Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3441

World Academy of Science, Engineering and Technology

[Medical and Health Sciences]

Online ISSN : 1307-6892

3441 Management of Gastrointestinal Metastasis of Invasive Lobular Carcinoma

Authors: Sally Shepherd, Richard De Boer, Craig Murphy

Abstract:

Background: Invasive lobular carcinoma (ILC) can metastasize to atypical sites within the peritoneal cavity, gastrointestinal, or genitourinary tract. Management varies depending on the symptom presentation, extent of disease burden, particularly if the primary disease is occult, and patient wishes. Case Series: 6 patients presented with general surgical presentations of ILC, including incomplete large bowel obstruction, cholecystitis, persistent lower abdominal pain, and faecal incontinence. 3 were diagnosed with their primary and metastatic disease in the same presentation, whilst 3 patients developed metastasis from 5 to 8 years post primary diagnosis of ILC. Management included resection of the metastasis (laparoscopic cholecystectomy), excision of the primary (mastectomy and axillary clearance), followed by a combination of aromatase inhibitors, biologic therapy, and chemotherapy. Survival post diagnosis of metastasis ranged from 3 weeks to 7 years. Conclusion: Metastatic ILC must be considered with any gastrointestinal or genitourinary symptoms in patients with a current or past history of ILC. Management may not be straightforward to chemotherapy if the acute pathology is resulting in a surgically resectable disease.

Keywords: Breast Cancer, metastasis, gastrointestinal metastasis, invasive lobular carcinoma

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3440 Bionaut™: A Microrobotic Drug-Device Platform for the Local Treatment of Brainstem Gliomas

Authors: Alex Kiselyov, Suehyun Cho, Darrell Harrington; Florent Cros, Olin Palmer, John Caputo, Michael Kardosh, Eran Oren, William Loudon, Michael Shpigelmacher

Abstract:

Despite the most aggressive surgical and adjuvant therapeutic strategies, treatment of both pediatric and adult brainstem tumors remains problematic. Novel strategies, including targeted biologics, immunotherapy, and specialized delivery systems such as convection-enhanced delivery (CED), have been proposed. While some of these novel treatments are entering phase I trials, the field is still in need of treatment(s) that exhibits dramatically enhanced potency with optimal therapeutic ratio. Bionaut Labs has developed a modular microrobotic platform for performing localized delivery of diverse therapeutics in vivo. Our biocompatible particles (Bionauts™) are externally propelled and visualized in real-time. Bionauts™ are specifically designed to enhance the effect of radiation therapy via anatomically precise delivery of a radiosensitizing agent, as exemplified by temozolomide (TMZ) and Avastin™ to the brainstem gliomas of diverse origin. The treatment protocol is designed to furnish a better therapeutic outcome due to the localized (vs systemic) delivery of the drug to the neoplastic lesion(s) for use as a synergistic combination of radiation and radiosensitizing agent. In addition, the procedure is minimally invasive and is expected to be appropriate for both adult and pediatric patients. Current progress, including platform optimization, selection of the lead radiosensitizer as well as in vivo safety studies of the Bionauts™ in large animals, specifically the spine and the brain of porcine and ovine models, will be discussed.

Keywords: Micro-robot, glioma, brainstem, Bionaut, local delivery, radiosensitizer

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3439 Transcriptomics Analysis on Comparing Non-small Cell Lung Cancer with Normal Lung, and Early-Stage Compared with Late-Stages of Non-Small Cell Lung Cancer

Authors: Achitphol Chookaew, Paramee Thongsukhsai, Patamarerk Engsontia, Narongwit Nakwan, Pritsana Raugrut

Abstract:

Lung cancer is one of the most common malignancies and the primary cause of death due to cancer worldwide. Non-small cell lung cancer (NSCLC) is the main subtype in which the majority of patients present with advanced-stage disease. Herein, we analyzed differentially expressed genes to find potential biomarkers for lung cancer diagnosis as well as prognostic markers. We used transcriptome data from our 2 NSCLC patients and public data (GSE81089) composing of 8 NSCLC and 10 normal lung tissues. Differentially expressed genes (DEGs) between NSCLC and normal tissue and between early-stage and late-stage NSCLC were analyzed by the DESeq2. The pairwise correlation was used to find the DEGs with FDR adjusted p-value  0.05 and |log2 fold change|  4 for NSCLC versus normal and FDR adjusted p-value  0.05 with |log2 fold change|  2 for early versus late-stage NSCLC. Bioinformatic tools were used for functional and pathway analysis. Moreover, the top ten genes in each comparison group have verified the expression and survival analysis via GEPIA. We found 150 up-regulated and 45 down-regulated genes in NSCLC compared to normal tissues. Many immunoglobulin-related genes, e.g., IGHV4-4, IGHV5-10-1, IGHV4-31, IGHV4-61, and IGHV1-69D, were significantly up-regulated. Early versus late-stage NSCLC, 22 genes were up-regulated, and five genes were down-regulated in late-stage compared to early-stage NSCLC tissues. The top five DEG genes were KRT6B, SPRR1A, KRT13, KRT6A, and KRT5. Keratin 6B (KRT6B) was the most significantly increased gene in the late-stage NSCLC. From GEPIA analysis, we concluded that IGHV4-31 and IGKV1-9 might be used as diagnostic biomarkers, while KRT6B and KRT6A might be used as prognostic biomarkers. However, further clinical validation is needed.

Keywords: gene ontology, differentially expressed genes, early and late-stages, non-small cell lung cancer transcriptomics

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3438 Clinicians' and Nurses' Documentation Practices in Palliative and Hospice Care: A Mixed Methods Study Providing Evidence for Quality Improvement at Mobile Hospice Mbarara, Uganda

Authors: G. Natuhwera, M. Rabwoni, P. Ellis, A. Merriman

Abstract:

Aims: Health workers are likely to document patients’ care inaccurately, especially when using new and revised case tools, and this could negatively impact patient care. This study set out to; (1) assess nurses’ and clinicians’ documentation practices when using a new patients’ continuation case sheet (PCCS) and (2) explore nurses’ and clinicians’ experiences regarding documentation of patients’ information in the new PCCS. The purpose of introducing the PCCS was to improve continuity of care for patients attending clinics at which they were unlikely to see the same clinician or nurse consistently. Methods: This was a mixed methods study. The cross-sectional inquiry retrospectively reviewed 100 case notes of active patients on hospice and palliative care program. Data was collected using a structured questionnaire with constructs formulated from the new PCCS under study. The qualitative element was face-to-face audio-recorded, open-ended interviews with a purposive sample of one palliative care clinician, and four palliative care nurse specialists. Thematic analysis was used. Results: Missing patients’ biogeographic information was prevalent at 5-10%. Spiritual and psychosocial issues were not documented in 42.6%, and vital signs in 49.2%. Poorest documentation practices were observed in past medical history part of the PCCS at 40-63%. Four themes emerged from interviews with clinicians and nurses-; (1) what remains unclear and challenges, (2) comparing the past with the present, (3) experiential thoughts, and (4) transition and adapting to change. Conclusions: The PCCS seems to be a comprehensive and simple tool to be used to document patients’ information at subsequent visits. The comprehensiveness and utility of the PCCS does paper to be limited by the failure to train staff in its use prior to introducing. The authors find the PCCS comprehensive and suitable to capture patients’ information and recommend it can be adopted and used in other palliative and hospice care settings, if suitable introductory training accompanies its introduction. Otherwise, the reliability and validity of patients’ information collected by this PCCS can be significantly reduced if some sections therein are unclear to the clinicians/nurses. The study identified clinicians- and nurses-related pitfalls in documentation of patients’ care. Clinicians and nurses need to prioritize accurate and complete documentation of patient care in the PCCS for quality care provision. This study should be extended to other sites using similar tools to ensure representative and generalizable findings.

