Search results for: international medical graduates

Authors: Hernan D. Mejia, Gilberto B. Gaitan, Mauricio A. Franco

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420 steel is normally used in the manufacture of dental and surgical instrumentation, as well as parts in the chemical, pharmaceutical, and food industries, among others, where they must withstand heavy loads and often be in contact with corrosive environments, which leads to wear and deterioration of these steels in relatively short times. In the case of medical applications, the instruments made of this steel also suffer wear and corrosion during the repetitive sterilization processes due to the relatively low achievable hardness of just 50 HRC and its hardly acceptable resistance to corrosion. In order to improve the wear resistance of 420 steel, TiAlN coatings were deposited, increasing the aluminum content in the alloy by varying the power applied to the aluminum target of 900, 1100, and 1300 W. Evaluations using XRD, Micro Raman, XPS, AFM, SEM, and TEM showed a columnar growth crystal structure with an average thickness of 2 microns and consisting of the TiN and TiAlN phases, whose roughness and grain size decrease with a higher Al content. The AlN phase also appears in the sample deposited at 1300W. The hardness, determined by nanoindentation, initially increases with the aluminum content from 9.7 GPa to 17.1 GPa, but then decreases to 15.4 GPa for the sample with the highest aluminum content due to the appearance of hexagonal AlN and a decrease of harder TiN and TiAlN phases. It was observed that the wear coefficient had a contrary behavior, which took values of 2.7; 1.7 and 6.6x10⁻⁶ mm³/N.m, respectively. All the coated samples significantly improved the wear resistance of the uncoated 420 steel.

Keywords: hard coatings, magnetron sputtering, TiAlN coatings, surgical instruments, wear resistance

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Authors: Yilei Xue, Yat-Hing Ham, Wenting Qiu, Wan Chan, Stefan Nagl

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Polydopamine (PDA) is a popular material in biological and medical applications due to its excellent biocompatibility, outstanding physicochemical properties, and facile fabrication. In this project, a new sandwich-structured PDA and silver (Ag) hybrid material named PDA-Ag-PDA was synthesized and characterized layer-by-layer, where silver nanoparticles (Ag NPs) are wrapped in PDA coatings, using SEM, AFM, 3D surface metrology, and contact angle meter. The silver loading capacity is positively proportional to the roughness value of the initial PDA film. This designed film was subsequently integrated within a digital microfluidic (DMF) platform coupling with an oxygen sensor layer for on-chip antibacterial assay. The concentration of E. coli was quantified on DMF by real-time monitoring oxygen consumption during E. coli growth with the optical oxygen sensor layer. The PDA-Ag-PDA coating shows an 99.9% reduction in E. coli population under non-nutritive condition with 1-hour treatment and has a strong growth inhibition of E. coliin nutrient LB broth as well. Furthermore, PDA-Ag-PDA film maintaining a low cytotoxicity effect to human cells. After treating with PDA-Ag-PDA film for 24 hours, 82% HEK 293 and 86% HeLa cells were viable. The SERS enhancement factor of PDA-Ag-PDA is estimated to be 1.9 × 104 using Rhodamine 6G (R6G). Multifunctional PDA-Ag-PDA coating provides an alternative platform to conjugate biomolecules and perform biological applications on DMF, in particular, for the adhesive protein and cell study.

Keywords: polydopamine, silver nanoparticles, digital microfluidic, optical sensor, antimicrobial assay, SERS

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Authors: Ali Aqa Mohammad Jawad

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Taking a relational approach, this paper analyzes the causal mechanisms associated with successful mobilization and rapid demobilization of the Enlightening Movement in post-2001 Afghanistan. The movement emerged after the state-owned Da Afghan Bereshna Sherkat (DABS) decided to divert the route for the Turkmenistan-Uzbekistan-Tajikistan-Afghanistan-Pakistan (TUTAP) electricity project. The grid was initially planned to go through the Hazara-inhabited province of Bamiyan, according to Afghanistan’s Power Sector Master Plan. The reroute served as an aide-mémoire of historical subordination to other ethno-religious groups for the Hazara community. It was also perceived as deprivation from post-2001 development projects, financed by international aid. This torched the accumulated grievances, which then gave birth to the Enlightening Movement. The movement had a successful mobilization. However, it demobilized after losing much of its mobilizing capabilities through an amalgamation of external and internal relational factors. The successful mobilization yet rapid demobilization constitutes the puzzle of this paper. From the theoretical perspective, this paper is significant as it establishes the applicability of contentious politics theory to protest mobilizations that occurred in Afghanistan, a context-specific, characterized by ethnic politics. Both primary and secondary data are utilized to address the puzzle. As for the primary resources, media coverage, interviews, reports, public media statements of the movement, involved in contentious performances, and data from Social Networking Services (SNS) are used. The covered period is from 2001-2018. As for the secondary resources, published academic articles and books are used to give a historical account of contentious politics. For data analysis, a qualitative comparative historical method is utilized to uncover the causal mechanisms associated with successful mobilization and rapid demobilization of the Movement. In this pursuit, both mobilization and demobilization are considered as larger political processes that could be decomposed to constituent mechanisms. Enlightening Movement’s framing and campaigns are first studied to uncover the associated mechanisms. Then, to avoid introducing some ad hoc mechanisms, the recurrence of mechanisms is checked against another case. Mechanisms qualify as robust if they are “recurrent” in different episodes of contention. Checking the recurrence of causal mechanisms is vital as past contentious events tend to reinforce future events. The findings of this paper suggest that the public sphere in Afghanistan is drastically different from Western democracies known as the birthplace of social movements. In Western democracies, when institutional politics did not respond, movement organizers occupied the public sphere, undermining the legitimacy of the government. In Afghanistan, the public sphere is ethicized. Considering the inter- and intra-relational dynamics of ethnic groups in Afghanistan, the movement reduced to an erosive inter- and intra-ethnic conflict. This undermined the cohesiveness of the movement, which then kicked-off its demobilization process.

