Day 1 :
Keynote Forum
Thisara C Weerasuriya
Ayr University Hospital, UK
Keynote: All in one complications of a total hip replacement
Time : 09:30-10:00
Biography:
Thisara C Weerasuriya pursued his MBBS and MS in Sri Lianka, MRCS in England and FEBOT in Switzerland. He is currently working as a specialist in Trauma and Orthopaedics at University Hospital of Ayr in The UK.
Abstract:
A 65 year male with a high BMI, underwent an uncomplicated left total hip replacement. He insisted on going home on the 2nd post-operative day and dislocated his hip at home twice and the hip was reduced under anaesthesia twice. During mobilization he developed a pulmonary embolus necessitating thrombolytic therapy. Th is caused a haematoma which led to sciatic nerve palsy and his hip dislocated a third time. He had a posterior lip augmentation device fi tted and developed a likely wound infection subsequently. A 65 year old male with a BMI of 42 was admitted to the elective unit of the hospital for a routine total hip replacement using cement. He had osteoarthritis of his left hip which was disturbing him in his daily routine and was keeping him awake in the night. His walking distance was limited to 100 yards due to pain. He had to rely on a walking stick to help him mobilize this short distance. He was on a maximum dose of Co-Codamol and Diclofenac Sodium for pain relief, which according to him was of limited benefi t . He had to discontinue Tramadol due to constipation. Th e patient was also under treatment for type two diabetes and hypertension. He had surgery previously for retinal detachment and also has issues with sleep apnoea. Th e gentleman concerned walked with an antalgic gait. All hip movements were accompanied with an audible crepitus. The radiographs of the pelvis showed gross osteoarthritis of the left hip with narrowing of joint space, peri-articular sclerosis and osteophyte formation. Th e patient opted for a total hip replacement of the left hip has he felt that he had no other option. Following the relocation of the left hip the patient went home. He was not fi tted with an abduction brace due to anatomical constraints. Five days later he dislocated the hip once more. Two days post-reduction the patient developed sudden onset hypotension and hypoxia. A pulmonary embolus was considered and a CT pulmonary angiogram demonstrated a saddle thrombus of the pulmonary vasculature. Th rombolytic therapy led to the formation of a haematoma posteriorly at the left hip which caused pressure on the sciatic nerve causing a drop foot. He dislocated his left hip for the third time. A device was operatively fi tted on to the left hip. During surgery it was noted that his sciatic nerve was in continuity. Th e patient was re-admitted to hospital with a wound haematoma necessitating debridement and re-suture. He was treated with a course of antibiotics. However with recent research showing that obesity does not seriously alter the outcome following joint arthroplasty. More surgeons are off ering hip and knee arthroplasty to obese patients and patients may be less conscientious in making an eff ort to reduce weight. High BMI adds additional challenges to the operative procedure itself. In conclusion joint replacement should be off ered to patients with perhaps increased awareness of the full list of complications possible being clarifi ed at the very outset. Motivation to lose weight should be encouraged for the actual arthroplasty
Keynote Forum
Rachad Mounir Shoucri
Professor, Royal Military College of Canada, Canada
Keynote: Indexes derived from the end systolic pressure volume applied to the study of heart failure
Time : 10:00-10:30
Biography:
Rachad Mounir Shoucri has completed his PhD in Theoretical Physics in 1975 at Laval University, Canada. After graduation he has worked for five years at the Institut de Cardiologie de Quebec where he has developed his current interest in mathematical physiology. Since 1981 he is with the Department of Mathematics and Computer Sciences, Royal Military College of Canada.
Abstract:
Based on the theory of large elastic deformation of the myocardium, a mathematical expression was derived for the non linear end systolic pressure volume relation (ESPVR). A rich collection of new indexes derived from the parameters describing the non linear ESPVR can be used to assess the ventricular function and the state of the myocardium. In particular relations obtained between ejection fraction (EF) and the new indexes derived from the non linear ESPVR give new insight into the problem of heart failure with normal or preserved ejection fraction (HFpEF) and can be used for prognostic, diagnostic and monitoring purposes. The figure shows how a relation between percentage occurrence of heart failure (HF) and EF (left side) has been extended to derive a relation between percentage occurrence of HF and SWR/SW (right side; SW=Stroke work, SWR=SWx-SW=Stroke work reserve, SWx is the maximum possible SW calculated from the area under the ESPVR). Five clinical groups are presented in the figure: Normal group (*), aortic stenosis (o), aortic valvular regurgitation (+), mitral valvular regurgitation (^), miscellaneous cardiomyopathies (x). Notice that the normal group (*) in both cases appear near the bottom of both curves with EF≈0.67 and SWR/SW≈0.34. Similar relations can be obtained for other indexes derived from the ESPVR, which show the strong potential use that can be made of the ESPVR for clinical applications.
