Background: Worldwide, the numbers of cosmetic procedures continue to climb. However, cosmetic surgery (CS) continues to be plagued by negative stigmatization. This study reviews the literature to identify how attitudes toward CS vary by sex, age, race, culture, and nationality, and aims to determine how other factors like media exposure interact with demographics to influence how well CS is accepted. Methods: A PRISMA-guided systematic review of the literature was conducted to identify all English-language papers reporting on CS or plastic surgery acceptance, attitudes, or stigmatization, specifically examining for data on age, sex, race/ethnicity, culture, and media influence. Results: In total, 1515 abstracts were reviewed, of which 94 were deemed pertinent enough to warrant a full-text review. Among the potential demographic predictors of CS acceptance, the one with the most supportive data is sex, with women comprising roughly 90% of all CS patients in virtually all populations studied and consistently exhibiting greater CS knowledge and acceptance. Culturally, the pursuit of beauty through CS is a universal phenomenon, although different countries, races, and cultures differ in how willingly CS is embraced, and in the aesthetic goals of those choosing to have it. In countries with culturally diverse societies like the United States, non-Hispanic Whites continue to predominate among CS patients, but the number of CS patients of other races is rising disproportionately. In this trend, social media is playing a major role. Conclusion: Healthcare practitioners performing cosmetic procedures need to consider demographic and cultural differences of the patients in order to enhance their understanding of their patients’ aesthetic goals and expectations.

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Burns are potentially catastrophic injuries that disproportionately affect non-Western countries. We summarize results on the epidemiology of burn injuries in Saudi Arabia of all eligible papers through 2019, specifically evaluating the age and gender of patients, the location and mechanism of injury, burn size and severity, and outcomes. Between July 5 and July 10, 2019, a comprehensive literature review was performed on MEDLINE, EMBASE, Google Scholar, and the Cochrane Library. For this search, “Saudi Arabia,” coupled with the search terms “burn,” “thermal burn,” “flame burn,” “chemical burn,” “electrical burn,” and “contact burn” to identify all abstracts potentially relating to the topic of interest. Eleven studies, encompassing 3308 patients, met eligibility criteria. Younger children (variably defined as ≤10–12) accounted for 52% of all burns. Males outnumbered females by an overall ratio of 1.42:1. About 83% of burns occurred at homes. Scald injuries accounted for 62.4% of injuries, followed by flame-induced burns (28.7%), electrical burns (3.3%), and chemical burns (2.8%). Pertaining to burn extent and severity, 80% to 100% of the burns were limited to <40% total body surface area, while roughly 60% were second-degree burns. Most patients remain in the hospital for 1 to 4 weeks. The overall mortality across studies including patients of all ages was 6.9%, while just 0.76% in the two studies restricted to pediatric patients. Scald injuries involving young children comprise the lion’s share of burn injuries in Saudi Arabia. Increased public awareness is necessary to reduce the incidence and severity of these potentially catastrophic injuries.

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Concern about increasing incidents of petroleum hydrocarbon spills and spillage into different marine environments is rising day by day due to enhanced human activities in marine water. The toxic compounds of spilled petroleum hydrocarbon in marine water lead to the immediate death of numerous marine organisms as well as initiate various vicious biogeochemical cycles in the marine environment resulting in prolonged toxic impacts on the marine environment. Recently, many sophisticated techniques, including physical methods, chemical methods, and biological methods, have been developed and adopted for the treatment of marine environments polluted with petroleum compounds. However, biological treatment is one of the most promising methods in this field by which microorganisms such as bacteria, fungi, and algae are used for biodegradation of pollutants such as the spilled petroleum hydrocarbon into neutralized or eco-friendly compounds. This review has been focused on different aspects of the pollution of the marine ecosystem by oil, mainly Petroleum hydrocarbons, the fate of spilled oil in marine environments and the role of microbial communities in it, as well as various techniques, especially the bioremediation and biodegradation of spilled oil including the factors affecting the capacity of techniques. Moreover, some future aspects of research in the field of biodegradation and bioremediation of spilled oil have been proposed.

Introduction: The ketogenic diet has been in use since the 1920s as a therapy for epilepsy. Since the 1960s, it has also become widely known as one of the methods for obesity treatment. Recently, this diet has been promoted as a lifestyle, making it highly controversial in terms of its practicality as a lifestyle diet and its duration without affecting one's health or quality of life. Hence, this study assessed ketogenic diets from the people's perspective of side effects, attitude, and quality of life.Method: This retrospective observational study evaluated people who experienced or still practice a ketogenic diet. Health-related quality of life, the standard four-item set of healthy days core questions, was employed. We distributed the survey as an electronic self-assessment using Google Forms. The data were reviewed and automatically copied into a personal computer, arranged in a data-sheet in Microsoft Excel, and analyzed using Statistical Package for the Social Sciences version 27 (Armonk, NY: IBM Corp.). The data were mainly expressed as numbers and percentages.Results: A total of 226 subjects who adopted a ketogenic diet were interviewed to explore their diet experience. Females were slightly more than males (52.7% vs. 47.3%), and more than one-half (55.3%) of this study population aged 18-35 years. Obesity accounted for 55.3%, and the majority of the respondents (69.9%) adopted a ketogenic diet for more than one month. Among the most frequently reported symptoms were nausea (mild, 29.2%; moderate, 16.4%; severe nausea, 5.8%), dizziness (mild, 39.8%; moderate, 27.4%; severe, 11.5%), polyuria (72.1% in total), and lethargy (69.7%). Furthermore, 90.3% of them felt happy about adopting a ketogenic diet, and 81.9% would recommend it for anyone who wants to lose weight. Conclusion: A ketogenic diet was practiced mostly for one to six months, making it a short-term solution to weight loss. The outcomes of the participants approved the efficacy of the ketogenic diet in weight reduction. Different symptoms and side effects occurred with varying intensities, especially in the first few days of adopting this diet. Overall, the ketogenic diet did not affect the quality of life and yielded a very positive overall experience.

