.51) and in the CG (t=-0.36, P =0.72). Conclusion: Water immersion and water temperature during diving exposure could cause and accelerate hemodynamic changes in pulmonary circulation induced pulmonary interstitial edema and led to the increase of external respiratory work. Instant effects of diving exposure in the study are quite consistent with the long-term cumulative effect of professional divers in previous research, which is FVC reduced because small airway become narrower. The results illustrate even the small depth of short-range diving exercise have definite influences on pulmonary ventilation, which mainly comes from the environmental factor but not the pressure increases.
279 The Neuroinvasive Potential of SARS-CoV-2 on the Central Nervous System (lesions in the brain) , Samir Djemli*, Abdelkrim Tahraoui, Mabrouk Boussena, Faiza Rouag, Ines Refes, Samia Messikh, Ibtissem Chouba, Mohamed Kouadria and Rouya Memouni
The coronavirus that causes Covid-19 could infect the central nervous system like other coronaviruses. Is this related to the cases of anosmia reported by doctors among infected people?
280 Gender Differences in Dynamic of Family Stress Indicators in Population Aged 25-64 Years from 1988 To 2017 , Gafarov VV*, Elena Gromova, Dmitriy Panov, Gagulin IV and Gafarova AV
The aim: To determine gender differences in the dynamic of family stress indicators in an open population of 25-64 years over a long-term period - 29 years in Russia / Siberia (Novosibirsk). Methods: Within the framework of the screening in 1988-89 under the WHO MONICA-psychosocial program (n=1676, 49.5% males, mean age 44.1±0.4 years), in 2003-2005 under the international project HAPIEE (n=1650, 34.9% males, mean age 54.25±0.2 years), in 2013-2016 (n=975, 43.8% males, mean age 34.5±0,4 years) and 2016-2017 (n=663, 41.3% years 51.95±0.32 years) within the framework of the budgetary theme No. AAAA-A17-117112850280-2, random representative samples of men and women in one of districts in Novosibirsk were examined. Family stress indicators were assessed using the questionnaire “Knowledge and attitude towards own’s health”. Results: In 1988, men were 7% more likely than women to report serious illness or death of close relatives in the past year. By 2016-17, the share of such persons decreased to 20.1% of men and 28.1% of women. Women more often than men reported changes in marital status over the past 12 months in 1988: married, divorced, left family, widowed, had a child, etc. The frequency of these changes was higher in the younger age group. In 2013-2015, these changes occurred equally often in men and women but their share decreased subsequently. The difference in the perception of conflicts in the family is present among men and women aged 25-64. In 1988, men more often than women believed that there were no serious conflicts in the family, especially in the younger age groups. Gender gap towards family conflicts is reducing among older participants. The proportion of women who reported family conflicts dropped significantly in 2013-2016 and 2016-17. It has led to gender parity in the frequency of family disagreements. Men more often than women reported that “something disturbs their rest at dwelling “. By 2017, the proportion of such persons increased, reaching the maximum levels (80-90%) among men and women in certain age groups. Conclusions: Women are more likely than men to report changes in marital status and conflicts in the family. Men are more often than women dissatisfied with rest at home. Gender differences are diminished with age.
281 Children Vaccinations , Shimon Shatzmiller
Israel is already in a closing mood, in the U.S. more than two million people a day are being vaccinated, in the U.K. almost half of the population has received the shot - but in the E.U. the epidemic is in full swing.
282 Scar-Free Healing of Wounds Resulting Commonly from Domestic Accidents , Wan Keung Raymond Wong*, Ka Lun Ng and Cheuk Yin Lai
Scalds and cuts are common causes of childhood injuries at home. Although the impairments are often non-fatal, timely and effective treatments for them may not only help prevent infections, but also facilitate faster recovery from the injuries and scarless wound healing. Skin growth factors including the 53-amino acid human epidermal growth factor (EGF) and the 146-amino acid human basic fibroblast growth factor (bFGF) have been shown to play important physiological functions in promoting the growth and regeneration of our skin cells. Moreover, they have been employed individually to enhance the healing process of various types of wound. The specific bioactivities exhibited by EGF and bFGF in the epidermal and dermal layers, respectively, strongly support the notion that they may function cooperatively in wound healing. In this communication, making use of our own recombinant EGF (rEGF) and bFGF (rbFGF) products, which share the same primary structures with their native counterparts, we present research findings to demonstrate that rEGF and rbFGF work collaboratively to promote healing of various types of wound, including scalds, punctures and lacerations. More importantly, despite the severity of the injuries, subsequent to their treatments with rEGF and rbFGF, the healed wounds were virtually scar-free and devoid of the formation of an outgrowth scar, a keloid scar.
283 A New Grape Seed Extract Pharma Standard Supplement (ECOVITISTM) Prevents and Controls Borderline Hypertension and Endothelial Dysfunction , MR Cesarone, G BELCARO*, M Dugall1 M Hosoi, S Hu U Cornelli, P Morazzoni, A Ledda, L Pellegrini, D Cox B Feragalli1,4 and R Cotellese
This registry evaluates the effect of ECOVITIS™ (grape seeds extract) in borderline hypertension (also evaluating endothelialmediated vasodilatation). The main targets of the registry were the normalization of blood pressure and of an altered endothelial function (EF); 3 groups of 15 subjects used: Standard Management (SM) (GROUP 1); GROUP 2: SM+ECOVITIS™ (150 mg/day); GROUP 3: SM+ECOVITIS™ (300 mg/day). Results. The groups were comparable. Tolerability/safety were optimal. Blood tests, urines and ECG were normal at 4 and 12 weeks. BMI showed, minimal variations (<26) in 3 months. Blood pressure (systolic, diastolic) and heart rate indicate a progressive improvement in Group 3 (p<0.05) with better values at 4 and 12 weeks. The lower dose improved (p<0.05) blood pressure and heart rate better than SM. Lipids and oxidative stress were improved better with the high dose (p<0.05). The lower dose resulted better than SM (<0.05). Other metabolic parameters (blood sugar and glycosylated hemoglobin) followed the same patterns (Group 3 resulted better that the other two groups) (p<0.05). Laser Doppler measurements (skin flux) and strain gauge plethysmography measured an improvement in post-occlusive flow (EF) at the level of the arm (p<0.65). This was confirmed by artery ultrasound measurements showing a larger increase in size in the brachial artery after occlusion with ECOVITIS TM (subjects in Group 3 had the best results (p<0.025); the lower dose (Group 2) was superior to SM (p<0.05). Tc PO2 increased more in group 3 (p<0.05); PCO2 was decreased. Results in the lower dose group were better (p<0.05) than results in the SM patients. In conclusion, this pilot registry shows that ECOVITIS™ is safe, well tolerated and may control and improve blood pressure and EF in borderline subjects. More studies may be needed for a longer period of time.
284 Family Stress and The Risk of Cardiovascular Diseases in Working-Age Population 25-64 Years (WHO program MONICA-Psychosocial) , Gafarov VV*, Gromova EA1,2, Panov DO, Gagulin IV and Gafarova AV
Purpose: To determine the influence of family stress on the risk of cardiovascular diseases (myocardial infarction and stroke) in an open population aged 25–64 years in Russia / Siberia. Methods: Within the framework of the III screening of WHO’s MONICA-psychosocial program, a random representative sample of the population of both sexes of 25-64 years of Novosibirsk in 1994 (men n = 657, mean age 44,3 ± 0,4y, response 82.1%; women: n = 689, mean age 45,4 ± 0,4y, response 72.5%) was examined. The screening included: socio-demographic data, the definition of the family stress. New-onset cases of MI and stroke in women - 15 and 35 cases and in men - 30 and 22 cases, respectively detected in the cohort over follow-up period in frame of budgetary theme â�?�? AAAA-A17-117112850280-2. Results: In the open population aged of 25-64 years the prevalence of high family stress was higher in men (31.5%) than women (20.9%). The risk of myocardial infarction in men and women experiencing stressful situations in the family was 5.9 and 5.58-fold higher, respectively over 16-year period. The most significant risk factors for the development of myocardial infarction were divorce (HR = 3.9) and widowhood (HR = 6.3). The risk of developing a stroke was 3.45-fold higher in men and 3.52-fold higher in women with family stress. The risk of developing stroke was higher among those with high school and elementary education levels, both in men (HR = 3.9 and HR = 6.3) and women (HR = 2.87 and HR = 3.33). Conclusion: Stress in the family is more common in men within the working-age population. Family stress increases the risk of developing both myocardial infarction and stroke among men and women.
285 Determinants of visits of cancer patients to Dutch Community Based Psychosocial Support Centres (CBPSCs) , Adriaan Visser
Aim: The psychosocial support for cancer patients in the mental health care is often limited because of difficulties in access and the expense to patients. In response, informal regional support centers have been developed in the Netherlands called “Community-based Psychosocial Support Centres (hereinafter: CBPSCs) for cancer patients and relatives. They offer supporting complementary activities and professional psychological help which are easily accessible and free of charge. We studied the use (frequency, duration and future use) and the determinants of the visits to CBSPCs. Method: Visitors covering 701 cases from 25 CBPSCs filled-out a web-based questionnaire, answering questions about how often they contacted CBPSCs (frequency, duration and future use) and which personal factors, mainly based of the ASE model, influenced the use of CBPSCs. Also, the well-being of the patient, the evaluation of the visits and the significance of the support received were studied as dependent variables, in addition to the role of the ASE factors, applying multivariate analyses. All sum scores showed a strong internal consistency. Results: Most patients did not know what CBPSCs are or where to find them. About one-fifth was alerted by family, friends and acquaintances. Another 20% was informed about CBPSCs by hospital oncology nurses and through leaflets. Patients rarely reported being referred by their GPs and medical specialists. Health care providers in hospitals were much better informed about CBPSCs, referring approximately half of their patients to CBPSCs. Around two thirds of the patients visited the CBSPC once a week for 2 to 3 hours and intended to continue these visits in years to come. Present use generally showed that the most important determinants are the attitude towards the visits, whether the patient is a recent visitor, the patient’s perceived significance of the visits and having a socially-inactive lifestyle. Conclusions: The study confirms the high value that this type of organisation provides in informal support in cancer care. The CBPSCs need to improve their visibility in the healthcare system through more public campaigns and better information to patients. More countries should introduce and stimulate this type of easily-accessible, cheap, effective and highly-valued supportive care centres, and explore the needs of patient and family members.
286 Perceptions and Attitudes of Health Care Givers and Patients on Medically Unexplained Symptoms: A Narrative Review with a Focus on Cultural Diversity and Migrants ,  An Mariman, Peter Vermeir*, MÃ?¡rta Csabai , Melinda LÃ?¡tos, Anne Weiland, Karen M StegersâÂ?Jager ,Marloes L Jacobs and Dirk Vogelaers
Background: Health care providers often struggle with the management of MUS patients, especially with a different ethnic and /or cultural background. Objectives: A review on behaviors and attitudes of health care providers towards MUS patients and of patients themselves, in order to improve healthcare provider-patient interaction. Methods: Screening of PubMed, Web of Science, Cinahl and Cochrane Library on the keywords ‘Medical unexplained (physical) symptoms (MUS)’, ‘Somatoform disorder’, ‘Functional syndrome’, ‘Diversity’, ‘Migrants’, ‘Ethnicity’, ‘Care models’, ‘Medical education’, ‘Communication skills’, ‘Health literacy’. Results: MUS patients, especially with a different ethnic background, often feel not-understood, which may provoke medical shopping. Health care providers experience feelings of helplessness. From undergraduate trainees to senior physicians, attitudes and perceptions tend to be negative, impacting on the quality of the patient/health care provider relationship and subsequently on health outcomes, patient satisfaction and therapeutic adherence. Conclusion: This review identified significant room for improvement in both attitudes and behavior of health care providers towards MUS patients, including migrants and patients from cultural diverse backgrounds. These need to be addressed in order to improve outcomes.
