March 2022 | Volume 05 General Surgery: Open Access

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PEDIATRIC SURGERY & IMMUNOLOGY March 11, 2022 | Webinar

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Scientific Program

2022

Introduction 09:00-09:15 Friday| March 11, 2022 Sessions on: COVID-19 | Pediatrics | Pediatric Nutrition Title: Development of methods about safe application of possessing DNA-genome 09:15-09:45 viral strains as material for novel molecular vaccines against SARS-CoV-2/COVID-19 Iskra Sainova, Bulgarian Academy of sciences, Bulgaria 09:45-10:15

Title: Sudden Infant Death Syndrome and the diaphragm: Is there a link? Pontus M Siren, Independent researcher Crassier, Switzerland Break 10:15-10:30

10:30-11:00

Title: A rare case of Acute Pancreatitis in a pediatric patient with COVID-19 Riti Bhalla, Staten Island University Hospital, USA

Title: SARS-CoV-2 infection impacts carbon metabolism and depends on 11:00-11.30 Glutamine for replication in Syrian Hamster Astrocytes Jean Pierre Peron, University of Sao Paulo, Brazil Break 11:30-11:45 11:45-12:15

Title: Early onset of immunotherapy in high risk Neuroblastoma Neofit Spasov, University Hospital “Sveti Georgi”, Bulgaria

Title: Right-sided congenital diaphragmatic hernia associated with hepatopulmonary 12:15-12:45 fusion and Congenital pulmonary malformation Athary Saleem, Kuwait University, Kuwait Title: Challenges of managing patients for urgent CABG in covid times-our 12:45-13:15 experience Rupinder Kaur Kaiche, Ashoka Medicover Hospital, India

Thanks Giving and Closing Ceremony

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Pulsus is a publisher of scientific, technical, clinical and medical journals. Founded in 1984, Pulsus Group has remained faithful to its commitment to publish world-class, peer-review medical journals, highly respected by physicians and researchers. Endorsed by medical societies, Pulsus is an ardent supporter of international medical research and publishes journals in association with International medical and scientific societies.

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Supporting Journals

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Supporting Journals Journal of Immune Disorders & Therapy Current Pediatric Research Medical Toxicology: Current Research

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Upcoming Conferences

4th Global Experts Meeting on Chemistry and Medicinal Chemistry April 18-19, 2022 | Tokyo, Japan 5th International Congress on

Allergy and Clinical Immunology May 02-03, 2022 | Barcelona, Spain

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Scientific Tracks & Abstracts

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March 11, 2022

Sessions COVID-19 | Pediatrics | Pediatric Nutrition Session Introduction

Title: Development of methods about safe application of possessing DNA-genome viral strains as material for novel molecular vaccines against SARS-CoV-2/COVID-19 Iskra Sainova, Bulgarian Academy of sciences, Bulgaria Title: Sudden Infant Death Syndrome and the diaphragm: Is there a link? Pontus M Siren, Independent researcher Crassier, Switzerland Title: A rare case of Acute Pancreatitis in a pediatric patient with COVID-19 Riti Bhalla, Staten Island University Hospital, USA Title: SARS-CoV-2 infection impacts carbon metabolism and depends on Glutamine for replication in Syrian Hamster Astrocytes Jean Pierre Peron, University of Sao Paulo, Brazil Title: Early onset of immunotherapy in high risk Neuroblastoma Neofit Spasov, University Hospital “Sveti Georgi”, Bulgaria Title: Right-sided congenital diaphragmatic hernia associated with hepatopulmonary fusion and Congenital pulmonary malformation Athary Saleem, Kuwait University, Kuwait Title: Challenges of managing patients for urgent CABG in covid times-our experience Rupinder Kaur Kaiche, Ashoka Medicover Hospital, India

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Iskra Sainova, Gen Surg: Open Access, Volume 05

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Development of methods about safe application of possessing DNA-genome viral strains as material for novel molecular vaccines against SARS-CoV-2/COVID-19 Iskra Sainova Bulgarian Academy of Sciences, Bulgaria