Keynote Forum
Francis Yu-Sing Chan
Tameside Hospital NHS Foundation Trust, UK
Keynote: An exceptional comparative study of different treatment modalities (including ultrasound bone stimulator) of the not uncommon tibia shaft & the rare fi bula shaft fractures non-union in the same individual from a sport injury
Time : 10:00-10:30
Biography:
Francis Yu-Sing Chan is a Consultant Orthopaedic Surgeon in Manchester UK and the Lead Appraiser of the Tameside Hospital NHS Foundation Trust on doctors revalidation. He completed his medical school in Queen’s University of Belfast and graduated with MB, BCh, BAO (with distinction) and BSc (with 1st class honours). He completed the basic surgical training in Northern Ireland. He completed the Higher Surgical Training in Trauma & Orthopaedic Surgery in Manchester (Clinical Lecturer of the Manchester University and Specialist Registrar). He completed the world renowned Kurgan Ilizarov Fellowship in 2003 and the AO International Trauma Fellowship in 2005. Between 2009 and 2012, He was the Clinical Director of Department of Orthopaedics at Tameside General Hospital. In addition to a busy clinical practice, He am actively involved in education. He have over 40 presentations in local and international meetings and over 40 publications in journals and book chapter. He is UK MRCS &FRCS(Tr&Orth) examiner. He is the Chairman of the Greater Manchester East Research & Ethics Committee of the UK NHS Health Research Authority. He works as the teaching faculty of the MCh(Orth) Programmes of both the Dundee University and the Edge Hill University. In 2016, He was granted with the Fellowship of the European Federation of Orthopaedics and Traumatology for recognition of my clinical and academic achievement.
Abstract:
Introduction: While simultaneous tibia & fi bula shaft fractures are not uncommon in both routine trauma & sport related trauma (with seventy fi ve per cents of tibia fractures have associated fi bula fractures), tibia fractures have long been regarded as the main injury and surgeons attention 'and surgical treatments are as a result focused on the tibia fractures. With the abundant soft tissues attachments to the fi bula, the traditional wisdom informs us that fi bular non-union is uncommon. Once the tibia fractures have been stabilised, the fi bula fracture would commonly united usually prior to the tibia fractures union. In the residual small number of fi bula non-union, persistent symptoms from the non-union is even rare. Th us, very little was known or published on symptomatic fibula fractures non-union following the associated tibia fracture union is achieved. In the limited literature available, while there was reported use of surgery or other non-invasive methods in the treatment of symptomatic fi bular non-union, there has been no reported use of non-invasive ultrasound bone stimulator. In this study, we reported the use of ultrasound bone stimulator in this rare symptomatic non-union. Objective: 1. To report a rare symptomatic fibula fracture non-union following tibia fracture union in a keen sports woman. 2. Th e first documented assessment of the eff ectiveness of Ultrasound Bone Stimulator in the treatment of the rare symptomatic fibula non-union. Results: On completion of the 20 weeks period of ultrasound bone stimulator treatment, the patient's right leg symptoms have completely resolved and she has returned to skiing and water skiing without further symptoms. The fibular fracture was also confi rmed to be united radiological. Conclusions: With its abundant soft tissues attachment, it has long been claimed that fibula fracture has the ideal environment for union to occur. Hence, fi bula fracture non-union is rare. In previous study of 440 patients who sustained both tibia and fi bula fractures, the reported incidence of (symptomatic and asymptomatic) radiological fi bula non-union is less than 1% and symptomatic fibula non-union is less than 0.25%. In this study, the symptomatic fi bula fracture non-union following the tibia fracture union constitutes a rare clinical situation. Review of the literature has shown treatments with electrical stimulation, and/ or surgical interventions (e.g. resection of distal fragment, internal fi xation with/ without bone graft etc.). In this study, we reported the fi rst successful use of ultrasound bone stimulator in its treatment.
- Case Reports: Psychology | Neurology | Cardiology | Diabetes | Surgery | Opthamology | Clinical Pathology
Session Introduction
Thisara C Weerasuriya
Ayr University Hospital, UK
Title: All in one complications of a total hip replacement
Time : 09:30-10:00
Biography:
Thisara C Weerasuriya pursued his MBBS and MS in Sri Lianka, MRCS in England and FEBOT in Switzerland. He is currently working as a specialist in Trauma and Orthopaedics at University Hospital of Ayr in The UK.
