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Authors: Mitakshara Sharma, Sonal Sharma

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Vesiculobullous diseases are heterogeneous group of dermatological disorders with protean manifestations. The most important technique for the patients with vesiculobullous diseases is conventional histopathology and confirmatory tests like direct immunofluorescence (DIF) and indirect immunofluorescence (IIF). DIF has been used for decades to investigate pathophysiology and in the diagnosis. It detects molecules such as immunoglobulins and complement components. It is done on the perilesional skin. Diagnosis of DIF test depends on features like primary site of the immune deposits, class of immunoglobulin, number of immune deposits and deposition at other sites. The aim of the study is to correlate DIF with clinical and histopathological findings and to analyze the utility of DIF in the diagnosis of these disorders. It is a retrospective descriptive study conducted for 2 years from 2015 to 2017 in Department of Pathology, GTB Hospital on perilesional punch biopsies of vesiculobullous lesions. Biopsies were sent in Michael’s medium. The specimens were washed, frozen and incubated with fluorescein isothiocyanate (FITC) tagged antihuman antibodies IgA, IgG, IgM, C3 & F and were viewed under fluorescent microscope. Out of 401 skin biopsies submitted for DIF, 285 were vesiculobullous diseases, in which the most common was Pemphigus vulgaris (34%) followed by Bullous pemphigoid (21.5%), Dermatitis herpetiformis (16%), Pemphigus foliaceus (11.9%), Linear IgA disease (11.9%), Epidermolysisbullosa (2.39%) and Pemphigus herpetiformis (1.7%). We will be presenting the DIF findings in the all these vesiculobullous diseases. DIF in conjugation with histopathology gives the best diagnostic yield in these lesions. It also helps in the diagnosis whenever there is a clinical and histopathological overlap.

Keywords: antibodies, direct immunofluorescence, pemphigus, vesiculobullous

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Authors: S. Teimouri, S. Abbasi

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Milk-fruit juice mixture is a type of soft drinks, which can be produced by mixing milk with pieces of fruits, fruit juices, or fruit juices concentrates. The major problem of these products, mainly the acidic ones, is phase separation which occurs during formulation and storage due to the aggregation of caseins at low pH Short-chain inulin (CLR), long-chain inulin (TEX), native inulin (IQ) and Long-chain inulin (TEX) and short-chain inulin (CLR) combined in different proportions (2o:80, 50:50, and 80:20) were added (2-10 %) to sourcherry juice-milk mixture and their stabilization mechanisms were studied with using rheological and microstructural observations. Stevioside as a bio-sweetener and sugar-replacer was added at last step. Finally, sensory analyses were taken place on stabilized samples. According to the findings, TEX stabilized the mixture at concentration of 8%. MIX and IQ reduced phase separation at high concentration but had not complete effect on stabilization. CLR did not effect on stabilization. Rheological changes and inulin aggregates formation were not observed in CLR samples during the one month storage period. However TEX, MIX and IQ samples formed inulin aggregates and became more thixotropic, elastic and increased the viscosity of mixture. The rate of the inulin aggregates formation and viscosity increasing was in the following order TEX > MIX > IQ. Consequently the mixture which stabilized with inulin and sweetened with stevioside had the prebiotic properties which may suggest to diabetic patients and children.

Keywords: prebiotic, inulin, casein, stabilization, stevioside

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Authors: Shadrack Mambo, Karim Djouani, Yskandar Hamam, Barend van Wyk, Patrick Siarry

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This paper discusses the current trends in medical image registration techniques and addresses the need to provide a solid theoretical foundation for research endeavours. Methodological analysis and synthesis of quality literature was done, providing a platform for developing a good foundation for research study in this field which is crucial in understanding the existing levels of knowledge. Research on medical image registration techniques assists clinical and medical practitioners in diagnosis of tumours and lesion in anatomical organs, thereby enhancing fast and accurate curative treatment of patients. Literature review aims to provide a solid theoretical foundation for research endeavours in image registration techniques. Developing a solid foundation for a research study is possible through a methodological analysis and synthesis of existing contributions. Out of these considerations, the aim of this paper is to enhance the scientific community’s understanding of the current status of research in medical image registration techniques and also communicate to them, the contribution of this research in the field of image processing. The gaps identified in current techniques can be closed by use of artificial neural networks that form learning systems designed to minimise error function. The paper also suggests several areas of future research in the image registration.

Keywords: image registration techniques, medical images, neural networks, optimisaztion, transformation

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Authors: Leila Yazdanpanah, Hajieh Shahbazian, Seyed Mahmoud Latifi, Armaghan Moravej Aleali, Saeed Ghanbari

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Introduction: This study was designed to determine the prevalence of diabetes in people aged over 20 years in Ahvaz, Iran. Material and Methods: The study population selected by cluster sampling. Fasting blood sugar (FBS) assessed after minimum 8 hours night fasting. A questionnaire included: age, sex, weight, height, blood pressure, waist circumference and previous history of diabetes were completed for each patient. FBS≥126mg/dl and/or oral hypoglycemic treatment and/or insulin was defined as diabetes, FBS=100-125 mg/dl as impaired fasting glucose (IFG) and FBS<100mg/dl as normal. Results: Study population was 936 persons (47.2 % male and 52.8% female). The mean age of a population was 42.2±14 years. Diabetes was detected in 15.1 % of population. Only 57cases(6.1%) were aware of their disease and 9% had unknown diabetes. Diabetes was detected in 14.5% of male (11.3% unknown and 3.2 % known diabetes) and in 11.7% of female (7% unknown and 4.7% known diabetes). Prevalence of diabetes had no significant difference (P=0.21) in male and female but unknown diabetes was significantly higher in male (P=0.025). Prevalence of diabetes was increased with rising of age between 20-60 years old but decreasing after 60 years old. Diabetes was related to age, waist circumference and systolic and diastolic blood pressure, TG level and BMI in both sex (P=0.0001). Conclusion: More than half of female and three-fourth of male diabetic patients are unaware of their disease in South of Iran. Diabetes screening should be intensified in this population.