287 New Doctrine and Principles of Treatment of Acute Inflammation of the Lung Tissue ,  Igor klepikov
Modern ideas about the nature of acute inflammatory processes in the lungs are focused on the leading significance of the etiology of the disease. The predominance of this concept defines etiotropic therapy as the basis for providing medical care to this category of patients.
288 Oral Phytorelief: Prevention of Upper Respiratory Tract Viral Conditions; Virucidal (Covid) and Germicidal Activity , Cesarone MR, Hu S, Scipione V , Scipione C , Belcaro G, Bombardelli E, Cox D, Cotellese R and Feragalli B
This review presents results from recent supplement studies on PhytoRelief, an oral product including standardized natural extracts of pomegranate, curcuma and ginger. PhytoRelief (PF) lozenges dissolve slowly in the mouth producing a protective mucosal gel/film acting as a barrier against the most common upper respiratory tract (URT) viral infection. GLOBAL EVALUATION: PR (as a pharma-standard supplement) appears to be effective – according to recent, controlled and prospective registry studies - as a virucidal (on Covid-19) and a germicidal (bactericidal) product – but more clinical studies in patients with different conditions are needed. Clinically, PR helps preventing a number of episodes of cold and flu and limits symptoms and the duration of the URT problem. This OTC product can be used without prescription – without risks of side effects - and it appears to be generally effective on most signs and symptoms of viral infections. PR has a good preventive value. No side effects or tolerability problem were observed in any patient. The important virucidal and germicidal activities to be better defined need larger and a more prolonged evaluation period in different contexts associated to viral infections. With predictive analytics and careful planning, it is possible to show the virucidal-bactericidal effects (and their clinical preventive efficacy) of PR in weeks. The planning of new studies – also evaluating the effects of PR on the immune system - is in progress.
289 Reliability of Cardiac Percussion Technique to Determine Left Ventricular Geometry in Comparison with Transthoracic Echocardiography , Muhammad Saad*, Syed Arsalan A Zaidi , Jared Micho, Muhammad T Hassan, Shoaib Ashraf, Manoj Bhandari, Angel De La Cruz, Lava Raj Timsina, Jonathan N Bella and Timothy J Vittorio
Background: Cardiac percussion (CP) is a bedside technique to evaluate cardiac borders and chamber size. Although advanced cardiac imaging has revolutionized the methods to detect cardiomegaly, art of CP remains the most convenient option, especially in emergent situations. Although transthoracic echocardiography (TTE) is considered the gold standard to determine left ventricular (LV) size, CP can estimate LV size with equal accuracy as TTE in appropriate clinical setting. The aim of this study was to investigate the correlation of LV size assessed by CP technique versus standard TTE, as well as cardiothoracic ratio (CTR) on chest roentgenography (CXR). Methods: This descriptive study was conducted on Telemetry units. Patients were positioned in supine position at Gatch angle of 30-45 degrees. Cardiac dullness was measured in cm by percussing from mid clavicular line towards gladiolus of sternal body. Subsequently, findings were correlated with TTE dimensions of left ventricular end-diastolic diameter (LVEDD). Results: In 200 patients, mean age was 63+15.8 years, with 51% females. The LV diameter (LVD) measured by CP technique was observed to be similar to LVEDD measured by TTE (Mean- 4.65+0.67 cm versus 4.69+0.76 cm, COV 7.6%). The BlandAltman comparison of CP technique and TTE measurements indicated significant differences in variances between the two measures (r=0.270, p=<0.001). The LVD measured by CXR did not show correlation with LVEDD (5.79+1.21 cm, COV 14.3%) with significant differences in the variances between the two measures (r=-0.475, p<0.001). The LV volumes measured by CP technique were observed to have correlation with LV volumes measured by TTE (COV 14.9%). Conclusion: CP technique is a convenient bedside method that can be utilized to assess LVD and volume. It is shown to have a precise correlation with LVEDD measured by TTE. The study emphasizes role of bedside estimation of LV size by using the art of physical examination.
290 Ovulation Induction in Patients with Polycystic Ovarian Syndrome (PCOS) & Hyperprolactinemia (HPRL): Efficacy of Letrozole (LE) Combined with Cabergoline (CE) in Comparison to (LE) Alone , Aisha Mohamed Elbareg* and Fathi Mohamed Essadi
Objectives: (PCOS) is the most common cause of anovulatory infertility, with majority of patients having mild (HPRL). (CE), a dopamine receptor agonist, inhibits prolactin secretion, leading to better ovulatory response. (LE), an aromatase inhibitor, without adverse effects on endometrium & induces fewer mature follicles with less risk of OHSS. Our aim was to investigate effects of combined (LE) & (CE) in comparison to (LE) alone on ovulation & clinical pregnancy rates in (PCOS) patients with (HPRL). Patients & Methods: 180 women with (PCOS) and of 22-38 years old, were enrolled in a hospital based clinical trial. Patients randomly allocated into 2 groups, (A&B). All with a serum prolactin > 32 ng/ml. Patients in (A): (92) were given (LE), 5mg for 5days: (3 – 7 of the cycle)/3 cycles and (CE), 0.5mg weekly for 12 weeks. Those in (B): (88) received only (LE), same dose & duration as in (A). All patients were matched for their age and BMI. Exclusion criteria: other causes of (HPRL). Outcome measure: ovulation rate & detection of both chemical & clinical pregnancies by βhCG and ultrasound of fetal cardiac activity, 2-4 weeks after missed period. Follow-up for 6 months. Data analysis by using SPSS version for windows, P-value significant if (< 0.05). Results: 3 patients from (A) & 5 from (B) had drug side effects and were excluded. None of patients were lost during the follow-up period. In (A), difference between mean serum prolactin level before & after treatment was statistically significant (P0.05). After treatment, BMI in (A) 24.1± 3.2, & 24.2 ± 3.6 in (B) (P=0.567). (56.2%) of women in (A) became regularly menstruating but only (30.1%) in (B) (P< 0.05). Ovulation rate was higher in (A) (50.6%) in comparison to (B) (26.5%), (P<0.05). Clinical pregnancy rate in (A) (41.6%) and (21.6%) in (B) (P<0.05). Neither twin pregnancy, nor OHSS were recorded in both groups. Conclusions: The combination of (LE) & (CE) is superior to (LE) alone in management of anovulatory patients with (PCOS) and should be used as the first-line treatment for them.
291 CREBBP is a Novel Biomarker for Diagnostic and Prognostic of Patients with Renal Cell Carcinoma , Pei Chen, Qiqi Zhang, Yuanguo Li, Fangxu Li , Tian Qin, Jing Qi, Tiecheng Wang* and Chaoxiang Lv*
As an important transcription co-regulator, CREBBP played important roles in gene transcription and signal transduction. It had been reported that its low expression was closely related to cancer progression. We explored the roles of CREBBP expression among renal cell carcinoma in order to clarify its potential clinical application value in the diagnosis, pathological process and patients prognosis. In the present study, we found that CREBBP expression was reduced in renal cell carcinoma compared with normal tissues, and its expression was negatively correlated with tumor progression. Furthermore, lower CREBBP expression in dead than survival patients, and it had good clinical diagnostic value in renal cell carcinoma. The OS and RFS of patients with low CREBBP expression were significantly shortened, and it was a dependent predictor for poor prognosis. Additionally, we also found the reactive oxygen species pathway, DNA repair and myc-targets V2 signaling were significantly enriched in the low CREBBP expression phenotype. In conclusion, low CREBBP expression could be regarded as a prognosis biomarker and potential therapeutic target for renal cell carcinoma.
292 A Validation Study of an AFP Whole Blood One-Step Rapid Home Detection Kit in Screening for HCC , Wei Shen and Bing Ruan
Hepatocellular carcinoma (HCC) is still a main cause of cancer-related death in China. Early detection and diagnosis may increase the likelihood of curing the HCC. Dynamic monitoring AFP levels can be a surveillance indicator to detect early-stage HCC. However, to our disappointment, most people with chronic liver diseases do not test AFP levels regularly for a variety of reasons. The AFP whole blood one-step rapid home detection kit, with a high sensetivity and specifitivity, can be used to test AFP levels periodically by community residents with chronic hepatitis B. This can make it possible to detect, diagnose and treat HCC much earlier. This research aimed to verify the previous studies on the kit’s performance, characteristic, application and usage. The result was that the positive accordance rate and the negative accordance rate of the AFP whole blood one-step rapid home detection kit and ARCHITECT AFP were 96.77% (90/93) and 97.94% (95/97). The rapid home detection kit is introduced and popularized to apply into screening and diagnosing early-stage HCC in community individuals with chronic liver diseases, which is meaningful to achieving the goal of reducing mortality in patients with HCC to a great extent.
293 Reflections between Ethics, Pedagogy and Violence within the Health Personnel , Alan Suresh V�¡zquez Raposo*, Maria de los Angeles Dichi Romero, Olga Margarita Bertadillo Mendoza, Luis Rey Garcia Cortes, Fatima Korina Gaytan Nu�±ez and Maria Guadalupe Saucedo Martinez
The relationships between ethics, pedagogy and violence were clarified to account for a training need in which the doctor has as main character, in most aspects of learning, the coercion of the student. The interaction between medical expertise and student ignorance reflects the focus of direct pedagogy, the fundamental problems that arise require attention. There are few works that evaluate violence in health institutions caused by staff against the staff itself, this phenomenon has had little visibility, however, there are studies that show important data. The institutional order of medicine, the effects on professionals are of various circumstances, it dissolves in the meanings of medical staff, residents are a vulnerable group in the IMSS given the socio-political and academic conditions in which they find themselves - for example- Since in many occasions these groups are opposed to the cooking of the subjects with greater hierarchy, this is impotent for doctors because they must assume the conditions to continue with their academic and professional development.
294 Transcultural Adaptation and Validation of the Fear of COVID-19 Scale into Mexican-Spanish , Moreno-Torres Luis Antonio and Ventura-Alfaro Carmelita Elizabeth*
The new coronavirus, SARS-CoV2, causing the disease known as COVID-19, has repercussions at mental health level of the population. Aim: To validate into Mexican-Spanish the Fear of COVID-19 Scale. Methods: A cross-sectional study was conducted for transcultural validation and for psychometric properties in adults over 20 years of age. Using the international guidelines by Beaton and Guillemin; as well as Cronbach’s alpha and Pearson’s correlation coefficients. Results: In a total of 438 people who agreed to carry out the survey, a suitable transcultural validation was obtained as well as psychometric properties of the scale were assessed obtaining a Cronbach’s Alpha of 0.85 and a correlation coefficient of 0.2662 to 0.6906. Conclusion: A Spanish language validated instrument was obtained which is suitable to be used for the early detection of fear in the face of the COVID-19 pandemic and to be able to implement actions for the prioritization of psychological and even psychiatric care.
295 Phytorelief-CC in Prevention of Flu and Cold: A 4 To 6 Month Registry Study , Luzzi R*, Hu S and Belcaro G
The aim of this supplement, registry study was to evaluate the effects of the use of standardized, oral supplement (PhytoRelief CC, Alchem). Phyto-Relief CC includes anti-inflammatory, antioxidant and anti-edema natural compounds.