I

nvestigation on the possibility of safe application of possessing DNA-genome viral strains about production of new vector vaccines, including against SARS-CoV-2/COVID-19. Taking in consideration the proved activated formation of thrombs on the influence of Spike (S) protein of virus strain SARS-CoV-2 [1-3] it is necessary to be designed molecular vaccines (which could be with DNA, RNA or protein nature) against other virus proteins, as for instance, against viral envelope (E) protein, against virus membrane (M) protein or against virus nucleocapsid (N) protein, different of the virus S protein. At the same time boosting with previously designed specific siRNAs against virus gene, coding virus S protein is necessary. Materials and Methods: Sub-populations of laboratory-incubated mammalian cells were transfected with previously designed recombinant gene constructs, based on the DNA-genome of Adeno-Associated Virus (AAV – Parvoviridae family). Other in vitro-cultures of mammalian cells were inoculated with low initial infectious titers (high initial dilutions of viral suspensions) of vaccine avipoxviral strains (Poxviridae family). The monolayers of the inoculated cells were then freezed at −800C in the presence of cryo-protector Dimethylsulfoxide (DMSO), subsequently thawed and re-incubated. As a source of the extra-cellular virus forms served the centrifuged and filtrated cultural fluids, and of their intra-cellular forms - scraped-off cellular monolayers. Then, de novo-seeded cultures of mammalian cells were inoculated with the so prepared intra- and extra-cellular forms of the vaccine viral strains. In vitro-incubated cultures of non-malignant 3T3 mouse embryonic fibrobasts, of containing endogenous retrovirus mouse malignant myeloma cells, as well as mixed cultures of both cellular types, were lysed by treatment of previouslyprepared cell suspensions with 10% tri-chloroacetic acid (Cl3CCOOH) and 0.48M solution of K3PO4. ELISA was applied for determination of the presence and titers of antibodies. Results and Discussion: Presence and expression of the inserted copy of the respective gene of interest was observed in separate sub-populations of mammalian cells, transfected by based on AAV DNA-genome recombinant gene constructs, containing it (Fig. 1). The titers of the intra-cellular forms of both vaccine avipoxviral strains were significantly higher compared with these of their extra-cellular forms (Fig. 2). After the 24-th hour p. i., increase in the titers of both forms of the viral strains was established. Standard PCR 1 2 3 4

a Fig. 1. Agarose gel electrophorhesis for prove of the presence of additionally-inserted gene copy in the applied for transfection based on AAV recombinant DNA-construct and for prove of its expression, by standard PCR (A) and RT-PCR (B), respectively, and in the “donor” recombinant viral DNA-vector (A – lanes 1 & 2; B - lanes 3 & 5) and “recipient” (A – lanes 3 & 4; B – lanes 6 & 7); lane 1 - marker (M).

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RT-PCR 1 2 3456 7

b Fig. 2. Infectious titers of intraand extra-cellular forms of each

Fig. 2. Infectious titers of intraand extra-cellular forms of each

Pediatric Surgery & Immunology 2022

Fig. 3.Average titers of anti-ganglioside antibodies in extracts from in vitroincubated cultures of non-malignant 3T3 mouse embryonic fibroblasts, of containing endogenous retrovirus mouse malignant myeloma cells, as well as from mixed cultures of both cellular types. OD – optical density.

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Pediatric Surgery & Immunology March 11, 2022 | Webinar The probable reason was the proved in the scientific literature changed properties of many membrane molecules in these conditions, but also with the influence of many inter-molecular interactions. These features could be explained with the transition of the extra-cellular forms of both strains to their in intra-cellular forms. Furthermore, a possibility for transfer of nucleotide (DNA- and/or RNA-) fragments from virus to cellular genome, as well as in the opposite direction (from cellular to viral genome), influence of organic detergents as DMSO plus availability of drastic temperature changes, was suggested, which was in conformation with the literature findings [4]. Additionally, a possibility for production of membrane receptor glycoproteins (Figs. 1, 2) and antibodies/immunoglobulins (Fig. 3) by non-myeloid and non-lymphoid cellular types on the influence of viruses or viral antigens, of malignant cells/antigens, etc., was suggested, which was in agreement with the respective literature data [5, 6]. However, because the so produced immunoglobulins/antibodies are out of the germinative centers, for escape of the chronic inflammation process, which could lead to maligannt transformation or to degenerative changes, their functions should be controlled by small ions or molecules as gangliosides. Key words: viral vectors as material for construction of molecule vaccines, non-myeloid and non-lymphoid cellular types as alternative sources of immune molecules, methabolitic control. Biography Iskra Sainova is a Research Associate at Institute of Experimental Morphology, Pathology and Anthropology with Museum (IEMPAM) to Bulgarian Academy of Sciences (BAS), Sofia, Bulgaria. [email protected]

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Pontus M Siren Gen Surg: Open Access, Volume 05

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Sudden Infant Death Syndrome and the diaphragm: Is there a link? Pontus M Siren Independent researcher Crassier, Switzerland