Abstract:
A 65 year male with a high BMI, underwent an uncomplicated left total hip replacement. He insisted on going home on the 2nd post-operative day and dislocated his hip at home twice and the hip was reduced under anaesthesia twice. During mobilization he developed a pulmonary embolus necessitating thrombolytic therapy. Th is caused a haematoma which led to sciatic nerve palsy and his hip dislocated a third time. He had a posterior lip augmentation device fi tted and developed a likely wound infection subsequently. A 65 year old male with a BMI of 42 was admitted to the elective unit of the hospital for a routine total hip replacement using cement. He had osteoarthritis of his left hip which was disturbing him in his daily routine and was keeping him awake in the night. His walking distance was limited to 100 yards due to pain. He had to rely on a walking stick to help him mobilize this short distance. He was on a maximum dose of Co-Codamol and Diclofenac Sodium for pain relief, which according to him was of limited benefi t . He had to discontinue Tramadol due to constipation. Th e patient was also under treatment for type two diabetes and hypertension. He had surgery previously for retinal detachment and also has issues with sleep apnoea. Th e gentleman concerned walked with an antalgic gait. All hip movements were accompanied with an audible crepitus. Th e radiographs of the pelvis showed gross osteoarthritis of the left hip with narrowing of joint space, peri-articular sclerosis and osteophyte formation. Th e patient opted for a total hip replacement of the left hip has he felt that he had no other option. Following the relocation of the left hip the patient went home. He was not fi tted with an abduction brace due to anatomical constraints. Five days later he dislocated the hip once more. Two days post-reduction the patient developed sudden onset hypotension and hypoxia. A pulmonary embolus was considered and a CT pulmonary angiogram demonstrated a saddle thrombus of the pulmonary vasculature. Th rombolytic therapy led to the formation of a haematoma posteriorly at the left hip which caused pressure on the sciatic nerve causing a drop foot. He dislocated his left hip for the third time. A device was operatively fi tted on to the left hip. During surgery it was noted that his sciatic nerve was in continuity. Th e patient was re-admitted to hospital with a wound haematoma necessitating debridement and re-suture. He was treated with a course of antibiotics. However with recent research showing that obesity does not seriously alter the outcome following joint arthroplasty. More surgeons are off ering hip and knee arthroplasty to obese patients and patients may be less conscientious in making an eff ort to reduce weight. High BMI adds additional challenges to the operative procedure itself. In conclusion joint replacement should be off ered to patients with perhaps increased awareness of the full list of complications possible being clarifi ed at the very outset. Motivation to lose weight should be encouraged for the actual arthroplasty
Rachad Mounir Shoucri
Professor, Royal Military College of Canada, Canada
Title: Indexes derived from the end systolic pressure volume applied to the study of heart failure
Time : 10:00-10:30
Biography:
Rachad Mounir Shoucri has completed his PhD in Theoretical Physics in 1975 at Laval University, Canada. After graduation he has worked for five years at the Institut de Cardiologie de Quebec where he has developed his current interest in mathematical physiology. Since 1981 he is with the Department of Mathematics and Computer Sciences, Royal Military College of Canada.
Abstract:
Based on the theory of large elastic deformation of the myocardium, a mathematical expression was derived for the non linear end systolic pressure volume relation (ESPVR). A rich collection of new indexes derived from the parameters describing the non linear ESPVR can be used to assess the ventricular function and the state of the myocardium. In particular relations obtained between ejection fraction (EF) and the new indexes derived from the non linear ESPVR give new insight into the problem of heart failure with normal or preserved ejection fraction (HFpEF) and can be used for prognostic, diagnostic and monitoring purposes. The figure shows how a relation between percentage occurrence of heart failure (HF) and EF (left side) has been extended to derive a relation between percentage occurrence of HF and SWR/SW (right side; SW=Stroke work, SWR=SWx-SW=Stroke work reserve, SWx is the maximum possible SW calculated from the area under the ESPVR). Five clinical groups are presented in the figure: Normal group (*), aortic stenosis (o), aortic valvular regurgitation (+), mitral valvular regurgitation (^), miscellaneous cardiomyopathies (x). Notice that the normal group (*) in both cases appear near the bottom of both curves with EF≈0.67 and SWR/SW≈0.34. Similar relations can be obtained for other indexes derived from the ESPVR, which show the strong potential use that can be made of the ESPVR for clinical applications.
Francis Yu-Sing Chan
Tameside Hospital NHS Foundation Trust, United Kingdom
Title: An exceptional comparative study of different treatment modalities (including ultrasound bone stimulator) of the not uncommon tibia shaft & the rare fi bula shaft fractures non-union in the same individual from a sport injury
Time : 10:30-11:00
Biography:
Francis Yu-Sing Chan is a Consultant Orthopaedic Surgeon in Manchester UK and the Lead Appraiser of the Tameside Hospital NHS Foundation Trust on doctors revalidation. He completed his medical school in Queen’s University of Belfast and graduated with MB, BCh, BAO (with distinction) and BSc (with 1st class honours). He completed the basic surgical training in Northern Ireland. He completed the Higher Surgical Training in Trauma & Orthopaedic Surgery in Manchester (Clinical Lecturer of the Manchester University and Specialist Registrar). He completed the world renowned Kurgan Ilizarov Fellowship in 2003 and the AO International Trauma Fellowship in 2005. Between 2009 and 2012, He was the Clinical Director of Department of Orthopaedics at Tameside General Hospital. In addition to a busy clinical practice, He am actively involved in education. He have over 40 presentations in local and international meetings and over 40 publications in journals and book chapter. He is UK MRCS &FRCS(Tr&Orth) examiner. He is the Chairman of the Greater Manchester East Research & Ethics Committee of the UK NHS Health Research Authority. He works as the teaching faculty of the MCh(Orth) Programmes of both the Dundee University and the Edge Hill University. In 2016, He was granted with the Fellowship of the European Federation of Orthopaedics and Traumatology for recognition of my clinical and academic achievement.
