Abstract Objective: To determine factors influencing anesthesiology choice among resident doctors at the medical school of Marrakech. Materials and Methods: We have conducted a descriptive cross-sectional study based on an anonym ous questionnaire. Results: A total of 406/672 questionnaires were returned, with a female/male sex ratio of 1.07. The duration of the training (OR: 3.3; CI 95%: 1.74 - 6.23; p < 0.001), intellectual challenge (OR: 3.02; CI 95%: 1.69 -5.37; p < 0.001), doctor-patient relationship (OR: 2.22; CI 95%: 1.02 - 4.84; p: 0.04), and financial aspects (OR: 2.14; CI 95%: 1.09 - 4.21; p: 0.02) were inde pendent factors that influenced the choice of anesthesiology. Conclusion: we recommend the succeeding: 1) Support students in their choice; 2) Correct misconceptions about certain specialties; 3) Promote clinical clerkship; 4) En courage mentorship; 5) Increase the salary of at-risk specialties .

Abstract Objective: To investigate the changes of related immune cytokines (Dendritic Cells (DC) cells, CD4+, CD8+, Th17, IgG, IgM, IgA) in patients with non small cell lung cancer (NSCLC) before and after chemotherapy. Methods:Eighty-five NSCLC patients who were treated in the Oncology Department of the Affiliated Hospital of Chengde Medical College from December 2018 to February 2021 were selected as the research objects, and the patients were analyzed at different time points (before chemotherapy, after the first che motherapy, and after the second chemotherapy) Changes in the expression levels of DC cells, CD4+, CD8+, Th17, IgG, IgM, IgA in peripheral blood, and explore their correlation. Results: Before chemotherapy, after the first che motherapy, and after the second chemotherapy, the peripheral blood CD4+and CD8+ were significantly increased, and the Th17, IgG, IgM, and IgA le vels gradually decreased. The difference was statistically significant. But there was no obvious change in DC cells. Conclusion: There is no significant change in DC cells in peripheral blood of NSCLC patients before and after chemotherapy. CD4+ and CD8+ are significantly increased, Th17, IgG, IgM, and IgA levels are all decreased, which is a manifestation of impaired immune function of patients after emotherapy.

Abstract Introduction: Burnout syndrome is prevalent to a great extent among medi cal residents, and this can interfere with their training and patient manage ment. However, the extent of the problem is still unknown in our setting. This study therefore aimed at determining prevalence and factors associated with burnout syndrome among resident doctors at tertiary teaching hospitals in Dar es Salaam, Tanzania. Method: A cross-sectional study of resident doctors was carried out in four teaching hospitals of Muhimbili University of Health and Allied Sciences between January 2021 and March 2021. Partici pants were interviewed using a structured questionnaire and Maslach Bur nout Inventory. Results: The study had 398 participants with a mean age of 35 ± 3.5 years. Overall burnout prevalence was 33.7%, as for the burnout di mensions, 205 (51.5%) respondents reported burnout in the dimension of emotional exhaustion (EE), 177 (44.5%) in the dimension of depersonaliza tion (D), and 144 (36.2%) in the dimension of reduced personal accomplish ment (RPA). Independent factors associated with burnout syndrome were: inadequate support from residency program supervisors (Odds Ratio (OR) 1.97, 95% CI: 1.23 - 3.14, p = 0.005), work-related family conflicts (Odds Ra tio (OR) 3.2, 95% CI: 1.35 - 7.71, p = 0.008), stressful call perception (Odds Ratio (OR) 3.31, 95% CI: 1.90 - 5.76, p = 0.001) and each added year of study (Odds Ratio (OR) 3.46, 95% CI: 1.08 - 6.73, p = 0.009). Conclusion: Burnout is a problem among resident doctors in Tanzania. This could be addressed by directing preventive and intervention measures in the residency training program. Periodic assessment is also needed to mitigate factors associated with burnout among resident doctors.