T

here are over 12,000 publications on Sudden Infant Death Syndrome on the PubMed database. Of these, only 59 are related to SIDS and the diaphragm, even though the diaphragm powers the vital respiratory pump, and its failure is a well-known cause of death in adults. Two recent communications published in Nature Pediatric Research (Blind Spot and The Missing Link) on April 6 and June 5th, 2021, respectively, highlight the fact that there is a potentially consequential blind spot in SIDS research. This presentation highlights three important facts: 1. The diaphragm has not been adequately studied in the context of SIDS 2. There is no compelling evidence to exclude the diaphragm from SIDS research 3. There is compelling data to suggest that diaphragm failure may play a role in SIDS and that the hypothesis should be investigated Despite decades of intense research, the cause of death in Sudden Infant Death Syndrome (SIDS) remains unknown. This short communication draws attention to the blind spot and highlights five reasons for why the diaphragm should be investigated in the context of SIDS: 1) There is broad consensus that SIDS likely has a respiratory origin 2) All key cardiorespiratory organs, except the diaphragm, have been extensively investigated in the context of SIDS 3) The diaphragm powers the vital respiratory pump and is critical for survival 4) There is no compelling evidence to suggest the diaphragm can be excluded from SIDS research 5) There is a substantial body of evidence to suggest that the diaphragm plays a central role in SIDS, and the SIDS – Critical Diaphragm Failure (SIDS-CDF) hypothesis posits that all SIDS risk factors either increase the workload of the diaphragm or reduce its force generating capacity The origin of SIDS remains a mystery, but there is broad consensus that the syndrome likely has a respiratory origin because research and clinical investigation has ruled out airway occlusion or trauma as the cause of the syndrome. The number of articles published on PubMed is a good indicator of the focus of SIDS research. In Q4h, 2021, there are 12,365 publications on sudden infant death syndrome. Of these, 2285, relate to SIDS & the heart, 714 to SIDS & lungs, 982 to SIDS & central nervous system. There is no evidence in the published works to indicate that the diaphragm should be excluded from SIDS research. There are at least five compelling reasons to investigate the diaphragm in the context of SIDS: 1. There is a strong correlation between SIDS and nonlethal infections. Infections can produce severe respiratory muscle weakness in adults, which is a major contributor to respiratory failure. Infections can reduce the diaphragm’s ability to generate force by as much as 50% in 24 h. 2. The prone sleeping position is an important risk factor for SIDS. For an infant, the prone position significantly increases the

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Pediatric Surgery & Immunology March 11, 2022 | Webinar work of breathing and decreases respiratory muscle endurance. 3. SIDS is associated with rapid eye movement (REM). The intercostal muscles show both phasic and tonic inhibition during REM sleep that renders them largely or totally inactive. The chest wall muscles are critical for ventilation in the infant with a pliable chest wall, and loss of muscle tone increases the diaphragm’s workload. 4. Elevated levels of vascular endothelial growth factor in the cerebrospinal fluid of SIDS infants indicate that they experience one or more hypoxic events over several hours to days before death. Hypoxia exacerbates diaphragm and abdominal muscle fatigability and can impair the diaphragm’s ability to generate force. 5. Hyperthermia is independently associated with an increased risk of SIDS. It is well known that hyperthermia increases the workload of the respiratory muscles. Conclusion: SIDS likely has a respiratory origin and despite decades of intense research, the cause of death is unknown. Besides the diaphragm, all other key cardiorespiratory organs have been comprehensively investigated in the context of SIDS. There is no evidence to suggest the diaphragm should be excluded from SIDS research. On the contrary there is compelling evidence to suggest that diaphragm should be comprehensively investigated in the context of SIDS. Yet, the diaphragm remains a collective blind spot that may contribute decisively to our inability to uncover the cause of SIDS. Biography Pontus M Siren is an Independent Researcher, Crassier, Switzerland. [email protected]

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Riti Bhalla Gen Surg: Open Access, Volume 05

Pediatric Surgery & Immunology March 11, 2022 | Webinar

A rare case of Acute Pancreatitis in a pediatric patient with COVID-19 Riti Bhalla Staten Island University Hospital, USA Introduction: Acute pancreatitis a common pediatric condition. While pancreatitis in adults is often due to gallstone disease and alcohol use, pancreatitis in children and adolescents usually arises from infection, medications, trauma, genetic variants, or anatomic abnormalities. Infectious causes of acute pancreatitis are largely viral, including mumps, measles, coxsackie, influenza, and Epstein Barr Virus. Herein, we present a case of acute pancreatitis in the setting of COVID-19 infection – a new clinical manifestation of the novel coronavirus. Case: A 5-year-old male with a history of horseshoe kidney and autism spectrum disorder presented with abdominal pain and vomiting for 2 days. Laboratory evaluation was consistent with acute pancreatitis; other infectious and anatomic etiologies of pancreatitis were ruled out, as was multisystem inflammatory syndrome in children (MIS-C). CT revealed an edematous pancreas with peripancreatic fluid, consistent with acute pancreatitis (Figure 1). Discussion: It is important to establish the etiology of acute pancreatitis in children, when possible, in order to prevent recurrence and progression to chronic pancreatitis, though up to 30 percent of cases are idiopathic after ruling out identifiable causes. In our patient, infectious and anatomic etiologies of pancreatitis were ruled out, as was MIS-C. As such, the diagnosis was attributed to COVID-19. Typically, COVID-19 causes a mild infection in children, sometimes with GI symptoms of abdominal pain and diarrhea. Given our patient’s case, it is important for clinicians to evaluate for pancreatic inflammation in COVID-positive patients presenting with non-specific abdominal symptoms. Likewise, practitioners should consider COVID-19 infection when aiming to establish an etiology of acute pancreatitis. Conclusion: As the pandemic continues and our knowledge of COVID-19 evolves, this case of acute pancreatitis represents a new clinical manifestation of the novel coronavirus. It is important that clinicians recognize this association in order to optimize patient management and prevent delay of appropriate intervention.

