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Journal of Clinical Review & Case Reports

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1 Recurrent cervical hemorrhages and thromboses associated to pulmonary thrombembolism in a hereditary thrombophilia with heterozygous mutants of MTHFR and PAI-1. Case Report and Pathophysiology Hypotheses , Manuela Cristina Russu*1, A Bogza1 , Codruta Mirciulescu2 and Ilinca Gussi1
A 30 years Caucazian nullipara, 1 blighted ovum, former Yasmin user (1 year), without antiphospholipid antibodies, prophylactic cervical cerclage at 19 weeks pregnancy, is readmitted in emergency at 21 weeks gestation for heavy pelvic pains, and abundant vaginal red blood loss, with cerclage suppression. Under tocolysis and vaginal progesterone, she presents 3 new episodes of intense pains and red, pulsatile blood loss from different cervical areas at 24- 36 hours after admittance, with mechanical hemostasis by nylon sutures at cervico- vaginal junction. The 4th episode is followed by severe anemia (Hb= 6.03mg/dL, Ht= 18.32%), haemodinamic instability, coagulation disorders- hematomas, generalized petaechia, and at 24 hours after last vaginal sutures she claims thoracic pains, dyspneea, cianosis. There are not registered fetal distress, placental abnormalities, cervical shortness below 2.5 cm (when cerclage), and maternal heart abnormalities at repeated ultrasound examinations. No thoracic computer tomography because maternal refuse. After a cardiologist consultation it is appreciated a mild/moderate pulmonary thrombembolism, without deep legs venous thrombosis, and it is started continuous intravenous anticoagulant therapy – heparine 25,000UI/day x 6 days, then fraxiparine in increased dosages continued to term, and 6 weeks postpartum. The laboratory test confirms intravascular disseminated coagulation with secondary fibrinolysis, and positivity for heterozygous mutants of MTHFR (methylene tetrahydrofolate reductase deficiency C677T and A1298C), and PAI (plasminogen activator inhibitor)-1 (4G). Cesarean delivery is performed at 37 weeks for fetal distress at labor onset, with extraction of a girl 3340g, Apgar=7/8, premature senescent placenta, thin umbilical cord. No maternal and neonate postpartum complications.
2 8 years vein glue therapy with VenaSeal® – 8 special cases , Ulf Th Zierau*, Lilia Martel and Wolfgang Lahl
Since 1949 the chemical compound of cyanoacrylate glue is known, first being used in operative medicine in the early 60s. Tissue adhesive or replacement of wound sutures Nearly all operative disciplines were / are using cyanoacrylate i.e. dermatology, ophthalmology, orthopedics, surgery, orthodontics, interventional radiologists. The VenaSeal® - Closure System has been CE and ISO certified since 2011. The American health authority FDA announced the approval of the system in the USA in 2/2015. Until October 20th of 2020, vein glue is used successfully for the treatment of truncal varicose veins in over 160 000 cases worldwide. The authors have been working with the VenaSeal®-Closure System since August 1th. 2012, and have so far successfully treated 2840 saphenous veins in 1476 patients with the vein glue. Closure effectiveness of 96,09% achieved over 98 months.
3 Propofol Infusion Syndrome: A Life Threatening Condition Blunted by Continuous Renal Replacement Therapy , Jay Pandav* and Rasika Hatti
Propofol is a common intensive care unit anesthetic which was approved by FDA in 1989. It possesses sedative, anxiolytic, and anticonvulsant properties. Case reports of Propofol related infusion syndrome (PRIS) started in early 1990s. Reported signs and symptoms included acute refractory bradycardia, severe metabolic acidosis, cardiovascular collapse, lactic acidosis, rhabdomyolysis, hyperlipidemia, renal failure, and hepatomegaly. It is associated with both high dose cumulative and short-term infusions. This case report highlights the development of PRIS in a patient admitted to the ICU, symptoms of which were assumed to be blunted because of continuous renal replacement therapy support.
4 The Usage of Physiotherapeutic Intervention to Improve the Function Ability of the Upper Limb , Nina Sladekova* , Elena Ziakova and Peter Hybela
Background: The aim of clinical study was to investigate and compare impact of robotic assisted therapy by using virtual reality to classical kinesiotherapy improving the function abilities of upper limb. Patients and Methods: 60 patients were divided randomly into two groups. Main group completed a robotic assisted therapy and comparative group completed classical kinesiotherapy. The patients with impaired upper limb were from 6 to 17 years old and all underwent twenty therapies. Results: Statistically significant results were obtained in the patients who completed a robotic assisted therapy by ArmeoSpring® in all Fugl-Meyer Assessment of Physical Performance, the best improvement (p = 0.000) in all tested blocks, apart from block H, where was the statistical significant (p = 0.002). Comparative group of the patients achieved statistically significant results only in testing of the Fugl - Meyer in block of sum of motor function A-D (p = 0.009). In other blocks were the results without statistically significant p ≥ 0.05. Conclusion: The patients with cerebral palsy are statistically more effective from robotic assisted therapy by using virtual reality for the improvement of function ability of paretic upper limb, than those who completed the classical kinesiotherapy
5 Family Health Care for Amphetamine-abused Adolescent in Thai Context: Cases Study , Kannika Rattaworn1 and Saovakon Virasiri*2
Amphetamine abuse has become a major challenge facing Thai society. The cases study was aimed at exploring how nurses provide care for family with amphetamine used teenagers at community hospital setting. The concept of Family healthcare and Family Resiliency were applied. The participants were 5 families with amphetamine-abused teenagers. The study tools comprised of Family Health Care Intervention (FHCI) that included family health assessment, family intervention, and Family Power Handout. Data was collected by in-depth interview, questionnaire, and health examination. Content analysis was used to analyze data. Findings displayed all parents had severe stress. Some fathers had high anger and punished their sons by striking. The adolescent boys had several risks behaviors; delinquency, theft, and video game addiction. Families coped with various methods such as taking sons to ordain. The family system had poor function. The nurses started therapeutic communication with parents and teenagers. Reducing suffering, providing emotional and information support were done. Some mothers were referred to psychiatrist due to severe depression. Family meeting and counselling were used; as well as follow-up, which was done for 4 weeks. Family psychoeducation and modification were conducted. After 4 sessions, family stress was decreased. Family function had adjusted to provide care for the teenagers, which could help them to decrease amphetamine using. Some fathers had seen function change of positive fathering. In summary, the FHCI could provide care for the family as a total unit. However, this situation is very complex, thus, longitudinal study design is needed for monitoring and evaluating the family health outcome.
6 COVID-19 on a Patient with Familial Hypercholesterolemia , Salihu Kushtrim1 and Abdullahu Valon*2
Covid-19 is disease caused by a novel coronavirus also known as severe acute respiratory syndrome coronavirus 2, a name that describes the disease if causes. It was first detected in Wuhan, China in December of 2019 where it arose to spread in the entire world to cause the global COVID-19 Pandemic. This virus causes severe bilateral pneumonia and acute respiratory distress syndrome which requires to be managed in intensive care unit requiring mechanical ventilation. We present a 77-year old Covid-19 patient with familial hypercholesterolemia and stroke who presented with the main symptom of confusion. After exclusion of our first differential that was stroke, we tested the patient for Covid-19 and resulted positive. After treatment with oxygen, steroids and antibiotics, the patient recovered and was discharged. An important lesion from this patient was that the presentation of Covid-19 has various types and manifestations.
7 A Case Report of Palliative Care in a Patient with Breast Cancer , Vjollca Ndreu*1, Enkeleda Sinaj2 and Anila Sula3
Breast cancer is the most frequently diagnosed life-threatening cancer in women and the leading cause of cancer death among them worldwide [1-3]. Breast cancer is mainly diagnosed in early stages (90–95%), however 20–30% of these patients become metastatic and to this day incurable. Bone is the single most frequent site for metastases and is involved in about 70% of all metastatic patients [4-6]. Here we report the case of a 61-year-old female patient diagnosed with breast cancer with bone metastasis. Due to bone metastases, the lady has complains from the pain. Metastatic breast cancer can hardly be cured and is often treated by treatments with palliative intent to alleviate or prevent breast cancer-induced unpleasant symptoms and possibly prolong survival of the patient. Cancer‐related pain is mostly managed using drug therapy. There is increasing recognition of the need for non‐drug approaches and TENS may have a significant role to play. For softening the pain, it was recommended, to the lady, to have 2 sessions of 30 minutes each a day of TENS. TENS is a very efficient therapy for soothing the invasive pain.
8 The Allergenic Role of the Drug Excipient in a Case of Allergy in Pcsk-9 Inhibitor , Salihu Kushtrim1 and Abdullahu Valon*2
Hyperlipidemia is a well-established risk factor for the development of cardiovascular disease (CVD) [1]. Proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors are novel drugs in use against hyperlipidemia [2]. The gene for this enzyme is encoded by the PCSK9 gene that is located on chromosome 1. This gene contains one of 27 loci associated with increased risk of coronary artery disease [3, 4]. PCSK-9 is expressed in many tissues and it has the ability to bind to low-density lipoprotein receptor (LDL-R) and to reduce its number on the extracellular side of cell membranes. This results in a decreased ability of the cells to uptake low-density lipoprotein (LDL) and in this way, in a higher concentration of LDL in blood circulation [5]. Therefore, blocking PCSK-9 can lower blood LDL concentrations thus having an important medical importance [6]. We present a case of allergy on Alirocumab only, one of PCSK-9 inhibitors.
9 Medical History and Physical Examinations: Tools for early diagnosis and Means to avoid unnecessary investigations , Parvin Rahman
Background: Medical history and physical examination is one of the essential skills for clinicians. Detailed and adequate history taking and physical examination usually lead to a timely and accurate diagnosis of the disease. Depending on the acquired patient history and examination findings, physician can decide to do further investigations to confirm the initial diagnosis. The primary goal of this article is to emphasize on the importance of patient history taking and physical examination during the diagnosis stage. Material and Methods: Present study highlights the importance of patient history taking and physical examination via multiple medical cases apprehended by the author over a period of 2 years. Some systematic approaches are summarized as a means to use efficient history taking and proper physical examination as a strong tool of disease diagnosis. Finally, some common hinders and challenges regarding these two powerful tools in context of Bangladesh are discussed and some viable solutions are provided. Conclusion: If done precisely, adequate history taking and proper physical examination can certainly protect patients from the risks of unnecessary testing. Hence, this process is cost-beneficiary, which is a great plus for the people of developing countries. Accordingly, it is of paramount importance to keep proper documentation of Patient’s history and physical examination findings as well as tests and investigations done previously. Good documentation is a great resource to learn from past clinical incidents and avoid future adverse ones, hence greatly aiding in ensuring patient safety. Informative and detailed medical history along with inclusive physical examination followed by proper documentation can determine the correct diagnosis at an early stage and pave the way for an effective treatment plan.
10 Evaluation and Pain Management in Children with Cancer: About 48 Cases in Dakar , Fattah M1, Fattah R1 , Sow NF1 , Diagne Akonde FB1 , Diouf MN1 , Keita Y1 , Ndongo AA1 , Sylla A1 , Moreira C1 and Ndiaye O2
Introduction: Pain is ubiquitous in cancer and is the most dreaded symptom in children with cancer. It is a medical emergency. In Senegal, there is little data on the assessment and management of pain in children. The objective of this study is to evaluate the role of morphine in cancer pain management in children. Methodology: This is a prospective study carried out over a period of 4 and a half months (from April 15 to August 31, 2017). All children hospitalized at the pediatric Oncology Department and who used morphine as part of their treatment were included in this study. The hospital prevalence was 69.5%. The most common tumor pathologies found were acute leukemia, followed by nephroblastoma and Burkitt’s lymphoma. Results: Pain was present for an average of 30.3 days; It was abdominal in half of the cases. Nociceptive pain was present in 89.6% of cases. An average 40% reduction in pain intensity was observed following morphine administration on the first day. Analgesia was obtained on average after 6 days. Conclusion: Morphine has a crucial role in pain management in children with cancer. Efforts still need to be made in our unit to improve the quality of pain management in children.
11 Role of Brown Adipose Tissues / Beige Adipose Tissue (BAT/bAT) relevant genes expression and polymorphism in regulating human body weight , Fattah M*1, Fall AL1 , Bass I2 Faye PM1 , Thiongane A1 , Ba I1 , Sow A3 , and Ndiaye O1
Introduction: Tetralogy of Fallot is the most common cyanogenic congenital heart disease. In sub-Saharan Africa, the incidence of the disease is unknown. Hospital studies show that it is the most common cyanogenic congenital heart disease. This heart disease, which varies in severity, has benefited from considerable medical progress over the last fifty years. The main objective of the work is to study management modalities of this heart disease in Senegal. Method: This retrospective study conducted from first January 2010 to thirty-one December 2015 in the pediatric cardiology department of the Albert Royer National Children Hospital of Dakar (CHNEAR), involves 125 children diagnosed with tetralogy of Fallot. Results: Tetralogy of Fallot accounted for 18.6% of congenital heart disease. Inbreeding and trisomy 21 were the main risk factors. Cyanosis was the main sign of disease discovery (33.2%) followed by anoxic malaise. Pulsed oxygen saturation averaged 70%. Severe acute malnutrition was detected in 21.8% of our patients. Ultrasound showed a regular pattern in 81 patients (64.8%) and an irregular pattern in 44 cases (35.2%). Modified Blalock surgery was performed in 16 patients (12.8%) and a surgical cure in 43 patients (34.4%). We reported 20 (16%) deaths in this series. Conclusion: The results of our series show an improvement in the management of Fallot tetralogy in Senegal, but the data is insufficient. Effort must be made in the context of disease screening and early surgical management.
12 Odontogenic Myxoma of the Mandible , Ebtissam M Sahli*1 , Mohammed Bayazeed2 , Ahmad Othman3 , Shahed Riyaz4 , Kholoud N Moussa4 and Abdulla Al Gorashi4
Odontogenic myxoma is a rare neoplasm wich can occure in soft tissue or bone, which has the high risk for massive destruction of the jaws and derividing from mesenchymal tooth forming tissues, OM has a predilection in the mandiblular posterior region. In this report we present the case of a typical odontogenic myxoma in a 20-year-old male patient, who acquired large swelling and involved the whole the left half of the mandible including the ramus and molar region resulting in grossly facial assymetry within a peroid of 3 years. After the diagnosis was confirmed the patient was treated with left hemimandibulectomy and reconstruction was done.
13 First case report of perioperative management in a novel entity of macrothrombocytopenia: the autosomal dominant macrothrombocytopenia with platelet dysfunction associated with reduction of surface αIIbβ3 , Francisca Tavares*1 , Susana Domingues1 , Ana Cristina Pires1 , and Carla Cavaleiro2,3
Autosomal dominant macrothrombocytopenia with platelet dysfunction associated with reduction of surface αIIbβ3 (ADM) is an autosomal dominant form of Glanzmann’s thrombasthenia reported in few families in the literature. This case presents the first report of perioperative approach of a patient with ADM successfully submitted to a surgical procedure. The multidisciplinary approach including immunohaemotherapy consultation was considered the best clinical approach to avoid bleeding. The use of desmopressin and tranexamic acid in the preoperative period followed by desmopressin plus aminocaproic acid in the postoperative period showed to be safe and effective in the perioperative approach of the patient with ADM.
14 How We Improved Our Results of Hair Transplantation , Jalal Hamasalih Fattah
Background : Follicular unit extraction has evolved dramatically as the most recent advancement in surgical hair restoration as it leaves little scar, and creates natural, and pleasing result. The aim of this study is to demonstrate our new modifications and showing its effectiveness in improving our results. Materials and Methods: A Prospective analysis of 247 male patients with Androgenic alopecia who underwent hair transplantation with Strip or FUE technique Between August. 2015 and June 2019 at our center was conducted. The mean age was [35.93 ± 4.40] Years. At one year postoperatively, patients were asked to fill up a questionnaire which included their satisfaction level, need for 2nd session, and complications. Informed written consent obtained from all patients. Data were analyzed using the statistical package for social science SPSS V. 23. Results: In the last 134 cases, addition of 40 mg of Triamcinolone to the LA solution led to dramatic reduction of the incidence of postoperative oedema, from 74.3% to 6.7%. Adding three sessions of PRP at 2nd,4th, and 6th month post operatively resulted in increased patient satisfaction rate with better hair density and thickness where the rate of highly satisfied patient increased from 62.6% to 74.3%. Conclusions: Addition of 40 mg Triamcinolone to the LA solution is highly effective in reducing postoperative oedema. FUE is preferred over strip method to avoid visible donor scar totally. Three sessions of PRP at 2nd,4th, and 6th month post operatively is recommended.
15 The Opioid Crisis Viewed Through the Lens of a Black and White Camera , Robert G. Smith DPM., MSc., R.Ph
The United States’ opioid epidemic is a national public health emergency. As opioid use has not been shielded from health care disparities furthered by economic, gender, race, and sex biases, discrepancies in the rates of abuse and access to treatment exist among non-white minorities. This narrative literature review is an evaluation of the literature centered on minority racial disparities in opioid use, abuse, and care in the United States. Racial disparities in prescribing opioid-containing compounds are staggering among non-white individuals. A historical review of opioid regulatory control is offered as an explanation for the cognitive biases demonstrated by clinicians. Governmental regulation is among the polyfactorial roots of racial inequity in the opioid epidemic. Literature describing physician bias and portrayals of racial and sexual disparities in opioid abuse disorders are presented. As part of the national response to this evident disparity, addressing these issues will be an important factor in curbing this epidemic and tools to assist in mitigating these obstacles are presented.
16 Ectopic Gallbladder: An Incidental Finding , Mubashar Hussain1 , Jimmy Mena2* and Kristine Joyce Cadiz3
Ectopic gallbladder is a rare entity with an incidence of 0.1%- 0.7% [1]. Normally, it lies on the gallbladder fossa, on the inferior surface of the liver in between the right and left hepatic lobes, maintaining a constant relationship to porta hepatis [2]. On Ultrasonographic imaging, the gallbladder can be identified by the relationship of the gallbladder neck anterior to the right branch of the portal vein. Ectopic gallbladder can be located in various positions such as intrahepatic, within the lesser omentum, retroduodenal, within falciform ligament, abdominal wall muscles and in thoracic cavity [3, 4]. An ectopic gallbladder is a dangerous entity as it can lead to misdiagnosis. We were presented a case of ectopic gallbladder, which was missed in ultrasound, and CT scan report but was discovered intra operatively during laparoscopic cholecystectomy
17 Pneumococcal Meningitis Among Children in the Post-13-Valent Pneumococcal Conjugate Vaccine Era: Three Case Reports , Hind Al Hajri1 , Hilal Al Hashami2 and Salah Al Awaidy*3
We report three cases under two years of age, of meningitis due to Streptococcus pneumoniae in vaccinated children. Two grew non-typable strain and the third serotype 10A. All improved with no neurological sequel. Continued monitoring of the epidemiology of bacterial meningitis within the post13-valent pneumococcal conjugate vaccine introduction is warranted.
18 Vertebral Artery Dissection in a 7-year-old girl: A case report, pictorial review, and review of literature , Mohammed Elkhazendar1*, Salah El Rai2 , Ahmad Alhammada3 , Mohammed Mekki1,3
Vertebral artery dissection (VAD) is a not uncommon cause of arterial ischemic stroke in the pediatric population. Though it is frequently overlooked, and resources help in diagnosis often a concern, the establishment of diagnostic criteria is very crucial for treatment and prognosis. Here, we present a case of VAD with a pictorial and literature review, in addition to imaging recommendations.
19 Advances in Imaging Studies of Brain Structural and Functional Impairment in Chronic Alcohol Dependence , Sun Yuting1 , Yin Changhao2 , Xu Zheng1 and Zhu Xiaofeng*3
Chronic alcohol dependence (CAD) is a chronic, recurrent, and highly prevalent disease that causes significant health and financial burden. Chronic alcohol exposure affects all organ systems, especially the central nervous system, which is often manifested in a range of neurological and psychiatric symptoms. Therefore, the problem of brain damage caused by alcohol dependence needs to be solved urgently. In recent years, imaging has been widely used in the study of substance addiction, especially the study of alcohol dependence has made significant progress, which is of great significance for the early diagnosis and prognosis evaluation of the disease. This article reviews the progress of imaging studies on brain structure and function damage in CAD patients.
20 Third Molar: Optional Tooth , Maria Concepcion Parreñas DMD, MScD
There is always a nagging question, which heightens my curiosity on the appropriate removal of an impacted third molar in this specific situation: What if you have a carious or beyond-repair second molar or second bicuspid? Will you try to heroically upright the mesially and horizontally impacted third molars? How about resorbed second molar or a third molar in close proximity of mandibular inferior alveolar nerve. Uprighting of mesially impacted tilted molars is the recommended treatment and should be done as soon as possible. If not properly corrected, mesially impacted molars may lead to complications such as elongation of opposing teeth, periodontal problems on the mesial side of the affected teeth, caries in the unerupted molars, temporomandibular disorders and poor oral hygiene. Some clinical procedures have been used to upright the third molar. Is it really worth working to leave the third molar be uprighted or have it surgically removed? As most maxillofacial oral surgeons, prefer.
21 Diagnosis of Frontal Meningioma Presenting with Psychiatric Illness in Hemodialysis Patient A Case Report and Review of the Literature , Nevin Abdelmonem1 , Amro Salah1 , Ali Alharbi2 , Dujanah Mousa2 and Mohammed Al-homrany*2
Meningioma is typically a slowly growing tumor that arises from the meninges. Symptoms depend on the location of the tumor pressing on the nearby tissues. Frontal meningioma is often asymptomatic and patient may present with psychiatric symptoms. We report here a case of end stage renal disease on regular hemodialysis presented with symptoms of personality changes, depression, dementia, and increased intracranial pressure due to frontal meningioma confirmed by contrast-enhanced MRI Brain. Meningioma are not uncommon condition in chronic kidney disease on chronic hemodialysis with few case reports, however, such condition needs to be considered in hemodialysis patients presented with abnormal behavior.
22 Primary Hyperparathyroidism Due to Parathyroid Carcinoma of Ectopic Origin a Case Report , De la Vega F1, Zuluaga L1 , Corral M1 , Rizo Topete L2 , Valencia A3 , and Rodriguez R3
The following is a rare case of a 43-year-old woman who arrived at the emergency department with symptoms associated with hypercalcemia that were caused by primary hyperparatoriodism secondary to ectopic parathyroid carcinoma. The diagnostic difficulty and management of these patients is discussed below.
23 Seventy Years of Dunphy’s Puzzle Revisited , Kangla Tsung
In 1950 Dr. J Englebert Dunphy published an essay titled “Some observations on the natural behavior of cancer in man” in the New England Journal of Medicine in which he challenged the main stream concept of cancer as a “steady and irrevocable growth” by describing four cancer cases with unpredictable outcome ranging from spontaneous regression to explosive metastases a er resection of primary tumor. His main point is to raise the awareness that there is a “local tissue resistance” that causing cancer to go through periodic arrest or even regression amid general trend of progression.  e question to be answered “is not what makes the cells suddenly grow, but what has held them in abeyance for long”. With this question answered, he hoped in the future, “it may be possible to determine the growth curves of a given tumor so as to plan extirpation at periods of quiescence rather than during periods of very active growth”. 70 years have passed since Dunphy’s original writing and we know that what he called “natural tissue resistance” in his essay is what we call antitumor immunity today. Yet even with this knowledge, today’s cancer surgeons still do not base their surgical decisions on the actual interaction between tumor and host antitumor immunity.  ey still do not plan the surgical timing based on tumor growth pro le.  is essay is a revisit of Dunphy’s view by analysing the cases in Dunphy’s original essay with today’s knowledge and by presenting a few more cases in which we followed his hypothesis and obtained desired outcomes.
24 Interventricular Communications of the Child: Retrospective Study of 293 Cases at the Dakar Chu , Fall AL*1, Basse I2 , Sow A3 , Sarr-Ndao F1 , Dieng YJ1 , Coundoul AM1 , Ndiaye N2 , Obambi DC2 , Boiro D3 , Ciss G4 , Diagne Gueye NR2 , Faye PM1 and Ndiaye O
Interventricular communications (IVC) are non-cyanogenic congenital heart diseases characterized by dehiscence of the interventricular septum. It represents 20 to 30% of congenital heart diseases. Our objectives were to determine the hospital frequency of isolated IVC, to describe the clinical aspects, to assess medical and surgical management and to assess the prognosis. It is a retrospective descriptive and transversal study. All patients with isolated IVC aged 0 to 15 years were included. Sphinx plus2 software was used for database design and analysis. We collected 293 files, a prevalence of 44 per 1000. The average age at the time of diagnosis was 16 months. The sex ratio was 1.02. Recurrent infections accounted for 65.9%. Parental consanguinity was found in 35.8% of cases. Heart failure was noted in 7.5% of the cases, weight loss in 48.1%. Cardiomegaly was noted in 74.1% of cases with 54.9% of pulmonary hypervascularization. Perimembranous IVC was the most frequent with 84.6%. Large IVC represented 62.5% and multiple IVC 8.2%. Pulmonary arterial hypertension (PAH) was present in 58% of cases. Diuretics were prescribed in 76.5% of cases. Fifteen (15) catheterizations were performed, ie 5.1%. A complete cure was carried out in 20.1% of the cases. IVC are frequent, serious due to the repercussions, especially in the lungs. Surgical management of impacted forms should be improved.
25 Non-Puerperal Uterine Inversion in a Nulliparous Woman with no Uterine Mass: A Case Report and a Literature Review , Parvin Rahman
Background: Non-puerperal uterine inversion (NPUI) is an extremely rare condition. Most reported cases of uterine inversion ware in multiparous women. Moreover, non-puerperal uterine inversion usually occurs when there is a benign or malignant uterine mass present. In literature, there have been only 9 reported cases of non-puerperal uterine inversion in a nulliparous woman in the 10 year window from 2006 to 2017 [1]. Case: Here, a case of non-puerperal uterine inversion is discussed. Initially the patient was diagnosed as a sub-mucosal fibroid of the uterus. The diagnosis of Non-puerperal uterine inversion was made only during operation. But the case reported in this paper, is the first reported case in a patient who did not have any uterine mass and also was nulliparous. At first, an attempt to reposition the uterus was made by Huntington method but was failed. Then, it was decided to perform the total abdominal hysterectomy. Her postoperative period was uneventful and she was discharged without complication after only seven days. Conclusion: Non-puerperal uterine inversion is rarely encountered by Gynecologist. However, the rare occurrence of this case is often difficult to diagnose, especially when the exact cause of the condition is not known preoperatively. Our patient was lean, thin and malnourished, suffered from general weakness for long time. Could the weakness of the uterine muscle and ligaments be the cause for inversion? The reported case provides an indication for future research on the causes of nonpuerperal uterine inversion, specifically the scenario which has no association to uterine mass in a nulliparous woman.
26 Is a Cath Really Necessary? , Samantha Gelman*, Andrew Benin, Javad Savoj, Rajesh Gulati and Kaustubh Patankar
Pulmonary embolism is associated with elevated troponin levels. Many conditions are known to cause this and are thus regarded to as an NSTEMI in the setting of demand ischemia. We present a 78-year-old male with multiple comorbidities who is found to have an NSTEMI in the setting of a pulmonary embolism. The patient subsequently undergoes catheterization and is found to have mild coronary artery disease. Catheterizations are procedures that come with their own set of risks and may not necessarily need to be performed if troponinemia is deemed to be from demand ischemia. Currently, there is no cut off point for which patients who present with an NSTEMI secondary to these other underlying conditions should undergo catheterization. Further research should be done to determine troponin cut offs in pulmonary embolism and the need for additional evaluation via catheterization.
27 Grievances of the SARS-CoV-2 over the planet – a review , Ilai Goshen1 and Daniel Benharroch*2
In this review, the unique idiosyncrasies of the SARS-CoV-2 were screened, with sights set on characterizing the most pertinent features of the virus that may clarify its inconsistent and different behavior. The characteristics of COVID-19 were in like manner investigated, to connect them with one of the strides of the virus in its journey around the world. Albeit a hypercytokinemia is unquestionably an inborn part of the infection, we have proposed that the ‘cytokine storm’ may not be a systemic piece of COVID-19, and, while microthrombosis might be represented by the CAC/DIC auxiliary to viral sepsis, different degrees of bleeding have been accounted for.
28 Resilience of biological homeostasis: A single shield against the coronavirus. Naisberg Yakov AMCHA (R.A)-National Israel Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation , Naisberg Yakov
Medical practice demonstrated that subjects who inherited normal genes can maintain a healthy schedule throughout life expectancy and vigorously ensure their physical and mental resilience as a shield against infectious diseases. Resilience is based on macro biophysical neurophysiological parameters comparing healthy homeostasis, to address specific external means of maintaining normal neuronal loop (NNLA) activity, providing synchronized body operating ranges (BOR) with four daytime and four nighttim sleep phases. The NNLA protects the movement of biochemicals and others, including fluids in BOR that synchronize daytime rest alertness, with minimal, moderate, and maximum physical or mental load and slow down BOR speeds during sleep stages I, II, III, and IV. These BOR phases are fed from external physical information units in a stable dynamic homeostatic margin range that we refer to as transient homeostatic synchronization (THR) mode. THR is synonymous with resilience and reversal within the internal organism driven by objective obtained from a macro biophysical neurophysiological objective data and subjectively the person feels his relaxed body rewards him with pleasant biological emotion and cognitive well-being. Subjects who have inherited or acquired abnormal genes have been linked in action to abnormal neuronal loop operation (ANLO) that causes chronic distress at different levels of intensity, we call transient homeostatic desynchronized (THD) condition with accelerated BOR and causes hypersensitivity or slowing of BOR to be hyposensitive. It provides a single or mixed DSM IV disorder. The purpose of this paper is twofold, treating resilience as internal homeostasis on the one hand and replacing THD with macro biophysical neurophysiological informative therapy (MBNIT) that drive the BOR given to a resilient version of THR or to a flexible healthy state on the other.
29 Instrumental diagnosis and laparoscopic treatment of the giant sigmoid diverticulum: technical notes. Internal hernia and abdominal abscess after one month , Raffaele Porfidia*1 , Maria Giovanna Ciolli1 , Pietro Picarella1 , Angela Romano1 , Simona Grimaldi2 , Mauro Carfora3 , Giuseppe Russo4 , Daniela Berritto5 , Giuseppina Dell’Aversano Orabona4 , Antonio Romeo4 , Raffaele Nappi4 , Giuseppina Napolitano4 , Piero Brusa3 and Sergio Grimaldi1
The giant colon diverticulum is a rare disease. Symptomatology is non-specific but can cause acute abdomen in 30% of cases. Diagnosis is often accidental and is mainly based on CT. The treatment is surgical but there are still few cases treated laparoscopically. We present the case of a patient treated laparoscopically who returns to the ward after a month with intra-abdominal abscess and internal hernia without intestinal occlusion.
30 Aripiprazole induced compulsive eating in adolescent: Is this the effect of aripiprazole on Serotonin receptors? , Sachidanand Peteru1 and Mohammad A Usmani*2
Objective: To present a case of new onset Aripiprazole induced compulsive eating in an adolescent male. Method: We describe a case history of an adolescent male treated with Aripiprazole who developed compulsive eating behavior. Result: The compulsive eating behavior stopped once the Aripiprazole was discontinued. Conclusion: We argue that the compulsive eating behavior in the adolescent male was induced by Aripiprazole and the effect of Aripiprazole on eating behavior may be due to the effect of Aripiprazole on serotonin receptors.
31 Aripiprazole induced compulsive eating in adolescent: Is this the effect of aripiprazole on Serotonin receptors? , Sachidanand Peteru1 and Mohammad A Usmani*2
Objective: To present a case of new onset Aripiprazole induced compulsive eating in an adolescent male. Method: We describe a case history of an adolescent male treated with Aripiprazole who developed compulsive eating behavior. Result: The compulsive eating behavior stopped once the Aripiprazole was discontinued. Conclusion: We argue that the compulsive eating behavior in the adolescent male was induced by Aripiprazole and the effect of Aripiprazole on eating behavior may be due to the effect of Aripiprazole on serotonin receptors.
32 Chronic Complications of Type 1 Diabetes in Children , Djibril Boiro1 , Babacar Niang2 , Jean Pierre Diagne1 , El hadji Malick Sy, Amadou Sow*1 , Oumou Fadly Touré1 , Maïmouna Touré3 , Aminata Mbaye2 , Aliou Abdoulaye Ndongo4 , Aliou Thiongane2 , Demba Diedhiou1 , Ndiogou Seck, Modou Guéye1 , Ousmane Ndiaye2 and Papa Amadou Ndiaye
Introduction: Chronic complications of type 1 diabetes are rare in children The aim of this work is to determine their prevalence in paediatric settings and the factors associated with them Methodology: This was a prospective study, conducted in two reference services in the management of childhood diabetes at the University Hospital of Dakar. We included all patients with type 1 diabetes under 20 years of age as recommended by the 2009 ISPAD. Results: Of the 67 patients in our cohort, only 46 met the inclusion criteria. There were 19 boys and 27 girls. The average age was 11.57 years +/- 4.3 years. The average age of discovery was 8.71+/- 3.8 years. The average duration of the evolution was 34 months. Almost half of the patients had an average glycated hemoglobin greater than 9%. Growth retardation was severe in 17% and moderate in 11% of cases. Five patients (20%) had significant microalbuminuria and 5 (20%) had retinopathy, 3 with macular edema and 2 with diffuse microhaemorrhages. Multivariate analysis of the different parameters studied showed that retinopathy was associated with high HbA1c values (p=0.043) and poor compliance (p=0.021). Kidney disease was only associated with poor adherence with p=0.0025. Conclusion: Chronic complications of T1D are not that uncommon, especially in our regions where management is not optimal. We suggest that they be detected around 10-11 years of age regardless of how long the diabetes progresses.
33 The Immune Cells and Its Link to COVID-19 , Archana Tripathy
World health organization has declared SARS-CoV-2 infection as a worldwide pandemic on March 11, 2020 and it is continuously affecting public health throughout the globe. The disease progresses from mild symptoms to a pneumonia like condition with severe inflammation of the respiratory tract due to cytokine release or cytokine storm that is the major characteristic of this disease. T cells numbers decrease and become exhausted in COVID positive patients this might be due to excessive amount of IL 10, IL 6, and TNFα. CD8+T cells and NK cells have showed functional impairment on differentiation, maturation and adequate amount cytokine production which lead to compromise the host immune response against SARS-CoV-2 infection. IFNƳ behaves as a protective cytokine at early or recovery stages and at severe stage, it acts as more pathogenic by inducing anti-viral responses. This review has summarized the current states of immune responses regarding SARS-CoV-2 infection. It might be helpful on offering new understandings and therapeutic approaches for COVID-19.
34 A Case of Schmidt Syndrome Masqueraded by End Stage Renal Disease , Sarahi Herrera- Gonzalez and Martha Bilbatua*
Autoimmune Polyendocrine Syndromes (APS) are a rare manifestation of autoimmune diseases, this syndrome is composed by 5 types, nevertheless Type I (or juvenile) and Type II (or Adult) syndromes are the most common. APS II englobes Adrenal Insufficiency associated with Autoimmune thyroid disease or/and Diabetes Mellitus Type 1 [1]. We present and interest case of a patient with Autoimmune Hypothyroidism and Adrenal insufficiency whose diagnosis was delayed by masquerade of diagnosis by concomitant End Stage Renal disease.
35 Cognitive Impairment Associated with Chronic Alcohol Dependence: Recent Advances in The Understanding of Disease Pathogenesis , Jiang Qingmei1 , Yin Changhao2 and Zhu Xiaofeng*1
At present, a large increase in global alcoholics, the resulting problems associated with alcohol dependence cognitive dysfunction has become increasingly serious, the domestic and foreign research shows that long-term excessive drinking seriously damage the body organs, this paper mainly study the influence of the alcohol dependence on the central nervous system, from signal transduction, oxidative stress and neuritic response, neurotransmitter release and its receptor, nutrition metabolism, brain structure change analysis of alcohol dependence summarized research progress to do related to the pathogenesis of cognitive impairment.
36 One Case of Anti-Yo Antibody Positive Subacute Cerebellar Degenera , Qian Tang1 and Changhao Yin2*
Subacute cerebellar degenera also known as paraneoplastic cerebellar degeneration, is one of the typical neurological lesions caused by paraneoplastic neurological syndrom. It is caused by changes in the immune response. A case of tumor-negative anti-Yo antibody-positive subacute cerebellar degeneration is reported to strengthen clinicians’ understanding of the disease. Early diagnosis of subacute cerebellar degeneration is essential to improve patient survival and quality of life.
37 How to Understand the COVID 19 Epidemic Phenomenon? , Bohdan W Wasilewski
The author discusses the mental barriers that are obstacles to understanding the phenomenon of COVID19 pandemic, and proposes a thesis that the crisis is not due to a new or a sudden mutation of a dangerous virus, but rather the collapse of our natural biological defences as we head into a civilizational cul-de-sac. The consequence is an attack by elements from within a biotope, which for millions of years had held within it viruses in many ways similar to that currently ravaging the planet. The popular perspective however is that of an alien, oriental, indeed criminal entity against which we must defend ourselves. However, the newest scientific research posits a different vision, which situates the virus in a biocenosis of which we are also a part. A balanced relationship had existed in which both man and virus formed a functional whole and in which biological mechanisms existed to create immunity (analogous to vaccination) up to the point where this relationship has been disrupted by man’s activities. The reduced resistance to infection of today’s children is symptomatic of this disruption as increasing susceptibility to infection appears to be in tandem with our civilisation as it continues its so -called progressive trajectory. We are now under attack from elements within our biocenosis with which we had been existing in a functional relationship for millions of years. In the evolutionary process viruses were assigned a regulatory function maintaining herd functionality through effecting the removal of aged and ailing units. The Sars2 Cov virus now performs this function killing those weaker aging or ailing members of our species and illustrates the reality of the 6th great species extinction as a part of the Anthropocene. The author treats COVID 19 as a factor accelerating human transformation to one in which cyborgization become a dominant trope of existence, affecting in the first instance human communities in which urbanisation and civilizational transformation is proceeding rapidly.
38 An Investigation of the Outcomes of Stroke Patients in the Community: is it Possible to Recovery Well after Golden Rehabilitation Period , Chiu Wen Hsi*, Wang Su Feng, Yu-Ju Hsieh and Wang Hsin Min
Stroke is the fourth leading cause of death in Taiwan and is the main cause of disability globally [1]. Chiou stated that the disability of patients with stroke is about 60% after one month, and about 50-55% for 3~6 months after stroke [2]. Yang, et al, address most of the stroke people whose aged 65 and over are cared for at home, but the frequency of rehabilitation care for these elderly is the lowest. Community-based care is another way to look after stroke patients in long-term condition. Currently, little is known about community clinic care of stroke patients when the patients returned home from the hospital. The purpose of this study is to analyze the patient data of a community clinic to understand the outcome of the care of stroke patients. A retrospective study which reviewed the stroke patients’ charts in a community clinic was adopted. Data were collected from 2011 to 2016. 389 patients’ data were showed in this study. The result showed that the improvement of stroke patients in the upper limbs and lower limbs is the most significant, and its progress can reach nearly 75~80%. Moreover, the slurred speech of this group can be improved by about 20%. Although the symptoms of drooling and choking were also improved, the progress is about 10~15%. This result indicates that the community clinic care may be another way to facilitate the progress of stroke patients after transition from the hospital to the home.
39 Legal Implication of Nerve Injuries Induced by Phlebotomy , Claudio Bianchin*1 , Carolina Prevaldi2 , Matteo Corradin3 , Mario Saia4 , Manuela Crucitti5 and Maria Carolina Barbazza6
Although venipuncture is ordinarily a routine, low-risk procedure, and injuries to the peripheral nerves that cross the cubital fossa have rarely been reported, they are sometimes the subject of compensation claims from patients who complain of having suffered this type of damage. There is no lack of judgements in civil law in which the resulting outcomes are contested, for example the positioning of a cannula needle, inter alia without informing the patient of potential risks (Court of Cassino, Judgement 09/08/2016). A dated Supreme Court judgement (No. 32553 of 25/08/2005) already observed that taking blood samples from the vein, albeit a routine practice, is nonetheless an invasive procedure which can cause the patient harm if not performed by professionally prepared practitioners and following precise techniques and methodologies.
40 Legal Implication of Ovarian Cysts in Prepuberal Girl , Claudio Bianchin1 , MCarolina Barbazza2 , Carolina Prevaldi3 , Matteo Corradin4 , Mario Saia5 and Manuela Crucitti6
Ovarian torsion is a condition that can occur in a normal ovary, but it is more likely to happen when the presence of a cyst or other tissues (tumor) in the ovary can displace it. The extra weight or mass on the ovary can cause it to start to twist and rotate around its supporting ligaments. Ovarian torsion can cause severe pain, more frequently on the right-hand side. However, in some cases, the clinical course is prolonged, as the torsion can be intermittent. Early diagnosis and surgery are essential to protect ovarian and tubal function and prevent severe morbidity ending with annessiectomy. The ovarian cyst is an insidious risk factor for ovarian torsion and can cause sudden lower abdominal pain and loss of ovarian function with possible legal implications and malpractice. A timely diagnosis of ovarian cyst is of paramount importance to prevent necrosis and preserve ovarian viability. To avoid such a dangerous complication, it is essential the preventive management of the cyst. A cyst becomes a problem when it does not go away or gets bigger. The treatment of ovarian cysts depends on several factors but the size of the cyst and its appearance need to be monitored.
41 Perioperative Visual Loss Following Transanal Endoscopic Microsurgery in Prone Position: Medico Legal Consideration , Claudio Bianchin*1 , Carolina Prevaldi2 , Mario Saia3 and Mazzon Davide4
A 67-yr-old man developed Perioperative Vision Loss (POVL) after Transanal Endoscopic Microsurgery (TEM) under general anesthesia in prone position with head-down and turned to one side. After surgery, he complained of ocular pain and no light perception in the left eye. The examination revealed lid edema, ptosis, exotropia, proptosis, chemosis and fixed pupil not reactive to direct light. At funduscopy examination a pathognomonic cherry-red spot in the macula and retinal and disk ischemic pallor were appreciable. The right eye was normal. A diagnosis of left central retinal artery occlusion (CRAO) due to intraoperative extrinsic pressure on the eye was suspected. He never regained vision. POVL is frequently involved in malpractice claims. We discuss the legal implication for anesthesia practitioners.
42 Early-Onset Neonatal E. coli Sepsis in Term Infants in the Absence of Antenatal or Intrapartum Risk Factors for Infection , Krystal Koh*1, Rajeswari Kathirvel2 and Manisha Mathur3
Early-onset neonatal sepsis (EONS), an important cause of neonatal morbidity and mortality, is usually due to ascending infection from maternal genital tract or infected amniotic fluid. The most common organism is group B streptococcus (GBS), followed by Esc herichia coli (E. coli). Risk factors include maternal GBS colonization, chorioamnionitis, prolonged membrane rupture, prematurity, and intrapartum maternal pyrexia. The presentation of EONS can be varied, ranging from temperature instability to profound hypotension. We present two cases of E. coli EONS in term infants presenting as respiratory distress, without risk factors for infection. The first case is a 34-year-old female, with history of one previous caesarean section (CS), who underwent a repeat CS at 37+1 week’s gestation for obstetric cholestasis. Investigations performed on the second day of neonatal life in view of persistent respiratory distress, revealed E. coli bacteremia, complicated by septic shock. The mother developed fever on the first post-operative day due to E. coli bacteremia. The second case is a 31-year-old GBS negative primigravida with gestational diabetes, who underwent an induction of labor at 38+ 3 weeks. She had a forceps delivery for fetal distress six hours after membrane rupture. On the second day of life, the neonate had retractions and poor feeding, and blood cultures grew E. coli. There were no risk factors for EONS. The neonate rapidly deteriorated and despite extracorporeal membrane oxygenation, passed away on the seventh day of life. These cases illustrate the importance of E. coli as a cause of EONS and the need for a high index of suspicion due to the subtle presentation. Prompt recognition and treatment are important even in the absence of risk factors, as there is potential for rapid deterioration if treatment is delayed. In the presence of definite risk factors, broad-spectrum antibiotics should be considered for E. coli and GBS.
43 Congenital Hyperinsulinism Due to a Novel Activating Glucokinase Mutation: A Case Report and Literature Review , Nikitas S Skarakis*1 , Christina Kanaka-Gantenbein2 , Dimitra Dimopoulou1 , Amalia Sertedaki2 and Feneli Karachaliou1
Background: Congenital Hyperinsulinism (CHI) constitutes a major cause of persistent and recurrent hypoglycemia, especially in the neonatal period, showing notable phenotypical heterogeneity among affected subjects. Activating mutations of the Glucokinase gene (GCK) are responsible for mild forms of hypoglycemia, due to CHI, usually easily medically managed. Case report: We present a patient at the age of 3.5 years old investigated for persistent hypoglycemia. Laboratory evaluation showed hyperinsulinism during the hypoglycemic episode with a required glucose infusion rate greater than 8-10 mg/kg/min to maintain normoglycemia. Targeted gene panel sequencing revealed an activating missense novel mutation p.Val71Ala in exon 3 of GCK gene, dominantly inherited by his mother. In silico, analysis of this novel missense variant assessed its pathogenicity as being of uncertain significance Conclusions: GCK gene mutations result in varying phenotypic characteristics and responsiveness to diazoxide depending on the type of activating mutation.
44 Some Aspects of Psychocorrection in Oncology , I Chernikowa1 , S Savina2 and B Zaydiner*3
Cancer is the second leading cause of death globally; it accounted for 9.6 million deaths worldwide in 2018 (around 15% of all deaths). Of all deaths, 1 in 4 cases is attributable to different forms of oncological diseases [1]. Meanwhile the number of survivors continues to grow, not just because of earlier detection and treatment, but also because of revolutionary new therapies. About 9 million Americans of all ages are living with a current or past diagnosis of cancer; in 2007-13 five-year survival rates for all cancers increased to 67%. For many individuals, this changes the landscape from a terminal illness to more of a chronic illness with periods of remission and exacerbation of symptoms. This perspective on neoplasms has broadened the scope of care from treating the disease alone to managing cancerrelated symptoms at different stages of the disease trajectory including mental disorders. According to Holland, Alici, and Massie the prevalence of psychiatric disorders in cancer patients is over 50% [2, 3].