Abstract:
Introduction: While simultaneous tibia & fi bula shaft fractures are not uncommon in both routine trauma & sport related trauma (with seventy fi ve per cents of tibia fractures have associated fi bula fractures), tibia fractures have long been regarded as the main injury and surgeons attention 'and surgical treatments are as a result focused on the tibia fractures. With the abundant soft tissues attachments to the fi bula, the traditional wisdom informs us that fi bular non-union is uncommon. Once the tibia fractures have been stabilised, the fi bula fracture would commonly united usually prior to the tibia fractures union. In the residual small number of fi bula non-union, persistent symptoms from the non-union is even rare. Th us, very little was known or published on symptomatic fi bula fractures non-union following the associated tibia fracture union is achieved. In the limited literature available, while there was reported use of surgery or other non-invasive methods in the treatment of symptomatic fi bular non-union, there has been no reported use of non-invasive ultrasound bone stimulator. In this study, we reported the use of ultrasound bone stimulator in this rare symptomatic non-union. Objective: 1. To report a rare symptomatic fi bula fracture non-union following tibia fracture union in a keen sports woman. 2. Th e fi rst documented assessment of the eff ectiveness of Ultrasound Bone Stimulator in the treatment of the rare symptomatic fi bula non-union. Results: On completion of the 20 weeks period of ultrasound bone stimulator treatment, the patient's right leg symptoms have completely resolved and she has returned to skiing and water skiing without further symptoms. Th e fi bular fracture was also confi rmed to be united radiological. Conclusions: With its abundant soft tissues attachment, it has long been claimed that fi bula fracture has the ideal environment for union to occur. Hence, fi bula fracture non-union is rare. In previous study of 440 patients who sustained both tibia and fi bula fractures, the reported incidence of (symptomatic and asymptomatic) radiological fi bula non-union is less than 1% and symptomatic fi bula non-union is less than 0.25%. In this study, the symptomatic fi bula fracture non-union following the tibia fracture union constitutes a rare clinical situation. Review of the literature has shown treatments with electrical stimulation, and/ or surgical interventions (e.g. resection of distal fragment, internal fi xation with/ without bone graft etc.). In this study, we reported the fi rst successful use of ultrasound bone stimulator in its treatment.
Zachary Bloomgarden
Editor, the Journal of Diabetes; Clinical Professor, Icahn School of Medicine at Mount Sinai, USA
Title: The Future of Diabetes
Biography:
Bloomgarden is a clinician in private practice with an international reputation for writing and lecturing on diabetes, having authored more than 450 articles. He is Clinical Professor at Mount Sinai School of Medicine, and is Editor of the Journal of Diabetes. He served on the Board of the American Association of Clinical Endocrinologists, the Journals Managing Subcommittee of the Endocrine Society, and the Editorial Board of Diabetes Care, and has been principal investigator in numerous studies. In 2012, Dr. Bloomgarden was awarded the title of Master of the American College of Endocrinology. He has been listed for many years in the “Castle Connolly Guide: The Best Doctors New York Metro Area.†Dr Bloomgarden's interests span the overall field of diabetes. He has carefully followed the development of therapeutic approaches over the past two decades, and for many years wrote a renouned monthly commentary in Diabetes Care, entitled "Perspectives on the News," focusing on this and other aspects of clinical care. Currently, as the Editor of the Journal of Diabetes, he writes frequent commentaries spanning various aspects of treatment. He is interested in the epidemiology of diabetes with particular focus on cardiovascular disease, and has paid particular attention to questions of cardiovascular safety and, even more important, to the potential for cardiovascular benefit of diabetes treatment, and he has written on the inapplicability of current FDA recommendations for cardiovascular outcomes to the crucial questions we wish to examine in determining optimal therapeutic approaches. He also is a frequent commentator on novel treatment approaches including insulin treatment modalities, incretin-based treatments, and inhibitors of glucose transport aimed at increasing urinary glucose loss.