Keywords: enlightening movement, contentious politics, mobilization, demobilization

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Authors: Yasemin Ilkay

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Urban spatial pattern interacts with the minds and bodies of citizens and influences their perception and attitudes, which leads to a two-folded map of the same space: physical and Psychogeographic maps. Psychogeography is a field of inquiry (rooted in literature and fiction) investigating how the environment affects the feelings and behaviors of individuals. This term was posed by Situationist International Movement in the 1950s by Guy Debord; in the course of time, the artistic framework evolved into a political issue, especially with the term Dérive, which indicates ‘deviation’ and ‘resistance’ to the existing spatial reality. The term Dérive appeared on the track of Flânéur after one hundred years; and turned out to be a political tool to transform everyday urban life. The three main concepts of psychogeography [walking, dérive, and palimpsest] construct the epistemological framework for a psychogeographic spatial analysis. Mental representations investigating this framework would provide a designer to capture the invisible layers of the gap between ‘how a space is conceived’ and ‘how the same space is perceived and experienced.’ This gap is a neglected but critical issue to discuss in the planning discipline, and psychogeography provides methodological inputs to cover the interrelation among top-down designs of urban patterning and bottom-up reproductions of ‘the soul’ of urban space at the intersection of geography and psychology. City centers and university campuses exemplify opposite poles of spatial organization and walking practice, which may result in differentiated spatial appropriation forms. There is a traditional city center in Van, located at the core of the city with a dense population and several activities, but not connected to Van Lake, which is the largest lake in the country. On the other hand, the university campus is located at the periphery, and although it has a promenade along the lake’s coast and a regional hospital, it presents a limited walking experience with ambiguous forms of spatial appropriation. The city center draws a vivid urban everyday life; however, the campus presents a relatively natural life far away from the center. This paper aims to reveal the differentiated psychogeographic maps of spatial appropriation at the city center vs. the university campus, which is located at the periphery of the city and along the coast of the largest lake in Turkey. The main question of the paper is, “how do the psychogeographic maps of spatial appropriation differentiate at the city center and university campus in Van within the walking experience with reference to the two-folded map assumption.” The experiential maps of a core group of 15 planning students will be created with the techniques of mental mapping, photographing, and narratives through attentive walks conducted together on selected routes; in addition to these attentive walks, 30 more in-depth interviews will be conducted by the core group. The narrative of psychogeographic mapping of spatial appropriation at the two spatial poles would display the conflicting soul of the city with reference to sub-behavioural regions of walking, differentiated forms of derive and layers of palimpsest.

Keywords: attentive walk, body, cognitive geography, derive, experiential maps, psychogeography, Van, Turkey

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Authors: José Antonio Donaire Benito, Konstantina Zerva

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Historically, cities have been places where people from many nations and cultures have met and settled together, while population flows and density have had a significant impact on urban dynamics. Cities' high density of social, cultural, business offerings, everyday services, and other amenities not intended for tourists draw not only tourists but a wide range of city users as well. With the coordination of city rhythms and the porosity of the community, city users order and frame their urban experience. From one side, recent literature focuses on the shift in urban tourist experience from 'having' a holiday through 'doing' activities to 'becoming' a local by experiencing a part of daily life. On the other hand, there is a debate on the 'touristification of everyday life', where middle and upper class urban dwellers display attitudes and behaviors that are virtually undistinguishable from those of visitors. With the advent of globalization and technological advances, modern society has undergone a radical transformation that has altered mobility patterns within it, blurring the boundaries between tourism and everyday life, work and leisure, and "hosts" and "guests". Additionally, the presence of other 'temporary city' users, such as commuters, digital nomads, second home owners, and migrants, contributes to a more complex transformation of tourist cities. Moving away from this traditional clear distinction between 'hosts' and 'guests', which represents a more static view of tourism, and moving towards a more liquid narrative of mobility, academics on tourism development are embracing the New Mobilities Paradigm. The latter moves beyond the static structures of the modern world and focuses on the ways in which social entities are made up of people, machines, information, and images in a moving system. In light of this fluid interdependence between tourists and guests, a question arises as to whether overtourism, which is considered as the underlying cause of citizens' perception of a lower urban quality of life, is a fair representation of perceived mobility excessiveness, place consumption disruptiveness, and residents displacement. As a representative example of an overtourism narrative, Barcelona was chosen as a study area for this purpose, focusing on the incoming city users to reflect in depth the variety of people who contribute to mobility flows beyond those residents already have. Several statistical data have been analyzed to determine the number of national and international visitors to Barcelona at some point during the day in 2019. Specifically, tracking data gathered from mobile phone users within the city are combined with tourist surveys, urban mobility data, zenithal data capture, and information about the city's attractions. The paper shows that tourists are only a small part of the different incoming city users that daily enter Barcelona; excursionists, commuters, and metropolitans also contribute to a high mobility flow. Based on the diversity of incoming city users and their place consumption, it seems that the city's urban experience is more likely to be impacted by over-mobility tan over-tourism.

Keywords: city users, density, new mobilities paradigm, over-tourism.

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Authors: Adaour Mohamed Amine, Bachene Mohamed Sadek, Fortassi Mosaab, Siouda Wafaa

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Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73% and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

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Authors: Blanche Aguida, Marootpong Pooam, Nathalie Jourdan, Margaret Ahmad

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COVID-19-related morbidity is associated with exaggerated inflammation and cytokine production in the lungs, leading to acute respiratory failure. The cellular mechanisms underlying these so-called ‘cytokine storms’ are regulated through the Toll-like receptor 4 (TLR4) signaling pathway and by reactive oxygen species (ROS). Both light (photobiomodulation) and magnetic fields (e.g., pulsed electromagnetic field) stimulation are non-invasive therapies known to confer anti-inflammatory effects and regulate ROS signaling pathways. Here we show that daily exposure to two 10-minute intervals of moderate-intensity infra-red light significantly lowered the inflammatory response induced via the TLR4 receptor signaling pathway in human cell cultures. Anti-inflammatory effects were likewise achieved by electromagnetic field exposure of cells to daily 10-minute intervals of either pulsed electromagnetic fields (PEMF) or to low-level static magnetic fields. Because current illumination and electromagnetic field therapies have no known side effects and are already approved for some medical uses, we have here developed protocols for verification in clinical trials of COVID 19 infection. These treatments are affordable, simple to implement, and may help to resolve the acute respiratory distress of COVID 19 patients both in the home and in the hospital.