Figure 1: CT abdomen showing an edematous pancreas with peripancreatic fluid

Biography Bhalla is a General Pediatrics resident physician in the second year of her post-graduate training at Staten Island University Hospital (Northwell Health) in New York, USA. She is currently conducting research on eosinophilic esophagitis in the pediatric population in Staten Island and plans to pursue fellowship training in Pediatric Gastroenterology. [email protected]

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Jean Pierre Peron Gen Surg: Open Access, Volume 05

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SARS-CoV-2 infection impacts carbon metabolism and depends on Glutamine for replication in Syrian Hamster Astrocytes Jean Pierre Peron University of Sao Paulo, Brazil

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oronaviruses belong to a well-known family of enveloped RNA viruses and are the causative agent of the common cold. Although the seasonal coronaviruses do not pose a threat to human life, three members of this family, i.e., SARS-CoV, MERS-CoV and recently, SARS-CoV2, may cause severe acute respiratory syndrome and lead to death. Unfortunately, COVID-19 has already caused more than 4.4 million deaths worldwide. Although much is better understood about the immunopathogenesis of the lung disease, important information about systemic disease is still missing, mainly concerning neurological parameters. In this context, we sought to evaluate immunometabolic changes using in vitro and in vivo models of hamsters infected with SARS-CoV-2. Here we show that, besides infecting hamster’s astrocytes, SARS-CoV-2 induces changes in protein expression and metabolic pathways involved in carbon metabolism, glycolysis, mitochondrial respiration, and synaptic transmission. Interestingly, many of the differentially expressed proteins are concurrent with proteins that correlate with neurological diseases, such as Parkinsons's disease, multiple sclerosis, amyotrophic lateral sclerosis, and Huntington's disease. Metabolic analysis by high resolution realtime respirometry evidenced hyperactivation of glycolysis and mitochondrial respiration. Further metabolomics analysis confirmed the consumption of many metabolites, including glucose, pyruvate, glutamine, and alpha ketoglutarate. Interestingly, we observed that glutamine was significantly reduced in infected cultures, and the blockade of mitochondrial glutaminolysis significantly reduced viral replication and proinflammatory response. SARSCoV-2 was confirmed in vivo as hippocampus, cortex, and olfactory bulb of intranasally infected hamsters were positive for viral genome several days post-infection. Altogether, our data reveals important changes in overall protein expression, mostly of those related to carbon metabolism and energy generation, causing an imbalance in important metabolic molecules and neurotransmitters. This may suggest that some of the neurological features observed during COVID-19, as memory and cognitive impairment, may rely on altered energetic profile of brain cells, as well as an unbalanced glutamine/glutamate levels, whose importance for adequate brain function is unquestionable. Biography Jean Pierre Peron is an Associate Professsor Department of Immunology - University of Sao Paulo G4 Associate Researcher Scientific Platform Pasteur-University of Sao Paulo. [email protected]

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Neofit Spasov Gen Surg: Open Access, Volume 05

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Early onset of immunotherapy in high risk Neuroblastoma Neofit Spasov University Hospital “Sveti Georgi”, Bulgaria