Keywords: diabetes, prevalence, risk factor, awareness

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Authors: Jae-Hyung Jin, Kyung-Tae Lee, Yee-Seul So, Eunji Jeong, Yeonseon Lee, Dongpil Lee, Dong-Gi Lee, Yong-Sun Bahn

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Cryptococcus neoformans causes cryptococcal meningoencephalitis mainly in immunocompromised patients as well as immunocompetent people. But therapeutic options are limited to treat cryptococcosis. Some signaling pathways including cyclic AMP pathway, MAPK pathway, and calcineurin pathway play a central role in the regulation of the growth, differentiation, and virulence of C. neoformans. To understand signaling networks regulating the virulence of C. neoformans, we selected the 114 putative phosphatase genes, one of the major components of signaling networks, in the genome of C. neoformans. We identified putative phosphatases based on annotation in C. neoformans var. grubii genome database provided by the Broad Institute and National Center for Biotechnology Information (NCBI) and performed a BLAST search of phosphatases of Saccharomyces cerevisiae, Aspergillus nidulans, Candida albicans and Fusarium graminearum to Cryptococcus neoformans. We classified putative phosphatases into 14 groups based on InterPro phosphatase domain annotation. Here, we constructed 170 signature-tagged gene-deletion strains through homologous recombination methods for 91 putative phosphatases. We examined their phenotypic traits under 30 different in vitro conditions, including growth, differentiation, stress response, antifungal resistance and virulence-factor production.

Keywords: human fungal pathogen, phosphatase, deletion library, functional genomics

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Authors: Maneka Marianne Britto, Hansraj Riteesh Bookun

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The ability of a junior doctor to deliver complex multi-disciplinary care to patients in a paradigm of respect and collaboration requires a multitude of interpersonal skills and competencies. A short survey was used to explore the perspective of allied health staff on the desirable attributes of a junior doctor which are conducive to good teamwork. 23 allied health professionals (14 nurses, 4 physiotherapists, 2 dietitians, 1 occupational therapist, 1 speech therapist and 1 audiologist) responded to this 17-item survey. There were 17 females. The mean age of the respondents was 34.9 ± 10.1 years. The salient findings of our survey are that 95% of our respondents rated friendliness and non-clinical small talk with average importance or greater. 45% of them viewed these 2 items as very important or absolutely essential. A single respondent viewed these 2 items with little importance. The other criteria which were rated with high levels of importance were the acknowledgment of allied health suggestions and good ward organizational skills. Training these collaborative skills is challenging, and an enhanced understanding of interprofessional perspectives will help a junior doctor to achieve better clinical outcomes. It is hoped that this paper will further stimulate discussion in this area and will encourage junior doctors to engage in non-clinical conversations with allied health staff in the spirit of promoting effective teamwork.

Keywords: allied health, collaboration, doctor, medicine, surgery

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Authors: Ke Qiu, Minzi Mao, Jianjun Ren, Yu Zhao

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Although much has been done to investigate the influence of obstructive sleep apnea (OSA) on cognitive function, little attention has been paid to the role which gender differences play in this association. In the present study, we aim to explore the gender-specific association between OSA and cognitive impairment. Participants from UK biobank who have completed at least one of the five baseline cognitive tests (visuospatial memory, prospective memory, fluid intelligence, short numeric memory and reaction time) were included and were further categorized into three groups: (1) OSA, (2) self-reported snoring but without OSA, and (3) healthy controls (without OSA or snoring). Multivariable regression analysis was performed to examine the associations among snoring, OSA and performance of each of the five cognitive domains. A total of 267,889 participants (47% male, mean age: 57 years old) were included in our study. In the multivariable regression analysis, female participants in the OSA group had a higher risk of having poor prospective memory (OR: 1.24, 95% CI: 1.02～1.50, p = 0.03). Meanwhile, among female participants, OSA were inversely associated with the performances of fluid intelligence (β: -0.29, 95% CI: -0.46～-0.13, p < 0.001) and short-numeric memory (β: -0.14, 95% CI: -0.35～0.08, p = 0.02). In contrast, among male participants, no significant association was observed between OSA and impairment of the five cognitive domains. Overall, OSA was significantly associated with cognitive impairment in female participants rather than in male participants, indicating that more special attention and timely interventions should be given to female OSA patients to prevent further cognitive impairment.

Keywords: obstructive sleep apnea (OSA), cognitive impairment, gender-specific association, UK biobank

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Authors: Maryam Vaezjalali, Foad Davoodbeglou, Mehrnaz Mesdaghi, Hossein Goudarzi, Fariba Shojaei, Hourieh Aram

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Introduction: Hepatitis B virus (HBV) infection causes chronic infection in human population, with high mortality. Some people are more susceptible to this infection. One of the high risk communities is mentally retarded children, who are institutionalized. Special conditions in these centers predispose children for HBV infection and transmission to healthy people. In this study our objective was to determine the prevalence of HBV infection among institutionalized mentally retarded children and study its associated risk factors. Materials and methods: In this study, 250 mentally retarded children (younger than 14 years old) were included. They were living in 5 nursing institutions, located in different parts of Tehran. HBsAg was measured in the sera of these patients by ELISA method. Results: Among 250 children, 20 children (8%) were HBsAg positive. HBV infection in girls was more than boys (11% to 5.6%). Among the types of mental retardation, children with cerebral palsy had the highest positive result for HBsAg. The most HBV infection (28.5%) was seen in children with longest duration of being institutionalized (10 to 11 years). Vaccinated children were more HBsAg positive (8.7%) than non-vaccinated children (5.3%). However, no significant relationship was observed between any of these factors and HBsAg positivity. Conclusion: Despite improvement of people’s health condition and implementation of HBV vaccination, the prevalence of HBV infection is high in institutionalized mentally retarded children, which highlights the need for active measures to reduce this infection among this high risk population.