Keywords: COVID 19, electromagnetic fields therapy, inflammation, photobiomodulation therapy

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Authors: Ivy Chen XQ

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This research places a much-needed focus on the conservation of the Blue Economy (BE) by focusing on the design and development of monitoring systems to track critical indicators on the status of the BE. In this process, local experiences provide an insight into important community issues, as well as the necessity to cooperate and collaborate in order to achieve sustainable options. Researchers worldwide and industry initiatives over the last decade show that the exploitation of marine resources has resulted in a significant decrease in the share of total allowable catch (TAC). The result has been strengthening law enforcement, yet the results have shown that problems were related to poor policies, a lack of understanding of over-exploitation, biological uncertainty and political pressures. This reality and other statistics that show a significant negative impact on the attainment of the Sustainable Development Goals (SDGs), warrant an emphasis on the development of national M&E systems, in order to provide evidence-based information, on the nature and scale of especially transnational fisheries crime and under-sea marine resources in the BE. In particular, a need exists to establish a compendium of relevant BE indicators to assess such impact against the SDGs by using selected SDG indicators for this purpose. The research methodology consists of ATLAS.ti qualitative approach and a case study will be developed of Illegal, unregulated and unreported (IUU) poaching and Illegal Wildlife Trade (IWT) as component of the BE as it relates to the case of abalone in southern Africa and Far East. This research project will make an original contribution through the analysis and comparative assessment of available indicators, in the design process of M&E systems and developing indicators and monitoring frameworks in order to track critical trends and tendencies on the status of the BE, to ensure specific objectives to be aligned with the indicators of the SDGs framework. The research will provide a set of recommendations to governments and stakeholders involved in such projects on lessons learned, as well as priorities for future research. The research findings will enable scholars, civil society institutions, donors and public servants, to understand the capability of the M&E systems, the importance of showing multi-level governance, in the coordination of information management, together with knowledge management (KM) and M&E at the international, regional, national and local levels. This coordination should focus on a sustainable development management approach, based on addressing socio-economic challenges to the potential and sustainability of BE, with an emphasis on ecosystem resilience, social equity and resource efficiency. This research and study focus are timely as the opportunities of the post-Covid-19 crisis recovery package will be grasped to set the economy on a path to sustainable development in line with the UN 2030 Agenda. The pandemic raises more awareness for the world to eliminate IUU poaching and illegal wildlife trade (IWT).

Keywords: Blue Economy (BE), transnational governance, Monitoring and Evaluation (M&E), Sustainable Development Goals (SDGs).

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Authors: Sonia A. Stoica, Lexi Frankel, Amalia Ardeljan, Selena Rashid, Ali Yasback, Omar Rashid

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Introduction Enterococcus is a vast genus of lactic acid bacteria, gram-positivecocci species. They are common commensal organisms in the intestines of humans: E. faecalis (90–95%) and E. faecium (5–10%). Rare groups of infections can occur with other species, including E. casseliflavus, E. gallinarum, and E. raffinosus. The most common infections caused by Enterococcus include urinary tract infections, biliary tract infections, subacute endocarditis, diverticulitis, meningitis, septicemia, and spontaneous bacterial peritonitis. The treatment for sensitive strains of these bacteria includes ampicillin, penicillin, cephalosporins, or vancomycin, while the treatment for resistant strains includes daptomycin, linezolid, tygecycline, or streptogramine. Enterococcus faecalis CECT7121 is an encouraging nominee for being considered as a probiotic strain. E. faecalis CECT7121 enhances and skews the profile of cytokines to the Th1 phenotype in situations such as vaccination, anti-tumoral immunity, and allergic reactions. It also enhances the secretion of high levels of IL-12, IL-6, TNF alpha, and IL-10. Cytokines have been previously associated with the development of cancer. The intention of this study was to therefore evaluate the correlation between Enterococcus infections and incidence of bone carcinoma. Methods A retrospective cohort study (2010-2019) was conducted through a Health Insurance Portability and Accountability Act (HIPAA) compliant national database and conducted using International Classification of Disease (ICD) 9th and 10th codes for bone carcinoma diagnosis in a previously Enterococcus infected population. Patients were matched for age range and Charlson Comorbidity Index (CCI). Access to the database was granted by Holy Cross Health for academic research. Chi-squared test was used to assess statistical significance. Results A total number of 17,056 patients was obtained in Enterococcus infected group as well as in the control population (matched by Age range and CCI score). Subsequent bone carcinoma development was seen at a rate of 1.07% (184) in the Enterococcal infectious group and 3.42% (584) in the control group, respectively. The difference was statistically significant by p= 2.2x10-¹⁶, Odds Ratio = 0.355 (95% CI 0.311 - 0.404) Treatment for enterococcus infection was analyzed and controlled for in both enterococcus infected and noninfected populations. 78 out of 6,624 (1.17%) patients with a prior enterococcus infection and treated with antibiotics were compared to 202 out of 6,624 (3.04%) patients with no history of enterococcus infection (control) and received antibiotic treatment. Both populations subsequently developed bone carcinoma. Results remained statistically significant (p<2.2x10-), Odds Ratio=0.456 (95% CI 0.396-0.525). Conclusion This study shows a statistically significant correlation between Enterococcus infection and a decreased incidence of bone carcinoma. The immunologic response of the organism to Enterococcus infection may exert a protecting mechanism from developing bone carcinoma. Further exploration is needed to identify the potential mechanism of Enterococcus in reducing bone carcinoma incidence.

Keywords: anti-tumoral immunity, bone carcinoma, enterococcus, immunologic response

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Authors: Irfan Khan, Chiemeka David Ekene Arize, Hilly Swami, Suprabha Jha

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Background: The rise of myocardial infarction (MI) among young adults, especially those with psychiatric conditions on antipsychotic medications, highlights the need to explore non-traditional cardiovascular risk factors. Case Presentation: We discuss a 24-year-old male with acute MI, diagnosed with an acute anxiety disorder, treated with risperidone and quetiapine, and with a history of occasional smoking. Despite no significant medical history, his presentation underscores the complex interactions between psychiatric conditions, antipsychotic medication, and lifestyle choices in the etiology of MI. Discussion: This case sheds light on the intricate relationship between minimal smoking habits, the use of atypical antipsychotics, and psychiatric illness as contributory factors to cardiovascular risk in young patients. It suggests a synergistic effect, amplifying the risk of MI, which is not adequately captured by traditional risk models. Conclusion: The case emphasizes the importance of an integrated care appro ach for young MI patients with psychiatric conditions and highlights the urgent need for further research to understand the compounded cardiovascular risk posed by psychiatric medications and lifestyle factors. It advocates for comprehensive risk assessments that consider these non-traditional factors to improve outcomes for this vulnerable patient population.