Abstract Glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide adequate glycemic control, weight reduction, low risk of hypoglycemia, and CV risk reduction. Their usage for type 2 DM (T2DM) is recommended mainly when hypoglycemia or weight gain should be considered, also, whenever initial therapy is failed. There are many recent updates in the treatment paradigm of T2DM. There are many types of GLP-1RAs, with a knowledge gap regarding switching between the different types. A Saudi task force gathered to develop an explicit, evidence-based consensus for switching between GLP-1RAs, when, why, and how? This article contains the expert panel’s recommendations as a contribution to complement the knowledge gap in this area from the national perspective. As an alternative to intensifying therapy, switching from one GLP-1RA to another has various advantages. Improvements in glycemic con trol, weight loss, adherence, and medications with established cardiovascular benefits are among them. Also, switching needs to be individualized upon many discussed factors like the dose of the previous GLP1-RA and gastroin testinal adverse effects. Discussion with patients about the why and how to switch is critical.

Abstract Background: The significant improvement of immediate and long-term func tional results of treating patients is the fundamental problem of modern medical science. A deep understanding of the pathogenesis is the key point in creating the management strategy for patients with various diseases. In formation about the mechanisms of origin and development of purulent inflammatory diseases and sepsis is essential for finding effective ways to prevent and treat them. The aim of the research is to use the method of flu orescence spectroscopy in creating the pathogenetic diagnostic and treatment model for the prevention and treatment of purulent-inflammatory diseases and sepsis, modification of treatment tactics, search for new markers of pu rulent-septic diseases, as well as monitoring of patients during the treatment.Materials and methods: The proposed approach, along with standard diag nostic methods, was used to organize the treatment process of 100 patients with purulent-inflammatory diseases, including 15 patients with sepsis, 35 with acute inflammatory abdominal pathology, 20 patients with burn injury (main group) and 35 patients with burn injury (comparison group). Results:The behavior of spectral-fluorescent characteristics in their dynamics has been studied, and the new markers for assessing patients’ conditions have been proposed. Their effectiveness for the diagnosis of purulent-septic dis eases has been proved, which advances the results of standard research me thods by 24 - 48 hours. Conclusions: The proposed diagnostic and treatment approach is fundamentally important for diagnosis and monitoring during the treatment of patients with purulent-septic diseases. Particularly relevant is the proposal to modify the treatment process for these patients, associated with the use of infusion of donor albumin solutions.

Abstract Background: Multiplex virus assays are useful in immunocompromised hosts but still challenging in routine clinical settings in terms of their sensitivity, specificity, reproducibility, and time and cost performances. In recent years, we developed a qualitative multiplex virus PCR assay capable of the simultaneous detection of 13 virus species within 3 h. However, because of the multiple and concomitant nature of this virus assay, it should be validated for qualitative reliability. Materials and Methods: As a preclinical examination, this multiplex PCR was able to detect 1.25 × 103 copies/mL of 13 synthesized virus genomes and preserved same virus DNAs by the serial dilution method. Blood samples from 40 patients who underwent hematopoietic stem cell transplantation were then examined by multiplex PCR for 13 virus species, followed by quantitative real-time PCR for all 13 virus species as reference PCR when these patients developed symptoms suggestive of viral infection. Results: In 421 cumulative qualitative-quantitative tests, the multiplex PCR certainly detected 1.0 × 103 copies/mL of 5 viruses (CMV, JCV, BKV, HHV-6, ADV) that were frequently detected and thus reasonably analyzed. The positive and negative predictive values of multiplex PCR were 84.2% - 93.3% and 90.7% - 99.0%, respectively, and sensitivity and specificity were 59.0% - 83.3% and 97.2% - 99.2%, respectively, for these 5 viruses. Conclusion: From these performances, the multiplex PCR assay may be acceptable in a routine clinical laboratory setting.