Keywords: palliative care, documentation, Quality improvement, information case sheet

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3437 Contraception in Panajachel, Guatemala and the Surrounding Areas: Barriers Affecting Women’s Usage

Authors: Natasha Bhate

Abstract:

Contraception is important in helping to reduce maternal and infant mortality rates by allowing women to control the number and spacing in-between their children. It also reduces the need for unsafe abortions. Women worldwide use contraception; however, the contraceptive prevalence rate is still relatively low in Central American countries like Guatemala. There is also an unmet need for contraception in Guatemala, which is more significant in rural, indigenous women due to barriers preventing contraceptive use. The study objective was to investigate and analyze the current barriers women in Guatemala, in Panajachel and the surrounding areas, face in using contraception with a view of identifying ways to overcome these barriers. This included exploring the contraceptive barriers women believe exist and the influence of males in contraceptive decision making. The study took place at a charity in Panajachel, Guatemala, and had a cross-sectional, qualitative design to allow an in-depth understanding of information gathered. This particular study design was also chosen to help inform the charity with qualitative research analysis, in view of their intent to create a local reproductive health programme. A semi-structured interview design, including photo facilitation to improve cross-cultural communication, with interpreter assistance, was utilized. A pilot interview was initially conducted with small improvements required. Participants were recruited through purposive and convenience sampling. The study host at the charity acted as a gatekeeper; participants were identified through attendance of the charity’s women’s-initiative programme workshops. Twenty participants were selected and agreed to study participation with two not attending; a total of eighteen participants were interviewed in June 2017. Interviews were audio-recorded, and data was stored on encrypted memory sticks. Framework analysis was used to analyze the data using NVivo11 software. The University of Leeds granted ethical approval for the research. Religion, language, the community, and fear of sickness were examples of existing contraceptive barrier themes recognized by many participants. The influence of men was also an important barrier identified, with themes of machismo and abuse preventing contraceptive use in some women. Women from more rural areas were believed to still face barriers which some participants did not encounter anymore, such as distance and affordability of contraceptives. Participants believed informative workshops in various settings were an ideal method of overcoming existing contraceptive barriers and allowing women to be more empowered. The involvement of men in such workshops was also deemed important by participants to help reduce their negative influence in contraceptive usage. Overall, four recommendations following this study were made, including contraceptive educational courses, a gender equality campaign, couple-focused contraceptive workshops, and further qualitative research to gain a better insight into men’s opinions regarding women using contraception.

Keywords: barrier, Religion, Contraception, machismo

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3436 Assessment of Sleep Disorders in Moroccan Women with Gynecological Cancer: Cross-Sectional Study

Authors: Amina Aquil, Abdeljalil El Got

Abstract:

Background: Sleep quality is one of the most important indicators related to the quality of life of patients suffering from cancer. Many factors could affect this quality of sleep and then be considered as associated predictors. Methods: The aim of this study was to assess the prevalence of sleep disorders and the associated factors with impaired sleep quality in Moroccan women with gynecological cancer. A cross-sectional study was carried out within the oncology department of the Ibn Rochd University Hospital, Casablanca, on Moroccan women who had undergone radical surgery for gynecological cancer (n=100). Translated and validated Arabic versions of the following international scales were used: Pittsburgh sleep quality index (PSQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg's self-esteem scale (RSES), and Body image scale (BIS). Results: 78% of participants were considered poor sleepers. Most of the patients exhibited very poor subjective quality, low sleep latency, a short period of sleep, and a low rate of usual sleep efficiency. The vast majority of these patients were in poor shape during the day and did not use sleep medication. Waking up in the middle of the night or early in the morning and getting up to use the bathroom were the main reasons for poor sleep quality. PSQI scores were positively correlated with anxiety, depression, body image dissatisfaction, and lower self-esteem (p < 0.001). Conclusion: Sleep quality and its predictors require a systematic evaluation and adequate management to prevent sleep disturbances and mental distress as well as to improve the quality of life of these patients.

Keywords: Body image, Sleep Quality, self esteem, gynecological cancer

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3435 Efficacy and Safety of Filgotinib as Maintenance Therapy for Patients with Moderately to Severely Active Ulcerative Colitis: Results from the Phase 2b/3 SELECTION Study

Authors: Miles Sparrow, Laurent Peyrin-Biroulet, Edward Loftus, Silvio Danese, Severine Vermeire, William Sandborn, Ronald Fogel, Sandeep Nijhawan, Radoslaw Kempinski, Rafal Filip, Ihor Hospodarskyy, John McNally, Chohee Yun, Sally Zhao, Xiaopeng Liu, Chantal Tasset, Robin Besuyen, Mamoru Watanabe, Stefan Schreiber, Gerhard Rogler, Toshifumi Hibi, Brian Feagan

Abstract:

Purpose: The study aimed to report the efficacy and safety of filgotinib (FIL), a preferential JAK1 inhibitor, in the SELECTION (NCT02914522) Maintenance Study, a double-blind, randomized trial of FIL as maintenance therapy for patients with moderately to severely active UC who achieved clinical remission or Mayo Clinic Score (MCS) response after 10 weeks of induction with FIL 200mg, FIL 100mg or placebo (PBO). Methods: Patients randomized to FIL induction were rerandomized 2:1 to FIL induction dose or PBO. Those on PBO during induction continued PBO maintenance. Steroid tapering was required. The primary endpoint was endoscopic/rectal bleeding/stool frequency (EBS) remission at Wk58, defined by Mayo endoscopic subscore (ES) ≤1, rectal bleeding subscore=0, and ≥ 1-pt decrease in stool frequency subscore (SFS) from baseline and SFS ≤ 1. Key secondary endpoints included 6-month corticosteroid-free clinical remission, sustained clinical remission, MCS remission, endoscopic remission, and Geboes histologic remission at Wk58. Results: 664 patients were enrolled and treated in the Maintenance Study (from induction placebo [n=93], FIL 100mg [n=270] and FIL 200mg [n=301] ); efficacy analyses included only patients who received FIL during induction (n=558). Baseline demographics and disease characteristics were generally balanced across treatment arms; approximately 40% of patients had previously been treated with biologics. Compared with placebo, the proportion of patients achieving EBS remission was significantly higher in those receiving maintenance therapy with FIL 200mg (placebo, n=11/98 [11.2%]; FIL 200mg, n=74/199 [37.2%]; p < 0.025) or FIL 100mg (placebo, n=12/89 [13.5%]; FIL 100mg, n=41/172 [23.8%]; p < 0.05). Significantly higher proportions of patients receiving FIL 200mg versus placebo, achieved key secondary endpoints (p < 0.025 for all) including 6-month corticosteroid-free clinical remission (placebo, n=3/47 [6.4%]; FIL 200mg, n=25/92 [27.2%]) and histologic remission (placebo, n=13/98 [13.3%]; FIL 200mg, n=76/199 [38.2%]). Generally, the frequencies of adverse events (AEs), serious AEs, and discontinuations due to AEs were similar throughout treatment regimens. Occurrences of serious infection and herpes zoster infection were uncommon across groups. No opportunistic infections occurred. There were no venous thromboses, including pulmonary embolism, among FIL-treated patients. Two patients on FIL 200mg died (1 from asthma exacerbation, 1 from left ventricular failure), both considered unrelated to FIL. Conclusions: FIL 200mg and 100mg were effective as maintenance treatment for patients with moderately to severely active UC who had achieved a clinical response to induction treatment with FIL. FIL 200 mg met all key secondary endpoints, including endoscopic, histologic, and 6-month corticosteroid-free remission. FIL was well tolerated in patients with moderate to severely active UC.