Keywords: myocardial infarction, young adults, psychiatric illness, antipsychotic medications, smoking

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Authors: Taghreed Abu-Salim

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This paper develops and investigates a framework for the assessment of customer involvement in the service design process of result oriented product-service systems in order to improve the service offering in a business to business (B2B) context. The framework comprises five main criteria and fifteen sub-criteria that contribute to customer involvement in a hierarchy using a maturity grid to highlight the strengths and weaknesses for each criterion. To develop the customer involvement framework, an extensive literature review related to service design, result oriented product-service system (PSS) and customer involvement in service design was carried out. Key factors that significantly influence customer involvement from industry and literature were identified to develop an initial framework. This framework was tested in six companies from four different sectors of industry: district cooling, medical equipment, transportation and oil storage. Validation of the framework was carried out using expert opinions and industrial case studies. A major contribution of the developed framework includes a hierarchy of appropriate criteria for assessing customer involvement in the service design process within results oriented PSS; the definition of four maturity levels which are suitable to describe the whole spectrum of customer involvement in the service design process; and finally, The paper concludes by enabling service providers to: take proactive decisions; screen and evaluate new services; improve perceived service quality; and provide barriers against imitation.

Keywords: customer involvement, maturity grid, new service development, result oriented product-service system, service design

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Authors: Elif Ates, Naile Bilgili

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Background: One of the most important medical complications that individuals with spinal cord injury (SCI) face are the neurogenic bladder. Objectives: To review methods used for management of neurogenic bladder and their effects. Methods: The study was conducted by searching CINAHL, Ebscohost, MEDLINE, Science Direct, Ovid, ProQuest, Web of Science, and ULAKBİM National Databases for studies published between 2005 and 2015. Key words used during the search included ‘spinal cord injury’, ‘bladder injury’, ‘nursing care’, ‘catheterization’ and ‘intermittent urinary catheter’. After examination of 551 studies, 21 studies which met inclusion criteria were included in the review. Results: Mean age of individuals in all study samples was 42 years. The most commonly used bladder management method was clean intermittent catheterization (CIC). Compliance with CIC was found to be significantly related to spasticity, maximum cystometric capacity, and the person performing catheterization (p < .05). The main reason for changing the existing bladder management method was urinary tract infections (UTI). Individuals who performed CIC by themselves and who voided spontaneously had better life quality. Patient age, occupation status and whether they performed CIC by themselves or not were found to be significantly associated with depression level (p ≤ .05). Conclusion: As the most commonly used method for bladder management, CIC is a reliable and effective method, and reduces the risk of UTI development. Individuals with neurogenic bladder have a higher prevalence of depression symptoms than the normal population.

Keywords: bladder management, catheterization, nursing, spinal cord injury

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Authors: Karthikeyan Srinivasan, Ranjana Singh, Yatin Talwar, Karthikeyan Srinivasan

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Healthcare services play a vital role in the life of human being. The Setup of Hospital varies in wide spectrum of cost, technology, and access. Hospital’s of Public sector satisfies need of a common man to poorer, which can differ at private owned hospitals on cost and treatment. Patient assessing hospital frequently assumes spending time at the hospital is miserable and not aware of what is happening around them. Mostly they are queued up round the clock waiting to be admitted on hospital beds. The idea here is to highlight the role in admitting patient population of Outdoor as well as Emergency entering the Post Graduate Institute of Medical Education and Research, Chandigarh with available hospital beds. This study emphasizes the trend forecasting and acquiring beds needed. The conception “if patient population increases’ likewise increasing hospital beds advertently perceived. If tend to increase the hospital beds, thereby exploring budget, Manpower, space, and infrastructure make compulsion. This survey ideally draws out planning and forecasting beds to cater patient population in and around neighboring state of Chandigarh for admission at territory healthcare and research institute on available hospital beds. Executing healthcare services for growing population needs to know Roemer’s law indicating "in an insured population, a hospital bed built is a filled bed".

Keywords: admissions, average length of stay, bed days, hospital beds, occupancy rates

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Authors: Niu Shu Fen

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Sleep disturbance is highly prevalent among shift-working nurses. We aimed to evaluate whether aerobic exercise (i.e., walking combined with jogging) improves objective Sleepparameters among female nurses at the end of an 8-week exercise program and 4 weeks after study completion. This single-blinded, parallel design, randomized controlled trial was conducted in the floor classroom of a would-be medical center in northern Taiwan. Sixtyeligible female nurses were randomly assigned to either aerobic exercise (n = 30) or usual care (n = 30) group. The moderate-intensity aerobic exercise program was performed over 5days (60 min per day) a week for 8 weeks after work hours. Objective sleep outcomes including total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE), were retrieved using an Actigraph device. A generalized estimated equation model was used for data analyses. The aerobic exercise group had significant improvements in TST and SE at 4 weeks and 8 weeks compared with baseline evaluation(TST: B = 70.49 and 55.96, both p < 0.001; SE: B = 5.21 and 3.98, p < 0.001 and 0.002).Significant between-group differences were observed in SOL and WASO at 4 weeks but not8 weeks compared with the baseline evaluation (SOL: B = −7.18, p = 0.03; WASO: B =−11.38, p = 0.008). The positive lasting effects for TST were observed only until the 4-week follow-up. To improve sleep quality and quantity, we encourage female nurses to regularly perform moderate-intensity aerobic exercise.