296 An Oral Combination of Turmeric-Pomegranate (With Ginger) Prevents Viral (Cold/ Flu) Episodes in Immunocompromised Patients , Shu Hu, Maria R Cesarone, Gianni Belcaro, Beatrice Feragalli, Morio Hosoi, Claudia Maione Claudia Scipione, Valeria Scipione and Roberto Cotellese
The aim of this pharma standard (“PS”) supplement, registry was the evaluation – in a period of 3 months – of the effects of the use of a standardized combination (oral supplement including turmeric, pomegranate and ginger) in preventing common, winter, viral events (cold and flu episodes). Results: No safety or tolerability problem was observed with the supplement. The two resulting registry management groups – standard management (SM) and SM+the supplement combination – were comparable. The number of viral (cold/flu) episodes (lasting more than 3 days), and the total number of subjects with any episode was in favor of the group managed with the preventive supplement combination (p<0.05). The average number of days of disease and the lost working days were lower with the combination (Phyto Relief). The use of other OTC products and the number of complications were significantly lower (<0.05) with the supplement combination. The number of subjects with a clinical extension of the disease to more than 7 days with bronchial or tracheal complications was also lower (p<0.05) with the supplements in comparison with the SM group. Salivation was improved more in the supplemented group (p<0.05). The results of this concept, preliminary study in mildly immuno-compromised subjects shows that Phyto Relief may help prevent some episodes of cold/flu and help (by shortening the length of the episodes) the evolution of viral episodes when used early, when the initial symptoms can be identified. More specific evaluations and larger prevention studies are needed, in a more heterogenous population. The extension of this supplementary prevention to more subjects and for longer periods may indicate a more permanent effect of this supplement combination on improving local, mucosal immunity and resistance to viral spread. Conclusions: The evaluation of immunocompromised subjects is significant in clinical conditions prevention (winter viral episodes) with this natural combination which may also avoid prolonged respiratory complications.
297 The Dilemma of the Physician, Going Back to The Clinician, Back to Basics , Rodriguez-Guerra Miguel *, Singh Tushi and Vittorio Timothy J
Background: Technology has allowed the scientific side of medicine to evolve more rapidly causing the “modern” physicians to greatly rely on laboratory values and imaging studies thereby leading to the loss of clinician abilities and skills. Case: A 52-year-old female with multiple cardiovascular co-morbidities including ischemic heart disease, presented to the emergency department in the morning with diffuse body pain associated with malaise, numbness and paresthesias of the right upper and lower extremity. This was followed by an “out of body” sensation. She then experienced transient sharp left-sided chest discomfort described as moderate to severe in intensity with a duration of approximately 2 minutes slowly subsiding on its own. Subsequently, she reported difficulty lifting the right hand and leg as well as slurred speech. The strength in her limbs returned within the hour but numbness and paresthesias persisted and continued to bother her. At the time of presentation, she was hypertensive but no other abnormalities were found on the physical examination. An elevated troponin level was noted but acute coronary syndrome (ACS) was unsuspected in the 12-lead electrocardiogram (ECG). A noncontrast computed tomography (CT) of the head was unremarkable. A subsequent 12-lead ECG revealed new T wave inversions in the lateral leads. This provoked a repeat neurological exam in greater detail, and there was objective weakness of the distal muscle groups of the right upper and lower limbs. The NIH score was now 6 (prior was 0). Brain magnetic resonance imaging (MRI) the following day showed an acute infarct of the left internal capsule. Approximately 72 hours after the initial presentation, the patient remarkably improved and was planned for discharge by the 5th admission day. Conclusion: Clinical skills are crucial in the technological era; it could definitely prevent mistakes or time matter diagnosis. Hence, a reason why in times of dilemma, a return to the basics promoting these skills will always be helpful.
298 Complications of Patella in Total Knee Arthroplasty (TKA) , Saccomanni Bernardino
Background and Methods: Postoperative complications may impair the outcome of total knee arthroplasty (TKA). Patellar instability is a major cause of postoperative pain and functional limitation for which revision surgery may be necessary [1]. It may occur after TKA with or without patellar resurfacing. Results and Conclusion: Subluxation is more common than dislocation; the incidence of symptomatic instability leading to revision is low (0.5 to 0.8%) [2, 3]. In a multicentre study of low contact stress mobile bearing TKAs, only 6 of 259 revisions were associated with patellar instability, which accounted for a revision rate of 0.1% after a mean follow-up duration of 5.7 years [4]. A revision rate of 12% was reported secondary to complications of the extensor mechanism [5]. The aetiology of patellofemoral instability can be related to (1) the surgical technique and component positioning, (2) extensor mechanism imbalance, and (3) other causes.
299 Remembering the footsteps of five distinguished ophthalmologists from the present in the era of the COVID-19 pandemic , Akira Awaya* and Yoshiyuki Kuroiwa
We have reported that 40 specific intractable diseases and 24 types of cancer and malignancies as well as Kawasaki disease may be triggered by pollen in our previous papers. Further, we reported in 2021 two articles regarding relation of outbreak of Influenza and COVID-19, and pollen exposure. In this paper, five distinguished ophthalmologists will be considered and described. Mikito Takayasu was the first person to report the discovery of Takayasu’s arteritis, one of the vasculitis syndromes, which may be a pollen-induced disease as well as Kawasaki disease. Next, Einosuke Harada, Alfred Vogt and Yoshizo Koyanagi are considered and described as the reporters of Vogt-Koyanagi-Harada disease. The fifth ophthalmologist is Li Wenliang who was the first person in the world to report the outbreak of SARS-COV-2 infection. Many people are still unaware of the fact that exposure to pollen can lead to many diseases. The author hopes that those who are involved in medical care will consider the scientific facts, keep their eyes open, and use this knowledge in their daily activities, although clear proof in experimental medicine is craved.
300 Cytological Differentiation of Ductal Carcinoma in Situ and Invasive Ductal Carcinoma of the Breast: A Personal View and a Literature Review , Ivana Mi�¡e
Although some find it controversial, it is possible to differentiate breast ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) using cytology only, with certain limitations. Invasiveness is the consequence of specific biological, i.e. aggressiveness potential of malignant cells, which is different with respect to the pre-existent DCIS, consequentially with different morphology. During the invasion, malignant cells go through multiple morphological changes, losing their epithelial and acquiring mesenchymal features in the fantastic process of epithelial-mesenchymal transition, which explains their morphology in cohabitation with the environment, includes the disruption of intercellular junctions, the increase of mobility and the release of the original epithelium. This mesenchymal-like phenotype supports the migration and invasion of cells, i.e. thus epithelial-mesenchymal transition ensures the tumor dissemination and metastasizing. Therefore, invasiveness can cytologically be “measured” by detecting morphological signs of increase of biological aggressiveness of malignant cells – through the change of their appearance (cytoplasm elongation in malignant squamous cells, i.e. in adenocarcinoma intracytoplasmic lumina, atypical nucleoli, coarsely clumped chromatin, eu-/parachromatin), but also with stromal parameters (disruption of the intercellular matrix, elastin fragments, capillaries endothelium) presented by tumour diathesis, fibroblast proliferation, fragments of elastoid stroma, invasion of connective and/or adipose tissue by groups and individual malignant cells. For the invasion are also very predictive tubular malignant structures, irregular angulated clusters of reduced cohesiveness, absence of benign naked nuclei, polymorph single tumour cells, less myoepithelial cells on tumour groups, fewer microcalcifications and foamy macrophages. Opposite morphological findings suggest DCIS. Even though cytologically we do not see and cannot see the basement membrane, highly likely we can predict the invasion – necessarily and always with the triple-diagnostic approach or clinical-radiological-morphological correlation to every breast lesion, in the representative well cellular sample and with good knowledge of patohistology and cytology.
301 Croatia��?s First Experiences in Cytological Diagnosis of High-Grade Ductal Carcinoma in Situ of the Breast: Case Reports and a Review of Literature , Ivana Mi�¡e
Cases here presented are also first Croatia’s experiences in the cytological diagnosis of breast ductal carcinoma in situ (DCIS). The first patient was a 64-year-old woman, by imaging methods with a wide area of suspect microcalcifications in the left breast lower medial quadrant and abundant, dense, yellow-greyish discharge of the same mammilla and second was a 65-year-old woman with an equivocal lesion in left breast lower lateral quadrant. Morphological findings of both aspirates and nipple discharge from the first patient were practically the same - moderately to highly cellular, with 3D solid aggregates, monolayer sheets and many scattered single clearly malignant cells of large - mainly >5x the diameter of an erythrocyte, round-to-ovaloid, manifestly irregular nuclei, dark blue, polymorphous, often multiple (macro)nucleoli, irregular nuclear outlines and dense, more basophilic, mostly scant cytoplasms arranged in syncytium–like structures. “Dirty” background was overfull of comedo necrosis and dark grayish, sharp, irregular microcalcifications. Cytological diagnosis in both cases was DCIS, high-grade, comedo type. Histopathologically first tumor was big, 6 cm large, estimated as comedo carcinoma with microinvasion focuses not bigger than 1 mm, but without signs of angioinvasion, while the second tumor was smaller, 0.6 cm with wide ducts fully with large polymorphic malignant epithelial cells, central comedo necrosis, cancerisation of some lobules but with the intact basement membrane. It was pure high-grade DCIS, comedo type. Presented cases completely reflect to date knowledge about cytological diagnostic of high-grade DCIS; include necessary morphological criteria - highgrade nuclear atypia, an abundance of comedo necrosis and microcalcifications, confirm our limitation in the presumption of invasion status with large lesion extent, but also prove that cytology is the unquestionably reliable in breast morphological diagnostic, even in such sophisticated and demanding pathological issue like DCIS.
302 Low Serum Zinc in Critically Ill Patients Fed Oral and Enteral Nutrition in a Brazilian Terciary Hospital: A Cross-Sectional Study , Cristina Gama Matos Pereira*, Erely Ruama Santos Santana, Miraldo Nascimento da Silva Filho, Nara Nayane Brito Menezes, Marco Ant�´nio Prado Nunes and Roberta Machado de Souza
Purpose: Since zinc is required for immunity and inflammation regulations, this paper aimed to investigate serum zinc levels in critically ill patients receiving Enteral (EN) and Oral Nutrition (ON) and correlate these values with demographic, clinical and laboratory parameters. Material and Methods: This is a cross-sectional study. Researchers collected data from electronic medical records in Intensive Care Units (ICUs) of a Brazilian tertiary hospital. Flame Atomic Absorption Spectrophotometry measured serum zinc (normal range: 70-120 mcg/dl). Evaluated variables: age, sex, diagnoses, ICU type, iron, hemoglobin, leukocytes, C-reactive protein, severity score, and mortality. Results: Researches assessed 203 medical records. Mean zinc score was low (EN: 59.13 ±16.26 mcg/dl; ON: 64.75 ±16.80 mcg/dl; p= 0.010). Mean age was high (EN: 77.48 ± 16.26 years; ON: 75.01 ± 13.03 years; p= 0.012). Iron was positively correlated with zinc in EN (p= 0.012). Age was correlated negatively with zinc in ON (p=0.001). Hemoglobin was correlated positively with zinc in EN (p= 0.007) and ON (p= 0.018). Conclusions: Most of the ICU patients had low zinc. EN had lower zinc levels than ON. Lower hemoglobin, lower zinc in both groups. Lower iron, lower zinc in EN. Old age was correlated with low zinc in ON.
303 Camelid Antibodies May well be effective Against SARS-CoV-2 variants , Samir Djemli*, Abdelkrim Tahraoui, Mabrouk Boussena, Faiza Rouag, Ines Refes, Samia Messikh, Ibtissem Chouba, Mohamed Kouadria, and Rouya Memouni
Are camels at the origin of a new treatment against Covid-19? What is certain is that these animals have small antibodies, absent in humans, which neutralize SARS-CoV-2 and some of its variants, according to Australian scientists.