Keywords: Maintenance Therapy, ulcerative colitis, filgotinib, JAK1 inhibitor

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3434 Efficacy and Safety of Filgotinib as Induction Therapy for Patients with Moderately to Severely Active Ulcerative Colitis: Results from the Phase 2b/3 Selection Study

Authors: Miles Sparrow, Laurent Peyrin-Biroulet, Edward Loftus, Silvio Danese, Severine Vermeire, John McNally, Chohee Yun, Sally Zhao, Xiaopeng Liu, Chantal Tasset, Robin Besuyen, Mamoru Watanabe, Stefan Schreiber, Gerhard Rogler, Toshifumi Hibi, Brian Feagan, William Sandborn, Tim Tim Ritter, Rajiv Mehta, Ursula Seidler, Frank Seibold, Ian Beales, Hyo Jong Kim

Abstract:

Purpose: Selection (NCT02914522) Induction Studies aimed to evaluate filgotinib (FIL), a JAK1 inhibitor, efficacy and safety as induction therapy for patients with moderately to severely active ulcerative colitis (UC) who were biologic naive but failed conventional therapy (Cohort A Induction Study) or failed prior biologics (Cohort B Induction Study). Methods: Both studies randomized (2:2:1) patients to FIL 200mg, FIL 100mg or placebo (PBO). The primary endpoint was endoscopic/rectal bleeding/stool frequency (EBS) remission at Week 10. EBS was defined as a Mayo endoscopic subscore (ES) ≤ 1, rectal bleeding subscore=0, and ≤-point decrease in stool frequency subscore from baseline and stool frequency subscore ≤ 1. Secondary endpoints included: Mayo Clinic Score (MCS) remission, endoscopic remission (ES=0), and Geboes histologic remission at Week 10. Results: A total of 625/659 patients in Cohort A and 635/689 patients in Cohort B who were randomized and treated completed the studies. In both cohorts, baseline demographics, UC disease characteristics, and concomitant medications were similar across treatment groups. Prior treatment failures in cohort B included anti-tumour necrosis factor (TNF) therapies (86%), vedolizumab (52%), or both (43%). Baseline means MCS and patients with the severe endoscopic disease (ES=3) were 8.6 and 56% in cohort A and (9.3 and 78%, in cohort B, respectively). Significantly higher proportions of patients treated with FIL 200mg achieved EBS remission versus placebo in Cohorts A (treatment difference [95%CI]: 10.8% [2.1, 19.5]; p=0.0157) and B (7.2% [1.6, 12.8]; p=0.0103). More patients receiving FIL 200mg versus placebo in Cohort A achieved MCS remission (24.5% vs 12.4%, p=0.0053), endoscopic remission (12.2% vs 3.6%, p=0.0047) and Geboes histologic remission (35.1% vs 16.1%, p < 0.0001); in Cohort B, significant benefits for MCS remission (9.5% vs 4.2%, p=0.0393) and Geboes histologic remission (19.8% vs 8.5%, p=0.0019) were observed. Rates of AEs, serious AEs, and AEs leading to discontinuation (the most common reason for discontinuation) were similar across treatment groups during the induction period. In PBO, FIL 100mg, and FIL 200mg groups, serious infection occurred in 0.7%, 0.7%, and 0.4% (Cohort A) and 1.4%, 1.4% and 0.8% (Cohort B); herpes zoster infection occurred in 0%, 0% and 0.8% of (Cohort A) and in 0%, 0.4% and 0.4% of (Cohort B). One patient on FIL 200mg experienced a pulmonary embolism on Day 19; the patient’s medical history was significant for hypothyroidism and pulmonary symptoms of unknown origin. Conclusions: Selection included a high proportion of dual-refractory patients, and patients with severe endoscopic disease. Both doses of FIL were well tolerated. Filgotinib 200mg was effective as an induction treatment for both biologic-naive and biologic-experienced patients with moderately to severely active UC.

Keywords: ulcerative colitis, filgotinib, JAK1 inhibitor, induction therapy

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3433 The Current Ways of Thinking Mild Traumatic Brain Injury and Clinical Practice in a Trauma Hospital: A Pilot Study

Authors: P. Donnelly, G. Mitchell

Abstract:

Traumatic Brain Injury (TBI) is a major contributor to the global burden of disease; despite its ubiquity, there is significant variation in diagnosis, prognosis, and treatment between clinicians. This study aims to examine the spectrum of approaches that currently exist at a Level 1 Trauma Centre in Australasia by surveying Emergency Physicians and Neurosurgeons on those aspects of mTBI. A pilot survey of 17 clinicians (Neurosurgeons, Emergency Physicians, and others who manage patients with mTBI) at a Level 1 Trauma Centre in Brisbane, Australia, was conducted. The objective of this study was to examine the importance these clinicians place on various elements in their approach to the diagnosis, prognostication, and treatment of mTBI. The data were summarised, and the descriptive statistics reported. Loss of consciousness and post-traumatic amnesia were rated as the most important signs or symptoms in diagnosing mTBI (median importance of 8). MRI was the most important imaging modality in diagnosing mTBI (median importance of 7). ‘Number of the Previous TBIs’ and Intracranial Injury on Imaging’ were rated as the most important elements for prognostication (median importance of 9). Education and reassurance were rated as the most important modality for treating mTBI (median importance of 7). There was a statistically insignificant variation between the specialties as to the importance they place on each of these components. In this Australian tertiary trauma center, there appears to be variation in how clinicians approach mTBI. This study is underpowered to state whether this is between clinicians within a specialty or a trend between specialties. This variation is worthwhile in investigating as a step toward a unified approach to diagnosing, prognosticating, and treating this common pathology.

Keywords: clinician, Survey, mild traumatic brain injury, adult

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3432 Pulmonary Embolism Indicative of Myxoma of the Right Atrium

Authors: A. Kherraf, M. Bouziane, A. Drighil, L. Azzouzi, R. Habbal

Abstract:

Objective: Myxomas are rare heart tumors most commonly found in the left atrium. The purpose of this observation is to report a rare case of myxoma of the right atrium revealed by pulmonary embolism. Observation: A 34-year-old patient with no history presented to the emergency room with sudden onset dyspnea. Clinical examination showed arterial pressure at 110/70mmHg, tachycardia at 110bpm, and 90% oxygen saturation. The ECG enrolled in incomplete right bundle branch block. The radio-thorax was normal. Echocardiography revealed the presence of a large homogeneous intra-OD mass, contiguous to the inter-atrial septum, prolapsing through the tricuspid valve, and causing mild tricuspid insufficiency, with dilation of the right ventricle and retained systolic function with PAPs estimated at 45mmHg. A chest scan was performed, revealing the presence of right segmental pulmonary embolism. The patient was put under anticoagulant and underwent surgical resection of the mass; its pathological examination concluded to a myxoma. The post-operative consequences were simple, without recurrence of the mass after one year follow-up. Discussion: Myxomas represent 50% of heart tumors. Most often, they originate in the left atrium, and more rarely in the right atrium or the ventricles. Myxoma of the right atrium can be responsible for life-threatening pulmonary embolism. The most predictive factor for embolization remains the morphology of the myxomas; papillary or villous myxomas are the most friable. Surgery is the standard treatment, with regular postoperative follow-up to detect recurrence. Conclusion: Myxomas of the right atrium are a rare location for these tumors. Pulmonary embolism is the main complication and should routinely involve careful study of the right chambers on echocardiography.