Keywords: sleep quality, aerobic exercise, nurses, shift work

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Authors: Davit Pipoyan, Meline Beglaryan, Nicolò Merendino

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Mining industry is one of the priority sectors of Armenian economy. Along with the solution of some socio-economic development, it brings about numerous environmental problems, especially toxic element pollution, which largely influences the safety of agricultural products. In addition, accumulation of toxic elements in agricultural products, mainly in edible parts of plants represents a direct pathway for their penetration into the human food chain. In Armenia, the share of plant origin food in overall diet is significantly high, so estimation of dietary intakes of toxic trace elements via consumption of selected fruits and vegetables are of great importance for observing the underlying health risks. Therefore, the present study was aimed to assess dietary exposure of potentially toxic trace elements through the intake of locally grown fruits and vegetables in Akhtala community (Armenia), where not only mining industry is developed, but also cultivation of fruits and vegetables. Moreover, this investigation represents one of the very first attempts to estimate human dietary exposure of potentially toxic trace elements in the study area. Samples of some commonly grown fruits and vegetables (fig, cornel, raspberry, grape, apple, plum, maize, bean, potato, cucumber, onion, greens) were randomly collected from several home gardens located near mining areas in Akhtala community. The concentration of Cu, Mo, Ni, Cr, Pb, Zn, Hg, As and Cd in samples were determined by using an atomic absorption spectrophotometer (AAS). Precision and accuracy of analyses were guaranteed by repeated analysis of samples against NIST Standard Reference Materials. For a diet study, individual-based approach was used, so the consumption of selected fruits and vegetables was investigated through food frequency questionnaire (FFQ). Combining concentration data with contamination data, the estimated daily intakes (EDI) and cumulative daily intakes were assessed and compared with health-based guidance values (HBGVs). According to the determined concentrations of the studied trace elements in fruits and vegetables, it can be stressed that some trace elements (Cu, Ni, Pb, Zn) among the majority of samples exceeded maximum allowable limits set by international organizations. Meanwhile, others (Cr, Hg, As, Cd, Mo) either did not exceed these limits or still do not have established allowable limits. The obtained results indicated that only for Cu the EDI values exceeded dietary reference intake (0.01 mg/kg/Bw/day) for some investigated fruits and vegetables in decreasing order of potato > grape > bean > raspberry > fig > greens. In contrast to this, for combined consumption of selected fruits and vegetables estimated cumulative daily intakes exceeded reference doses in the following sequence: Zn > Cu > Ni > Mo > Pb. It may be concluded that habitual and combined consumption of the above mentioned fruits and vegetables can pose a health risk to the local population. Hence, further detailed studies are needed for the overall assessment of potential health implications taking into consideration adverse health effects posed by more than one toxic trace element.

Keywords: daily intake, dietary exposure, fruits, trace elements, vegetables

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Authors: Amirreza Razzaghipour, Mahdi Khalili

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References from the World Health Organization and the Center for Disease Control for deceleration the spread of the Novel COVID-19, comprises social estrangement, frequent handwashing, and covering your mouth when around others. As hearing healthcare specialists, the influence of existenceinvoluntary to boundary social interactions on persons with hearing impairment was significant for us to understand. We found ourselves delaying cochlear implant (CI) surgeries. All children, and chiefly those with hearing loss, are susceptible to reductions in spoken communication. Hearing plans, such as cochlear implants, provide children with hearing loss access to spoken communication and provision language development. when provided early and used consistently, these supplies help children with hearing loss to engage in spoken connections. Cochlear implant (CI) is a standard medical-surgical treatment for bilateral severe to profound hearing loss with no advantage with the hearing aid. Hearing is one of the most important senses in humans. Pediatric hearing loss establishes one of the most important public health challenges. Children with hearing loss are recognized early and habilitated via hearing aids or with cochlear implants (CIs). Suitable care and maintenance as well as continuous auditory verbal therapy (AVT) are also essential in reaching for the successful attainment of language acquisition. Children with hearing loss posture important challenges to their parents, particularly when there is limited admission to their hearing care providers. The disruption in the routine of their hearing and therapy follow-up services has had substantial effects on the children as well as their parents.

Keywords: healthcare, covid-19, cochlear implants, spoken communication, hearing loss

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Authors: Adrian Ionut Nicoara, Denisa Ionela Ene, Alina Maria Holban, Cristina Busuioc

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At present, the development of materials with biomedical applications is a domain of interest that will produce a full series of benefits in engineering and medicine. In this sense, it is required to use a natural material, and this paper is focused on the development of a composite material based on bacterial cellulose – hydroxyapatite and silver nanoparticles with applications in hard tissue. Bacterial cellulose own features like biocompatibility, non-toxicity character and flexibility. Moreover, the bacterial cellulose can be conjugated with different forms of active silver to possess antimicrobial activity. Hydroxyapatite is well known that can mimic at a significant level the activity of the initial bone. The material was synthesized by using an ultrasound probe and finally characterized by several methods. Thereby, the morphological properties were analyzed by using Scanning Electron Microscopy (SEM) and Transmission Electron Microscopy (TEM). Because the synthesized material has medical application in restore the tissue and to fight against microbial invasion, the samples were tested from the biological point of view by evaluating the biodegradability in phosphate-buffered saline (PBS) and simulated body fluid (SBF) and moreover the antimicrobial effect was performed on Gram-positive bacterium Staphylococcus aureus, Gram-negative bacterium Escherichia coli, and fungi Candida albicans. The results reveal that the obtained material has specific characteristics for bone regeneration.

Keywords: bacterial cellulose, biomaterials, hydroxyapatite, scaffolds materials

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Authors: Rim Frikha, Nouha Bouayed, Afifa Sellami, Nozha Chakroun, Salima Daoud, Leila Keskes, Tarek Rebai

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Introduction: Recurrent pregnancy loss (RPL) defined as two or more pregnancy losses, is a serious clinical problem. Methylene-tetrahydro-folate-reductase (MTHFR) polymorphisms, commonly the variant C677T is recognized as an inherited thrombophilia which might affect embryonic development and pregnancy success and cause pregnancy complications as RPL. Material and Methods DNA was extracted from peripheral blood samples and PCR-RFLP was performed for the molecular diagnosis of the C677T MTHFR polymorphism among 70 patients (35 couples) with more than 2 fetal losses. Aims and Objective: The aim of this study is to determine the frequency of MTHFR C677T among Tunisian couples with RPL and to critically analyze the available literature on the importance of MTHFR polymorphism testing in the management of RPL. Result and comments: No C677T mutation was detected in the carriers of RPL. This result would be related to sample size and to different criteria (number of abortion), - The association between MTHFR polymorphisms and pregnancy complications has been reported but with controversial results. - A lack of evidence for MTHFR polymorphism testing previously recommended by ACMG (American College of Medical medicine). Our study highlights the importance of screening of MTHFR polymorphism since the real impact of such thrombotic molecular defect on the pregnancy outcome is evident. - Folic supplementation of these patients during pregnancy can prevent such complications and lead to a successful pregnancy outcome.