45 Papillary Trunk Bifurcation Angles as Major Determinants of Ocular Perfusion: A Cross-Sectional Study , Tabinda Hasan* and Kavitha Ganesh
Background: Notable work has been done by Cecile and Murray in as early as 1926, on the structural and topological aspects of vasculature based on the concept that blood vessel size and arrangement is such that it provides blood flow with minimum energy loss. In the theoretical analysis of arterial networks, the existence of geometric optimisation for enabling functional adequacy has long been suggested, but observational studies have not yet fully corroborated these theories. Data on branching or bifurcation angles of retinal microvasculature is not only insufficient but also inconclusive. Aim: Attending to this gap in information, we compared the central retinal artery (CRA) branching angles of known diabetics with healthy subjects and explored their possible role in determining the circulatory adequacy of human retina. Methods: This study was done on North Indian subjects attending retina clinics of prominent tertiary centers of north India during 2019 through 2020. Fundus images were acquired through convenience sampling from 860 consecutive eyes of 430 subjects. Fluorescein fundus angiography was followed up for diabetics. CRA branching angles from digitalized fundus photographs of known diabetics and healthy subjects was analyzed through semi-automated digital image management tool and the readings were clinically correlated to note the occurrence and severity of retinopathic perfusion defects was Results: We found marked differences between CRA branching angles among diabetics and healthy subjects and a significant correlation between branching anless and the occurrence and severity of retinopathic perfusion defects. Discussion and Conclusion: The orientation of retinal blood vessels on the fundus plane is not merely ‘a matter of chance’ in the anatomic chronicle of the human body; rather, it has biological heralds and functional consequences. Direction, branching, angles; all determine the efficacy and abundance of blood flow in the human retina that hold indispensible relevance for optimal vision and might be subtle indicators of micro vascular damage in disease states. This study has elucidated retinal vascular geometrics of healthy and diseased Indians, a knowledge that can improve our understanding of ‘abnormal features’ and ‘natural variants’ in retinal vascular architecture. In this study, we quantified the ‘structural factors’ behind perfusion defects of the Diabetic retina.
46 Hyperparathyroidism Secondary to Long-Term Use of Lithium Carbonate , Martha Bilbatua, Sarahi Herrera-Gonzalez* and Divya Shanbhogue
Lithium carbonate has been used for over half a century in the management of many psychiatric conditions like persistent depression, self-mutilation behaviors and bipolar disorder, where it has been proven to have benefit in suicide prevention [1]. Nevertheless, many side effects have been linked to its use, some of which include chronic tubule-interstitial disease, nephrogenic diabetes insipidus, thyroid dysfunction and, the focus of this case report, hypercalcemia and hyperparathyroidism [2].
47 Association of Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery with Aortopulmonary Window. Two case report , Yudith Escobar Bermúdez1 , Alfredo M Naranjo Ugalde2 , Raquel Maciques Rodriguez1 , Giselle Serrano Ricardo3 , Gilberto Bermúdez Gutiérrez2 and Midael Gámez Columbie4
Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare entity. Brooks described first cases in 1885. Only 25% to 30% % of cases are associated with congenital defects such as aortopulmonary window and tetralogy of Fallot. It is recommended the reimplantation of the right coronary artery in the Aorta, with redistribution of coronary flow avoiding the signs of ischemia or other complications even when the diagnosis is done in asymptomatic patients. This is the report of two infants with who debuted with murmur and signs of heart failure. ARCAPA and Pulmonary Aortic Window were diagnosed and they were surgically corrected through intrapulmonary tunneling with a favorable evolution.
48 Cardiac Compression and Tamponade from Gastric Volvulus Presenting as Acute Chest Pain , Joyce L Ho1*, Andrew W Hwang1 , Rasiq Zackria1 and Eric H Choi2
Gastric volvulus is an uncommon condition that classically presents with Borchardt’s triad of severe epigastric pain, retching without vomiting, and inability to pass a nasogastric tube [1]. We report a rare and fatal case of severe gastric volvulus presenting as chest pain with electrocardiographic changes in a patient with a significant cardiac history.
49 A Case of Acute Encephalopathy Due to Autoimmune Overload , Sabhyata Sharma*, Masih Sadeghi, Enoch Lule and Sudhakar Mallela
Acute disseminated encephalomyelitis, also known as postinfectious encephalomyelitis, is considered an autoimmune disorder that causes inflammation of the brain and spinal cord. It was seen mainly in pediatric population possibly due to vaccination but there have been cases identified in adult [1-9]. Acute disseminated encephalomyelitis can be challenging to diagnose owing to fact that there have been many overlapping symptoms among other demyelinating disorder such multiple sclerosis and Neuromyelitis Optica. In this case report, we will discuss a case about a patient that presented due to acute encephalopathy and was noted to have an atypical MRI of the brain that was not consistent with results of the lumbar puncture [10-12]. Knowledge gained from this case will help bring awareness to the diagnose of acute disseminated encephalomyelitis and how imaging in context with the clinical picture can help us differentiate between the various demyelinating disorders; thereby, giving a better understanding of managing these patients as management can affect prognosis and outcomes.
50 Renal artery thrombosis following synthetic cannabinoid ingestion , Joyce L Ho*1 , Youhanna Gad2 and Remus Popa3
Cannabis and synthetic cannabinoids have been associated with cardiovascular events including myocardial infarction, arrhythmias, and stroke. The psychoactive cannabinoid delta-9-tetrahydrocannabinol (THC) is a partial agonist for cannabinoid receptors found in the brain, vascular endothelium, liver, and adipose tissue. THC has been implicated in cases of cannabis arteritis and vasculopathy. We describe a case of acute renal artery infarction following synthetic cannabinoid ingestion, with successful thrombolysis and revascularization.
51 A Case of a Disseminated Coccidioidomycosis Presenting as Supraclavicular Mass , Andre Johnson1 and Sudhakar Mallela2
Coccidioidomycosis, also known as Valley fever, is an infection caused by exposure to dimorphic soil-dwelling fungi of the genus Coccidioides. Inhalation of the arthroconidia from either fungi C. immitis or C. posadasii causes lung infections. Lung pathology is by far the most common presentation of coccidioidomycosis, representing over 95% percent of all cases. Disseminated coccidioidomycosis, a rare complication, presents as meningitis, osteomyelitis, or cutaneous lesions, results from the hematogenous spread of the organism. Though coccidioidomycosis dissemination is well known, it is rarely considered in the differential of a supraclavicular mass, where the diagnosis is malignancy until proven otherwise. Here we report a case of disseminated coccidioidomycosis in an immune-component individual presenting as supraclavicular mass.
52 Kawasaki disease: About a case in Senegal , Papa Souleye Sow*1 , Amadou Sow1 , Djibril Boiro1 , Sofiatou Dieye1 , Guilaye Diagne2 , Khadim Bop2 , Aliou M Coundoul2 , Aminata Mbaye2 , Ndeye F Sow3 , Awa Kane1 , Mohameth Mbodji2 , Serigne T Ndiaye, Modou Gueye1 , Idrissa D Ba2 , Ramatoulaye Diagne4 and Ousmane Ndiaye2
Kawasaki disease is an acute multisystemic vasculitis. We report the case of a 10-month-old boy received for a fever of 38.7° Celsius persisting on usual antipyretics for 10 days and bilateral conjunctivitis. The patient had bilateral serous rhinorrhea, polymorphic rash with diffuse perineal erythema, bilateral angular cheilitis, erythematous throat, plus perioral, periorbital and trunk desquamative lesions. There was microcytic hypochromic anemia at 9.5g/dL, thrombocytosis at 760x103/mm3, hyperleukocytosis at 28.27x103/mm3, positive C-reactive protein at 58 mg/L and an elevated sedimentation rate at 88 mm at the second hour. Aspartate amino transferase acid (AST) was elevated to 30 IU/L and alanine amino transferase acid (ALT) to 45 IU/L. Gamma glutamate transferase (γ-GT) was elevated at 488mg/dl. Cytobacteriological examination of the urine indicated aseptic pyuria. Cardiac Doppler ultrasonography showed low-grade pericarditis without coronary involvement. In the presence of prolonged fever > 5 days: bilateral conjunctivitis, oropharyngeal involvement, polymorphic rash, CRP >30mg/dL, VS >40mm/h, thrombocytosis, elevated transaminases and gamma GT, aseptic pyuria and pericarditis, we retained the diagnosis of Kawasaki disease in its incomplete form. The patient had been treated with acetylsalicylic acid 50mg/kg/24h. The evolution was favorable with stable apyrexia, regression of mucocutaneous lesions and normalization of cardiac ultrasound.
53 Using Two Clinical Glucose Measurement Datasets, Finger Glucose As Lower Bound and Sensor Glucose As Upper Bound, to Establish A Rational Range of HbA1c Values for Type 2 Diabetes Patients (GH-Method: Math-Physical Medicine) , Gerald C Hsu
This paper describes a rational range of HbA1C for type 2 diabetes (T2D) conditions based on big data analytics of a lower bound from finger-piercing and glucose testing strip method (Finger) and an upper bound from a continuous glucose monitoring sensor device (Sensor). It uses the “eAG” concept defined by ADA to conduct this comparison study.
54 Management of Pseudomonas Aeruginosa Related Infection in Emergency Department , Waad H Al-Kathiri1,2 and Ahmad Alkathiry3
Pseudomonas aeruginosa relating infection has high mortality rate in health care setting. In particular, immunocompromised and critically ill patients. Recent studies suggested considering broad-spectrum antipseudomonal antibiotics for Gramnegative bacteria coverage in the emergency Department, especially for high-risk patients. A number of studies have been conducted to assess risk factors of resistance. This review will evaluate the available antipseudomonal antibiotic along with its resistant pattern. Also it will discuss selected antipseudomonal agent in managing Multidrug resistant duo to Pseudomonas aeruginosa. The review will discuss the Drug selection approaches for patients with neutropenia, pneumonia, and urinary tract infections. The last part in the review will highlight the preferred empirical antipseudomonal antibiotic used at Emergency Department.
55 Management of Pseudomonas Aeruginosa Related Infection in Emergency Department , Waad H Al-Kathiri1,2 and Ahmad Alkathiry3
Pseudomonas aeruginosa relating infection has high mortality rate in health care setting. In particular, immunocompromised and critically ill patients. Recent studies suggested considering broad-spectrum antipseudomonal antibiotics for Gramnegative bacteria coverage in the emergency Department, especially for high-risk patients. A number of studies have been conducted to assess risk factors of resistance. This review will evaluate the available antipseudomonal antibiotic along with its resistant pattern. Also it will discuss selected antipseudomonal agent in managing Multidrug resistant duo to Pseudomonas aeruginosa. The review will discuss the Drug selection approaches for patients with neutropenia, pneumonia, and urinary tract infections. The last part in the review will highlight the preferred empirical antipseudomonal antibiotic used at Emergency Department.
56 Case Reports on the Use of Dry Needling to Improve Observable Knee Joint Space Width in Tibiofemoral Osteoarthritis as Seen on Unilateral Standing Knee Radiograph , Diana Pinto and Navin Khade
There has been much discourse and study on the management of Osteoarthritis Knee. Studies have focused on improving Joint Cartilage health, improving the joint functionality symptomatically or improving the quality of life of a patient with Knee Osteoarthritis. There have been no studies so far on altering Joint Space Width in an Osteoarthritic Knee joint with an attempt to improving the functionality at the Knee joint. Our case reports were aimed at understanding whether Radiologically Altered Knee Joint Space Width in Osteoarthritic Knees could be changed through Dry Needling Techniques.
57 Digestive Neuroendocrine Tumors about 40 Cases , R Boujarnija1 *, F Saddouki1 , S Berrad1 , N Acharfi1 , L Nouakh1 , I Ouafki1 , K Oualla1 , Z Benbrahim S1 , S Arifi1 , A Douida2 , H ELfatemi2 , I Staouni3 , Alaoui Lamrani Y3 , Ibrahimi A4 and Mellas N1
Neuroendocrine tumors of the digestive system account for 1% of all digestive tumors. These are a group of clinically and biologically heterogeneous neoplasms. The objective of this article is to report the epidemiological, clinical, paraclinical, histological, therapeutic, and progressive characteristics of digestive NETs in our context. Through a study of files over the period from January 2010 to September 2018, 40 cases of NET been collected in the medical oncology department of CHU HASSAN II in Fez. Clinical, paraclinical, therapeutic and evolutionary data were collected. The average age found was 50.42 years. A slight female predominance was noted with a sex ratio of 0.66. The clinical presentation was dominated by non-specific digestive symptoms. Carcinoid syndrome was found in 12.5% of patients. According to the WHO classification: 65% of patients presented well-differentiated NETs versus 30% of poorly differentiated CNE, 5% are undifferentiated NETs. The highest frequency of these tumors was observed in the D-P block (22.5%) and the small intestine (22.5%), followed by NET of unknown origin 15%.The majority of patients presented at an advanced stage (stage 4 in 65%), and the extension assessment already revealed distant metastases, particularly in the liver, and 57.5% of patients received chemotherapy.
58 Self-Acceptance, Self-Compassion and Loving Connection in Recovery Post Detox , Vanessa Wallace
Relapse rates back into addiction post detox can be quite high. Ongoing support may be overlooked and individuals who are connected with community groups or have fellow peers who are also in recovery have a higher chance of remaining clean. Quality of life can be limited for those battling to stay clean and is often routed in a lack of self -compassion or acceptance about themselves and their past using history and its ramifications. Vital therapy work may be omitted, and individuals may return to work or family life to make up for time lost in active addiction. It is essential in therapy to understand and make consideration for the lack of resilience brought on by years of addiction. Struggles to regulate emotions can be very difficult in early recovery. Self-compassion and self-acceptance are key in providing this platform of resilience as well as having loving relationships with people who understand and who those in recovery can share honestly with. Ongoing healthy recovery and happiness is increased for those who demonstrate self-acceptance, hold a compassionate view of themselves, can forgive others, manage resentments and also find a community or at least close friends and family who accept them for who they are and their past.
59 Clinical and Neurobioligical Features of Gambling Disorders and Internet-Gaming Disorders , Tatyana Zinchenko
In the presented work the acutance and relevance of the growth in behavioral addictions problem associated with gaming activities, such as gambling disorder (GD) and Internet gaming disorder (IGD) is demonstrated on the materials of numerous studies. These studies address both the prevalence and negative clinical and social consequences of these addictions. The gaming industry is developing at a tremendous pace and today is a multi-billion dollar business with billions of active players of all ages, starting with preschool children. Information technologies of involvement and retention in the game are constantly being improved. Which leads to an increase in problem and pathological players. The characteristic clinical and neurobiological features of these addictions, personality changes and negative social consequences are highlighted. The emphasis is not on the common clinical manifestations to all addictions, but on the specific to them disorders. Such as: the rapid formation and development of addiction to the stage where the game becomes the dominant need in human life with the replacement of even basic needs; episodes of altered state of consciousness (game trance) with impaired perception of time, events in the game, memory of them, affective narrowing of consciousness and changes in self-identification; the predominance of the cognitive component in the impulsive-compulsive syndrome, thoughts quickly become obsessive and develops a very intense and generalized attraction to the game (craving), with almost no struggle of motives; high suicidality: ideas in 50-80%, attempts in 15-31% of players. At IGD this question is not investigated. The rapid increasing of the personality changes, depression, anxiety disorders and social maladjustment. Behavioral dependencies associated with IGD and GD gaming activities require deep and comprehensive study. The materials of this report can be useful in clinical practice to develop effective treatments for these disorders. The search of studies was conducted using the following databases: Scopus, PsycINFO, Science Direct, PsycARTICLES, PubMED, Wiley Online Library and Google Scholar.
60 The Forgotten Valve, Isolated Pulmonic Valve Endocarditis, a Rare Case Report , Abhishiek Setia*, Gaurav Aggarwal and Will Grist
Of the four cardiac valves, the pulmonic valve is the least suspected in most pathologies when one thinks of endocarditis, pulmonary valve is hardly considered. We can call it a “forgotten valve”. Isolated pulmonary valve endocarditis has less than 100 reported cases [1]. We present a case of isolated pulmonary valve endocarditis in a 27-year-old male with past medical history of IVDA, who presented to the hospital with sudden onset of chest pain and shortness of breath.
61 Intra-Abdominal Solitary Fibrous Tumor secretes high molecular weight IGF-II, causing Hypoglycemia , Abhishiek Setia*, Martha Bilbatua, Sarahi Herrera-Gonzalez and Mindy Griffith
Hypoglycemia is a common event that has many well-known causes. Nevertheless, Non-islet cell tumor hypoglycemia (NICTH) is not one of them. As a matter of fact, NICTH is a rare but serious paraneoplastic syndrome. Solitary Fibrous tumor (SFT) is a rare spindle cell neoplasm derived from mesenchymal cells that in just 5% of cases releases “The Big” Insulin-like Growth Factor (IGF) II leading to hypoglycemic events [1].
62 Some Issues on Cancer Epidemiology – Prevalence of Comorbid Mental Disorders , Irina Chernikowa, Svetlana Savina and Boris Zaydiner*
Cancer diseases affect approximately 10 million people only in Europe, As a result of the demographic development; their prevalence is expected to double during the next 10 years. Cancer is a leading cause of death. It accounted for eight million deaths worldwide (around 15% of all deaths) in 2010 (38% more than in 1990) Meanwhile the number of survivors continues to grow, not just because of earlier detection and treatment, but also because of revolutionary new therapies. About 9 million Americans of all ages are living with a current or past diagnosis of cancer. For many individuals, this changes the landscape from a terminal illness to more of a chronic illness with periods of remission and exacerbation of symptoms. This perspective on neoplasms has broadened the scope of care from treating the disease alone to managing cancerrelated symptoms at different stages of the disease trajectory including mental disorders.
63 Tuberculous Colitis: A Case Report , Shaikha Daoud Al-Shokri, MD1,2
21-year old Bangladeshi man with no past medical history presented with abdominal pain for 10 days. He described his abdominal pain as a periumbilical colicky in nature, started mild then progressed to severe 4 days prior to ED presentation. It worsened with food ingestion. He had lost around 6 kilograms over a month. The pain was not associated with diarrhea, nausea or vomiting. He did not have dysuria, change in urine color, nor fever. He did not have history of black stool, fresh bleeding per rectum. He did not have sick contact, and he did not have skin rash or joint pain. His past medical history is significant for Helicobacter pylori (H. pylori) associated gastritis, which was treated successfully, 3 years ago.
64 Neuroprotection in Perimenopause New Insights for Hormone Therapy , Manuela Cristina Russu MD, Ph.D
Endocrine and Neural Senescence overlap by intertwined complex feedback loops. The variable levels of estradiol, progesterone, DHEA(S), and neurotransmitters -GABA, serotonin, dopamine and glutamate dependent on sexual steroids make women’s brain to suffer from the menarche to menopause, perimenopause being a “critical period”, “a neurological transition state” offering to the scientific and medical communities a “window of opportunity” to delay the onset of brain aging, The modern medical communities are moving from focusing on the treatment of already identified dementia to develop strategies for accurate depiction of predementia conditions/risk factors for brain aging, for prevention and slowing
65 25th Anniversary of First Urological Laparoscopic Surgeries in Croatia , Nikola Radovic
The first urological laparoscopic surgeries in Croatia were performed 25 years ago, and the results and video footage of those were shown at the 1st Croatian Congress of Urology in Zagreb, that took place in the Congress Centre of the “Vatroslav Lisinski” hall, from the 26th to the 28th October 1995.
66 The Pathogenesis of Memory and Its Causes , Arnaldo P G de Paiva Neto
Objective: to evaluate the memory phenomenon when synchronizing an area of the brain interacting with the external environment. Introduction: Dr. Dale Bredesen estimates that there will be more than 160 million individuals with Alzheimer’s dementia in the world by 2050. Amnesia in temporal lobe epilepsy indicates that the hyperactive excitability generated in this temporal lobe impairs the ability to memorize, destabilizing the rhythm in relative to the other brain lobes. Methodology: through literature review it is assessed that there is a working relationship between the region on the cortical side of the brain and the contralateral homotopic cortex. Results and discussion: the types of amnesia are classified in a first group whose organic causes predominate. We must not forget the danger of the accumulation of non-functional proteins that can precede the formation of beta-amyloid aggregates. They replicate more intensely than an infectious agent does, because they do not need genetic material for their multiplication. Conclusion: the first group may also be due to the lack of memory consolidation (sleep disorders, lack of mnemic exercise, malnutrition, infection or other conditions). There is a second group whose psychological causes predominate. Studies on the hormone DHEA (dehydroepiandrosterone) can help improve these neurodegenerative processes.
67 Crohn’s Disease: Hematopoietic and Mesenchymal Stem Cell Therapy as Potential Treatment , Brianna Weir and Vincent S Gallicchio*
Purpose: The purpose of this work was to comprehensively review literature to determine the safety and efficacy of stem cells for the treatment of Crohn’s disease and compare the effects of hematopoietic stem cells (HSCs) to that of mesenchymal stem cells (MSCs). Results: The data search included 5 animal models and clinical trials found on PubMed. The 5 studies included for HSCs and the 15 trails for MSCs found them to be a safe and effective as a treatment option (allogeneic and autologous bone marrow and adipose derived) for CD except for one multicenter randomized trial for HSC therapy. Most trials investigate the impact of stem cells specifically on perianal fistula, a common occurrence in patients with CD. Conclusion: While both HSCs and MSCs proved their safety and efficacy, MSC studies showed a greater therapeutic effect over HSCs. Adipose MSCs and Bone Marrow Derived MSCs reached similar clinical healing rates, with studies backing support for both sides. Across the board, autologous stem cell transplants proved to be safer and more effective compared to their allogeneic counterparts.
68 Exploring Researcher Perceptions on Current HIV Care and Stigma Among HIVinfected Individuals in New York City , Christina Marini1 *, MPH and Alexis Merdjanoff2 , PhD
Background: Several studies emphasize barriers and facilitators to HIV care; however, this article emphasizes the perspective of HIV researchers working in New York City with a focus on the shift in HIV stigma since 1980s. Purpose: The purpose of the study was to speak with researchers about the shift in the HIV care continuum and to discover differences between researcher and provider perspectives; particularly emphasizing the shift in stigma since the 1980s and the current barriers to HIV treatment in New York City. Methods: In this qualitative study, ten New York City researchers participated in semi structured in-depth interviews. Results: The main themes were the shift of HIV stigma since 1980, patient barriers to HIV care and facilitators to care. Since the 1980s, stigma has shifted from HIV/AIDS transmission to structural stigma around racial and economic barriers; once treatment options were discovered. Conclusions: Researchers work to gain greater knowledge about HIV treatment and their input is vital in articulating the needs of an HIV-infected individual. It is crucial to apply this finding to clinical practice to enhance the collaboration of researchers and providers.
69 ADHD-Relevant Motor and Cognitive Effects of a Fixed-Dose Combination of Caffeine, Gingko Biloba and β-Phenethylamine (PEA) , Michael Krakovsky1 , Dalia Shabashov1 , Yoram Sela1 , Morris Zelkha2 and Itschak Lamensdorf1 *
Background: The aim of the study was to evaluate Cogniben, a fixed-dose combination of caffeine, Ginkgo-biloba and β-Phenylethylamine (PEA) as a potential therapeutic option for attention deficit hyperactivity disorder. Methods: Cogniben-treated mice were tested with the open-field test, object-recognition test, passive avoidance test and activity wheel test. In vitro, the effect of Cogniben and its constituents on release of NO from cultured murine macrophages was assessed. Finally, patients with ADHD were treated with Cogniben and the effect on ADHD Rating Scale-IV and clinical global impression was evaluated. Results: Cogniben exhibited stimulant-like activity, as exhibited by both the open-field test and the activity wheel test. Treatment with Cogniben had positive effects of reducing anxiety and enhancing learning and memory in mice. In-vitro, the Cogniben combination reduced LPS-induced NO release from macrophages, to a similar extent to that of Dexamethazone. In the clinical evaluation, a 43% change from baseline was observed in the ADHD-RS-IV and a 34% reduction in severity from baseline was observed in the CGI-S following treatment with Cogniben. Conclusion: Together, the beneficial effects of the Cogniben combination, suggest that it may be a valuable treatment for ADHD.
70 Immune-Related Myocarditis Presenting as Shortness of Breath and Complete Heart Block in an Urothelial Cancer Patient Receiving Pembrolizumab: A Case Report , Monica Kathleen Wattana1 *, Saamir Hassan2 and Cielito Reyes-Gibby1
Pembrolizumab is an immune-checkpoint inhibitor (ICI) drug approved for the treatment of patients who have locally advanced or metastatic urothelial cancer and are not eligible for cisplatin-containing therapy. However, like other antiPD-1s, pembrolizumab can cause immune- related adverse events (irAEs), some of which can be serious enough to warrant emergency care 3-7. Pembrolizumab-related cardiac irAEs, owing to the increased morbidity and mortality associated with them, can present a special challenge in the emergency department. Most documented cardiac irAEs occurred in patients receiving anti-PD-1s in combination with other agents or in patients with pre-existing heart conditions and were easily resolved with steroid treatment8. Herein, we describe a case with unclear symptom presentation in a patient with no previous cardiac history receiving only 1 dose of pembrolizumab. Knowledge gained from this case and others will help elucidate the early- and late-onset toxic effects associated with pembrolizumab and inform the development of effective algorithms for the identification and management of these effects, thereby optimizing the safety of pembrolizumab and other immunotherapy agents in the Emergency Department.
71 A Study of the Diagnostic Practices for Mental Disorders in Ghana , Atakora Michael 1 * and Asampong Emmanuel2
Introduction: A lack of awareness of the diagnosis of mental disorders exists in the Ghanaian community due to the general misconceptions about mental health. One major challenge in diagnosing mental disordersis that no blood test orscan can be performed to confirm a particular mental disorder, unlike other medical conditions such as cancer, malaria, diabetes, and hepatitis. A stepwise progressive observation and assessment to rule out all possible medical conditions that might be associated with a mental disorder is essential to enhance the quality of diagnosis and treatment. This study focuses on describing the diagnostic practices of mental disorders to educate the public, create awareness, and to improve diagnosis in Ghana. Objective: This paper aims to describe the current diagnostic practices used to diagnose mental disorders to understand the impact of the diagnosisofmentaldisordersandtoprovideevidence formentalhealthpolicyandplanningtoimprovediagnosticpractice inpsychiatryinGhana. Methods: We collected and described data on the diagnosis of mental disorders from 30 mental health professionals aged 20 years and above who were purposively selected from six hospitals. We carried out in-person structured interviews with all participants at their various hospital premises. Results: Stages of diagnosing mental disorders can be single, dual, or multiple. Proportions representing the patterns of diagnosis of the most common types of mental disordersin the population included 73.3%for maniawithout psychotic syndrome, and 63.3%for hebephrenic schizophrenia. Moderate depressive episodes, bipolar affective disorder with mild or moderate depression, and organic delusion (schizophrenia-like) disorder achieved the same results(56.7%). Phobic anxiety disorder and schizoid personality disorderwere also reported by the same proportions(46.7%). Also, symptomatic epilepsy and epileptic syndrome was reported by (43.3%) and 40% for mood disorder due to known physiological condition with manic symptoms. Persistent delusional disorder as well as dementia with behavioral disturbance and dementia with depression and anxiety were reported by the same proportions (36.7%), and 33.3% for psychoactive substance abuse with psychoactive sub-induced anxiety disorder. The level of diagnostic quality in the psychiatric hospitals was higher than in the primary health centers (83.3% vs 63.3%). The most suitable intervention to improvediagnostic quality (40%)was associatedwith diagnostic education.Most participants(56.7%) assigned amoderate rating to the effectiveness of the interventions to improve diagnostic practices. Conclusion: We plan to use ourfindingsto solicitsupport from mental health stakeholdersto provide comprehensive public education involving basic and specific knowledge on the diagnosis of mental disorders. We recommend that any national programme would need to have sustainable long-term policies to encourage and motivate mental health professionals to participate in diagnostic activities and to pay more attention to patients. Incorporating mental health education into the school curriculum is also important.
72 Understanding Energy Infusion and Energy Diffusion through Glucose Wave Fluctuation Leading Into Glucose Control via Optimized Combination of Food and Exercise (Math-Physical Medicine) , Gerald C Hsu
The author used wave theory from electronics engineering and energy theory from mechanical engineering combined with his developed math-physical medicine to research the following topic: energy imbalance between infusion and diffusion through glucose wave fluctuations resulting from weight change, food intake, and exercise activities.
73 IFN-γ as a Major Antiviral Therapeutic for Viral Epidemics, Including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Clinically Forgotten but Potential Antiviral Cytokine and Non-Virus-Specific Antiviral as a New Antiviral Strategy , Geunwoong Noh
IFN-γ is a type II IFN known as immune IFN that differs from virus-induced type I and III IFNs. IFN-γ has been clinically used to treat a wide variety of diseases. The original function of IFN-γ is its natural antiviral activity, and this molecule may be effective in viral infection and consequent disseminated multi-organ invasion. Despite its role as an inflammatory cytokine, IFN-γ induces regulatory T cells and antigen-specific regulatory B cells, which play a counter-regulatory role in the immune reaction, possibly preventing or controlling excessive immune responses such as cytokine storms that can result in death. The advantages of IFN-γ are as follows: 1) IFN-γ is a non-virus-specific antiviral therapeutic and can be used in new virus infections and epidemics; 2) IFN-γ is strongly predicted to be effective in viral infection; 3) adequate clinical data for the clinical protocols of IFN-γ including dosage and period of use, are available; 4) IFN-γ is a relatively safe drug with few side effects and no rare severe side effects; 5) IFN-γ is available immediately; and 6) IFN-γ is not expensive. New viruses have appeared every several years, causing serious epidemics to pandemic circumstances. Researchers must develop antiviral strategies against viral diseases, especially for critically serious viral epidemics. Among the IFNs, IFN-γ is regarded as suitable and strongly recommended as a major antiviral agent, at least in high-risk patients who are infected by viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), when no vaccines or virus-specific antiviral therapeutics are available.
74 Soy as Goitrogen Foods , Xu Chen
Soy product is a common meat substitute among vegetarians. However, soy has its drawbacks. One of the dark sides of soy is that it is a goitrogen. The contents inside soy is not good for thyroid. In fact, American people totally do not know how to eat. The soy in vegan diet are hard to digest, but they think it is healthy; the European gourmet cheese that bugs flying out from are considered not sanitary enough; fermented soy are not considered everyday food on American dinner table. In this review, this author will discuss how to eat soy to benefit thyroid health.
75 Spectrum of Ocular Trauma Presenting to ophthalmic OPD , Sideenah Badr MJ1 , Alfaitouri M Fathalla2 * and Gumma Almusmari3
Introduction: Ocular trauma is one of the most common causes of vision loss. Etiologies of ocular injury differ from area to area and from country to country, difference according to demographic or socioeconomic classes have been reported. Measures to be taken for prevention of ocular trauma require knowledge of the cause and mechanism of injury, which may enable more accurate planning to prevent such injuries. The classification of ocular trauma with standardized terminology was developed by Kuhn and associates. The International Society of Ocular Trauma subsequently used this terminology to develop a classification system for mechanical injuries of the eye. This study was conducted to identify the etiology and nature of ocular trauma affecting our population. Aim: To identify the causes of ocular trauma and determine the types of various injuries presenting to the ophthalmic OPD Al-Thawra central hospital Al-Baida Libya. Subjects and Methods: 80 patients included in this study Presented to ophthalmic OPD Al-Thawra central hospital AlBaida Libya with history of Trauma during a period of three months. Following data were collected: patient’s age, gender, affected eye, etiology of trauma, place of trauma, visual acuity and Ocular Injury to time of presentation. Result: There were 80 eyes of 80 patients, of which 77.50% were males and 22.50% were females. The ages ranged from 1–50 years. The highest incidence of trauma was seen in the 21– 30-year age group (30.0%). Blunt trauma occurred in 42.5% of cases and foreign body trauma in 33.3% of cases. The highest incidence of eye injury occurred at workplace (50.0%) followed by the Home (22.5%), then Playground (20.0%). Assault-related eye injury was seen in 25% of cases and 75% of all injuries were accidental. Conclusion: Education programs regarding the safety measures to be taken to protect the eyes during work and other activities will be quite helpful to minimize the incidence of ocular trauma among the risk groups.
76 Intravitreal Avastin as a Treatment of Diffuse Diabetic Macular Edema , Sideenah Badr MJ1 , Alfaitouri M Fathalla2 * and Gumma Almusmari3
Background: Macular edema, defined as retinal thickening within 2 disc diameters of the center of the macula, results from retinal microvascular changes that compromise the blood-retinal barrier, causing leakage of plasma constituents into the surrounding retina and, consequently, retinal edema. Focal edema is associated with hard exudate rings caused by leakage from micro aneurysms. Diffuse edema is caused by leakage from micro aneurysms, retinal capillaries, and arterioles. Avastin (Bevacizumab) is a recombinant humanized monoclonal IgG1 antibody that binds to and inhibits the biologic activity of human vascular endothelial growth factor (VEGF). It contains human framework regions and the complementaritydetermining regions of a murine antibody that binds to VEGF. Avastin produced in a Chinese Hamster Ovary mammalian cell expression system in a nutrient medium containing the antibiotic gentamicin and has a molecular weight of approximately 149 kilo Daltons. Purpose: To assess the anatomic effect and visual acuity response after intravitreal (Avastin) in patients with diffuse diabetic macular edema. Patients and Methods: This study included 15 eyes of15 Patients with stable diabetes mellitus with diffuse diabetic macular edema. All eyes had received some form of argon laser photocoagulation (pan retinal photocoagulation (PRP), Focal or Grid of duration not less than 6 months. Mean age of 59 years treated with two intravitreal injections of Avastin 1.25 mg in 0.05 ml six weeks apart. Patients were examined by experienced ophthalmologist visual acuity, evaluation of diabetic retinopathy, central macular thickness by optical coherence tomography each was evaluated at the begging of study (baseline) and follow-up visits. Results: 15 eyes of 15 diabetic patients with persistent diffuse macular edema with no improvement in visual acuity. All the patients received two injections of A vastin six weeks apart. No complications were observed in any patient. The mean baseline visual acuity was (log Mar=1.338±0.455) and the mean visual acuity at three months following the second intravitreal injection was (log Mar=1.094±0.254), the mean central macular thickness at baseline was 492 µm decreased to 369 µm at the end of three months. Conclusions: A vastin resulted in a significant decrease in macular thickness and improvement in visual acuity at three months after the second injection.
77 Intralesional Steroid Injection for Primary Chalazion in Adults , Alfaitouri M Fathalla
Background: Chalazion (Meibomian cyst) a chronic lipo-granulomatous inflammation seconday to retention of sebum caused by obstruction of Meibomian gland duct of unknown cause. It is manifested by localized painless swelling in upper or lower lid usually points towards conjunctival side of lid (to be differentiated from stye). Vary in presentation from a small painless nodule self-limiting to a painful lid swelling complicated by corneal astigmatism and mechanical ptosis. Treatment option in case 2ry infection is hot compresses and topical antibiotic and if large surgery excision (vertical incision into the tarsal gland from conjunctiva surface). Injection of steroid (Triamcinolone) inside Chalazion considered as alternative treatment option with high success rate particularly in patients where incision and curette is difficult to perform due to poor patient’s cooperation. Or risk of lacrimal passage injury when the lesion located near to it... The aim of this study is to assess the effectiveness of intralesional triamcinolone acetonide (TA) injection for the treatment of primary chalazion in adults. Methods: 24 adult Patients mean age 38.6 ± 13.2 years with primary chalazion subjected to intralesional triamcinolone injection as management of primary chalazion. 0.05 to 0.15mL of triamcinolone injected into the center of the chalazion transconjunctivally in three patients the eversion of the upper lid were difficult and the injection was given transcutaneous. Result: 15 females and 9 males were included in this study. right eye was more affected than the left side14/10 respectively in all cases chalazion locate in the upper lid, mean chalazion size 0.74 ± 0.4 mm², time for complete resolution of the chalazion17.5 ± 12.0 days. There were no significant complications reported from this procedure Conclusion: Intralesional triamcinolone acetonide (TA) injection for the treatment of primary chalazion in adult was effective and without any significant complications.
78 Factors Associated With Maternal Death among Women of Child Bearing Age on the Community Perspectives; a Case Study of Kisemvule Village in Mkuranga District, Tanzania 2019 , Adam Malaika*, Ezekiel Mbao, Achilles Kiwanuka, Pedro Pallangyo, Said Kilindimo, Naizijwa Majani and Mohamed Janab
Objective: In the world, 303,000 women lose their life due to the complications related to pregnancy and childbirth. Tanzania is ranked 6th and 4th among the countries with high maternal mortality globally and Africa respectively. About 23 women in Tanzania are dying daily due to preventable causes, related to pregnancy and childbirth that is approximately one woman every hour. The objective of this study was assessment of risk factors on community setting associated with maternal death among women of childbearing age. Results: We enrolled 124 women of childbearing age. The mean age was 17.7. (37%) mentioned preeclampsia as the most risk factor leading to maternal death, 21% reported abortion, 13.7% mentioned anemia, and 12.1% reported postpartum hemorrhage, and 10.5% pregnancy induced hypertension (PIH), 3.2% ante partum hemorrhage and 2.4% early pregnancy. Other risk factors that seemed to cause maternal death included; delay to seek health facility to pregnant mother (8.9%), long distance from health facility to people’s residents (57.%), poor transport system in the village to reach the present health care facility (4.8%), negligence from health workers was also reported by the women as contributing factor (13.7%), economic condition-poverty (7.3%) absence of emergency blood bank in the health facility(4.8%), and poor nutrients to pregnant mother (3.2%). More studies are needed in the community to explore more on the risk factors among women of different life group.
79 Combined Studies on Aloe Vera and Argemone mexicana for the Management of Psoriasis , Nalini kanta Sahoo¹, Mohammad Gayoor khan2 * and Umama Yezdani³
Psoriasis is an autoimmune condition, which results in the body attacking itself. It occurs in the age group of 30 years to ≥ 65 years. More than 100 million individuals around the world are affected with this disease. The main objective of this study is to provide patients with more effective and safer treatment to this disease. More than 10 million cases per year in India are being recorded. Around 15% of cases emerge before the age of 10 years. In the case of psoriasis, white blood cells known as T cells mistakenly attack the skin cells. Around 80% of people have mild psoriasis, and the other 20% have moderate to severe psoriasis. There are different types of psoriasis they are Plaque psoriasis occurs in about 80-90% of people, it appears as raised, inflamed, red lesions, covered by a silvery, white scales, usually on the elbows, knees, scalp, and lower back. Inverse psoriasis appears in the different parts like armpits, the groin, under the breasts, and in other skin folds such as the buttocks and around the genitals. Aloe vera originates from the Arabian Peninsula, but grows wild in tropical, semi-tropical, and arid climates around the world. It is cultivated for agricultural and medicinal uses. The species is also used for decorative purposes and grows successfully indoors as a potted plant also used for herbal medicine and cosmetic products. Argemone Mexicana (Mexican poppy, Mexican prickly poppy, flowering thistle, cardo or cardosanto) is a species of poppy found in Mexico and now widely naturalized in many parts of the world.
80 Why TKI Therapy Targeting Minority Population of Tumor Cells Could Achieve Complete Control of Entire Tumor: The Self-Driven and Non-Autonomous Replication in Cancer and Their Connection through Inflammation , Kangla Tusung1 *, Xu Zhang1 , Hui Zhang1 and Jinming Zhao2
Despite wide application of targeted therapy with small molecule tyrosine kinase inhibitors (TKI) in cancer clinic, some questions for the mechanisms of these inhibitors remain unresolved. For example, how can a tumor be completely controlled for extended period (more than a year) by the drug when the target population in the tumor is not even in majority? Here we report our observations in one such case of lung cancer and provide explanation for this long-awaited clinical puzzle. Our analyses indicate that in many of the similar cases, the cancer is composed of two populations of tumor cells, one capable of autonomous (or self-driven) replication through the known mutation, and the replication of the other is inflammationdependent. The connection is through inflammation induced by the tumor cells capable of self-driven replication. The control of this population by TKI terminates induction of inflammation thus results in control of the non-autonomous population. The identification of these two replicating tumor cells and their relationship holds many answers to current clinical confusions in many cancer cases where accelerated tumor progression, high inflammation and loss of therapy efficacy are often the common feature. By understanding these processes, we can begin to manage cancer in a more proactive manner to avoid the once recognized unavoidable fate of cancer.
81 Ovarian Endometrioma Surgery - How to Safeguard the Follicular Reserve , M Bardi*, G Pezzetti, R Laquintana, G Gangarossa, A Iliakis, C Di Cesare, D Perrucci, B Salerno and P Rosaschino
Ovarian endometrioma is a particular anatomopathological entity in the context of endometriotic pathology. The ovary is the organ most frequently affected by endometriosis and in 30% of cases, the pathology is bilateral. The effect of endometriosis on fertility is varied; however, women with severe endometriosis and the presence of endometriomas appear to have significantly lower pregnancy rates, also following IVF treatment, when compared with women with severe endometriosis but without endometriomas. Surgical treatment is indicated if the endometrioma becomes symptomatic and increases in size despite medical therapy, and in cases of related infertility. However, endometrioma surgery can reduce the follicular reserve either through stripping that does not take into account the correct cleavage plan and involves an exaggerated “traction-counter traction”, or with an indiscriminate electro-hemostasis or, with a too narrow suture that causes ischemia. In consideration of this important issues, we have organized a surgical-excision technique that tries to safeguard as much as possible the follicular reserve of the ovary affected by endometriosis.
82 Spontaneous Rupture of the Spleen in Postpartum , Echchikhi M1 *, Essaber H1 , Benayada M2 , Allali N1 and Chat L1
Introduction: Spontaneous rupture of the spleen in postpartum or in pregnancy is a rare condition with severe complications and a high risk of mortality that must be suspected on clinical examination and confirmed immediately by ultrasound and CT scan. Case Report: We report the case of a 28 years woman who was admitted for abdominal pain and hemorrhagic shock on her second postpartum day. The splenic rupture was found in the US and CT scans. Given the patient improvement and the favorable control of lesions after drainage, surgical intervention was not required. Conclusion: Spontaneous splenic rupture is an important diagnosis to call to mind in women presenting in postpartum an acute abdominal pain with signs of hemorrhage. Imaging has a fundamental role in the immediate diagnosis of the attack to speed up its management and avoid its complications.
83 Health Network’s Developing in Prison Communities by Empowerment , Thitinun Phunphokha* and Tawan Khetpanya
Correctional institutions or prisons are places with a large number of people living crowded, which affects the health status of inmates. The main objective of this developmental research is to studied the model of health network development in prison communities by using empowerment process and has a specific purpose were 1. To study the characteristics of communities and health problems of Kalasin Prison Communities. 2. To develop an appropriate health care model for people in Kalasin Prison Community and 3. To develop the potential of the health network in the Kalasin prison. The population is as many as 3,005 inmates living in prisons. The sample consists of 75 inmates in the Kalasin Prison Community, 2 nurses’ inmates of nurse units in the prison, the total of 77 person. The instruments consisted of knowledge assessment form, understanding of case manager in community health care of public health volunteers in prisons and in-depth interviews, focus group interviews, and transcription lessons in supervision. The results showed that 1. The top 5 health problems that sick inmates were: 1.1 Upper respiratory infection 1.2 Rash / itch 1.3 Muscle pain 1.4 Arthritis 1.5 Gastrointestinal disease and health risks such as Stress, Depression, Obesity, Diabetes, Hypertension and Dyslipidemia. 2. Appropriate forms of health care for people in Kalasin prison community, namely Public health volunteers in prisons have a role in screening health conditions. Illness surveillance and education for self-care in order to prevent illness. 3. After the training in general knowledge about public health volunteers in prisons. The sample group had the mean scores and knowledge median of 11.65 and 12.00 (X = 11.65, Med. = 12.00) respectively which increased statistically significant. And the development of the potential of the health network in prisons should focus on participation providing empowerment to volunteers with appreciation and record the merit points. Suggestions since it is a studied in a closed community. Therefore should be cooperation from all sectors involved in driving the public health volunteers in prisons for strength and sustainability, which will lead to further reduction of illness in prisons.
84 Amino Acid Imbalance in Atherosclerosis , PA Karavay1 , LI Nefyodov2 * and NL Karavay3
A mini-review of literature data on the mechanisms of formation of the stock of free amino acids and their derivatives in atherosclerosis and methods for correcting metabolic imbalance.
85 Bugs Can Be Busted: How to Prevent Hospital-Acquired Infections A Success Story of Norwegian American Hospital, Chicago, U.S.A, in Substantially Reducing Hospital-acquired Infection (HAI) Rates , Siddiqui Tahseen Javed* MD, MRCP and Klein Jennifer
Hospital-acquired infections (HAIs) including Central Line -Associated Bloodstream Infections (CLABSI), CatheterAssociated Urinary Tract Infections (CAUTI), Methicillin-Resistant Staphylococcus aureus (MRSA) infections, Clostridium difficle Infections (CDI), Surgical Site Infections (SSI), and Ventilator-Associated Pneumonia (VAP) are among the most common and serious patient safety threats in the health care settings, which contribute to significant morbidity, mortali-ty, length of patient stay, and healthcare cost. To combat increasing number of HAI, Norwegian American Hospital (NAH), Chicago, Illinois, USA, strategically developed, and successfully implemented a HAI control and prevention initia-tive in 2013. As a result, NAH dramatically reduced its infection rates over the next several years and the trend continues to date. Guided by Gap analysis, driven by data, gathered from both internal and external sources, and supported by hospital leadership, NAH initiated a process of gradual and transformational re-forms, by engaging, educating and empowering all clinical and administrative staff, patients, their families and community, promoting a culture of mutual responsibility, incorporating best practic-es, integrating technology into clinical practices, developing electronic standing order- sets and nurse-driven protocols, creating hand hygiene, sepsis and sexually transmitted infections task forces, and antimicrobial stewardship program, NAH successfully managed to achieve and maintain high-quality standards of patient care and lower then national benchmarks HAI rates for the last four consecutive years (January 2016 to December 2019). Among the device-associated infections (CAUTI/CLABSI), we encountered only one CAUTI and no CLABSI in 2016, none in 2017, only one CAUTI and no CLABSIs in 2018 and only one CAU-TI and one CLABSI in 2019. Furthermore, our VAP rate remained zero, we had only one SSI in 2019 and the C. Difficle Infection rates have also been steadily declining since the implementation of new preventive measures. As a result, NAH received several recognition awards from the lo-Cal as well as national health organizations.
86 Neuroprotective Aspects of Cannabinoid Compounds , Alexandra Kasabova-Angelova
The accumulation of reliable data on the effects of cannabinoids is essential for understanding their possible beneficial effects on the central nervous system (CNS). Investigating individual substances along with the action of different combinations may show new possibilities for cannabinoids as neuroprotective agents. The data collected so far reveals the complexity of the mechanism of cannabinoids action on CNS, and even more complex and poorly understood are the effects when combined. Moreover, combining cannabinoids with different drugs and chemicals may lead to a decrease in beneficial effects. These characteristics of their action emphasize the complexity of the molecular mechanisms of neuroprotection and the lack of reliable information that may contribute to the safe and effective use of cannabinoids as medicines with valuable neuroprotective properties. The current brief review summarizes present data related to the protective effects of some cannabinoids on CNS and possible mechanisms involved in cannabinoid-mediated neuroprotection.