304 Attachment-Based Treatment for Anxiety Disorders Use of spontaneity as a mode of relating to resolve anxiety , Martin Fields
Although we have established effective treatments for anxiety disorders,the problem is on the rise worldwide, and the effect sizesfor treatments suggest that advancements are needed. Part of the reason for the limitations in our treatments may be because they are designed to address the disorder’s symptoms rather than its underlying cause. This paper is geared toward presenting a likely neurobiological cause and a proposed treatment. There is significant evidence that the basis for anxiety is a combination of stress, especially interpersonal stress, and an inability to find solutions to resolve it. Anxiety is the result of this lack of coping ability. The part of the brain involved in designing these coping strategies, especially when the stressor is complex and emotion-based, is the dorsolateral prefrontal cortex. That is because it is the brain’s “sketch pad,” in that it allows us to think of solutions on a “symbolic” rather than a concrete basis.Anxiety arises when the person is unable to use this brain region effectively in formulating solutions, and instead designs ineffective solutions. The reason for that deficit may stem from early childhood, during a phase of attachment in which parents do not engage spontaneously in child-induced play. The mother is unable to be spontaneous in sharing the child’s play,which is needed for the child to generate his or her own solutions to problems. This leads to an inability of the child’s dorsolateral prefrontal cortex structure to properly develop. This will manifest as a lack of “insight,” or ability to generate spontaneous solutions to problems instead focusing on routinized solutions to emotion-based problems later in life that often do not work. Evidence is provided in a case report of a patient with an anxiety disorder who could not solve his interpersonal problems because he lacked the necessary insight. This deficit was so profound that he could not use insight-based psychotherapy and found use of medication too sedating. By modelling a more spontaneous give and take between the therapist and the patient’s wife, who served as a “co-therapist,”the patient was able to learn to develop his own insight. His wife would tell the therapist the problems the patient was unable to tell him and would help the patient to learn to respond to the interpretations offered by the therapist. The patient learned how to imitate his wife and describe his problems, and then to imitate the therapist and generate his own insight. As this occurred, his anxiety was resolved. The basis of the attachment that developed with his therapists was based on the use of spontaneity, from which the patient learned his own insights resolving his anxiety.
305 The Application of the Novel â�?�?Six-Step Teaching Methodâ�? In the Teaching Management for the Nursing Interns     , Liu Rui, Yuan Kun* and Li Yuanyuan
Objective: To study the application of the novel “Six-Step Teaching Method” in the teaching management for the nursing interns. Methods: Seventy nursing interns in the year of 2018 and 2019 practiced in The Fourth Hospital of Shijiazhuang were selected and divide into control group and observation group. The control group received the traditional teaching method for nursing practice, and the observation group was given the new “Six-Step Teaching Method” for nursing practice. The novel “Six-Step Teaching Method” includes the teachers showing the operation, the teacher guiding the interns operation, the interns independent operation, the interns self-evaluation, the evaluation between of teachers and interns, and the head nurses’ appraisal. After the interns practiced 10 months, the theoretical achievement, the practical operation skills achievement, the satisfaction between the teachers and interns each other and adverse events happened in the interns of two groups were recorded and compared. Results: Compared with the control group, the theoretical achievement increased by 29.82% (P<0.05) and the practical operation skills achievement increased by 22.60% (P<0.05). The satisfaction of teachers to interns of each other was raised 13.40% and 19.83%, respectively. The adverse events happened in interns was lowered by 62.50% in the observation group, as compared with control group. Conclusion: The novel “Six-Step Teaching Method” can raise the theory and practice level, enhance the satisfaction between the teacher and the nursing interns and lower the adverse events happened. These results suggested that the novel “Six-Step Teaching Method” has a good practical value in the teaching management for nursing interns and is worth for application in the clinic.
306 Clinical Prognosis of AKT2 and COX2 Mutation on Colorectal Cancer , Caroline Tatim Saad, Maria Cristina Sartor, Camila Cavalcanti Barcelos Rodrigues, Alexandre Bueno Merlini*, M�¡rio Rodrigues Montemor Netto and Jorge Eduardo Fouto Matias
Cancer has become one of the most mortal diseases in the world. It was estimated in 2018 18.1 millions new cancer cases. The colorectal cancer (CRC) is the third most common type of cancer in men and the second in women around the world [1]. The incidence risk in the occidental population is 5% to 6%, and it can increase to 15% to 30% when a first degree relative has the diagnoses. In hereditary predisposition cancer syndrome like the Lynch syndrome it can grow up to 80% [2].
307 Detailed Study of HPRT1 Gross Deletions Found in 10 Italian Lesch-Nyhan Families , Paola Cattelan, Daniela Segat, Maria Vittoria Enzo, Uros Hladnik and Paola de Gemmis*
Background: Lesch-Nyhan disease (LND) is an X-linked rare pathology involving the purine nucleotides salvage pathway. Its incidence is estimated in 1:350.000 born. The condition is due to mutations in the HPRT1 (hypoxanthine phosphoribosyl transferase 1) gene of which in our cohort 28% (10/35) are large deletions. In order to better assess the nature of the observed deletions in our LND population we analyzed 10 families carrying large deletions in the HPRT1 gene region and studied the underlying pathogenic mechanisms. Methods: We performed PCR based localization of the break points and sequenced the gap-junction fragments. Bioinformatics analysis was performed through several web tools on the 5’ and 3’ break points to determine the factors involved in the deletion mechanism. Results: We precisely mapped 10 unique large deletions involving the HPRT1 gene region that span from 300 bp to 64 kbp. No common breakpoints were found and each deletion appears to be family specific. Conclusions: The deletions in the HPRT1 gene area are consistent with the Micro homology-Mediated Break-Induced Replication (MMBIR) mechanism. There are strong links with Alu-s and no recurrent break points with all of the observed deletions being unique. The relatively large amount of deletions in the HPRT1 region is peculiar and linked with the almost absolute lack of polymorphic sites in the HPRT1 gene making it a very interesting region for further studies.
308 Gender differences and trends of attitude toward smoking and diet behavior in population aged 25-64 years from 1988 to 2017 , Gafarov VV*, Panov DO, Gromova EA, Krymov EA, Gagulin IV and Gafarova AV
Although we have established effective treatments for anxiety disorders,the problem is on the rise worldwide, and the effect sizesfor treatments suggest that advancements are needed. Part of the reason for the limitations in our treatments may be because they are designed to address the disorder’s symptoms rather than its underlying cause. This paper is geared toward presenting a likely neurobiological cause and a proposed treatment. There is significant evidence that the basis for anxiety is a combination of stress, especially interpersonal stress, and an inability to find solutions to resolve it. Anxiety is the result of this lack of coping ability. The part of the brain involved in designing these coping strategies, especially when the stressor is complex and emotion-based, is the dorsolateral prefrontal cortex. That is because it is the brain’s “sketch pad,” in that it allows us to think of solutions on a “symbolic” rather than a concrete basis.Anxiety arises when the person is unable to use this brain region effectively in formulating solutions, and instead designs ineffective solutions. The reason for that deficit may stem from early childhood, during a phase of attachment in which parents do not engage spontaneously in child-induced play. The mother is unable to be spontaneous in sharing the child’s play,which is needed for the child to generate his or her own solutions to problems. This leads to an inability of the child’s dorsolateral prefrontal cortex structure to properly develop. This will manifest as a lack of “insight,” or ability to generate spontaneous solutions to problems instead focusing on routinized solutions to emotion-based problems later in life that often do not work. Evidence is provided in a case report of a patient with an anxiety disorder who could not solve his interpersonal problems because he lacked the necessary insight. This deficit was so profound that he could not use insight-based psychotherapy and found use of medication too sedating. By modelling a more spontaneous give and take between the therapist and the patient’s wife, who served as a “co-therapist,”the patient was able to learn to develop his own insight. His wife would tell the therapist the problems the patient was unable to tell him and would help the patient to learn to respond to the interpretations offered by the therapist. The patient learned how to imitate his wife and describe his problems, and then to imitate the therapist and generate his own insight. As this occurred, his anxiety was resolved. The basis of the attachment that developed with his therapists was based on the use of spontaneity, from which the patient learned his own insights resolving his anxiety.
309 Gender differences and trends of attitude toward physical activity in population aged 25- 64 years from 1988 to 2017     , Gafarov VV, Panov DO1,2, Gromova EA, Krymov EA, Gagulin IV and Gafarova AV
The aim: To determine gender differences in the dynamic of attitude toward physical activity in an open population of 25-64 years over a long-term period - 29 years in Russia / Siberia (Novosibirsk). Methods: Within the framework of the screening in 1988-89 under the WHO MONICA-psychosocial (MOPSY) program (n=1676, 49.5% males, mean age 44.1±0.4 years), in 2003-2005 under the international project HAPIEE (n=1650, 34.9% males, mean age 54.25±0.2 years), in 2013-2016 (n=975, 43.8% males, mean age 34.5±0,4 years) and 2016-2017 (n=663, 41.3% years 51.95±0.32 years) within the framework of the budgetary theme No. AAAA-A17-117112850280-2, random representative samples of men and women in one of districts in Novosibirsk were examined. Physical activity assessed by questionnaire proposed by MONICA-MOPSY protocol. Results: Men were 2 times more likely than women to report that they did not need to do physical exercises in 1988. In 2013- 2016, the proportion of young men and women who regularly did physical exercises increased significantly: 28.7% and 21.4%, respectively. In 2017, this trend continued among women but there were fewer men who regularly train. 59.9% of men and 73.1% of women aged 25-64 in 1988 reported “failed” attempts to exercise regularly. By 2017, the share of such men has not changed but for women it decreased to 7%. Women more often than men (30.3% vs 24.6%) spent their leisure time physically actively in 1988. By 2017, there was a tendency towards an increase in women aged 25-34 years with passive pastime to 21.1% and among men their share did not change. In 1988, the proportion of those who became less mobile during the year increased linearly with age, reaching 31.5% for men and 38.8% for women 55-64 years old. In 2017, the proportion of men and women who became less mobile decreased in comparison with 1988 and 2003 (11.6% and 22.2%, respectively; p <0.05). In 1988, women more often than men considered themselves insufficiently active. In 2013-2017, individuals of both sexes began to report more often that they are physically more active than other people of their own age. Males aged of 25-44 years considered themselves as active more often than females. But in the older age groups there was an increase in physical activity among women. Conclusions: There is an essential decline in physical activity with age but trends in self-rated levels of physical activity show a steady increase from 1988 to 2017, predominantly in women.
310 The Management of Balance and Proprioception Discrepancies for a Patient with Cervicogenic Headache: A Case Report , Rob Sillevis*, Micah Tew and Karen Wyss
Introduction: Previous research studies have established a link between cervical dysfunction, proprioception, and balance deficits in patients with cervicogenic headache. However, no current research exists to determine if the implementation of a balance program for these patients has any effect on their balance and proprioception capabilities. This case study aimed to identify if significant changes can be made the overall balance of a patient with cervicogenic headache as measured by the NeuroCom Sensory Organization Test. Case Description: The patient was a 50-year-old female, who had been suffering from long term cervicogenic headaches with increasing frequency and intensity for 6 months. Outcomes: The patient was seen for six visits over six weeks for balance training in addition to traditional physical therapy interventions including manual therapy and therapeutic exercise. After 6 sessions the patient made an overall improvement in balance (+7.9%) measured via the NeuroCom Sensory Organization Test and clinically significant improvements in reported pain via the Headache Disability Index (91.6%), Neck Disability Index (63.6%) and the Visual Analog Scale (2.5 points). Discussion: This case report demonstrates when balance training is added to standard manual therapy interventions for the management of cervicogenic headache you can successfully improve overall balance control measured with the NeuroCom Sensory Organization Test. Further research is necessary to further validate balance programming as a key intervention strategy for the general population with cervicogenic headache and guide decision-making for these patients.