Keywords: methylenetetrahydrofolate reductase, C677T, recurrent pregnancy loss, genetic testing

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Authors: Ming Ze Kao

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Static magnetic fields (SMF) are widely used in several medical applications, especially in diagnosis of tumors. However, biological effects of the SMFs on modulating cell physiology through the Lorentz force, which is highly frequency and magnitude dependent, remain to be elucidated. Specific patterns from SMFs of static MF, delivered by means of Halbach array magnets with a gradient increment of 6.857mT/mm from center to border, were found to have profound inhibitory effect on the growth rate of human cell line derived from Nasopharyngeal carcinoma patients. The SMFs, which were shown to be noncontact, selectively impact rapid dividing cells while quiescent cells stay intact. The phenomenon acts in two modes: the arrest of cell proliferation in the G2/M phase and destruction of cell mitosis in cell division. First mode is manifested by impacting the proper formation of mitotic spindle, whereas the second results in disintegration of the cancer cell. Both modes are demonstrated when SMF was applied for 24 hours to cancer cells, the results revealed that metaphase arrest during mitosis due to activation of DNA damage response (DDR), resulting in high expression of ATM-NBS1-CHEK signaling pathways and higher G2/M phase ratio compared with control group. Here, experimental data suggest that the SMFs cause activation of cell cycle checkpoints, which implies the MFs as a potential therapeutic modality as a sensitizer for radiotherapy or chemotherapy.

Keywords: static magnetic field, DNA damage response, Halbach array, magnetic therapy

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Authors: Hazlin Kadir Shahar, Razaleigh Muhamat Kawangit, Badlihisham Mohd Nasir, Rosmawati Mohamad Rasit

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Stigma and discrimination have become the main topic of discussion when dealing with HIV/AIDS issues. They affect the daily life of People Living With HIV(PLHIV), families, friends and people around them indirectly. This paper discusses the potential measurement in helping to reduce stigma and discrimination existence among Islamic Religious Officers towards PLHIV in Malaysia. These people have been trained with special programmes to tackle the HIV/AIDS issues by using a manual, namely as ‘The Manual of Islam and HIV/AIDS’, specifically designed by the Islamic Development Department of Malaysia (JAKIM). The objectives of the training programmes are to give the accurate information about HIV/AIDS and to suggest ways on how to handle the PLHIV issues in Islamic perspective. This research used quantitative methodology by survey. A pilot test had been done over thirty (30) trained Islamic Religious Officers in Malaysia. The findings have shown that the trainings have given a positive impact for them as they managed to acquire the knowledge of HIV/AIDS from both primer and authorized sources such as medical practitioners, Muslim chaplains and social workers. The knowledge they have acquired from the trainings has guided them in changing their perception, thus helping to reduce their own stigma and discrimination towards PLHIV. The training programmes have given them opportunities to practice what they have learned through several outreach sessions as they have had the opportunities to approach PLHIV directly.

Keywords: Islamic religious officers, people with HIV, stigma and discrimination, training programmes

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Authors: Teresa Carlone, Matteo Mannocchi

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In the last decade, a growing number of International Organizations are pushing toward green solutions for adaptation to climate change. This is particularly true in the field of Disaster Risk Reduction (DRR) and land planning, where Nature-Based Solutions (NBS) had been sponsored through funding programs and planning tools. Stakeholder engagement and co-creation of NBS is growing as a practice and research field in environmental projects, fostering the consolidation of a multidisciplinary socio-ecological approach in addressing hydro-meteorological risk. Even thou research and financial interests are constantly spread, the NBS mainstreaming process is still at an early stage as innovative concepts and practices make it difficult to be fully accepted and adopted by a multitude of different actors to produce wide scale societal change. The monitoring and impact evaluation of stakeholders’ participation in these processes represent a crucial aspect and should be seen as a continuous and integral element of the co-creation approach. However, setting up a fit for purpose-monitoring strategy for different contexts is not an easy task, and multiple challenges emerge. In this scenario, the Horizon 2020 OPERANDUM project, designed to address the major hydro-meteorological risks that negatively affect European rural and natural territories through the co-design, co-deployment, and assessment of Nature-based Solution, represents a valid case study to test a monitoring strategy from which set a broader, general and scalable monitoring framework. Applying a participative monitoring methodology, based on selected indicators list that combines quantitative and qualitative data developed within the activity of the project, the paper proposes an experimental in-depth analysis of the stakeholder engagement impact in the co-creation process of NBS. The main focus will be to spot and analyze which factors increase knowledge, social acceptance, and mainstreaming of NBS, promoting also a base-experience guideline to could be integrated with the stakeholder engagement strategy in current and future similar strongly collaborative approach-based environmental projects, such as OPERANDUM. Measurement will be carried out through survey submitted at a different timescale to the same sample (stakeholder: policy makers, business, researchers, interest groups). Changes will be recorded and analyzed through focus groups in order to highlight causal explanation and to assess the proposed list of indicators to steer the conduction of similar activities in other projects and/or contexts. The idea of the paper is to contribute to the construction of a more structured and shared corpus of indicators that can support the evaluation of the activities of involvement and participation of various levels of stakeholders in the co-production, planning, and implementation of NBS to address climate change challenges.

Keywords: co-creation and collaborative planning, monitoring, nature-based solution, participation & inclusion, stakeholder engagement

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Authors: K. R. Padma, K. R. Don

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Background and aims: A balanced nutritional diet is essential in maintaining immunity and for deterrence as well as desisting of viral infections. Nevertheless, currently, very less information is available online regarding nutrition consumption during the period of coronavirus infection, i.e. (COVID-19). In our systematic review article, we portrayed and aimed to evaluate evidence from various previous clinical trials, which was based on nutritional interventions for viral diseases and given a concise overview. Methods: A systematic search was carried out employing 3 key medical databases: PubMed®, Web of Science®, and SciVerse Scopus®. Studies were performed and evaluated suitable if clinical trials in humans, appropriate immunological parameters on viral and respiratory infections, need to perform. Basic Clinical trials on nutritional vitamins, minerals, nutraceuticals as well as probiotics were included. Results: We have explored 10 review articles and extracted data for our study. A total of > 2000 participants were included and excluded several other trace elements as well as various vitamins, but in inclusion criteria mainly concentrated on those who have shown propitious immune-modulatory effects against viral respiratory infections. Conclusions: We have encapsulated the potential health benefits of some minerals, vitamins, as well as certain designer foods, nutraceuticals, and probiotics in viral infections. Based on this nutritional interventional strategy available from our present data, it could be promising to abstain and reduce the COVID-19 infection replication and boost our immunity to fight against the virus.