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euroblastoma is the most common extracranial solid tumor in children, accounting for 15% of all pediatric cancer deaths. High-risk neuroblastoma (HRNB) is a particularly difficult-to-treat form of the disease that requires aggressive therapy. According to the International Society of Paediatric Oncology European Neuroblastoma group (SIOPEN), the standard of care for patients with HRNB is intensive induction therapy with rapid COJEC (time-intensive cisplatin, carboplatin cyclophosphamide, vincristine, etoposide) ± TVD (topotecan, vincristine, doxorubicin) followed by consolidation therapy with high-dose busulfan/ melphalan and autologous stem cell transplant, and maintenance therapy with dinutuximab beta (five cycles)+/- 13-cis retinoic acid. In the last decade, different induction chemotherapeutic regimens are used in order to improve the results, but still due to the lower toxicity rates, Rapid Cojec protocol remains the best option. Despite treatment advances, the prognosis of these patients remains poor. As a better response to induction therapy has been associated with prolonged survival in patients with HRNB, we hypothesized that early use of dinutuximab beta – post induction therapy – may improve patient outcomes. We describe here our experience of administering at least one cycle of dinutuximab beta post induction in three children with HRNB who did not achieve a complete response to induction chemotherapy. From the start of that treatment modality, we treated 12 patients for the last three years- just 2 patients have relapsed after achieving remission(2-year and 3-year OS- 100%, 2 year- and 3-year EFS-83% ) and still on treatment, which is better in comparison to the results, recorded in SIOPEN study by Ladenstein et al in 2019. 11 of this patients are with HRNB with MYCN amplification and just one patient is with HRNB without MYCN amplification. From the MYCN amplified group just 1 patient(8.3%) experience a late relapse as the other patients all achieved remission and have 3-year EFS. 11/12 patients achieved full remission and just the patient with MYCN non-amplified tumor did not achieve full remission at any stage. Dinutuximab beta given post induction therapy has therefore the potential to improve responses in patients with HRNB who do not achieve a complete response with induction therapy and therefore to improve the 3-year OS and EFS in these patients. Further evaluation will be done after another two year follow up period. Biography Neofit Spasov is a Professor at Medical University Plovdiv, Department of Pediatrics and Medical Genetics, Oncohematology Unit, University Hospital "Sveti Georgi", Plovdiv, Bulgaria. [email protected]

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Athary Saleem Gen Surg: Open Access, Volume 05

Pediatric Surgery & Immunology March 11, 2022 | Webinar

Right-sided congenital diaphragmatic hernia associated with hepatopulmonary fusion and Congenital pulmonary malformation Athary Saleem Kuwait University, State of Kuwait Coronaviruses belong to a well-known family of enveloped RNA viruses and are the causative agent of the common cold. Background: Congenital diaphragmatic hernia is defined as patent pleuroperitoneal canal through the diaphragm. CDH can be divided into two types, anterimedial retrosternal hernia (Morgagni hernia), and the posterolateral hernia (Bochdalek hernia). Right-sided CDH that is associated with hepatopulmonary fusion is considered as rare congenital anomaly. In the literature review, there is only 32 reported cases of hepatopulmonary fusion. The prevalence of hepatopulmonary fusion in right sided congenital diaphragmatic hernia is 3 in 1000 infants. Case summary: A 5 days old baby boy, was born full term to a 41-year-old mother. He was delivered by spontaneous vaginal delivery with birth weight of 3.4 kg and the (APGAR) scores was 7 and 9. Immediately after delivery, he developed respiratory distress and admitted to neonatal intensive care unit. The infant was treated with nasal oxygenation, intravenous fluids, and parenteral antibiotics. Then, chest X-ray was done, showing right-sided CDH. Computed tomography was done to differentiate between CDH and eventration. Chest fluoroscopy was performed and suspicion raised between right-sided CDH and right eventration. After patient stabilization, right thoracoscopy was performed during which the right lung found to be adherent to the liver. Thoracoscopy was carried out and there were many adhesions. So, it was decided to proceed to thoracotomy to separate the liver from lung, which was technically challenging. There was also shared vasculature between the liver and the lung in addition to the fusion. The atelectatic part of the lung was dissected with the rim of the liver in order to be able to repair CDH. Gore-Tex mesh was used in order to close the huge diaphragmatic defect. Conclusion: The detection of the right hepatopulmonary fusion that is combined with right-sided CDH was considered as novel intraoperative finding in the presence of Bochdalek hernia. Biography Athary Saleem is graduated of bachelor degree of medical sciences from faculty of medicine, Kuwait University. Currently, she is final year medical student who will be awarded her doctor of medicine degree on December 2021. Ms. Saleem is interested in genetics, surgery, neurology and cardiology and involved in research projects related to those fields such as thyroid carcinogenesis, cardiac physiology, and pediatric surgery. She is member of medical education and leadership club at Kuwait university. Also, she was participated in various scientific and academic events and presented many posters. Ms. Saleem had published a case report in Journal of Pediatric Surgery Case reports. Beside research and clinical activities, she volunteers in health awareness campaigns related to chronic diseases, breast cancer, and other health conditions. She plans to continue her role with enthusiasm as a health educator, research leader, and lifelong learner for better patient’s care. [email protected]

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Rupinder Kaur Kaiche Gen Surg: Open Access, Volume 05

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Challenges of managing patients for urgent CABG in covid times-our experience Rupinder Kaur Kaiche Ashoka Medicover Hospital, India Background: Cardiac surgeries have decreased during COVID-19 pandemic however with hospitalized patients showing raised troponin,heart and vessel involvement warrents attention. We analysed cases for urgent CABG to understand COVID-19 effects,justify surgery with limited resources and management to achieve optimum results. Methods: We analysed retrospectively urgent CABGs done in 1 month during second wave peak. S.no