87 Distal Chevron Osteotomy without Fixation for Correction of Hallux Valgus: A Ten Year Retrospective Study , Reuven Lexier* and Camalene Chrysostoum
Introduction: More than eighty surgical methods have been proposed to correct Hallux Valgus Deformity. This study evaluates the efficacy of Distal Chevron Osteotomy by means of assessing pre-operative and post-operative radiographic parameters and clinical results. Methods: The authors performed a ten-year retrospective study, on patients treated with Chevron Osteotomy alone without internal fixation, by the senior author, at the Toronto Western Hospital, between the years 2000-2009. The association of Hallux Valgus with demographics, other pre-operative foot pathology, etiology, intra-op pathology, complications (late and early) and radiographic parameters (pre-operative and post-operative IMA and HVA’s) were studied. Results: Two hundred and eight-five Chevron osteotomies were performed, on one hundred and seventy-eight patients with Hallux Valgus. In the study group 89% were female, the average age was 44 years ± 14 (range 16 to 77), 60% were bilateral. Radiographic measurements of the Hallux Valgus angle (HVA) and Intermetatarsal angle (IMA) demonstrated a statistically significant difference in pre-operative and post-operative measurements (p <0.05) t-test. The mean correction in the HVA for the left foot was 14.94 degrees compared with 14.98 degrees for the right foot. A mean correction of 1.99 degrees in the IMA for the left foot and 2.05 degrees for the right foot was obtained. The recurrence rate for Hallux Valgus was 0.70% (2 feet). In 12.36% of the study group, unexpected intra-operative findings such as EHL tendon contracture, bursae, intra-osseous ganglion cysts, and osteoporosis or capital osteophytes resulted in adding to, or modifying, the standard operative procedure. Conclusion: Despite minor and largely reversible post-operative complications, this study demonstrates that with distal Chevron osteotomy excellent radiographic and cosmetic correction of the deformity was achieved with a high level (99.30%) of patient satisfaction. Patients should be advised pre-operatively about their risk for developing Keloids 5.61%, transfer metatarsalgia 4.56% and recurrence 0.70% when treated by Chevron osteotomy.
88 A Comparison between Suzuki Method and Traditional Piano Method on Children with Autism Spectrum Disorder: Case Study , Tianqi Chen, ARSM
Autism Spectrum Disorder is a neurological disorder that has a growing diagnostic rate among children. Children with ASD first show signs during infancy or childhood, and the progression varies greatly between individuals. An increasing number of parents decide to engage their children in artistic development, with piano being a popular choice. Though observational studies have noted the heightened sensitivity to sound and enhanced recall abilities of children with autism when learning instruments, there is little consensus on which piano teaching method is the most effective in developing musical skills. The goal of this study is to assess the effects of two piano-instruction methods on an autistic child’s music performance, which is assessed by categories, including tone quality, technique, interpretation and artistry. This paper presents the case of a 9-year-old child diagnosed with autistic disorder living in New Jersey. The Suzuki method and the traditional method are utilized to improve the piano abilities of this child. The different results in piano performance following the application of the two teaching methods in a three-year-period (2017/1-2019/12) may suggest the modality of different teaching methods on this child. This study may lay the groundwork for future research on selective piano teaching techniques for children with autistic disorder
89 Langerhans cell histiocytosis (LCH) presenting as pneumothorax and neck lymphadenopathy , Masoud Mohamadpour¹, Bahareh Yaghmaii¹, Seyed Abbas Hassani¹, Meisam Sharifzadeh¹, Zeinab Najafi¹, Anahita Majmaa² and leila Tahernia²
Langerhans Cell Histiocytosis (LCH) is a rare clonal disease characterized by dendritic cells infiltration in various main organs. We report a 6-month-old infant with severe respiratory distress, cervical lymphadenopathy, and reddish skin rashes on face. Diagnostic work up revealed spontaneous pneumothorax on Chest X-ray (CXR). Multiple thin-walled lung cysts and emphysema was discovered on spiral chest CT scan. Lung tissue and cervical lymph node biopsy revealed dendritic cells infiltration. Broncho alveolar lavage (BAL), cervical lymph node and lung tissue biopsy was performed and histopathology was assessed. It was suggestive of LCH with positive immunohistochemistry markers including CD1a, CD68 and S100.
90 An Evaluation of Anti-Clastogenic Activities for Garlic (Allium Sativum), Turmeric (Curcuma Longa) and Tulsi (Ocimum Tenuiflorum) with Clastogen (Mitomycin) in Human Lymphocytes – A Case Study , Tamilselvan C1 *, Arigila Seshaiah2 and Bharathi Rajan UD2
Chromosomal aberrations based human syndrome are very critical and sometimes leads to lethality. Such syndrome or disorders are often irreversible. In this present study, we evaluated the preventing effect of herbal extracts from Ocimum (tulsi), Curcuma (turmeric) and Allium (garlic) in developing chromosomal aberrations in whole blood human lymphocytes. The results showed that the clastogenic effect was minimised by the combination of all three herbal extracts compared to the individual extract effects. The spontaneous chromosomal aberrations caused in lymphoma cells were also minimized by the herbal extracts.
91 Interdisciplinary Review on 6 Concepts Relevant to Non-Perceptual Social Interaction , Igor Val. Danilov1 *, Sandra Mihailova2 and Viktorija Perepjolkina2
Phenomenon from everyday life that is routine and mundane for all of us, if it exists, then it should be visible from and can manifest itself through different studies. Thus, the observation of various studies from different social sciences has been chosen to find evidence of unconscious mental collaboration between individuals. The review aims to substantiate the assumption of nonperceptual social interaction by analyzing the results of studies on 6 known concepts: Theory of Mind (ToM), Visuospatial Perspective taking (VSP), Implicit memory, Unconscious thinking, Interpersonal perception, and Socialization. The review introduces the new concept of nonperceptual social interaction, proposing one of its explanations based on the existing laws of physics – the theory of Coherent Intelligence.
92 Transfusion-Associated Graft-Versus-Host Disease Confirmed by Human Leukocyte Antigen Typing in a Patient with Severe Combined Immunodeficiency and Review of the Literature , Daifulah ALZahrani1 *, Meshab ALShamrani2 , Ahmed Kassar3 , Sami ALThubaiti4 , Khalid ALGamdi2 , Mehmet Guler5 , Alaa Iskandrani6 , Amir Shehzad7 and Farzal Anwar8
Background: Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare, but often lethal complication of cellular blood component transfusion that produces a graft-versus-host clinical manifestation in immunodeficient patients. We report a patient who developed TA-GVHD and provide a review of the literature. Method: We report an infant with severe combined immunodeficiency (SCID) who developed TA-GVHD. The patient received a nonirradiated, packed erythrocyte cell suspension and platelet transfusions from unrelated donors, before the diagnosis of SCID. The patient manifested symptoms and signs of TA-GVHD (fever, skin rash, diarrhea, icterus, eosinophilia and bone marrow failure) 3-weeks after blood product transfusions. Result: Immunology investigation was consistent with T– B– NK+ SCID. The recto-sigmoid biopsies confirmed the gold standard features of grade-II acute GVHD. HLA typing of the patient and his parents showed that the patient has an extra-parental-allele of major histocompatibility complex (MHC) class I B*53. He received high doses of methylprednisolone, IVIG and ursodeoxycholic acid, but he had progressive hyperbilirubinemia and bone marrow failure, then he developed candidemia and pseudomonas aeruginosa sepsis and multiorgan failure then he died. Discussion / Conclusion: SCID is one of several risks for TA-GVHD. TA-GVHD develops when transfused blood-derived immunocompetent, alloreactive T lymphocytes able to engraft in the recipient’s lymphoid tissues that fail to reject them. Those lymphocytes mediate immune response causing damage and dysfunction of the skin, gastrointestinal tract, liver and bone marrow failure. Our patient showed all features of TA-GVHD that was complicated by fulminant sepsis and multiorgan failure despite aggressive management. The diagnosis of this lethal condition needs high index of suspicion and the transfusion history must be questioned in all immunodeficiency patients. The disease is fulminate and rapidly fatal in majority of patients even with aggressive treatment, while irradiation of blood products that to be given to recipients at risk is the preventive method of choice.
93 Should You “Do It for the ‘Gram?” A Review of the Psychological and Sociocultural Effects of Social Media , Joseph Z Conger and Sangeeta Singg*
Even though Social Media (SM) has penetrated the lives of roughly half the population of the world, connecting billions of people with friends and family, there are disadvantages that span the psychological and sociocultural dimensions of these users’ lives. At the present time, the disadvantages of SM outweigh the advantages. Many users have developed SM-based psychopathologies, such as addiction and depression, and SM is contributing to sociocultural crises, such as the fear of missing out (FOMO), self-objectification, and life dissatisfaction. This awareness has spawned a plethora of studies; researchers are uncovering new complexities about SM, and are expanding communal knowledge of factors that contribute to the psychological and sociocultural lives of SM users. Effects of SM are examined in this integrative review because they directly and indirectly influence the mental and physical health of SM users.
94 Data Analyses with ImageJ Software in Diabetic Retinopathy, By Processing the Optical Coherence Tomography Images , D Moraru1 *, S Istrate2 , C Eniceicu3 and P Sterian1,4
The study is based on Optical Coherence Tomography images resulting from investigation of 24 patients (with a total of 33 eyes) with non-proliferative diabetic retinopathy and of 19 patients (with a total of 26 eyes) without diabetes mellitus as control group. Patients’ age was between 43 and 92 years old, with a mean age of 66.4 years for first group, and a mean age of 67.6 years for the second one. From this large group, after the first data evaluation, we selected patients aged 40 to 65. We evaluated daily each patient, at 9 am, 12 pm, 3 pm and 6 pm, through glycemic level and Optical Coherence Tomography investigation using Macular Cube 512x128 images acquisition type. In the same time, we made specifically measurements of photoreceptor and retinal pigment epithelium layers thickness using ImageJ software. We analysed comparatively data given by Optical Coherence Tomography tool and those obtained through direct thickness measurements for three macular zones: one central (foveola) and two circulars (para-foveolar and peri-foveolar), having 1 mm, 3 mm, respectively 6 mm in diameter. We concluded that age and time of the day are significantly factors that influence the diabetic retinopathy. We also suggest this method as further investigation tool mostly for patients at the beginning of illness discovering, in order to diminishing and even stopping its evolution.
95 Foodborne Illness a Dynamic, Everywhere Possible Emergency Field Today , Liana Monica Deac
Foodborne illness afflicts people throughout the world. The CDC defines a foodborne disease outbreak as the occurrence of two or more similar illnesses resulting from ingestion of a common food. Each year, in USA, one in 10 people experiences a foodborne illness, 128,000 are hospitalized, 3,000 die, and 33 million healthy life-years are lost. While few patients with foodborne illness present with life-threatening symptoms, there are a number of foodborne infectious diseases and toxins that the emergency physician or other health care provider must consider in the evaluation of these patients. Given the frequency of international travel, as well as the risk associated with recurrent outbreaks of foodborne illness from commercial food sources, it is important to recognize various syndromes of foodborne illness, including those, which may require specific evaluation and management strategies. Foodborne illness poses a significant public health threat to the United States. The disease is defined as any ailment associated with the ingestion of contaminated food and is most often associated with gastrointestinal symptoms, including diarrhea, nausea, and/or vomiting. Individuals who are aged less than 5 years or more than 60 years or who are immunocompromised are at greatest risk for acquiring a foodborne illness. The most common cause of gastroenteritis is Salmonella infection. Annually, nontyphoidal Salmonella causes 1.2 million cases of foodborne illness and 450 deaths. Most Salmonella outbreaks were attributed to seeded vegetables (6.9%), pork (4%), or vegetable row crops (1.7%). Adults older than 65 years, people with weakened immune systems, and non-breastfed infants are more likely to have severe infections. Approximately 8% of patients with nontyphoidal salmonellosis will develop bacteremia and require treatment with antibiotics, including ceftriaxone or azithromycin in children and a fluoroquinolone (commonly levofloxacin) or azithromycin in adults. The summer months (peaking in July or August) had the highest percentage of cases. The use of certain medications to reduce stomach acidity can increase the risk of Salmonella infection. The food safety systems in some countries afford better consumer protection than others. This situation, combined with differing climates and ecologies, results in the association of different types of foodborne illness with different regions of the world. In a global economy, both people and food travel the world. Clinicians need to consider foreign travel as well as the consumption of food from other parts of the world when determining the cause of foodborne disease. The key to reducing the incidence of foodborne illness is prevention. Proper food storage, refrigeration, handling, and cooking are vital. Patients should be educated to avoid high-risk items such as unpasteurized milk and milk products, as well as raw or undercooked items like oysters, meat, poultry, and eggs. The consumption of more meals in the home may also decrease the risk of foodborne illness.
96 Problems of Effective Therapy of Brain Neoplasms: Fatality or Positive Outlook , Junlan Zhu1 , Alexandra Zamaro2 , Zhanna Kaliadzich3 , Yuri Shanko4 , Siargei Hubkin2 , Valeria Navitskaya4 and Vladimir Kulchitsky2 *
The search for “mesenchymal stem cells, glioma, and treatment” showed 446 articles in PubMed on December 18, 2019. The results of scientific research presented in articles by professionals on oncological topics focus on the problem of malignancy of brain tumors and early detection of neoplasms in brain. The degree of glioblastoma’s (GB) malignancy is determined by the content of cancer stem cells, identification of transcription factors, for example, OLIG2, cyclin D2 (CCND2) [1]. The complexity of therapy in glioblastomas is largely determined by tumor heterogeneity and insoluble problem of complete removal of tumor cells during surgery. These facts are the basis for accurate identification of cells in GB by sequencing in order to personalize combined therapy and increase effectiveness of antitumor therapy. Unfortunately, the effectiveness of gliomas’ treatment and, especially treatment of grade IV glioblastoma, is premature to state, given the statistics of mortality from this pathology [1-3]. New innovative solutions are needed in this field of oncology. Positive results of cell therapy of brain tumors in experimental and clinical conditions are among these solutions. Articles have been published that contain analyses of the studies of authors who introduced umbilical cord mesenchymal stem cells (MSCs) into GB tissue and observed inhibition of GB cell growth and development [3]. MicroRNA molecules released from Extracellular Vesicles of umbilical cord MSCs are considered to be the proposed mechanism of such therapeutic effect [3]. Therefore, data are accumulating on the functional role of exosomes in oncological topics and the reality of MSCs use as one of the components in the treatment of GB [3-5].
97 Microbiota Innovative Management Modalities in Mastering a Healthy Gut … Feeding Update …! , Said MM El Deib1 and Amr I M Hawal2 *
Introduction: Our mini review aims to state the evidence-based effect of the implementation of newborn infant nutrition with prebiotics and probiotics has been demonstrated in changing microflora composition toward the desired breast-feeding pattern and stimulating immune response Considerable efforts have been made to mimic the composition of human milk by the addition to formula feeding of living bacteria (probiotics), non-digestible fibers, nucleotides and oligosaccharides (prebiotics), and bovine lactoferrin in order to induce a breast-fed-similar microbiota colonization in formula-fed infants, with the final aim to stimulate the maturation and proper function of the immune system Several studies performed in the past decades have clearly demonstrated the complexity of gut microbiota composition and the modulatory effect played by several endogenous and exogenous factors on it. Type of feeding in the first months of life appears as one of the most important determinants of the child and adult well-being, and its protective action seems to rely mainly on its ability to modulate intestinal microflora composition at early stages of life. Diet has a dominant role over other possible variables such ethnicity, sanitation, hygiene, geography, and climate, in shaping the gut microbiota. In recent years, the implementation of milk formula with prebiotics, probiotics, and lactoferrin has been demonstrated to change newborns’ microflora composition toward breast-feeding pattern and stimulate immune response Conclusions: The aim of this Mini Review is to elucidate the specific immunologic role of the human milk-associated microbiota and its impact on the newborn’s health and life, highlighting the importance to properly study the biological interactions in a bacterial population and between the microbiota and the host. This mini review discusses the composition of human milk and its biological benefit for infants. Additionally, we also discuss how these beneficial effects can be mimicked if breastfeeding is not possible. And to highlight the specific and fundamental role of human milk-associated bacteria in modulating and influencing the newborns’ immune system during their life.
98 Effect of an Educational-Psychological Intervention on Anxiety, Bodily Embarrassment, Judgment Concern, and Comfort in Female Patients who referred to a Male General Surgeon for Colorectal Examination , Jamshid Eslami1 , Asghar Karbord2 *, Masoume Rambod3 , Farkhondeh Sharif3 and Zinat Akadeh4
Introduction: Psychological issues are big barriers for female patients referring for colorectal examination. Some interventions might reduce these issues. This study aimed to determine the effect of an educational-pyschyological intervention on anxiety, bodily embarrassment, judgment concern, and comfort in female patients who referred to a male general surgeon for colorectal examination. Methods: This clinical trial with a pre/posttest design was conducted in Imam Hassan Mojtaba Clinic, Darab, Iran. Total of 110 female patients who referred to a male general surgeon for colorectal examination were included in this study. The participants were randomly assigned to an intervention (n=55) and control (n=55) groups. The psychological training program was conducted for 60 minutes (30 minutes for examinations and 30 minutes for the psychological counseling). Beck Anxiety Inventory and Medical Embarrassment Questionnaires were used. The data were analyzed using chi-square, independent and paired t-test. Results: After the intervention, a significant difference was observed between the intervention and control groups in terms of bodily embarrassment and comfort. In addition, a significant difference was found in the intervention group regarding the mean differences of anexity, bodily embarrassment, judgment concern, and comfort scores before and after the intervention (p<0.001). Conclusion: The findings showed that the educational-psychological intervention reduced anxiety, bodily embarrassment, and judgment concern, and it improved comfort in female patients who referred to the male general surgeon for colorectal examination. Hence, this intervention might be used in primary, secondary and tertiary health centers to educate patients when referring to a male surgeon.
99 Screening Questionnaires for Obstructive Sleep Apnea: An Updated Systematic Review , Babak Amra1 , Behzad Rahmati2 *, Awat Feizi3 and Forogh Soltaninejad4
Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder, which is associated with significant morbidity. The aim of the current study was to do an updated systematic review of literature on studies assessed the accuracy of screening questionnaires for OSA against polysomnography (PSG) as the reference test. Methods: An English literature search was performed using Medline, Cochrane Database of Systematic Reviews and Scopus between January 2010 until April 2017. The reference list of included studies were also manually searched for finding additional studies. Results: Thirty-nine studies comprising 18068 subjects included in the systematic review. The sensitivity of STOP-Bang questionnaire (SBQ) in detecting mild (AHI≥5 events/h) and severe (AHI≥30 events/h) OSA was higher in comparison to other screening questionnaires (ranged from 81.08% to 97.55% and 69.2% to 98.7% respectively). However, STOP questionnaire (SQ) had the highest sensitivity in prediction of moderate OSA (AHI≥15 events/h) (ranged from 41.3% to 100%). Conclusion: The results of the present systematic review suggested SQ and SBQ for screening of OSA among sleep clinic patients. Although further validation studies of screening questionnaires on general populations are required.
100 Open bite case treated with Invisalign , Manuela Daian
Anterior open bite (AOB) is defined as the lack of incisal contact between anterior teeth in centric relation. Prevalence in the population ranges from 1.5% to 11.6%. The age factor, however, affects prevalence, since sucking habits decrease and oral function matures with age. At six years old 4.2% present with AOB whereas at age 14 the prevalence decreases to 2%. Anterior open bite is considered to be one of the most difficult treatments. Proper diagnosis and treatment planning, successful treatment, and retention have been stressed for the long-term stability of open bite treatment. There are several factors that could be related to the development of open bite. Among these are an unfavorable mandibular growth pattern, heredity, imbalances between jaw postures, digit-sucking habits, nasopharyngeal airway obstruction, tongue posture and activity and head position. Various treatment modalities have been proposed for the correction of anterior open bites: surgical and nonsurgical. In general, stability is the most important criteria in choosing an acceptable method of treatment for patients with open bite malocclusion. Many previous studies have indicated that if open bite correction is not stable, it is because the tongue continues to be postured anteriorly, which causes the bite to reopen. We will present an adult case treated with Invisalign. The treatment duration was 40 weeks and the anterior open bite was mainly corrected with relative extrusion of the incisors.
101 Experiences in a Nursing Certification Program , Oliveira ACR1 *, Tomasella GMF2 , Machado MM3 , Farras BC4
The aim of this study is to report the experience of nurses and nursing technicians in the Nursing Certification Program, from the perspective of two program surveyors. The reported experience took place in November 2019 with nursing professionals from a Brazilian general hospital participating in the Nursing Certification Program. The experience report was held at the fifth meeting of the program after building the learning process. It was possible to identify behavioral changes in the groups, which demonstrated motivation regarding the performance of professional practices, so that the perception of autonomy was increased, especially in the group of nurses and leaders.
102 Building Asian Women Cancer Support Group , Xu Chen
A support system is a very important factor for a cancer patient. It is an even more important aspect among Asian women cancer patients than other ethnicities. China is the only country that women suicide rate is higher than that of men. The reason for that is domestic violence. This paper is about how a woman cancer patient can build her own support system. When they experience domestic violence, Who they should turn to, whether and how to work to make her job a wellness program. Also, where she should choose to live. Cancer treatment is more than chemo and radiation. It is about an all-around program to make the patient feel overall good.
103 A Clinical Case Study of a 45 y/o Female Suffering with PTSD, Bipolar D/O, Depression, Anxiety and Chronic Pain Syndrome Taking 42-58 Pills Per Day and Weaned off of All Medications Using Medical Cannabis , Joseph Rosado, MD, MBA
Post-traumatic stress disorder (PTSD) is a prevalent, chronic, and disabling depression and anxiety disorder that may develop following exposure to a traumatic event. Although the use of Medical Cannabis for the treatment of physical and psychological disorders is controversial, medical marijuana is currently legal in Canada, 33 states in the United States and many countries around the world. Studies published in Molecular Psychiatry and Science Daily showed that treatment using particular compounds found in cannabis may benefit those with PTSD, and that “plant-derived cannabinoids [psychoactive chemicals] such as cannabis may possess some benefits in individuals with PTSD by helping relieve haunting nightmares and other symptoms of PTSD” and as a result of taking medical cannabis, participants reported a decrease in re-experiencing the trauma, less avoidance of situations that reminded them of the trauma, and a decline in hyper-arousal, respectively. There’s also convincing evidence from multiple studies for reduced endocannabinoid availability in PTSD, i.e., reduced levels of the endocannabinoid anandamide and compensatory increase of CB1 receptor availability in PTSD, and an association between increased CB1 receptor availability in the amygdala and abnormal threat processing, as well as increased severity of hyperarousal, but not dysphoric symptomatology, in trauma survivors. Other studies suggest that Medical Cannabis therapy, as an adjunct to a traditional analgesic therapy, can be an efficacious tool to make more effective the management of chronic pain and its consequences on functional and psychological dimensions. The patient in this case study had been treated for over 20 years with multiple opiates, Selective Serotonin Re-Uptake Inhibitors (SSRIs), Serotonin Norepinephrine Re-Uptake Inhibitors (SNRIs), typical and atypical antipsychotics, antiepileptics, etc. to manage her multiple medical conditions, i.e., migraine headaches, seizures/tremors, general anxiety disorder with panic attacks, major depressive disorder-moderate and recurrent, attention deficit disorder, fibromyalgia, hot flashes and generalized edema. We will review how she was weaned off of the majority of the pharmacological treatments solely using Medical Cannabis in less than one year.
104 Determination of the Relationship between Ego-Strength and Body Image with the Mental Health of Adolescent High School Female Students , Reza Pourhosein1 *, Fatemeh Dehghani1 and Fereshteh Darabi2
Introduction: Mental health plays a prominent role in psychosocial development in period adolescence. Adolescents’ mental health can be related to a wide range of features. This research aims to determine the relationship between ego-strength and body image and mental health in adolescent female high school student. Material and Methods: Statistical population in this descriptive-correlation research includes all adolescent female high school student from 22 educational districts of Tehran in 2014-2015 years and its statistical sample consists of 250 girls students at the high school selected through simple random multi-stage sampling method. Data obtained in this study through questionnaires including Basharat Mental Health Basharat Inventory (MHI-28), Cash Multidimensional Body-Self Relations Questionnaire (MBSRQ) and Basharat Ego-Strength Scale (ESS). Pearson correlation method was used to analyze data. Results: Results showed that there is a significant relationship between ego-strength and body image with psychological well-being and psychological distress. There was also a positive significant relationship between all components of ego-strength and psychological well-being and a negative effect with psychological distress and body image’s components including face assessment, body fitness assessment, fitness orientation and satisfaction with the body had a positive significant relationship with psychological well-being and a negative one with psychological distress, but there was no relationship between body image’s components including appearance orientation and mental weight with psychological well-being and distress. Conclusion: According to findings, adolescents’ mental health depends on their ego-strength and body image and high level of ego-strength and correct assessment of body image can provide adolescents’ mental health and vice-versa.
105 Hemodialysis Catheter-related Masses Case Report the Pro Inflammatory State in Chronic Kidney Disease , John D Rozich*, Jacob J Rozich, Thomas W Schultz and Noah S Rozich
Indwelling venous catheters provide essential functional vascular access for patients requiring emergent or urgent hemodialysis, though their long-term use is practically limited by known complications including increased rates of infection as compared with surgically created arteriovenous (AV) fistulas. Converging lines of evidence also support that chronic kidney disease (CKD) represents a pro-inflammatory state, an environment with active cellular and inflammatory pathobiology. Accordingly, implantation of catheters for even short-term use is associated with a fibrinthrombin-cellular matrix often forming around the catheter. This “biomass” long considered innocuous, can cause occlusion of the catheter, contributing to reduced flow rates during dialysis. It may also result in embolic injury of downstream structures. This case report identifies a complex catheter-related biomass remaining after removal of the hemodialysis catheter and focuses on two concerns. First, intravenous masses associated with the catheter, or remaining after removal may provoke embolic and direct hemodynamic-related injury. But perhaps less obvious is their potential linkage to vascular immunoreactivity found in CKD. This latter potential may need to be part of the larger discussion surrounding the outcomes of such pathologic immunoresponsiveness in CKD patients on hemodialysis.
106 Knowledge and Attitudes of Pediatric Nurses Regarding Pain Management in Palestinian Hospitals in West Bank , Ahmad Bajjali
Pain is one of the most stressful situations that every child will experience in some point, it is often described as the most distressing part of the hospital stay, whether it is from common bumps and bruises, or because of more chronic conditions such as gastrointestinal issues, headaches, or diabetes [1]. Further pain prevalence studies done thereafter, have reported similar prevalence rates ranging between 20% and 27% [2]. Nursing staff spend more time with patients in pain than any other health care providers, In most hospital settings, nurses are the first health personnel approached by admitted patients requiring assistance. Moreover many painful procedures are routinely performed by nursing staff. So nurses need to get appropriate knowledge about pain to understand, assess, evaluate, and do best intervention to relieve pediatric pain. Under-treated chronic pain can limit daily activities, increase disability, negatively affect the quality of life, create suffering, cause anxiety, depression, anger, fear, and increase the risk for suicide. Aprevious study reported that children with poorly managed pain mayhave longer stays in hospital, higher readmission rates, more frequent outpatientvisits, delayed healing of wounds, and altered immune functions [3]. Unfortunately, health professionals, including nurses, have historically underestimated the existence of pain in children; therefore, pain management has often been less than optimal [4]. The role of the nurse in pain management includes the entire nursing process. The nurse do assessment for presence of pain, makes plan of pharmacological and non-pharmacological pain management strategies with the medical team, implements the plan, and evaluates the effectiveness of the interventions. Many factors have been identified that influence effective pain management such as lack of knowledge and attitudes on the side of health care providers. In addition to inaccurate, insufficient, and poor nurses’ knowledge and attitudes in assessing and managing children’s pain. The aim of the present study was to assess the level of knowledge and attitudes regarding pain management of nurses working at pediatric units in West Bank.
107 Effect of Vaginal Miodesin™ in Pentravan™ on the Response to Progestin Therapy in Patients with Deep Endometriosis and Adenomyosis , Hugo Maia1 *, Wilson Saback2 , Clarice Haddad3 and Paulo R Sitya4
Introduction: The effects of Myodesin™ (Fagron, Brazil) on pain scores were investigated in a group of 18 patients with endometriosis who failed to respond to oral dienogest or Mirena. Patient and Methods: Eighteen patients with endometriosis were enrolled for this study and divided into 2 groups according to the treatment scheme. Group A (n=10) comprised of patients who were using 2 mg of dienogest and continuing to have pain and breakthrough bleeding when treatment with vaginal Miodesin™ (500 mg/dose daily) (Fagron Brazil) was initiated. In Group B (n=8) patients were treated with Miodesin™ after they had been using a Mirena ™ unsuccessfully to treat endometriosis pain for at least 3 months. Myodesin™ was always dispensed through the vaginal mucosa dissolved in Pentravan™ (Fagron, Netherland) at bedtime. Hysteroscopy with endometrial biopsies were performed in 4 patients in the Mirena™ group to evaluate the cause of uterine bleeding and to assess the presence of aromatase and VEGF expression in the endometrium by immunohistochemistry. Results: In this group of deep endometriosis patients treatment with Dienogest or Mirena ™ caused a modest albeit significant reduction in total pain scores (VAS). However after vaginal Myodesin™ treatment was initiated there was a significant further reduction in pain scores in both groups albeit the post treatment scores were significantly smaller in Group B than in Group A. In Mirena™ users with bleeding and pain aromatase and VEGF expressions were detected in ¾(75%) of endometria but they became negative after Myodesin™ treatment in all cases. A great reduction in endometrial vascularization was also observed. Conclusion: Miodesin treatment increased the efficacy of Dienogest and Mirena™ to reduce pelvic pain in patients with deep endometriosis and adenomyosis that were not responding adequately to these treatments. At least in Mirena™ users this was accompanied by a reduction in endometrial vascularization and in both VEG|F aromatase expression in the endometrium.
108 Congenital Trans Mesenteric Hernia (CTMH) in a Female Patient with Familial Mediterranean fever (FMF): Case Report and Review of the Literature , Marina J AL Ataallah1 and Rateb Shahoud2 *
Congenital Trans mesenteric Hernia (CTMH) is a rare entity of internal hernia that occur as a congenital defect in children due to an error in the rotation of the midget, presenting usually with an abdominal pain, fever and bilious vomiting. However, if left untreated, disastrous outcomes such as acute bowel obstruction and strangulation can take place. Its diagnosis is sometimes challenging to physicians and requires exploratory laparotomy to confirm the presence of a hernia defect. CT scan prior to surgery is seldom needed and may not have a benefit to guide for the exact diagnosis. For treatment, surgical repair, either open or laparoscopic, is the procedure of choice to manage such a condition. We report a case of CTMH in a 3.5–year-old female patient who presented to our hospital with abdominal pain and inconsolable crying.
109 Congenital Trans Mesenteric Hernia (CTMH) in a Female Patient with Familial Mediterranean fever (FMF): Case Report and Review of the Literature , Marina J AL Ataallah1 and Rateb Shahoud2 *
Congenital Trans mesenteric Hernia (CTMH) is a rare entity of internal hernia that occur as a congenital defect in children due to an error in the rotation of the midget, presenting usually with an abdominal pain, fever and bilious vomiting. However, if left untreated, disastrous outcomes such as acute bowel obstruction and strangulation can take place. Its diagnosis is sometimes challenging to physicians and requires exploratory laparotomy to confirm the presence of a hernia defect. CT scan prior to surgery is seldom needed and may not have a benefit to guide for the exact diagnosis. For treatment, surgical repair, either open or laparoscopic, is the procedure of choice to manage such a condition. We report a case of CTMH in a 3.5–year-old female patient who presented to our hospital with abdominal pain and inconsolable crying.
110 Magnetic Resonance Imaging and Its Applications in Dentistry: A review , Damla Soydan1 and Fatma Akkoca Kaplan2 *
Magnetic resonance imaging (MRI) is currently one of the essential imaging methods in medicine. Since it is a noninvasive method that does not use ionizing radiation, its applications are getting more and more attention in the dentistry field. MRI is specifically used for the evaluation of soft tissues. Temporomandibular disorders, paranasal sinuses, determination of lesion contents and endodontics are just some of the application subjects. The aim of this review is to inform dentists and oral surgeons about the application fields of MRI.
111 A Rare Variantion of Left Vertebral Artery Originating from External Carotid Artery: A Case Report , Kenan Kıbıcı, Ali Önder Atca and Berrin Erok*
Variations of vertebral arteries are congenital anomalies occurring during the embryonic development. We established a variant left vertebral artery which is a branch of left external carotid artery, by using magnetic resonance angiography and computerized tomographic angiography in a 43-year-old female patient whose vertebral arteries could not be detected in Doppler ultrasonography performed for the evaluation of her dizziness. This vertebral artery was extending up outside the transverse foramina until it entered into the left transverse foramen of the cervical vertebrae at the C1 level. Awareness of such variations of vertebral arteries is important with regard to the prevention of possible cerebrovascular injuries in interventional radiological procedures and vascular surgeries. For this reason, we would like to present this rare case of left vertebral artery showing a different origin and course outside the transverse foramina.
112 Tardive Dyskinesia and Akathasia: A Dopamine System Theory Clinical Review , Dr. Tammi McGill-Carter
Long term use of first generation anti-psychotics (FGAs) have been theorized in the formation of motion disorders Tardive Dyskinesia and Akathasia and due to the breakdown in the extra pyramidal system (EPS) located in the Basal Ganglia [1]. The second generation anti-psychotics (SGAs) were sourced to be the “treatment” of TD by blocking dopamine receptors with dopamine agonists of the D2-D5 receptors while also being seen as the genesis of AK. However, the blocking of the receptors in both motion disorders is a theory known as the dopamine blockage theory, despite the intermingle of other neurotransmitters such as Serotonin and Norepinephrine [2].
113 Macular atrophy in neovascular age related macular degeneration , Emad Selim1 * MD, FRCOphth, Marah Selim1 , RehabAuf 2 MD, PhD
Age related macular degeneration has been the leading cause of blindness in industrialized countries. Various treatments have been developed in the last few years. The pinnacle of treatment of neovascular age related macular degenerations have been anti-vascular endothelial growth factors. This article is an opinion on macular atrophy developing in neovascular age related macular degeneration.
114 Clinical, Epidemiological Description and Implementation of Infection Prevention and Control Measures for Hospital Outbreak Intervention by Kluyvera Ascorbata Producer of Carbapenemase in Colombia , Martínez Rosado LL* and Arregocés D
In 1936, AJ Kluyver and CB Niel Goes, postulate that could exist A group of organisms with polar flagellum in the family Pseudomonadae; that they had a type of acid-mixed fermentation similar to the delta Escherichia. Asai and Okumura described in 1956 five such organisms with polar flagellum and proposed the number of genus Kluyvera in honor of AC Kluyver In 1981, this group as integrates the Enterobacteriaceae family and will count back species [1]. Kluyveva, a genus
115 How Can Federally Qualified Health Centers Ensure A Streamlined Referral Process? , Viveak Kandaswam
Federally Qualified Health Center (FQHC) in the United States is a non-profit entity comprising of clinical care providers that operate at comprehensive federal standards. The care providers in FQHC are a part of the country’s health care safety net, which is defined as a group of health centers, hospitals, and providers who are willing to provide services to the nation’s needy crowd, thus ensuring that comprehensive care is available to all, regardless of income or insurance status. FQHC is a dominant model for providing integrated primary care and public health services to low-income and underserved population. There are two types of FQHCs, one receives federal funding under Section 330 of Public Health Service Act and the other meets all requirements applicable to federally funded health centers and is supported through state and local grants. To receive federal funding, FQHCs must meet the following requirements.
116 A Case of Intracranial Melanoma Metastasis Presenting with Arteriovenous Shunting , Rakesh Danny Biju1 *, Arjun S Chandran1 , Amal Abou Hamden1,2 and Rebecca Scroop2
Melanoma metastases to the brain are highly vascular lesions and have a high predilection to haemorrhage. Due to their degree of vascularity, these lesions sometimes demonstrate arteriovenous shunting. They may even mimic separate entities such as arteriovenous malformations (AVM). We present one such case; a 32-year-old male who was transferred to our unit with acute left sided hemiparesis and slurred speech. Imaging demonstrated a large intracerebral haemorrhage (ICH) with arteriovenous shunting and presumed underlying AVM. This was initially managed conservatively, however progressive neurological decline over subsequent days necessitated surgical intervention and the hematoma was evacuated. An arterialised vein and nidus of abnormal vessels were identified intra-operatively and disconnected from feeding MCA vessels. There were no macroscopic appearances suggestive of a melanoma. The final diagnosis of metastatic melanoma was only made on histopathological analysis of the resected specimen. This case highlights the importance of sending all ICH samples for histopathological analysis regardless of appearances on imaging.
117 A Case of Intracranial Melanoma Metastasis Presenting with Arteriovenous Shunting , Rakesh Danny Biju1 *, Arjun S Chandran1 , Amal Abou Hamden1,2 and Rebecca Scroop2
Melanoma metastases to the brain are highly vascular lesions and have a high predilection to haemorrhage. Due to their degree of vascularity, these lesions sometimes demonstrate arteriovenous shunting. They may even mimic separate entities such as arteriovenous malformations (AVM). We present one such case; a 32-year-old male who was transferred to our unit with acute left sided hemiparesis and slurred speech. Imaging demonstrated a large intracerebral haemorrhage (ICH) with arteriovenous shunting and presumed underlying AVM. This was initially managed conservatively, however progressive neurological decline over subsequent days necessitated surgical intervention and the hematoma was evacuated. An arterialised vein and nidus of abnormal vessels were identified intra-operatively and disconnected from feeding MCA vessels. There were no macroscopic appearances suggestive of a melanoma. The final diagnosis of metastatic melanoma was only made on histopathological analysis of the resected specimen. This case highlights the importance of sending all ICH samples for histopathological analysis regardless of appearances on imaging.
118 Neurobiology of Increase in Violence in Pakistan and the Role of Online Medical Care in its Reduction , Mahsa Houshdar
Causes of increase in violence in a named society, apart from socio-political and economical reasons, will be examined in this study. One of the most important reasons for increase in levels of hostility in a society is prevalence of psychological depression among population, which can lead to violent behavior and cause physical harm to one or others, increase in suicidal tendencies and destruction of property. Increase and prevalence of internal medical diseases are one of the main causes of increase in depression, among which diabetes, hypothyroidism, vitamin D, calcium, and vitamin B12 deficiency, hypo and dyslipidemia can be mentioned. The main cause for increasing prevalence of depression in Pakistan can be attributed to: -Rapid increase in spread of diabetes (mean prevalence13.14%), which increased 2 times in during 7 years period. Share of other illnesses contributing to depression can be summarized as follows, 20% to spread of diabetes in urban areas. - 6.6% to spread of vitamin B12 deficiency - 84.3% to spread of vitamin D deficiency - 8.29% of subclinical hypothyroidism In order to have more accurate results further measurements of prevalence of functional vitamin B12 deficiency and calcium is recommended. By using on line medical care system in Iran, it was found that 85% of people suffering from depression had at least one of the above mentioned causes, and after treatment symptoms of depression were noticeably reduced. At the end of this article there is an announcement for specialists in Pakistan and other countries to adapt the online medical care system to their own circumstances.
119 Sımple Management of an Acute and Large Wound , Bilgen Can
Wound care has been one of the most important building blocks of plastic surgery from past to present. Currently, The famous reconstruction ladder has been changed in parallel with the development of negative pressure wound therapy, tissue engineering and surgical methods and has been used as a reconstruction matrix. In our study, we aimed to present our approach to acute and wide wounds resulted from crush injury affects on the anterior part of the thigh in the light of the current literatüre.
120 Associations and Reality in the Etiology 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.
121 The Challenge of Transfusion of Patients Infected with HIV/AIDS , Dr. Carlos A. Gonzalez1, 2* Silvana Gonzalez3 and Jeremías Gonzalez4
The transfusional support of human immunodeficiency virus-infected patients is a challenge both for the clinical physician and for the blood services, either because of the immunohematological problems or the microbiological/thrombotic risk associated. The immunohematological risk caused by positive crossmatch is resolved by autologous adsorption; if the patient was recently transfused, the adsorption will be homologous. The thrombotic risk (due to hypercoagulable state) is resolved by pretransfusion heparin administration and leukoreduction only in autoimmune hemolytic anemia cases; and the presumed microbiological risk is similar to HIV-negative patients.
122 A Mathematical Model of Clinical Diagnosis and Treatment on the Method of Fuzzy Duster Analysis , Bin Zhao1 *, Xia Jiang2 , Kuiyun Huang1 , Jinming Cao3 and Jingfeng Tang4
In the process of this paper, all the factors related to cervical scoliosis can be grouped into 6 kinds of factors (5 levels), and all the possibilities of the cervical scoliosis can be divided into five classes. A fuzzy logic study was performed on 318 patients who had undergone cervical scoliosis with our hospital from August 2013 to August 2018. And the clinical diagnosis and treatment on the method of fuzzy duster are analyzed with the mathematical model be established. Then, we study a new differentiated diagnosis method of cervical torticollis (scoliosis) by an Asian wild horse with fuzzy mathematics, and successfully treated after cervical nerve plexus block.
123 Tango Therapy: What should we do to Maximize the Effectiveness of Tango Therapy? , Youngsoon Koh1 , Yoonchul Hur2 , Younghwa Baek3 , Sangwook Park4 , Suok Kim5 , Jung O Suh6 , IC Soo Kim7 , Chang Won Ha8 and Geunwoong Noh9 *
A more systemic analysis of tango movement for proper and effective therapeutic application of tango is necessary for medical purposes. The aim of this study was to systematically approach how Argentine tango is being used and investigated for the therapeutic purpose in medical field to improved gait and balance.
124 The Solitary Thoracic Schwannoma of the Intercostal Nerve: A Case Operated , Doumbia M1,2*, Diarra B I1 , Diatta S2 , Diarra S2 , Banga DD Nkomo2 , Sawadogo A2 , Mariko M1 , Ciss AG2 , Ndiaye A2 and Ndiaye M2
The authors report a case of benign thoracic schwannoma developed from the intercostal nerve in a young adult discover during a random chest pain examination, with the common analgesics having no effect on that. The radiographic image shows a parietal mass on the right side. The Schwannoma’s diagnosis must be suspected in front of any subcutaneous tumor of the thorax. The accuracy of the diagnostic is histological. The total resection is the only guarantee of a complete recovery without recurrence.
125 It’s All in the History , Sanad Esmail* and Muhammad Rafiq
We discuss the case of an 84-year old left-handed lady who presented to the emergency department with dysphasia, for whom CT neuroimaging showed a left-sided, posterior intraventricular meningioma. A closer analysis of the temporal profile of symptoms from the history unmasked dual underlying pathologies, the second of which was acute ischaemic stroke, which was subsequently confirmed on MRI. We highlight several learning points from this clinical case and emphasize the crucial importance of revisiting the clinical history when interpreting neuroimaging and constructing appropriate differential diagnoses.
126 Bacterial Vaginosis in Pregnant Women Receiving Care at Maxixe Health Centre , Izaidino Muchanga1 *, Célio Alfredo1 , Guido Nchowela1 , Rey Candido1 , Baivo Neves1 , Arnaldo Cumbane2 and Hilário Massango3
Bacterial Vaginosis is a vaginal infection that occurs when there is a change in the balance of the vaginal flora with vaginal discharge, which may or may not have a characteristic smell, a decrease in vaginal pH, and it is one of the most common public health problems in Sub-Saharan African countries in women in reproductive age. Premature birth, underweight newborns and increased risk of HIV infection are some of its consequences. In Sub-Saharan countries like Mozambique, the real prevalence of this infection is almost unknown. Thus, this study was developed with the aim of analyzing the prevalence of bacterial vaginosis in pregnant women receiving care in the Maxixe City Health Centre (CSM) and identifying the risk factors associated with it. 253 samples of pregnant women attending prenatal external consultations at CSM were used in this study. Samples of vaginal exudate were obtained, stained by the Gram method and observed microscopically using the Nugent method to identify the bacterial vaginosis. The prevalence of bacterial vaginosis was 12, 3%, and the highest prevalence was recorded in the age group of 15-24. In this population, the inconsistent use of condom in sexual intercourse and multiple partners may be the risk factors in acquiring this infection. Therefore, it is concluded that the knowledge of etiology, correct diagnosis and appropriate treatment of bacterial vaginosis may contribute to a more comprehensive prenatal examination, aiming to reduce the rates of bacterial vaginosis and its consequences in pregnancy
127 Bacterial Vaginosis in Pregnant Women Receiving Care at Maxixe Health Centre , Izaidino Muchanga1 *, Célio Alfredo1 , Guido Nchowela1 , Rey Candido1 , Baivo Neves1 , Arnaldo Cumbane2 and Hilário Massango3
Bacterial Vaginosis is a vaginal infection that occurs when there is a change in the balance of the vaginal flora with vaginal discharge, which may or may not have a characteristic smell, a decrease in vaginal pH, and it is one of the most common public health problems in Sub-Saharan African countries in women in reproductive age. Premature birth, underweight newborns and increased risk of HIV infection are some of its consequences. In Sub-Saharan countries like Mozambique, the real prevalence of this infection is almost unknown. Thus, this study was developed with the aim of analyzing the prevalence of bacterial vaginosis in pregnant women receiving care in the Maxixe City Health Centre (CSM) and identifying the risk factors associated with it. 253 samples of pregnant women attending prenatal external consultations at CSM were used in this study. Samples of vaginal exudate were obtained, stained by the Gram method and observed microscopically using the Nugent method to identify the bacterial vaginosis. The prevalence of bacterial vaginosis was 12, 3%, and the highest prevalence was recorded in the age group of 15-24. In this population, the inconsistent use of condom in sexual intercourse and multiple partners may be the risk factors in acquiring this infection. Therefore, it is concluded that the knowledge of etiology, correct diagnosis and appropriate treatment of bacterial vaginosis may contribute to a more comprehensive prenatal examination, aiming to reduce the rates of bacterial vaginosis and its consequences in pregnancy
128 The Process of Oncology Nurse Practitioner Patient Navigation: Triage an Essential Process , Frances Mary Johnson
One of the most daunting challenges faced in the health care delivery system is the complexity of cancer care, and the process of care coordination, a subcomponent of patient navigation. A study was undertaken to identify a central navigation process utilized by nurse practitioners practicing oncology. The data in this article is a component of a larger study entitled: The Process of Oncology Nurse Practitioner Patient Navigation: A Grounded Theory Approach. Utilizing a grounded theory approach N = 20 oncology nurse practitioners (ONP) were recruited. To be eligible for the study the ONP had to have a: 1) license to practice in their respective state; 2) certification to practice as an oncology nurse; 3) minimum of 5 years full time experience in oncology nursing; and 4) English speaking. The participants were recruited by: 1) word of mouth networking with peers: 2) Soliciting volunteers through public announcements at professional nursing conferences; 3) Contacting authors of oncology NP navigation articles or convention pamphlets via telephone or e-mail; 4) Posting information soliciting oncology NP volunteers on blogs or websites of professional organizations with organizational director approval; and, 5) Recruiting by snowball sampling. Telephone interviews were conducted utilizing an open-ended questionnaire. Data analysis and coding revealed the central navigation processes. The triage process was carried out in a variety of unique settings, and utilized in some instances within navigation subsystems. Key triage paths were identified along the cancer continuum; documenting the need for ONP navigators to strategically place these systems in areas along the cancer continuum, to expedite timely delivery of patient care. Literature search revealed that cancer specific triage tools are lacking. Implications for research and practice include the development of these tools for cancer care. Of critical importance is the need to identify service gaps in cancer care, and strategically place triage systems, to offset these service gaps. Practical application of the research findings in relationship to current literature is integrated for discussion.