Keywords: hepatitis B virus, HBV vaccine, intellectually disabled children, mentally retarded

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Authors: S. P. Singh, Shweta Gupta, Kshama Dwivedi, Shivangi Singh

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Aim: To compare the postoperative pupil cosmesis, mydriasis, and anterior chamber depth (ACD) in traumatic and congenital iris defects after Single-Pass Four-Throw pupilloplasty (SFTP). Method: SFTP was performed along with cataract surgery in 6 patients, each of congenital and traumatic iris defects and pupil size, mydriasis, and ACD was compared after three months. Results: SFTP was successful in repairing congenital and traumatic cases except in 1 traumatic case with a large iris defect. Horizontal pupil diameter decreased while ACD increased in both groups and was comparable between the two groups. The traumatic group showed a significant decrease in pupil diameter while there was an insignificant change in the horizontal pupil diameter in the congenital group. Mydriasis was adequate for fundus examination and was comparable between the two groups. The effect of SFTP on ACD was inconclusive due to the confounding effect of cataract surgery. The incidence of iris atrophy was equal in both groups. Conclusion: SFTP results in anatomical and functional restoration in cases of iris defects with no inadvertent effect on mydriasis.

Keywords: anterior chamber depth, mydriasis, pupil cosmesis, single-pass four-throw pupilloplasty

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Authors: Lamia Bensissaid

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Goals: Endometriosis affects 6 to 10% of women of childbearing age. 17 to 44% of them have ovarian endometriomas. Medical and surgical treatments represent the two therapeutic axes with which PMA can be associated. Laparoscopic intraperitoneal ovarian cystectomy is described as the reference technique in the management of endometriomas by learned societies (CNGOF, ESHRE, NICE). However, it leads to a significant short-term reduction in the AMH level and the number of antral follicles, especially in cases of bilateral cystectomy, large cyst size or cystectomy after recurrence. Often, the disease is at an advanced stage with several surgical patients. Most have adhesions, which increase the risk of surgical complications and suboptimal resection and, therefore recurrence of the cyst. These results led to a change of opinion towards a conservative approach. Sclerotherapy is an old technique which acts by fibrinoid necrosis. It consists of injecting a sclerosing agent into the cyst cavity. Results : Recurrence was less than 15% for a 12-month follow-up; these rates are comparable to those of surgery. It does not seem to have a negative impact on ovarian reserve, but this is not sufficiently evaluated. It has an advantage in IVF pregnancy rates compared to cystectomy, particularly in cases of recurrent endometriomas. It has the advantages: · To be done on an outpatient basis. · To be inexpensive. · To avoid sometimes difficult and iterative surgery: · To allow an increase in pregnancy rates and the preservation of the ovarian reserve compared to iterative surgery. · of great interest in cases of bilateral endometriomas (kissing ovaries) or recurrent endometriomas. Conclusions: Ethanol sclerotherapy could be a good alternative to surgery.

Keywords: Endometrioma, Sclerotherapy, infertility, Ethanol

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Authors: Yu-Chieh Huang, Pei-Shih Chen, Tao-Hsin Tung

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Background: Urinary tract infection is the most common bacterial infection to our best knowledge. Objective: This study is to investigate whether cranberry ingesting could improve the urinary tract infection. Methods: We searched the PubMed and Cochrane Library for relevant randomized controlled trials without language limitations between 9 March 1994 and June 30, 2017, with a priori defined inclusion and exclusion criteria. The search terms included (cranberry OR Vaccinium macrocarpon OR Vaccinium oxy-coccus OR Vaccinium microcarpum OR Vaccinium erythrocarpum OR Vaccinium) AND (urinary tract infection OR bacteriuria OR pyuria) AND (effect OR effective-ness OR efficacy) AND (random OR randomized). Results: There were 26 studies met the selection criteria included among 4709 eligible participants. We analyzed all trials in meta-analysis. The random-effects pooled risk ratio (RR) for the group using cranberry versus using placebo was 0.75; 95%CI[0.63, 0.880]; p-value=0.0002) and heterogeneity was 56%. Furthermore, we divided the subjects into different subgroup to analysis. Ingesting cranberry seemed to be more effective in some subgroups, including the patients with recurrent UTI (RR, 0.71; 95%CI[0.54,0.93]; p-value=0.002) (I²= 65%) and female population (RR, 0.73, 95%CI[0.58,0.92]; p-value=0.002) (I²= 59%). The prevention effect was not different between cranberry and trimethoprim (RR, 1.25, 95%CI[0.67, 2.33]; p-value=0.49) (I²= 68%). No matter the forms of cranberry were capsules or juice, the efficacy was useful. Conclusions: It is showed that cranberry ingesting is usefully associated with prevention UTI. There are more effective in prevention of UTI in some groups.