Abstract:
Projections: Diabetes is increasing. Number of people with diabetes has more than doubled over the past 2 to 3 decades. One driving factor is obesity. In parallel with the increase in obesity has been the aging of the population. There are progressively fewer younger and older persons, and by the year 2100, the numbers of persons 65 years of age and older, 45 to 64 years, and below 20 years will be roughly equal. Because the fastest growth in the occurrence of diabetes has occurred in older persons, who currently have a prevalence of diabetes of 20% to 25% in most countries, this less well-recognized cause of the increase in the number of people with diabetes is of great concern and will further the burden of diabetes complications. Issues: It is widely recognized that the likelihood of myocardial infarction, stroke, lower-extremity amputation, end stage renal disease, and a variety of other micro-macro vascular conditions are more common in individuals with diabetes than in those without diabetes. The relative increase in these conditions attributed to diabetes has declined, leading some to the optimistic position that we may be better addressing diabetes and its complications. Furthermore, advances in treatment that have led to reduction in rates of myocardial infarction and amputation may or may not reduce the healthcare burden for individuals at risk, given the increasingly costly therapeutic approaches required for people with advanced disease. Large cardio-vascular safety trials carried out over the past decade have led many to the opinion that intensive glycemic control is not of benefit in reducing macro vascular risk. The recent report on the 23-year follow up of participants in the Da Qing study, showing a striking 41% reduction in cardiovascular mortality in those who had undergone lifestyle intervention for pre diabetes, certainly suggests that we should not abandon our efforts in the younger, healthier persons with diabetes for whom clinical judgment impels us to continue to endeavor to improve control. Future directions: It has become commonplace to proclaim that what we know derives from our standing on the shoulders of giants, and no discussion of the future of diabetes can overlook the contribution of Kelly West, the epidemiologist who pointed out nearly 40 years ago that “a preventive and a cure are already at hand for most diabetes. The cause is usually obesity; the preventive, and often the cure, is leannessâ€. How, though, can we reverse the environmental influences of high-calorie foods contributing to the growth in diabetes? It is increasingly apparent that the paradigm of acute care-based medical practice with infrequent visits to providers prescribing medications is of only incomplete relevance to the management of diabetes, which requires a set of lifestyle interventions combined with measures to promote adherence. Novel interventions using technologies such as smartphone apps to improve communication and understanding of appropriate self-care for persons with diabetes will be crucial in helping to bring this.
Biography:
Beniamino has completed his graduation in Medicine in 1972 from the University of Modena. He completed his post-graduation studies in Hematology, Surgery, Maxillo-facial, Plastic Surgery from University of Modena and University of Milano from 1975-1985. Present he is working as a Professor in University of Modena in the department of Surgery. More than 12.000 surgical operations in the field of: General Surgery (coloproctology oncological and general, , laparoscopic and hepatobiliary surgery), Breast (oncological- sentinel and oncoplastic)Head and neck (specifically thyroid-parathyroid), Maxillo facial and emergency surgery, Plastic and Reconstructive Surgery Laser Surgery, Expert of second opinion in surgery
Abstract:
Case: A 66 year old caucasian male went to our second opinion medical office complaining of long tending severe abdominal discomfort due to marantic abdominal muscle atrophy , and an enormous laparocele with visible bowel movements across the very thin skin with dermal atrophy. He was obese and diabetic With an infra-renal aortic prosthesis and could not perform A normal daily activity because of excruciating pain due to the heavy abdominal burden of the visceral contents pressing the thin subcutaneous layer with the impending risk of pressure ulcer or of traumatic gut laceration. He had been judged absolutely unoperable after many surgical consultation because of the very bad abdominal skin quality, the severe muscle & fascia atrophy and the impossibility to bury any mesh under such a fragile tissue courtain. We are supposed to turn him to operating room after an attempt to increase the abdominal wall thickness, from 0,3 up to O, 8 -1 cm infiltrating a great amount of highly cross-linked hyaluronic acid in the space between the sub cutis and epidermis. We thus planned that 1kg. of this compound would be necessary to perform the procedure, ignoring on the other hand ,the kinetics and the possible side effects of such a great volume suddenly bioavailable into the belly ,especially considering the heparin like properties of this glucosaminoglycan class. The patient took the challenge , signed an informed consent after local ethical committee approval, and was sub-dermally injected with local anesthesia with 3 mm size 30 cm long lipoflling cannulae through 5 holes in the different quadrants of the abdomen under ultrasound control in order to prevent peritenl leaking !; he tolerated the procedure very well and was immediately discharged from the day surgery unit without any untoward effect ; an homogenous sub-dermal layer of hyaluronic acid ( VISCODERM, the most highly cross-linked and dense cosmetic medicine market available filler for wrinkles, was complimentary supplied by ADODERM GmBh,GERMANY ) was monthly monitored by ultrasounds in the following months up to one year. When the sub-dermal layer appeared homogenously and steadily thick, the patient was admitted to the operating room, and a wide 70x70 collagen mesh was sutured to repair the wide abdominal gap, to the approximated musculo aponeurotic margins. The patient had some minor post op complications, but he recovered pretty soon, and the abdominal artificially thickened skin showed a very good resistance to the abdominal pressure and collagen mesh integration without necrosis or ischemia even in presence or previous incisional scars. Actually, due to collagen mesh reabsorption, laparocele is still present, but the abdominal wall is much thicker, and more stiff and no pain and no movements limitations are any more complained by the patient. This case is quite paradigmatic of an unconventional very useful (in this case probably “life-savingâ€) approach to cross-linked hyaluronic acid on a mini-vasive abdominal wall filling basis, ancillary to major surgical procedures. Safety and biocompatibility of this fermentative produced muchopolisaccharide even at very high dosages have been definitely stressed by the present case, and the indication described as well as the method should be taken in account for similar clinical conditions
Biography:
Ian trained as a cardiologist and went to Nigeria where he completed a monumental work on cardiomyopathy which formed the basis for his doctoral thesis ('Heart muscle disease in Nigeria'). However, on his return he decided to train in psychiatry at the Maudsley Hospital. He developed a strong interest in nosology of psychiatric illnesses. He moved to Chicago as a Visiting Professor where he produced several works on the nosology of psychiatric illnesses in association with R E Kendell and H Y Meltzer. He moved to Manchester University as a senior lecturer and was very soon appointed to a chair at the University of Birmingham. By this time, he had also developed an interest in postpartum psychiatric illnesses and was one of the founders of the Marcé Society, and the founder of the Section on Women's Mental Health in the World Psychiatric Association. Along with Ramesh Kumar, he produced two volumes, Motherhood and Mental Illness, and Motherhood and Mental Illness, Causes and Consequences. He is also known for his avocation of the restoration of a Tudor farmhouse. He is currently researching Menstrual Psychosis.