129 Extra Pulmonary Sarcoidosis Disguised as Nodular Lung & Testicular Lesions , Sai Mannam1 *, Haris Hatic2 and Mohan Krishnamachary3
Introduction: Sarcoidosis can affect multiple systems in the body especially the lungs and the skin. In our case, we highlight an extrapulmonary case of sarcoidosis masquerading as lung & testicular mass in a 30-year-old African-American male. Hospital Course: An African American male without previous medical history presented with coughing and testicular swelling for over 1 month. The patient had adrastic weight loss, exertional dyspnea, and bilateral testicular swelling. Smoked daily one-fourthpack-per-day. On physical exam, patient had clear auscultation of the chest bilaterally and large left testicular mass measuring at least 6 cm. Laboratory tests show relatively unremarkable CBC and CMP. LDH was high at 238. Computed tomography of the chest/abd/pelvis without contrast showed innumerable pulmonary nodules in the bilateral lungs. Ultrasound of testicles found numerous bilateral hypoechoic testicular lesions. A right upper lung endobronchial biopsy revealed granulomatous inflammation without malignant cells related to pulmonary sarcoidosis with testicular involvement. ACE send-out was high at 138 U/L. Patient was started on steroids with 10 mg daily and doxycycline 100 mg twice daily for seven days. Discussion: The “great mimicker” is a well-deserved moniker for sarcoidosis because of its multisystem involvement and broad symptomology it can be a challenging diagnosis. In order to diagnose sarcoidosis, a thorough history and physical exam are required. The genitourinary presentations of sarcoidosis are extremely rare. Extrapulmonary sarcoidosis can regress spontaneously or it can progress in select patients to malignancy which requires tailored treatment with either corticosteroids or orchiectomy
130 Panton-Valentine Leukocidin (PVL) Skin Abscesses in Children and Adolescents Diagnostic and Treatment - A Case Report , Katharina Schulte1 * and Rizwan Attia2
Panton–Valentine leukocidin is a cytotoxin, which is associated with an increased virulence of isolates of Staphylococcus aurous. It can cause necrotic dermal lesions or recurrent skin abscesses and in rare cases necrotic haemorrhagic pneumonia. In our case a 15-year-old immunocompetent male was seen in the emergency department complaining of a painful tibial swelling. He had been travelling to South East Asia a year ago and had been suffering from multiple skin abscesses since then. Clinically, a tibial abscess was diagnosed and operatively excised the same day. The postoperative course of the patients was uneventful. In the microbiological analysis a methicillin-susceptible Staphylococcus aurous was isolated and the presence of lukF-lukS genes for Panton–Valentine leukocidin was determined. In order to avoid further spread of the cytotoxin the patient underwent an ambulant antibiotic eradication therapy with Cotrimoxazole 960mg twice daily for 5 days along with a decolonisation. An infection with Panton–Valentine leukocidin should be suspected diagnosed and treated in young immunocompetent patients with recurrent cutaneous abscesses or affected contacts.
131 A Rare Case of Spinal Subdural Hematoma Complicating Minimally Invasive Lumbar Micro Discectomy and Decompression for Recurrent Lumbar Disc Herniation , Kenan kıbıcı1 , Ali önder atca2 , Berrin Erok3 * and Muhammed Zeki Gültekin4
Spinal subdural hematomas is a very rare and unusual complication of spinal interventions. We present a case of subacute SSDH in the lumbar region of a 60 year-old woman following microdiscectomy for recurrent lumbar disc herniation. By presenting this rarely seen case of postoperative subacute SSDH, we want to bring attention to the possible postoperative complications like spinal hematomas in the differential diagnosis of failed back surgery syndrome in patients who do not respond to conservative treatment or develop neurological deficits and to the importance of radiological imaging in such cases.
132 Biomineralization of Heart Valves , Maciej Pawlikowski
Studies were conducted on biomineralization of mitral valves and aortic valves as well as heart valve prostheses. Mineralogical methods were used, including optical microscopy, scanning electron microscopy with analysis (EDS), as well as X-ray diffractometry and infrared spectrophotometry. It was observed that biomineralization is concentrated both inside the valves and on their surface. It develops in places of damage that are the centers of crystallization. Such damage may have different genesis: it may be genetic, caused by excessive heart work (overloads), by toxins associated with infections, or by external factors. Substances that mineralize the valves are phosphates and crystalline apatite. Among organic compounds the dominant one is cholesterol. Phosphates and cholesterol usually co-exist in different proportions.
133 Libman-Sacks Endocarditis and Chordae Tendineae Rupture as Sudden Presentation of Systemic Lupus Erythematous , Maricarmen Milán-Esteva1 *, Laura Rodriguez2 , Vanessa Fonseca Ferrer1 , Jose Rodriguez1 , Jonathan Martinez1 , Luis Pineiro1 , Elizardo Matos2 and Maria Uzcategui2
22-year-old Puerto Rican male was diagnosed with Systemic Lupus Erythematous (SLE) after presenting with gradual onset shortness of breath during the past 24 hours. Transthoracic Echocardiogram revealed moderate-severe mitral regurgitation with anterior leaflet prolapse at A1 level with suspected rupture chordae, which later was confirmed by Transesophageal Echocardiogram (TEE). Laboratory results came back positive for Antinuclear Antibody, Anti-Double stranded DNA and Neuronal Nuclear Antibody, for which Systemic Lupus Erythematous was diagnosed. Broad spectrum antibiotics were provided due to the possibility of Libman-Sacks Endocarditis debuting as SLE also was started on intravenous steroids. Patient underwent Mitral Valve Replacement instead of repair given high risk of native valve recurrent damage or complication due to his newly diagnosed connective tissue disease.
134 The Relationship between Serum Thyrotrophic and Components of Metabolic Syndrome , Khalid S Aljabri* and Samia A Bokhari
Background and objective: Metabolic syndrome (Meets) is a cluster of obesity, hyperglycemia, dyslipidemia and hypertension (HTN). Thyroid hormones play an important role in regulating energy homeostasis, carbohydrate, lipids and protein metabolism. Therefore the present study was an effort to investigate the influence of TSH levels in each component of patients with Meets in a population of Saudi Arabia. Design: We analyzed retrospectively 656 participants with MetS whom are between the ages 20 to 98 years. All patients were from the population of the Primary health centre at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. All data were collected on the basis of a review of electronic medical data. Patient who are pregnant were excluded. The reference range values of TSH 0.22-4.2 MIU/L, Free T4 12.0-22.0 pmol/L. TSH was divided into three groups; <1.5, 1.5-2.5 and >2.5-4.2. Metabolic risk factors were defined using the 2006 IDF criteria that define elevated triglyceride as ≥150 mg/dL (≥1.7 mmol/L) and reduced high density lipoprotein cholesterol (HDL) as <40 mg/dL (<1.03 mmol/L) for male and as <50 mg/dL (<1.29 mmol/L) for female. Elevated blood pressure was defined when the systolic blood pressure was ≥130 mm Hg and/or diastolic blood pressure was ≥85 mm Hg in addition to receiving any medication for HTN. Abnormal glucose metabolism was con¬sidered when HbA1c (≥5.7) or when patients were known to have type 2 diabetes mellitus (T2DM). The total number of cohort was separated on basis of age values into four groups: <40 years, 40-49 years, 50-59 years and ≥60 years. Results: 656 subjects with MetS were included. There were 86 (13.1% ) male and 570 (86.9%) were female with mean age 55.6 ±12.7 with mean body mass index 32.8 ± 7.2 kg/m2 . HbA1c>5.6 or T2DM, hypertension, triglyceride (≥1.7 mmol/l) and low HDL were present in 94 (14.3%), 354 (54.0%), 328 (50.2%) and 487 (74.2%) respectively. The mean TSH and FT4 values were 2.1 ±1.0 mIU/l and 15.4 ±3.1 pmol/l respectively. Patients with TSH (>2.5-4.2) were non-significantly younger and have significantly higher BMI compared to patients with TSH (<1.5) or TSH (1.5-2.5), 50.9 ±12.4 vs. 53.5 ±12.7 vs. 53.4 ±13.0 respectively, p=0.05 and 33.6 ± 8.2 vs. 31.7 ± 6.1 vs. 33.2 ± 7.0 respectively, p=0.01. Females compared to males were non-significantly predominant in patients with TSH (>2.5-4.2) compared to patients with TSH (<1.5) or TSH (1.5-2.5), 87.3 vs. 12.7%, 89.4 vs. 10.6% and 84.0 vs. 16.0%, p=0.2. Cases with HbA1c>5.6 or T2DM were significantly more prevalent in patients with TSH (>2.5-4.2) compared to TSH (<1.5) or TSH (1.5-2.5), 18.8% vs. 13.9% vs. 10.0 respectively, p=0.03. Cases with HTN were significantly less prevalent in patients with TSH (>2.5-4.2) compared to TSH (<1.5) or TSH (1.5-2.5), 46.3% vs. 54.3% vs. 61.6 respectively, p=0.005. Cases with serum triglyceride (≥1.7 mmol/l) were significantly more prevalent in patients with TSH (>2.5-4.2) compared to TSH (<1.5) or TSH (1.5-2.5), 57.6% vs. 44.9% vs. 47.2 respectively, p=0.02. Cases with low HDL were significantly more prevalent in patients with TSH (>2.5-4.2) compared to TSH (<1.5) or TSH (1.5-2.5), 85.1% vs. 74.9% vs. 71.1 respectively, p=0.002. Higher prevalence of HbA1c>5.6 or T2DM, low HDL , triglyceride (≥1.7 mmol/l) and HTN in patients with age 40-59 years compared to <40 years or more than 60 years, p<0.0001, p=0.4, p=0.02 and p=0.3 respectively. Conclusion: We found that an increase in serum TSH was positively correlated with components of metabolic syndrome and might be a risk factor for metabolic syndrome in Saudis. Further investigations are essential to further confirm the relationship between TSH and components of metabolic syndrome in Saudis as well as the underlying mechanism(s).
135 How Long Might Recoveries Continue After Very Severe Brain Injury? , Barbara A Wilson
While most people who sustain a severe brain injury will not return to their premorbid state, a majority will show improvement over time. To what extent can we call such improvements ‘recovery’? Jennet and Bond interpreted recovery as a return to normal life, perhaps with minor neurological or psychological deficits [1]. This may happen for some survivors of brain injury but is unlikely to occur for those with very severe damage. The majority of patients will fit Marshall’s definition that recovery means the ‘diminution of impairments in behavioural or physiological functions over time’ [2]. Kolb provides a more apposite definition when he suggested recovery typically involves partial recuperation of function together with substitution of function [3]. This is probably the definition of recovery that most closely reflects the situation for most survivors of severe brain damage. More recently, Hammel suggests that recovery should be more about focussing on what people can do rather than what they cannot do and that it is not so much a cure as a process of changing one’s attitudes and values [4]. Recovery in this context is concerned with helping people to live “a hopeful, satisfying, meaningful, purposeful, and contributing life within the limitations caused by one’s disease or impairment” (p57). Such aims could also be seen as applying to the rehabilitation that is being achieved in the cases described below. Before looking at these cases it is perhaps worth noting that there is a mistaken belief among some patients and families that all recovery will occur within a certain time period. This is sometimes six months, sometimes one year and sometimes two years. While this may be true for people with mild injuries, those with very severe injuries may continue recovering for many years. This paper describes four patients with very severe impairments who continued to show improvements for many years.
136 Diagnosis of May-Thurner Syndrome in a Case of Acute Pulmonary Embolism with Multiple Risk Factors: A Case Report and Review of Literature , Amy Belba
Background: May-Thurner Syndrome (MTS) is aniliac vein compression syndrome which results in a thrombosis of the common left iliac vein. The main cause of this compression is the overlying right common iliac artery. Method: In this article we describe the case of a 35-year-old woman with bilateral lobar pulmonary embolism (PE) together with an investigation of the risk factors leading to PE. The final diagnosis was a MTS with asymptomatic left internal vein thrombosis, further complicated by a PE. Results: Precipitating factors were polycystic ovarian syndrome, combined oral contraceptives and a possible protein S deficiency.Treatment encompassed anticoagulation during the first year of treatment. Re-evaluation together with further retesting of protein S and imaging will determine the need for an endovascular approach to the iliac vein compression. In this article we discuss the diagnostic approach to patients with PE with an asymptomatic deep venous thrombosis. Conclusions: This article seeks to draw attention to MTS as an incompletely studied syndrome which is potentially frequent in female patients with PE and interacts with other factors to increase the risk of a thrombosis. MTS should be considered in the differential diagnosis of a patient with PE in addition to patients presenting with a proximal deep venous thrombosis.
137 Intellectual Corruption in Modern Science: A Case Study , James F Welles
A reviewer of a book I wrote claimed an idea presented therein could be found elsewhere. Nine years later, no one could say where, but no one would correct the erroneous claim, so what began as an effort to obtain a redress of a legitimate grievance slowly degenerated into a tour d’farce of a surreal ethics warp in our intellectual community. The citations submitted to document the claim failed to do so, and the file on the dispute maintained by the American Psychological Association (APA) really is not about my case at all. The University of Connecticut (UConn) and the American Association for the Advancement of Science (AAAS) failed to hold anyone accountable. There was a basic conflict between the conduct of officials of all these organizations and their ethical codes. In a culture of intellectual corruption, behavior consisted of a pervasive and extended cover-up characterized by sophistry, secrecy, fantasy, irrelevance, rationalization, misattribution, misrepresentation, fabrication, falsification, failure to communicate and an adamant refusal to deal logically and fairly with the facts of the case. This demonstrated a complete lack of cognitive integrity and constitute
138 Challenges when diagnosing locked-in syndrome following TBI: The Story of U.P. a Clinical Puzzle , Mistry N, Wilson BA* and Rose A
Background and aims: Locked-in syndrome (LIS) is a rare neurological disorder; patients with LIS are awake, conscious with normal or nearly normal cognitive functioning. They cannot produce speech, facial or limb movements with complete paralysis of all voluntary muscles except for those controlling eye movements. LIS is associated with lesions of the brain stem and the pons, with 60% of people having sustained a stroke. LIS following traumatic brain injury (TBI) is rare; brain stem lesion plus cortical damage makes diagnosis of LIS challenging. Method: We describe U.P, a 42 year old man who sustained a TBI. A CT scan showed traumatic subarachnoid haemorrhage with a pre-pontine bleed. Awake, conscious, presenting with right sided paralysis and severe left sided paresis;U.P could produce voluntary horizontal eye movement, tracking people and stimuli of interest. Vertical eye movements emerged later, reading simple instructions and following commands. Results: U.P could use eyebrow movements for “yes” and a slight head shake for “no”. He could read some written instructions; non-verbal responses were inconsistent and sometimes unreliable. Discussion: Based on assessments from speech and language therapy and neuropsychology with U.P, we discuss LIS plus additional cognitive problems and the difficulties with diagnosing LIS following TBI.
139 Sexually Transmitted Infections and HIV: Knowledge, Attitudes and Practices as Transmission Risk Factors in Pregnant Women at Maxixe Health Centre, Mozambique , Izaidino Muchanga1, 2*, Célio Alfredo1 , Guido Ntchowela3 , Hilário Massango4 , Rey Candido1 , Baivo Neves1 and Arnaldo Cumbane2
Sexually transmitted infections are among the most common public health problems worldwide. Female and male infertility, mother to child transmission, causing miscarriages or congenital disease, and increased risk for Human Immunodeficiency Virus infection (HIV) are some of their consequences. In Sub-Saharan Africa countries, such as Mozambique, the prevalence of these infections is high, women being those who carry the higher burden. Thus we developed this cross-sectional study with objective of characterizing some sexually transmitted infections, HIV infection, syphilis and trichomoniasis in pregnant women, verifying if their management was in accordance with guidelines and recommendations in the country and identifying practice, Knowledge and associated risk factors. Samples were collected from 253 pregnant women attending Centro de Saúde de Maxixe. Vaginal samples were obtained and observed microscopically by wet mount and direct microscopic examination (Trichomonas vaginalis). HIV antibody testing was performed with the tests Determine HIV-1/2 and Uni-GoldTM and against, T. pallidum by RPR, SD BIOLINE Syphilis 3.0 and Determine TP tests in plasma samples. In this study, 11.1% of the pregnant women were infected with HIV, 2.8% with active syphilis, 5.1% with Trichomonas vaginalis and 9.1% with yeast. Antibodies against T. pallidum were identified in 8,3% of these women. In relation to HIV, 7, 5% of them were new cases. Samples were taken from 253 pregnant women attending ante-natal outpatient consultation at the health centre, which were informed about the nature of the study and submitted to a semi-structured interview after signing the free informed consent. In this study, the inconsistency on condoms use and the existence of multiple partners by the participants contributing for these infections transmission. Participants have shown that they had information about these infections modes of transmission, as also which measures to use to prevent them. A significant number of women present with any symptom related to infections that were diagnosed to them, proving that the use of syndrome approach in vaginal discharge must be given some thought in relation to its value in this situation. The data obtained in this study shows that some gaps also exist in the prenatal care clinics of this Centre, from routine procedures that are not performed in accordance with MISAU recommendations. The high prevalence of some STI found in this population, their risk behavior, together with the non-observance of some guidelines in the management of those infections by the health personal very worrying. The implementation of a teaching program on quality control, prevention and management of these infections by the health professional seems to us to be of utmost importance, so these can act in accordance with the present guidelines and transmit correct information to the pregnant women who attend prenatal care.
140 Laparoscopic Sleeve Gastrectomy in a Morbidly Obese Kidney Recipient for Preserving Graft Function , Abrar A AlAtwan¹*, Meshari AlMuhanna², Ali AlJewaied², Talal AlKhadher² and Mohannad AlHaddad²
The obesity epidemic involves the healthy population and transplant recipients equally. In renal transplantation, obesity is not only associated with a number of disorders exerting adverse effects on the transplanted organ, but with poorer graft function and peritransplant complications. Treating obesity in transplant patients can improve graft function and manage comorbidities that are associated with renal failure. As conservative weight loss programs shows disappointing results in these patients, bariatric surgery is the most effective and long term treatment for obesity
141 Neuropsychological Correlates of Reading and Writing in Brazilian Children with Developmental Dyslexia , Roseline Nascimento de Ardiles*, Eda Marconi Custódio, Alexandra Reis and Salomé Morais
Due to the close relationship between reading and quick naming, people with developmental dyslexia (DD) would have difficulty reading words accurately and quickly, writing by phonographic coding and reading by grapheophic decoding. Cognitive abilities of reading and writing were evaluated in two groups of primary school students: 23 with DD and 23 with typical development (DT) of the state of São Paulo, Brazil. The Reading Age Test (TIL), the Rapid Automatized Naming (RAN) test and the writing subtest of the 3DM Battery were used. There was a high association and similarity (p <0.01) between TIL (total of correct answers, sentence read per second and final note) and RAN (time to recognize the stimuli). DT read 80.6% of sentences, scored 75%; the DD read 50% and hit 44.4%. DT obtained better performance in the time variable for all RAN stimuli. The stimulus “Letters, numbers and Colors” revealed a greater distance of result between the groups, with difference of 21,14 seconds. DT obtained better performance for the writing test (8.7 errors, σ = 2.7; 5.5 hits, σ = 2.8) than the DD (15.5 errors, σ = 5.7; 47.3 hits, σ = 6.2). Of the 357 errors, DD presented a higher incidence of errors in words with irregular grapheme-phoneme correspondence (186), complex graphemes (72), contextual grapheme-phoneme (56) and simple grapheme-phoneme (48). The DD revealed inferior performances compared to the DT and difficulty in reading gramophonetically irregular words, speed, accuracy and fluency, expressing significant difficulty in accessing the lexicon. The phonological component didn’t reveal to be the central cause of deficits for children with DD in this study, suggesting that the deficit in visual and visual-orthographic attention interacts with language problems, causing reading deficits even before access and phonological recovery.
142 Unicentric Castleman’s Disease in a Man Originally Diagnosed with Sarcoidosis: A Case and Analysis of the Key Differences in Diagnosis , William Grist* and Yasmine Elamir
Castleman Disease (CD) is a lymphoproliferative disorder characterized by enlarged hyperplastic lymph nodes with regressed follicles surrounded by expanded mantle zones of small lymphocytes, and interfollicular vascular proliferation in the hyaline-vascular type. There are two types: unicentric and multicentric. Unicentric, hyalinevascular type of Castleman’s disease can be treated successfully with complete surgical resection with monitoring for reoccurrence. Here we report a case of a patient originally diagnosed with sarcoidosis who was found to have Unicentric Castleman’s disease.
143 Low Dose Methotrexate Toxicity Leading to Death in the Intensive Care Unit , William Grist and Yasmine Elamir*
Methotrexate toxicity has been widely shown to cause myelosuppression but the literature demonstrating low doses of the drug causing the same issue is much scarcer. Our patient presented with severe pancytopenia which began to improve with treatment but she ultimately succumbed to a superimposed pneumonia.
144 Pragmatic Psychology: What Abilities are hiding Behind Disabilities? , Susanna Mittermaier
Mental health professionals are often trained to look at what doesn’t work – not at what does – and this process can prevent our clients from being able to see beyond their defining diagnosis or disability. Once trapped within the confines of their perceived disability, the client is discouraged from forming any sense of identity based on ability, potential and self-empowerment.
145 Sarcomatoid Carcinoma of the Lung: A Rare and Unfortunate Disease , William Grist and Yasmine Elamir*
Pulmonary sarcomatoid carcinoma (PSC) is an extremely rare malignancy with a poor overall survival rate. Sarcomatoid tumors (SC) can arise out of many organs in the body and are generally rare but primary PSC’s are among the rarest. Of all lung tumors, PSC’s represent less than 1%. Our case presents a male with a past medical history of chronic obstructive pulmonary disease (COPD) who presents with a pleural effusion secondary to PSC.
146 Treating Patients with Atypical Familial Hemolytic Uremic Syndrome (aHUS) In the Critical Care Setting: A Case and Discussion , William Grist and Yasmine Elamir*
Hemolytic Uremic Syndrome (HUS) is usually recognized as the diarrheal associated (D+) and less as atypical/non diarrheal (aHUS). AHUSis caused by over activation of the alternative pathway of the complement system. It is a rare genetic disorder that is not often seen. Here we present a case of a patient with aHUS, who came to our ICU, discuss the pathophysiology, and how to treat and monitor a patient with aHUS with plasmapheresis and eculizumab in the critical care setting.
147 The Anatomy of Running a Successful Aesthetic Medical Clinic , Pyn Lim
There is no doubt that running a aesthetic medical practice these days can be overwhelming for a medical doctors especially in this highly competitive cut-throat industry. Due to its high return, a lot of aesthetic doctors or surgeons are willing to take up the challenge. As now as aesthetic medical doctors, not only you need to be a doctor, you also have to put on your business hat and developed good business acumen.
148 Multiple Malignant Meningiomas Presenting As Thrombocytopenia , Xiaoyu Wang and Hongwu Zeng
Backgrounds: Malignant meningiomas are CNS tumors arising from the arachnoids cap cells of the meninges, very rare in infants. Clinically, intracranial hypertension or focal neurological deficits are usually seen for mass effect, rather than leukemoid symptoms. Methods: Retrospectively analyze the detailed clinical development, diagnosis and treatment of a 10-month-old boy initially hospitalized due to leukemoid symptoms. After careful examination, malignant meningioma (WHO grade III) was proved by the biopsy and histopathology. Chemotherapy (three cycle of ifosfamide 100 mg/kg for 3 days, plus doxorubicin 1 mg/ kg for 2 days every 21 days) in combination with imatinib. Results: Dura nodules significantly reduced in size, skin bleeding spots, thrombocytopenia and enlarged superficial lymph almost disappeared. Conclusion: This study was conducted to demonstrate dynamic changes after effective individualized treatment. Meanwhile, we proposed that the invasiveness of meningioma induces somatic DNA damage, leading to abnormal platelet production and megakaryocytic morphology
149 Aesthetic Medicine , Khrushch Galina Viktorovna
GalynaViktorovnaKhrushch plastic surgeon, maxillofacial surgeon, international candidat ASPS, Periorbital area is worthily considered as one of the most complicated regions in terms of correction of the age-related changes using injection techniques of medical aesthetics.
150 Review of Causes of Hyponatremia in the Paediatric Age Group 10-Year Data in a Busy University Hospital , Myat Su Win*, Vipan Datta, Himal Gurung and Shalini Singh
Hyponatremia is one of the most common electrolyte disturbances in hospitalised children, which can potentially cause significant morbidity and mortality. We reviewed the causes of severe hyponatremia (Na+ < 125 mmol/L) over the last ten years (2006- 2016) in the neonatal unit and the paediatric unit (<16-year-olds) at Norfolk and Norwich university hospital.
151 New Approaches to the Design of Automatic Diagnostic Systems and Math Algorithms of Breast Cancer , Sorush Niknamian
The present study aimed to investigate the design of a computer-assisted pathology system for diagnosis and clustering of cancerous lesions in magnetic resonance imaging of breast, using computer code in MATLAB software. In the analysis of breast segmentation by Atlas method, mass tumors 4 and non-mass tumors 5 are identified and segmented. Characteristics of the morphology, kinetics and matrix of the gray level co- occurrence of the tumors are extracted. In this study, a new feature called “dual-tree complex wavelet transform (DTCWT” was extracted and five characteristics associated with this type of property were extracted. After extracting these properties, the feature vectors were assigned to the clustering with different kernels and the combined clustering, which combine the linear discriminate analysis method and the nearest neighbor, and clustering of the tumors was performed into two benign and malignant categories. Using the new feature introduced in this study and applying it to the SVM cluster, AZ values for mass tumors, non-mass tumors and their combination were 0.71, 0.77 and 0.70, respectively, and by applying it to the combined cluster s LDA and NN-k were 0.70, 0.44 and 0.69, respectively. Also, in the Atlas-based segmentation, the FCM cluster was used for them first time. The use of this cluster caused that there is no empty cluster and the accuracy of the results would increase. In the feature extraction section, the feature of dual-tree complex wavelet transform (CWT-DT) was applied for the first time in magnetic resonance images of the breast and on mass and non-mass tumors and a combination of them was applied. Detection and extraction of non-mass tumors is the main challenge of this study, and applying the proposed feature group of non-mass tumors created an acceptable result, and the value of AZ increased compared to previous studies.
152 Evaluating the Adherence of Primary Health Care Centers in Gaza Strip to the WHO-PEN Protocol 1: A Cross-Sectional Study , Tayseer Afifi¹, Diaeddin Dwekat¹, Abdallah Alwali¹, Hasan Alyazouri¹ and Khamis Elessi¹
Background: Cardiovascular disease (CVD) is common in the general population, affecting many of adults above 40 years of age. It is a multi-factorial disease. Some risk factors; such as family history, gender, ethnicity and age cannot be changed. Other risk factors are modifiable including high blood pressure, high cholesterol and diabetes. Patients will not necessarily develop cardiovascular disease if they have a risk factor. But the more risk factors they have the greater the likelihood that they will, unless protective measures and actions are taken to modify their risk factors and work to prevent them compromising their heart health. Objectives: The objectives of this study were: to evaluate the adherence of major primary health care centers to the WHO-PEN Protocol 1, Package of essential noncommunicable (PEN) disease interventions for primary health care, recommendations;and to provide more accurate estimate of cardiovascular risk using hypertension, type 2 diabetes mellitus and tobacco use as entry points. Methods: A cross-sectional study involving 200 patients who were already diagnosed with NCDs was conducted atprimary health care centers. Data was collected retrospectively using a self-designed questionnaire based on the WHO- PEN checklist. Patients’ files were selected randomly. Results: Based on the analysis of whole cohort (200 cases). The prevalence of type 2 diabetes was 39% and hypertension was 28.5%, whereas 32.5% had both. There were only 17 smokers among patients representing 8.5% of the sample. Using WHO/ISH, WHO/International Society of Hypertension, Risk prediction charts; half of patients were in the tenyear cardiovascular risk category of less than 10%. On the other hand, 5% had a ten-year cardiovascular risk over 40%.49% of patients had a first-degree family history of heart disease? All patients were counseled on diet, exercise and smoking cessation. Conclusion: These results demonstrate high adherence to the WHO-PEN protocol in these two centers reflecting a high quality of care and follow-up. Furthermore, the medical records were fully filled with adequate information for each item. However, there were some deficiencies in the risk estimation, which should be documented for better counseling for patients with high risk.
153 Malignant Pleural Mesothelioma and Lung Cancer in a Very Young Age , Neuza Oliveira Veira Taxeira Lopes1 *, Abraham Gregor2 and Odilia Soares3
The presence of cancer of the lungs is rare in adolescent patients, particularly in those under 20 years of age. A cancer that begins in the lungs is most often found in older patients with a history of tobacco use. In literature cancer in younger patients mostly meditational origins. Hence, we found two cases of lung cancer in a 15 and 17 years old male with different clinical presentation and history. In this paper, we hope to illustrate the unique challenges in diagnosing and treating young patients with lung cancer. The third case is 29 years old young man with malignant pleural mesothelioma which is a rare, invasive and often fatal neoplasm that develops in the thin layer of tissue surrounding the lungs known as the pleura. Although rare, mesotheliomas do occur in the young; their characteristics are distinct from those of older patients.
154 Challenges in Diagnosis and Management of External Ear Melanoma Case Report and Literature Review , Erisa Kola1 *, Edlira Horjeti2 , Elmijola Janushaj3 , Ina Kola4 and Mehdi Alimehmeti1
Primary external ear melanomais a rare disease that accounts for only 1% of all cutaneous melanomas and only 14,5% of cutaneous melanomas of the head and neck region [1]. The external ear represents a site with high ultraviolet exposure and predisposed to various cutaneous lesions. The path physiology of these tumors is different from other skin lesions because of their specific anatomical site close to cartilage, lymphatic drainage and functional characteristics. Malignant melanoma of the ear was considered to be very aggressive, with a propensity for spreading to both regional lymph nodes and distant sites. Surgical management of external ear melanoma has always been a challenge between avoiding aggressive amputations, achieving an aesthetic pleasant result and adequate oncologic control. According to our literature review a limited number of publications exist regarding malignant melanoma of the external ear. We present the case of a 69-year-old woman, who was presented at the Department of Dermatology because of an ulcerated lesion in the helix part of the left ear. Clinical, histopathological and immunohistochemical examination confirmed the diagnosis of malignant melanoma of the external ear, nodular type, ulcerated.
155 Prostatic Adenocarcinoma, Diagnosis “Gleason Score” , Bouchikhaoui Hiba*
Prostate Cancer is the one of the leading causes of death in the world among men, and one of the cancers that management has the most evolved in recent years. Indeed, the incidence of prostate cancer is increasing with diagnoses made more in younger patients. Prostate cancer is before all a pathological diagnosis. It is always based on a histological examination and or cytology. The variant, score and grade also the differentiation have to be correct and sure for an effective therapy. The only criterion that Gleason’s score depends is the architecture that is based on this last.
156 Toxic Epidermicnecrolysis Two Cases Presentation , Leroy Olaechea Varona1 *, Claudia Khenzani Ngobeni2 and Maria Teresa Diaz3
Toxic epidermal necrolysis (TEN) is a type of severe skin reaction. Together with Stevens-Johnson syndrome (SJS) it forms a spectrum of disease, with TEN being more severe and commonly the risk of death in most of the cases it is very high. Early symptoms include fever and flu-like symptoms. A few days later or hours the skin begins to blister and peel forming painful raw areas. Mucous membranes, such as the mouth, are also typically involved. Complications include dehydration, sepsis, pneumonia, and multiple organ failure, and death. Aim: The aim of this prospective observational study was to describe the features of these two patients admitted by the Medical team in our tertiary hospital. Methods: These two cases were admitted by the medical team of our hospital with TEN/SJS over the period of two years. Severity was graded according to the percentage of the skin involved. Co-morbidity diagnoses, clinical features, investigations and complications were noted. Results: Case number one an HIV positive on Alluvia for 2 years, the probable cause was the pain killer that he was on due to back pain. On his last reviewed he was well and all the denuded areas healed. Second case a female patient history of diabetes mellitus and Neuropathy treated with Tegretol (Carbamazepine) sadly died in our hospital due to complications. Conclusions: The causes of TEN in these patients were due to anti-inflammatory and carbamazepine. More than 50% of the skin was involved, and severe sepsis was the complication that provokes the death of the second patient.
157 A Case Report of Cerebral Venous Sinus Thrombosis in Palestine: The Importance of Rapid Diagnosis and Treatment of CVST , Mohammed Riyaz², Rawan Utt¹*, Rawnaq Mayadma³, Tayseer Afifi4 , Maen Shuqair5 and Majdi Zaid⁶
Cerebral venous sinus thrombosis (CVST) is an often under-diagnosed, life-threatening condition. We report the first case of CVST in Palestine of a 39-year-old female who presented with a history of loss of consciousness preceded by severe vertigo and headache. Brain CT scan without contrast was done, in which no abnormality was detected. Further Brain MRI and MRV studies with contrast showed thrombosis of left transverse sinus with extension to left sigmoid sinus and left jugular vein. The patient was anticoagulated and admitted to the ICU for regular monitoring and frequent brain CT scans to rule out hemorrhagic transformation. The patient made a full recovery. Lab and molecular studies were carried out as an outpatient to investigate the etiology of this presentation. The aim of this case report is to demonstrate the importance of early detection and treatment of CVST for a successful outcome.
158 My Experience of What Works As a Caring Professional , Lorinda Brink Bergh
This article is about my experience as a clinical psychologist working with a variety of patients/clients over a period of more than 30 years in different settings. The purpose of this article is to provide information regarding what I found works in a therapeutic situation when working with clients as a caring professional.
159 The Risk of Stroke Using CHA2 DS2 -VASc Score in Hemodialysis Patients at a Tertiary Hospital in Riyadh, Saudi Arabia , Albaz M1 *, Alsaeed L1 , Almutairi F1 , Aladhyani M1 , Alhumaidi M1 , Almakenzi H1 , Alboghdadly A2 and Alwaily M3
Introduction: Patients undergoing hemodialysis are at increased risk of stroke. However, less known about the impact of some of the stroke risk factors, and the value of stroke risk scores in determining the risk in those patients. Our main goal. To assess the risk factors for stroke in hemodialysis patients and the use of the new CHA2DS2-VASc score for stroke assessment. Methods: Single center, retrospective cohort study of 336 patients undergoing hemodialysis from June 24, 2018, to September 6, 2018, was recruited. Baseline demographics, clinical, and laboratory data were collected. We calculated the CHA2 DS2 -VASc score for stroke assessment in all patients and categorized them into high, moderate and low risk patients according to CHA2 DS2 - VASc score and subcategorized them to two groups atrial fibrillation (AFib) and Non- Atrial fibrillation (Non AFib) patients. Results: 336 patients were included in our study; the majority of patients were at high risk with a CHA2 DS2 -VASc Score mean of 2.9± 1.5, although history of stroke was observed only in 15 patients (4.46%). According to CHA2 DS2 - VASc score, 280 patients were at high risk, 172 (51.19%) were high-risk patients on treatment (anticoagulant or antiplatelet) and 108(32.14%) patients were high risk patients not on treatment 48 were at moderate risk (14.28%) and 8 were at low risk (2.38 %). Patients were divided into subgroups as non-AFib and AFib. In non-AFib patients 320 (95.23%), high-risk patients 103 (32.18%) were not treated; high-risk patients with treatment are 162 (50.62%), moderate patients were 47 (14.68%), 8(2.5%) was in low risk. AFib patients were 16 with a mean CHA2 DS2 -VASc score of 4.4±1.1. Patients with AFib were all at high risk except 1 was at moderate risk (6.25%). There were 11 (68.75%) patients on treatment and 5 (31.25%) patients not on treatment. The risk factors for stroke that were statistically significant in increasing score risk for all patients were: age > 65 (95% CI, -2.04– -1.29; p = 0.000), being female (95% CI, -1.36– -0.68; p = 0.000) hypertension (95% CI, -2.59– -1.37; p = 0.000), diabetes (95% CI, -2.10– -1.50; p = 0.000), CVD (95% CI, -2.07– -1.24; p=0.000), history of stroke or TIA (95% CI, -3.70– -2.03; p = 0.000), CHF or LVEF (95% CI, -2.28– - 0.91; p = 0.000). Conclusions: The risk of stroke in hemodialysis patients is significant according to the use of CHA2 DS2 -VASc score in Non-AFib hemodialysis patients shows supportive evidence of increased risk of stroke in those patients, which suggest the importance of close monitoring of patients with stroke risk factors by the nephrologist and the stroke team which will lead to the initiation of early prophylaxis in those patients.
160 Evaluation the Effect of Low Level Laser on Nanoparticles Containing Chemotherapy Drug Procedure in Prostate Cancer Cells in Vitro , Ehsan kamani*, Mohammad Reza Razzaghi, Shirin Farivar, Mohammad Hossein Ghazimoradi and Zahra Kamani
Prostate cancer is the second most common cancer after lung cancer in men. Chemotherapy is one of the common methods of treating prostate cancer that results in the destruction of cancer cells. The side effects of chemotherapy include head and eyelash loss, white blood cell counts, weak immune defenses, infections, pain, dry mouth and osteoporosis. The presence of toxic effects of chemotherapy drugs is one of the problems of treatment because these drugs often act nonspecifically. Over the past two decades, new drug delivery systems have been developed that have somewhat been able to Liposomes can be used as a biocompatible drug delivery system for carrying out chemotherapy drugs.
161 Rehabilitation Issues , Nick Schouten, BSW
Every human being on this planet wants to have a good life. Enough joy in life, someting to be proud of, to be loved by his or her parents; we want to be loved by our family. Maslow said: “Human life will never be understood unless its highest aspirations are taken into account. Growth, self-actualization, the striving toward health, the quest for identity and autonomy, the yearning for excellence (and other ways of phrasing the striving “upward”) must by now be accepted beyond question as a widespread and perhaps universal human tendency …” [1]. If we do not have a mother or father or siblings or even if we do not have fosterparents or lifeteachers in life that coach us, we want to be loved by the ones that can love us and we want to succeed in being happy in life. Some of us don’t know our parents that well anymore because we decided not to talk to them anymore for various reasons. From the day we are born until the day we are hopefully old and die we want to look back at our lives and be happy about what we will have experienced in life.
162 Short Term Effects of the Vaginal Administration of Gestrinone and Miodesin™ on Endometriosis Pain , Hugo Maia1 *, Wilson Saback2 and Elsimar M Coutinho3
Introduction: Gestrinone a 19 nor testosterone derivative with androgenic, anti-estrogenic and anti-progesterone properties was used either alone or associated with plant derived anti-inflammatory drugs to treat pain in deep endometriosis patients. Patient and Methods: In the present study Gestrinone was used alone or in combination with either a higher (500 mg) or a lower (170 mg) doses of Myodesin™ in order to treat pelvic pain in patients with deep endometriosis . In the higher dose group Miodesin™ was dispensed without Astaxanthin. Miodesin is the trade name for a herbal complex prepared by Fagron Brazil whose composition contains a mixture of plant extracts from an amazon tree Uncaria tomentosa together other plants. In the lower dose group (170 mg), on the other hand, a novel composition of Miodesin™ was tested that also contained H. pluviallis extract containing Astaxanthin. Forty patients with deep endometriosis and severe pain were enrolled for this study. Patients were divided into 3 groups according to treatment scheme. In Group A (n=11) they were treated with vaginal Gestrinone alone (2,5mg/g twice a week). In Group B (n=17) the patients received Gestrinone (2.5 mg/g twice a week) together with Miodesin™ (500 mg/3g daily)(Fagron Brazil). In Group C (n=12) the patients were treated with a daily dose of 1 mg/g of Gestrinone together with a lower dose of Miodesin™ 170 mg/g containing H pluvialis extract as described above . All medications were dispensed vaginally dissolved in Pentravan® (Fagron, Netherland). In group C only 1g of Pentravan® was necessary to dissolve 170 mg of the new composition of Miodesin™ containing H. pluvialis extract while in group B it was necessary to use 3g to solubilize the 500 mg of traditional Miodesin™. Results: In all 3 groups total pain scores reduced significantly after one month of treatment. However the post treatment scores were always significantly lower in patients who had used either the higher dose of Miodesin™ (Group B) or the new composition of Miodesin™ (Groups C) when compared to Gestrinone alone (Group A )(p<0.02). Conclusion: Although Miodesin™ was administered in a lower dose in group C the addiction of H.pluviallis extract standardized to contain Astaxanthin increased its efficacy to treat endometriosis pain when used together with Gestrinone. Miodesin™ is an inhibitor of NF-kappa-b activation while Astaxanthin is a carotenoid with potent antioxidant effects and their combined administration had a synergetic effect that allowed the reduction of the doses of Miodesin™ without compromising its efficacy.
163 Immediate Implants Loading by 4 Units Temporary Restoration: A Case Report , Faleh AL-Hojhouj1, 2, 3* and ArwaAlSayed4
Immediate implant placement is the placement of dental implant in the extraction socket immediately after extraction with no healing of bone or soft tissues. The timing of implant placement has increased the debate, while patients have become persistent in their desire to be treated in an efficient and expedient manner. When seeking a solution, they wish for safe and effective treatment that can be performed in the shortest possible time and with as little pain and discomfort as possible. Dental professionals with their expertise are addressing patients request as much as possible. Immediate implant placement and loading are valuable techniques for the clinician to call upon, but their skill and experience, as well as case selection, are all crucial elements to ensure successful long-term results [1]. The placement of implants immediately in fresh sockets with immediate loading is a well known treatment modality, but the practitioner has to follow a very strict protocol. This case report describes the detailed procedures of immediate implant placement with immediate loading for 2 – implants supporting 4 – units’ provisional restorations with 5 years follow-up.
164 Enhancing Patient Well-being: Apply Positive Psychology in Nursing Practice , Farida Bibi Mughal
Objective: Positive psychology is the emerging concept in the medical field and has shown the positive effects on one’s well-being. This paper highlights the application of PERMA model in nursing practice. Method: The model applied in the clinical area to access improvement in patient’s well-being. The concept of positive psychology’s applicability is discussed with the real life examples. Result: The PERMA model when applied yields a positive impact on patient’s health and overall well-being. Conclusion: The learning outcomes of this research will help the people in health care to understand the relationship between positive psychology and nursing practices for the wellbeing of patients. And if one tries to apply the concepts of positive psychology in clinical area then it can promote speedy recovery of the patients.
165 Curative Medical Treatment for Acute Appendicitis without Surgical Appendectomy (Jaber Maneuver) , Mustafa Jaber* and Diaa Eddin
Clinical and Pathological evaluation Acute abdomen with a mixture of modern radiographic images, diagnostic laboratory investigations and clinical observation such as (McBurney’s triangle manifestations with rebound tenderness) [1]. All these signs suggest firmly acute appendicitis with mucosal viral or bacterial infection within the narrow lumen of appendix leading to luminal obstruction, this leads to increase the mucosal secretions, and inflammatory exudates, which increase the intraluminal pressure, obstructed lymphatic drainage. Edema and mucosal ulceration develop with bacterial transudation to the submucosa. Resolution may occur at this point either spontaneously or in response to antibiotics.
166 Tuberculosis among Health Care Workers , Migena Brati*, Kushtrim Salihu and Erisa Kola
Tuberculosis (TB) is a bacterial disease caused by Mycobacterium Tuberculosis. It spreads form one person to another through air. When infected people with TB cough, sneeze or spit, they propel the TB germs in the air. A person needs to inhale only a few of these germs to be infected. Evidence of TB has been reported in human remains dated thousands of years. About one quarter of the world’s population has latent TB, which means TB bacteria have infected people but are not (yet) ill with the disease and therefore cannot transmit the disease. Tb occurs in specific risk groups such as immigrants, HIV-positive patients, homeless patients, prisoners, and alcoholics. Health care workers, who face frequent occupational exposure, are at particularly high risk. When a person develops active TB, the symptoms (such as cough, fever, night sweats or weight loss) may be latent for many months. This can lead to delays in seeking care and transmission of the bacteria to others. People with active TB can infect 10-15 other people through close contact over the course of the course of a year. Without treatment, 45% of HIV- negative people with TB on average and nearly all HIV- positive people with TB will die. Transmission of tuberculosis (TB) in health care settings to both patients and health care workers has been reported from virtually every country of the world, regardless of local TB incidence. We are presenting the case of an asymptomatic 28- year-old Caucasian male from Europe who initially was being screened for TB for pre-employment purposes.
167 Tuberculosis among Health Care Workers , Migena Brati*, Kushtrim Salihu and Erisa Kola
Tuberculosis (TB) is a bacterial disease caused by Mycobacterium Tuberculosis. It spreads form one person to another through air. When infected people with TB cough, sneeze or spit, they propel the TB germs in the air. A person needs to inhale only a few of these germs to be infected. Evidence of TB has been reported in human remains dated thousands of years. About one quarter of the world’s population has latent TB, which means TB bacteria have infected people but are not (yet) ill with the disease and therefore cannot transmit the disease. Tb occurs in specific risk groups such as immigrants, HIV-positive patients, homeless patients, prisoners, and alcoholics. Health care workers, who face frequent occupational exposure, are at particularly high risk. When a person develops active TB, the symptoms (such as cough, fever, night sweats or weight loss) may be latent for many months. This can lead to delays in seeking care and transmission of the bacteria to others. People with active TB can infect 10-15 other people through close contact over the course of the course of a year. Without treatment, 45% of HIV- negative people with TB on average and nearly all HIV- positive people with TB will die. Transmission of tuberculosis (TB) in health care settings to both patients and health care workers has been reported from virtually every country of the world, regardless of local TB incidence. We are presenting the case of an asymptomatic 28- year-old Caucasian male from Europe who initially was being screened for TB for pre-employment purposes.