Keywords: cranberry, effectiveness, prevention, urinary tract infect

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Authors: Myoungsoon You, Heejung Son

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During a pandemic, hospital workers should protect not only their vulnerable patients but also themselves from the consequences of rapidly spreading infection. However, the evidence on the psychological impact of an outbreak on hospital workers is limited. In this study, we aim to assess hospital workers’ psychological well-being and function at the workplace after an outbreak, by focusing on ‘psychological resilience’. Specifically, the effects of risk appraisal, emotional experience, and coping ability on resilience indicated by the likelihood of post-traumatic syndrome disorder and willingness to work were investigated. Such role and position of each factor were analyzed using a path model, and the result was compared between the healthcare worker and non-healthcare worker groups. In the investigation, 280 hospital workers who experienced the 2015 Middle East Respiratory Syndrome outbreak in South Korea have participated. The result presented, in both groups, the role of the appraisal of risk and coping ability appeared consistent with a previous research, that was, the former interrupted resilience while the latter facilitated it. In addition, the role of emotional experience was highlighted as, in both groups, emotional disruption not only directly associated with low resilience but mediated the effect of perceived risk on resilience. The differences between the groups were also identified, which were, the role of emotional experience and coping ability was more prominent in the non-HCW group in explaining resilience. From the results, implications on how to support hospital personnel during an outbreak in a way to facilitate their resilience after the outbreak were drawn.

Keywords: hospital workers, emotions, infectious disease outbreak, psychological resilience

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Authors: Isaac Quiros-Fernandez, Angel Cid-Arregui

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Tumor-reactive T cell receptors (TCRs) are being subject of intense investigation since they offer great potential in adoptive cell therapies against cancer. However, the identification of tumor-specific TCRs has proven challenging, for instance, due to the limited expansion capacity of tumor-infiltrating T cells (TILs) and the extremely low frequencies of tumor-reactive T cells in the repertoire of patients and healthy donors. We have developed an approach for rapid identification and characterization of neoepitope-reactive TCRs from the T cell repertoire of healthy donors. CD8 T cells isolated from multiple donors are subjected to a first sorting step after staining with HLA multimers carrying the peptide of interest. The isolated cells are expanded for two weeks, after which a second sorting is performed using the same peptide-HLA multimers. The cells isolated in this way are then processed for single-cell sequencing of their TCR alpha and beta chains. Newly identified TCRs are cloned in appropriate expression vectors for functional analysis on Jurkat, NK92, and primary CD8 T cells and tumor cells expressing the appropriate antigen. We have identified TCRs specifically binding HLA-A2 presenting epitopes of tumor antigens, which are capable of inducing TCR-mediated cell activation and cytotoxicity in target cancer cell lines. This method allows the identification of tumor-reactive TCRs in about two to three weeks, starting from peripheral blood samples of readily available healthy donors.

Keywords: cancer, TCR, tumor antigens, immunotherapy

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Authors: Noorjehan Joosub-Vawda

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Objectives: The aim of this poster presentation is to examine cultural contextual understandings of ABI that could aid conceptualisation and the development of a model for neuropsychological rehabilitation in this context. Characteristics of the South African context that make the implementation of international NR practices difficult include socioeconomic disparities, sociocultural influences, lack of accessibility to healthcare services, and poverty and unemployment levels. NR services in the developed world have characteristics such as low staff-to-patient ratios and interdisciplinary teams that make them unsuitable for the resource-constrained South African context. Methods: An exploratory, descriptive research design based on programme theory is being followed in the development of a South African model of neuropsychological rehabilitation. Results: The incorporation of African traditional understandings and practices, such as beliefs about ancestral spirits in the etiology of Acquired Brain Injury are relevant to the planning of rehabilitation interventions. Community-Based Rehabilitation workers, psychoeducation, and cooperation among the different systemic levels especially in rural settings is also needed to improve services offered to patients living with ABI. Conclusions. The preliminary model demonstrated in this poster will attempt to build on the strengths of South African communities, incorporating valuable evidence from international models to serve those affected with brain injury in this context.

Keywords: neuropsychological rehabilitation, South Africa, acquired brain injury, developing context

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Authors: Sujata Sethi, Pawan Kumar, Sameer Aggarwal

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Depression and anxiety are of significant concern in youth with type 1 diabetes mellitus (T1DM) and these are correlated with glycemic control in multiple ways. The extent of depression and anxiety in children with T1DM remains poorly studied in India. The index study aimed to find the prevalence of depression and anxiety and their correlation with HbA1c (glycated hemoglobin) levels in children with T1DM. Material and methods: This study was a cross-sectional study carried out on a purposive sample of 45 children with T1DM. Depressive symptoms were assessed using Children’s Depression Rating Scale-Revised (CDRS-R) and anxiety symptoms were assessed using Spence Children’s Anxiety Scale (SCAS). Glycated hemoglobin (HbA1c) levels of all the participants were recorded. Results: 43 out of 45 children were analyzed as HbA1c status for two was not known. 48.8% were females. Mean age was 12.95+2.04. The average duration of diabetes was 3.63+1.82. Mean CDRS-R score was 41.6+12.25 and mean SCAS score was 33.07+12.29. Mean recording of HbA1c level was 7.90+1.51. 27 (62.8%) out of 43 participants had abnormal scores on CDRS-R and 24 (55.8%) out of 43 had abnormal scores on SCAS. The correlation coefficient between HbA1c levels and the CDRS-R score came out to be 0.57 and between HbA1c and SCAS, it was 0.53. Both correlations were significant with the p-value of < 0.02. Conclusion: Children with T1DM have high co-morbidity of depression and anxiety which is significantly correlated with the HbA1c levels. Thus, it becomes important to screen the patients for depression and anxiety for better outcomes.