Abstract Introduction: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spread through person-to-person transmission and has become a global pandemic. At Saitama Medical University Hospital, many medical staff members have been involved in treating patients with COVID-19. The Care Task Force was established in collaboration with physicians, medical staff, and clerical staff in the various hospital departments to strengthen infection control measures based on standard precautions. Methods: To determine the outcome of infection control measures, we administered anti-SARS-CoV-2 antibody tests and questionnaires to all 2461 employees including nonhospital workers, as a local standard, between June 29 and July 10, 2020. Results: Among the hospital workers, 698 (33.99%) had contact with patients with COVID-19 and 325 healthcare workers worked in specialized wards for the COVID-19, intensive care unit, and high-fever outpatient clinics. Positive for the anti-SARS-CoV-2 antibody were only 4 (0.16%) employees. Among them, the past histories of two employees were unknown, while the other two had a history of COVID-19 before the test and were not involved in the medical care of COVID-19 patients at our hospital. Conclusion: It is the first study assessing the seropositive rate in Saitama-prefecture, a bed-town of Tokyo. Compared with the local standard, we found that health care workers are not at risk for viral droplet transmission, especially with SARS-CoV-2 and even with the current pandemic, with infection control measures based on standard precautions. Based on our findings and with no clusters formed in our university and hospital, we continued current infection control measures.

Abstract The utility model discloses a new type of flat vehicle for emergency patient transfer, comprising a support frame, a bed board, an infusion stand and a transfer assembly; the transfer assembly comprises a trapezoidal base fixed on the upper part of the support frame, and a trapezoid mounted on the bottom or side of the bed board. A sliding sleeve, a limit pin, a fixing cylinder and a spring; the trapezoidal sliding sleeve is matched on the trapezoidal base, a pin shaft hole is arranged on the trapezoidal base, the fixing cylinder is fixed on the trapezoidal sliding sleeve, and the limit pin is sleeved in the fixing cylinder, The bottom of the limit pin protrudes from the trapezoidal sliding sleeve, and the upper part is provided with a traction rod; the spring is sleeved on the traction rod, and a limiting plate is arranged at intervals on both sides of the trapezoidal base, and the limiting plate is wrapped in the trapezoidal sliding sleeve. The outer end: by setting the transfer component, the bed board is allowed to be fixed, slid and completely disengaged from the support frame, which is convenient for transferring the bed board together with the patient on it during the patient transfer process. It provides convenience for medical staff.

Abstract This paper focuses on discussing a novel scoring for stage III rectal cancer patients and all the challenges in creating and developing a clinical score. Background: It is fundamental in my opinion to give space to new generations of scientists, medical doctors and researchers to study and, backed with evidence-based information, improve the current knowledge of clinical medical science. It is fundamental for result obtained by medical researchers to bring their findings to the scientific community. Every scientific finding is of vital importance. In this essay a new Clinical Scoring system, the Sarandria Score, developed by myself is discussed, together with the methods and path in order for a young medical researcher with an idea to bring it to the scientific community. Main topics: Colorectal Cancer (CRC) is a major public health problem, representing the third most commonly diagnosed cancer in males and the second in females. Various studies have reported relevant differences related to CRC primary location site (right-sided colon, left-sided colon, rectum) including response to adjuvant chemotherapy and prognosis. In stage III CRC patients, previous findings showed that higher density of tumor-associated neutrophils (TANs) was associated with better response to 5-FU-based chemotherapy. Novel findings were discovered by Dr Nicola Sarandria on the role of neutrophils in rectal cancer, which include different factors which point to an anti-tumoral role of neutrophils in rectal cancer when in presence of chemotherapeutic agents (5-fluorouracil). The clinical significance of TANs was assessed and whether it can be different depended on the location of the primary CRC (right-sided colon, left-sided colon, rectum). Conclusions: This essay officially discusses a new clinical prognostic and predictive scoring (Sarandria Score) involving intratumoral neutrophilic infiltration in rectal cancer and the possibility of a new inclusion criteria based on this infiltrate for Stage III rectal cancer patients treated with 5-FU therapy. This paper includes data published on my medical degree thesis and in a previous review (on Journal of Cancer Therapy) showing that higher levels of TANs densities were associated with better disease-free survival (DFS) in 5-FU treated patients affected by rectal cancer (while it was inversely related in patients without 5-FU therapy). This was also as further evidence in support possible conceptual division of what is now known as Colorectal cancer into Colon and Rectal cancer.