Keywords: Pulmonary Embolism, myxoma, right atrium, heart tumors

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3431 Tenofovir-Amino Acid Conjugates Act as Polymerase Substrates: Implications for Avoiding Cellular Phosphorylation in the Discovery of Nucleotide Analogs

Authors: Sergio Martinez, Weijie Gu, Hoai Nguyen, Hongtao Xu, Piet Herdewijn, Steven De Jonghe, Kalyan Das

Abstract:

Nucleotide analogs are used for treating viral infections such as HIV, hepatitis B, hepatitis C, influenza, and SARS-CoV-2. To become polymerase substrates, a nucleotide analog must be phosphorylated by cellular kinases, which are rate-limiting. The goal of this study is to develop dNTP/NTP analogs directly from nucleotides. Tenofovir (TFV) analogs were synthesized by conjugating with natural or unnatural amino acids. It demonstrates that some conjugates act as dNTP analogs, and HIV-1 reverse transcriptase (RT) catalytically incorporates the TFV part as the chain terminator. X-ray structures in complex with HIV-1 RT/dsDNA showed binding of the conjugates at the polymerase active site, however, in different modes in the presence of Mg²⁺ vs. Mn²⁺ ions. The adaptability of the compounds is seemingly essential for catalytic incorporation of TFV by RT. 4d with a carboxyl sidechain demonstrated the highest incorporation. 4e showed weak incorporation and rather behaved as a dNTP-competitive inhibitor. This result advocates the feasibility of designing NTP/dNTP analogs by chemical substitutions to nucleotide analogs.

Keywords: dNTP analogs, nucleotide analogs, polymerase, tenofovir, X-ray structure

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3430 Effect of Smoking on Tear Break-Up Time and Basal Tear Secretion

Authors: Kalsoom Rani

Abstract:

Tobacco contains nicotine, which causes addiction to many toxic chemicals. In the world, people consume it in the form of smoke, chew, and sniffing, smoke of it is composed of almost 7000 active chemicals, which are very harmful to human health as well as for eye health, inhalation of tobacco smoke and fumes can accelerate and cause many blinding eye diseases. Dry eye and smoking have not been covered extensively in researches; more studies are required to unveil the relationship between smoking and dry eye. This study was conducted to determine the quantity and quality of tears in smokers. 60 subjects participated in the study, which was divided into two groups on the basis of consumption of cigarettes per day with age matched non smokers of 15-50 years. All participants have gone through a study based questioner, eye examination, and diagnostic 'Dry Eye Tests' for evaporative tears evaluation and measurement of basal tear secretion. Subjects were included in the criteria of 10 cigarettes per day with a minimum duration of 1 year; passive smokers for control groups were excluded. The study was carried out in a Medina Teaching Hospital, Faisalabad, Pakistan, ophthalmology department for the duration of 8 months. Mean values for tear break up time (TBUT), was reported 10sec with SD of +3.74 in controlled group, 5sec with SD + 2.32 in smokers and 4sec SD +3.77 heavy smokers in right eye (RE) and left eye (LE) 10.35sec with SD of +3.88 in controlled 5sec with SD + 2.3 in smokers and much reduced TBUT in heavy smokers was 3.85sec SD+2.20. Smoking has a very strong association with TRUT with a significance of P=.00 both eyes. Mean Schirmer-I value of the subjects was reported 12.6mm with SD + 8.37 in RE and 12.59mm with SD + 8.96 LE. The mean Schirmer-II test value was reported in the right, and left eye with a mean value for control was 20.23mm with SD + 8.93, 20.75mm with SD + 8.84 respectively, and in Smokers 9.90mm with SD + 5.74, and 10.07mm with SD + 6.98, and in heavy smokers 7.7mm, SD + 3.22 and 6.9, SD + 3.50 mm, association with smoking showed p=.001 in RE and .003 in LE. Smoking has deteriorated effect on both evaporative tear and aqueous tear secretion and causing symptoms of dry eye burning, itching, redness, and watering with epithelial cell damage.

Keywords: smokers, dry eye, tear break-up time, basal tear secretion

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3429 The Prevalence and Factors Associated with Virological Non-Suppression among HIV-Positive Adult Patients on Antiretroviral Therapy in Woliso Town, Oromia, Ethiopia: A Retrospective Cross-Sectional Study

Authors: Teka Haile, Behailu Hawulte, Solomon Alemayehu

Abstract:

Background: HIV virological failure still remains a problem in HV/AIDS treatment and care. This study aimed to describe the prevalence and identify the factors associated with viral non-suppression among HIV-positive adult patients on antiretroviral therapy in Woliso Town, Oromia, Ethiopia. Methods: A retrospective cross-sectional study was conducted among 424 HIV-positive patient’s attending ART in Woliso Town during the period from August 25, 2020 to August 30, 2020. Data collected from patient medical records were entered into Epi Info version 2.3.2.1 and exported to SPSS version 21.0 for analysis. Logistic regression analysis was done to identify factors associated with viral load non-suppression, and statistical significance of odds ratios were declared using 95% confidence interval and p-value < 0.05. Results: A total of 424 patients were included in this study. The mean age (±SD) of the study participants was 39.88 (±9.995) years. The prevalence of HIV viral load non-suppression was 55 (13.0%) with 95% CI (9.9 – 16.5). Second-line antiretroviral therapy treatment regimen (AOR=8.98, 95% CI: 2.64, 30.58) and routine viral load testing (AOR=0.01, 95% CI: 0.001, 0.02) were significantly associated with virological non-suppression. Conclusion: Virological non-suppression was high, which hinders the achievement of the third global 95 target. The second-line regimen and routine viral load testing were significantly associated with virological non-suppression. It suggests the need to assess the effectiveness of antiretroviral drugs for epidemic control. It also clearly shows the need to decentralize third-line antiretroviral therapy treatment for those patients in need.

Keywords: Art, Ethiopia, virological non-suppression, HIV-positive, Woliso town

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3428 The Social Influences on Americans' Mask-Wearing Behavior During COVID-19

Authors: Ruoya Huang, Ruoxian Huang, Edgar Huang

Abstract:

Based on a convenience sample of 2,092 participants from across all 50 states of the United States, a survey was conducted to explore Americans’ mask-wearing behaviors during COVID-19 according to their political convictions, religious beliefs, and ethnic cultures. The purpose of the study is to provide evidential support for government policymaking to drive up more effective public policies by taking into consideration the variance in these social factors. It was found that the respondents’ party affiliation or preference, religious belief, and ethnicity, in addition to their health condition, gender, level of concern of contracting COVID-19, all affected their mask-waring habits both in March, the initial coronavirus outbreak stage, and in August, when mask-wearing had been made mandatory by the state governments. The study concludes that pandemic awareness campaigns must be run among all citizens, especially among African Americans, Muslims, and Republicans, who have drastically lagged behind in wearing masks to protect themselves and others.