Patient Demographics

Comorbidities

Covid status

Euroscore

LVEF

NIL 1

75/M

CriticalTVD,AWMI,

DM,HTN

2.72

40%

NIL 2

60/M

DM,HTN

3

52/F

DM,HTN

1.33

50%

2.05

60%

NIL

4

65/M

DM,HTN

POST-COVID 4Mnths

51/M

DM,HTN

6

52/M

DM,HTN

7

76/F

DM,HTN

8

54/M

DM,HTN

COVID(mild) on treatment COVID(mild)on treatment

CABGx3 LIMALAD,SVGOM1,SVG-PDA

Critical DVD,ACS,UA,No RWMA

CABGx3 LIMA-D1,Lt Radial(Aorta)Ramus,SVG-PDA

Critical TVD,ACS,UA,No RWMA

CABGx3 LIMALAD,SVGD1,SVG-OM1

Critical VD,AWMI,UA,

CABGx2 LIMA-LAD,Lt Radial(Aorta)OM

30%

1.38

60%

Critical LMCA,TVD,ACS,UA,RWMA.

CABGx3 LIMALAD,RIMAY-OM1-PDA Sequential

2.7

40%

Critical DVD,IWMI,UA,RWMA

CABGx2 LIMALAD,RIMA-PDA

2.9

30%

Critical LMCA,TVD,ACS,UA,RWMA

CABGx3 LIMALAD,SVGOM,SVG-PDA

2.97

30%

Critical LMCA,DVD,ACS,UA,RWMA

CABGx2 LIMALAD,SVG-OM

2.97

POST-COVID 15Days

UA,RWMA

Graft Details

RWMA,Calcified vessels.

NIL 5

CAG ECHO

Table-1: LMWH replaced anti-platelet drugs 5 days prior to surgery,due to thromboembolic nature of COVID-19.COVID treatment started. Coronary vasodilators started and cardiac,respiratory and renal functions monitoring.

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Pediatric Surgery & Immunology March 11, 2022 | Webinar Anesthetic Management 1.Restricted theatre personnel with PPEs. 2.Heparin 5000 I.U pre-induction for thromboprophylaxis. 3.Covid patients given 5 litre oxygen via reservoir bag 1 hour prior to shifting. 4.Viral filters in inlet and outlet limbs of anaesthesia circuit to prevent aerosol contamination. 5.Rapid sequence intubation,difficult airway cart ready. 6.ACT kept 250-300s with heparin. 7.Fluid restriction. 8.Lung protective ventilation- low TV(6-8ml/kg ),peep adjusted to lung compliance,low inspiratory pressure,plateau pressure< 30cmH2O,applying recruitment manoeuvers before and after shifting to ICU. 9.Long-term Coronary vasodilators. 10.OPCABG to prevent pump-induced inflammatory markers considering COVID-19 causes massive release of inflammation boosting cytokines. 11.Strict B.P and sugar control using vasoconstrictors,inotropes,insulin. 12.Post-operative FiO2 adjusted to saturation>94%. 13.Diaphragm protective ventilation in ICU. 14.Fast-tracking.Extubated within 2 hours, put on NIV support till needed. 15.Budesonide nebulization post-op. Results: Overall cardiac surgery cases have decreased.Currently it is not known if mortality of people who did not seek care increased.Decompensated patients with ACS or unstable angina seeked treatment.50% of our patients were at various stages of COVID-19.Following organ-protective anaesthetic techniques,modifying ventilation,maintaining acceptable levels of saturation for optimum resource utilization and meticulously followed protective methods helped decrease morbidity and mortality,while maintaining personnel safety. Conclusion: The COVID-19 pandemic ,due to its highly contagious nature,unprecedented global spread,aggressive and varied clinical presentation and evolving treatment modalities,has strained healthcare facilities limiting available resources.However with precise planning, understanding disease pathophysiology,organ-protective anaesthesia and surgical techniques and using protective equipment can keep the patient,doctor and OR personel safe. Keywords: ACS(Acute Coronary Syndrome),COVID-19,PPE(Personal Protective Equipment),TV(Tidal Volume),UA(Unstable Angina),CABG(Coronary artery bypass grafting) Biography Rupinder Kaur Kaiche is a cardiac anaesthesiologist and intensivist based in Nashik, India. She has anaesthesized more than 5000 cardiac surgery patients, many of them high risk with ejection fraction of less than 20%. She has also managed chronic renal failure patients for CABG followed by renal transplant, apart from CABGs on and off-pump, valve surgeries, valve + CABG, congenital defects, unstable ventilated patients for angioplasty and high risk cardiac patients for non-cardiac surgery. Having graduated from medical school from Mumbai, she pursued Anaesthesiology and Critical Care for her post-graduation. She was in UK for a few years for international experience. She has many national and international research publications to her credit. She is currently working on a concise anaesthesia booklet for quick view. Apart from medical research, she has also published 3 books of poetry which has got international recognition. She has also released a poetical music audiobook. [email protected]