311 Giant cell glioblastoma in childhood-Pathohistological and immunohistochemical analysis, forecast and complex treatment , Lena Marinova, Radoslav Georgiev, Nikolay Evgeniev
A six year old child is presented with giant cell glioblastoma multiforme. The importance of pathohistological and immunohistochemical analysis is discussed for the diagnosis of this rare pathohistological subtype glioblastoma in childhood. The Magnetic Resonance Image Characteristics, unfavorable prognosis and high cancer cell resistance to radiotherapy (RT) and chemotherapy (Ch) are also highlighted. The risk of local recurrences and tumor progression is high, despite the complex treatment, including visibly total tumor surgery, postoperative RT and adjuvant Ch. By this pediatric clinical case of childhood giant cell glioblastoma multiforme, we emphasize the emerging need to optimize early diagnostics and the multidisciplinary healing approach.
312 The corona returns to israel-this thime with the indian triple mutant 2delta , Shimon Shatzmiller*
The biggest threat: “Not only in Israel-the” Delta”variant worries the world [1-5] report. ‘Delta’ variant evolves to form ‘Delta Plus’, is there a cause to worry? Covid-19 The ‘delta’ variant of COVID-19-a version first detected in India- has evolved to form the ‘delta plus’ or AY.1 variant. Scientists say it has acquired a mutation associated with escaping immunity, but there is no cause for concern yet.
313 The Impact of exposure to screen during COVID-19 Lockdown on the General health of students in Punjab, Pakistan     , Amna Gill, Fatima Afzal, Hira Aamer, Amjad Khan, Ali Akram Khan, Asad Aslam Khan, Saira Afzal*
Background: Since Covid-19 was declared a pandemic and a worldwide lockdown was imposed, it was predicted that there would be an increase in screen usage, especially among students, which could potentially have a lot of negative symptomology associated with it. Objective: The objective of our study was to determine the extent of screen exposure among medical students during lockdown and to study the symptoms that they faced due to it along with their frequency. Methods: In our descriptive cross-sectional study, we distributed the specifically designed questionnaire through online media to the concerned population, in order to gather important data about the physical and mental symptoms experienced by the medical students as a result of excessive screen exposure. Results: Of the 400 participants, 93.75 % reported an increase in screen time during the lockdown. As a consequence of increased screen usage, 207 (51.75%) of the participants reported headache, 267 (66.75%) reported fatigue, 283 (70.75%) reported eye strain, 121 (30.25%) reported dry eyes, 143 (35.75%) reported blurry vision, 154 (38.5%) reported teary eyes, 154 (38.5%) reported ear ache, 247 (61.75%) reported neck and back stiffness and 148 (37%) participants agreed to having experienced fingers and hand fatigue. We also established that increasing screen time was associated with a progressive decrease in physical activity (p=0.11) and increase in food consumption (p=0.002). A significant association was also recorded with weight gain (p=0.03). We found that the students previously diagnosed with a refractive error were more likely to complain of eye strain (p=0.004) and those diagnosed with migraine experienced more screen related headache (p=0.001). Of the 11 symptoms related to mental health in the questionnaire, students with screen usage of less than 4 hours marked a median of 2 symptoms, those with screen time of 4-8 hours marked a median of 4 symptoms and those with a screen usage >8 hours ticked a median of 5 symptoms. Students who had been diagnosed with anxiety or depression in the past checked an average of 5.24 symptoms while those with no such diagnosis had only 3.51 symptoms on average. Conclusion: The results proved a potential impact on the general health of the medical students. A significant increase in weight was observed along with other serious short and long term effects on their physical and mental wellbeing.
314 Peeling with 25% trichloroacetic acid in the treatment of facial skin photoaging , Israel Alfonso Trujillo*, Idaisy Guerra Est�©vez, Nadia Alejandra Castillo Ni�±o, Mayra Alexandra Ortega Arciniegas, Tamara Emilse Guerra Guerra, Yetter Cruz Leon , Angela Rosa Guti�©rrez Rojas
Introduction: The chemical peel consists of the application of chemical exfoliants that eliminate the layers of the skin so that it can regenerate with an improved texture and pigmentation. It is currently a valuable therapy in dermatology, however, few studies objectively evaluate its efficacy. Objective: To evaluate the efficacy and safety of peeling with 25% trichloroacetic acid in the treatment of facial skin rejuvenation. Method: An observational, analytical and longitudinal study was carried out in 250 patients from two hospitals (Surgical Clinic: “Hermanos Ameijeiras” and General Teaching: “Enrique Cabrera”), in the period between January 2010 and January 2020. Treatment It was applied monthly for 6 months. The final evaluation was carried out 3 months after the end of the treatment. Results: 238 women and 12 men were treated with an average age of 30.5 (± 8.4) years. After treatment, there were significant changes in the Glogau Photo Damage Scale (P=0.012), in the Lemperle Wrinkle Assessment Scale (P=0.016) and in the Global Aesthetic Improvement Scale (P=0.021). The adverse events found were burning, inflammation and scaling. The degree of satisfaction reported by the patients was good (4.4%) and very good (95.6%) (P=0.011). Conclusion: The 25% trichloroacetic acid peel proved to be effective and safe to reduce the signs of facial skin aging, associated with a high degree of patient satisfaction.
315 How Antioxidant Have an Effect on Scavenger Receptors Action , Sepideh Farahiniya
Today’s lifestyle has changed in comparison with the past. Using junk foods and unhealthy foods leads to increasing the risk of heart attacks. Atherosclerosis is an inflammation disease made by many factors that lead to cardiovascular diseases (CVD). Macrophages, endothelial cells, OX-LDL, and some oxidants such as reactive oxygen species (ROS) are the reasons for this transformation, and they have an important role in causing cardiovascular disease. Hyperlipidemia is a major reason for atherosclerosis. Increase in the use of fatty food and fast food can lead to a rise in the risk of atherosclerosis. Macrophages are special cells derived from monocytes and can make plaque which led to increased risk of atherosclerosis. Curcumin is one of important ant inflammation can reduce the risk of CVD. Some studies illustrate that a class SRs, SR-AI and SR-AII, and 2 members of the B class, CD36 and SR-BI, involved in atherosclerosis process. Some studies strongly suggest that oral antioxidants are effective in atherosclerosis treatment, most of them have been unsuccessful except probucol. The aim of this study is illustrating that how curcumin as antioxidant can effect on atherosclerosis proses and scavenger receptor’s activation.
316 General Factors of Anatomical Variation on the Size and Number of Dental Roots Influencing the Choice of Immediate Implants , Josiel Abrah�£o Pereira de Oliveira*, Adilson Chaves, Tarley Pessoa de Barros, Rubens Guimar�£es Teixeira and Ricardo Grillo
Bone metabolism is gaining more prominence due to osseointegrated implants. Even after a minimally traumatic tooth extraction, there are natural reductions and losses in the proportions of the alveolar bone and other periodontal tissues. Maintaining these dimensions has become a challenge for researchers. Immediate implants are set in the same surgical act as tooth extraction. Implants are recommended aiming at reducing the waiting time for bone repair and thus offering the necessary stimuli to the bone for its dimensional, functional, and esthetic maintenance. Planning prior to immediate setting should take into account anatomical variations and even anomalies mainly related to the dimensions and number of tooth roots. Among the general factors of anatomical variation, those related to Gender, Age, Biotype, and Ethnicity stand out. These data were provided in studies carried out by several authors in several countries, correlating them with the dimensions and number of tooth roots. A selection of works using measurement methods as Cone Beam Computed Tomography or direct measurements in extracted teeth was carried out. Studies confirm that Panoramic Radiography presents greater distortions and does not provide sharpness for dimensional boundary markings. Significant data were obtained and confirm the correlation of these general factors of anatomical variation with the length and number of tooth roots. Further studies need to be carried out, in order to provide clinicians with details of these variants, important in the planning and prior choice of the best shape and size of the dental implant to be installed.
317 Aberrant neuroplasticity in autism spectrum disorder , Daniela Capdepon*
Developments have taken place within the neurobiology research in Autism spectrum disorder (ASD), and results from these studies indicate that the brain in ASD is related to aberrant neuroplasticity.
318 Efficacy of adjuvant phosphatidylcholine in the management of egyptian patients with non alcoholic fatty liver disease (NAFLD) , Reda Elwakil*, Azza El Sayed Mansy, Sarah Mahmoud Shaheen, Alaa Barakat, Nehal Mohamed Nageeb Abou-Seada, Manal El Hamamsy
Background and Aim: Non-Alcoholic Fatty Liver Disease (NAFLD) has become the most common liver disorder with increased liver related and non-related complications and mortality as a result of increasing obesity, type 2 diabetes and metabolic syndrome (MetS). The current study aims to evaluate the efficacy of adjuvant phosphatidylcholine in treating patients with NAFLD. Methods: This interventional randomized controlled study recruited 100 patients with NAFLD and MetS randomized into: a control group (n=50) that received standard care of life style modifications and an intervention group (n=50) that received phosphatidylcholine (2100 gm/day) plus standard care. Both groups received health education through clinical pharmacist for achieving sustainable weight loss for 6 months. Body mass index (BMI), waist and hip circumference, liver function, lipid profile, homeostasis model of assessment-insulin resistance (HOMA-IR) score, NAFLD-fibrosis score, steatosis score and liver stiffness measurement by transient elastography were recorded at baseline, 3 and 6 months. Results: Intervention group showed significantly (p<0.05) higher number with normalized; alanine aminotransferase, total cholesterol and low density lipoprotein at midpoint and endpoint, aspartate amiontransferase at midpoint and high density lipoproteins and malondaldehyde at endpoint. Intervention group showed a significantly higher participants’ number who shifted to more favorable category of NAFLD-fibrosis score (p=0.02), radiological fibrosis stage (p=0.015) at endpoint, radiological steatosis grades and HOMA-IR score at midpoint and endpoint (p<0.05). Additionally, significant number of participants in intervention group (34%) lost MetS components compared to (10%) in control group at endpoint (p=0.004). Conclusion: Adjuvant phosphatidylcholine has shown laboratory, radiological and clinical benefits in the management of Egyptian patients with NAFLD and ameliorate MetS parameters.
319 Accessibility of primary healthcare in low and middle income countries: a systematic review , Muhammad Daood, Saira Afzal, Ahtisham ul Haq, Ali Akram Khan, Taimoor Akram Khan, Khunsa Junaid
Background: Accessibility to healthcare is the capability of a population to obtain a specified set of healthcare services. There is a direct link between the distance patients travel to access health and the reduction of ill health and suffering in a country. This has an important impact on the quality of life of people. Objective: To find the spatial or geographic determinants of accessibility of primary healthcare provision in low and middle income countries during last two decades. Methods: Systematic review was done according to PRISMA guidelines. Data bases used were Google scholar, PubMed and Science direct. We found ten different studies from eight different economic groups of countries. Accessibility of primary healthcare in low and middle Income countries published during the period of last two decades were included using the key words like Spatial Accessibility;Geographical Accessibility; Primary Health Care; Primary Care; Low and middle income countries. The countries included were Afghanistan, Bangladesh, Bhutan, Democratic Republic of Congo, India, Indonesia, Sudan, Mozambique /Rural Africa. Two studies each from India and Mozambique (Rural Africa) were included. The categorization as low and middle income counties was as per World Bank classification. Results: We found that accessibility to primary healthcare was worse in low income countries like Afghanistan, Mozambique and South Sudan where more than two third of the population lived in underserved or difficult to access areas while rest of the countries, which come under category of lower middle income countries, more than half of the population lived in underserved or difficult to access areas. Conclusion: Health care ease of access is a single most important component for equitable and adequate health system. Guaranteeing a healthcare system which is easily accessible to the people is a basic consideration for public health policy makers, policy implementers and academicians.