Keywords: Religious Beliefs, Ethnicity, United States, COVID-19 pandemic, mask-wearing, policymaking implications, political affiliations

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3427 Teaching Basic Life Support in More Than 1000 Young School Children in 5th Grade

Authors: H. Booke, R. Nordmeier

Abstract:

Sudden cardiac arrest is sometimes eye-witnessed by kids. Mostly, their (grand-)parents are affected by sudden cardiac arrest, putting these kids under enormous psychological pressure: Although they are more than desperate to help, they feel insecure and helpless and are afraid of causing harm rather than realizing their chance to help. Even years later, they may blame themselves for not having helped their beloved ones. However, the absolute majority of school children - at least in Germany - is not educated to provide first aid. Teaching young kids (5th grade) in basic life support thus may help to save lives while washing away the kids' fear from causing harm during cardio-pulmonary resuscitation. A teaching of circulatory and respiratory (patho-)physiology, followed by hands-on training of basic life support for every single child, was offered to each school in our district. The teaching was performed by anesthesiologists, and the program was called 'kids can save lives'. However, before enrollment in this program, the entire class must have had lessons in biology with a special focus on heart and circulation as well as lung and gas exchange. More than 1.000 kids were taught and trained in basic life support, giving them the knowledge and skills to provide basic life support. This may help to reduce the rate of failure to provide first aid. Therefore, educating young kids in basic life support may not only help to save lives, but it also may help to prevent any feelings of guilt because of not having helped in cases of eye-witnessed sudden cardiac arrest.

Keywords: Teaching, Children, Cardiac Arrest, basic life support, CPR

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3426 Two Weeks of Multi-Modal Inpatient Treatment: Patients Suffering from Chronic Musculoskeletal Pain for over 12 Months

Authors: D. Schafer, H. Booke, R. Nordmeier

Abstract:

Patients suffering from chronic musculoskeletal pain ( > 12 months) are a challenging clientele for pain specialists. A multimodal approach, characterized by a two weeks inpatient treatment, often is the ultimate therapeutic attempt. The lasting effects of such a multimodal approach were analyzed, especially since two weeks of inpatient therapy, although very intense, often seem too short to make a difference in patients suffering from chronic pain for years. The study includes 32 consecutive patients suffering from chronic pain over years who underwent a two weeks multimodal inpatient treatment of pain. Twelve months after discharge, each patient was interviewed to objectify any lasting effects. Pain was measured on admission and 12 months after discharge using the numeric rating scale (NRS). For statistics, a paired students' t-test was used. Significance was defined as p < 0.05. The average intensity of pain on admission was 8,6 on the NRS. Twelve months after discharge, the intensity of pain was still reduced by an average of 48% (average NRS 4,4), p < 0.05. Despite this significant improvement in pain severity, two thirds (66%) of the patients still judge their treatment as not sufficient. In conclusion, inpatient treatment of chronic pain has a long-lasting effect on the intensity of pain in patients suffering from chronic musculoskeletal pain for more than 12 months.

Keywords: Musculoskeletal pain, Chronic Pain, inpatient treatment, multimodal pain treatment

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3425 Use of Scaling to Improve Reach in Virtual Reality for People with Parkinson's Disease

Authors: Sharif Mohammad Shahnewaz Ferdous, Tanvir Irfan Chowdhury, John Quarles

Abstract:

The objective of this study is to investigate the effect of scaling in virtual reality (VR) to improve the reach of participants with Parkinson’s Disease (PD). People with PD often suffer from limited reach because of their impaired postural stability. This research explored two hypotheses: 1. Scaling a person’s movement in virtual reality can be helpful to improve reach, and 2. A person’s post-exposure reach is improved from pre-exposure reach. Seventeen participants were recruited to take part in a VR study, but ten of them were disqualified because of their inability to stand up for a long period. Two of them did not continue after the initial Unified Parkinson's Disease Rating Scale (UPDRS-8) clinical assessment. Five participants played a VR “water balloon smash” game where they had to reach to their left or right to catch the virtual water balloon thrown at them and smash them by crossing their mid-section. Midline crossing is a challenging task for people with PD and is often practiced as a part of their rehabilitation exercises. The water balloon smash game incorporates this midline crossing with the multidirectional reach test, a well-established test to measure the balance of a person. Scaling was applied to the displacement of their virtual hands that they can see in the virtual environment (VE). There were three counterbalanced study conditions - under-scaled (scale = 0.83), not-scaled (scale = 1), and over-scaled (scale = 1.2), where scale value is the ratio between the virtual reach that they perceive in the VE and their actual reach. During the balloon smash game, the distance of the balloons’ trajectory was increased or decreased following a staircase pattern based on consecutive success or failure of catching them. In total, six measurements of their reach were recorded – 1. Real World Reach (pre-exposure), 2. Virtual Reality Baseline Reach, 3. Virtual Reality Not Scaled Reach, 4. Under Scaled Reach, 5. Over Scaled Reach, and 6. Real World Reach (post-exposure) (RWR-post). Data shows that there was a significant improvement in reach in both left and right-hand sides in under-scaled and over-scaled conditions. Therefore, hypothesis 1 can be accepted. There was no significant improvement in reach in the not-scaled condition. The reason can be added difficulty (under-scale) or added motivation (over-scaled) might have an impact on reach. While comparing pre-exposure vs. post-exposure real-world reach, significant improvement was only observed on the right-hand side, not on the left-hand side. Therefore, hypothesis 2 cannot be accepted. In conclusion, the recommendation from this research is to include a scaling factor in virtual reality-based rehabilitation exercises for people with Parkinson’s disease.

Keywords: Virtual Reality, Rehabilitation, Parkinson’s disease, Scaling, reach

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3424 A Wearable Device to Overcome Post–Stroke Learned Non-Use; The Rehabilitation Gaming System for wearables: Methodology, Design and Usability

Authors: Javier De La Torre Costa, Belen Rubio Ballester, Martina Maier, Paul F. M. J. Verschure

Abstract:

After a stroke, a great number of patients experience persistent motor impairments such as hemiparesis or weakness in one entire side of the body. As a result, the lack of use of the paretic limb might be one of the main contributors to functional loss after clinical discharge. We aim to reverse this cycle by promoting the use of the paretic limb during activities of daily living (ADLs). To do so, we describe the key components of a system that is composed of a wearable bracelet (i.e., a smartwatch) and a mobile phone, designed to bring a set of neurorehabilitation principles that promote acquisition, retention and generalization of skills to the home of the patient. A fundamental question is whether the loss in motor function derived from learned–non–use may emerge as a consequence of decision–making processes for motor optimization. Our system is based on well-established rehabilitation strategies that aim to reverse this behaviour by increasing the reward associated with action execution as well as implicitly reducing the expected cost associated with the use of the paretic limb, following the notion of the reinforcement–induced movement therapy (RIMT). Here we validate an accelerometer–based measure of arm use, and its capacity to discriminate different activities that require increasing movement of the arm. We also show how the system can act as a personalized assistant by providing specific goals and adjusting them depending on the performance of the patients. The usability and acceptance of the device as a rehabilitation tool is tested using a battery of self–reported and objective measurements obtained from acute/subacute patients and healthy controls. We believe that an extension of these technologies will allow for the deployment of unsupervised rehabilitation paradigms during and beyond the hospitalization time.