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Upcoming Conferences 4th Global Experts Meeting on Chemistry and Medicinal Chemistry April 18-19, 2022 | Tokyo, Japan 5th International Congress on

Allergy and Clinical Immunology May 02-03, 2022 | Barcelona, Spain

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Accepted Abstracts

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Is chest radiography a valid alternative to computed tomography in evaluation of pectus excavatum? Cristina Martucci Bambino Gesù Pediatric Hospital - IRCCS, Italy Statement of the Problem: Current pectus excavatum management includes a Computed Tomography scan to evaluate the Correction Index, whose superiority to the Haller Index in terms of specificity and sensibility is still under debate. Furthermore, several studies report interchangeability between the Haller Index as measured by Computed Tomography and as measured by X-radiograph; however it is not clear whether this correlation also exists for the Correction Index. The aim of our study was to evaluate the correlation between measurements of the Haller Index and the Correction Index obtained by Computed Tomography and by X-radiograph. Methodology & Theoretical Orientation: This prospective study included 31 patients with Pectus Excavatum (who underwent preoperative chest Computed Tomography and X-radiograph) and a control group of 31 patients (who presented no chest deformity and underwent the same exams for other unrelated causes). We measured Haller Index and Correction Index on both exams for both groups. To demonstrate any correlation between Computed Tomography scans and X-radiographs for the two indexes, the Pearson R correlation test, Bland-Altman analysis and Anova Nested test were performed. Findings: Pearson's coefficient (0.829 with p < 0.0001) and Anova Nested test showed a significant correlation and similar results between the Haller Index and the Correction Index on Computed Tomography and on X-radiograph. Conclusion & Significance: Significant correlation and similar results are shown in our study in the measurement of CI and HI on Computed Tomography and X-radiograph. Further studies including a larger number of patients may be warranted.

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Acute Achilles tendon wounds in children from motorcycle accidents: epidemiological, diagnostic and therapeutic aspects Franck Grah Lohourou Bouake teaching hospital, Republic of Cote d’ivoire

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cute open injuries of the Achilles tendon resulting from motorbike accidents in children are common in our setting. We conducted an observational study, with retrospective data collection from the medical records of children managed for an acute Achilles tendon open injury, caused by motorcycle rear wheel spokes from January 2017 to December 2019. The aim of our study was to describe the epidemiological, diagnostic and therapeutic aspects of these lesions in our environment. During the study period, 51 children totalising 51 acute Achilles tendon injuries were identified. There were 33 boys (64.7%) and 18 girls (35.3%) with a sex ratio of 1.8. The mean age was 09.1 ± 3.2 years with extremes of 4 and 15 years. The pupils were mostly affected, in 80.4% of cases (n=41). Injuries were mostly sustained during the school period representing 94.1% (n=48). The section of the tendon was complete in 60.78% of patients (n=31). The predominant associated lesions were calcaneal fractures observed in 21.6% of injuries (n=11). The right side was more affected, with 84.3% (n=43). The number of rear passengers on the motorcycle was superior or equal to 3 children in 82.3% of circumstances of the accident (n=42). Postoperative complications were infectious in 39.2% (n=20); skin necrosis represented 13.7% (n=7). With at least a 6 months follow-up, the functional result evaluated according to the Mc Comis score was excellent in 29.3% (n=15); good in 35.3% (n=18); average in 17.7% (n=9) and poor in 17.7% (n=9) of cases respectively. The percentage of acute open Achilles tendon injury is high in students and is significant during the school year. Emergency definitive repair by suturing is possible for wounds seen early. The immediate postoperative course can be marked by infectious complications. Keywords: wound, Achilles tendon, motorcycle, child.