Abstract:
In my early career, as a cardiologist working in tropical Africa, I experienced the value of single cases supported by a multilingual literature review: Two cases were sufficient to indicate that an idiopathic disease (endomyocardial fibrosis) was a complication of eosinophil leukocytosis. Since 1975, I have studied the psychoses of childbearing in the literature over 4,000 cases, of which 30% in the English language, plus a personal series of 320 mothers. The study of 600 recurrent cases has shown that the problem is more than the eruption of a psychosis shortly after childbirth: There is a group of reproductive triggers; prepartum, post-abortion (including mole pregnancies), early and late postpartum (onset 1-2 weeks and 4-13 weeks after the birth), after weaning and at two phases of the menstrual cycle. The history of individual patients demonstrates associations between all of them. Since 1981, I focused on menstrual psychosis; several hundred cases in the literature and 60 of my own. Periodic monthly psychoses occur before and at the menarche during phases of amenorrhea, in the early months of pregnancy, after childbirth, after the menopause, in men and (in one remarkable observation from Japan) without a pituitary. Everything worth knowing about childbearing and menstrual psychoses comes from case description and indicates involvement of the gonadorelin neuronal network (2000 neurons) in the anterior hypothalamus (a needle in the haystack!)
Iacob Marcovici
McLeod Health-Ob/Gyn Dillon, USA
Title: Spontaneous Expulsion of an Essure Microinsert Seven Years After its Insertion
Biography:
Iacob Marcovici is currently working as an Assistant Professor of Ob/Gyn in McLeod Health-Ob/Gyn Dillon
Abstract:
"Introduction: A case of spontaneous expulsion of an Essure® micro-insert seven (7) years after its insertion is presented. Case: A 46 years old patient G2P1 had Essure® sterilization 7 years earlier. Her three months post insertion follow up hysterosalpingogram (HSG) did verify the presence of Essure® micro-insert in each fallopian tube. Five years after her sterilization the patient started complaining of heavy periods. The gynecological investigation at the time, found an 11 cm length uterus with a few fibroids, the largest of about 4 cm. Her symptoms subsided and two years later, the patient came back to our clinic with a coil in a bag saying “this is what came out of my vagina yesterdayâ€. In order to evaluate the present status of her tubes, an HSG was done. The result did show no spillage of contrast medium from either tube and therefore the assumption is both tubes are blocked. Only the left Essure® micro-insert is present in the fallopian tube. Comment: Essure® bilateral tubal occlusion is an elegant modality of sterilization because requires no abdominal incisions. It is considered a permanent solution for sterilization. The Essure® micro-insert is a 4 cm micro coil made out of a stainless steel inner coil, an elastic outer coil of nitinol and polyethylene terephthalate (PET) fibers contained within the coils. Once placed in the fallopian tube the outer coil of nitinol expands and the PET fibers start inducing an inflammatory/fibrotic response that in time will occlude the lumen of the tube. The manufacturer of Essure® recommends that an Essure Confirmation Test (basically a hysterosalpingogram) should be done 3 months after the procedure in order to confirm successful tubal occlusion. While expulsion of the Essure® coil after insertion before the 3 month HCG mark was reported, I found only one case report by Garcia et al; describing an expulsion at more than 3 months. In Garcia et al report, the expulsion occurred at about 14 weeks (2 weeks after the HCG confirmed the correct placement and the bilateral occlusion). They believe the micro-insert expulsion occurred at 14 weeks after placement because of incomplete scarring of the fallopian tube. When their patient got her period, the uterine contractile waves associated with menstruation just displaced the micro-insert into the uterus and then expelled through the cervix. In contrast, the present report is the first one describing a spontaneous expulsion of one Essure® micro-insert as far as seven years after its insertion. The reasons of such a delay inexpulsion are not clear and further investigation into the causes of such an event is warranted. "
Milen Velinov
New York State Institute for Basic Research in Developmental Disabilities, USA
Title: Whole Exome Sequencing identifies the etiology in over 50% of selected patients with Developmental Delay/Intellectual disability. Report of nine patients/families with distinct phenotypes
Time : 11:45-12:05
Biography:
Velinov is an Associate Professor at the Icahn School of Medicine at Mont Sinai and Director of the Genetic Service at Bronx-Lebanon Hospital. He is also the Program Director of Comprehensive Genetic Services and Specialty Clinical Laboratories at The New York State Institute for Basic Research in Developmental Disabilities. His research interests include Neuronal Ceroid Lipofuscinoses as well as rare/unique clinical manifestations and diagnoses in clinical genetics.