320 Dynamic diabetes solutions: physiologic insulin resensitization , Brian Loveridge,*, Tori Tucker, Melanie St. Laurent, Scott Hepford, Michael Alexander, Jonathan RT Lakey
Diabetes is a disease currently affecting over 30 million Americans and is a leading cause of amputation, blindness, and chronic kidney disease. Treatment of diabetes with medications and lifestyle modifications alone have not eliminated these complications, because in part they lack the ability to restore the periodic cycles and rest periods of insulin that exist in healthy physiology. Insulin is excreted in a cyclical and oscillatory pattern by the pancreas, that is critical to maintain adequate insulin sensitivity at the insulin receptor level. Administration of exogenous insulin bio identically matching this physiologic profile is more effective at controlling blood glucose level and reducing complications of diabetes than standard drug therapy and lifestyle modifications alone. This matching of physiological insulin helps reduce inflammatory cascades responsible for a number of diabetic complications. In this article, we will review how insulin is secreted and functions physiologically and highlight a dynamic insulin delivery modality that mimics normal secretion profiles. This biomimicry reduces insulin exposure, which appears to reduce the progression to or worsening of insulin resistance. We will review how administration of insulin in this manner has been associated with reduction of diabetic complications.
321 Ibrutinib induced atrial fibrillation complicated with massive hemoptysis , Rodriguez-Guerra Miguel*, Chinta Siddharth, Gupta Sorab, Ali Nisha
Background: The oncologic patient faces multiple adverse effects with cytotoxic medications, from tissue damage and intoxications that could be evident from muscle damage, neurologic to cardiac toxicity. Case: This is a case of a 79-year-old female who presented to our ED with the complaint of hemoptysis for one day, denied any associated cough, fever, chills, chest pain, SOB, nausea, vomiting, or abdominal pain. No history of trauma. Her medical history includes hypertension, uterine cancer status post-resection. The patient denied prior similar episodes, family history of similar complaints. Chest X-ray showed extensive bilateral infiltrates and cardiomegaly. CT chest ruled out pulmonary em-bolism but showed extensive multifocal pneumonia vs. ARDS, lymphoproliferative changes. While in the ED, the patient started having bloody nasal secretions noted, requiring nasogastric lavage revealing dark blood secretions, and then started having massive hemoptysis and rapidly decompensated requir-ing endotracheal intubation hypoxic respiratory failure. An emergent bronchoscopy was performed, which showed suspected alveolar hemorrhage (Figure 1). The CBC showed severe anemia requiring multiple transfusions due to active bleeding (Table 1). The patient was admitted to ICU. The patient’s PCP was contacted to obtain further information that reported a new history of atrial fi-brillation on rivaroxaban recently started, CLL on ibrutinib, and Coombs Hemolytic Anemia. The hospital course was complicated by distributive shock and ARDS. She was covered with broad-spectrum antibiotics and required fresh frozen plasma due to persistent bleeding. The patient improved after anticoagulation and ibrutinib were held. The patient was eventually extubated, required physical therapy for deconditioning, and then was discharged. Conclusion: This case represents clear evidence of how an appropriate assessment on time and the collateral gath-ering of medical history could impact the outcome of our patients. The literature review has shown new-onset atrial fibrillation and bleeding events related to ibrutinib. Given the risk for bleeding with rivaroxaban, their combination could present with massive alveolar hemorrhage that could become fa-tal if not recognized early.
322 The influence of narrated group discussions on the interpretational ability of medical students: a prospective observational study , Inbar Paz*, Tali Shafat, Yaniv Almog
Background: Clinical decision making is predominantly knowledge-based perception, interpretation under terms of uncertainty. It is unclear whether interpretational ability can be improved. We evaluated the effect of a narrated group-discussions course (NGDC) on the interpretational ability of first-year medical students. Objective: To evaluate the effect of our course on first year medical students in respect to: a) their interpretational abilities b) their attitude towards studying literature and the core subjects. Method: Using a pre-post questionnaire, of a semester-long course, among two consecutive classes, the authors evaluated the participant’s interpretational ability and depth of understanding when analyzing four complex passages. Results: Out of 235 students, 146 (62%) responded to both questionnaires. There was a significant increase in the participant’s interpretational ability (P=0.003). ninety one participants (38%) improved their level of understanding in at least one out of the four passages, and 37 participants (25%) improved in two passages. A multivariate analysis revealed that the improvement in the interpretational ability was associated with younger age (P=0.034, CI 95%=0.64-0.98, OR=0.79), positive pre-course attitude and motivation (P<0.001, CI 95%=1.43-3.05, OR=2.09), and lack of a prior literature background (P=0.064, CI 95%=0.17-1.05, OR=0.43). Conclusion: Our data suggests that NGDC may improve and refine interpretational ability. Further studies are required to establish the short- and long-term impact of this change and whether it can be translated into better clinical decision making
323 Depression a common condition in older hospitalized chronic patients-a transversal study , Vjollca Ndreu*, Fatjona Kamberi
Objective: To examine the prevalence of depression among older hospitalized patients and its relation to chronic diseases. Method: A transversal study was conducted in a Regional Hospital in South Albania which included a total of 100 hospitalized chronic patients. The study lasted one month and the Patient Health Questionnaire (PHQ-9) was used for the data collection. Each participant completed a validated Albanian version of the questionnaire. Patients diagnosed with various pathologies who presented for examination but were not admitted to the hospital were excluded from the study. For the data analyses were used descriptive statistics. Results: Participants’ mean age was 55.9 ± 18.45. 46 % of patients were female and 54% were male. The results of variables assessing the depression were as follows: 24% of female patients report “Little interest or pleasure in doing things” nearly every day; 15% of female and 11% of male patients report “Feeling down, depressed, or hopeless”; 39% of female and 24% of male patients feel “tired or have little energy”. The diagnosis was significantly associated with the trend for depression, p<0.05. The most frequent diagnoses diagnosis were hypertension, diabetes, and stroke respectively 23.00%, 14.00%, and 10.00%. Conclusion: Depressive symptoms occur more commonly in older hospitalized patients with chronic diseases. They require a longer rehabilitation time, which influences the day hospital stay. For improving the quality of care and life of this patient a routine depression screening and more support from nurses are recommended.
324 Real-world data on camrelizumab in digestive system cancers: a retrospective observational study , Xiaolei Wang,Qihe Long, Yu Su, Fanfan Li*
Objective: To explore the clinical efficacy and safety of camrelizumab in the treatment of digestive system malignancies in the real world. Methods: A retrospective study was designed. A total of 34 patients with advanced gastrointestinal cancer who received camrelizumab treatment in the xx hospital from July 2019 to May 2020 were included. The follow-up endpoint was set for October 30, 2020. The primary endpoint was objective response rate (ORR) and safety. Secondary endpoint measures included progression-free survival (PFS), and overall survival (OS). Cox regression was used for the analysis of factors associated with PFS. Results: As the best response, only 5 patients achieved a partial response and 10 patients had disease progression, with an ORR of 14.31%. Compared with gastric cancer, the ORR of esophageal cancer (3.0% vs 0.0%) (P<0.05). The PFS was 4.5 months (2-10 months). OS ranged from 4 to 11 months, and median OS has not been reached. Multivariate Cox regression analysis showed that gastric cancer (HR=1.695, 95% CI:11.216–2.435, P<0.05) was associated with still shorter PFS, and camrelizumab combined with other drugs (HR=0.512, 95% CI: 0.095–0.737, P<0.01) was associated with PFS in patients. The most common AEs were anemia (41.2%, 14/34) in all grades 1 to 2. Grade 3 AEs occurred in 3 patients (2.9%), including 1 case of immune pneumonitis, 1 case of hemangioma, and 1 case of transaminase increased. Other adverse events included diarrhea, nausea, neutropenia, thrombocytopenia, reactive cutaneous capillary proliferation (RCCEP), fatigue, and hypothyroidism, all of which did not exceed 12%. Conclusion: Camrelizumab is effective and safe in the treatment of patients with digestive system malignancies, but the overall response rate is limited.
325 Story of Allergens-collection of rhymes as a tool for dealing with the fear of needles in children , Diana Hristova*
Needle phobia is  an extreme psychiatric disorder that includes visual avoidance of the phobic stimulus. The average age of onset is 5.5 years and its incidence decreases with age. This condition  often is  the main reason for  inability to perform skin allergy tests. “Story of Allergens” for home education  improves cooperation in doctor-patient- parent interaction.  
326 Treatment of diabetic neuropathy induced non healing foot ulcer using merisistm supercellplatelet rich fibrin matrix: a clinical study , Sanjay Sharma, Manoj Bansode, Amol Gaikwad, Suchit Mali, Sarmistha Deb, Kaushik D Deb*
Objective: Non healing foot ulcers are a major debilitating condition in diabetic patients which leads to limb amputation.In this study we discuss the use ofMERISISTM Supercell plus Platelet Rich Fibrin Matrix (PRFM) kitfor point of care treatments towards limb salvation. Method: We selected diabetic mellitus patients havingDiabetic foot ulcer (DFU) grade 1 or higher. Use of MERISISTM Supercell plus PRFM is a biological matrix of extracellular matrix (ECM) protein plus growth factors derived from peripheral blood to treat the DFU 45 days over. Result: Following treatment the patients showed quick recovery and complete healing of the ulcers. Conclusion: Supercellplus PRFM therapy promotes wound healing in patients suffering from chronic non-healing diabetes foot ulcers. Supercells plus PRFM dressing is a safe and effective treatment modality to promote wound contraction in patients suffering from non-healing diabetic foot ulcers.
327 Spinal cord compression with acute para-paresis due to thoracic aneurysmal bone cyst (ABC): a case report and review of the literature , Farouq Alguayn*, Micky Gidon, Dyomin Victor, Abed Al Gawad Siag, Yuval Sufaro, Waleed Kian, Melanie Zemel, Israel Melamed
Aneurysmal bone cysts (ABCs) are benign, highly vascular osseous lesions characterized by cystic, blood-filled spaces surrounded by thin perimeters of expanded bone. Children and young adults are most often affected by spinal ABCs; more than 75% of patients are younger than 20 years old at the time of presentation. Although ABCs have been documented in all areas of the axial and appendicular skeleton, ABCs of the spine present unique challenges due to the risk of vertebral destabilization, pathological fracture, and vertebral body (VB) collapse with neurological compromise. We describe here a case of a 12-year-old child who presented with cervical pain and gait disturbances starting a few weeks prior to his admission with acute paraparesis at the time of admission. Subsequently he was found to have a Thoracic ABC involving T1-T3.This was accompanied by T2 vertebral body collapse and spinal cord compression. He was investigated and treated promptly by resection of the aneurysmal bone cyst with posterior Cervical-thoracic instrumentation. There was full post-operative neurological resolution.