Keywords: Stroke, wearables, hemiparesis, learned non use, ADLs

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3423 Partnering With Key Stakeholders for Successful Implementation of Inhaled Analgesia for Specific Emergency Department Presentations

Authors: Sarah Hazelwood, Janice Hay

Abstract:

Methoxyflurane is an inhaled analgesic administered via a disposable inhaler, which has been used in Australia for 40 years for the management of pain in children & adults. However, there is a lack of data for methoxyflurane as a frontline analgesic medication within the emergency department (ED). This study will investigate the usefulness of methoxyflurane in a private inner-city ED. The study concluded that the inclusion of all key stakeholders in the prescribing, administering & use of this new process led to comprehensive uptake & vastly positive outcomes for consumer & health professionals. Method: A 12-week prospective pilot study was completed utilizing patients presenting to the ED in pain (numeric pain rating score > 4) that fit the requirement of methoxyflurane use (as outlined in the Australian Prescriber information package). Nurses completed a formatted spreadsheet for each interaction where methoxyflurane was used. Patient demographics, day, time, initial numeric pain score, analgesic response time, the reason for use, staff concern (free text), & patient feedback (free text), & discharge time was documented. When clinical concern was raised, the researcher retrieved & reviewed patient notes. Results: 140 methoxyflurane inhalers were used. 60% of patients were 31 years of age & over (n=82) with 16% aged 70+. The gender split; 51% male: 49% female. Trauma-related pain (57%) saw the highest use of administration, with the evening hours (1500-2259) seeing the greatest numbers used (39%). Tuesday, Thursday & Sunday shared the highest daily use throughout the study. A minimum numerical pain score of 4/10 (n=13, 9%), with the ranges of 5 - 7/10 (moderate pain) being given by almost 50% of patients. Only 3 instances of pain scores increased post use of methoxyflurane (all other entries showed pain score < initial rating). Patients & staff noted obvious analgesic response within 3 minutes (n= 96, 81%, of administration). Nurses documented a change in patient vital signs for 4 of the 15 patient-related concerns; the remaining concerns were due to “gagging” on the taste, or “having a coughing episode”; one patient tried to leave the department before the procedure was attended (very euphoric state). Upon review of the staff concerns – no adverse events occurred & return to therapeutic vitals occurred within 10 minutes. Length of stay for patients was compared with similar presentations (such as dislocated shoulder or ankle fracture) & saw an average 40-minute decrease in time to discharge. Methoxyflurane treatment was rated “positively” by > 80% of patients – with remaining feedback related to mild & transient concerns. Staff similarly noted a positive response to methoxyflurane as an analgesic & as an added tool for frontline analgesic purposes. Conclusion: Methoxyflurane should be used on suitable patient presentations requiring immediate, short term pain relief. As a highly portable, non-narcotic avenue to treat pain this study showed obvious therapeutic benefit, positive feedback, & a shorter length of stay in the ED. By partnering with key stake holders, this study determined methoxyflurane use decreased work load, decreased wait time to analgesia, and increased patient satisfaction.

Keywords: Emergency, Analgesia, benefits, methoxyflurane

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3422 Protective Role of Autophagy Challenging the Stresses of Type 2 Diabetes and Dyslipidemia

Authors: Maitree Bhattacharyya, Tanima Chatterjee

Abstract:

The global challenge of type 2 diabetes mellitus is a major health concern in this millennium, and researchers are continuously exploring new targets to develop a novel therapeutic strategy. Type 2 diabetes mellitus (T2DM) is often coupled with dyslipidemia increasing the risks for cardiovascular (CVD) complications. Enhanced oxidative and nitrosative stresses appear to be the major risk factors underlying insulin resistance, dyslipidemia, β-cell dysfunction, and T2DM pathogenesis. Autophagy emerges to be a promising defense mechanism against stress-mediated cell damage regulating tissue homeostasis, cellular quality control, and energy production, promoting cell survival. In this study, we have attempted to explore the pivotal role of autophagy in T2DM subjects with or without dyslipidemia in peripheral blood mononuclear cells and insulin-resistant HepG2 cells utilizing flow cytometric platform, confocal microscopy, and molecular biology techniques like western blotting, immunofluorescence, and real-time polymerase chain reaction. In the case of T2DM with dyslipidemia higher population of autophagy, positive cells were detected compared to patients with the only T2DM, which might have resulted due to higher stress. Autophagy was observed to be triggered both by oxidative and nitrosative stress revealing a novel finding of our research. LC3 puncta was observed in peripheral blood mononuclear cells and periphery of HepG2 cells in the case of the diabetic and diabetic-dyslipidemic conditions. Increased expression of ATG5, LC3B, and Beclin supports the autophagic pathway in both PBMC and insulin-resistant Hep G2 cells. Upon blocking autophagy by 3-methyl adenine (3MA), the apoptotic cell population increased significantly, as observed by caspase‐3 cleavage and reduced expression of Bcl2. Autophagy has also been evidenced to control oxidative stress-mediated up-regulation of inflammatory markers like IL-6 and TNF-α. To conclude, this study elucidates autophagy to play a protective role in the case of diabetes mellitus with dyslipidemia. In the present scenario, this study demands to have a significant impact on developing a new therapeutic strategy for diabetic dyslipidemic subjects by enhancing autophagic activity.

Keywords: apoptosis, autophagy, Dyslipidemia, Type 2 diabetes, reactive oxygen species, reactive nitrogen species

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3421 In vitro Antioxidant and Antisickling Effects of Aerva javanica, and Ficus palmata Extracts on Sickle Cell Anemia

Authors: E. A. Alaswad, H. M. Choudhry, F. Z. Filimban

Abstract:

Sickle Cell Anemia (SCA) is one type of blood diseases related to autosomal disorder. The sickle shaped red blood cells are the main cause of many problems in the blood vessels and capillaries. Aerva Javanica (J) and Ficus Palmata (P) are medicinal plants that have many popular uses and have been proved their efficacy. The aim of this study was to assess the antioxidants activity and the antisickling effect of J and P extractions. The period of this study, air-dried leaves of J, and P plants were ground and the active components were extracted by maceration in water (W) and methanol (M) as solvents. The antioxidants activity of JW, PW, JM, and PM were assessed by way of the radical scavenging method using 2,2-diphenyl-1-picrylhydrazyl (DPPH). To determine the antisickling effect of J and P extracts. 20 samples were collected from sickle cell anemia patients. Different concentrations of J and P extracts (200 and 110 μg/mL) were added on the sample and incubated. A drop of each sample was examined with light microscope. Normal and sickled RBCs were calculated and expressed as the percent of sickling. The stabilization effect of the extracts was measured by the osmotic fragility test for erythrocytes. The finding suggests as estimated by DPPH method, all the extracts showed an antioxidant activity with a significant inhibition of the DPPH radicals. PM has the least IC50% with 71.49 μg/ml while JM was the most with 408.49 μg/ml. Sickle cells treated with extracts at different concentrations significantly reduced the percentage of sickling compering to control samples. However, JM 200 μg/mL give the highest anti-sickling affect with 17.4% of sickling compared to control 67.5 of sickling while PM at 200 μg/mL showed the highest membrane cell stability. In a conclusion, the results showed that J and P extracts have antisickling effects. Therefore, the Aerva javanica and Ficus palmata may have a role in SCA management and a good impact on the patient's lives.

Keywords: antioxidant, Aerva javanica, sickle cell anemia, antisickling, Ficus palmata

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3420 The Clinical Reasoning behind the Application of Sleep Assessments and Interventions in Occupational Therapy

Authors: Kathleen Dyan Apostol, Kanika Eng, Patricia Denisse Librea, Thong Hoang Vo

Abstract:

Sleep disruptions may impact an individual’s participation and performance in many areas of occupation. Occupational therapists (OTs) can address sleep by utilizing various sleep assessments and interventions. The aim of this study was to determine and understand the clinical reasoning and the decision-making process behind how OTs select and use sleep assessments and interventions in their practice. We also sought to identify any challenges that OTs encounter in addressing sleep. We surveyed 124 participants to obtain a detailed understanding of how and why OTs select sleep assessments and interventions. The results revealed that the reasons OTs select and utilize specific sleep assessments and intervention is based on convenience, environmental factors, knowledge and education, values, and client-centeredness. This study implies that there is a need for a standardized guideline for how to select sleep assessments and interventions that are reliable and valid. Furthermore, sleep assessments that are specific to the field of Occupational Therapy may assist in obtaining information to select the most appropriate sleep interventions.