Keywords: anxiety, depression, HbA1c, T1DM

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Authors: Wen-Shyong Tzou, Chih-Ching Huang, Chin-Hwa Hu, Ying-Tsang Lo, Tun-Wen Pai, Chia-Yin Chiang, Chung-Hao Li, Hong-Jyuan Jian

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Plasmin plays an important role in the human circulatory system owing to its catalytic ability of fibrinolysis. The immediate injection of plasmin in patients of strokes has intrigued many scientists to design vectors that can transport plasmin to the desired location in human body. Here we predict the structure of human plasmin and investigate the interaction of plasmin with the gold-nanoparticle. Because the crystal structure of plasminogen has been solved, we deleted N-terminal domain (Pan-apple domain) of plasminogen and generate a mimic of the active form of this enzyme (plasmin). We conducted a simulated annealing process on plasmin and discovered a very large conformation occurs. Kringle domains 1, 4 and 5 had been observed to leave its original location relative to the main body of the enzyme and the original doughnut shape of this enzyme has been transformed to a V-shaped by opening its two arms. This observation of conformational change is consistent with the experimental results of neutron scattering and centrifugation. We subsequently docked the plasmin on the simulated gold surface to predict their interaction. The V-shaped plasmin could utilize its Kringle domain and catalytic domain to contact the gold surface. Our findings not only reveal the flexibility of plasmin structure but also provide a guide for the design of a plasmin-gold nanoparticle.

Keywords: docking, gold nanoparticle, molecular simulation, plasmin

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Authors: En Hyung Kim

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Partial unilateral lentiginosis (PUL) is an unusual pigmentary disorder characterized by numerous lentigines grouped within an area of normal skin. Although treatment is not necessary, many patients with facial PUL seek medical help for cosmetic reasons. There is no established standard treatment for PUL. Conventional lasers may cause postinflammatory hyperpigmentation because keratinocytes are injured during the process. Also scarring, long downtime and pain are important issues. Case: A 19-year-old patient with facial PUL was treated with 1064-nm Q-Switched Neodymium-Doped Yttrium Aluminum Garnet (QS Nd:YAG) laser. The patient was treated at one-week intervals starting with a spot size of 6 mm, a fluence of 2.5 J/cm2 and a pulse rate of 10 Hz with 1-2 passes of slow sliding technique with approximately 5-15 % overlap. The fluence was elevated to 3 J/cm2 after the 4th session according to treatment response and patient tolerance. After 10 treatment sessions the lesions were remarkably improved. Discussion: Although the exact mechanism by which low fluence 1,064-nm QS Nd:YAG laser improves pigmentary lesions is unclear, the term ‘subcellular selective photothermolysis’ and ‘melanocyte apoptosis and replacement’ have been proposed. If appropriate measures are taken to monitor patient response during and after the procedure, low fluence 1064-nm QS Nd:YAG laser may achieve good cosmetic result in the treatment of PUL with a very safe and effective profile.

Keywords: laser toning, low fluence, 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser, partial unilateral lentiginosis

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Authors: Hatice Boyacioglu, Nursel Akkaya, Humeyra Ozge Yilanci, Hilmi Kansu, Nihal Avcu

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The strong relationship between the reduction in the size of the pulp cavity and increasing age has been reported in the literature. This relationship can be utilized to estimate the age of an individual by measuring the pulp cavity size using dental radiographs as a non-destructive method. The purpose of this study is to develop a population specific regression model for age estimation in a sample of Turkish adults by applying Cameriere’s method on panoramic radiographs. The sample consisted of 100 panoramic radiographs of Turkish patients (40 men, 60 women) aged between 20 and 70 years. Pulp and tooth area ratios (AR) of the maxilla¬¬ry canines were measured by two maxillofacial radiologists and then the results were subjected to regression analysis. There were no statistically significant intra-observer and inter-observer differences. The correlation coefficient between age and the AR of the maxillary canines was -0.71 and the following regression equation was derived: Estimated Age = 77,365 – ( 351,193 × AR ). The mean prediction error was 4 years which is within acceptable errors limits for age estimation. This shows that the pulp/tooth area ratio is a useful variable for assessing age with reasonable accuracy. Based on the results of this research, it was concluded that Cameriere’s method is suitable for dental age estimation and it can be used for forensic procedures in Turkish adults. These instructions give you guidelines for preparing papers for conferences or journals.

Keywords: age estimation by teeth, forensic dentistry, panoramic radiograph, Cameriere's method

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Authors: Aref Aasi, Sahar Ebrahimi Bajgani, Erfan Aasi

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Breast cancer (BC) continues to be the most frequent cancer in females and causes the highest number of cancer-related deaths in women worldwide. Inspired by recent advances in studying the relationship between different patient attributes and features and the disease, in this paper, we have tried to investigate the different classification methods for better diagnosis of BC in the early stages. In this regard, datasets from the University Hospital Centre of Coimbra were chosen, and different machine learning (ML)-based and neural network (NN) classifiers have been studied. For this purpose, we have selected favorable features among the nine provided attributes from the clinical dataset by using a random forest algorithm. This dataset consists of both healthy controls and BC patients, and it was noted that glucose, BMI, resistin, and age have the most importance, respectively. Moreover, we have analyzed these features with various ML-based classifier methods, including Decision Tree (DT), K-Nearest Neighbors (KNN), eXtreme Gradient Boosting (XGBoost), Logistic Regression (LR), Naive Bayes (NB), and Support Vector Machine (SVM) along with NN-based Multi-Layer Perceptron (MLP) classifier. The results revealed that among different techniques, the SVM and MLP classifiers have the most accuracy, with amounts of 96% and 92%, respectively. These results divulged that the adopted procedure could be used effectively for the classification of cancer cells, and also it encourages further experimental investigations with more collected data for other types of cancers.