328 Intramedullary spinal abscess associated with intramedullary dermoid and infected dermal sinus:case report and review of the literature , Farouq Alguayn*, Micky Gidon*, Elad Avraham, Melanie Zemel, Elron Oscar, Amit Azriel ,Waleed Kian, Israel Melamed
Intramedullary spinal abscesses are extremely rare. Most occur secondary to cardiopulmonary spread;contiguous origin is less frequent. Few intramedullary spinal abscesses have been reported secondary to dermal sinus tracts. A dermoid sinus is a congenital lesion (closed simple dysraphism) with rare incidence.Dermoid sinuses can ease local invasion and spinal infections (meningitis, intradural extramedullary and intramedullary abscesses), usually with thoracolumbar involvement. Here we describe acase of a 20-month-old boy who presented with fever and refusal to walk 2 days prior to admission. On examination of the lumbar spine, a small sinus with skin stigmata was noted.Neurological evaluation revealed paraparesis more prominent on the left side, reduced tone and reflexes, left leg hypoesthesia,reduced anal tone, and urinary retention.MRI scan demonstrated intramedullary abscess extending from L2 to S1 level. The patient was urgently admitted for drainage of intramedullary abscess and excision of the dermal sinus tract. Proper antibiotic treatment was completed for 6 weeks with gradual improvement and ultimately full ambulation ability.
329 Pembrolizumab induced cardiotoxicity , Rodriguez-Guerra Miguel*, Qureshi, Zaheer, Vittorio, Timothy, Gupta Sorab
Background: Pembrolizumab is a monoclonal antibody-based chemotherapy infusion, recently approved for unresectable or metastatic solid tumors with certain genetic anomalies. Discussion: Pembrolizumab is an IV infusion therapy for treating non-surgical or metastatic melanoma and non-small cell lung cancer. Multiple cardiac complications have been related to this drug, the mechanism is not precise, but a possibility is immune events involving the cytotoxic T-cell resulting in fibrosis of the cardiac cells. Conclusion: New oncologic medications have emerged with a potential reversible or irreversible cytotoxicity, including inflammation, dysfunction, or apoptosis that could represent a life-threatening condition. There is not enough data to establish proper therapy to avoid cardiotoxicity on monoclonal therapies, but an early approach and immunosuppressive therapy are thought to improve the outcome.
330 Successful integration of interdisciplinary pain rehabilitation and spinal cord stimulation for chronic naive back pain , Helena Jamnik*, Mitja Benedi�i�
Spinal cord stimulation for naive back pain is a therapeutic option that is rarely considered, especially when conventional stimulation parameters are used. Interdisciplinary pain rehabilitation program is another less feasible but effective therapeutic approach for the management of chronic pain that is not usually used in conjunction with interventional procedures.This case report presents a successful integration of an interdisciplinary pain rehabilitation program with an interventional procedure spinal cord stimulation using conventional stimulation parameters in a patient with chronic, predominantly nociceptive to nociplastic, naïve back pain.
331 A case in which TAS-102 produced disease control without severe adverse events in a patient with recurrent colorectal cancer and dihydropyrimidine dehydrogenase deficiency , Ryo Nakanishi*, Atsuko Tsutsui, Hiroto Tanaka, Kohei Mishima, Chie Hagiwara, Takahiro Ozaki, Kazuharu Igarashi, Satoru Ishii, Nobuhiko Okamoto, Kenji Omura, Go Wakabayashi
Fluoropyrimidine is commonly used to treat unresectable cases of metastatic colorectal cancer or as an adjuvant therapy for colorectal cancer. Dihydropyrimidine dehydrogenase (DPD) is an enzyme encoded by the DPYD gene, which is responsible for the rate-limiting step in pyrimidine catabolism and breaks down >80% of standard doses of 5-fluorouracil (5-FU). Reductions in DPD activity increase the half-life of 5-FU, resulting in excess 5-FU accumulation and toxicity, which can lead to life-threatening side effects. There have been several published case reports about DPD deficiency in colorectal cancer patients from Western countries. However, case reports of DPD deficiency in Japanese colorectal cancer patients are rare because the measurement of DPD activity is not covered by the public medical insurance system in Japan, and DPD activity is not currently measured in daily clinical practice. Furthermore, there have not been any reports about anticancer drug therapy for Japanese patients with DPD deficiency. In this report, we describe a case in which a Japanese patient with colorectal cancer was diagnosed with DPD deficiency. The DPD deficiency arose as a severe adverse effect of mFOLFOX6/CapOX treatment for recurrent colorectal cancer, and the patient was subsequently treated with TAS-102, without experiencing any severe adverse effects. We report this case along with a review of the literature.
332 Trimodal bladder-preserving treatment including high-tech radiotherapy in invasive bladder carcinoma-dissertation project with literature review     , Vaska Vassileva, Viktor Petrov, Lena Marinova*
Over the last two decades, there has been a significant evolution of the complex treatment of the invasive bladder carcinoma (BC), including both surgery methods and high-tech radiotherapy (RT), often combined with chemotherapy (Ch). Different protocols supporting multimodal treatment and the concept of the bladder preservation are currently developed. New high-tech radiation methods were presented combined with Ch to preserve the bladder as a healing alternative to radical cystectomy. The purpose of this overview is to present the place and healing effect of high-tech RT in the contemporary treatment approach to invasive BC. The expected contributions from this research project are: 1) For the first time in Bulgaria, modern bladder-sparing strategies combine maximal transurethral resection of bladder tumor (TURBT) followed by an induction course of concurrent radiation therapy (RT) and sensitizing chemotherapy will be held. 2) Disease-free survival, overall survival, local control and early radical toxicity in two patient groups after self intensity modulated radiation therapy (IMRT) and after concurrent chemoradiotherapy (CChRT) with VMAT will be analyzed. It is important to improve the quality of life by preserving the bladder in the invasive bladder carcinoma.
333 Integrative chemo-immune-radiological treatment of HER2 positive breast cancer combined with a review of potential microRNAs involved and analysis of experimental results from sub-THz vibrational spectroscopy , Tatiana Globus* Erika Struble, Linda M Sommers, Sylvia Hendrix, Jerome Ferrance, Barbara Peskova, Igor Gelmanov, Aaron Moyer, Alex Bykhovski, Boris Gelmont
In this paper we present the results of a Breast Cancer study by integrative analysis of a NIH approved treatment for HER2 positive breast cancer. This study is combined with analysis of Micro-RNA involvement from application of sub-THz spectroscopy for visualization of molecules circulating in blood by measuring saliva. The combination of Taxol-Generic Name-Paclitaxel (PT-J9267) and Trastuzumab-ANNS 0/0 and KadcylaTM (Genetic Name Ado-Trastuzumab Emtansine) were used in 3-stages of combined chemotherapeutic and immune-treatments followed by Radiation treatment. The goal of using PT was to stop spread of the disease to other organs outside of the breast and under arm lymph nodes, as well as to shrink the size of the tumor to facilitate surgery and radiology in continuation of the treatment. Trastuzumab (TZ) was added to PT in the 2nd step to prevent the development of chemoresistance. Intravenous infusion of Kadcyla was used mainly to prevent metastasis. Integrative analysis of microRNA participation was conducted based on literature review and sub-Terahertz vibrational spectroscopy measurements of absorption spectra from samples taken weekly before and after each treatment, using Vibratess’ spectrometer.  The results from sub-THz spectroscopy in this work demonstrate dramatical modification of spectroscopic signatures from patient samples following disease development and the initial steps in the course of treatment. These changes reflect the deep global regulation (reduction) of the initially participating microRNAs amounts and changes in the microRNAs contributing to the spectra.
334 Isolated acute renal infarction in an obese patient , Rodriguez-Guerra Miguel, Neelanjana Pandey, Montes de Oca Jr Manuel, Rehmani Arsalan, Fortuzi Ked, Kamalakkannan Gayathri, Nicu Marin, Patel Madanmohan
Background: Uncontrolled cardiovascular (CV) risk factors is been related to a higher incidence of atherosclerosis. Obesity itself could predispose to significant cardiac disease including arterial atheromatous leading to acute events.  Case: A 46 years old obese patient who presented with left abdominal pain radiating to the left quadrant and left testicle. No significant abnormality was observed in the laboratories, but imaging showed left renal lower pole may be due to renal infarct (Figure 1), and CT-Angiography (CTA) of the abdomen showed infarction of the anterior two-thirds of the lower pole of the left kidney (Figure 2) secondary to occlusion of the supplying small inferior segmental artery and minimal atherosclerosis. Transthoracic Echocardiogram (TTE) showed a density in the LVOT may be artifact vs. calcification (Figure 3). A transesophageal echocardiogram (TEE) showed Grade III atherosclerotic changes of descending aorta (Figure 4), aortic arch, and a mobile plaque seen in the thoracic aorta. Conclusion: Cardiovascular risk factors have been associated with multiple vascular complications. Obesity as a single cardiovascular risk factor is associated with advanced arterial disease; our case is an example of an unstable atheromatous lesion causing thrombosis and ischemia in the kidney in a patient without another risk factor for thrombosis. 
335 Assessing behavioural prevention strategies to reduce dental caries in the primary schools of the state of qatar-case study , Dr. Najat Abdrabbo Alyafei
Introduction: Multiple case studies were conducted using a public school and a private school to understand why the prevalence of dental caries was high among primary school children despite previous oral health strategies. The study is aimed to inform the refinement of current dental caries prevention behavioural strategies in Qatar for school children in both public and private settings. Methods: Purposive sampling was used to select 5 pupils, 5 parents, 5 teachers and 2 school nursese for the case study. A semi-structured in-depth interview was conducted with the participants to understand issues relating to prevalence and control of dental caries among school pupils. Results: The study found that home context plays a crucial role in terms of oral health motivation in Qatar. It was found that children are taught the most basic daily oral hygiene-related behaviours at home, including tooth brushing and dental flossing.   Discussion: The study revealed the role of parents at home in supporting oral health activities to motivate and empower children to take part in such behaviours. Also, parents and teachers work in collaboration to enhance oral health behaviours in children. 
336 The role of beta-agonist therapy for chronic obstructive airway disease in patients with coexistent atrial fibrillation , Rodriguez-Guerra, Miguel*, Chinta, Siddharth, Montes De Oca Manuel, Vittorio Timothy
Background: New advances have been made in medicine, but the incidence and prevalence of chronic obstructive pulmonary disease (COPD) are evident, and it is established as the fourth cause of death in the United States representing a high cost for the healthcare system. This condition has been related to atrial fibrillation due to the changes in the lungs and vasculature. Based on this history, we seek to evaluate the outcome of AF in the patients with COPD and its relationship with medical therapy utilized to treat this pulmonary condition with the objective of establishing the relationship between the use of beta-agonist therapy for obstructive airway disease in patients with AF. Discussion: Cell receptors participate in multiple reactions and the sympathetic response is received via the alpha- and betareceptors are related to the hemodynamic of the vasculature of the lungs and cardiovascular system. The beta-blockade agents are one of the most common medication classes used for rate control in cardiac arrhythmias, but the side effect could be COPD exacerbation; on the other hand, beta-adrenergic or beta-agonist as a therapy for this pulmonary condition could increase the heart rate leading to AF decompensation. There is a clear dilemma in our patients who have airway disease and AF since the treatment for one might worsen the other. The clear benefit in morbidity and mortality of beta-blocker therapy, especially beta1selective, outweighs the potential for any pulmonary side-effects related to ex-acerbation of COPD or airway disease.  Conclusion: There is clear data showing the evidence of the potential paradoxical side-effect between COPD and AF therapies, given the exacerbation of one due to treatment of the other, benefits versus risks should be discussed and the medical decision should be made based on them. The deteriorated cardiac condition can rapidly predispose to critical complications leading to death, which is why the use of beta-blockade agents will be chosen over possible complications with pulmonary disease. In other words, the benefit should outweigh the risk based on the best outcome for the patient.