Keywords: COVID-19, immunity, vitamins, nutritional intervention strategy

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Authors: Hsiao-Yung Wang

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This essay aims to examine how the discursive formation of the 'transing-nationalism' (which is extended and slightly modified from 'homonationalism') had been constructed in the Taiwanese news media before the legalization of 'sex reassignment surgery (SRS)' in 1988. Samples for rhetorical analysis were selected from two mainstream newspapers, including China Times, and United Daily. The time frame for sample selection is from August 1953 (when the first transgender case was reported) to 1988, while the SRS was legalized in Taiwan. To enhance understanding of media representation as contextualized-based, the author refers to the representative of spatial rhetoric Mikhail Bakhtin for his late study on 'emergence' and 'visualization of time' in Bildungsroman; thereby categorizing the media discourse of transgender into two critical period: (1) transgender as 'misrecognized' and 'included' into the rhetoric of modern medical space; (2) transgender as 'institutionalized' into discourse of protection and salvation by the reified sympathy of nation-state. These two periods and relevant spatial rhetoric were of no immediate concern on the vital interest of transgender individuals; therefore constructed the imagery of transgender for the service of nationalism rather than gender consciousness or human right rhetoric. Based on the research findings, this essay concludes that 'queer multiplicity' should be regarded as not only the guideline for the amendment of the gendered policies and laws but the rhetorical resources for the mobilization of transgender movement in Taiwan from now on.

Keywords: Bakhtin, legalization, rhetoric, sex reassignment surgery, transgender, transing-nationalism

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Authors: Donna L. Roberts

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2019 marked 23 years since Purdue Pharma launched its flagship drug, OxyContin, that unleashed an unprecedented epidemic touching both celebrities and common citizens, metropolitan, suburbia and rural areas and all levels of socioeconomic status. From rural Appalachia to East LA individuals, families and communities have been devastated by a trajectory of addiction that often began with the legitimate prescription of a pain killer for anything from a tooth extraction to a sports injury to recovery from surgery or chronic arthritis. Far from being a serendipitous progression of events, the proliferation of this new breed of 'miracle drug' was instead a carefully crafted marketing program aimed at both the medical community and common citizens. This research represents and in-depth investigation of the evolution of the marketing, distribution and promotion of prescription opioids by pharmaceutical companies and its relationship to the propagation of the opioid crisis. Specifically, key components of Purdue Pharma’s aggressive marketing campaign, including its bonus system and sales incentives, were analyzed in the context of the sociopolitical environment that essential created the proverbial 'perfect storm' for the changing manner in which pain is treated in the U.S. The analyses of these series of events clearly indicate their role in first, the increase in prescription of opioids for non-terminal pain relief and subsequently, the incidence of related addiction, overdose, and death. Through this examination of the conditions that facilitated and maintained this drug crisis, perhaps we can begin to chart a course toward its resolution.

Keywords: addiction, opioid, opioid crisis, Purdue Pharma

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Authors: Suhas Pednekar, Prashant Chavan, Ramesh Chaughule, Deepak Patkar

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Iron oxide (Fe3O4) magnetic nanoparticles (MNPs) are one of the most attractive nanomaterials for various biomedical applications. An important potential medical application of polymer-coated iron oxide nanoparticles (NPs) is as imaging agents. Composition, size, morphology and surface chemistry of these nanoparticles can now be tailored by various processes to not only improve magnetic properties but also affect the behavior of nanoparticles in vivo. MNPs are being actively investigated as the next generation of magnetic resonance imaging (MRI) contrast agents. Also, there is considerable interest in developing magnetic nanoparticles and their surface modifications with therapeutic agents. Our study involves the synthesis of biocompatible cancer drug coated with iron oxide nanoparticles and to evaluate their efficacy as MRI contrast agents. A simple and rapid microwave method to prepare Fe3O4 nanoparticles has been developed. The drug was successfully conjugated to the Fe3O4 nanoparticles which can be used for various applications. The relaxivity R2 (reciprocal of the spin-spin relaxation time T2) is an important factor to determine the efficacy of Fe nanoparticles as contrast agents for MRI experiments. R2 values of the coated magnetic nanoparticles were also measured using MRI technique and the results showed that R2 of the Fe complex consisting of Fe3O4, polymer and drug was higher than that of bare Fe nanoparticles and polymer coated nanoparticles. This is due to the increase in hydrodynamic sizes of Fe NPs. The results with various amounts of iron molar concentrations are also discussed. Using MRI, it is seen that the R2 relaxivity increases linearly with increase in concentration of Fe NPs in water.

Keywords: cancer drug, hydrodynamic size, magnetic nanoparticles, MRI

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Authors: Huseyin Sinan Gunesli

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Process Safety Management is a disciplined framework for managing the integrity of systems and processes that handle hazardous substances. It relies on good design principles, well-implemented automation systems, and operating and maintenance practices. Alarm Management Systems play a critically important role in the safe and efficient operation of modern industrial plants. In that respect, Alarm Management is one of the critical factors feeding the safe operations of the plants in the manner of applying effective process safety principles. Trans Anatolian Natural Gas Pipeline (TANAP) is part of the Southern Gas Corridor, which extends from the Caspian Sea to Italy. TANAP transports Natural Gas from the Shah Deniz gas field of Azerbaijan, and possibly from other neighboring countries, to Turkey and through Trans Adriatic Pipeline (TAP) Pipeline to Europe. TANAP plays a crucial role in maintaining Energy Security for the region and Europe. In that respect, the application of Process Safety principles is vital to deliver safe, reliable and efficient Natural Gas delivery to Shippers both in the region and Europe. Effective Alarm Management is one of those Process Safety principles which feeds safe operations of the TANAP pipeline. Alarm Philosophy was designed and implemented in TANAP Pipeline according to the relevant standards. However, it is essential to manage the alarms received in the control room effectively to maintain safe operations. In that respect, TANAP has commenced Alarm Management & Rationalization program as of February 2022 after transferring to Plateau Regime, reaching the design parameters. While Alarm Rationalization started, there were more than circa 2300 alarms received per hour from one of the compressor stations. After applying alarm management principles such as reviewing and removal of bad actors, standing, stale, chattering, fleeting alarms, comprehensive review and revision of alarm set points through a change management principle, conducting alarm audits/design verification and etc., it has been achieved to reduce down to circa 40 alarms per hour. After the successful implementation of alarm management principles as specified above, the number of alarms has been reduced to industry standards. That significantly improved operator vigilance to focus on mainly important and critical alarms to avoid any excursion beyond safe operating limits leading to any potential process safety events. Following the ‟What Gets Measured, Gets Managed” principle, TANAP has identified key Performance Indicators (KPIs) to manage Process Safety principles effectively, where Alarm Management has formed one of the key parameters of those KPIs. However, review and analysis of the alarms were performed manually. Without utilizing Alarm Management Software, achieving full compliance with international standards is almost infeasible. In that respect, TANAP has started using one of the industry-wide known Alarm Management Applications to maintain full review and analysis of alarms and define actions as required. That actually significantly empowered TANAP’s process safety principles in terms of Alarm Management.