168 Pharmacology, Pharmacognosy, Natural Medicine, and Medical Science , Reza rezaie khanghah
First of all, I found lots of medicine for lots of diseases like phlegm and sore throat and headache etc. I stated a Therapy for scrupulous and other kind of disease like this. Except disease and medical science and medicine and astronomy, I have some other research into/on other fields of study. I found how stars moves at constellation, they have two general movements, and in conclusion, I say some of my studies here. You drink water at stand up stance it can because you sweat a lot. My findings support my hypothesis. My hypothesis is can we have natural medicine instead of chemicals one? Does any disease have medicine? Can we success at our life? And other hypothesis that I explain it in manuscript. Most scrutinized literature was collected from different sources including PubMed. This database has been curetted using published methods for all most all pharmaceuticals. Required information for regular method development/validation such as IUPAC name, structure, solubility, chromatographic conditions, instrumentation information like HPLC, LCMS detection parameters, sample preparations, recovery details, limit of detection and limit of quantification, Tmax, Cmax etc., for routine application in BA/BE studies of pharmaceuticals was incorporated including official pharmacopeias information such as European Pharmacopeia, Japan Pharmacopeia and US Pharmacopeia. Database includes drug based bioanalytical methods covering most required fields and external database links of important drug portals such as drug bank, Rxlist, MEDLINE plus, KEGG Drug ID, KEGG Compound ID, Merck manual, PubChem compound ID, PubChem substance ID and USFDA. I use many studies and conducted my studies with lots of references that I said it at the end of my manuscript.
169 Mental-Growth Retardation, Microphthalmia, Microcornea, Iris and Uvea Colobomata, Transient Ocular Hypopigmentation, and Contralateral Optic Disc Colobomata, and Dilated Third Ventricle: A New Syndrome , Aamir Jalal Al Mosawi
There is a large number of dysmorphic mental-growth retardation syndromes associated with various combinations of low set ears, ocular abnormalities such as microphthalmia, microcornea, ocular hypopigmentation, and colobomatas of the iris, uvea, and optic disc. The aim of this paper is to report the novel occurrence of a new dysmorphic mental-growth retardation syndrome associated with asymmetric ocular abnormalities including microphthalmia, microcornea, iris and uvea colobomata, transient ocular hypopigmentation, and contralateral optic disc colobomata, and dilated third ventricle.
170 The Use of 0.2 Micron Filter for All Intravenous Fluids in Sheikh Khalifa Medical City Paediatric Intensive Care Unit Practice Change Project , Bha’a Aldeen Mohammad Fwwaz Khanfar*, Jolly George, Rosy Devassy, Manju Sebastian, Jeena Mathew, Princy Mathew, Saranya Chandran, Marianne Acacio, Litty Thomas, Lijo Thomas and Venda Pandurangan
The Aim of this paper is to determine if the use of inline filter (0.2 Micron filter) is an evidence based practice, wither it has any positive impact on Decreasing CLABSI (Central Line Associated Blood-Stream Infection), Removing Large Particles or Air from line thus at the end prevent phlebitis and air embolism. This paper is benchmarking similar institutions practice, reviewing hospital’s policy requirements in this matter, reviewing literatures related to this practice and providing a clue about the annual coast of the use of this filter in Sheikh Khalifa Medical City –Abu Dhabi PICU
171 Quality Improvement Project: Post-Implementation Evaluation of an electronic requesting system for diagnostic tests in George Eliot Hospital , Agathoklis Efthymiadis1 *, Manoj Srivastava3 , Sarah Mills2 , Frank Liggins2 , Ian Ogden2 , Jino Sebastian2 and Sid Singh2
In George Eliot hospital, pathology and radiology requests were traditionally made via paper. Paper forms can be lost, filled in and signed incorrectly, leading to delays in obtaining test results and compromising patient safety. Thus, a transition from paper requesting to an electronic requesting system for diagnostic tests was necessary. Such an electronic requesting system was initially launched in the Acute Medical Unit of George Eliot hospital. This enabled optimization of the electronic system in a controlled and small, but busy clinical environment. Once so optimized, this would facilitate a more successful roll out to the rest of the organization. The post implementation evaluation of the electronic requesting system was conducted using the Plan- Do- Study- Act cycle model for quality improvement. Business processes for both radiology and pathology were updated to ensure patient safety and improve workflow. The project team was only funded for the implementation phase and therefore human resources were limited to drive the post implementation phase of the project. Overall, the implementation of an electronic requesting system for diagnostic tests in George Eliot Hospital was safe. In addition, the quality of the diagnostic pathway improved because of better documentation and transparency. This increase in quality came at a cost of reduced time efficiency of clinical workflow. Generally, the post-implementation phase is neglected in the planning phase of any NHS Health IT projects and this has to be addressed.
172 Postpartum Ovarian Vein Thrombosis: Clinical Case , Ana Ribeiro1 *, Rafael Bras2 , Maria Lucia Moleiro2 , Antonio Braga2 and Jorge Braga2
Ovarian vein thrombosis (OVT) is a rare but potentially serious postpartum complication, which occurs in 0.05% to 0.18% of pregnancies and is diagnosed on the right side in 80% to 90% of the cases [1, 2]. As OVT can mimic acute abdomen it should be considered in the differential diagnosis of postpartum acute abdomen. We present a case of a 29-year-old female who presented a diffuse abdominal pain, fever and vomit on her third postpartum day. Her computed tomography demonstrated left ovarian vein repletion defect compatible with the presence of a thrombus. She was treated with enoxaparin and antibiotics, which lead to a resolution of the thrombus. Our case highlights the importance of prompt diagnosis and treatment of OVT in order to prevent morbidity and mortality.
173 Female Genital Mutilation in Sudan: Different Perspectives , Samia Mahdi Ahmed
Female genital mutilation (FGM) or female circumcision comprises all procedures that include partial or total removal of the external female genitalia, or other damage to the female genital organs for non-medical reasons. FGM is still widely practiced in Sudan; it is a cultural rather than religious practice. It has many complications especially for those who developed with disorders of sexual development. It has immediate complications like bleeding and long-term consequences (health and psychological). Thus, more efforts should be exerted to help in eradication of FGM; these could be through workshops, social media, and information media. Moreover, psychological assessment and treatment could be offered to those victims with female genital mutilation.
174 Hemangioma of the Oral Cavity; Un Unusual Presentation , Ashwag Mohammed Alwagdani
Hemangioma is a developmental vascular malformation capillaries that do not involute but persist and grow very slowly over years. The diagnosis of hemangiomas is mainly based on clinical evaluation. They tend to occur in the oral cavity, on the tongue, buccal mucosa and labial mucosa. Isolated hemangiomas in the tonsillar tissue is a rare occurrence. In this we report a case of adult tonsillar hemangioma of left side associated with recurrent tonsillitis. She was effectively managed surgically with preoperative embolization.
175 Psychotic Symptoms after Long Term Using Diazepam and Alprazolam Medication; Depend Syndrome of Alprazolam , Vjollca Nebih Ramiqi
Alprazolam and Diazepam two most prescribed benzodiazepine in the Kosovo have been potential for addictive use. Both drugs are rapidly absorbed and enter the brain tissue rapidly, leading to reinforcement. Alprazolam has a short half – life that may lead to more withdrawal symptoms than Diazepam. In experimental conditions, they are among the most reinforcing benzodiazepines. Each causes a withdrawal syndrome, but Alprazolam withdrawal may be more severe and may occur after a shorter period of use. Adverse effects from their use are rare, yet negative consequences may be seen with some regularly. Alprazolam deserves special caution, because of its relative newness great popularity-reinforcing capabilities relatively sense withdrawal syndrome, and reports of addiction and negative consequences of use.
176 Analysis of the Level of Knowledge on the Diet in Patient Diabetic Geriatrics , Jesús Cuéllar Alvarez1 *, Alejandro Delgado Pérez2 and Marilin Machado Aguero3
Background: the diabetic in bigger adults is necessary to prevent illness from the sciences of the health. Objective: to analyze of the level of knowledge on the diet in patient diabetic geriatrics. Methods: was carried out a study decriptivo, restrospective, with a sample composed by 18 old patients, belonging of the Policlinic “José Ramón León Acosta. It gathers it of the data was carried out through the empiric method as the questionnaire and for the analysis of the data the statistical calculation was used. Results: the state of individual health of this group prevailed as for knowledge that will allow them to modify its lifestyle and in turn an aging very happened to the minimum of limitations. Conclusions: the difficulties are focused in the sistematic of the development psicosocial and to prevent factors normative for the sanitary and social structure in bigger adults.
177 Physician Burnout Quality of Life/ Wellness Resource Pilot Program , Felicia Harvey
Burnout is a syndrome of emotional exhaustion, depersonalization, and a sense of low personal accomplishment that leads to decreased effectiveness at work [1]. Despite the efforts to combat burnout, the number of U.S. physicians who experience burnout rose from 45 percent to over 50 percent between 2011 and 2014. The purpose of this quality improvement evidence-based capstone project was to determine whether a physician wellness pilot program could reduce and or eliminate burnout and stress for practicing physicians at an acute care healthcare institution in the Chicago metropolitan area. The capstone project consisted of a pre-intervention survey, an intervention and a post intervention survey. The participants targeted for this evidence-based project were practicing physicians in Illinois that span across all specialty groups. The physician burnout wellness pilot program was implemented during a two-week period of time during which participants were provided with resources to reduce and or eliminate symptoms of burnout. The implementation of the physician wellness pilot program capstone project showed the physicians at this organization were less stressed and more satisfied with their job at (0.555) percent compared to pre intervention survey results that faired (0.77) and that of the national average of (0.80). Additionally, the post intervention survey results showed the physicians at this organization are experiencing a lower level of burnout (0.44) percent compared to pre intervention survey results that faired (0.53), but a higher level of burnout compared to the national average (0.29). Physician burnout is an epidemic that requires immediate attention because it not only effects the physicians, but it effects the healthcare system. As such, regardless of the specialty and demographics of the physicians, organizations and physicians alike must do their part in assessing if burnout exists. The findings showed the importance of physicians being able to recognize the warning signs of burnout, encourage them to seek help when they are stressed, and take active steps towards ridding or reducing burnout. The findings were compatible with evidence-based research that supports building physician resilience by way of the development of a wellness program. There is an alarmingly high prevalence of burnout amongst the working class in the United States. Strikingly it is even greater for physicians, particularly the front-line practitioner’s family medicine, general internal medicine and emergency medicine [2]. However, in recent years, the effect of burnout became even more evident when the increasing demand for doctors, coupled with the rising rates of physician burnout, threatened many organizations abilities to consistently deliver quality care and maintain a healthy physician workforce [3]. Consequently, burnout started to negatively impact health outcomes for both physicians and the patients they serve. Since burnout affects doctors in both individual practices and hospitals across the county, it is now viewed as a nationwide problem [4]. According to West, Dyrbye, Liselotte & Shanafelt, rates of burnout symptoms associated with adverse effects on patients, the healthcare workforce, costs, and physician health exceed 50% in studies of both physicians-in-training and practicing physicians [5]. A survey presented by Medscape Physician Lifestyle in 2015 reported that the rate of burnout has increased by 46 percent, which is double the rate of burnout in 2013 [6]. This data shows that the physician burnout rate is on the rise and has increased significantly with every passing year [6].
178 School Bulling in Saudi Arabia , Saad Omar Al-Khateeb
School bullying is recognized as a global problem with serious academic, physical, social, and psychiatric consequences. The importance of prevention of these phenomena in the psychosocial development of our future generation is crucial.
179 The Health Factors Affecting the Longevity of Elderly Living in the Community: Analysis with SOC and QOL , Tomoko Matsunaga
Japan has an aging society. Antonovsky has discussed the possibility that humans lead an energy abundant life, and created the sense of coherence (SOC) test, which consist of 29 items. This time, focusing on the elderly living in the community, we examined their SOC and QOL as well as cognitive and behavioral characteristics such as health factors affecting the longevity of elderly living in the community. Using a shorter 13 items SOC test created by Prof. Yamazaki of Tokyo Uni. Using the 40 items QOL test created by Dr. Mandai of Japanese Society of Quality of life Research. Clarification of the behaviors of elderly living in the community and research the correlation between QOL and SOC. The sample consisted of residents who showed minor dementia and could communicate by conversation. Cognitive, behavioral and life characteristics of elderly living in the community were analyzed. We extracted a total of 56 cases, they were females .It was a coefficient alpha of 0.806. This shows significantly higher levels of SOC were seen in subjects in the elderly living in the community. Upon researching the levels of QOL and SOC in the elderly living in the area. It was discovered that subjects with high levels of QOL often showed high levels of SOC. Subject in the elderly living in the community kept high levels of QOL, high ability to deal with stress, high positivity, and high ability to overcome the various difficulties in their lives.
180 The Health Factors Affecting the Longevity of Elderly Living in the Community: Analysis with SOC and QOL , Tomoko Matsunaga
Japan has an aging society. Antonovsky has discussed the possibility that humans lead an energy abundant life, and created the sense of coherence (SOC) test, which consist of 29 items. This time, focusing on the elderly living in the community, we examined their SOC and QOL as well as cognitive and behavioral characteristics such as health factors affecting the longevity of elderly living in the community. Using a shorter 13 items SOC test created by Prof. Yamazaki of Tokyo Uni. Using the 40 items QOL test created by Dr. Mandai of Japanese Society of Quality of life Research. Clarification of the behaviors of elderly living in the community and research the correlation between QOL and SOC. The sample consisted of residents who showed minor dementia and could communicate by conversation. Cognitive, behavioral and life characteristics of elderly living in the community were analyzed. We extracted a total of 56 cases, they were females .It was a coefficient alpha of 0.806. This shows significantly higher levels of SOC were seen in subjects in the elderly living in the community. Upon researching the levels of QOL and SOC in the elderly living in the area. It was discovered that subjects with high levels of QOL often showed high levels of SOC. Subject in the elderly living in the community kept high levels of QOL, high ability to deal with stress, high positivity, and high ability to overcome the various difficulties in their lives.
181 Speak Your Mind , Xu Chen
Previous trauma can be a risk factor for suicide behavior. Therefore, suicide prevention can be important for traumatized or oppressed people. In the current world, democracy and freedom are hot topics, while in some totalitarian countries; people take it to street to express their thoughts. Currently in Hong Kong, there are many people mysteriously die, and the causes of death were usually ruled as suicide. The question is, is speaking out a risk factor for suicide? In this article, this author will explore methods of suicide prevention and how speaking out affects people’s mental health.
182 Intervention in the Hospitalized Acute Patient with Cerebral Damage -DACER Model , Lorena Rodríguez Clemente1 , Miriam Suarez Castro2 , Marisa Martín Bernal3 , Sara Moya Millan4 * and Natalia Rodríguez Clemente5
The next article presents a type of intervention in patients who, after suffering Brain Damage, are hospitalized -DACER MODEL-. This model is the result of scientific evidence and clinical experience. The patient should experience as soon as possible, motor, sensory, cognitive and behavioral patterns, suitable to promote as normalized brain reorganization as possible. The model is structured in three fundamental premises, the first is early intervention, work the sooner the better with the patient. Global, unifying the entire environment (family and health workers) in the specific intervention of each affected person. And intensive, creating a stimulating environment for the patient to receive adequate care throughout the day. DACER MODEL consist of implementing performances in the phase in which the patient is hospitalized, to minimize future neurological and organic sequelae. To achieve this objective, the model includes three key actions: 1) Training and support for relatives and environment of the affected through the School of Families, a training action aimed at families, which is carried out in the hospital itself. 2) Specialization and support to health personnel who directly care for the patient with brain damage and 3) Early intervention of a multidisciplinary team specialized in neurorehabilitation, including medical professionals, neuropsychology, speech therapy, occupational therapy and physical therapy.
183 Transvaginal Cystocele and Rectocele Repair, Using a New Very Simple Suturing DE-ALWIS TECHNIQUE , Alwis Seneviratne
The purpose of this exercise is to introduce a very simple new technique of epithelial closure, in this case the vaginal wall. The new technique (the de Alwis method) has been used by us for decades. Proplapse of the uterus or several pelvic organs has been a problem for centuries and a most embarrassing experience for many. Different surgical and nonsurgical measures have been performed over centuries. The de Alwis method of vaginal epithelial wall approximation is shown to be cosmetically most accepted in our unit and has had no adhesions nor granulation tissue formation. Purpose: A different technique of vaginal repair with the de Alwis suturing technique of epithelium approximation, over a twenty-year period. Method: This is a retrospective review of 41 patients who underwent vaginal repairs with the de Alwis method suturing technique, for over a decade. In many, the Baden-Walker halfway classification was used before and during follow-up. Four elderly frail patients, with vaginal vault prolapsed and who were not sexually active, opted for Le Forts’ colpocleisis. Transvaginal vaginal repair followed by vaginal epithelial closure using the de Alwis surgical technique, had no granulation tissue formation, and was cosmetically satisfying.
184 Laparoscopic Entry via the DE-ALWIS METHOD , Alwis Seneviratne
Despite the rapid advances in laparoscopic surgery in the past 2 decades the initial entry still accounts for approximately 40% to 50% of laparoscopic complications and should be considered the most dangerous step of a laparoscopic procedure. In this review, the authors share a technique for initial umbilical entry, and provide alternative entry sites in cases where umbilical entry is comtraindicated. Rev Obstet Gynecol. 2009; 2(3):193-198 doi; 10.3909/riog0088. Laparoscopy for diagnostic purposes to a modality for minor and major surgical procedures, had been advancing rapidly over the last 3 decades. The initial entry still accounts for about 40-50% of laparoscopic complications and is the most dangerous step of this surgical procedure [1, 2]. Laparoscopic entry using a veres needle followed by a blind insertion of a sharp trocar is the common method used by gynaecologists [3-5]. There is no concensious as to which laparascopic entry is superior and the common recommendation is use the entry methods with which the surgeons feel comfortable [6]. Umbilical entry is not suitable in certain instances, such as previous midline abdominal incision, previous umbilical hernia surgery, previous pelvic peritonitis and so forth, due to the presence of pelvic adhesions. An open surgery does not guarantee against a visceral injury [7].
185 Diagnosis of Cystocele by Clinical Examination a New Technique, the De Alwis Positions , Alwis Seneviratne
Objectives: To diagnose the cystocele and compare with the standard methods of the past. Methods: Over a period of ten years, the cystocele was examined in the supine position, the left lateral position and the De Alwis positions, purely as clinical methods of examination. Conclusion: The findings were that the supine and left lateral positions, displayed the cystocele adequately, but the De Alwis technique gave a better assessment of the descent of the bladder, the cervix and the rectocele, that could be measured in relation to the inferior border of the pubic bone, instead of the hymenal ring which was mobile and not suitable to be considered for accurate measurements.
186 Is it time to rethink the diagnosis of Morton’s Neuroma? , Reuven Lexier1 * and Amanda Weston2
There is currently little consensus on the definition and correct diagnosis of Morton’s Neuroma. The literature offers multiple treatment options. Presently, a major concern is incorrectly or over-diagnosing of the condition. The objective of this paper is to examine the likelihood of an incorrect diagnosis of patients who receive treatment for Morton’s Neuroma and compare to the rates of diagnosis and treatments demonstrated in the academic literature. A retrospective case cohort review was conducted examining patient clinical records over a five-year period from a single clinical practice. The data collected pertained to who and how the diagnosis of Morton’s Neuroma was made, the treatments performed and their outcomes. Our review included 30 patients (mostly women) presenting on the right foot. A diagnosis of Morton’s Neuroma was suggested by a General Practitioner in majority of the cases, followed by Radiologists, Orthopaedic Surgeons and Vascular Surgeons respectively. The chief concern was the frequent inaccurate diagnosis of Morton’s Neuroma in this patient cohort. The uncertainties surrounding this condition result in delayed diagnosis and treatment, unnecessary expenditure of health care funds, and deleteriously affects quality of life in patients.
187 Cutaneous Intravascular/Angiotropic Lymphoma Following a Septic Shock Episode. Case Report and Literature Review , Jorida Memini1 *, Alert Xhaja2 , Erisa Kola3 , Ermira Vasili4 and Iris Ciraku5
Angiotropic lymphoma is a rare aggressive disease characterized by exclusive or predominant accumulation of malignant lymphoid cells within the lumen of small arteries, veins and capillaries. We describe a 74-year-old female patient who presented at the department of dermatology with widespread cutaneous telangiectasia and generalized edema. No neurologic symptoms were present during the course of these clinical manifestations. After close-up examination and further laboratory and radiological studies, the final diagnosis of cutaneous intravascular lymphoma was made in the histopathological report. Immunochemistry evaluation confirmed a B-cell subtype. Diagnosis of this rare disease, in most cases, is achieved by surgical biopsy. The biopsy and immunohistochemistry have increased the chances of an ante mortem diagnosis. Afterward, the patient was referred to Hematologic Department to follow the combined chemotherapy treatment, which resulted to be successful, and the cutaneous lesions began to disappear
188 Accidental Ingestion of Dental Bur during Dental Extraction , Afef Amri*, Dorsaf Touil, Yassine Oueslati, Eya Moussaoui, Lamia Oualha, Nabiha Douki
A 24-year-old female patient was admitted to the dental department of the university hospital Sahloul in Sousse in November 2019 for wisdom tooth extraction. The patient had chronic kidney failure and was on peritoneal dialysis. During the extraction, the patient had accidentally ingested the dental bur (Zekrya MANI®): the bur popped out from the airotor and fell into the patient’s throat. There were no immediate symptoms such as coughing, drooling, dyspnoea or any other symptom of respiratory distress. The patient was immediately taken to the department of radiology for abdominal radiographic investigation. She was advised to be on a diet rich of fibers (especially potato) which was impossible for our patient. In fact, potato is a main source of potassium and when kidneys fail, they can no longer remove excess potassium, which leads to hyperkalemia. Some of the effects of hyperkalemia are nausea, weakness, numbness and slow pulse.
189 Rituximab Use in Nephrotic Syndrome , Yasir Sharba*, Sadiqe Jabar AL-Muhana and Rafal Riayadh AL-Dikeli
Background: Nephrotic syndrome may be caused by primary (idiopathic) renal disease or by a variety of secondary causes. Patients present with marked edema, proteinuria, hypoalbuminemia, and often hyperlipidemia. Treatment of most patients should include fluid and sodium restriction, oral or intravenous diuretics, and angiotensin-converting enzyme inhibitors. Adults with nephrotic syndrome may benefit from corticosteroid treatment. The treatment of patients with the steroid-resistant nephrotic syndrome (SRNS) and steroid-dependent nephrotic syndrome (SDNS) is challenging. On the basis of suggestions that B lymphocytes are crucial in the pathogenesis of the nephrotic syndrome, rituximab (a monoclonal antibody against CD20 antigen) is used in treatment of these patients. Aim of study: To evaluate the role of rituximaband mycophenolic acid in treatment of patientswith steroid-resistant (SRNS) and steroid-dependent nephrotic syndrome (SDNS), whom not respond or relapse after calcineurin inhibitor (CNI) (tacrolimus or cyclosporine) had been used. Patients and methods: Case series study was done between 2012 - 2015 in AL-Sadder Teaching Hospital Nephrology Center and record 40 patients with different age groups, males and females with different histopathological types (Minimal Change Glomerulonephritis, Focal Segmental Glomerulosclerosis, Mesengeo Prolifrative Glomerulonephritis). These patients were taking prednisilone and\or calcineurin inhibitor (tacrolimus “prograf”) or (cyclosporine “sandimmune”), and they get either Steroid Dependent Nephrotic Syndrome or Steroid Resistant Nephrotic Syndrome with frequent admission more than four time per year. To these patients we start rituximab intravenous infusion monthly for at least six months with the use of steroid and mycophenolate mofetil during these six months. The patients followed up for 3-12 months after initiation of rituximab by different investigations and the patients were classified according to their response into complete, partial and no response. After one year stop rituximab treatment, follow the patients clinically and by investigations for (1-2) years to determine which patients get relapse. Results: Majority (80%) of patients with nephrotic syndrome who had good response to rituximab were younger age group < 15 years. Better response to rituximab associated with Minimal Change Glomerulonephritis. There was significant reduction in blood urea, serum creatinine, urine (protein/creatinine) ratio and serum cholesterol. Serum albumin was significant elevated. Response to rituximab was not significantly associated with gender or steroid response. Majority of patients with good response not relapse and need more time for follow up. Relapsing after stopping rituximab not significantly associated with age, gender, histopathological type and steroid response. Conclusion: Rituximab and mycophenolate mofetil used in steroid-resistant nephrotic syndrome to get ride from side effects of calcineurine inhibitor (tacrolimus or cyclosporine). Rituximab and mycophenolate mofetil used in steroid-dependent nephrotic syndrome after calcineurine inhibitorto get ride from side effects of steroid. Improvement in renal function is result from stopping of calcineurine inhibitor (nephrotoxic drugs) and/or from rituximab and mycophenolate mofetil. Cost of rituximab is less than the cost that needed if the patients had frequent admissions to the hospital or developed renal failure and ended with dialysis.
190 Toxicology and Clinical Manifestation of Arsenicosis: An Evaluation , Mohammad A Hye
Arsenicosis is an adverse health condition due to prolong ingestion of arsenic contaminated water. It is most prevalent in Bangladesh. More than 67 million people in Bangladesh are exposed to 0.05 mg/ liter or above of arsenic in their drinking water and it is now considering a biggest crisis in health and social sector in the modern world. Arsenicosis affects almost all the vital system of the body. Skin involvement is the earliest and commonest feature. Major dermatological manifestations are melanosis, keratosis and skin malignancies. Diagnosis is usually done by history, clinical feature and laboratory analysis. In this article, author describes the extent of arsenicosis in Bangladesh and emphasizes dermatological manifestations of the disease.
191 Co-existence of Down Syndrome and Alopecia Areata: An Evaluation of Its Treatment with Prednisolone in Two Cases , Mohammad A Hye*
Down syndrome (DS) is the most common congenital abnormality affecting numerous organs including skin and is associated with an increased incidence of alopecia areata (AA). DS is an extensively researched condition but AA seldom received appropriate attention. AA in DS is very refractory to treatment and there are only few relevant published data are available in medical literature. Two cases of alopecia areata associated with Down syndrome are presented here. These patients were treated with a short course of prednisolone; a good result was observed in one case but that was unsatisfactory in another case. The disease relapses in both cases within few months of treatment.
192 Ischemic stroke in an elderly patient on apixaban , Patrick Viet-Quoc Nguyen1,2*, Laverdure Simon3
Mr. LPH, an 86 year old patient taking warfarin for atrial fibrillation (AF) is admitted for a vertebral fracture. His calculated CHADSs score was of 6. A suboptimal control of diabetes was detected. Metformin and glyburide were increased. Four days after discharge, Mr. LPH was readmitted due to diarrhea and hyperglycemia. Metformin was discontinued. Glyburide dose was adjusted. INR dosage results fluctuated during hospital stay over and under therapeutic values. Warfarin was discontinued and apixaban 2.5 mg twice daily was started. Mr. LPH was later admitted for a pulmonary severe sepsis. His infection was complicated by two AF episodes. After the last episode, Mr. LPH presented dysarthria, facial asymmetry and left hemiparesis. On the cerebral scan, we observed a right Sylvian artery stroke. Conclusion: In this case, the 2.5 mg apixaban dose was used and may explain the stroke. It occurred after two consecutive AF episodes making it the most likely cause. The choice of the low drug dosage may have been in response to caution and patient frailty. The patient was stable on warfarin for the past 14 years and the fluctuating INR episode can be explained by drug interaction. Glyburide may enhance the anticoagulation effect of warfarin.
193 Role of Low Dose Intravenous Immunoglobulin in IVF Failure - A Retrospective Analysis , Bhavana Singla*, Kaberi Banerjee and Shweta
Background: In developing countries the number of in vitro fertilization (IVF) attempts is often limited by the high costs of the procedure and relatively low success rates. In such a setup we have tried to evaluate the effect of low dose intravenous immunoglobulins (IVIg) administered to patients who have had previous failed IVF outcomes. Bearing in mind that the inherent fecundity of Indian population is higher and thus a lower dose of IVIg may suffice to give positive outcomes at an affordable price, in this manner providing them with the possibility of affording more attempts if required. Objective: To evaluate the role of low dose intravenous immunoglobulin in IVF failure. Design: Retrospective analysis Materials and methods: This is a retrospective study beginning from 1st January 2014 till 31st December 2014. During this period, 124 patients with two or more failed IVF cycles were included. The controlled ovarian stimulation was started on cycle day 2 using gonadotropins (225 - 450 iu daily) and GNRH antagonist was added on the day when follicle reached 13 -14 mm. When follicles reached 18mm, transvaginal ultrasound guided oocyte aspiration was performed within 36 hours of the hcg trigger. On the ovum pick up day, 5 grams IVIg was administered to the patient as a slow infusion. Embryo transfer was done on day 2 or 3. Serum beta hcg was done 14 days after the embryo transfer and pregnancy rate and clinical pregnancy were evaluated. Results: The total pregnancy rate was 46% (57/124) and clinical pregnancy rate was 42.7% (53/124). Conclusion: Our study concluded that low dose IVIg may play a significant role in improving pregnancy rates in women with previous failed IVF attempts.
194 Eyes can’t See What the Mind doesn’t know - A case of Pneumothorax Complicating Clavicle Fracture , Ahmed I¹, ³*, Niaz Z², Kassem W³ and Nabeel M³
Pneoumothorax is an infrequent but serious complication of clavicular fractures. The importance of its prompt recognition and management cannot be overstated. There have been few cases reported in medical literature (English+ Non-English) but all those patients had respiratory signs or symptoms at presentation. We hereby report a case of isolated clavicular fracture associated with pneumothorax where patient had no respiratory symptoms at the time of presentation and diagnosis was missed. This case highlights that clinical signs may be subtle initially, when attention is focused on obvious bony disruption. We advocate obtaining a routine chest x-ray in all patients with displaced clavicular fracture regardless of respiratory status.
195 Relapses and Recurrent Chronic Bacteric Prostatitis – Biofilm Related, a Case Report , Luisetto M1 *, BehzadNili-Ahmadabad2 and Ghulam RasoolMashori3
This case report we like to introduce the problem involved in relapses in chronic bacterial prostatitis under also a specific clinical pharmacist and medicinal chemistry approach [1-4]. We describe a single case related to patient XY, 50 years old, male, diabetic tipe II, with a long time chronic prostatic disease often treated in the same way: Using oral antimicrobials (fluorochinolons, macrolides, and other) finasteride, serenoa, fans, local steroid but with systematic relapses.
196 History and Physiology of Plasmatic Growth Factors in Regenerative Medicine , Alcaraz Rubio Jesús*
There is no doubt that the use of plasma growth factors, within what is known as regenerative medicine, is emerging as a new medical discipline with a lot of clinical applications. Since its inception in use in sports medicine and dental implants in the mid-80s, gradually it has expanded its field of use in clinical specialties. More and more data on the physiology of angiotrope, immunomodulatory and cellular trophic power are known every day. Both the growth factors present in platelets and leukocytes produce on the cellular biological cycle, intervening in the processes of duplication, differentiation and apoptosis such as biochemical signals in the form of cytokine or chemokine cascades that intervene in the activation of these phenomena, through inflammation or ischemia, as well as the interrelationship between themNotwithstanding the great offer of existing indications and duplication of procedures for obtaining, which surpasses the scientific production capacity on this subject, that is questioning a biotechnology that well used in the near future will help improve the quality of life of the patients , optimizing those medical indications where it really is useful.
197 Clinical Significance of Tachycardia in Cystic Fibrosis Patients: A Case Report , Khalid Abou Farha*
Background: Post-bronchodilator evaluation of pulmonary function and collection of expectorated sputum samples are commonly used tests in cystic fibrosis (CF) clinical trials. β2 adrenergic receptor agonists, such as salbutamol, are used for this purpose.Supraventricular tachycardia is a known dose-related side effect of inhaled salbutamol. Under normal breathing conditions, CF patients have been found to be tachycardiac compared to healthy subjects. In addition, mutation in the cardiac CF transmembrane conductance regulatorgene may result in (subclinical) myocardial dysfunction and a deficiency in ischaemic preconditioning, resulting in an increased risk for ischemic heart disease in the CF patient. Nevertheless, the impact of β2agonists on the CF- associated tachycardia is often an ignored safety parameter in CF clinical trials. Case presentation: A 21 year old CF female patient received an inhalation dose of 400ug salbutamol, in the context of a clinical trial, to perform post-bronchodilator pulmonary function tests and collect spontaneously expectorated sputum. The patient’s cardiac electrical activities were monitored before and after salbutamol inhalation. The prebronchodilator (baseline) recording demonstrated large fluctuation in heart rate coupled with short episodes of sinus tachycardia. Post salbutamol administration, the tachycardia increased in rate and was associated with dynamic ST-T segment changes including flattening of the T wave and ST segment depression in at least 2 adjacent limb leads, ECG features suggestive of myocardial ischemia. Approximately 4 hours post salbutamol administration, heart rate and ST- T segment abnormalities returned to baseline morphology. Conclusion: CF patients might have tachycardia as part of their disease natural history. The presence of continuous or fluctuating tachycardia should be verified in this group of patients. Administration of inhalation β2 agonists to tachycardiac CF patients should be considered with caution. This may entail individualized dose adjustment and telemetry monitoring of patients’ cardiac electrical activity. This helps early detection and facilitates timely medical management of any emerged cardiovascular adverse effects such as myocardial ischemia in this medically fragile group of patients, particularly those with subclinical myocardial pathology.
198 Mini-Invasive Treatment for Cellulite Blemishes: 15 Months of Experience , Roberto Dell’Avanzato*, L’Albereta Relais and Chateaux
Introduction: In October 2016 I started, as one of the first in Europe, my experience with a new procedure that represents the only FDA-cleared minimally invasive treatment clinically proven to improve the cellulite blemishes for nearly four years in only one session. Materials and Methods: We report our experience after 15 months in 50 patients (48F; 2M) with cellulite treated in a single session. Follow-up were scheduled after 7 days (T7), 14 days (T14), 30 days (T30), 90 days (T90) and 180 days (T150) for all the 50 patients; 13 patients (1M) had a medical check at 12 months and 3 patients (1M) at 15 months. Outcome measures included subject photographs, Cellulite Severity Scale (CSS) and Global Aesthetic Improvement Scale (GAIS) assessment. Patient satisfaction and pain rating were also recorded. The treatment takes 45-60 minutes. Cellulite dimples are marked and the device is applied to stretch and stabilize tissue in a vacuum chamber, while local anesthesia is delivered. Then, a precise minimally-invasive subcutaneous release of the connective bands (TS-GS: stabilized-guided subcision) is performed with a micro-blade, without cuts or incisions. We have safely treated 6 to 45 sites in one session. After treatment, a light compression is applied and patients are able to return promptly to their daily life. Results: The procedure treated successfully the primary structural cause of cellulite blemishes in all the 50 patients. Patient satisfaction was 87% at T90 in 50 patients (48F; 2M), 95% at T180 in 50 patients, 97% at 12 months in 13 patients (1M) and 100% at 15 months in 3 patients (1M). Transient treatment-related adverse events were mild in severity and the most common side effects reported were soreness and bruising. Among 50 patients, 95% had bruising at T7, 23% at T14 and no patient had bruising at T30. Soreness is reported in 100% of patients at T7, 19% at T14, 4% at T30 and 0% at T90. Global Aesthetic Improvement Scale (GAIS) and Visual Analog Scale (VAS) are also reported. Conclusions: This revolutionary FDA-cleared procedure for the cellulite puckering, combines a proven approach with an innovative technology to treat the primary structural cause of cellulite blemishes in posterior thighs and buttocks. This study confirms his safety, and efficacy with vacuum-assisted precise tissue release for the treatment of cellulite, which is also strengthened by patients satisfaction.
199 The Role of Attachment in Shaping Core Beliefs and Interactions in Therapy: A Case Study , Lawrence Tan Kok Kah*
This paper explores a case study (which is , in reality, a composite of several real cases to protect client confidentiality) through the lens of Brennan, Clark & Shaver’s (1998) work on the dimensional model of attachment and Marmarosh, Markin & Spiegel’s (2013) work on attachment styles of individuals playing out in group work [1,2]. It is especially interesting to retrospectively re-look at the case, explore new possibilities and hypothesise different outcomes as a result. X is a 32/ Male/ Chinese referred to me by the hospital psychiatrist one year ago for the management of generalized anxiety disorder and major depressive disorder. X was first presented to the hospital in 2013 for the management of his benzodiazepine use and was placed on a long-term therapeutic and monitored dose of dizapam by the psychiatrist subsequently. In my intake interview with X, he disclosed that his mother was both verbally and physically abusive towards him when he was a young child while his father was often absent in his life. X elaborated that his father was a fairly successful businessman at that time and would often attempt to compensate for his absence by showering him with expensive gifts and being extra permissive with him whenever he was around. X mentioned that while he appreciated the presence of his father, he also felt resentful towards him deep inside. X was angry with his father for not protecting him and allowing the “atrocities” to continue (father stayed out of the situation between X and his mother). A part of him believed that the “niceness” of his father had a selfish motive underneath; so that he would not have to feel so guilty about being absent. X remembered mother being frustrated all the time and nothing he did would please her. His grades and subsequent careers he ventured into were never good enough for her and the focus was often on his shortcomings rather than his strength. X added that he grew up believing that the world is harsh and critical and people would either put him down and reject him or be nice to him because they had a secondary agenda. As a result, X often talked about his disdain for people around him and how they are likely to “reject and abandon him” after that have completely sucked the life out of him. As a result, he lived his adult life “as if” this was always going to happen to him, demonstrated by his tendencies to be, outwardly giving and accommodating in his relationships, often to the point of subjugating his needs, being hypersensitive to signs of rejection and lack of reciprocation to his giving and resentful over his partners not “playing their part” when he expected them to meet his emotional needs. He reported a pervasive pattern of being perceived as overly-clingy, calculative and hard to please by a number of partners he used to be in a romantic relationship with. He also talks about how this has reinforced his world view that people are generally cold, unappreciative and impossible to satisfy, just like his mother. If they were to be nice to him for any given periods, it must be because they wanted “something” from him and once he “fell into their trap”, they would eventually “betray” and “leave him high and dry”, just like his father. According to X, his anxiety and depression became unmanageable when his last girlfriend left him 3 years ago. X says that he became increasingly insecure and suspicious about people around him and these fears eventually transcended into other areas of his life, which resulted in him becoming increasingly isolated, lonely and depressed. He oscillates between talking about the yearning for connection and feeling fed up with not getting what he wants and swinging onto the other extreme of isolating himself and “running away” when people in his life attempted to get close to him because “they are going to hurt him anyway”.
200 GxP/GMP and its Consequences for Documentation and Information Technology Systems , Eleonora Babayants*
Documentation is a critical tool for ensuring GxP/GMP compliance. In the regulated environment which must be GxP/ GMP compliant, document control is the cornerstone of the quality system. It is so important that if an external audit identifies deficiencies in the document control system, the entire organization can be shut down. There are also GMP requirements for information technology. For a drug to be produced in a GxP/GMP compliant manner, some specific information technology practices must be followed. Computer systems involved in the development, manufacture, and sale of regulated product must meet certain requirements. Change control within quality management systems (QMS) and information technology (IT) systems is a formal process used to ensure that changes to a product or system are introduced in a controlled and coordinated manner. In the regulated industries, manufactures are required to use a change control procedure. In this article, the connection between GxP/GMP and document control is discussed. Details of document control procedures and the role of Quality Assurance in the documentation systems are described. GMP requirements for information technology and how computer systems including documentation management systems must meet GxP/ GMP requirements are reviewed. There is also a review of change control procedure and how it should be used in GxP/GMP environment.
201 A Case of Neurological Manifestations Accompanying Generalized Tuberculosis , Najada Como1 , Esmeralda Meta1 , Drini Dobi2 , Dhimiter Kraja1 and Arjan Harxhi1
Tuberculosis (TB), a multisystemic disease with variety presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide [1]. A 23-year-old, male, is admitted to the Infectious diseases clinic “Mother Theresa” hospital in Tirana, after one year intermittent FUO and exudative pleural effusion treated first in Albania and then Italy. He had fever, back pain, muscular weakness, difficulty walking, urinary retention. In chest x ray radiological examination, CT scan of thorax and MRI of spinal cord are seen military form lesions, and vertebral destructions that raise suspicion of a possible pulmonary and extra pulmonary TB. The patient’s condition is randomly assigned to the beginning of antitubercular therapy (ATT), manifesting disturbance of conscience and coma. LCS results with 50 cells / mm3 and the CT scan of head detects hydrocephalus; funduscopia detected papilledema on 1st stage; which mean that the case is complicated with TB meningitis. The patient passes to the intensive care unit where ATT tapered cortisone, CNS diuretics and supportive therapy. After a week the patient comes out of the coma, begins his clinical improvement, but the neurological consequences of hydrocephaly and paraplegia become clearer. Two months later the patient was better clinically, walking with support .Peripheral neurological deficits persisted up to 10 months after leaving the hospital but with progressive improvement. The best ways to reduce mortality and morbidity associated with TBM are the timely diagnosis.
202 Neurobiology of increase in violence in Syria and role of online medical care in its reduction , Mahsa Houshdar*
Causes of increase in violence in a named society, apart from socio-political and economic reasons, will be examined in this study. One of the most important reasons for increase in levels of hostility in a society is prevalence of psychological depression among population, which can lead to violent behavior and cause physical harm to one self or others, increase in suicidal tendencies and destruction of property. Increase and prevalence of internal medical diseases are one of the main causes of increase in depression, among which diabetes, hypothyroidism, vitamin D, calcium, and vitamin B12 deficiency, dyslipidemia can be mentioned. The main cause for increasing prevalence of depression in Syria can be attributed to: Rapid increase in spread of diabetes. Partially high prevalence of diabetes type 2 (%15.6) Share of other illnesses contributing to depression can be summarized as follows: 47% to spread of vitamin B12 deficiency. In order to have more accurate results further measurements of prevalence of deficiency in vitamin D, calcium, and spread of hypothyroidism, and subclinical hypothyroidism is recommended. By using on line medical care system in Iran, it was found that 85% of people suffering from depression had at least one of the above mentioned causes, and after treatment symptoms of depression were noticeably reduced. At the end of this article there is an announcement for specialists in Syria and other countries to adapt the online medical care system to their own circumstances.
203 A Deleterious Combination of Intravenous Drug Usage with HIV and Chronic Hepatitis Infection; How Renal Replacement Therapy Emanated? , Christian Castillo-Latorre*, Héctor R Cintrón-Colon, Fermín López-Rivera, Manuel Urbina-Paredes, Alexis Rivera-González, Maricarmen Milán-Esteva and Luis Gerena - Montano
Intravenous drug usage of substances like cocaine and heroin; encompasses a spectrum of generalized state of illness. A continuum insult which predispose patients to chronic viral illnesses, bacterial infections and subsequently end organ damage due to multiple factors. The renal structure is one of the target organs involved in this process, by which a majority of them will lately developed end stage renal disease and as a result renal replacement therapy. However, the spectrum of complications of this population is enormous starting with acquire infections like HIV, Hepatitis C, Hepatitis B, severe skin infections, pneumonias, cardiovascular diseases, endovascular complications as the well-known Lemierre’s syndrome, central nervous system infections, systemic complications like renal failure ending up in hemodialysis and most of them with a low expectancy of life. In our population 69 patients were randomly with a mean age of 44 years assign for investigation all of them known to have a poor social support in conjunction with intravenous drug usage of cocaine and heroin. All these patients were study using the electronic medical record system, several conditions were measure like HIV, Hepatitis B, Hepatitis C, Hypertension and Diabetes mellitus. Of the patients been study the admission diagnosis that lead to renal replacement therapy was recorded, and later in the process compared. Our population of 69 patients, 16 of them ended up in hemodialysis 23% (16/69), of this patients that had renal replacement therapy 4 of them had Hepatitis C 25% (4/16), Hepatitis B 19% (3/16), HIV 13% (2/16), Hypertension 6% (1/16) and Diabetes mellitus 6% (1/16) respectively. There were several precise findings that lead to hemodialysis in the population, with the majority been infected ulcers 25% (17/69), pneumonia 20% (14/69), upper gastrointestinal bleeding in 10 %(7/69) and symptomatic anemia 10% (7/69) respectively. All of this patient did not have good social support, none of them knew about the long-term consequences of renal failure and most of them did not had positive approach of stopping intravenous drug usage. As a whole, illicit intravenous drug usage is associated with a broad spectrum of diseases, all of them creating a rapid deleterious clinical picture; mostly debuting to medical assistance with infectious etiologies.
204 Commentary on the Challenges of Clinical Trials in Developing Nations: Ethiopian Perspectives , Etsubdink Abera Aboye
Clinical trials in Ethiopia and other developing nations can generally be considered to be in its embryonic stages. Despite that, motivation of the researchers and efforts to establish clinical trials unit in academic and research institutions is encouraging. This is reflected by increasing clinical trials registered from Ethiopia in trial registration database. Besides, some of the trials conducted in Ethiopia have informed treatment guidelines. However, trained workforce, governmental support, research infrastructure as well as financial support remain weak. Inter-sectoral collaborations, sustainable financial support, training of academic staff to conduct clinical trials and the commitment and engagement of the leadership in research are all important. There is a need for enhanced socio-economic development and translation of research findings into locally relevant evidence. The objective of this commentary is to reflect on the challenges of Clinical trials in developing nations: Ethiopian perspectives to identify the challenges, and use the opportunity to engage in clinical trials for the better health of the poor people.
205 Common Variable Immunodeficiency / Cvid , Nouf Khalid Hamid*
“Variable” refers to the heterogeneousclinicalmanifestations of thisdisorder, which can include: recurrentinfections, chroniclungdisease, autoimmune disorders, also involve varioussegments of the gastrointestinaltract and a heightenedsusceptibility to lymphoma. Itis a primaryimmunodeficiencythataffects 1 in 50,000 peopleworldwide. Itischaracterized by reducedimmunoglobulinserumlevels and absent or impairedantibody production. The pathogenic of CVID isnotknown; however, therehavebeennumerousassociatedlaboratoryfindingsincludingnumerousmutations in the genesresult in dysfunctional B cells. The mostfrequentmutationsoccur in the TNFRSF13B gene. Genesthathavebeenimplicated in monogenic CVID include ICOS, TNFRSF13B (TACI), TNFRSF13C (BAFF-R), TNFSF12 (TWEAK), CD19, CD81, CR2 (CD21), MS4A1 (CD20), TNFRSF7 (CD27), IL21, IL21R, LRBA, CTLA4, PRKCD, PLCG2, NFKB1, NFKB2, PIK3CD, PIK3R1, VAV1, RAC2, BLK, IKZF1 (IKAROS) and IRF2BP2 [1]. In addition, thereisevidence of complexinheritanceratherthan a monogenic CVID.
206 Diagnosis and Management of Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman with Type 1 Diabetes Mellitus , Saif Fehaid Alqahtani1 * MBBS, Abdulghani Alsaeed2 MBBS
Diabetic ketoacidosis (DKA) is a medical emergency in diabetes patients that needs urgent management. Because of the physiologic changes during pregnancy, pregnant women with diabetes are at a high risk of developing euglycemic DKA. Euglycemia could distract the treating physician from the early diagnosis and management of DKA, leading to fatal consequences for the mother, as well as the fetus. Here, we describe the case of a young pregnant woman with type 1 diabetes mellitus who was diagnosed with euglycemic DKA. She was successfully treated with an insulin infusion, dextrose 10% in water (D10W) intravenously, and potassium replacement.