General Surgery: Open Access

Pediatric Surgery & Immunology 2022

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Gen Surg: Open Access, Volume 05

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Personal history as risk factors in SARS-CoV-2 infection and the clinical course of COVID-19 in Pinar del Río, Cuba Liana Valdés Lanza Pepe Portilla Provincial Pediatric Hospital Introduction: The world is facing a new pandemic due to the SARS-CoV-2 outbreak that began in Wuhan, China in December 2019. The genetic differences of the host and risk factors such as: personal history, lifestyles and environmental factors can contribute to the marked inter-individual clinical variability in COVID-19. Objective: To identify the personal pathological history (comorbidities, infections and smoking) associated with SARS-CoV-2 infection and the clinical course of COVID-19 patients. Method: Analytical observational study of cases and controls in Pinar del Río. Personal history of chronic diseases, infections and smoking were explored. Results: personal pathological history of allergy and asthma were risk factors for developing symptoms. A history of dengue infection was associated with SARS-CoV-2 infection and the development of symptoms. A history of pneumonia/bronchopneumonia was associated with the symptomatic course of the disease. The active smoker is shown as a risk factor for infection. Conclusions: it is shown that personal history of chronic diseases, infections and smoking increase the risk of SARS-CoV-2 infection and contribute to the development of symptoms in COVID-19 patients in Pinar del Río. Keywords// COVID-19; SARS-CoV-2; coronaviruses; chronic diseases; infections, smoking.

General Surgery: Open Access

Pediatric Surgery & Immunology 2022

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Gen Surg: Open Access, Volume 05

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Exploiting immunity of hepatocellular carcinoma (HCC) to improve the treatment of patients Maya Saleh McGill University

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epatocellular carcinoma (HCC) is the most common liver tumor and among the deadliest cancers worldwide. Environmental risk factors for developing HCC include chronic hepatitis B or C virus infection, alcohol abuse and the metabolic syndrome. Despite a significant therapeutic advance in the treatment of advanced HCC with the arrival of immune checkpoint inhibitors (ICI), ~75% of patients do not respond to these immunotherapies for unclear reasons. Such a heterogenous response highlights the need to further explore etiology- and organ-specific immunity towards improved patient stratification and the development of new combination therapies. To better characterize the HCC immune microenvironment, we have employed 3′ end massively parallel single cell RNAseq (scRNAseq) with a 10x Genomics Chromium pipeline of live immune cells, FACS-sorted from dissociated tumors to particularly study the myeloid and innate lymphoid immune landscapes of HCC with respect to etiology and mutations in the β-catenin pathway that distinguish an immune-excluded class of HCC patients resistant to ICI. Our preliminary results uncovered marked differences in the HCC immune landscape compared to that of adjacent non-tumoral tissue and identified specific immune subsets according to etiology. This analysis will be expanded in a validation cohort, and in HCC patients receiving ICI. The geographical distribution of the identified immune cell subsets and their expression of specific biomarkers will be analyzed using multispectral immunofluorescence analysis (Vectra-Polaris) and spatial transcriptomics (10x Genomics Visium technology). Collectively, our project is expected to uncover immune biomarkers to better select patients who are likely to respond to current immunotherapies and identify novel therapeutic entry points for improved HCC patient care.

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Pediatric Surgery & Immunology 2022

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Gen Surg: Open Access, Volume 05

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Assessment of self-medication practices with antibiotics and associated risk factors among students of Hazara University Mansehra, Pakistan Mubasher Rehman Hazara University Mansehra, Pakistan

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elf-medication is defined as the use of drug without the prescription of medical specialists. Inappropriate use of medication may result in a prolonged diagnosis, antibiotic resistance and economic losses. This study was aimed to assess the prevalence rate and risk factors associated with self-medication practices. A total of 120 participants were randomly selected from four different departments of Hazara University Mansehra. Out of total, 56 (46.66%) were males, and 64 (53.33%) were females. The prevalence of self-medication was 71.66%. Over the counter sale (79.06%) and left-over antibiotics from previous prescriptions (23.25%) were recorded to be the two main sources of antibiotics procurement. Most common risk factors responsible for self-medication were less health care facilities, less time and less severity of diseases. Overall, most frequently used antibiotics in the form of self-medication were amoxicillin, erythromycin, co-amoxiclav or metronidazole. Thus, it is critical to implement strict legislation, provide proper health care facilities and to develop public awareness programs..

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INDEX

General Surgery: Open Access

Athary Saleem

19

Iskra Sainova

12

Jean Pierre Peron

17

Neofit Spasov

18

Pontus M Siren

14

Riti Bhalla

16

Rupinder Kaur Kaiche

20

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Email: [email protected]

Address:

Pulsus Healthtech 35 Ruddlesway Windsor, Berkshire SL4 5SF Phone: +44-203-769-1778 | +44-182-827-0013 USA/Canada Toll Free: 1-800-982-0387 | UK Toll Free: 0-800-088-5419

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Upcoming Conferences 4th Global Experts Meeting on Chemistry and Medicinal Chemistry April 18-19, 2022 | Tokyo, Japan 5th International Congress on

Allergy and Clinical Immunology May 02-03, 2022 | Barcelona, Spain

Hosting Organization: Pulsus Healthtech 35 Ruddlesway, Windsor, Berkshire, SL4 5SF Ph:+44-203-769-1778 https://pediatricsurgery.pulsusconference.com/ https://european-immunology.pulsusconference.com/