7563 Background: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening inflammatory syndrome that may accompany hematologic malignancies (HM). The diagnosis of HLH in patients with HM (HM-HLH) is confounded by a number of factors: the most commonly used HLH-2004 diagnostic criteria are derived from studies in infants while the Hscore used in adults is not specific for HMs; moreover, most parameters in these scoring systems may reflect features of the underlying HM rather than HLH associated inflammation; and finally specific diagnostic cutoff values for laboratory abnormalities in HM-HLH have not been defined. We therefore conducted a study to optimize the HLH-2004 laboratory thresholds for the diagnosis of HM-HLH. Methods: A multi-center retrospective study in adult patients with HM in whom testing for HLH was performed. HM-HLH was defined as fulfillment of 5/8 HLH-2004 diagnostic criteria. We established the optimal diagnostic cutoff levels for HLH-2004 laboratory parameters using receiver operating curves (ROC) and combined the best performing parameters into a combined index, using binary logistic regression. We then created a clinical decision tree using a Classification and Regression Tree (CART) analysis with all available parameters, using cross validation. We also determined the prognostic value of our combined diagnostic tool. Results: 225 adults were analyzed (112 with HM-HLH per HLH-2004 and 113 with HM only). 35% of patients were evaluated for HLH routinely upon HM diagnosis. Soluble CD25 (sCD25) and ferritin best discriminated HM-HLH from HM, with an area under the curve (AUC) of 0.83 for each. ROC analysis demonstrated an optimal cutoff of > 4190 U/mL for sCD25 (sensitivity/specificity 91%/69%) and an optimal cutoff of > 2636 ng/ml for ferritin (sensitivity/specificity 64%/86%) for HM-HLH. We term the combination of elevated sCD25 and ferritin using optimized cutoff levels the ‘optimized HLH inflammatory’ (OHI) index. This OHI index was highly specific for the diagnosis of HM-HLH (specificity of 92%, sensitivity 79%). CART analysis demonstrated that OHI index positivity was sufficient to diagnose HM-HLH. In patients without a positive OHI index an Hscore > 168 and either splenomegaly or triglycerides > 279 ng/dL can still diagnose HM-HLH. By following this decision pathway, approximately 92% of patients were accurately classified based on HLH-2004. Furthermore, the OHI was better (odds ratio (OR) 7.9; 95% confidence interval (CI) 4.2-14.6) than Hscore >169 (OR 5.5; CI 3.9-9.6) and > 5/8 HLH-2004 (OR 5.3; CI 3-9.3) at predicting mortality at 1 year. Conclusions: The OHI index derived here is a simple tool that can accurately diagnose HLH and predict mortality in patients with hematologic malignancies. Some patients may not need full HLH workup before intervening with therapy that is HLH directed and not only malignancy directed.

AIM: This study aimed to evaluate the improvement of HbA1c, lipid profile, blood pressure readings, and weight in type 2 diabetes at the clinical pharmacist diabetes clinic (CPDC) in ambulatory care clinic. METHODS: A retrospective study was conducted at a CPDC; the clinical pharmacist role was to follow-up the referred uncontrolled type 2 diabetes patients and providing comprehensive management. RESULTS: A total of 419 patients were included the study. The mean ± standard error of the mean (SEM) age was 58.9 ± 0.59 years old. Sixty-two percent of the patients were female. At baseline, mean HbA1C ± SEM was 10.69% ± 0.06%, mean low-density lipoprotein (LDL) ± SEM was 2.66 ± 0.04 mmol/l. After 3 months of follow-up, HgbA1C had a statistically significant improvement by a reduction of 1.69% to be 9% ± 0.09% (95% confidence interval [CI] [1.50–1.87], p < 0.001). Moreover, mean HbA1C had a statistically significant improvement after 6 months of follow-up compared to baseline by 1.78% to be 8.9% ± 0.21% (95% CI [1.33–2.22], p < 0.001). LDL had a statistically significant improvement after 3 months by 0.24 mmol/l to be 2.42 ± 0.04 mmol/l (95% CI [0.15–0.35], p < 0.001) and after 6 months of follow-up by 0.28 mmol/l to be 2.38 ± 0.04 mmol/l (95% CI [0.20–0.36], p < 0.001). CONCLUSION: The results stated that the clinical pharmacist anticipated care is achievable and had significant effect in the reduction of HbA1C and LDL levels in patients with uncontrolled type 2 diabetes.