207 The Incidence of Anterior Pituitary Hormone Deficiencies in Patients with Pituitary Microadenoma and Idiopathic Hyperprolactinaemia. A Retrospective Single Centre Study , Khalid S Aljabri*, Samia A Bokhari, Muneera A AL Shareef, Patan M Khan, Bandari K AlJabri
Introduction: Patients with microprolactinoma and idiopathic hyperprolactinaemia are not generally considered to be at risk of hypopituitarism and are therefore not routinely screened for this abnormality. Aims: We aimed to establish the frequency and clinical significance of anterior pituitary hormone deficiencies, comparing patients with radiologically proven microprolactinomas and idiopathic hyperprolactinaemia. Study Design: We retrospectively examined the case notes of 242 patients with hyperprolactinaemia from our centre. Patients who did not fit the profile of surgically naïve microprolactinoma or idiopathic hyperprolactinaemia or who had incomplete data were excluded, resulting in a study group of 185 patients. Results: Out of 242 patients, 185 patients were identified with microprolactinoma and idiopathic hyperprolactinaemia. 47 (20 %) were male and 148 (80 % ) were female with mean age 35.4 ± 13.7. 87(47%). Four types of hypofunctioning pituitary gland were seen such as panhypopituitarism, secondray hypogonadism, growth hormone deficiency and central hypothroidism and were associated with more frequent normal MRI. Patients with MRI evidence of microprolactinoma were identified, three (3.4%) of whom had one or more anterior pituitary hormone deficiencies. A total of 98 (53%) patients with MRI-negative idiopathic hyperprolactinaemia were identified, twelve (12.2%) of whom had one or more anterior pituitary hormone deficiencies. Patients in the MRI-positive and MRI-negative groups had panhypopituitarism, hypogonadotrophic hypogonadism and growth hormone deficiency that required hormone. Conclusion: The current study shows an increased frequency anterior pituitary hormone deficiency in patients with idiopathic hyperprolactinaemia, not with pitutary microadenoma. A prospective study would be required to assess the underlying cause for these abnormalities, as they suggest a nontumour pan-pituitary process. Limitations: Question of clustering of cases within the study region and limited study sample size.
208 Acute Renal Insufficiency , Sonja Hodzic
In the period from March to April in 2016. We had three young boys with acute renal insufficiency. All three of them were healthy and active in sport. One of them was active in athletic, running, and others two were regularly in gym. All three boys were taken multivitaminic pills. In laboratory tests we saw in all three patients higher urea and creatinin. Ultrasound of kidney in two patients showed kidney normal sizes and shapes but hyperchoes parenchims and erased borders. The third patient had completely normal ultrasound of kidney. Biopsy of kidney in our two patients showed acute tubular necrosis. One patient needed haemodialysis. Two of them had antibiotic therapy. All three had fully recovery of kidney functions.
209 Subacute Miocardial Infarction with On-Line Rupture , Roberto Cemin* and Priscilla Milewski
n old lady was admitted to our hospital with subacute miocardial infarction. We performed an echocardiogram, discovering a massive pericardial effusion, with documentation of heart rupture while taking the exam.
210 Purulent Pericarditis and Pneumopericardium by Streptococcus Anginosus , Daniel Vesga1 , Daniel Martín1 , Mauricio Calderón2 , Andrés Salgado3 , Carol Mayorga1 and Aldair Chaar1
We report a case of Purulent pericarditis and pneumopericardium by Streptococcus angiosus in 35-year-old man detained in prison, history of ischemic cerebrovascular event due to cocaine, with no recent surgical or traumatic history who had subacute clinical course of chest pain and signs of systemic inflammatory response. He was empirically treated with vancomycin and cefepime with subsequent pericardiotomy and drainage. The patient has a poor clinical evolution after the procedure, presents septic shock and dies. This is a rare case, a serious infection, the second reported in world, however in comparison to the first case the clinical course was different.
211 Endoscopic assisted suturectomy for primary craniosynostosis in infancy , Ramadan Shamseldien*, Hedaya Hendam and Abdelhfiz Shehbeldien
Background: Multiple procedures have been used for the treatment of craniosynostosis, ranging from simple suturectomy to extensive calvarial vault remodeling. The optimal timing for surgery is still controversial. The goal of therapy is to provide adequate intracranial volume, in addition to an aesthetically almost normal skull shape. Endoscopic synostosis repair described in 1998 by Jimenez and Baron [1]. This technique allows for a less invasive method that can result in excellent longstanding reconstruction of the cranial skeleton. This method is a minimally invasive approach that has less morbidity involved with traditional reconstruction techniques. Aim: Evaluation of early endoscopic suturectomy and its impact on both neurological functions and cosmetic appearance of infants up to 6 months of age suffering primary craniosynostosis. Methodology: This is a prospective analytical study of 50 patients with primary non syndromic craniosynostosis either single suture or multiple sutures, up to sixth months of age; with evident of skull shape deformity and or manifestations of increase intracranial pressure. from; October 2009 to October 2016 were managed byendoscopic assisted suturectomy the approach of Jimenez and Baron, in both Neurosurgery Department Shebin Elkom teaching hospital and Neurosurgery Department in Elsahel teaching hospital. Clinical and radiological follow up for six months postoperative. Results: This is a prospective analytical study of 50 patients with primary craniosynostosis, 28 patients are male and 22 patients are female. The age of patients range from one and half months to sixth months. The majority of cases presented with deformity alone 68%. Other clinical presentations as manifestations of increased intracranial pressure, fits, and delayed milestones plus deformity was 20%, 8%, and 4% respectively. Estimated blood loss, the mean loss was 56cc, minimum 30cc, and maximum was 100cc, with stander deviation ±18cc.The minimum hospital stay was one day and maximum was three days.There is significant change of head shape and head circumference postoperatively this observed by highly significant P value in head circumference (< 0.001). Conclusion: Endoscopic assisted suturectomy is minimally invasive approach with a very narrow range of complications, very limited need to blood transfusion and if it occurs, it is small volume in relation to total volume. Very short ICU and hospital stay also decrease the economic load.
212 Conception of Human Body Biomechanical Balance, Metacognitive Diversity, Interdisciplinary Approach , Tamari Matsaberidze*, Moreno Conte and Valerio Quatrano
What is the relationship between teeth and body posture? How does dental occlusion affect the alignment of the spine? The shortest answer has two words: Molar Lever, a bio-mechanical type 1 lever that finds its fulcrum on the molar teeth.
213 Laparoscopic Treatment of Retrocecal Hernia: Technical Notes and Literature Review , Raffaele Porfidia1 *, Nicola Castaldo1 , Maria Giovanna Ciolli1 , Pietro Picarella1 , Simona Grimaldi2 , Alfonso Bosco1 and Sergio Grimaldi1
Retrocecal hernia is a rare cause of mechanical ileus and requires surgical treatment in emergency. Laparoscopy is not a frequent approach in this type of pathology. The diagnosis preoperative is not easy despite the TC can provide information to that effect. We present the case of a 52-year-old male patient with no comorbidity and never operated on the abdomen previously, which arrives in the emergency room with symptoms of acute abdomen. Practice direct Rx abdomen and TC abdomen that highlight an ileal stop without signs of decompensation. It is implemented, first instance, a conservative therapy, naso-jejunal tube and gastrographin intake by the way oral. Due to the persistence of occlusive symptoms, he underwent surgery after 24 hours. In laparoscopy we highlight a retrocecocolic hernia that strangles the last ileal loops. Proceed to section of the throttling track and to the opening of the entire laterocolic shower on the right with the resolution of the occlusive frame. Laparotomy has been avoided; laparoscopy made it possible to diagnose and guarantee a minimally invasive treatment with rapid recovery of the patient. We did not consider it appropriate to close the hernial orifice as described by several authors in the literature. The technique is described laparoscopy comparing it with other authors.
214 Keratoconus Etiopatogenesis and True Cure : Modern Concepts , Massimo Lombardi*
A kind advise for the skeptics and denying persons, at any cost, please reflect on what has been written, two Centuries ago, by a great French Physiologist: Claude Bernard (1813-1878): “ what we know it is the main obstacle to acquire what we do not yet know”
215 Can Leptospirosis Be Treated Without Any Kind of Medication? , Huang W L*
Introduction: Leptospirosis is an acute infectious disease caused by pathogenic Leptospira. Spread in a variety of ways, though the digestive tract infection is the main route of infection. As the disease pathogen final position in the kidney, the urine has an important role in the proliferation of the disease spreading [1]. Purpose: The purpose of this study was to show if leptospirosis can be treated without any kind of medication. The methodology used was the presentation of one case report of a woman presenting three days of generalized pain all over her body, especially in her muscles, mainly the calves of her legs, fever, headache and trembling. A blood exam was asked, as well as serology and acupuncture to relieve her symptoms. Findings: she recovered very well after five sessions of Acupuncture once a day. A month later, she came back with the results of her serology: it was positive leptospirosis. Conclusion: In this case, leptospirosis was cured without the use any kind of medication, being acupuncture a good therapeutic option, reducing the necessity of the patient’s admittance into a hospital, minimizing the costs of the treatmentand restoring the patient to a normal life very quickly
216 Can the Use of Earrings Cause Eye Pain? , Huang W L*
Introduction: Eye pain can occur on the surface of your eye or within your eye’s deeper structures. Severe eye pain especially accompanied by any degree of vision loss may be a signal that you have a serious medical condition. Eye pain that’s on the surface of your eye might be described as itching, burning or shooting pain. Surface eye pain is often related to a foreign object in your eye, an eye infection, or anything that irritates or inflames the membrane covering the surface of your eye. You might describe eye pain originating deeper within your eye as throbbing or aching [1]. Purpose: The purpose of this study is to demonstrate that the use of earrings can be a causative factor of eye pain. Methods: A reading of the location of the eye in the human ear was carried out through a map showing the location of the organs according to Traditional Chinese Medicine. Results: Over two reports of clinical cases of patients with ocular pain at the time of the consultation or the acupuncture session, there was almost immediate improvement of ocular pain symptoms after removal of the earrings bilaterally. Conclusion: The use of earrings, which are usually above the eye point, according to Traditional Chinese Medicine, could be the cause of eye pain, based on these two clinical reports.
217 Histological Comparison Between Deep Chemical Peeling DE ROSSI FATTACCIOLI’s Formulae) and Ultra-Pulsed CO2 Laser Resurfacing , Daniel De Rossi-Fattaccioli*
The laser treatment of carbon dioxide ultra-pulsed and peelings chemical phenol-deep oil crotón (formulas BackerGordon and Litton) have been and remain the most used for the rejuvenation of the skin of the face. This study was conducted to compare the effects of both treatments by histological sections at different periods of the evolution of the same. Biopsies were performed face treaties skin before and retro immediately and 24 hours after the ablations CO2 laser and 24 hours after application of the formula of Litton for chemical peeling deep. Areas in areas near the biopsies were biopsied 12 hours, 24 hours, 1 week, 2 weeks, 2 and 3 months later, in the case of treatment with phenol 24 hours, 48 hours, 72 hours, 1 week, 1 year and 10 years later. The initial biopsies showed that being ablations CO2 laser deeper than the chemical peeling with phenol, a month both had formed an area neocolágeno. But after three months, the comparatively deep phenol chemical peeling (formula Litton) had been an area neocolágeno more compact and wide as that produced by the CO2 laser ultra-pulsed.
218 Recurrent Vulvo-Vaginitis and Immune System (RVVC) , Fabrício Prado Monteiro*
The Recurrent Vulvo-Vaginitis Candidiasis (RVVC) is determined by symptoms of itching, burning and viscousmucus secretion and white with the appearance of fissures, vulvar redness and foliculites satellites the femoralregion extremely bother and appear for more than three semi-annual or episodes over six episodes per year.
219 A Case Report of Metronidazole-Induced Pancreatitis , Cristina Corsini* and Zain Rahman
Case Summary: A 23-year-old African-American female came to the emergency department with sudden onset epigastric pain associated with nausea having begun one day before presentation. Her symptoms started after the third dose of Metronidazole therapy for treatment of bacterial vaginosis. Clinical examination showed moderate epigastric tenderness. Lipase was 771 IU/L on admission. CT abdomen showed mild haziness of peripancreatic fat, which was suggestive of inflammation and diagnosis of acute pancreatitis was made. A detailed history and biochemical evaluation excluded pancreatitis-gallstones, recent increased alcohol intake, ERCP, hypercholesterolemia, hypercalcemia or viral infections. Symptoms resolved quickly upon discontinuation of metronidazole. We conclude therefore that Metronidazole was thought the most probable etiological factor. Discussion: The proportion of cases of Metronidazole-induced pancreatitis occurs in less than 1% in the general population, and the mechanism of action is not well known. Overall has a benign clinical course when assessed and treated appropriately. Conclusion: There are only 15 previous case reports of Metronidazole-induced pancreatitis in the literature to our best knowledge. Identification of Metronidazole as the causative agent is the key to recovery, and physicians should discontinue metronidazole in patients with pancreatitis of no identifiable source to ensure proper healing
220 Non-ketotic Hyperglycemia Hemichorea-Hemiballismus: A lucky Catch , Cristina Corsini*
Case Summary: A 73-year-old man with past medical history of hypertension, type 2 diabetes mellitus and depression, presented with new onset right arm and leg movements. The physical exam showed right hemi body choreic movements and decreased reflexes to 1+ on the affected side. Laboratory abnormalities included blood glucose level of 310 mg/dL and a glycohemoglobin of 13.6 mg/dL. CT head showed increased density of the right caudate nucleus and right lentiform nucleus. Blood glucose was controlled by adjusting his insulin regimen and his abnormal movements resolved within seven days. Discussion: Development of involuntary movements is one of the least common neurological manifestations in uncontrolled diabetes mellitus and, it is more common in elderly patients. Contralateral hyperdensities in the contralateral basal ganglia in the CT is essential for diagnosis. Course and prognosis are benign. Most cases achieve a full recovery within six months of strict glucose control. Conclusion: Strict glucose control is the primary therapy for neurological complications in non-controlled diabetes mellitus. Proper identification of the disease is fundamental for the prompt resolution of symptoms.
221 The Role of Xylitol in Caries Prevention , Magda Saeed Mansour*
Xylitol is actually a very valuable tool for increasing our overall health. To put it plainly, xylitol is a sugar substitute that is far better for your body than typical white refined sugar. It is often considered a “diabetic sweetener” and is basically as sweet as sucrose, but has 33% less calories. Caries is one of the common infections that occurs in the oral cavity and affects populations across developed and developing nations. Studies show that dental caries is still a major health problem in most industrialized countries affecting 60–90% of schoolchildren and the vast majority of adults. Xylitol seems to be having the properties that reduce levels of mutans streptococci (MS) in the plaque and saliva and enhance it’s preventive effect on dental caries. Xylitol becomes well known of it’s Antibacterial Properties in addition to it’s role as an alkalizing agent. It increases the alkalinity and decreases the acidity in the body and mouth. Alkalinity is not a good situation for bacteria because it cannot grow in that condition. Therefore, it has been long praised for its ability to wipe out bacterial infections and colonies of all kinds throughout the body. Xylitol helps prevent tooth decay by reducing plaque formation. Blocks the acids that demineralize tooth enamel. Halts the growth of acid producing bacteria. Reduces gingival inflammation. Raises the pH level to be more alkaline. Xylitol belongs to the chemical group called “polyols”, more commonly known as sugar alcohols. Oddly enough, they are neither sugar nor alcohol, but their chemical structure resembles something in between.
222 Importance of p16 and Ki67. Immunohistochemical Expression and in a Typical Immature Metaplasia (AIM) , Ghirardi G1 *, Delfino I2 , Kaplan E3 , Sanchez A4 , Schuster W5 and Roca P6
Introduction: The term AIM was coined in 1983 to describe a squamous proliferation of the cervical transformation zone and glands associated with abnormal cytology and colposcopic findings. This condition may be a precursor of HPV integration. This subject is controversial because its biological and clinical significance are not well defined. Colposcopy suffers from the same diagnostic difficulties than Cytology and Pathology. The effect of gene inactivation in the cervical epithelium was investigated for the overexpression of p16 protein by Immunohistochemistry (IHC), which results in the loss of activation of Rb by the E7 protein of high-risk HPV. Objective: Investigate the use of biological markers, such as p16 and Ki67, which can be useful when diagnosing lesions with AIM. Material and Methods: A descriptive study of the IHC expression of p16 and Ki67 in 60 formalin-fixed paraffin-embedded cervical biopsies obtained from the private archive of a Pathology Laboratory, was conducted. Results: Negative cases for both p16 and Ki67 represented 69% of HPV lesions without dysplasia, whereas high-grade lesions (CIN III) were 100% positive for both p16 as Ki67. CIN I lesions were positive in 64% of the cases for both markers, and the rest were negative. CIN II lesions scored higher for p16 positivity, yielding positive results in 54% of the cases and 14% for Ki67. Conclusion: AIM is a complex entity can be associated with HSIL. The similarities between the AIM and LSIL can be consider a form of LSIL. p16 is a marker for HPV-induced dysplasia. We suggest cautious behavior, for the sake of diagnostic accuracy. Considering the increased incidence of cervical carcinoma and its relationship to HPV, we deem useful to use biological markers such as p16 and Ki67, that may allow to determine the possible progression of SIL to invasive carcinoma as more economical tool that may be more in tune with the socio-economic reality of Latin America and cost-effective, when compared to other more expensive techniques.
223 PET and MRI as Yardstick for Neuro-Inflammation, a Pathological Trademark of Multiple Sclerosis (MS) , Jes Paul*
NeurologicalMaladies such as multiple sclerosis (MS) are usually discernible with neuroinflammation. Todiscover the neuroinflammation Positron emission tomography (PET) using translocator protein (TSPO) ligands and magnetic resonance imaging (MRI) are reliable. This focal point of this workis to valuate neuroinflammation in MS using TSPOPET with 18F-VC701, in combination with magnetic resonance imaging (MRI) methods.
224 Chronic Mesenteric Ischemia and Ileus of Older People in Surgical Ward , Hussien Rabee1 * and Nabil M Aly2
Chronis mesenteric ischemia is a pathological condition and well known to be commoner in older people. With the advances of CT angiogram,signs of mesenteric stenosis occlusion became common changes in high proportion of scans of older people in surgical ward. Currently, there is no protocol or guideline to manage these incidental findings as far as it is not symptomatic in terms of weight loss or intestinal angina. However, during stress situation postoperatively, paralytic ileus as a commoner event in older people might be a manifestation of chronis mesenteric ischemia. This review might be a trigger to raise value of manage angioplastable lesions pre-operatively.
225 Purple Urine Bag Syndrome: A rare manifestation of Catheter Associated Urinary Tract Infection , Kyaw SoeTun* and Low Shoulin
Purple Urine Bag Syndrome (PUBS) is an infrequent manifestation associated with urinary tract infection in patients with long term catheterisation where the catheter bag and tubing turn a striking purple colour. It is a benign phenomenon but alarming for the patients, families and healthcare providers. We present a case report of this rare phenomenon occurring in an asymptomatic 83 year old lady, who was brought in for consultation at the Geriatric clinic.
226 Scrub Typhus Case Report; Acute Febrile Illness in a Young Lady , Adila Shaukat*
We are reporting a case of young Indian lady with history of recent travel to India, presented with acute febrile illness. Initially she was treated with antibiotics with diagnosis of sepsis but she did not respond. Thorough investigations were done to find out the cause of her illness but all the workup was negative. Later on detailed examination revealed an eschar on the right thigh. Based upon the fact that she has a history of recent travel to Andhra Pradesh that is endemic for scrub typhus, with the presence of eschar on the right thigh, empirical treatment with doxycycline was started. Patient responded very well to the treatment and was discharged home. High clinical suspicion of scrub typhus is necessary for early diagnosis and treatment in patients coming from endemic area. Presence of eschar is pathognomic but its absence does not make the disease unlikely. Early diagnosis is associated with better outcomes.
227 Asymmetry In Belief Updating And Carcinogenesis , Robert Skopec*
Accumulating evidence shows that the central nervous system (CNS) regulates the activity of the immune system. Concerning the role of immune system in cancer, psychosocial influences on immune function provide a mechanism of association between psychosocial factors (like interpersonal aggression) and cancer prognosis. Social conflicts between males, involving high aggression stress and threat (psychosocial conflicts) produce both an allostatic state and allostatic load. The costs for aggressors (Hawks) and victims (Doves) tested under semi laboratory conditions are quite different. Testosterone does not cause aggression, only exaggerates the pre-existing pattern and response to environmental triggers of aggression.
228 Chitin Nanofibrils: Turning Fishery’s Waste into Goods , Pierfrancesco Morganti*
According to the last FAO report, fisheries and aquaculture remain important sources of food and nutrition for a global population expected to reach 9.7 billion by 2050 [1]. With a global production if 167.2 million tons/year (MT), the capture fishery represented 93.4 MT compared to an increased aquaculture generating 73.8 MT in 2014. It is interesting to underline that world pro capita fish supply reached 20kg in 2014, representing one of the most-traded food commodities worldwide, thus playing an important role in providing food nutrition and employment to current and future generations. This is the positive aspect of the future food problem. The negative ones is represented from the discarded fish that is estimated to represent between 10 and 20% of the global marine fisheries catches [2]. The relative discarded organic materials causing hypoxia and anoxia of the seabed, exert a high biochemical oxygen demand (Fig.1). Thus they affect not only the food security but also the socioeconomic sustainability. Fish discards, in fact, can have direct and collateral effects on ecosystem food web processes and structure, increasing level of this materials in ecosystems and landfill where they are considered hazardous for their high perishability and high polluting effect when disposed off-shore. In addition FAO estimates that, each year, one-third of all food produced for human consumption in the world (~1.3 billion tons) is lost or wasted representing 45% of all fruit, 35% of fish and seafood, 30% of cereals, 20% of dairy products and 20% of meat (Fig.2) [3]. Thus the necessity to ameliorate the food chain from production to distribution and consumption, trying to change consumer behaviours, policies and regulations. Another must of our society should be the plain use of food and industrial by-products to make goods and energy with the goal to produce zero waste [4]. The major utilization of the underutilized chitin as by-product of the fishery’ processing go in this direction [5].
229 Deferred Stenting in a HIV Infected Patient with STEMI and Heparin Induced Thrombocytopenia , Mohammed Al Jarallah, Rajesh Rajan*, Ibrahim Mahmoud Elkhouly, Sarita Sunil and Raja Dashti
Coronary artery disease is one of the major cause of death in human immunodeficiency virus (HIV) positive patients. It can be due to endothelial dysfunction, hypercoagulability and inflammatory changes associated with HIV and highly active antiretroviral therapy (HAART) induced metabolic complications. This is one of the first reported deferred stenting in a HIV infected STEMI case withhistory of heparin-induced thrombocytopenia (HIT) positivity. Here we are reporting a 45-year-old Kuwaiti male who is known to be HIV positive as well as having heparin-induced thrombocytopenia presented to emergency room with acute ST elevation myocardial infarction (STEMI). We have opted for deferred stenting technique and performed angioplasty with drug eluting balloon (DEB) to the culprit vessel, the right coronary artery (RCA) under bivalirudin coverage. And on day 1 of the admission he underwent PCI to RCA with 2 drug-eluting stents (DES). Patient got discharged without any major complications on full anti ischemic treatment. PCI in HIV STEMI patients with HIT are related to major complications like restenosis, in-stent thrombosis hence initial management of deferred stenting is ideal.
230 Survival of Serious and Lethal Complication of Gastrointestinal Hemorrhage: Case Report , Ali Dawood Al-Hilfi1 , Kadhim S Al Ashoor2 and Falih Algazgooz3
Background Primary aortoduodenal fistula (PADF) is a rare, serious complication of abdominal aortic aneurysm (AAA). Frequently the diagnosis is missed due to the rarity of disease. Case description A 76 year old, Male referred to GIT center in our hospital suffering from severe upper gastrointestinal bleeding and melena. All investigation appears normal apart from elevated blood urea with 3 sessions of upper GIT endoscopy by expert GI Physician with no evidence of cause for the bleeding (he put in her mind Dieulaphoy lesion).
231 Tattoo Remoov 88 by Linda Paradis the Revolutionary INK Removal Technique , Linda Paradis*
Tattooing has long been a way of ceremonial rites and passages in most cultures throughout the world. From Africa’s scarification process to the Celt’s inking griffins and monsters that were later found on their corpses, tattoos are worn to mark special events, to pay honor or respect, and even to unite body to body with ash remains that are later inked under the skin.
232 Computer-Aided Diagnosis Approaches to Fatty Liver Disease According to Sonographic Images Based on Wavelet Transform: A Review Study , Hamidreza Moghassemi1 , Reza Rabiei2 , Hamid Moghaddasi3 *, Mahtab Shabani4 and Reza Ataee5
Introduction: Fatty liver is usually diagnosed by ultrasound, but this diagnosis can be difficult because the disease does not always lead to abnormal conditions on gray levels that can be detected by the eye. However, ultrasound is still the first choice to detect fatty liver due to its low cost and availability, and the lack of side effects. The study reviewed Computer-Aided Diagnosis approaches to fatty liver disease, based on wavelet transform sonographic image processing. Methods: In this review study, a search was conducted based on related keywords and articles that had been published in English over the last 12 years. The findings were extracted based on the aim of study. Findings: Nowadays wavelet transformation has been widely used in the field of medical image processing because of its adaptability to the characteristics of the human eye system. The well-known wavelets used to liver diseases detection include Haar, Symlet, Daubechies and Gabor. Extracting the proper properties of images plays an important role in detecting diseases. Important statistical features of image textures are: statistical descriptors based on the intensity histogram and the GLCM matrix (Gray level Co-occurrence Matrix). The popular algorithms used for liver disease include neural network, Support Vector Machine (SVM), Bayesian, decision tree, K-Nearest Neighbor (KNN), and regression. Conclusion: The sensitivity, specificity and accuracy of the extracted statistical features of the output components of wavelet transform are generally better than those obtained from the original image itself. Gabor’s wavelet transformation often has a higher efficiency than the Daubechies and Symlet wavelet transforms because the two transforms only break up the halfband of low frequencies and lose some of the intermediate frequency regions, while Gabor retains all of the frequency regions This precision also mainly depends on the type of features selected and the type of classification. Statistical features based on intensity histograms do not provide relative information about the spatial of pixels relative to each other. To enter this spatial information of pixels in a texture analysis, it is recommended to use GLCM matrix in gray images. The type of classifier used can significantly impact on the precision of the final diagnosis.
233 Females in Veterinary Medical Education: Why the Choice? , Satesh Bidaisee*
Veterinary Medicine as a profession has undergone a change from a male-oriented one, to being predominantly female. The increase in female students is a reflection of the increasing interest in veterinary medicine by females. This study focused on reasons for the specific choice of veterinary medical education among female veterinary students. A life history approach was applied in order to explore the lives of six female veterinary students from St. George’s University, School of Veterinary Medicine in Grenada. This methodology involved using interviews to collect personal accounts of students’ life experiences that provided data about the reasons for the choice of female students to pursue veterinary medical education. The study revealed that life experiences as well as socio-cultural realities surrounding the lives of the students were crucial in understanding the influences and reasons for their choice of veterinary medicine. A Life Stages Theory emerged from the use of grounded theory approach to data analysis which identified personal, financial and academic needs as primary to create interest in veterinary medicine. The choice of veterinary medicine by females was found to be based on their personal interests, their ability to overcome financial and academic barriers and receive opportunities of alternative academic pathways.
234 Maternal affective bond scientific findings , María Teresa Sotelo Morales*
Recent neurological, cardiovascular and neonatal studies, among others, have demonstrated the biochemical interaction between mother and fetus from the first moment of conception, maintaining at all times bio-molecular communication, transported through the umbilical cord and placenta, whose functions are not limited to filter nutrients and oxygen, but to capture emotions in the molecules and cells of both bodies. The mother-child connection is much deeper than what was previously known or imagined. Surprisingly the heart of the nasciturus, can translate the content of the emotions that the mother sends, intuitively the baby knows if it is, or not loved. This data is not surprising, the whole process of gestation occurs in a symbiotic process of molecular and cellular communication, in the middle of an electromagnetic field that the heart of both translates.
235 Pericentric Inversion of Chromosome 1 in a Child with Low Height: Diagnostic Dilemmas , Ada Paloma Soto Brambila12, Alejandro Marin-Medina2 , Eduardo Esteban Zubero5 , Sabrina Diaram4 , Moises Alejandro Alatorre Jimenez3 *
The inversions are one of the most common chromosomal abnormalities. They occur when two breaks occur in a chromosome; the segment as well originated is reversed and becomes the reintegration on the same chromosome. Generally, an inversion does not cause an abnormal phenotype in the carrier, but it can do so in their offspring. Which sometimes can be associated with cases of mental retardation, congenital malformations or infertility. It is critical to determine if the inversion has a family origin, where there usually is no risks for the individual, or if it is a de novo mutation, the risk is somewhat higher, possibly due to the interruption of a key sequence of the gene. The pericentric inversion of chromosome 1 is one of the structural chromosomal variations that are not common, and it has been observed in general population and patients with abnormal phenotypes and disease. We report the case of a child that came to the office for presenting a failure to thrive every year; the cytogenetic testing reported an inversion of chromosome 1 without maternal origin nor paternal. In this case, there is no evidence that low height has relation with the abnormal chromosome.
236 Evaluation of the Grenada Sports for Health Program , Satesh Bidaisee1 * and Calum Macpherson2
Objective: The study served to measure basic health outcome measures to help guide the continued implementation of the community exercise component of the Grenada Sports for Health program. Design & Methods: The study population consisted of Grenadian citizens enrolled in three different community exercise programs as part of the Royal Grenada Police Force, Point Saline and La Sagesse, Grenville, Gouyave and Tanteen community exercise program. Initial data collection for this prospective cohort study began during March of 2011 and continued data collection through quarterly assessments was continued to June/July 2014 and June/July 2016. The health indicators for the Sports for Health program were designed to monitor and analyse program participants’ physical health indicators, such as Body Mass Index (BMI), Waist to Hip ratio over time to determine if their participation in the community training program was promoting health benefits by reducing risk factors for non-communicable chronic diseases. Results: During the baseline evaluation period in March, 2011, complete data sets were obtained for 427 participants. During the evaluation period of March 2014, 337 complete data sets were collected from participants from 2011 and during June/July 2016 evaluation, 264 complete data sets were obtained. The BMI, Waist, hip, and waist: hip ratio is presented in Table 1. BMI and Waist: Hip ratio using a Student’s T-test (α=0.05) demonstrated a significant difference between 2011 and 2016 measures. Conclusion: Participants have demonstrated a significant and positive difference in physical health indicators over three years of participation in the Sports for Health program.
237 A Retrospective Cohort Study of Pediatric Unplanned Readmission with Medication Related Problems in Tertiary Hospital , Khawla Khamis Al Quaitaei1 , Laila Khalifa Al Saadi1 , Jehan Al Fannah2 and Alka Ahuja1 *
Hospital readmission is defined as “patient readmission into the hospital within 30 days (or 4 weeks) of discharge”. Readmission rates are used as an indicator of the quality of care that patients receive during a hospital admission and after discharge.
238 Therapeutic Drug Monitoring of Antiepileptic Drugs in Real Clinical Practice in Russia , Leonova Marina V*, Shteinberg Lyudmila L, Tischenkova Irina F
Introduction: Anticonvulsants refer to drugs with interindividual variability of plasma concentrations and clinical efficacy. Therapeutic drug monitoring (TDM) is an important tool for optimizing pharmacotherapy with anticonvulsants in real clinical practice. The aim of the study was to analyze the results of TDM of valproates (VPA) and carbamazepine (CBZ) in epilepsy adults in clinical practice in Russia. Methods: observation study in 800 epilepsy adults (mean age 35.5±0.5) the rate of achievement the therapeutic concentrations (TC) of VPA and CBZ in different drug forms using high performance liquid chromatography; range of TC for VPA 50-150 mg/l, for CBZ 4-12 mg/l. Results: The frequency of achievement TC on VPA was 66.4% in average dose – 1325.1±29.6 mg/day with no difference between sustain-released and immediate-released drug forms. Gender differences of VPA concentrations were identified: women mean Cmin and Cmax were higher than in men with significantly lower daily dose. The frequency of sub-TC VPA was 16.3% and over-TC – 1% (Cmax 164.2±2.4mg/l); the toxic concentration for CNS (175 mg/l) was not achieved. In VPA doses<500mg/day there was no patients with TC; in 1001–1500 mg/day TC have 75%, in doses 1501–2000mg/day – 97%; in >2000 mg/day – 86% and there was high risk of over-TC (4%). The frequency of achievement TC range VPA monotherapy was 2 times more than in combination VPA+CBZ (67% versus 34%). The frequency of achievement TC range on CBZ was 78.6%, the average daily dose was 922.2±23.0 mg/day with significantly higher rate of TC range achievement when using sustain-release forms of CBZ. The frequency of sub-TC CBZ was 6.3%, over-TC – 1.25%. In patients with over-TC mean dose was 1250 mg/day, Cmin 13.5±0.2mg/l, Cmax 15.1±0.7mg/l. At initial doses<600 mg/day 64.3% patients have TC; in doses>600 mg/day – 87%. In daily doses 600-1200 mg and >1200 mg 1.3% and 4.1% patients have over-TC by both Cmin and Cmax, only by Cmax – 8.8% and 18.4%, respectively. Conclusion: the frequency of TC on VPA and CBZ is high with rare cases of over-TC, but there was problem of paradox low concentrations in single cases. CBZ have less predictable concentrations in therapeutic doses range than VPA.
239 Depression‐Level Effectiveness of the Curse Words in Young Adults in Pune University , Rahul A Hajare*
Depression and substance abuse has on the increase all over the world. The poor and the rich are also involved in this dangerous habit that has impact not only on reproductive health but also has an impact on family, society, increase in health care expense and increased criminal activity. Health care providers have more concerned with treating the victims and less concerned on its prevention. Pregnant women beara greater brunt and there has adverse pregnancy outcome. Low birth weight, preterm labor, increased in miscarriage and raised perinatal mortality has some of the adverse effects. Children of such parents have more likely to inherit this bad trait. Children living in abusive homes where drugs and alcohol abuse occur simultaneously has often deprived of more than just the basics of food and shelter. Depression has, “Any act on the partof the husband, partner or family which causes physical, mental, social or psychological trauma to the woman and preventsher from developing her personality.” Reason for the increasein depression violence has; urbanization, industrialization, growth of urban slums, co-education and co-working in offices and factories, modern movies, television, obscene and pornographic literature and decreasing religious restrictions.
240 Clearing Surgical Drains-There is Now a New Standard of Care , Vance Shaffer* and H. Medina
Clearing surgical tubes is a common procedure in wound care, and it often comes as second-nature for clinicians. But it can still be time-consuming and complicated. So imagine how daunting and difficult it is for friends or family members who have never done such a thing, and are responsible for a loved one’s after-surgery care. There is now a product available that makes the process of clearing tubes easier and faster. It’s called TubeEvac.
241 A Clinic Case of Type 2 Diabetes Control Flow Using Quantitative Lifestyle Management and Glucose Predictions (Part of the Math-Physical Medicine) , Gerald C. Hsu
The author has spent 8-years monitoring and researching medical conditions and lifestyle details of a patient (himself), who has been diagnosed with type 2 diabetes (T2D), hypertension, hyperlipidemia for a period of 20 years. He has experienced many complications from diabetes such as kidney, bladder, foot ulcers, cardiovascular issues, and so forth. As seen in the chart (Figure 1), his medical examination data during the period from 2000 to 2010 were:
242 An Assessment of Nurses’ Knowledge Attitude and Practice (KAP) of Pharmacovigilance at a University Hospital , Uchenna Obi1 *, Jacqueline E Campbell and Maxine Gossell-Williams
Objective: To assess nurses’ knowledge, attitude, and practice (KAP) of pharmacovigilance. Design and Methods: A cross-sectional study that utilized questionnaires to evaluate nurses’ KAP of pharmacovigilance. A sample size of 234 nurses was selected using a 95% confidence level with the raosoft online sample size calculator. Stratified random sampling method was used to select nurses from different departments. Data were analysed with the SPSS 20 using descriptive and inferential measures. The chi-square test was used to test the association between two attributes at a P< 0.05 significance level. Results: 209 responses were received from 260 distributed questionnaires, giving an 80% response rate. Results for knowledge showed that 13.5% of the nurses had heard of the term pharmacovigilance prior to the study, while 58.4% correctly stated the functions of pharmacovigilance. Attitude towards pharmacovigilance revealed that 93.7% of the nurses felt it was a professional obligation to report adverse drug reactions (ADR). 98.1% of nurses felt that ADR reporting was necessary. Pharmacovigilance practice revealed that 68.8% of nurses indicated that they had noted an ADR while in practice, while 55.3% had reported an ADR. There was a significant association between nurses who noted ADRs in clinical practice and nurses who reported ADRs, χ2 (1) = 86.642, p < 0.05. Conclusion: Registered nurses at UHWI showed a good attitude towards pharmacovigilance, although their knowledge and practice was limited.
243 A Case Report of Cerebral Venous Thrombosis after Taking Tamoxifen in Breast Cancer Patient , Kitwadee S Athigakunagorn*, Chonnipa Nantavithya and Kanjana Shotelesak
Background: Tamoxifen is commonly used in adjuvant treatment in hormonal receptor positive breast cancer patients. Cerebral venous thrombosis is one of the rare adverse events from tamoxifen. Report of the case: A 52-year-old lady was diagnosed right breast cancer (stage T3N3M0). She was undergone right modified radical mastectomy. The pathological results revealed invasive lobular carcinoma, size 6x2.3x2 cm. , grade 2, negative resected margin, ten out of fifteen lymph nodes were positive for malignancy. The immunohistochemistry was ER 90%, PR 25%, Her2 negative, and Ki67 10%. She obtained adjuvant chemotherapy, 4 cycles of Doxorubicin and cyclophosphamide followed by 4 cycles of paclitaxel every 3 weeks. She was prescribed tamoxifen during adjuvant radiation to her chest wall and regional lymph nodes. Approximately 8 months after taking tamoxifen, she complained progressive headache, dizziness, nausea and vomiting. Emergency CT brain with Contrast was done to rule out brain metastases. The scan revealed hyper dense lesion at temporal area with vasogenic edema, focal filling defect at left transverse sigmoid junction and upper portion of internal jugular vein. There was no demonstrable parenchymal metastasis. MRI and MRV of the brain showed acute dural venous sinus thrombosis of the lateral aspect of the left transverse sinus, left sigmoid sinus, left upper internal jugular vein as well as cortical venous thrombosis in the left vein of Labbe. Venous infarction in the left temporal lobe and left superior cerebellar hemisphere. Causing intraparenchymal hematoma in the left lobe. Laboratory analysis was done. Protein C/S, Lupus anticoagulant, ant thrombin, homocystein, anticardiolipin IgG/IgM, anti B2 glycoprotein I-IgG/IgM was normal. She was given enoxaparin 0.6 ml SC every 12 hours and tamoxifen was off. The scan of CT brain 6 days later showed interval decreased attenuation intraparenchymal hematoma at left posterior temporal lobe. Her headache was improved and no neurological deficit was detected. Ultrasonography of both lower extremities showed no evidence of deep vein thrombosis. She then switched to aromatase inhibitors. Discussion: Clinical risk factors for venous thromboembolism are major general or orthopedic surgery, paralysis, pelvic fracture, trauma, cancer previous venous thromboembolism, cancer, major surgery, trauma, obesity, varicose veins, cardiac disease, pregnancy and nephritic syndrome. Our patient had none of these risk factors. Although it is quite rare, cerebral venous thrombosis must be kept in mind of possible adverse effect from tamoxifen.
244 The First Sign of an Impending Disaster? Headache in a Patient with Severe Hypertriglyceridemia - the Need for Preventive Plasmapheresis , Mohamad El Abdallah, Naba Saeed, Kadhim Al-Banaa, Rajiv john and Jonathan Zimmerman
Hypertriglyceridemian has been shown with accumulating evidence to contribute to ischemic stroke through many pathologic processes such as endothelial dysfunction, atherosclerosis and production of prothrombotic state, in addition to hypergoagulability and slugging [1]. Recent evidence suggests that hypertriglyceridemia may correlate with increased risk of cardiovascular disease, especially when associated with decreased HDL- C, increased LDL- C levels, or both [2]. However the debate remains whether Hypertriglyceridemia is an independent risk factor for ischemic stroke. Case Report: We present a case of 44 year old male patient with history of hypertriglyceridemia, who presented with severe headache, worsening over the last few days before admission. His triglycerides level was 10308 on admission. The headache was alarming and was considered as a sign of hyper viscosity with subsequent vaso- occlusive disease. He was started on IV insulin drip initially with minimal change in his triglycerides level over a 3- day period. With persistence of headache, the patient was started on plasmapheresis with dramatic resolution of the headache as the triglyceride levels dropped markedly. Conclusion: The use of plasmapheresis should be considered in patients with severe persistent hypertriglyceridemia, especially in patients who have persistent alarming headaches or signs if impending cerebral vaso- occlusive disease. Plasmapheresis should be considered primarily for stroke prevention in this population.
245 Liver Dysfunction in Children Cause by Metabolic Diseases: Review of 9 Cases , Jorge Sales Marques
Liver dysfunction can be a form of presentation of some metabolic disease in children. The aim of this study is review all cases of liver dysfunction found in pediatric department and correlate with other clinical and laboratory findings for the diagnosis of metabolic disorder. The results showed 9 cases (8M/1F), with the mean age of 30 months with metabolic diseases: tyrosinemia type 1, alpha1 antitrypsin (A1AT), ornithine transcarbamylase (OTC), citrin deficiency (2 cases), Danon disease, fructose intolerance, lysinuria and glucogenosis type 1. We conclude that clinical presentation and laboratory findings are important for the diagnosis. Molecular studies confirm the final diagnosis and help us for future genetic counseling and prenatal diagnosis.
246 Cold Therapy and Narcissistic Disorders of the Self , Sam Vaknin
For well over a century, since the publication of Freud’s seminal “On Narcissism” in 1914, pathological narcissism was widely considered to be a disorder of the “character” or the personality. This culminated in the 1980s and 1990s with the inclusion of Narcissistic Personality Disorder (NPD) in the third, fourth and text revision editions of the Diagnostic and statistical Manual (DSM). Cold Therapy is based on two premises: (1) That narcissistic disorders are actually forms of complex post-traumatic conditions and not disorders of the personality; and (2) That narcissists are the outcomes of arrested development and attachment dysfunctions. Consequently, Cold Therapy borrows techniques from child psychology and from treatment modalities used to deal with PTSD. Cold Therapy consists of the re-traumatization of the narcissistic client in a hostile, non-holding environment which resembles the ambience of the original trauma. The adult patient successfully tackles this second round of hurt and thus resolves early childhood conflicts and achieves closure rendering his now maladaptive narcissistic defenses redundant, unnecessary, and obsolete. In the process, both transference and countertransference are encouraged in order to most closely recreate the roles of the original “perpetrator” of abuse (abuser) and his or her victim (the patient or client). Cold Therapy makes use of proprietary techniques such as erasure (suppressing the client’s speech and free expression and gaining clinical information and insights from his reactions to being so stifled). Other techniques include: grandiosity reframing, guided imagery, negative iteration, other-scoring, happiness map, mirroring, escalation, role play, assimilative confabulation, hyper vigilant referencing, and re-parenting.
247 Trypansoma Cruzi Integrated Vector Management in Latin America , Shayda Pedram1 and Satesh Bidaisee2
The protozoan parasite Trypansoma Cruzi causes Chagas Disease in humans, which is known to be a disease of the Americas. Chagas Disease primarily affects rural and poor regions of Latin America [1]. Chagas Disease is a zoonotic disease with an interesting life cycle and is spread to humans via reduviid otherwise known as kissing bugs or triatomines [1]. This bug gets its name by taking its blood meal from a human host near the mouth and then releasing the parasite in its feces by the bite. The bites are typically painless but the parasite is further tunneled into the bite when the host scratches the area of the bite. Initially the patient could be asymptomatic; however ten to twenty years later he or she may develop symptoms that can be severe such as mega colon, dilated cardiomyopathy, and mega esophagus [1]. There is no treatment for chronic Chagas Disease; however this disease is extremely preventable making it a topic of public health interest and action [1].
248 The War Within: A Personal Journey with Obsessive Compulsive Disorder/Complex Post Traumatic Disorder-The Struggle, the Fight, and Recovery , Lucy Faranda
For years, I had suffered from OCD. I have been in and out of many psychiatric facilities both in the United States and in Canada. My experiences are complicated but also very informative for those seeking help with OCD. I have been in many crisis situations and have endured many treatments like CBT, mindfulness, guided meditation, ERP, hospitalization, and withstanding very intense OCD and CPTSD residential treatment programs. In time, with the right medical team, support groups, medication and self-motivation to fight against the debilitating symptoms OCD, I have gone from being on LTD for the inability to function and complete daily tasks like showering and dressing without compulsions, to reclaiming back my life and returning back to teaching. I hope to be able to pay it forward and speak to the great resources and staff available at Sunnybrook Hospital. I hope to share my story of struggle and recovery to help bring resource information and hope for those suffering from any mental illness. I have seen the good, the bad and the ugly. But, I have also seen hope and light. I now am able to know how it feels to be able to function again, as well as acknowledge a strength that I could never have known I had if it was not for the experiences I endured. I have the authority to now say OCD is not a life sentence, OCD can, in fact, be managed. I can be the voice that I so desperately needed years ago, when all I wanted to do was end my life because I had a lack of experience around me of seeing those who made it, those who survived and not just survived, but thrive into productive individuals who are able to manage their OCD and be successful.
249 Temporal Fossa Arachnoid Cysts Presenting as Chronic Subdural Hematomas Report of Two Cases and Brief Review of the Literature , Panagopoulos Dimitrios1 *, Mitsios Andreas2 and Sfakianos Georgios3
Introduction: Intracranial arachnoid cysts are considered to be congenital malformations with a predilection for the temporal fossa. They are often asymptomatic but can sometimes be symptomatic due to enlargement or hemorrhage [1]. Majority of arachnoid cysts, particularly those of smaller sizes, have a benign uneventful lifetime course [2]. Chronic subdural hematoma is one of the commonest diseases encountered by a neurosurgeon in daily practice. It is however rarely seen in young patients. Congenital arachnoid cysts have been implicated in both traumatic and spontaneous chronic subdural hematoma in young individuals. However, because most bleeding after trauma is delayed, it is often overlooked [3]. Arachnoid cyst - associated chronic subdural hematoma differs significantly from its counterparts without AC in epidemiologic, demographic, and clinical characteristics [4]. Optimum treatment strategies to address the chronic subdural hematoma and arachnoid cyst are not very well described [5]. We report two cases of Arachnoid cyst - related chronic subdural hematoma in young individuals, who were treated with evacuation of chronic subdural hematoma with craniotomy, without addressing the cyst itself. Fenestration and cerebrospinal fluid diversion should be reserved only as secondary procedures [5].