Abstract Objective: It demonstrates the correlation of the viral hemorrhagic fever with kidney failure and the treatment as well as the outcome. Method: A PubMed search of the English literature from 1999 to 2019 was performed using “viral hemorrhagic fever, Case Report, Renal Failure” as the subject. The inclusion criteria were the following: 1) case report and case series of two or more patients; 2) the report detailed the clinical presentation and reported the status of the renal system; 3) the report described the management of renal failure if any; and 4) the etiology of the infection is known and is one of the known agents of viral hemorrhagic fever, listed on the centers of disease control website. We excluded infections related to vaccination related to viral hemorrhagic fever. Result: We found the mean age of these patients was 41.5.The male to female ratio was about 3.5:1. Dengue and Hantaviruses constituted 70.5% of patients. The overall mortality of the study cohort was 32.2%. Half of the patients had acute kidney injury and required renal replacement therapy. The chi-square statistic is 0.41; The p-value is 0.51; The chi-square statistic is 6.4254. Overall mortality was 32.3% in one cohort of 78 patients. The illness goes through several stages [1] [2] of clinical features and some viruses in the group have a high case fatality rate. Conclusions: Early diagnosis with aggressive supportive care is critical for improving clinical outcomes. Renal involvement is common. Amongst the cohort reviewed, of patients who had acute kidney injury, half of the patients required renal replacement support. However, some viruses cause greater kidney injury than others, for instance, kidney injury is more severe in Dengue hemorrhagic fevers when compared to Hantaviruses. Simultaneous management of public health by prevention and control of outbreaks is particularly important.

Abstract Objective: In preeclampsia, abnormal fetal hemodynamics changes can be detected by Doppler ultrasound and predicted the perinatal outcome. But seldom studies focus on these preterm neonate’s hemodynamics changes during 72 hours after birth and the adverse short-term outcomes. The present study is planned to assess the parameters of middle cerebral arteries and associate the short-term outcome at 37 weeks early term age in pregnancies complicated by preeclampsia. Methods: A total of 114 preterm neonates were included. The Doppler cranial ultrasound was performed to bilateral middle cerebral arteries within 12 - 24 hours, 36 - 48 hours, 60 - 72 hours after birth for all the eligible study neonates. The parameters of resistive index (RI), resistive index (PI) and middle cerebral velocity (MBFV) were recorded by Doppler cranial ultrasound and 106 infants survived assessed by the Neonatal Behavioral Neurological Assessment (NBNA) at 37 weeks early term-equivalent age. Results: There were a total of 106 subjects that finally completed the NBNA examination at 37 weeks of early term-equivalent age. In the surviving infants, there were a total of 26 infants with abnormal NBNA scores, among them, 12 infants’ mothers were diagnosed with preeclampsia, accounting for up to 46.1%. In these preterm neonates, the lower velocity of bilateral middle cerebral arteries was observed in abnormal infants (p < 0.05) and the lowest velocity was observed in these abnormal babies with preeclampsia (p < 0.05). Conclusion: Velocity of middle cerebral artery is significantly abnormal in preeclampsia. The slower velocity in the 72 hours after birth, the higher associated with adverse perinatal short-term outcome.

