Young patients presenting with thrombotic events like pulmonary embolism and cardiological phenomenon such as presence of an intracardiac mass, without any underlying risk factors, should be promptly investigated for thrombophilias including antiphospholipid syndrome (APLS). This case is reported to highlight rare occurrence of co-existing bilateral extensive pulmonary embolism and an intra-cardiac mass at presentation of antiphospholipid syndrome as well as progression to near catastrophic APLS.

e14050 Background: Historically, metastatic spinal cord compression (MSCC) referrals trend towards a Friday peak in incidence (Koiter E, Radioth Onc 2013). However, data from a single, tertiary centre in the UK showed a reversal in the Friday peak (Adeleke S, Annals of Oncology 2020). This was attributed to early case referrals and quicker treatment decisions. In this new study, we explored whether a similar pattern was apparent in multiple district general hospital (DGH) settings and attempt to identify underlying causes. DGHs manage a larger proportion of cancer patients in the UK. Methods: 1,069 patients between 1 Jan 2015 and 31 Dec 2020 were identified across 4 hospitals in Kent, UK with a population of 1.6 million people. 220, 181, 182, 159, 134 and 193 MSCC patients were identified annually (2015-2020). Commonest cancers were prostate (24.1%), lung (19.3%) and breast (12.3%). Thoracic and lumbar regions constituted 80% of MSCC sites. Kruskal Wallis was used to compare differences in referrals across weekdays. Data was then dichotomised to Fridays only vs. other days of the week combined, as previously reported (De Bono B, Acta Neurochir 2019). Chi squared was used to compare frequency of referrals between the two groups. Chi squared goodness of fit test was conducted to detect if Friday reflected the day with highest referrals across the week. Results: Across the region, 2015 saw the highest number of Friday referrals relative to other days, p= 0.002. Friday referrals continued to drop, year on year, until 2018 with a corresponding increase in mid-week referrals. After 2018, there was a return in trend to a further Friday peak across the region, though p= 0.836. On an individual hospital basis, the persistent Friday peak in the region was driven by two hospitals. Having a 7-day acute oncology service (AOS), 7-day radiology reporting and single referral point of contact in the department, were factors identified that kept the referrals across the week uniform. On another note, a substantial shift towards a single 8Gy fraction vs. 20Gy in 5 fractions was observed across the region. This change coincided with SCORAD III data (Hoskin P, ASCO 2017) and demonstrates adherence to evidence-based practice in the region. Conclusions: This large multi-centre retrospective study shows a differential referral pattern in the region, with hospitals with 7-day AOS/Radiology reporting and single point of referral (e.g, similar to MSCC coordinator role) having a quicker treatment turnaround and uniform referrals across the week. The MSCC coordinator has been shown to streamline service, ensure timely decision-making and improved survival outcomes (Richards L, Spine J 2017). The role is recommended by NICE UK. DGHs should consider appointing an MSCC coordinator when designing/auditing their service. The shift towards single 8Gy fraction can provide a ‘one-stop’ service where patients are scanned, planned and treated on the same day.

The Internet of Things (IoT) provides ease of real-time communication in homes, industries, health care, and many other dependable and interconnected sectors. However, in recent years, smart infrastructure, including cyber-physical industries, has witnessed a severe disruption of operation due to privilege escalation, exploitation of misconfigurations, firmware hijacking, malicious node injection, botnets, and other malware infiltrations. The proposed agentless module for Wazuh security information and event management (SIEM) solution contributes to securing small- to large-scale IoT networks of industry 4.0. An agentless module is implemented by vigilantly examining the IoT device traffic without installing any agent or software on the endpoints. In the proposed research scheme, a module sniffs the network traffic of IoT devices captured from the gateway and passes it to a machine learning model for initial detection and prediction. The output of the ML model is embedded in the JSON log format and passed through the Wazuh agent to the Wazuh server where a decoder is added that decodes the network traffic logs. For event monitoring in Wazuh, industrial protocols are also thoroughly analyzed, and the feature set is determined. These features are used to write rules which are tested on the SWaT dataset, utilizing a common industrial protocol (CIP) for communication. Custom and dynamic rules are written at the Wazuh end to generate alerts to respond to any anomaly detected by the machine learning (ML) model or in the protocols used. Finally, in case of any event or an attack is detected, the alerts are fired on the Wazuh dashboard. This agentless SIEM solution has practical implications for the security of the industrial control systems of industry 4.0.

Objective: To compare efficacy of 3 commonly prescribed anti-depressants from classes’ selective serotoninreuptake inhibitor and serotonin-nor epinephrine reuptake inhibitors i.e. Venlafaxine, Duloxetine and Sertralinein the management of diabetic sensory neuropathy in subjects with type 2 diabetes mellitus. Study Design: Comparative, prospective study. Place and Duration of Study: Combined Military Hospital Jhelum, Mar 2018 to Jul 2018. Methodology: This study included 94 patients with metabolically stable type 2 Diabetes Mellitus with diabeticsensory neuropathy. Patients were randomly assigned into 3 treatment group, treatment group 1 (n1=29) receiving Venlafaxine 37.5mg × BD, treatment group 2 (n2=33) receiving duloxetine 30mg × BD and treatment group 3 (n3=25) receiving Sertraline 50mg × OD, each group being treated for 6 weeks, with optional dose titration fortnightly. The efficacy measure was done by revised Neuropathy Disability Score (NDS), measured at baseline and at the end of treatment period i.e. 6 weeks. The primary outcome of this study was “functional outcome” assessed by Disability Neuropathy scale (DNS) and overall improvement and adverse events were measured as secondary outcome measures. Results: There was significant improvement in Neuropathy Disability scale (DNS) at the end of treatment periodin all treatment groups from their baseline score, with comparable efficacy among all drug groups i.e. p-valuebetween venlafaxine and duloxetine, venlafaxine and sertraline were non-significant i.e. p>0.05 except betweenDuloxetine and Sertraline group where there was significant difference in efficacy (p<0.05). Good, moderate andmild improvement in symptoms was noticed in all study groups. Conclusion: Non-tricyclic Anti-depressants i.e. Venlafaxine..........

Objective: To determine the efficacy of intravenous iron along with erythropoietin for treatment of anemia in patients of chronic kidney disease undergoing maintenance haemodialysis. Study Design: Randomized comparative prospective, unblinded study. Study Place: Divisional Headquarter Teaching Hospital Mirpur Azad Kashmir. Duration Of Study: 06 Months, from June 2021 to December 2021. Methodology: This study was conducted in Divisional Headquarter Teaching Hospital Mirpur AJK and it included 107 patients with metabolically stable chronic kidney disease with hemoglobin of 8-11 g/dl. Patients were randomly assigned into 2 groups,, ”EPO group” which received subcutaneous erythropoietin only with each hemodialysis session and the “Iron group” which received erythropoietin with each session of hemodialysis and 200mg of intravenous iron once a month with up or down titration every monthly according to hemoglobin and transfer in saturation level in serum. Standard CKD measurement was same in both groups. Serum hemoglobin and serum transferrin saturation was measured at the start of the treatment. Both groups were followed every monthly for efficacy and side effect profile and assessed at 3 months with serum hemoglobin and seum transferrin saturation level.