250 The Era of Customized Medicine, Challenges and Skills Required by Health Care Professionals , Hamid Yahya Hussain
Tailoring of medical intervention to patients has long history, dated back to Hippocrates times, in recent years the term has been risen in use, due to the growth of new diagnostic and informatics approaches yield with deep and better understanding of the molecular basis of disease, in specific the genomics. Another name is Precision medicine, which describes particularly, all procedure that categorizes the patients into different subgroups, with medical decisions, practices, interventions tailored to the predicted response or risk of disease. The concept interchangeably used to describe the terms personalized medicine, precision medicine, and stratified medicine. Saying that an individual’s health would be strongly linked to genetic variation, behaviors, and influences from the environment. Personalized healthcare thus, is going to be designed, based on the dynamics of biological systems as well as uses of predictive tools to evaluate health risks. Personalized health care plans will eventually help patients mitigate risks, prevent disease and to treat it with precision when it occurs.
251 A Case of Growth Retardation in a Child with STING Associated Vasculitis , Rami George Maalouf, Georges Nicolas and Yara Salameh
This is a case report of a 6 year old Caucasian male presenting for growth retardation. The child exhibited stunted growth, along with interstitial lung disease, 2 year history of poly-articular joint pain and peripheral erythema associated with vasculitic rash upon further investigation. He was diagnosed with SAVI syndrome; an autosomal dominant, type 1 interferonopathy with interstitial lung disease, systemic inflammation, and peripheral cutaneous and joint involvement.
252 Chief of Neurology of the Hospital Center of the Presidential General Staff Mexico , Miranda Nava Gabriel
As I commented previously, alcoholism is by far the addiction with the highest prevalence and incidence in our country; only in 2011 were detected around six million people with a harmful consumption of alcohol, and that they developed some of the 52 diverse conditions already described.
253 Notes about Diabetes , Miranda Nava Gabriel
Diabetes Mellitus (DM) comprises a heterogeneous group of chronic, systemic diseases of unknown cause, with varying degrees of hereditary predisposition and the participation of various environmental factors that affect the intermediate metabolism of carbohydrates, proteins and fats that they are physiopathologically associated with a deficiency in the quantity, chronology of secretion and / or in the action of insulin [1-10]. These defects result in an abnormal rise in blood glucose after standard glucose loads and even in fasting as there is greater decompensation of insulin secretion [11].
254 Sleep Problems and Road Accidents , Miranda Nava Gabriel
Traffic accidents are considered a public health problem and demonstrate several causative factors that include sleep deprivation, hours and hours of driving without rest, drugs with sedative action (anxiolytics, hypnotics, tricyclic antidepressants and antihistamines), sleep disorders ( SAOS, narcolepsy), and alcohol consumption.
255 The Current Problem of Oral Health Due to Improper Tooth Brushing in The State of Mexico , María Elena Villaseñor Martínez*
In ancient times the importance to oral hygiene was already taken, diseases were often considered a punishment of the gods for offenses inflicted on them. Subsequently, dental caries was attributed to vitiated bodily fluids or worms. The medicine of Greek and Roman times are the problems of teething (Hippocrates, 460-377 BC, Galen, 130-200 AD) persistent milk teeth (Celso, 25 BC JC 50 Be JC) and the presence of erupted teeth in newborns (Pliny the Elder, 23-79 AD JC).
256 Effects of Workplace Stress on Hong Kong Employees’ Heart Rate Variability , Adrian Low*, PsyD and Rollin McCraty, PhD
Research on workplace stress measurements varied without much accuracy and effectiveness. The objective of this study was to introduce a new quantitative, assessment tool emWave Pro Plus (Institute of Heart Math) and to compare Heart Rate. Variability (HRV) results with the Personal and Organizational Quality Assessment (POQA) and the Perceived Stress Scale (PSS). Eightyfive (85) full-time employees, who were working at least 40 hours per week in a large corporation, participated in this study. Firstly, signify cant negative correlations were found between Subjective Stress and HRV measures: Perceived Stress and 5-minute Mean Inter-Beat-Interval (IBI), r=-0.217; Perceived stress and 5 min SDNN, r=-0.255 and Perceived stress and Ln 5 min RMSSD (Ln means the natural logarithm), r=-0.282. Secondly, significant negative correlations were found between age and the HRV measures: 1-minute SDNN (r=-.235, p<0.01); 5-minute SDNN (r=-0.290, p<0.01); 5-minute RMSSD (r=-0.395, p<0.01); Total Power (r=-0.272, p<0.05); Very Low Frequency (r=-0.215, p<0.05) and High Frequency (r=-0.402, p<0.01). Thirdly, significant negative correlation was found between Normalized Coherence and Relational Tension (r=-0.222, p<0.05). Additionally, significant positive correlations were found between Emotional Stress and the Mean Heart Rate Range (MHRR), r=0.216 and between Intention to Quit and 5-minute Ln Very Low Frequency (VLF), r=0.234. The research shows promising results and future studies should continue to tap into HRV as an objective measure of mental health and workplace stress.
257 The Changes of Electrocardiogram in Neuroleptic Cardiomyopathy , Volkov VP*
The data of medical records of 81 patients with schizophrenia who died (men – 58, women – 23) were retrospectively studied, almost two thirds of them were aged from 41 to 60 years. Three groups of observations were identified: group me (comparison) – 12 patients receiving antipsychotic therapy, but did not have a cardiac pathology; group II – 44 patients with NCH in the latent stage; group III – 25 patients with manifesting disease (developed and terminal clinical stages). 406 electrocardiograms were analyzed in groups 53, 282 and 71, respectively. Eight most common electrocardiographic signs are considered. Dynamics of certain characteristics was shown to be of value for early diagnostics of neuroleptic cardio toxic side effects.
258 Assessment of Nurse’s Knowledge About Glasgow Coma Scale at al Dhafra Hospitals, Abu Dhabi, United Arab Emirates 2018 , Ahmed Yahya Ayoub1 , Ahmed Saifan2 , Mohammad Alaween1 , Eida Saeed Almansouri1 , Hamid Yahya Hussain3 *, Nezar Ahmed Salim4
Background: The most important assessment in the neurological examination is to assess the level of consciousness (LOC), which is considered as the first step in neurological examination. Detecting the changes in level of consciousness depends on the accuracy of nursing assessment. The nurses should be knowledgeable, confident, and quick in performing this task. Purpose: of this study is to assess UAE nurses’ knowledge about GCS working in Al Dhafer Hospitals, Abu Dhabi, United Arab Emirates. Methodology: This study was carried out in the Dhafra hospitals, Abu Dhabi, United Arab Emirates in April 2018. It is a cross-sectional, descriptive study. Eighty-five nurses met the inclusion criteria, the survey was sent to 165 nurses (Respondent rate 51%). Data collection was carried out using a survey monkey instru¬ment called “Glasgow Coma Scale”. Data coding, entry and analysis has been conducted using SPSS 20 software. The difference has been tested at 95% level of significance, and the difference that has P-value < 0.05 was considered significant. Results: The study revealed that the knowledge percentages mean of correct answers about GCS is 56.1 % {SD: ±11.7; 95% CI: [26.67-100]}. On the other hand, it revealed also that the percentages of nurses who have a good knowledge about GCS were 50.6% and staffs whom have poor knowledge were 49.4 %. Moreover, the results revealed significant relation between gender and GCS training with level of GCS knowledge. Conclusion and recommendations: The present study showed that the nurses in Al-Dhafra hospitals reflect inadequate knowledge. This finding raises concerns about the importance of knowledge and skill in assessing GCS. Continuing education and practice on the use of the GCS tool are important. A Brochure and booklet should be designated and distributed to all nurses who working in critical care units and dealing with an unconscious patient. Specific and advanced courses about GCS should be conducted in Al-Dhafra hospitals.
259 Laparoscopic Hepatic Cyst Treatment Experience in a Second Level Hospital , José Arturo Vázquez Vázquez1 2* and Barrera is Socrates Salvador Barrera Hernandez1 2
Non-parasitic hepatic cysts occur in up to 5% of the total population; that presents one or more cysts, the incidence increases according to age and occurs more frequently in women between the 6th and 7th decades of life. It is considered that this pathology is due to the enlargement of the aberrant ducts formed during embryonic development, for which reason it is attributed that the formation of these is due to inflammatory hyperplasia of the ducts or to their obstruction with fluid retention [1,2]. The cystic fluid has a composition similar to that of serum, so it is not irritating to the peritoneum. They have cuboid epithelium, fibrous walls and chronic inflammatory changes [3].
260 Ovarian Dermoid Cyst: Ruqya and Negative Ions Treatment , Mira Bajirova
Dermoid Ovarian Cyst or Mature Teratoma, can be dreadfully looking because they look like a small human being in the ovary containing the teeth, hair, bone, endocrine tissue, brain, respiratory tissue, colon, eye, extremities and even penis. The world Teratoma is derived from “Theres”, the ancient Greek word for “monsters” and “beasts”. Additionally to the strange composition, the extra-ovarian location and diffusion, recurrence, occurrence in men and children, association with psychiatric demonic possession symptoms, the origin of the word Teratoma meaning “Monstre”, recovery with Ruqya treatment: all these prove the involvement of the hidden Evil Jinn as the name “Theres” indicates. Psychiatric symptoms initially were attached to the Anti-NMDA-receptor Encephalitis found in Ovarian Teratoma but later the same Encephalitis were found also in men, children and women without Ovarian Teratoma. This is also emphasizing the Jinn involvement including the family history, personal history of the patients. The best treatment is Ruqya associated to Negative Ions for the quicker and better results.
261 Pluri Psychopathology and Risk of Opioid Use Disorder , Teresa Lopez-Arteaga
Background: Psychiatric comorbidty is an important risk factor when predicting risk of opioid use disorder in chronic non-cancer pain. We present a case with gender dysphoria, in wich psychiatric comorbidity was not taken into account for de prescription of pharmacological treatment for pain. Case presentation: We report the case of a 51-year-old man with gender dysphoria, personality disorder, chronic pain disorder and opioid use disorder. For the last 9 years he has taken continuousy transdermal fentanyl prescribed by chronic non-cancer pain. Despite of presenting a pluripathology that discouraged the use of opioids in this patient, throughout his evolution, he has gone to different non-psychiatrists and has shown himself with a querulous, confictive and demanding attitude, so that he managed to keep on raising his dose of prescribed opioids. Conclusions: This case shows the importance of knowing the risk factors of consumption due to the use of opioids patients with chronic non-cancer pain, the importance of psychiatric comorbidity associated with prognosis and the neeed to know exactly how opioids are managed by some prescribers, as well as to carry out an interdisciplinary therapeutic plan to avoid risks.
262 Gastric Perforation in Ndola- Zambia: A Case Report , Duncan D Mugala1 *, Mwamba Simutowe2 , John Musongole3 , Anchindika Mugala4 and Chibale Benaya5
It is known that there is problem of gastric perforation (GP) in Africa, in the Japanese and the Western countries. However it occurs much less frequently [1,2]. Some cases have been free perforation and some have been major bleeding in patients with gastric cancer. Perforations are serious conditions with potentially dangerous effects however they are rare [3]. There is also evidence that neonatal gastric perforation (GP) does occur but it is a very rare event. It is associated with a poor prognosis and there is still much debate about its etiology [4]. It is believed that the perforation occurs in the lesser curvature and anterior wall of the stomach. Some authors think that gastric Perforation (GP), is caused by a mechanical rupture of the stomach wall, as a result of increased intragastric pressure, in adults, full-term and premature infants [5]. There is also a theoretical concern that the capnoperitoneum (Increased intra-abdominal pressure 10-12mmHg), may aggravate peritonitis and induce septic shock. It is associated with a poor prognosis [6]. The Gastric perforation is also seen that one of four ulcer perforations can be attributed to the use of nonsteroidal anti-inflammatory drugs, a risk factor of particular in the elderly [2]. In peptic ulcer or gastric perforation, Endoscopy and or Laparoscopy are being increasingly used in conditions even though there is complication of peritonitis [7-9].
263 Characterization of the Self-Knowledge on the Tobacco to Prevent Factors of Risks in Old Men , Jesús Cuéllar Álvarez
Background: tobacco consumption and its toxic consequences in elderly is an essential element in current healthcare work from the health professionals themselves. Objective: to characterize of the self-knowledge on the tobacco to prevent factors of risks in old men from the clinical psychology. Methods: a descriptive, cross-sectional study was conducted in a health area, where from a population of 60 there was a sample of 41 elderly with tobacco consumption belonging to the “José Ramón León Acosta” polyclinic in Santa Clara. Empirical and statistical methods, open interview and review of individual medical records were used. Results: the factors of risks of the consumption of tobacco and sex are the lung cancer (97, 6 %) , followed by the presence of cerebral heart attack (75,6 %) and hypertension with 70,7 %. The 70 % of the old men show to have a good knowledge on the harmful effects that it causes the tobacco for the health. In contrast with this 18 % of the old men refers to have had a bad own knowledge. Conclusions: tobacco consumption in elderly is a real health problem. It is very important to carry out health actions to prevent this toxic substance and factors of risks in the elderly from the clinical psychology.
264 Rhinophyma and Gnathophyma Concomitantly in a 54-Year-Old Female a Clinical-Histopathology Correlation and Review of the Literature , Erisa Kola1 *, Mehdi Alimehmeti1 , Gjergji Belba2
Rhinophyma (Greek “nose growth”) is a benign dermatologic disease of the nose [1]. It is characterized by a slowly progressive enlargement of the nasal skin, with irregular thickening and nodular deformation leading to an erythematous appearing nose. Phyma is the last stage of rosacea and is due to chronic inflammation and edema. Although the great majority of phymatous lesions occur on the nose (rhinophyma), they may also occur at other sites. It affects mostly men. Even though the exact cause of rhinophyma is unknown, it is believed to be multifactorial in origin with a principal etiology of unregulated superficial vasodilation. The main reasons that urge the patients to seek help are functional and cosmetic impairments, such as nasal obstruction or disfigurement. Surgical removal of the hyperplastic tumor mass is the treatment of choice for rhinophyma. The aim of the article is to present an update on the pathophysiology, clinical features and treatment of rhinophyma and gnathophyma in a 54-year-old female patient.
265 The Quantum Theory of Entanglement and Brain Physics , Shantilal Goradia
Entanglement is a century old issue. Our current knowledge of quantum mechanics provides a considerable experience on the subject of reality. Gravity is a subject of force. Forces experienced by the interaction of quantum particles are called the fundamental constants of Nature. Here, we say that constants of Nature have special significance for the fundamental cause of gravity. Physics is on doldrums without incorporating a theory of entanglement, quantum gravity, constants of nature, perceived abundance of dark matter, conflicts between collapsing wave functions and logistics, and biology involving the brain including consciousness.
266 Treatment of Endometriosis and Leiomyoma with the Association of Miodesin and Gestrinone in Pentravan Through the Vaginal Route , Hugo Maia1 *, Wilson Saback2 , Clarice Haddad3 and Paulo R Sitya4
Introduction: The effects of Myodesin™ (Fagron, Brazil) on uterine volume and pain scores were investigated in a group of patients with leiomyoma and endometriosis. Myodesin™ was used either alone or in combination with vaginal gastronone. Patient and Methods: Forty two patients with uterine leiomyoma and endometriosis were enrolled for this study and divided into 3 groups according to the treatment scheme. In Group A (n=16) they were treated with a higher dose of vaginal Gastronome alone (5mg twice a week). In Group B (n=16) patients received a lower dose of Gestrinone (2.5 mg twice a week) together with vaginal Miodesin™ (500 mg/dose daily) (Fagron Brazil). In Group C (n=10) patients were treated only with Miodesin™. All medications were dispensed vaginally dissolved in Pentravan™ (Fagron, Netherland). Results: The average uterine sizes before treatment were 200 cm3, 334 cm3, 242cm3 in group A, B and C respectively and they were not statistically different. After the second month a significant reduction in uterine volume was observed in all treated groups. However the reduction in uterine volume was greater in group than in group C. The proliferation rates in both stroma and endometrial gland measured by Ki-67 were low with a mean value of 2% with no significant differences between groups A and B. Treatment with Gestrinone decreased significantly total pain scores (VAS) when used either alone or in combination with Myodesin™. However this decrease was significantly greater in Group B than in Group A.Treatment with Miodesin alone (Group C) also decreased significantly pain scores. Conclusion: Miodesin treatment increased the efficacy of Gestrinone to reduce pelvic pain and uterine volume in patients with endometriosis and leiomyoma.
267 The Sub-microscopic Pathology of Brain Extracellular Space in Some Neuropathological Conditions. A Review , Orlando J Castejón*
The enlargement and content of perivascular and extracellular spaces in experimental and human material have been reviewed. The human edematous cerebral cortex associated to vascular anomaly, congenital hydrocephalus, brain trauma, and brain tumors were examined by transmission electron microscopy, using cortical biopsies of frontal, parietal, and temporal cortex. In congenital hydrocephalus, the pre-existing extracellular space that features immature cerebral cortex appears notably enlarged and occupied by electron transparent, non-proteinaceous interstitial edema fluid, due to the abnormal accumulation of non-circulating cerebrospinal fluid. In severe human brain trauma associated to subdural or estradural hematomas and brain tumors, the distended extracellular space contains either electron lucid non-proteinaceous edema fluid, and electron dense proteinaceous edema fluid, fibrinoid material, exosomes or extracellular vesicles, extracellular mitochondria, hemorrhagic foci, and non-nervous invading cells, such as phagocytic astrocytes, macrophages, microglia, and monocytes. In brain tumors, the widened extracellular space shows mainly electron dense proteinaceous edema fluid, and bundles of fibrinoid material and extracellular vesicles.
268 Kimura’s Disease in a Female Patient: Case Report and Review of the Literature , Ayman A Salman1 , Omar H Abu-Zaydeh2 and Mohammed M Maree2 *
Kimura’s disease is a rare chronic inflammatory disease of uncertain cause, manifesting commonly as a painless swelling of the subcutaneous tissue in the head and neck region with predilection for peri auricular areas. A significant increase in serum levels of immunoglobulin E and eosinophilia in the peripheral blood and in tissues has been associated with this disorder. Many cases of nephropathy in patients with Kimura’s Disease had been reported in the literature. Excisional biopsy for histopathological evaluation is the only way to confirm the diagnosis of Kimura’s Disease. We report a case of Kimura’s disease in a 26-year- old female patient who presented to our clinic with painless right retro-auricular swellings.
269 The Role of Reiki in the Medicalsetting to Reduce Stress and Relieveanxiety , Rita Glassman
Reiki is an ancient healing art recognized by the National Institute of Health as a form of alternative medicine. It is an energy therapy based on the belief that an unseen energy flows through all living things and directly affects the quality of a person’s health. This belief has been part of the wisdom of many cultures since ancient times.
270 A 5-Year Analysis of Spinal Infections at a Neurosurgical Department in New Zealand , RD Biju*, S Rajadurai, J Rowland and L Jani, Z Hussain, T Muthu, P Gan and S Raunio
A spinal infection is defined as an infectious disease that affects the vertebral body, intervertebral disk or adjacent paraspinal tissue [1]. The main routes of infection include hematogenous spread, direct inoculation into the region by spinal surgery or other minor procedures and direct extension from adjacent infected tissue [2- 4]. A native/de-novo infection is one that occurs without any prior intervention to the natural human body. Although this disease is considered uncommon in developed countries, its incidence is on the rise [5]. Diagnosis is often delayed because of its rarity and presentation as vague signs and symptoms.
271 Rush Immunotherapy Using Ifn-Gamma for Cefazoline Allergy , Geunwoong Noh1*, Bum Soo Kim2 and Chang Won Ha3
Cefazolin is a first generation cephalosporin widely used for preoperative antibiotic prophylaxis. Although cefazolin hypersensitivity constitutes a potential life-threatening condition with serious consequences, correct diagnosis of cefazolin hypersensitivity is not straightforward for various reasons. A graded challenge is perhaps the most reliable in vivo test for the diagnosis of cefazolin allergy. Desensitization is performed by the cautious administration of incremental doses of the drug to the patient. In the case of intravenous drug, the challenge and desensitization has been regarded as extremely dangerous. IFN-gamma has allergen-specific tolerogenic effects, together with the administration of allergens. Moreover, IFN-gamma was introduced for desensitization for aspirin and cefaclor. In this case report, two cases were described concerning challenge test and desensitization for anaphylactic drug allergy for intravenous cefazolin using IFN-gamma.
272 The Effectiveness of Nanomaterials in the Management of Dentine Hypersensitivity-A Review , Stanley Chibuzor Onwubu1 *, Phumlane Selby Mdluli2 and Shenuka Singh3
Dentin hypersensitivity [DH] associated with short sharp pain is a public health concern with a dire consequence to good oral health hygiene. Although different materials and desensitizing toothpastes have flooded the market with claim to provide relief for DH patients by occluding patent dentinal tubules, their occluding abilities have been limited. As such, a new strategy it’s required to effectively manage DH. The use of nanomaterial for dentinal tubules occlusion is predicted to revolutionize the treatment of DH. This article aimed to review the effectiveness of nanomaterials in the management of DH.
273 A Permanent Cure for Vitiligo: Immigration of Healthy Skin Cells to Unhealthy Sides of the Skin in Vitiligo Through a New Treatment , Akbar Mohammadrezaei* and Nooshin Mohammadiasl
This article is about a skin disorder which manifests itself as white patches (pigment destruction) in different locations of the body. There are many classifications for this disorder such as segmented, focal, generalized and universal vitiligo. In my article, I have mentioned some of the current methods used in the treatment such as UV rooms. However, there are many risks and long term side effects to this treatment. Besides at the end of the treatment, the patient leaves the clinic in disappointment and without being treated. I was suffering from the same disorder for 14 years, so I can feel how deep is the depression and suffering of those vitiligo patients. My motivation behind the discovery of this treatment was me myself. I was suffering from the same disorder. It was so painful to be out in the society where everybody gazed at you and some were even afraid to talk to you. Because of my economic issues, I did not have access to labs and research centesrs. So I studied a lot and broadened my understanding and knowledge abut human body and biology. After I dicovered the treatment, I cured myself in 5months and then many more patients from England, Iran, Turkey and Azerbaijan. In my article, I have written about some blood tests the patients have to take. I have also mentioned the vitamins, pills and the creams they should use (different for kids and adults). My only intention for writing this article is to let all my colleague dermatologists know about the new treatment. Moreover, the whole treatment takes 5 months or so and is affordable by everybody. If the patients follow the simple advice mentioned in the article, the disorder will not come back. I would kindly ask you to go through my article and read it deep. I have treated myself and many others, so I can replicate the treatment on the cases given by you. The treatment and progress is visiblr from the first month.
274 Tango Therapy: Current Status and the Next Perspective , Youngsoon Koh1 , IC Soo Kim2 and Geunwoong Noh3 *
Dance is basically a complex physical activity which either casually or formally organized in which people take part for fitness, health and well-being, social relationships or competition and a worldwide human activity that involves complex whole body movements through space synchronized to music. Dance-related reviews of evidence have examined the effectiveness of dance therapy on psychological and physical health and well-being outcomes in patients with cancer, for schizophrenia, and on depression. Dance therapy was officially described firstly in 1948. The medical application of dance therapy was well reviewed in neurologic conditions. Dance has been used extensively for the treatment of gait and balance dysfunction in individuals with Parkinson’s disease. Especially, Argentine tango is the most frequently employed dance form in the treatment of Parkinson’s disease. Tango therapy may hold promise as an intervention to improve gait, balance, and mobility in a variety of neurological conditions. Tango therapy was approached from dance therapy to the current status of medical application. A more systemic analysis of tango movement for proper and effective therapeutic application of tango is necessary for medical purposes.
275 Aggressive Surgical Cancer ASC Protocol to Cure Cancer , David Andrew Yeung
In 1987, after my Fellowship in Cardio-Thoracic Surgery in the USA: THI (Cooley-1977), St Vincent Hospital (Kay-1978) - where I started dreaming about the Ideal Heart-Lung Machine IHLM which “can extend so much our therapeutic range” and “save millions of hearts, lungs and limbs”, I wrote the Blue Thesis on Controlled Hibernation and Transplantation CH & T which aimed at saving 60 million of lives yearly and at a new Era in Transplantation.
276 Features of Intellectual Disability Information System: A Comparative Study , Mozhgan Karimi1 , Farkhondeh Asadi2 , Hamid Moghaddasi2 * and Reza Rabiei2
The aim of this paper is to review the literature related to intellectual disability information systems in the United States, England and Southern Ireland. Electronic databases were used to collate data using key terms such as intellectual disability, service providers, integrated service delivery, organizational structures and features of intellectual disability information system; exchanged data among service providers. This review of the literature presents features of intellectual disability information systems in studied developed countries. It highlights importance of applying integrated and collaborative approaches in providing services as well as exchanged information among the service providers. The study helps to identify what is needed to improve intellectual disability information systems in orderto promote appropriate and more effective service management.
277 Ruqya and Negative Ions Treatment , Mira Bajirova
“The Quran is the most complete cure from all physical and psychological illnesses - the illnesses of this World and the illnesses of the Hereafter. How can a disease overcome the speech of the Lord of the Heavens and the Earth, the speech which if it was sent upon a mountain, would render that mountain to dust? The speech that if it was sent upon the Earth, would break the Earth into pieces? There is no illness of the heart and the body except that the Quran contains the means to guide how to cure it, why it happens, and how to protect from it, for those whom Allah gives the understanding of his book. As for the diseases of the heart, Allah mentions them in detail along with their causes and the method of curing them.” “Whoever abandons the Quran would abandon treating sickness and seeking healing through it-i.e., the Quran.” (Al-Fawaa’id Ibn Qayyim, p.156). Allah the Almighty created the nature with amazing healing power due to the high concentration of the Negative Ions; He “…sent down upon you from the sky, rain by which to purify you and remove from you the evil (suggestions) of Satan and to make steadfast your hearts and plant firmly thereby your feet.” (Quran, Al Anfal, 8:11).
278 Testimonies of the Nurses from Lipik of the Homeland War , Ljerka Pavković* and Mirjana Cahun
The story “Testimonies of the Nurses from Lipik of the Homeland War” was created according to archive photographs collected by war cameramen whose materials were used to write historical documentation for the town of Lipik. The aim was to authentically show the city’s tragedy, sufferings of civilians, the supernatural efforts of the defenders of Lipik, human destinies and all the other horrors only war can bring. The destruction and revival of the city with a great historical heritage was witnessed by nurses participating in those war events. Before the Homeland War, Lipik was a beautiful town known for its thermal water, health resort, hundred-year-old park, beautiful promenades, horses, dance halls, pools and everything that can help a healthy person feel healthier and the sick to get the care they need. In the early morning of a summer day an aerial bombing attack broke off all the beauty of life in Lipik. It was August the 19th 1991, 5 a.m. The children’s home, hospital, school, church, stables and civilian objects were all devasted by the falling grenades. How they felt, what they were thinking, what they were doing, how they organized and what was most difficult is told by the surviving nurses who bravely participated and aided defenders and people in the war. After the liberation of Lipik on December 6th 1991, the city returned to life bit by bit. The contribution of nurses will remain permanently recorded in the history of Lipik and the Republic of Croatia in connection with the organization of palliative care in the country and the Society of Nurses of the Homeland War of the Croatian Association of the Croatian Association of Nurses.
279 Outcome of Precontoured Anatomical Plate in Displaced Middle Third Clavicular Fractures , KC (Ghimire) Milan, Pandey Dipendra*, Bhandari Pratap Babu and Pokhrel Jhapindra
Introduction: Non operative treatment for middle third clavicle fractures remained the mainstay for until last two decades. But due to the prevalence of nonunion, symptomatic malunion and shortening for displaced fractures, now the trend has shifted towards operative management. Our study is aimed at prospectively evaluating the functional outcome of 120 patients treated with open reduction and plating with precontoured anatomical plate. In addition to patient demographics, this study also estimates the rate of fracture union, lists the complications of clavicular plate fixation, estimate the time of clinical and radiological union of fracture and functional outcome in terms of DASH score. Methodology: 120 patients from 16 years to 60 years of age, with displaced (>2cm ) and/or shortened (>2cm) or comminuted middle third clavicular fractures were included in this prospective observational study conducted in Bir Hospital and National Trauma Center over a period of four years. Open reduction and internal fixation with precontoured anatomical plate was done. Postoperatively the arm is held in a sling for about 3 weeks with intermittent pendulum exercise of the arm after one week or as soon as the pain is tolerable and passive and active range of motion exercise started after four weeks of the surgery. Patients were followed up on 2, 6, 12 and 24 weeks. Functional outcome was assessed using DASH score and radiographs taken. Statistical analysis was done using SPSS v 22 for Windows. Results: Mid clavicular fractures were more common in males than in females and left side was more common than right. Younger age group was more commonly affected. All fractures united in a mean radiological union period of 7.1 weeks. 6 cases developed pain, 23 had hardware prominence, 5 case developed superficial infection and none had shoulder stiffness. DASH score was at a significant negligible level by 24 weeks. 98% of patients returned to their work by 12 weeks. Conclusion: Open reduction and internal fixation with pre-contoured anatomical plate in displaced middle third clavicular fractures is a safe procedure that avoids complications associated with non-operative management and provides good functional outcome with early return to pre-injury activities.
280 Documents Review about Elderly People’s Fear of Falling , Tomoko Matsunaga
I investigated fall prevention in a women’s learning society for M City to plan the spread of fall prevention classrooms for elderly people. Also, 10% of people said they had a fear of falling. From this investigation, I was surprised that people didn’t know about the fall prevention classroom even though some people were scared of falling. Therefore, to raise awareness, I performed a review of documents about elderly people’s fear of falling and examined the present conditions and problems. In Medical Online, there were 13 documents from until 1999 through 2016. CiNii had 36 documents, and Central medical journal had 40 documents. From these, I extracted 20 documents and examined them. It is said that people who have fallen before have a higher chance of falling again, but simple fear is not the only factor putting people at risk. Other factors include physical pain resulting from their fall, the cause of their previous fall, loss of independence, and the physiological fear of being a burden on other people. Previas experience with falling is not the only factor, the combination of body function and sense of fear is also a factor.
281 Correlations between Hand Ultrasonography Changes and Autoantibody Profile in Patients with Systemic Sclerosis , Mazur Anna1 , Walecka Irena2 , Wislowska Malgorzata3 * and Kubera Lukasz4
Aim: To assess hand ultrasonography changes in systemic sclerosis (Ssc) patients and find a potential correlation of autoantibody profile Materials and method: 59 SSc patients, 40.7% dsSSc, 59.3% lcSSc, were hands US examinations, laboratory test, ESR, CRP, anti-Scl70, ACA, anti-RNAP III antibodies, anti-CCP, RF. Results: Sclerosing tenosynovitis occured significantly more frequently in dcSSc patients than in lcSSC: in 4 out of 24 (16.7%) with dcSSc vs none (0%) out of 35 with lcSSc (p=0.0233). Anti-Scl70-positive patients increase ESR and CRP was observed – 61.5% (p=0.0014) and 29.0% (p=0.0420) respectively. Swelling in the hands soft tissue in 7 (21.9%) out of 32 anti-Scl70-positive patients vs 1 (13.7%) out of 27 anti-Scl70-negative (p=0.06) were observed. Sclerosing tenosynovitis occured only in anti-Scl70-positive patients. Inflammatory tenosynovitis occured statistically significantly often in males (in 3 (33.3%) out of 9) than in females (in 1 (2%) out of 50) (p=0.0095). It was observed that synositis, inflammatory and sclerosing tenosynovitis, severe inflammation in the hands soft tissue US examination occured statistically significantly often in patients with dsSSc (p=0.0006) as well as positive anti-Scl70 (p<0.0001), and significantly less than in ACA-positive. Synovitis occured in 20 (33.9%) out of 59 patients with Ssc. No patient was found to be anti-CCP antibody positive. Conclusion: The hand ultrasonography features correlate with the clinical picture of SSc as well as the antibody profile, hand US may be used as a tool to assess the disease activity, as well as a predictive factor during the course of the disease.
282 Solving Heterogeneities in Defibrillation for a Vascular Remodel of the Human Heart , Arianna Pahlavan
Introduction: Current mathematical models impede the amelioration of defibrillation protocol. Heterogeneities such as intracellular clefts, scarring, blood vessels, and fiber orientation are excluded in modeling. Such geometries pose a positive curvature, magnifying resistance when faced with electrical shock. Thus, such geometries have the potential of revolutionizing AED machines-a prospect we have not gained enough data on to consider. Objective: The purpose of my study is to quantify the effect of each non-conformity in relation to the electrical dynamics of the human heart. Post-quantification, I hypothesize that the electrical impedance decreases as the heterogeneity size decreases. Posed with such a window of pertinence, my goal is to remodel the human heart including all heterogeneities-a previous infeasibility. Methodology: Using CHASTE cardiac software library, electrical shock was applied to cardiac tissue engineered in Mesh Lab. Cardiac tissue, the slab geometries, contained blood vessels in the center of varying vessel size-400, 200, 100μm. Results: Overall, the results showed that without heterogeneities biological reality and computational modeling have severe discrepancies; mainly, the experimentally supported therapy of low-energy ant fibrillation shows failure in math modeling. Perpendicular fiber orientation perceived shock at a 1.74x more efficacies. In the most sensitive case scenario, 400 and 200μm affected the defibrillating wave-front, while the 100μm heterogeneity did not. Conclusion: All heterogeneities cannot be extracted by magnetic resonance angiography due to its limiting factor of magnetic susceptibility; however, by filtering can anatomically accurate mathematical remodel capable of representing the necessary cardiac vessels is created.
283 Computational Modeling, Neuroscience, and Visual Algorithm , Nydia J Gutierrez
Computational Modeling and Visual Algorithm allows for the creation of a Visual cognitive diagram that explains areas of the brain they represent to spatial abstraction and mental calculation. For example, the temporal lobe is associated with memory and the occipital lobe is associated with vision. The cerebral cortex is where decision- making, thinking, and information process takes place. Moreover, in the frontal lobe is where decision making, takes place and the parietal lobe influences areas of the brain that correlate to spatial calculation and mind mapping. This is created in a diagram that expresses each area like a visual algorithm. A visual algorithm is created in different scales that are associated with numerical numbers and the frontal lobe sub division [1]. The creation of this visual algorithm explains the nodes and the functioning of the levels of the brain and neuroscience. The connection and the functions of the brain control our learning, motor content, and mayor nerve connections. The visual algorithm present an abstract and perception pattern to look at thinks. It connects with the nodes that affect our cognitive human perception factor. The lobes of the brain resemble this area and provide an in-depth understanding to what a cognitive hierarchy is. The lobes are important factor to the perception of thinking, learning, and memory. Each one with a significant function to learning and neuroscience [2].
284 Human Memory and Recall: Bridging the Gap between Encoding and Recall of Information , Tamara McGill-Carter* and Iva Kolarov
This article/packet includes a proposal that presents that the student is intending to conduct the research on memory encoding by including research questions, a purpose statement, and a problem statement so to give an outline of why such a subject should be researched and/or studied. The literature review is presented secondly as it gives detailed information into the subject of memory, although it summarizes previously published research. Data on Time Decay, certain genes involved in memory encoding, and even experiments replicated from previous researchers are included as well. Lastly, peripheral documents are included as they tie the entire packet together such as the chosen journal publication criteria, the letter to the editor of the journal the author has chosen, and the actual article itself.
285 Adenoidal Hypertrophy and Physiotherapy , Julia Lomaeva
Adenoid hypertrophy (AH) refers to the most common pathology of pediatric otorhinolaryngology. The lymphatic pharyngeal ring plays a leading role in creating the immune barrier of the upper respiratory tract. In this regard, the conservative methods of therapy that do not require surgical intervention and ensure the preservation of the immune protection are more relevant.
286 Therapeutic Apheresis in Oncology , Voinov VA*, Orlov SV, Karchevsky KS and Isaulov OV
Background: Given the steady growth of oncologic diseases incidence worldwide, their treatment still remains not effective enough. The used methods of radio- and chemotherapy are associated with severe intoxication, underlying thanatogenesis. Besides, the tumor process is also associated with increasing intoxication. Objective: To study pathogenesis of tumor endotoxemia, radio- and chemotherapy complications, and to discover possibilities to use extracorporeal methods of detoxification and immune correction in treatment of malignant tumors. Method: To review the world literature concerning tumor conditions treatment complications and methods of their correction; to use own methods of extracorporeal detoxification and immune correction. Results: WHO reports present rather discouraging findings about a significant increase of patients with malignant tumors for the last 30 years and remaining rather high level of death rate. Using plasmapheresis weekly during the course of radiotherapy for pancreatic cancer was able to prevent a lot of complications and continue the treatment. There is a report about using plasmapheresis with lymphocytes isolation ant their incubation with roncoleukin (IL-2) in patients with small-cell carcinoma of the lungs. They show a significant increase of IL-2, TNFα, and interferon serum concentration in the patients, and their survival rare increased from 0.5 to 2-2.5 years. Conclusion: Extracorporeal detoxification and immune correction can help eliminate endotoxemia and improve the treatment outcome. At the same time, higher doses of chemotherapeutic agents can be used.
287 Recording Vital Signs: A Neglected Nursing Practice? , Bellini Rosa Leda, Damasceno Marilia M, Restituti Ana Carla PL* and Machado Mara M
Vital signs are patient’s health status indicators and their measurement and interpretation at opportune moments contribute to the early diagnosis of clinical deterioration and implementation of interventions. The IQG surveyors observed the lack of registration of vital signs during their visits, noting the need to evaluate this practice in IQG’s Health Services Accreditation Programs. The objective of this study is to verify the recording of vital signs in the patient’s chart considering the completeness at the opportune moments. The data was obtained between April 2017 and March 2018 by IQG surveyors during national and international accreditation visits to 141 hospitals participating in Health Services Accreditation Programs. The recording completeness of the eight vital signs (blood pressure, respiratory rate, heart rate, body temperature, pain, pulse oximetry, level of consciousness and urinary output) was checked by hospital. At each visit, between 05 and 07 records of patients admitted to open clinical and surgical care units were randomly examined. In the absence of registration of vital signs in one of the medical records, it was considered that the hospital does not present completeness. Evidence for the recording of vital signs at the appropriate moments (hospitalization, transfer of care, immediate postoperative period, nursing prescription and risk score result) defined the completeness criterion in a sample of 141 hospitals. The data were collected from 141 hospitals. At appropriate times, heart rate and blood pressure was recorded in 96% of hospitals and heart rate, blood pressure and body temperature in 81%. The completeness of vital signs at opportune moments was evidenced in 65% of the hospitals. The next challenge of IQG will be to understand the reasons that lead the nursing team to neglect the measurement, recording and interpretation of vital signs in clinical practice.
288 Epidemic Keratocunjunctivitis Treatment and Management , Hristian Duma and Valvita Reci*
Epidemic keratoconjunctivitis (EKC) is a viral conjunctival and corneal inflammation with high contagiosity, which, if is not adequately treated, may cause blurred vision for several years. The purpose of this study was to describe the clinical and epidemiological characteristics of adenoviral keratoconjunctivitis, as well to present the latest news regarding diagnosis, treatment and prophylaxis. Are known two well-defined clinical syndromes of adenoviral keratoconjunctivitis: epidemic keratoconjunctivitis and faringococcal fever, which are caused by various serotypes of adenoviruses. The exact incidence of adenoviral keratoconjunctivitis is not known. However, it mainly occurs during the winter months. Infection can occur during direct contact or through equipment, devices in ophthalmologic ambulances, etc. The virus is extremely resistant to various chemical and physical agents. Symptomatology is similar to other types of conjunctivitis, with high incidence of conjunctival pseudo membrane formation. In the cornea, the changes varying from epithelial punctate keratitis to sub epithelial infiltrates and the creation of nummular keratitis that leads to visual impairment. Diagnosis is mainly clinically decided, and etiology can be confirmed based on cell culture analysis. Conclusion: Until now there is no approved therapy against epidemic adenoviral keratoconjunctivitis. Uncontrolled use of antibiotics, particularly corticosteroids, which reduce tissue resistance, is responsible for the deterioration of such conditions. Priority in prevention EKC is the rigorous application of hygienic disinfectant measures in hospital areas, respectively medical devices in ophthalmologic ambulatory services.
289 Antagonistic Effect of Flumazenil on Isoflurane in the Emersion of General Anesthesia , Javier E Moreno S*, Juan Carlos Padilla and Jonathan De Freitas H
Introduction and Objectives: Isoflurane, an inhalational general anesthetic widely used in medical practice, belonging to the group of volatile liquids together with desflurane and sevoflurane. Volatile inhalational anesthetics (halogenated) as mechanism of action, has the property of increasing inhibitory synaptic transmission at postsynaptic level by potentiating ion channels regulated by ligand activated by alpha-amino butyric acid (GABA). Flumazenil is a benzodiazepine. It is currently known that there is no specific drug capable of antagonizing the effects of halogenates that allow the rapid and complete recovery of general anesthesia, for this reason this work focuses its efforts on demonstrating whether flumazenil has the ability to reverse the actions of the patient. Isoflurane and allow an early restoration of the level of consciousness. Materials and Methods: The study to be performed is a clinical type of longitudinal, prospective, unicentric and double blind. The sample will be formed by patients who are going to be subjected to a balanced general anesthesia. The sample will be divided into 2 large groups: group C (control) and group F (Flumazenil). At the end of the surgery, the mixture will be administered according to the selected group in a random manner (Flumazenil 0.25mg or 0.9% solution in a 20cc syringe) and the time of extubation, recovery time of the level of consciousness, time of discharge UCPA and hemodynamic state (FC, TAM and SO2). Results: The flumazenil group showed a significantly shorter time from injection to extubation than the placebo group (p = 0.007). Differences in terms of shorter times needed to achieve Aldrete of 9 points in the flumazenil group (P = 0.04) were observed as were shorter anesthetic arousal times represented by a Ramsey 2. Heart rate, mean arterial pressure and saturation they had similar values between the 2 groups. Conclusion: The study showed that a single dose of 0.25 mg of flumazenil administered at the end of the surgical act, just after completing all surgical stimulation was beneficial (P = 0.007) in the context of extubation times and shorter anesthetic arousal times.
290 Utilization of Bio Impedance Spectroscopy in lieu of Invasive Monitoring for Monitoring Fluid Overload , Andrew J Accardi1 * and J Thomas Heywood2
Congestive heart failure (CHF) has become one of the most common diagnoses and a leading cost concern for Medicare and insurance companies. The majority of costs associated with CHF surround hospitalization and re-admissions. As a result of these rising costs, there has been a push to identify early markers of impending congestion as a surveillance tool and possible measure of effectiveness of treatment. The measurement of diastolic pulmonary artery (PA) pressure from invasive devices has been shown to be useful in the management of New York Heart Association (NYHA) class III heart failure (HF) patients. It has been suggested that bio impedance spectroscopy (BIS) could be used as a surrogate for volume overload, offering a non-invasive option for patients. We present a case of a NYHA class III HF patient with end stage liver disease. The patient had previously been implanted with a Cardio MEMS device. Over several weeks, diastolic PA pressures and weight were compared to BIS measures from a SOZO, (noninvasive fluid monitoring system). The use of BIS to estimate extracellular fluid accumulation shows excellent correlation to both diastolic PA pressure and weight, suggesting a use for non-invasive monitoring
291 Congenital Fibrosis of the Extra-Ocular Muscles Syndrome , Shahin Asadi*, Hossein Amjadi*, Gholnesa Valizadeh and Mohammadreza Aranian
CFEOM Syndrome is prevents the normal development and function of these muscles. As a result, people under the influence of the syndrome cannot move their eyes regularly. CFEOM1 syndrome and rare cases of CFEOM3 are caused by the mutation of the KIF21A gene, which is based on the long arm of chromosome 12, 12q12.
292 Prevention of Lymphatic Complications after Pelvic Laparoscopic Lymphadenectomy by Microporous Polysaccharide Absorbable Hemostat , MV Gavrilov1,2, IA Lapina1,2, VV Taranov1 * and Yu E Dobrokhotova1,2
Introduction: One of the mandatory components of radical treatment of patients with endometrial cancer is the impact on regional lymph nodes. Nowadays, pelvic lymphadenectomy remains not only therapeutic, but also a diagnostic method in case of predicting the effectiveness of treatment. However, it is important to point out that there are a lot of complications which can occur after dissection of lymph nodes. Lymphorrhea and lymphocele are among the most common postoperative complications of pelvic lymphadenectomy, with a reported incidence of 1% to 50%. Except for the occurrence of undesirable symptoms it can increase the time of drainage standing, which contributes to the delay of further stages of combined treatment. The aim of the study: The aim of the study was to evaluate the effectiveness of the intraoperative application of micro porous polysaccharide absorbable hemostat taking into account the functional outcomes to improve the long-term results of surgical treatment. Materials and methods: In order to solve the tasks, we analyzed the treatment of 12 patients with verified diagnosis of endometrial cancer. We divided the patients in 2 different groups. The first group included patients with polysaccharide absorbable hemostat application (6 patients). The second one (control group) included patients who were provided, according to traditional methods, without using polysaccharide application (6 patients). All patients underwent ultrasound examination on postoperative days 7, 14, 28. Groups were comparable in age, risk profile, and lymph node numbers. Postoperative drain loss and development of early and late lymphocyte were analyzed. Results: Group 1 showed a lower drainage volume and in this group there wasn’t any lymphocyte development. But the control group (group 2) showed 4 occasions of lymphocyte formation. Also two of them were symptomatic and were treated with percutaneous drainage (duration: 25 days in untreated patients versus 7 days in patients with absorbable hemostat using). Conclusion: In this preliminary investigation, the intraoperative application of micro porous polysaccharide absorbable hemostat on lymph node dissection areas significantly decreases total drain loss. In addition, it reduces frequency of lymphocyte formation, which contributes to the timely implementation of further stages of multidisciplinary approach in endometrial cancer’s treatment. A multicenter randomized clinical trial with a larger number of patients and longer follow-up is necessary toevaluate the overall outcomes of the combination of laparoscopic lymphadenectomy plus polysaccharide hemostat application.
293 Effect of Illicit Drug use on the Fetus and Newborn: Case Report , Moreira GS*, Fontes RCFB, Toledo DO, Souza AL and Souza ACJ
Drug use, especially crack and cocaine, is a growing public health problem worldwide. Studies show that about 90% of women who use crack are in the reproductive period. Thus, in addition to all the losses already faced by the use of these illicit drugs, such as family suffering, living with crime, imminent risk of death, exposure to communicable diseases, there are also those related to gestation and to the concept, as illustrated in the following case.