Keywords: Occupational therapy, Clinical Reasoning, sleep assessments, sleep interventions

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3419 Digital Rehabilitation for Navigation Impairment

Authors: Milan N. A. Van Der Kuil, Anne M. A. Visser-Meily, Andrea W. M. Evers, Ineke J. M. Van Der Ham

Abstract:

Navigation ability is essential for autonomy and mobility in daily life. In patients with acquired brain injury, navigation impairment is frequently impaired; however, in this study, we tested the effectiveness of a serious gaming training protocol as a tool for cognitive rehabilitation to reduce navigation impairment. In total, 38 patients with acquired brain injury and subjective navigation complaints completed the experiment, with a partially blind, randomized control trial design. An objective navigation test was used to construct a strengths and weaknesses profile for each patient. Subsequently, patients received personalized compensation training that matched their strengths and weaknesses by addressing an egocentric or allocentric strategy or a strategy aimed at minimizing the use of landmarks. Participants in the experimental condition received psychoeducation and a home-based rehabilitation game with a series of exercises (e.g., map reading, place finding, and turn memorization). The exercises were developed to stimulate the adoption of more beneficial strategies, according to the compensatory approach. Self-reported navigation ability (wayfinding questionnaire), participation level, and objective navigation performance were measured before and after 1 and 4 weeks after completing the six-week training program. Results indicate that the experimental group significantly improved in subjective navigation ability both 1 and 4 weeks after completion of the training, in comparison to the score before training and the scores of the control group. Similarly, goal attainment showed a significant increase after the first and fourth week after training. Objective navigation performance was not affected by the training. This navigation training protocol provides an effective solution to address navigation impairment after acquired brain injury, with clear improvements in subjective performance and goal attainment of the participants. The outcomes of the training should be re-examined after implementation in a clinical setting.

Keywords: Serious Gaming, cognitive rehabilitation, spatial navigation, acquired brain injury

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3418 A Case Study on Effectiveness of Hijamah (Wet Cupping) on Numbness of Foot in Diabetic Patient

Authors: Nafdha Thajudeen

Abstract:

Hijamah therapy is one of the leading alternative & complementary modalities in the World. It is a kind of detoxification, rejuvenation, and blood purification method. It comes under Ilaj bil Tadbeer (Regimental therapy) in the Unani medical system. In diabetes, hands and foot care in people is very important because of slow blood circulation, where blood sometimes is not able to fully penetrate the capillaries. Hijamah therapy works upon the following two principles- Tanqiyae Mawad (Evacuation of morbid humor) and Imalae Mawad (Diversion of humor). The aim of this study was to find out the effectiveness of hijamah therapy on the numbness of legs in a diabetic patient. This case study was carried out in Ayurvedic Research Hospital (Non-Communicable Diseases), Ninthavur, Sri Lanka. A 63 years old female diabetic patient came to the clinic with the complain of numbness in both feet for one year. The treatment history of the patient revealed that she had taken western medicine for her complaints for 7 months. In her first visit, wet cupping was done on local and distal points. The patient said there was a remarkable improvement; internal medicines were given to keep the sugar level in normal with some external applications. Every week, wet cupping was done on the same points, with repeating the same medicines. Foot numbness was fully cured within one month. The finding of this study shows that the complaint of numbness in the diabetic patient was treated with hijamah therapy with internal & external medicine. This case study can be concluded as hijamah therapy is very effective in treating diabetic numbness. This single case study may be the entrance for future clinical studies

Keywords: Diabetes, numbness, Hijamah therapy, Ilaj bil thadbeer

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3417 Peptidoglycan Vaccine-On-Chip against a Lipopolysaccharide-Induced Experimental Sepsis Model

Authors: Katerina Bakela, Ioanna Zerva, Irene Athanassakis

Abstract:

Lipopolysaccharide (LPS) is commonly used in murine sepsis models, which are largely associated with immunosuppression (incretion of MDSCs cells and Tregs, imbalance of inflammatory/anti-inflammatory cytokines) and collapse of the immune system. After adapting the LPS treatment to the needs of locally bred BALB/c mice, the present study explored the protective role of Micrococcus luteus peptidoglycan (PG) pre-activated vaccine-on chip in endotoxemia. The established protocol consisted of five daily intraperitoneal injections of 0.2mg/g LPS. Such protocol allowed longer survival, necessary in the prospect of the therapeutic treatment application. The so-called vaccine-on-chip consists of a 3-dimensional laser micro-texture Si-scaffold loaded with BALB/c mouse macrophages and activated in vitro with 1μg/ml PG, which exert its action upon subcutaneous implantation. The LPS treatment significantly decreased CD4+, CD8+, CD3z+, and CD19+ cells, while increasing myeloid-derived suppressor cells (MDSCs), CD25+, and Foxp3+ cells. These results were accompanied by increased arginase-1 activity in spleen cell lysates and production of IL-6, TNF-a, and IL-18 while acquiring severe sepsis phenotype as defined by the murine sepsis scoring. The in vivo application of PG pre-activated vaccine-on chip significantly decreased the percent of CD11b+, Gr1+, CD25+, Foxp3+ cells, and arginase-1 activity in the spleen of LPS-treated animals, while decreasing IL-6 and TNF-a in the serum, allowing survival to all animals tested and rescuing the severity of sepsis phenotype. In conclusion, these results reveal a promising mode of action of PG pre-activated vaccine-on chip in LPS endotoxemia, strengthening; thus, the use of treatment is septic patients.

Keywords: sepsis, myeloid-derived suppressor cells, peptidoglycan, Si-scaffolds

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3416 Salvage Reconstruction of Intraoral Dehiscence following Free Fibular Flap with a Superficial Temporal Artery Islandized Flap (STAIF)

Authors: Allyne Topaz

Abstract:

Intraoral dehiscence compromises free fibula flaps following mandibular reconstruction. Salivary contamination risks thrombosis of microvascular anastomosis and hardware infection. The superficial temporal artery islandized flap (STAIF) offers an efficient, non-microsurgical reconstructive option for regaining intraoral competency for a time sensitive complication. Methods: The STAIF flap is based on the superficial temporal artery coursing along the anterior hairline. The flap is mapped with assistance of the doppler probe. The width of the skin paddle is taken based on the ability to close the donor site. The flap is taken down to the level of the zygomatic arch and tunneled into the mouth. Results: We present a case of a patient who underwent mandibular reconstruction with a free fibula flap after a traumatic shotgun wound. The patient developed repeated intraoral dehiscence following failed local buccal and floor of mouth flaps leading to salivary contamination of the flap and hardware. The intraoral dehiscence was successfully salvaged on the third attempt with a STAIF flap. Conclusions: Intraoral dehiscence creates a complication requiring urgent attention to prevent loss of free fibula flap after mandibular reconstruction. The STAIF is a non-microsurgical option for restoring intraoral competency. This robust, axially vascularized skin paddle may be split for intra- and extra-oral coverage, as needed and can be an important tool in the reconstructive armamentarium.