337 Hidradenitis suppurativa, holistic approach and surgical reconstruction , Badr M I Abdulrauf*, Jamal A M Ilyas
We present a young adult male patient with chronic Hidradenitis Suppurativa (HS) stage â�?¡-â�?¢, mostly involving buttocks, thighs and perineum. The patient has been followed initially by a dermatologist for 2 years with trials of Biologic treatments. The ongoing purulent discharges made him quite dysfunctional. Patient was offered a definitive and extensive surgical option. Considering this conditions’ devastating social, psychological effects, such patients should be managed with a multidisciplinary team, elaborated education and counseling. Initial line of treatment plans should be considered as preparatory to the definitive surgical excisional therapy. Patient’s acceptance to the entire package that goes with the definitive surgery is fundamental for a successful and lasting outcome. Complete surgical resection of the disease and reconstruction remains to be the only available option for cure in a fully established HS.
338 Tonsillectomy, appendectomy and splenectomy: sequels and malignant evolution     , Anton Osyntsov, Daniel Benharroch*, Lidia Osyntsov, Mordehai Krause
The excision of secondary lymphoid organs might not be harmless. Although the procedure itself, is less and less performed presently, infectious sequels in total splenectomy might occur and are possibly fatal. Among further complications, thromboembolic and immune alterations should also be expected. The most debatable of consequences, probably associated with an immune adjustment, concerns the development of malignancies. Considering post-splenectomy tumors, discrepancies emerge between their occurrence in humans, and their consequent protective effect in experimental animals. It is recommended that surgeons aspire at preserving as much of lymphoid tissues a feasible, when performing such resections.
339 Thyroid storm induced congestive heart failure , Miguel Rodriguez-Guerra, Manuel Montes De Oca*, Neelanjana Pandey, Timothy J Vittorio
Background: Uncontrolled thyrotoxicosis is known to lead to a state of prolonged tachycardia that may then progress to the onset of reversible congestive heart failure. Case: The patient is a 36-year-old female with a history of Asthma, bilateral ovarian benign cysts, chronic goiter presented due to persistent cough, wheezing, and shortness of breath for about two days duration, echocardiogram had been done for respiratory failure, showing reduced ejection fraction, diastolic dysfunction, and dilated cardiomyopathy. She was subsequently admitted to the MICU for treatment of respiratory failure due to asthma exacerbation. Then began feeling symptoms of anxiety, palpitations, tremulousness, facial flushing. Evaluation of her labs showed elevated T3 at >650, elevated T4 at 22.6, with diminished TSH level at 0.01. The patient was diagnosed with thyroid storm in consideration of lab values with clinical features. TSI was ordered, which returned at 674. Endocrinology was consulted; the patient added a history of tremors for three weeks and weight loss of about 5 pounds over several months, with symptoms of generalized anxiety and dysphagia; she also reported diarrhea in the past weeks. She refers to a family history of goiter in her aunt. The recommendation from an endocrinology perspective was to obtain TSI level and ESR, continue methimazole. The patient was clinically stabilized, discharged on medications for heart failure and methimazole. However, she developed a rash on methimazole, and this was stopped. The patient went for radioactive iodine ablation, and a repeat echo showed an improvement of her ejection fraction. The patient was asymptomatic at a one-year cardiology follow-up, and cardiology medications were discontinued. Conclusion: Hyperthyroidism is a known cause of congestive heart failure secondary to tachycardia-induced cardiomyopathy if untreated. After the proper treatment, this heart failure can be reversed if tachycardia is controlled.
340 Intraoperative radiotherapy for early breast carcinoma-dissertation project with literary review , Gabrovski I, Sedloev T, Usheva S, Kovacheva S, Radeva G, Radev R, Vasileva V, Marinova L*
Breast cancer (BC) is a socially significant illness. Radiotherapy (RT) is an important part of the complex treatment of early BC after a breast preserving surgery (BPS). Partial breast irradiation (PBI) has been established as a suitable treatment option for appropriately selected women with early stage BC by numerous clinical trials dating back to the 1990s. Risk¬ adapted single¬ dose targeted intraoperative radiotherapy during lumpectomy (TARGIT ¬IORT) is a method of PBI for early BC. In this literary review, we will present the therapeutic capabilities of intraoperative radiotherapy (IORT) for early BC, the necessary patients’ selection, as well as the advantages and disadvantages of this combined with surgery radiotherapeutic approach. IORT has potential efficacy advantages related to overall survival related to reduced cardiopulmonary radiation doses, as well as prior to oncoplastic reconstruction to improve accuracy of adjuvant radiation delivery, or when used as a boost in higher risk patients to improve tumor control. The expected contributions from this research project are: 1) For the first time in Bulgaria to use IORT in the treatment of early breast cancer.;2) Local control and early toxicity for patients receiving IORT in comparison with whole breast irradiation with or without boost. 
341 Is peritoneal dialysis an effective treatment for cardiorenal syndrome with decompensated heart failure? A single center experience , Gomes da Silva Francisca, Calça Rita, Martins Ana Rita, Araújo Inês, Aguiar Carlos, Fonseca Cândida6 Branco Patrícia
Introduction and Objectives: ultrafiltration techniques have shown promise in the treatment of diuretic-resistant heart failure (HF). The aim of this study was to describe a center experience in treating refractory HF with peritoneal dialysis (PD). Methods: we performed a retrospective study of 14 patients presenting symptoms and signs of refractory congestive HF despite optimal pharmacological therapy, all excluded as candidates for heart transplantation. Baseline characteristics, laboratory data, Charlson score, and transthoracic doppler-echocardiogram results were collected. PD adequacy was evaluated through peritoneal equilibrium test results. Results: 12 patients were males and 2 females, with a median age of 72.13 years. The mean following time was 52.5 months. Symptoms of HF improved in 5 patients, with an upgrade of New York Heart Association (NYHA) Functional Classification and improvement in ejection fraction. NHYA remained the same in 6 PD treated individuals, despite and improvement of absolute ejection fraction. At the beginning of PD, the mean Charlson Score value was 5.7 ± 2.3, which reduced to 5.3 ± 2.6 by the end of observation time (p<0.01; r=0.984). Six patients presented one episode of decompensated heart failure needing hospitalization, with a median length of stay of 2 days. During the observation period 2 patients died, 1 from an acute hemorrhagic stroke and the other with a septic shock. Discussion: PD treatment in refractory HF seems to be effective since it improves quality of life and functional class. 
342 Remarkable pain control and functional improvement in clubfeet-related ankle osteoarthritis post autologous expanded mesenchymal stem cell therapy , Hassan Mubark*
Ankle joint osteoarthritis (OA) is not as common as knee and hip OA but it causes a significant socioeconomic burden in society. The causes of ankle OA could be primary or secondary to previous ankle trauma, inflammatory arthritis like rheumatoid arthritis, avascular necrosis, post-infectious, clubfoot, and other rare causes. Ankle OA is hard to treat conservatively. Limited options, including physiotherapy, supportive custom-made braces, weight reduction, and anti-inflammatory medicines. Standard surgical options are joint arthrodesis and ankle replacement. Arthrodesis can limit the movement of talar and subtalar joints, making it difficult to be accepted by athletes who require functional joint movement. Ankle replacement might last between five and ten years and is sometimes technically challenging.  Herein we report a case of a seventy-one-year-old male property investor. His past medical history of bilateral congenital clubfeet with the left foot more affected and pointed backward required three surgeries at the age of two through five to align the foot in the correct direction, and his left ankle was fused. In his mid-forties, he had mild ankles discomfort which was managed by suitable orthotics, despite the ankle pathology he enjoys various recreational physical sports at a premium competitive level with determination. At the age of sixty-seven, his symptoms increased gradually. He was diagnosed with severe secondary severe subtalar and mild talar OA, confirmed by X-rays; by the age of seventy-one, he had significant pain and loss of ankle function to the extent he could hardly walk five steps or play any sport. He failed conservative management with various supportive orthotics and long-term anti-inflammatory medicines. He elected experimental autologous fat-derived expanded mesenchymal stem cells (MSCs) combined with platelet-rich plasma (PRP). After two doses nine months apart, he responded superbly to become pain-free. Three months after the second dose, he was able to walk normally, play sports, and intend to return to competitive table tennis, but we recommended continuing using supportive orthotics. We predict MSCs slow the progression of OA. We believe this is the future medicine to try efficiently and safely regardless of the number of booster doses given.
343 Enhanced bone regeneration by Aloe vera gel conjugated barnacle cement protein composite hyaluronic acid hydrogel based hydroxyapatite derived from cuttlefish bone , Dong-Myong Kim, Hyung-Kon Lee, Yong-Seong Kwon, and Yeon-Mea Choi
Injectable Aloe vera gel W (AGW®)-conjugated Barnacle Cement Protein (BCP) composite Hyaluronic Acid (HA) hydrogels provide local periodontal tissue for bone filling in periodontal surgery. We developed a novel type of injectable self-supported hydrogel (2 mg/ml of AGW®-BCP/HA) based cuttlefish bone derived hydroxyapatite (CBH) for dental graft, which could good handling property, biodegradation or biocompatibility with the hydrogel disassembly and provided efficient cell adhesion activity and no inflammatory responses. Herein, the aim of this work was to evaluate bone formation following implantation of CBH and collagen membrane in rabbit calvarias defects. Eight male New Zealand rabbits were used and four circular calvarias defects were created on each animal. Defects were filled with different graft materials: 1) collagen membrane, 2) collagen membrane with CBH, 3) collagen membrane with bovine bone hydroxyapatite (BBH), and 4) control. The animals were sacrificed after 2 and 8 weeks of healing periods for histologic analysis. Both sites receiving CBH and BBH showed statistically increased augmented volume and new bone formation (p<0.05). However, there was no statistical difference in new bone formation between the CBH, BBH and collagen membrane group at all healing periods. Within the limits of this study, collagen membrane with CBH was an effective material for bone formation and space maintaining in rabbit calvarias defects.
344 Survey of knowledge, attitude, risk perception and practice of the elderly about Covid-19 in Urmia , Ehsan Movahed, Monireh Rezaee Moradali, MoradAli Zareipour*, Zahra Moradi, Sahar Karbasi Salmasi
Background: The first need for behavioral modification to reduce the prevalence of Covid 19 disease among the elderly is to understand their knowledge and attitudes about Covid 19-related issues. If the goal is to reduce the risk of the disease in the elderly, its important to know what the risks are and how to avoid them. Objectives: The aim of this study was to investigate the knowledge, attitude, risk perception and practice of the elderly about Covid disease in Urmia. Methods: The present study was a cross-sectional study that was performed on 1400 elderly people in Urmia, Iran in 2020 by simple random sampling. The data collection tool in this study was a researcher made questionnaire that included demographic characteristics, knowledge, attitude, risk perception and practice questionnaire. Data were analyzed by SPSS 18 software using ANOVA and logistic regression tests. Results: The mean age of the elderly was 66.6 ± 97.4 years  old. 67% of seniors had knowledge, 65% had attitude, 52% had practice and 60% had risk perception of Covid-19. Knowledge about Covid-19 was significantly associated with gender and marital status and having a chronic illness, attitude toward gender and having a chronic illness, risk perception with age and education and having a chronic illness, behavior with age, gender, marital status and having a chronic illness (05/0>p). Also, Results showed that the highest to lowest predictive constructs of masking behavior of the elderly, The most effective factor in predicting masking was risk perception (P<0.0001, wald=17.20) and attitude and knowledge were involved in predicting masking in the next step, respectively (P<0.05) Conclusion: Perception of risk was recognized as the most effective factor in predicting the use of masks, so it is necessary to pay attention to strict rules in communities with low risk perception and careful monitoring of the dissemination of information through virtual channels and networks.