Keywords: breast cancer, diagnosis, machine learning, biomarker classification, neural network

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Authors: Sana Ilyas, Kishalaya Mukherjee, Suresh Shetty

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Lip Augmentation has become more common in recent years. Patients do not expect to experience facial palsy after having lip augmentation. This poster will present the findings of such a presentation and will discuss the possible pathophysiology and management. (This poster has been published as a paper in the dental update, June 2022) Aim: The aim of the study was to explore the link between facial nerve palsy and lip fillers, to explore the literature surrounding facial nerve palsy, and to discuss the case of a patient who presented with facial nerve palsy with seemingly unknown cause. Methodology: There was a thorough assessment of the current literature surrounding the topic. This included published papers in journals through PubMed database searches and printed books on the topic. A case presentation was discussed in detail of a patient presenting with peripheral facial nerve palsy and associating it with lip augmentation that she had a day prior. Results and Conclusion: Even though the pathophysiology may not be clear for this presentation, it is important to highlight uncommon presentations or complications that may occur after treatment. This can help with understanding and managing similar cases, should they arise.It is also important to differentiate cause and association in order to make an accurate diagnosis. This may be difficult if there is little scientific literature. Therefore, further research can help to improve the understanding of the pathophysiology of similar presentations. This poster has been published as a paper in dental update, June 2022, and therefore shares a similar conclusiom.

Keywords: facial palsy, lip augmentation, causation and correlation, dental cosmetics

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Authors: M. Błoch, P. Karpiński, P. Gasperowicz, R. Płoski, A. Lebioda, P. Skiba, A. Rozensztrauch, D. Patkowski, R. Śmigiel

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Introduction: The cause of the isolated form of esophageal atresia has been yet unknown. Objectives: The primary objective of this study was to indicate epigenetic factors which may play an important role in the etiopathogenesis of esophageal atresia. Methods: We recruited a group of 6 pairs of twins, among whom one of the twins developed EA. The selection of such a group for testing allows for excluding external factors (e.g., infections, drugs, toxins) as the cause of the birth defect. The analyzes were performed with the use of genetic material isolated from the whole blood and esophagus tissue of a patient with EA. The reduced representation bisulphite sequencing (RRBS) technique was used to study the change in the genomic imprinting -a change in the expression of genes, which may be the epigenetic cause of EA. Results: In the course of the analyzes, significant hypomethylation and hypermethylation regions were identified. 65 genes with probably increased expression and 65 with decreased expression were selected. These genes have not been marked in literature as possibly pathogenic in esophageal atresia. However, their participation in the pathogenesis of esophageal atresia cannot be clearly excluded. Conclusion: We suggest a role of hypomethylation or hypermethylation of selected genes as one of the possible epigenetic factors in EA pathogenesis. The use of the RRBS technique in the search for the cause of EA is pioneer research; therefore, it seems necessary to extend the research group to new patients with EA. Acknowledgment: The work was supported by the National Science Centre, Poland, under research project 2016/21/N/NZ5/01927.

Keywords: esophageal atresia, epigenetics, embryonic development, surgery, genes expression, twins

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Authors: I. Mentziou, C. Delezos, D. Krikidis, A. Nestoridou, G. Boskou

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Introduction: The systems of production and distribution of meals can have a significant impact on the food intake of hospital patients who are likely to develop malnutrition. In hospitals, the consequences of food borne infections can range from annoying to life-threatening for a patient, since they can lead up to death in vulnerable groups Aim: The aim of the present study was the evaluation of food safety management systems implementation, as well as the general evaluation of the total quality management systems in Greek hospitals. Methods: This is a multifocal study on the implementation and evaluation of the food safety management systems in the Greek hospitals of Attica region. Eleven hospitals from the city of Athens were chosen for this purpose. The sample was derived from the high rank personnel of the nutritional department (dietician, head-chef, food technologist, public health inspector). Tailor made questionnaires on hygiene regulations were used as tools for the interviews. Results: Overall, 30 employees in the field of hospital nutrition participated. Most of the replies implied that almost always the hygiene regulations are implemented. Nevertheless, only 30% stated that there is a Hazard Analysis Critical Control Points HACCP system (HACCP) in the hospital. In a small number of questionnaires there were proposals for changes by the staff. Conclusion: Measurement of the opinion of the personnel about the provided food services within a hospital can further lead to continuous improvement of the hospital nutrition.

Keywords: evaluation, food service, HACCP, hospital, personnel

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Authors: Frantisek Kopriva, Kamila Michalkova, Radim Dudek, Jana Volejnikova

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Rationale: Diagnostic criteria of asthma–COPD overlap syndrome (ACOS) are controversial in pediatrics. Emphysema is characteristic of COPD and usually does not occur in typical asthma; its presence in patients with asthma suggests the concurrence with COPD. Low-dose chest computed tomography (CT) allows a non-invasive assessment of the lung tissue structure. Here we present CT findings of emphysematous changes in a child with ACOS. Patient and Methods: In a 6-year-old boy, atopy was confirmed by a skin prick test using common allergen extracts (grass and tree pollen, house dust mite, molds, cat, dog; manufacturer Stallergenes Greer, London, UK), where reactions over 3 mm were considered positive. Treatment with corticosteroids was started during the course of severe asthma. At 12 years of age, his spirometric parameters deteriorated despite treatment adjustment (VC 1.76 L=85%, FEV1 1.13 L=67%, TI%VCmax 64%, MEF25 19%, TLC 144%) and the bronchodilator test became negative. Results: Low-dose chest CT displayed irregular regions with increased radiolucency of pulmonary parenchyma (typical for hyperinflation in emphysematous changes) in both lungs. This was in accordance with the results of spirometric examination. Conclusions: ACOS is infrequent in children. However, low-dose chest CT scan can be considered to confirm this diagnosis or eliminate other diagnoses when the clinical condition is deteriorating and treatment response is poor.