Abstract:
Whole Exome Sequencing (WES) is a new clinical testing approach based on next generation sequencing that rapidly gains popularity in medical genetics. It is used for the evaluation of patients with suspected genetic condition and with no aparent recognizable syndrome. Our service had conducted WES testing for patients with developmental delay/intellectual disability for whom genetic etiology is suspected. Here are presented the probands and affected relatives of nine families tested by us during the last year, in whom causative mutations were identified. In addition to the intellectual disability, the selection of patients to be tested was based on the presence of unique clinical features and positive family history. All patients included in WES protocols were previously found to be negative for chromosomal rearrangements. The total number of tested probands was 17. In nine of them (slightly over 50% positive of all tested) a causative mutation was identified. The identified mutations were in genes IQSEQ2, FOXP1, EXOSC3, KIAA2022, CTNNB1, SAMHD1, ATP13A2, TFAP2A, ARID1B. In two of the cases (genes SAMHD1 and ATP13A2) therapy trials specific for the identified genes were identified. Specific follow up protocols were implemented in one affected relative of the proband with IQSEQ2 mutation. In the family with TFAP2A mutation specific surveillance protocol was implemented. The proband with X-linked KIAA2022 mutation was one of the first female patients with such mutations. Her manifestations were associated with skewed X chromosome inactivation. The proband with mutation in gene ARID1B is the oldest known patient with such mutation, who presents with some unique features. In all families with identified causative mutation better informed family planning became possible. Detailed clinical description of each proband/family will be provided. Overall in our patient population WES is an efficient method of identifying causative mutations in individuals with suspected genetic etiologies. WES also has high potential for clinical benefit for the tested patient and family. Various issues regarding test limittations and possible incidental findings are discussed. Factors that increased the likelihood of identifying causative mutations in our patients were the presence of unique clinical manifestations, parental consanguinity and more than one affected family member.
Satish Babu
North Middlesex University Hospital NHS Trust at London, UK
Title: Bilateral posterior interosseous nerve palsy
Time : 11:45-12:05
Biography:
Satish Babu Janipireddy has completed his DNB (Orthopaedics) from National Board of Examinations in India. He has then moved to the UK in 2007 to pursue a Research degree MCh Orthopaedics from University of Dundee in Scotland. He has then worked at North Middlesex University Hospital NHS Trust at London and attained the FRCS (Tr and Orth) in 2015. He is presently working as a Consultant at the same hospital.
Abstract:
We present a very unusual case of Bilateral Posterior Interosseous Nerve (PIN) Palsy in a 52 year old. PIN palsy is an extremely rare occurrence with 0.7% incidence recorded in the literature. A 52 year old male who works as a chef, presented to the clinic with gradual onset of inability to use his right hand and decreasing power. It was insidious in onset with gradual worsening over a period of 6 months. There was no history of trauma and mentions he has had no problem in using his right hand prior to this period. He had similar issues about a year ago, for which he was diagnosed with PIN palsy and had extensive investigations including Nerve Conduction studies (NCS) and MRI. He has had a tendon reconstruction (at a different hospital) done for his left side. On clinical examination of his right hand now, he had finger drop with wrist extension in radial deviation. Elbow movements showed good flexion with restriction of terminal extension (fixed flexion of 10 deg). Pronation was full, supination was 80 deg (10 deg Lag), but symmetrical. There were no signs of other nerve involvement and sensory examination was normal. A clinical diagnosis of PIN palsy was made. Investigations which included radiographs of his elbow and forearm and NCS were performed. NCS confirmed severely abnormal spontaneous activity in the form of positive sharp waves and fibrillations, discrete recruitment pattern and decreased recruitment interval in posterior interosseous innervated muscles. There was no abnormal radial head noted in the plain radiograph. To rule out a mechanical cause of compression, MRI of the right elbow was performed. MRI confirmed partial subluxation of radial head with marked thickening of the capsule. In order to confirm the same on the left side an MRI of the left elbow was also undertaken, which confirmed similar findings. The patient was explained the same and offered pysiotherapy/orthosis for the right elbow (left side was already attended to by tendon transfer surgery and hence no further treatment was required). He was planned for surgical exploration with/without annular ligament reconstruction. Patient wished to defer surgery, but agreed to continue the conservative management. He was seen in 2 months at the clinic and noted to have regained full power of the finger extensors and thumb. He has been explained that this could recur and shall need the above procedure. Posterior interosseous nerve palsy is a rare occurrence and involvement bilaterally is the first of such kind which has not been reported in the literature.