Keywords: process safety principles, energy security, natural gas pipeline operations, alarm rationalization, alarm management, alarm management application

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Authors: Angelis P. Barlampas

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PURPOSE: The purpose of this paper is to demonstrate the important role of taking an appropriate and detailed history, in order to reach the best possible diagnostic conclusion. MATERIAL: A patient presented to the emergency department due to the sudden onset of continuous abdominal pain, during the last hour and with the clinical symptoms of an acute abdomen. During the clinical examination, signs of peritoneal irritation and diffuse abdominal tenderness were found. The rest of the clinical and laboratory tests did not reveal anything important. From the reported medical history, nothing of note was found, except for the report of a large liver cyst, for which he was advised not to take any further action, except from regular ultrasound examination . METHOD: A computed tomography examination was performed after per os administration of gastrografin, which revealed a hyperdense ascitic effusion, similar in density to that of gastrografin within the intestinal tract. The presence of a large cyst of the left hepatic lobe was confirmed, contacting and pushing against the stomach. In the area of the contact between the liver cyst and the pylorus, there were extraluminal air bubbles and local opacity of the peritoneal fat, with a small hyperdense effusion. Result : The above, as well as the absence of a history of stomach ulcer or recent trauma, or other pathology, argue in favor of acute pyloric perforation, due to mural necrosis, in response to chronic external pressure from the pre-existing large liver cyst.

Keywords: perforation, stomach, large liver cyst, CT abdomen, acute abdominal pain, intraperitoneal leakage, constrast leakage

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Authors: A. Razavykia, A. Esmaeilzadeh, S. Iranmanesh

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Many orthopedic implants like proximal humerus cases require lower surface roughness and almost immediate/short lead time surgery. Thus, rapid response from the manufacturer is very crucial. Tool path strategy of milling process has a direct influence on the surface roughness and lead time of medical implant. High-speed milling as promised process would improve the machined surface quality, but conventional or super-abrasive grinding still required which imposes some drawbacks such as additional costs and time. Currently, many CAD/CAM software offers some different tool path strategies to milling free form surfaces. Nevertheless, the users must identify how to choose the strategies according to cutting tool geometry, geometry complexity, and their effects on the machined surface. This study investigates the effect of different tool path strategies for milling a proximal humerus head during finishing operation on stainless steel 316L. Experiments have been performed using MAHO MH700 S vertical milling machine and four machining strategies, namely, spiral outward, spiral inward, and radial as well as zig-zag. In all cases, the obtained surfaces were analyzed in terms of roughness and dimension accuracy compared with those obtained by simulation. The findings provide evidence that surface roughness, dimensional accuracy, and machining time have been affected by the considered tool path strategy.

Keywords: CAD/CAM software, milling, orthopedic implants, tool path strategy

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Authors: Kristel Dame Bañez Sumagaysay, Marie Victoria Cruz-javier

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The current subject is a case of a 21 year-old woman at 29 1/7 weeks of gestation with Pre-B cell Acute Lymphoblastic Leukemia who was admitted to the coronary care unit (CCU) of the St. Luke’s Medical Center-Global City for Severe Acute Respiratory Distress Syndrome (ARDS) secondary to hospital-acquired pneumonia secondary to pneumocystis jiroveci; central line-associated bloodstream infection (E. aerogenes). She presented with chronic hypoxemia caused by Pulmonary edema, probably secondary to heart failure secondary to cardiomyopathy chemotherapy-induced. Due to worsening feto-maternal status, extracorporeal membrane oxygenation (ECMO) for respiratory support was instituted, and an elective cesarean section was done due to multiple maternal factors and deteriorating health status under total intravenous anesthesia assisted by veno-venous extracorporeal membrane oxygenation. She delivered a live preterm newborn male, APGAR Score: 1, 0, 0, birth weight 985 grams, birth length: 40.5cm, small for gestational age.

Keywords: extracorporeal membrane oxygenation, pre-b cell acute lymphoblastic leukemia, severe acute respiratory distress syndrome, ethical dilemmas

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Authors: Amr Hamdy

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Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Many methods have been developed to decrease its rate. The aim of this study was to evaluate the applicability of a new non-pharmacologic maneuver in decreasing its rate. Methods: This case series study was conducted in one centre in Cairo, Egypt, from January-2010 to June-2013. 400 pregnant–women aged 18 years or more and candidate for normal labour; were enrolled to this study. High-risk subjects for PPH were excluded. After placental delivery, the new maneuver was done by sustained traction of the anterior and posterior lips of the cervix by two ovum forceps for duration of 90 seconds. The amount of blood loss was estimated by standardized visual estimation after removal of the forceps. All subjects were followed up for 6 hours. Results: The rate of PPH, defined as more than 500 ml, was 8 cases (2%) with 95% CI (0.63-3.37%). The rate of PPH was not affected by parity, gestational age, episiotomy or the presence of tears. PPH is more in cases with anemia (p 0.032). It occurred in all cases with uterine atony (p <0.001). The range of estimated blood loss was 550-600ml in cases with PPH and 150-450ml in cases without PPH. Severe PPH more than 1000 ml, did not occur. Conclusion: This pilot study introduced a novel maneuver that can be helpful in decreasing the rate of PPH and reducing the amount of post partum blood loss.Despite the low rate of PPH showed in this study, the need for conducting a randomized controlled study is at its highest level before further inclusion of such manoeuvre to be a part of the current medical practice and before considering it as an evident tool to decrease the burden of PPH.

Keywords: maternal mortality, new manoeuvre, post-partum haemorrhage, uterine atony

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