Abstract Background: With the development of globalization, the rising cost of clinical trials in Europe and the United States, and the huge drug consumption market in developing countries, multinational pharmaceutical giants have set their sights on emerging developing countries. As a leader in developing countries, China has unparalleled advantages, so more and more clinical trials are registered and carried out in China. Objective: The objective of the study is to understand the current practice of informed consent in clinical trials in public hospitals in Xuzhou. Methods: In this study, a 15-question questionnaire was distributed to 369 subjects in the affiliated hospital of Xuzhou medical university. Each question was graded on a 3-point scale (1 = no, 2 = unsure, 3 = yes). The sum of the scores for the 15 questions represented the level of awareness of clinical trials. Results: Valid questionnaires were received from 300 subjects. A considerable number of subjects still had insufficient understanding of clinical trials, especially concerning the nature of clinical trials, understanding of informed consent forms, contact with researchers, and ethics committee. (The “yes” rate was around or below 50%). Factors associated with responses to the survey include education, occupation, and source of medical expenses. Conclusion: Overall, this study showed that the implementation of informed consent in China remained room for improvement. Legislators, ethics officers, and researchers should work together to protect the interests of subjects.

Abstract The practice of medicine in Muslim nations dates to the millennia before the advent of the religion of Islam. As far as the pre-Islamic period is concerned, what evidence is available indicates the medical evolution began nearly 6000 years ago in Mesopotamia, where medicine for the first time in history became a recognised profession. In ancient Egypt, it was practised by priest-physicians who demonstrated astonishing knowledge in various medical subjects. The origins of medicine in ancient Persia (Afghanistan, Iran, and parts of Central Asia) span the 6th century B.C. and to the Zoroastrian religious book of Avesta, which delved into such topics as preventive and clinical medicine. In reference to the account of medicine in the Arab peninsula, limited information exists. In terms of post-Islamic ages, the foundations of Islamic science were laid during the reign of the second Abbasid Caliph, al-Mansur, and the establishment of Baghdad as its capital in 762 A.D., when the Arabic translation movement commenced. During the next six centuries, medicine and other fields of science flourished, and prominent physicians such as the Bukht Yishu family, Râzī, Majūsī, Avicenna, Jorjânī, Al-Zahrāwī, and other scientists emerged. In both the pre- and post-Islamic ages, Islamic medicine was heavily influenced by Mesopotamian, Egyptian, Persian, Indian, and, predominantly, Greek medicine. Nevertheless, the advancements and innovations in medical science and healthcare systems that were achieved during the early and medieval Islamic ages have indubitably made an invaluable contribution to the evolution of medicine throughout the world, and to the invention of numerous procedures and practices which are still widely performed today. Hence, the value of comprehending the pivotal role Islamic medicine played (and indeed still plays) in the progression of medical practice across the globe cannot be overstated.

Abstract Background: Hiccups, also known as Singletus, can be a cause of worry and anxiety for most patients when persistent. It has long been associated with various infectious pathologies. Its association with SARS-COV-19 is relatively new with only a few cases reported so far. This case report highlights a unique presentation of Covid pneumonitis as intractable hiccups as the only symptom. With adequate laboratory and instrumental investigations, the aetiology was found to be Covid pneumonitis. Once the cause was detected and treatment initiated, the symptoms subsided. Conclusion: While hiccup can be a sign of various underlying chronic illnesses, its association with Covid-19 is relatively new with very few literatures reporting this finding. It is very crucial for clinicians to keep a high index of suspicion in patients presenting with hiccups.

Abstract Background: Ventral hernia is a complex and progressive condition that may lead to serious complications. However, no specified grading or classifying system is found to categorize the hernia, which leads to clinical complexities and may affect the patient outcome. Aim: The general aim of this paper is to build up an easy and comprehensive grading system to categorize ventral hernia. Methodology: By carrying out a secondary search over clinical presentation, physical examination, and imaging studies of ventral hernia, a valid grading system is developed. Results: Hanoon’s grading system is composed of seven grades, grades 1, 2A, 2B, 3A, 3B, 3C, and 4. Each grade entailed different clinical presentations, imaging characteristics, and progressivity of ventral hernia. Conclusion: Hanoon’s grading system for ventral hernia can be used to solve the clinical complexities of ventral hernia. Also, it can be a step forward in hernia research to build upon.