Keywords: child, asthma, low-dose chest CT, ACOS

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Authors: Gabriel Sitler, Yousef Sardahi, Asad Salem

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This paper presents an optimal and robust sliding mode controller (SMC) to regulate the position of the knee joint angle for patients suffering from knee injuries. The controller imitates the role of active orthoses that produce the joint torques required to overcome gravity and loading forces and regain natural human movements. To this end, a mathematical model of the shank, the lower part of the leg, is derived first and then used for the control system design and computer simulations. The design of the controller is carried out in optimal and multi-objective settings. Four objectives are considered: minimization of the control effort and tracking error; and maximization of the control signal smoothness and closed-loop system’s speed of response. Optimal solutions in terms of the Pareto set and its image, the Pareto front, are obtained. The results show that there are trade-offs among the design objectives and many optimal solutions from which the decision-maker can choose to implement. Also, computer simulations conducted at different points from the Pareto set and assuming knee squat movement demonstrate competing relationships among the design goals. In addition, the proposed control algorithm shows robustness in tracking a standard gait signal when accounting for uncertainty in the shank’s parameters.

Keywords: optimal control, multi-objective optimization, sliding mode control, wearable knee exoskeletons

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Authors: Madhukar Kasarla, Sumit Fogla, Kiran Panuganti, Gaurav Jain, Abhijit Ramanujam, Astha Jain, Shashank Kraleti, Sharat Musham, Arun Chaudhury

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Patients have often chosen to travel for care — making pilgrimages to academic meccas and state-of-the-art hospitals for sophisticated surgery. This culture is still persistent in the landscape of US healthcare, with hundred thousand of visitors coming to the shores of United States to seek the high quality of medical care. One of the major challenges in this form of medical tourism has been the language barrier. Thus, an Iraqi patient, with immediate needs of communicating the healthcare needs to the treating team in the hospital, may face huge barrier in effective patient-doctor communication, delaying care and even at times reducing the quality. To circumvent these challenges, we are proposing the use of a state-of-the-art tool, Talk2All, which can translate nearly one hundred international languages (and even sign language) in real time. The tool is an easy to download app and highly user friendly. It builds on machine learning principles to decode different languages in real time. We suggest that the use of Talk2All will tremendously enhance communication in the hospital setting, effectively breaking the language barrier. We propose that vigorous incorporation of Talk2All shall overcome practical challenges in international medical and surgical tourism.

Keywords: language translation, communication, machine learning, medical tourism

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Authors: Zahra Hassani

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Background and Purpose: Poststroke depression (PSD) is one of the complications of a stroke that reduces the patient's chance of recovery, becomes irritable, and changes personality. Cognitive rehabilitation is one of the non-pharmacological methods that improve deficits such as attention, memory, and symptoms of depression. Therefore, the purpose of the present study is to evaluate the Efficacy of Cognitive Rehabilitation Therapy on Poststroke Depression among Survivors of stroke. Method: In this study, a systematic review of the databases Google Scholar, PubMed, Science Direct, Elsevier between the years 2015 and 2019 with the keywords cognitive rehabilitation therapy, post-stroke, depression Search is done. In this process, studies that examined the Efficacy of Cognitive Rehabilitation Therapy on Poststroke Depression among Survivors of stroke were included in the study. Results: Inclusion criteria were full-text availability, interventional study, and non-review articles. There was a significant difference between the articles in terms of the indices studied, sample number, method of implementation, and so on. A review of studies have shown that cognitive rehabilitation therapy has a significant role in reducing the symptoms of post-stroke depression. The use of these interventions is also effective in improving problem-solving skills, improving memory, and improving attention and concentration. Conclusion: This study emphasizes on the development of efficient and flexible adaptive skills through cognitive processes and its effect on reducing depression in patients after stroke.

Keywords: cognitive therapy, depression, stroke, rehabilitation

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Authors: Brahmi Brahim, Mohammad Habibur Rahman, Maarouf Saad, Cristóbal Ochoa Luna

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A repetitive training movement is an efficient method to improve the ability and movement performance of stroke survivors and help them to recover their lost motor function and acquire new skills. The ETS-MARSE is seven degrees of freedom (DOF) exoskeleton robot developed to be worn on the lateral side of the right upper-extremity to assist and rehabilitate the patients with upper-extremity dysfunction resulting from stroke. Practically, rehabilitation activities are repetitive tasks, which make the assistive/robotic systems to suffer from repetitive/periodic uncertainties and external perturbations induced by the high-order dynamic model (seven DOF) and interaction with human muscle which impact on the tracking performance and even on the stability of the exoskeleton. To ensure the robustness and the stability of the robot, a new nonlinear backstepping control was implemented with designed tests performed by healthy subjects. In order to limit and to reject the periodic/repetitive disturbances, an iterative estimator was integrated into the control of the system. The estimator does not need the precise dynamic model of the exoskeleton. Experimental results confirm the robustness and accuracy of the controller performance to deal with the external perturbation, and the effectiveness of the iterative estimator to reject the repetitive/periodic disturbances.