Keywords: mandibular reconstruction, free fibula flap, intraoral dehiscence, superficial temporal artery islandized flap

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3415 The Use of Online Multimedia Platforms to Deliver a Regional Medical Schools Finals Revision Course During the COVID-19 Pandemic

Authors: Matthew Edmunds, Andrew Hunter, Clare Littlewood, Wisha Gul, Gabriel Heppenstall-Harris, Thomas Humphries

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Background: Revision courses for medical students undertaking their final examinations are commonplace throughout the UK. Traditionally these take the form of a series of lectures over multiple weeks or a single day of intensive lectures. The COVID-19 pandemic, however, has required medical educators to create new teaching formats to ensure they adhere to social distancing requirements. It has provided an unexpected opportunity to accelerate the development of students proficiency in the use of ‘technology-enabled communication platforms’, as mandated in the 2018 GMC Outcomes of Graduates. Recent advances in technology have made distance learning possible, whilst also providing novel and more engaging learning opportunities for students. Foundation Year 2 doctors at Aintree University Hospital developed an online series of videos to help prepare medical students in the North West and byond for their final medical school examinations. Method: Eight hour-long videos covering the key topics in medicine and surgery were posted on the Peer Learning Liverpool Youtube channel. These videos were created using new technology such as the screen and audio recording platform, Loom. Each video compromised at least 20 single best answer (SBA) questions, in keeping with the format in most medical school finals. Explanations of the answers were provided, and additional important material was covered. Students were able to ask questions by commenting on the videos, with the authors replying as soon as possible. Feedback was collated using an online Google form. Results: An average of 327 people viewed each video, with 113 students filling in the feedback form. 65.5% of respondents were within one month of their final medical school examinations. The average rating for how well prepared the students felt for their finals was 6.21/10 prior to the course and 8.01/10 after the course. A paired t-test demonstrated a mean increase of 1.80 (95% CI 1.66-1.93). Overall, 98.2% said the online format worked well or very well, and 99.1% would recommend the course to a peer. Conclusions: Based on the feedback received, the online revision course was successful both in terms of preparing students for their final examinations, and with regards to how well the online format worked. Free-text qualitative feedback highlighted advantages such as; students could learn at their own pace, revisit key concepts important to them, and practice exam style questions via the case-based format. Limitations identified included inconsistent audiovisual quality, and requests for a live online Q&A session following the conclusion of the course. This course will be relaunched later in the year with increased opportunities for students to access live feedback. The success of this online course has shown the roll that technology can play in medical education. As well as providing novel teaching modes, online learning allows students to access resources that otherwise would not be available locally, and ensure that they do not miss out on teaching that was previously provided face to face, in the current climate of social distancing.

Keywords: Online Learning, medical school, COVID-19 pandemic, Revision course

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3414 Functions and Pathophysiology of the Ventricular System: Review of the Underlying Basic Physics

Authors: Mohamed Abdelrahman Abdalla

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Apart from their function in producing CSF, the brain ventricles have been recognized as the mere remnant of the embryological neural tube with no clear role. The lack of proper definition of the function of the brain ventricles and the central spinal canal has made it difficult to ascertain the pathophysiology of its different disease conditions or to treat them. This study aims to review the simple physics that could explain the basic function of the CNS ventricular system and to suggest new ways of approaching its pathology. There are probably more physical factors to consider than only the pressure. Monro-Killie hypothesis focuses on volume and subsequently pressure to direct our surgical management in different disease conditions. However, the enlarged volume of the ventricles in normal pressure hydrocephalus does not move any blood or brain outside the skull. Also, in idiopathic intracranial hypertension, the very high intracranial pressure rarely causes brain herniation. On this note, the continuum of the intracranial cavity with the spinal canal makes it a whole unit and hence the defect in the theory. In this study, adding different factors to the equation like brain and CSF density and positions of the brain in space, in addition to the volume and pressure, aims to identify how the ventricles are important in the CNS homeostasis. In addition, increasing the variables that we analyze to treat different CSF pathological conditions should increase our understanding and hence accuracy of treatment of such conditions.

Keywords: communicating hydrocephalus, functions of the ventricles, idiopathic intracranial hypertension physics of CSF

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3413 Amblyopia and Eccentric Fixation

Authors: Kristine Kalnica-Dorosenko, Aiga Svede

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Amblyopia or 'lazy eye' is impaired or dim vision without obvious defect or change in the eye. It is often associated with abnormal visual experience, most commonly strabismus, anisometropia or both, and form deprivation. The main task of amblyopia treatment is to ameliorate etiological factors to create a clear retinal image and, to ensure the participation of the amblyopic eye in the visual process. The treatment of amblyopia and eccentric fixation is usually associated with problems in the therapy. Eccentric fixation is present in around 44% of all patients with amblyopia and in 30% of patients with strabismic amblyopia. In Latvia, amblyopia is carefully treated in various clinics, but eccentricity diagnosis is relatively rare. Conflict which has developed relating to the relationship between the visual disorder and the degree of eccentric fixation in amblyopia should to be rethoughted, because it has an important bearing on the cause and treatment of amblyopia, and the role of the eccentric fixation in this case. Visuoscopy is the most frequently used method for determination of eccentric fixation. With traditional visuoscopy, a fixation target is projected onto the patient retina, and the examiner asks to look straight directly at the center of the target. An optometrist then observes the point on the macula used for fixation. This objective test provides clinicians with direct observation of the fixation point of the eye. It requires patients to voluntarily fixate the target and assumes the foveal reflex accurately demarcates the center of the foveal pit. In the end, by having a very simple method to evaluate fixation, it is possible to indirectly evaluate treatment improvement, as eccentric fixation is always associated with reduced visual acuity. So, one may expect that if eccentric fixation in amlyopic eye is found with visuoscopy, then visual acuity should be less than 1.0 (in decimal units). With occlusion or another amblyopia therapy, one would expect both visual acuity and fixation to improve simultaneously, that is fixation would become more central. Consequently, improvement in fixation pattern by treatment is an indirect measurement of improvement of visual acuity. Evaluation of eccentric fixation in the child may be helpful in identifying amblyopia in children prior to measurement of visual acuity. This is very important because the earlier amblyopia is diagnosed – the better the chance of improving visual acuity.

Keywords: amblyopia, Visual acuity, eccentric fixation, visuoscopy

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3412 The Sexual Knowledge, Attitudes and Behaviors of College Students from Only-Child Families: A National Survey in China

Authors: Jiashu Shen

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This study aims at exploring the characteristics of sexual knowledge, attitudes, and behaviors of Chinese college students from the 'one-child' families compared with those with siblings. This study utilized the data from the 'National College Student Survey on Sexual and Reproductive Health 2019'. Multiple logistic regression analyses were used to assess the association between the 'only-child' and their sexual knowledge, sexual attitudes, sexual behaviors, and risky sexual behaviors (RSB) stratified by sex and home regions, respectively. Compared with students with siblings, the 'only-child' students scored higher in sex-related knowledge (only-child students: 4.49 ± 2.28, students with siblings: 3.60 ± 2.27). Stronger associations between only-child and more liberal sexual attitudes were found in urban areas, including the approval of premarital sexual intercourse (OR: 1.51, 95% CI: 1.50-1.65) and multiple sexual partners (OR: 1.85, 95% CI: 1.72-1.99). For risky sexual behaviors, being only-child is more likely to use condoms in first sexual intercourse, especially among male students (OR: 0.68, 95% CI: 0.58-0.80). Only-child students are more likely to have more sexual knowledge, more liberal sexual attitude, and less risky sexual behavior. Further health policy and sex education should focus more on students with siblings.

Keywords: sexual knowledge, attitudes and behaviors, only-child students, students with siblings

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