294 Neonatal Myasthenia Gravis: Case Report , Moreira GS*, Fontes RCFB, Toledo DO, Souza AL and Souza ACJ
Neonatal myasthenia gravis is characterized by impaired neuromuscular transmission. It affects up to 30% of the children of pregnant women with myasthenia gravis. The absence of maternal symptoms is not related to the non-occurrence of the disease. It is believed that there is a transfer of antibodies against nicotinic acetylcholine receptors, which may cause hypotonia, respiratory failure, weak crying, sucking difficulty, arthrogryposis, hyperbilirubinemia, among other alterations.
295 The Value of Laparocenteza in the Diagnosis of Closed Abdominal Trauma , Shaposhnikov VI
The author focuses on the need to resort to the laparocentezu in the diagnosis of closed abdominal trauma, especially when there is a mass flow of victims. This method allows you to properly perform medical triage that is to provide first aid to those most in need. He describes a more efficient and safer way than the traditional laparocenteza. He rightly points out that, in recent years, increased surveillance of natural and man-made disasters, when the hospital immediately received many victims to sort based on the principle of providing assistance to those most in need first, and then really all the rest. Of particular importance in this regard belongs to the techniques that enable you to quickly understand the health status of the incoming person. To methods such as times and dates laparocentesis, which allows for a few minutes to recognize a catastrophe in the abdominal cavity. However, the traditional method of laparocenteza carries a certain danger. In doing so, he became convinced over the years a traumatologist and surgeon. In his view, the traditional method of laparocenteza, the proposed zone entrance needle or trocar into the abdomen does not guarantee the safety of the bladder and other organs from the damaging action of these instruments.
296 Immune Thrombocytopenia Secondary Splenic Tuberculosis: A Case Report , Namdaroglu S
Despite all the medical and scientific improvements over the past decades; tuberculosis still remains wide-spread and deadly serious. Splenic tuberculosis is a rare form of extra pulmonary tuberculosis. Immune thrombocytopenia is an auto-immune condition that results in isolated thrombocytopenia. Moreover, with its secondary form; it is scientifically proven that immune thrombocytopenia can be triggered with numerous infections or even non-infectious conditions. Although the symptoms and results can be severe, subordinate immune thrombocytopenia which is associated with splenic tuberculosis has not yet taken its crucial and much-needed place in the medical history, surprisingly this matter has not been profoundly covered and analysed yet. A report states that on a 63-year-old patient, diagnostic splenectomy was performed. This elderly patient suffers from purpura and petechial with the cause of immunemediated thrombocytopenia which is secondary to splenic tuberculous; and after the diagnostic splenectomy; splenic tuberculosis was pathologically detected in tests and microbiologic examinations. However, the treatment on patient worked and the medical experts treated the patient with splenectomy and antituberculous therapy. The crucial point here is that patients, who have immune thrombocytopenic purpura, should be exposed to relevant tests and the medical professionals should suspect the high-risk possibility of splenic tuberculosis especially in the endemic area in-patients who have higher risk. Regarding the diagnosis, histopathological examination remains as an ideal method, when it comes to a solid confirmation, executed with microbiological examination.
297 Primary PCI for STEMI Patients: Has Patient’s Access and Hospital Outcome Improved over the Last 5 Years , Mohammed Balghith*, Amir Salih, Kamal Ayoub, Ali Alghamdi, Gaida Albargy, Feras Asiri, Basil Saeed
Background: Reperfusion therapy by Primary PCI in ST-segment elevation myocardial infarction (STEMI result in great benefit than from fibrin lytic therapy, The fast access to PPCI will improve hospital outcome, We believe that patient access to PPCI facility would have improved due to improved public awareness and expanding evidenced-based health provision. Method: This is a retrospective study to analyze and compare data for STEMI patients during 2010 (Group l = 223 pts) and those treated between August 2014 and August 2015 (Group 2 = 288 pts). We compared demographic and baseline characteristics, patient’s access, reason for no access and hospital mortality for the two groups. Results: Among the 288 patients in G2, 247 patients (85%) were males with average age of 57 yrs. 49% were diabetics, 48% hypertensive, 48% were smokers and 27% were obese. These were not different in G1. Of G2, 164 pts (57%) only had access to PPCI compared to 56% in G1 (p = 0.536-NS). In G2, the main reasons for no PPCI was late presentation in 47% vs 53% in G1; P = 0.34-NS and 27% due to thrombolysis vs 17% in G1 (p = 0.11NS). Hospital mortality in G2 was 4% in those treated with PPCI compared to 2.3% in Gi (P = 0.522-NS). Mortality In pts who did not receive PPCI in G2 was 8% compared to 11.3% in G1 (p = 0.49-NS). Females in G2 have about 3 times higher mortality. Compared to 2010, pts treated for STEMI in the last 12 months at KACC still have same, relatively low access to pPCI due mainly to persistent pattern of late presentation and prior thrombolysis which reflect apparent lack of direct access to hospitals with PPCI facilities. Conclusion: Comparing the two periods there was no change in the practice, the low access to PPCI was mainly due to late presentation and Prior thrombolysis, Hospital mortality rate for patients treated with PPCI remained low during the two eras, this seemingly relates to both lack of public awareness and health provision factors in PPCI organizations.
298 Neonatal Wells Syndrome Associated With Eosinophilic Gastroenteritis , Diallo M* , Diop A, Diadie S, Ndiaye M, Dieng M.T and Kane A
Background: Eosinophilic cellulitis (Wells syndrome) is an uncommon eosinophilic dermatosis of unknown pathogenesis, which signals undiagnosed infectious, malignant or systemic disease. It has been reported exceptionally in association with inflammatory bowel disease. Case report: A 7-month-old female infant, whose parents had no particular medical history, was seen for pruriginouspapulo-nodular lesions evolving since her birth. She was followed for evolutive intestinal pseudoobstruction, diagnosed as Hirschsprung disease, and was treated by discharge colostomy after an obstruction. Biological examinations showed hypereosinophilia and anaemia. Skin hispathology revealed a dense eosinophilic infiltrate, with flame figures typical of eosinophilic cellulitis. Histopathology of the resected colon showed a dense eosinophilic infiltrate throughout the bowel wall, with the presence of ganglion cells and normal nervous plexus. Discussion: This case of eosinophilic cellulitis is of particular interest because of its neonatal occurrence, nodular presentation and association with eosinophilic gastroenteritis. To our knowledge, this is the third reported association between eosinophilic cellulitis and eosinophilic gastroenteritis, which appear to have the same pathophysiology. Wells syndrome should therefore be added to the list of dermatosis associated with inflammatory bowel disease.
299 Ectopic Pregnancy in a Caesarean Section Scar Case Report , Maheshgir S Gosavi*
I report a rare case of ectopic pregnancy occurring in the scar of a previous caesarean section, diagnosed by ultrasonography of pelvis and confirmed with histopathological diagnosis. I present the clinical details and imaging findings, followed by discussionof the etiology, pathogenesis, and imaging of this condition.
300 Ectopic Pregnancy in a Caesarean Section Scar Case Report , Maheshgir S Gosavi*
I report a rare case of ectopic pregnancy occurring in the scar of a previous caesarean section, diagnosed by ultrasonography of pelvis and confirmed with histopathological diagnosis. I present the clinical details and imaging findings, followed by discussionof the etiology, pathogenesis, and imaging of this condition.
301 Case of Ovarian Tumor with Concurrent Heterotopic Pregnancy , Maheshgir S Gosavi*
Most common ovarian masses encountered during pregnancy are functional cysts of ovary and luteomas being unique to pregnancy. The other ovarian masses in order are benign cystic teratomas, serous cystadenoma, paraovarian cyst, mucinous cystadenoma and endometrioma.2 Whenever malignancy is suspected in ovarian tumor during pregnancy, it is generally a germ cell tumour or borderline epithelial ovarian tumour.4,5 These are generally of low stage and low grade and consequently prognosis is good.4,5 The incidence of surgery during pregnancy is 1:1312.2 . Heterotopic pregnancy is extremely rare and ovarian tumor in a heterotopic pregnancy is extremely rare. Cases of ectopic pregnancy are reported in a case of concurrent teratomas, cystadenomas. However heterotopic pregnancy is not much reported.
302 Extra-osseous Ewing sarcoma of the thyroid gland mimicking a hemorrhagic cyst of Hashimoto thyroiditis , Georges El Hachem1*, Christiane Jungels2 , Nicolas De Saint Aubain3 , Ahmad Awada2 and Thierry Gil2
Ewing’s family of tumors, including Ewing sarcoma, Askin tumor, and peripheral primitive neuroectodermal tumors, were first identified by James Ewing in 1921. Ewing sarcoma is more common in bones. However, extraosseous Ewing sarcoma (EoES) is a very rare separate entity and was first described by Tefft and al. in 1969. It is a highly malignant round-cell tumor and contains a reciprocal translocation between chromosomes 11 and 22, t(11;22). In this report, we present the case of a 34 years old female patient who was unfortunately diagnosed with Ewing sarcoma of the thyroid after being operated for a hemorrhagic cyst in a context of Hashimoto thyroiditis.The patient was followed at the endocrinology department for an auto-immune thyroiditis for two years. She complained of neck pain and a suspicious hemorrhagic cyst was discovered on thyroid ultrasound. She underwent total thyroidectomy; three weeks later, she suffered from right sided firm swelling in her neck. The pathology was in favor of EoES of the thyroid. To date and to the best of our knowledge, this is the first case of Ewing sarcoma of the thyroid in auto-immune thyroiditis. EoES of the thyroid is a very rare entity and should be considered in the differential diagnosis of a solid tumor in the thyroid. Diagnosis is based on ultrastructural examination, immunostaining and evidence of abnormal translocation t(11;22). It is usually an aggressive disease.Early diagnosis with adequate surgical management and chemotherapy are the mainstay of the treatment and may change the outcome.
303 The egenerative Treatment of Compressive Radiculo-Neuropathy. Case Report , Victoria Palinska* and Palinskiy I
Statement about the Abnormal Medical Condition Although disc herniation is the most common etiology of compressive radiculopathy [1,2]. Lumbar radiculopathy is indication to operative surgery [3-5]. Purpose of this study is to show the results of regenerative treatment of compressive radiculo-neuropathy in yung girl without neurosurgical treatment. Case report: patient V., 24 years had been treating in Private Scientific Institute ITHEC “Victoria” for 1 year with diagnosis: vertebral osteochondrosis, hernia disk L5-S1 with rightside lateralization, chronic radicular syndrome, compressive radiculo-neuropathy, disk protrusion L4-5. At the moment of coming patient had complaints on pain and hypestesy in lumbar part of back and in the dorsal surface of thigh rightside and in lateral surface of shin and foot, paresis of right foot and gait disorder. From anamnesis-patient was volleyball player for 10 years. In neurological status was determinate segmental loss of sensitivity and paresis of right foot. MRI showed hernia disk L5-S1 rightside localization, size 16mm and compression of radix S1. Patient refused surgery and got start regenerative treatment by “Protocol of medical care for patient with radiculopathy” №V-14.3.3.4.2.13-M54.1. After 4 hours pain reduced and to finish of 2d month paresis was reduced. For 1 year patient hasn’t pain and performed gymnastic yet. MRI-control of lumbar part of spine showed hernia disk reduce (calcification) to 10 mm. was performed style life modification and patient hasn’t pain and paresis for 3 years. The patient is monitored yet. Findings: Regenerative treatment has anti-inflammatory effect and promotes faster regeneration of the radix and peripheral nerve.
304 Not Your Typical Preseptal Cellulitis: A Case Report Of Pott’s Puffy Tumor , Tala M Kassm1 *, Aparna Ramasubramanian1 , Chris Compton1,2 and Roxana Fu1
Pott’s puffy tumor (PPT) is defined as a subperiosteal abscess and osteomyelitis of the frontal bone that occurs as a rare complication of trauma or acute sinusitis. Most common presenting symptoms include headache, fever, rhinitis, local tenderness and nasal obstruction. While initially thought to be a rare entity, PPT appears to be occurring with increasing frequency with most complications managed surgically. We present a 14 year-old girl who presented with an initial diagnosis of preseptal cellulitis that failed both oral and intravenous antibiotics. Repeat imaging revealed a frontal bone subperiosteal abscess and osteomyelitis, without intracranial extension and was successfully managed medically without surgical intervention.
305 Diagnosing Hereditary Ataxias: A Case-Based Step-By-Step Approach , William S Baek*
Diagnosing ataxias can be challenging. The differential diagnosis for both acquired and hereditary ataxias is vast and expansive, obligating the neurologist to first rule out all potential treatable causes of ataxia prior to considering the possibility of hereditary ataxias. Family history is important, but more often than not family history is lacking, and sporadic cases are not uncommon. Not uncommonly an extensive workup might be unrewarding, which could be due to the variability of phenotypes, lack of commerciallyavailable genetic testing, or perhaps more significantly, cost.
306 Comparison between Epworth Sleepiness Scale and Polysomnographic Parameters in Patients with Obstructive Sleep Apnea Syndrome , Daniela Vieira Martins*, Gabriel Liria Juares, Leticia Helena de Sousa Marques and Fábio Tadeu Moura Lorenzetti
Introduction: Obstructive sleep apnea syndrome (OSAS) is the most common sleep-related respiratory disorder. With the purpose of assisting in the screening or evaluation of OSAS patients, some scales and questionnaires were proposed. Objective: To evaluate and critically compare the relationship of excessive daytime sleepiness with the presence or absence of OSAS, in addition to other polysomnographic data. Material and method: Systematic review of the literature. Results: Six studies were included, with a total of 4258 patients; four studies demonstrate association between the Epworth sleepiness scale and the hypopnea apnea index (AIH); of those, two studies showed significant differences between ESS score and OSAS severity. Five studies (4233 patients) demonstrated lower minimum oxygen saturation in the group with excessive daytime sleepiness. There was an increase in sleep efficiency in in patients with excessive daytime sleepiness, as per the results of 3 studies (3002 patients). Discussion: The relationship between the presence of excessive daytime sleepiness and OSAS is still questioned, and its pathophysiological mechanism uncertain. Excessive daytime sleepiness secondary to OSAS seems to be an independent event, related to nocturnal hypoxemia and sleep fragmentation. Conclusion: The confidence intervals obtained from these studies do not provide clinical safety to use the Epworth sleepiness scale for screening or stratifying the risk of patients suspected of having sleep apnea.
307 Diagnosing Hereditary Ataxias: A Case-Based Step-By-Step Approach , William S Baek*
Diagnosing ataxias can be challenging. The differential diagnosis for both acquired and hereditary ataxias is vast and expansive, obligating the neurologist to first rule out all potential treatable causes of ataxia prior to considering the possibility of hereditary ataxias. Family history is important, but more often than not family history is lacking, and sporadic cases are not uncommon. Not uncommonly an extensive workup might be unrewarding, which could be due to the variability of phenotypes, lack of commerciallyavailable genetic testing, or perhaps more significantly, cost.
308 Comparison between Epworth Sleepiness Scale and Polysomnographic Parameters in Patients with Obstructive Sleep Apnea Syndrome , Daniela Vieira Martins*, Gabriel Liria Juares, Leticia Helena de Sousa Marques and Fábio Tadeu Moura Lorenzetti
Introduction: Obstructive sleep apnea syndrome (OSAS) is the most common sleep-related respiratory disorder. With the purpose of assisting in the screening or evaluation of OSAS patients, some scales and questionnaires were proposed. Objective: To evaluate and critically compare the relationship of excessive daytime sleepiness with the presence or absence of OSAS, in addition to other polysomnographic data. Material and method: Systematic review of the literature. Results: Six studies were included, with a total of 4258 patients; four studies demonstrate association between the Epworth sleepiness scale and the hypopnea apnea index (AIH); of those, two studies showed significant differences between ESS score and OSAS severity. Five studies (4233 patients) demonstrated lower minimum oxygen saturation in the group with excessive daytime sleepiness. There was an increase in sleep efficiency in in patients with excessive daytime sleepiness, as per the results of 3 studies (3002 patients). Discussion: The relationship between the presence of excessive daytime sleepiness and OSAS is still questioned, and its pathophysiological mechanism uncertain. Excessive daytime sleepiness secondary to OSAS seems to be an independent event, related to nocturnal hypoxemia and sleep fragmentation. Conclusion: The confidence intervals obtained from these studies do not provide clinical safety to use the Epworth sleepiness scale for screening or stratifying the risk of patients suspected of having sleep apnea.
309 Intralobar pulmonary sequestrations in adults , Mhamdi.S*,Rouis.H, Daboussi.S, Moetamri.Z, Aichaouia.C, Khdhraoui.M and Cheikh.R
Intralobar sequestration accounts for 75% of pulmonary sequestrations. It is characterized by the presence of nonfunctional parenchymal lung tissue, receiving systemic arterial blood supply. We conducted a retrospective medical records review of all patients evaluated and treated in our pulmonary department of military hospital of Tunisia with diagnosis of PS from January 2007 through December 2015. Among them, we report 5 cases of intralobar pulmonary sequestrations operated. There are three women and two men; the mean age is 27.6 years. The sequestration was intralobar in all cases. Clinical presentations were chest pain and productive cough in three cases. Chest X-ray showed left basal opacity in three cases, bilateral basal reticulonodular opacities in one case and round hydric opacity in the right lower lobe in one other case. Computed tomography was performed and revealed an aberrant systemic artery born from the lateral side of aorta supplying a left lower lobe sequestration in four cases and a right lower lobe mass in only one case. The confirmation was operative in all cases and histologic only in three cases. All patients were treated by lobectomy. Only one case presented with a pulmonary sequestration combined with tuberculosis and he was treated firstly by antituberculous chemotherapy. The results were excellent with a favorable clinical course and the mortality was nil.
310 Unusual Osseous Metaplasia in Colonic Polyp: Two Case Reports and Review of the Literature , Bin-cai Pan1 , Chun-hua Wang1 , Gui-fang Huang1 , Xiao-ying Tian2 and Zhi Li3*
Background: Osseous metaplasia occurring within the gastrointestinal tract is a rare phenomenon. Only a few of cases have been documented that osseous metaplasia can occur in colorectal polyps, although its underlying pathogenesis has not yet been elucidated. Methods: Two cases of osseous metaplasia within inflammatory and adenomatous polyps of colon, respectively. The clinical and histological features of this lesion, as well as suggested mechanisms for its pathogenesis are discussed. Results: Under the histological examination, both cases demonstrate the typical normal-looking osseous trabeculae rimmed by a layer of scattered osteoblasts in the stroma of inflammatory polyp or tubular adenoma of colon. To the best of our knowledge, they are possible the first cases of osseous metaplasia in colorectal polyps in Chinese. Conclusion: Although it has not been found to have any significance in clinical treatment and prognostic evaluation, our data suggest that persistent inflammatory process and/or pluripotent stromal cells in polyps might contribute to the formation of osseous metaplasia in colonrectal neoplastic and non-neoplastic polyps.
311 Newly Discovered Way of the Function of Cardio-Vascular System and the Latest Theory of the Development of Hypertension and Other Cardio-Vascular Diseases , Vladimir A Mikhaylov
Background: It is known that the power of the heart alone is about 3.3 W, and the length of the vessels is about 100,000 km. It made us doubt that with this power the heart can deliver blood to the capillary bed. Effects on the vascular wall of various modes of laser radiation (wavelength of 630-640 nm.) showed that if continuous radiation did not affect the parameters of blood pressure, frequency regimes had an impact. This leads us to the idea that the root cause of the development of different cardiovascular diseases is the system disturbance of the activity of the vascular pump leads to the increase of intra vascular pressure and the emergence of the hypertensive illness and the coronary heart disease. The local disturbances can cause various diseases depending on the organ where they develop. Rationale: According to our calculations - the length of the arterial bed is 29.1 - 504,6 km. Mathematical modeling showed that if the delivery of blood from the heart to the capillary bed, the required power ranges from 660 to 11942 W. Thus, the main load during transportation the blood to the capillary bed rests on the artery but not on the heart and the vascular pump plays the major role in transportation of blood. Even minor changes in the wall of the arteries, which disrupts vascular pump, lead to the emergence of various vascular diseases. The rationale for this idea I got Ming Chien Kao Awards 2015 [1]. The mortality from the diseases due to the affection of vessels came out now on the first place. The use of the Intravenous laser blood irradiation (ILBI) within the last 30 years showed its high efficiency in a treatment of diseases of vessels and heart, and other system diseases. Therefore ILBI, as the method of the system impact on the blood system, allows to lower the lethality and to increase the life expectancy [2]. The lasers used for treatment of various diseases, the waves having length of 630-640 nanometers are the most effective for the direct impact on the blood and the vascular wall. The energy of the waves of this length is absorbed by oxygen, improves the microcirculation in tissues, changes the viscosity of the blood and affects the wall of vessels [3].
312 Venous Ectasia Mimicking Intraparotid Mass: MRI Findings , Nusabe Kaya1*, Muhammed Pamukcu2 and Berrin Erok3
Background: Venous ectasias of the parotid region are rarely lesions that mimic mass of the parotid gland. The detection of venous ectasia has significantly increased with the increased use of cross-sectional imaging in the last two decades, especially in asymptomatic patient who scanned for other reasons. We report MRI findings and appropriate radiological investigation of case with venous ectasia in the parotid gland imitated intraparotid mass. Case Report: A 58-year old woman underwent cranial MRI due to the history of headache. Incidentally, was detected well-defined nodular lesion with regular contours in the parotid gland, hypointense on T1-weighted scan and homogeneous hyperintense on T2-weighted scan similar with solid mass. Lesion completely and strongly enhanced after contrast administration. Axial T2-weighted images demonstrates incomplet phase-encoding artefact in the lesion indicating flow. The gray scala and Doppler ultrasonography rule out solid mass and confirm diagnosis of venouse ectasia. Therefore, fine needle aspiration was not performed. Since the absence seriously discomfort of patient advanced invasive procedure as venography or surgery treatment were not done. Conclusion: To know MRI findings of intraparotid venous ectasia important for accurately diagnosis and differential diagnosis of intraparotid masses and can prevent unnecessary invasive procedures. Gray scale and Doppler US combined with clinical examination are sufficient for correct diagnosis.
313 Calcifying Fibrous Tumor Present as Small Bowel Obstruction: Case Report , Safi khuri1*, Sobhi Mansor1 , Yoram Kluger1,2 and Bishara bishara1,3
Calcifying fibrous tumor is a rare benign mesenchymal tumor that usually affect children and young adults. This tumor is usually solitary, with unknown etiology. It usually arise in the extremities and trunk. Gastrointestinal involvement is very rare. Herein, we present a case of a 24 year old male patient who was diagnosed with calcifying fibrous tumor presented as small bowel obstruction.
314 Endoscopic Management of Gastro-colic Fistula Following Leak from Laparoscopic Sleeve Gastrectomy , Safi Khuri1*, Yasin Kamel2 , Kinan Halon1 , Wisam Abboud1 3 and Bishara Bishara1 3
Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric procedure effective for the management of morbid obesity. Staple line leak is the most feared complication after LSG and can present early or late following operation. Untreated, chronic staple line leak (>12 weeks) can lead to abscess formation, which in turn form a fistulous tract to adjacent epithelial lined structures. Herein, we present a case of gastro-colic fistula following leak from LSG treated at our department. A 49 years old male patient, presented 14 weeks after LSG to our emergency department with fever and upper abdominal pain. Imaging studies revealed intra-abdominal abscess between the stomach and the spleen with oral contrast leakage into the abscess cavity. An endoscopic evaluation revealed a fistula distal to the gastro-esophageal junction. Endoscopic management of the fistula done by over the scope clip (OTSC), which later failed. The patient re-admitted 12 weeks later and re-imaging studies showed a gastro-colic fistula and distal stenosis of the gastric sleeve. Endoscopic treatment was completed by OTSC closure of the fistula opening on the stomach side and hem clip closure of the fistula opening on the colon side. Also, fluoroscopically-guided endoscopic balloon dilation was done to treat distal stenosis. At 30 months follow up, the patient is doing well.
315 Bedsore Revitalization by-Laser Therapy (Low Level Laser: LED-Ga-Al- As, 660 nm , Nazrul islam1* , Golam Abu Zakaria2 , kazi Shamimuzzaman3 and QuamrulAkhter Sanju4
Background: In 1967 a few years after the first working laser was invented, EndreMester in Semmelweis University Budapest, Hungary wanted to find out if laser might cause cancer. He took some mice, shaved the hair off their backs, divided them into two groups and gave a laser treatment with a low powered ruby laser to one group. They did not get cancer and to his surprise the hair on the treated group grew back more quickly than the untreated group. That was how “laser biostimulation” effects were discovered. Purpose of the work: The effects of pulsed monochromatic light, with fixed pulsations and wavelengths, on the healing of pressure ulcers were evaluated in this prospective, randomized, controlled study. Method: A placebo-controlled, double-blind study using low energy photon therapy (LLLT) was performed in ten patients with bedsore on the back. Treatment was given three times a week for 10 weeks, using monochromatic (red) optical sources; diode 660nm (GaAl-660). The patients who were randomized to placebo treatment received sham therapy from an identical-appearing light source from the same delivery system. Results: Ten patients with bedsore were randomized to receive LLLT or placebo therapy. At the conclusion of the study, the percentage of the initial ulcer area remaining unhealed in the LLLT and placebo groups was 24.4% and 84.7%, respectively (P = 0.0008). The decrease in ulcer area (compared to baseline) observed in the LLLT and placebo groups was 193.0 mm2 and 14.7 mm2, respectively (P = 0.0002). One patient dropped out of the study, complaining of lack of treatment efficacy; he was found to be randomized to the placebo group. There were no adverse effects. Conclusions: In this placebo-controlled, double-blind study LLLT was an effective modality for the treatment of bedsore which were resistant to conventional medical management. The results are encouraging as pulsed monochromatic light increased healing rate and shortened healing time. This will positively affect the quality of life in elderly patients with pressure ulcers.
316 Cytological Screening of Conjunctiva Changes among Sudanese Patients Attending Ophthalmic Clinics , Sajda yagoup1 , Amel.A.Ahmed1* and Abdallah Hasb Alnabi2
Introduction: The conjunctiva eye cytology is a part of the diagnostic eye cytology provides a tool of a diagnosis of many ocular diseases and conditions with using of a suitable tool of collection of sample. This kind of cytological procedures doing as screening for population, or specify the disease under study also for comparison of accuracy and usefulness of the different types of tools use in collection of samples. Objectives: The aim of this study was to screen the conjunctival eye cytology in the population under study ,and to describe the cellular pattern in different eye condition to find out the different factors affect cellular components of the conjunctiva and subsequently the eye health status, and to evaluate the usefulness of the conjunctiva eye cytology as an important diagnostic procedures in the diagnosis of different eye condition. Materials and Methods: This was a descriptive cross sectional hospital base study, done in university of Khartoum, faculty of medical laboratory sciences in department of histopathology and cytology ,to screen conjunctiva cytological changes of ophthalmic clinic patients using swabbing and scrapping cytology for different ocular diseases in period from January 2014 to May 2014.Conjunctiva swabbing and scrapping smears were collected from Abd Alfadeel centre for medicine and eye surgery, Noor Alauoon military eye hospital, Alneelin university eye hospital (collage of optometry) and Maka charity foundation for eye medicine (Ridhy division) ophthalmology clinic. Ninety two 92 patients participated in this study, 56 were females and 36 were males, conjunctiva smears were fixed by 95% alcohol and air then stained by Pap , Giemsa and hematoxylin stains for cytological evaluation. Results: (89.4%) of cytological finding among adequate samples shown matching with the clinical ocular diagnosis. Scrapping method had the best role in getting adequate samples ( 90%), with marked increase of adequacy of sample obtained from elder age patients (34.2% from 41- 60 year, 31.5% from 61-80year) and in cases of infection (48.7%). Bacteria was the major cause of infections (86.2%). Conclusion: Conjunctiva cytology is an impressive tool to get information about ocular tissue health status, and can be a useful complementary diagnostic method ,get its role in epidemiological surveys of endemic ocular diseases such as trachoma in our population and for better understand of diseases spreading manner
317 Non-Alcoholic Fatty Liver Disease in First Degree Relatives of Patients with Nafld , Amrutha Prabhakaran R K1* , Geetha P2 and Sasidharan P K3
Non Alcoholic Fatty Liver Disease (NAFLD) includes a spectrum of hepatic pathology that resembles alcoholinduced liver disease but develops in individuals who deny a significant history of alcohol ingestion. NAFLD comprises a wide spectrum of liver damage, ranging from simple macrovesicular steatosis to steatohepatitis, cirrhosis and hepatocellular carcinoma. The prevalence of NAFLD has doubled during last 20 years, whereas the prevalence of other chronic liver diseases has remained stable or even decreased. Moreover with increasing incidence and prevalence, the perception of NAFLD being a benign condition of little clinical significance is rapidly changing. Obesity, metabolic syndrome, type 2 diabetes (T2DM) and dyslipidemia are predisposing factors for NAFLD. All these are directly linked with diet and lifestyle of an individual and hence preventable and modifiable. The study was conducted to identify the prevalence of NAFLD among the first degree relatives of a patient already diagnosed with NAFLD. The study demonstrated the increased prevalence of NAFLD among the family members. Further risk factor analysis in the study strengthened the role of diet and lifestyle in the etiology of NAFLD.
318 Maggot Bio-Debridement Therapy for Diabetic Foot ulcers–Literature Review , Alaa Atamna* and Avishay Elis
Diabetic foot ulcers are chronic, difficult to treat wounds that are associated with high morbidity andmortality. Several therapies have been proposed as adjuncts to the traditional wound care, among them is the maggot debridement therapy (MDT). MDT had been used for decades for treating non-healing wounds. However, with the beginning of the antibiotic era, itsuse had gradually faded. In the last years, MDT has re-emergedin clinical use, mainly because of the rise of anti-microbial resistance. Herein we summarize the last decade accumulated data on the clinical implication of the treatment by maggot debridement for non-healingdiabetic foot ulcers.
319 Laparoscopic Treatment of the Largest Mesothelial Adrenal Cyst in Literature , Raffaele Porfidia1*, Maria Giovanna Ciolli1 , Pietro Picarella1 , Simona Grimaldi2 , Nicola Castaldo1 and Sergio Grimaldi1
Introduction: Adrenal cyst lesions are rare, with varying etiology, with unspecified symptomatic kit and instrumental diagnosis not simple if of large size. The directions for surgical treatment are well defined. Clinical Case: A 28-year-old patient complained of abdominal swelling, slight dyspnea, pain in the right flanking region associated with a lack of weight loss despite voluntary diet. He practices a TC and RM abdomen. That point out a cystic lesion of 30x21x38 cm but do not clarify the origin. He is subjected to laparoscopic surgical treatment which allows to clarify the peritoneal background of cysts, its drainage and removal. Histological examination confirms the mesothelial nature of cysts. The TC abdominal control at a distance of six months points out the correct localization of the abdominal organs, previously moved to the left, and the right surreal leftover. Conclusions: Surgical treatment allows to clarify diagnostic doubts in case of large cystic lesions and to carry out a radical therapy. The removal of only cysts or the entire adrenal gland is controversial. The laparoscopic approach, if possible, is preferable as it guarantees the same result with faster recovery times and less risk of site infection or surgical wound.
320 Radiological Evaluation of a Chondromyxoid Fibroma , Austin Fletcher
Chondromyxoid fibroma (CMF) is a very rare benign cartilaginous tumor representing less than 0.5% of all bone tumors while also being the rarest cartilaginous bone tumor. Common locations of occurrence include the metaphysical region of the proximal tibia and distal femur. We report a case of a 10-year-old female affected by a CMF of the left lower tibia. The radiological features demonstrated by X-ray and magnetic resonance imaging (MRI) are discussed.
321 Molecular Characterization of Carbapenemase Producing Klebsiella Pneumoniae Dominance of OXA-48, KPC, VIM and NDM Producers in Khartoum, Sudan , Abdelhakam Hassan Ibrahim Ali* and Al Fadhil A Omer
Background and Objectives: Little is known about carbapenemase producing Klebsiella pneumoniae (CPK) in Sudan. This study aimed to determine the prevalence of CPK in a major hospital in Khartoum, Sudan between may 2015 - January 2017 and to characterize the isolates and detect the types of carbapenemase (s) they produced. Materials and Methods: The study was done in the Department of Molecular Microbiology, Faculty of Medical Laboratories Science, Al-Neleen University. All the isolates were obtained from clinical samples of patients treated inside the hospitals. Strains of K. pneumoniae resistant to at least one carbapenem (imipenem or meropenem) by using disc diffusion technique according to the CLSI guidelines were included in this study. Molecular detection of carbapenemase genes was achieved using Real-Time PCR (Sacace Biotechnologie, Italie). Results: A total 96 strains of K. pneumoniae of different non duplicated isolates were obtained from different hospitals. Seventy-two percent (70/96) isolates were positive for carbapenemase genes; 59.4% (57/96) were positive for blaKPC genes, 57.3% (55/96) were positive for blaNDM genes, 37.5% (36/96) were positive for blaVIM genes and 35.4% (34/96) were positive for blaOXA-48 genes. Nineteen isolates possessed four genes (blaKPC, blaNDM, blaVIM and blaOXA-48), fourteen isolates possessed three genes{( blaNDM, blaVIM and blaOXA-48=6), (blaKPC, blaNDM, and blaOXA-48=3), (blaKPC, blaNDM and blaVIM =3), (blaKPC, blaVIM and blaOXA-48=2)}, 27 isolates possessed two genes{( blaKPC and blaNDM =21), (blaKPC, blaOXA-48=2), (blaNDM and blaVIM =3), (blaNDM and blaOXA-48=1)}, 10 isolates possessed only one gene (blaKPC =8, blaOXA-48=1 and blaVIM =1) and the remaining 26 isolates were free from these genes. Conclusion & Recommendation: In Sudan, the most common type of carbapenemase gene multidrug-resistant K. pneumoniae is KPC. Co-production of KPC, VIM, NDM and OXA-48 genes are found in K. pneumoniae. To our knowledge, this study was done for the first time in Sudan. Therefore, it is necessary to determine carbapenem resistance in K. pneumoniae isolates and take essential infection control precautions to avoid spread of this resistance.
322 Screening for Phytochemical Constituents of Selected Medicinal Plants from Al-Khums Region, Libya , Salem Mohamed Edrah*
The massive majority of conventionally charity medicinal plants have hitherto to be sufficiently assessed. This study search for to sights the traditional medicinal of selected plants (Coriandrum sativum, Ocimum basilicum L and Petroselinum sativum Hoffm) used by the Libyan for therapeutic efforts with the aim of identifying the prominent medicinal plants and their uses for phytochemical research. The extraction methods used to aim to imitative as carefully as potential the traditional methods to produce as carefully as conceivable the traditional ‘herbal’ drug consequently to reservation potential energetic constituents of the plant part. The selection of solvent system largely rest on the precise environment of the bioactive compound being embattled and this similarly affects the procedures of decontamination to be used.Quantitative percentage yield of phytochemical components of selected plants leaves were for ethanolic extracts of Coriandrum sativum contained highest percentage yield 95 %, while Petroselinum sativum Hoffm and Ocimum basilicum L contained 90 and 86 % respectively, and for aqueous extracts of Coriandrum sativum, Ocimum basilicum L and Petroselinum sativum Hoffm 91, 83and 86 correspondingly. Whereas the Quantitative estimation of percent crude chemical constituents in these plants evaluations for Petroselinum sativum Hoffm highest percentage of crude flavonoids 36%, though, Ocimum basilicum L the lowest yield of flavonoids 9% and for the Coriandrum sativum 12%. In addition, the highest yield of Petroselinum sativum Hoffm was found to contain highest yields of alkaloids that are 8 %, and for each, the lowest yield was found in both of Coriandrum sativum and Ocimum basilicum L otherplants4% for each. Saponins were as well attained from the yield noted were highest alternating from 24% in the Coriandrum sativum, 20 % in the Ocimum basilicum L and to the lowest 16 % in the Petroselinum sativum Hoffm.
323 Double Prevention of Skin Cancer: Primary and Secondary Forces United Against Actinic Keratosis , Zainab Al-Nasser
Actinic keratoses (AKs) are clinically defined as scaly erythematous plaques that develop on sun-damaged skin after prolonged exposure to ultraviolet (UV) radiation [1]. They are mainly seen on sunexposed areas including the face, neck, scalp and extremities [2]. The importance of diagnosing AKs lies in their ability to transform to cancer, squamous cell carcinoma (SCC) specifically [3]. Protecting the skin from harmful UV radiation is an incontrovertible fact that has been proven to be effective in preventing AKs by reliable studies [4].
324 Attachment Based Pilot Group Psychotherapy on Promoting Awareness and Coping Skills for Parents of Children with Autism , Piyali Chakrabarti1*, Chua Xiao Ying Angelin2 , Wong Jia Yen2 and Chng Jia Hui3
With a worldwide trend of an increasing number of children identified with Autism Spectrum Disorder (ASD), more families are faced with the demands of having to care for children with ASD [1]. Parents and caregivers of children with ASD are confronted with a more diverse and complex range of challenges [1-3] and face more stress (Weiss, 2002) than caregivers of typically developing children despite the severity of the ASD. In highly stressful situations, individuals with insecure attachment were found to experience more distress and seem to be at risk of maladjustment [4]. Parents with insecure attachment styles were associated with less sensitive parenting and more negative support behaviours [5,6]. Given that parenting children with ASD is associated with increased stress, it is likely that parents with insecure attachment may experience greater distress than parents with secure attachment when caring for children with ASD. Such disposition, in turn, may further limit their abilities to care for their children with ASD. As such, an 8-week psycho-group therapy was piloted to facilitate parents’ acceptance of their children with ASD through increasing awareness of their attachment styles, their coping strategies and facts about ASD. Six participants participated in the group therapy. Preliminary analyses, based on their written and verbal responses, appear to suggest that parents with insecure attachment styles tended to use ineffective coping strategies (e.g. denial: “remain silent”) as compared to more effective coping strategies (e.g. problem-focused “explain my thoughts”). There appears to be a shift in the perspective of their children and parenting from deficit focused (e.g. “Stay in his own world”) to more acceptance statements (e.g. “Patience”).
325 Epstein – Barr Virus Associated with Hashimoto’s Thyroiditis and Treated with a Novel Nanobiological Therapy Based on Micro RNAs: A Case Report , GLADY Gilbert*
Hashimoto’s thyroiditis, on the one hand, represents one of the most common autoimmune diseases in general, and on the other hand displays a proven genetic and environmental determinism. Its prevalence has been rising up in the last decades everywhere and the disease shows multifactorial etiologies. For some time now, different viruses have been regularly mentioned among the environmental factors involved in the onset of the disease, but it is only recently that Epstein-Barr Virus, a common human herpes virus known to infect most of the world population, has been mentioned in this context of human pathology, while its participation during its latency phase is more and more often demonstrated in a growing number of autoimmune diseases. MicroRNAs (miRNAs) are small noncoding endogenously produced RNAs that play key roles in controlling the expression of many cellular genes at a post-transcriptionally level. After cytoplasmic recruitment and incorporation into a ribonucleoprotein complex, they can target specific mRNAs and interfere in their translation into proteins. Consequently, miRNAs can regulate many cellular pathways and processes, and their dysregulation may largely contribute to several kinds of diseases, particularly those related to autoimmune mechanisms. We will show with the help of a clinical case that such a pathological association can be regulated thanks to a new method of immunotherapy in ultra-low doses.
326 Candy Cane Syndrome after Gastric Cancer Surgery , R Marti Fernandez, R Marti Obiol* , A Espi Macias and F Lopez Mozos
Patient with antecedent of partial gastrectomy + Roux- en- Y by gastric cancer in 2009 (T2N1M0). Subsequent controls rule out tumor recurrence. The patient refers a 12 month history of abdominal pain and fullness that begins during the intake of food, which forces its interruption and stops after rest. It doesn’t associate nausea, vomiting or altered bowel habits. It is accompanied by loss of 3 kg. Physical exploration is anodyne even though the episodes of abdominal pain. In the intestinal transit, images compatible with candy cane syndrome (figures 1 and 2) are seen.
327 Pseudo Angiomatous Stromal Hyperplasia of the Breast: A Case of A 19-Year-Old Asian Girl , Yuzhu Zhang1 , Weihong Zhang2# , Yijia Bao1 , Yongxi Yuan1,3*
Pseudoangiomatous stromal hyperplasia (PASH), a benign disease with extremely low incidence, is manifested as giant breasts, frequent relapse after surgery, or endocrine disorder. Cases with unilateral breast and undetailed endocrine condition have been reported in African and American. In this case, a 19-year-old Asian girl suffered from bilateral breast PASH after the human placenta and progesterone treatment for 3-month delayed menstruation. Her breasts enlarged remarkably 1 month after the treatment, with extensive inflammatory swell in bilateral mammary glands and subcutaneous edema in retromammary space. The patient received the bilateral quadrantectomy plus breast reduction and suspension surgery to terminate the progressive hyperplasia of breast. During the whole treatment period, the patient was given tamoxifen treatment for 4 months, and endocrine levels were intensively recorded. The follow-up after 4 months showed recovered breast with normal shape and size, and there was no distending pain, a tendency toward breast hyperplasia, or menstrual disorder
328 Re-expansion Pulmonary Edema after Drainage of Pleural Effusion in a Pediatric Patient with a Large Anterior Mediastinal Mass , Daniel N. Vo MD, FAAP*
Clinical case presentation of a 13 year old male with a newly diagnosed anterior mediastinal mass who developed rapid respiratory distress after drainage of a pleural effusion. We include a discussion of the incidence, natural history, and peri-operative management of children with re-expansion pulmonary edema.
329 A Chronic Care Approach to the Prevention, Treatment, and Management of Addiction , Raymond V. Tamasi*
Addiction is a chronic health condition that affects 40 percent of the American public. It costs society more than $400 billion annually (excluding nicotine), is responsible for up to 45% of all hospital emergency room admissions and is implicated in 66% of incarcerations [1,2]. Of the estimated 23-25 million people who need addiction treatment, about 2.5 million (10%) receive it [3]. Stigma, insurance barriers, and the perception by many that they don’t have a problem have limited access to care. Efforts to reduce stigma through awareness programs, the 2008 Mental Health and Addiction Parity Act, and the influx of newly insured patients through the ACA have sparked investor interest and led to rapid growth of inpatient rehabilitation programs. However, despite wider acceptance of addiction as a chronic brain disorder, treatment systems continue to be developed and defined by an emphasis on acute, time-limited treatments. For more than forty years, addiction treatment has been defined and judged by this misplaced perception that a fixed duration of treatment will “fix the problem”. Patients and families have been led to believe that a month in rehab would “take care of the problem”. This fragmented approach fails to provide the life-long management necessary to ensure sustained remission. The greatly underemphasized problem is the absence of substantial and comprehensive community based continuing care and the paucity of prevention, early identification and intervention efforts. Relegating follow-up care, prevention and early intervention to the sidelines contradicts the standard treatment of chronic disease. New ideas, innovative service delivery methods, alternative clinical interventions, and technological supports are not robustly developed, tested, and integrated. It is time for a new vision that addresses addiction as the chronic disease it is. This paper will describe an approach that incorporates prevention, early intervention, and extended engagement with traditional models of care to create a seamless, integrated system of care that addresses addiction as a chronic condition that can produce more favorable long term outcomes.
330 The Application of Rebonding of the Body to a Women’s Substance Abusive Program , Deanna L Mulvihill
Women who have experienced Intimate Partner Violence (IVP) are at greater risk of physical and mental health problems, including Post-traumatic Stress Disorder (PTSD) and Alcohol Dependence (AD) [1,2]. Two third of women with substance abuse have mental health problems that include PTSD [2,3]. Women with IPV and AD who seek treatment have a difficulty benefiting from present treatment program [4,5]. They also have negative feeling about their experience and some of their therapist has negative feeling about them [3].
331 Education and Training for Clinical Forensic Psychological Work with Juvenile Firesetting and Bomb Making , Ronn Johnson1* and Patricia Jones-Reece2
Juvenile firesetting and bomb making (JFSB) represents an important international issue in several disciplines (e.g., education, law enforcement, fire service, social services, and clinical forensic psychology). An examination of policies, laws, and attitudes revolving around JFSB behaviors, reveals startling knowledge gaps that create significant detrimental impacts on public safety. These same concerns reinforce the primacy of broad general education and training for psychologists in this area. This article reviews critical training factors with respect to JFSB that should be included in the training of all psychologists working with youth, public safety, and community mental health and exposing trainees to interdisciplinary experiences that are vital to provision of clinical forensic services needed in these cases. One section speaks to the educational relevance of developing diagnostic (DSM-5 Quadrant) and culturally responsive intervention skills. Additionally, this article discusses the role of practicums and advanced practicums, through which exposure to the many clinical forensic contours of JFSB cases, function as a proficient training platform. Finally, the article draws conclusions and offers future directions for education and training.
332 Arthrogryposis and Veptr: One Centre Case Series , Maredi E, Vommaro F, Giacomini S, Scarale A, Baioni A, Di SilvestreM, Pipola V, Pescuma G and Greggi T
As in others rare syndromes Kyphoscoliosis is the most common deformity you can find, and is a very early onset, rapidly evolving and become very stiff from early age. The incidence of scoliosis in arthrogryposis in literature varies from 30% to 67%. Due to the complexity of the clinical is necessary a multidisciplinary approach and as soon as possible (Pediatric orthopedic surgeon, anesthesiologist, pulmonologist). There are a limited number of studies on arthrogryposis and early onset scoliosis (EOS) surgically treated. We reviewed our children affected by EOS in arthrogryposis and surgically treated to describe the efficacy or ribbased distraction systems in these particular cases of deformities. We use Vertical Expandable Prosthetic Titanium Rib (VEPTR1 and 2) device.
333 Ethical Behavior and Accountability in Leadership, a Technological Framework & Design for Tracking Blood Disorders , Laura Thompson* and Kimberly Scott
To address the challenges associated with accountability in for and nonprofit organizations, a sequential explanatory mixed method design was employed, along with action research. The existing research produced a model where organizational accountability and rules formation were highly correlated to information access (those who have access to information). The purpose of this study is to derive the components needed to provide transparent decision-making, track, and monitor blood disorders like Sickle Cell Anemia (SCA) in Africa and globally. Sickle cell anemia (HbSS) is responsible for most cases of sickle cell disease. The improvement of mortality rates has been an exhausted topic both in the United States and parts of Africa, where Sickle cell hemoglobin or HbS is concerned. In Africa alone, where 80% of affected births occur, babies born with the disease die undiagnosed in early childhood. According to Fleming (1989), of the patients in Nigeria with SCA, approximately 50% die before the age of 1 year. The lack of information distributed in resource-poor countries like Nigeria, remains an ethical challenge with accountability in leadership. We propose the framework from this case study as the component required to track, organize and maintain the data for SCA decision making efforts.