Keywords: backstepping control, iterative control, Rehabilitation, ETS-MARSE

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Authors: Lolwa Alansari, Hanen Mrabet, Kholoud Khaled, Abdelhamid Azhaghdani, Sufia Athar, Aska Kaima, Zaineb Mhamdia, Zubaria Altaf, Almunzer Zakaria, Tamara Alshadafat

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Introduction: The Obstetrics and Gynecology Emergency Department at Alwakra Hospital has faced significant challenges, which have been further worsened by the impact of the COVID-19 pandemic. These challenges involve issues such as overcrowding, extended wait times, and a notable surge in demand for emergency care services. Moreover, prolonged waiting times have emerged as a primary factor contributing to situations where patients leave without receiving attention, known as left without being seen (LWBS), and unexpectedly abscond. Addressing the issue of insufficient patient mobility in the obstetrics and gynecology emergency department has brought about substantial improvements in patient care, healthcare administration, and overall departmental efficiency. These changes have not only alleviated overcrowding but have also elevated the quality of emergency care, resulting in higher patient satisfaction, better outcomes, and operational rewards. Methodology: The COVID-19 pandemic has served as a catalyst for substantial transformations in the obstetrics and gynecology emergency, aligning seamlessly with the strategic direction of Hamad Medical Corporation (HMC). The fundamental aim of this initiative is to revolutionize the operational efficiency of the OB-GYN ED. To accomplish this mission, a range of transformations has been initiated, focusing on essential areas such as digitizing systems, optimizing resource allocation, enhancing budget efficiency, and reducing overall costs. The project utilized the Plan-Do-Study-Act (PDSA) model, involving a diverse team collecting baseline data and introducing throughput improvements. Post-implementation data and feedback were analysed, leading to the integration of effective interventions into standard procedures. These interventions included optimized space utilization, real-time communication, bedside registration, technology integration, pre-triage screening, enhanced communication and patient education, consultant presence, and a culture of continuous improvement. These strategies significantly reduced waiting times, enhancing both patient care and operational efficiency. Results: Results demonstrated a substantial reduction in overall average waiting time, dropping from 35 to approximately 14 minutes by August 2023. The wait times for priority 1 cases have been reduced from 22 to 0 minutes, and for priority 2 cases, the wait times have been reduced from 32 to approximately 13.6 minutes. The proportion of patients spending less than 8 hours in the OB ED observation beds rose from 74% in January 2022 to over 98% in 2023. Notably, there was a remarkable decrease in LWBS and absconded patient rates from 2020 to 2023. Conclusion: The project initiated a profound change in the department's operational environment. Efficiency became deeply embedded in the unit's culture, promoting teamwork among staff that went beyond the project's original focus and had a positive influence on operations in other departments. This effectiveness not only made processes more efficient but also resulted in significant cost reductions for the hospital. These cost savings were achieved by reducing wait times, which in turn led to fewer prolonged patient stays and reduced the need for additional treatments. These continuous improvement initiatives have now become an integral part of the Obstetrics and Gynecology Division's standard operating procedures, ensuring that the positive changes brought about by the project persist and evolve over time.

Keywords: overcrowding, waiting time, person centered care, quality initiatives

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Authors: Taruna Katyal Arora, Geeta Kumari, Hari Shankar, Neelima Mishra

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Substandard and counterfeit antimalarials is a major problem in malaria endemic areas. The availability of counterfeit/ substandard medicines is not only decreasing the efficacy in patients, but it is also one of the contributing factors for developing antimalarial drug resistance. Owing to this, a pilot study was conducted to survey quality of drugs collected from different malaria endemic areas of India. Artesunate+Sulphadoxine-Pyrimethamine (AS+SP), Artemether-Lumefantrine (AL), Chloroquine (CQ) tablets were randomly picked from public health facilities in selected states of India. The quality of antimalarial drugs from these areas was assessed by using Global Pharma Health Fund Minilab test kit. This includes physical/visual inspection and disintegration test. Thin-layer chromatography (TLC) was carried out for semi-quantitative assessment of active pharmaceutical ingredients. A total of 45 brands, out of which 21 were for CQ, 14 for AL and 10 for AS+SP were tested from Uttar Pradesh (U.P.), Mizoram, Meghalaya and Gujrat states. One out of 45 samples showed variable disintegration and retension factor. The variable disintegration and retention factor which would have been due to substandard quality or other factors including storage. However, HPLC analysis confirms standard active pharmaceutical ingredient, but may be due to humid temperature and moisture in storage may account for the observed result.

Keywords: antimalarial medicines, counterfeit, substandard, TLC

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Authors: Fatema Salman, Ridha Hammam, Fatima Khairallah, Fatima Aradi, Nafeesa Abdulla, Mohammed Alsafar

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Purpose: This study aims at measuring the extent of nurses’ knowledge and attitudes toward the use of physical restraints in different hospital wards at Salmaniya Medical Complex (SMC). Background: The habitual use of physical restraint is a widespread practice among nurses working in the clinical settings. Restraints inflict many deleterious consequences on patients physically and psychologically which in turn increases their morbidity and mortality risk and jeopardizes care quality. Nurses’ knowledge and attitudes toward physical restraints are crucial determinants of the persistence of this practice. Literature review: the evidence of lack of knowledge among nurses regarding the use of physical restraints is overwhelming in various clinical settings, especially in two main areas which are the negative consequences and the available alternatives to physical restraints. Studies explored nurses’ attitudes toward physical restraints yielded inconsistent findings. Equally comparable, some studies found that nurses hold positive attitudes toward the use of physical restraints while some others reported just the opposite. Methods: Self-administered knowledge and attitudes scales to 106 nurses working in the SMC. Findings: nurses hold the moderate level of knowledge about restraints (M=58%) with weak negative attitudes (M = -20%) toward using it. Significant moderately-strong negative correlation (r= -0.57, r2= 0.32, p= 0.000) was uncovered between nurses knowledge and their attitudes which provided an empirical explanation of this phenomenon (use of physical restraints). Recommendations: Induction of awareness program that especially focuses on the negative consequences and encourages the use of alternatives is an evident need. This effort necessarily should be adjoined with policy and procedure adjustments.

Keywords: attitudes, knowledge, nurses, restraints

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