Thisara Weerasuriya
Ayr University Hospital, UK
Title: Avascular necrosis of a polyarticular nature
Time : 12:25-12:45
Biography:
Thisara C Weerasuriya pursued his MBBS and MS in Sri Lianka, MRCS in England and FEBOT in Switzerland. He is currently working as a specialist in Trauma and Orthopaedics at University Hospital of Ayr in The UK
Abstract:
We report the case of a forty year old lady who presented with avascular necrosis of her right hip. She underwent a hip replacement for this but re-presented the following year with the same pathology in her left hip. Th is too was replaced. However, over the following year, she developed avascular necrosis of both her knees and her left shoulder. Th is was confi rmed on magnetic resonance imaging. She has a background of previous drug dependent syndrome and alcohol misuse. While the avascular necrosis in her hips was initially attributed to her alcohol consumption, the widespread systemic nature of her condition is likely to be purely due to this. Th is lady has benefi tted from her bilateral hip replacements. However, she is under regular clinic review for the avascular necrosis in her knees and left shoulder. Her mobility is reduced and she uses crutches or a wheelchair. She has ongoing pain and reduced function in her left arm at present. In this case of polyarticular avascular necrosis, bilateral hip replacements have provided pain relief and improved function. However, due to the continuing polyarticular nature of her condition, further investigation to identify other possible causes and pathological processes is warranted.
Francis Yu-Sing Chan
Tameside General Hospital, UK
Title: Mini-open approach for internal fi xation of radial head fractures
Time : 12:45-13:05
Biography:
Francis Yu-Sing Chan is a Consultant Orthopaedic Surgeon in Manchester UK and the Lead Appraiser of the Tameside Hospital NHS Foundation Trust on doctors revalidation. He completed his medical school in Queen’s University of Belfast and graduated with MB, BCh, BAO (with distinction) and BSc (with 1st class honours). He completed the basic surgical training in Northern Ireland. He completed the Higher Surgical Training in Trauma & Orthopaedic Surgery in Manchester (Clinical Lecturer of the Manchester University and Specialist Registrar). He completed the world renowned Kurgan Ilizarov Fellowship in 2003 and the AO International Trauma Fellowship in 2005. Between 2009 and 2012, He was the Clinical Director of Department of Orthopaedics at Tameside General Hospital. In addition to a busy clinical practice, He am actively involved in education. He have over 40 presentations in local and international meetings and over 40 publications in journals and book chapter. He is UK MRCS & FRCS(Tr & Orth) examiner. He is the Chairman of the Greater Manchester East Research & Ethics Committee of the UK NHS Health Research Authority. He works as the teaching faculty of the MCh(Orth) Programmes of both the Dundee University and the Edge Hill University. In 2016, He was granted with the Fellowship of the European Federation of Orthopaedics and Traumatology for recognition of my clinical and academic achievement.
Abstract:
A thirty year old lady fell off her horse and landed on both her out stretched hands resultingin bilateral Mason’s 2 radial head fractures. Her elbows were swollen and bruised with no external injury. She had no pain anywhere else in the body. Th e elbow movements were globally restricted bilaterally of both elbows. Flexion beyond 90 degrees was impossible due to pain and extension was possible to about 170 degrees from 90 degrees. Pronation and supination were nil. Th e integrity of both posterior interosseus nerves were maintained with no fi nger drop noted. Th e radial pulses of both sides were equal and normal in volume and rate. Her cervical spine was non-tender and her lower limbs and hip joints were normal without any clinical or radiological evidence of injury. Both radial head fractures were closed fractures.
Lydia Nabil
Alexandria University, Egypt
Title: Surgical removal of a large complex maxillary odontoma causing facial asymmetry in a teenager: A case report
Time : 15:10-15:30
Biography:
Lydia N. Melek is a faculty member of the OMS department, Faculty of Dentistry, Alexandria University, Egypt. She is a member of the International Association of Oral & Maxillofacial Surgeons (IAOMS) and a reviewer in the Peer Review Board of Alexandria Dental Journal (ADJ)
Abstract:
Odontomas are benign developmental tumors of odontogenic origin. They are characterized by slow growth and nonaggressive behavior. Complex odontomas tend to occur in the posterior mandible or maxilla and only rarely reach a considerable size. Radio graphically, the complex odontoma appears as a dense amorphous irregular mass with well-demarcated borders. Occasionally this tumor reaches a large size, causing bony expansion followed by facial asymmetry. Otherwise these tumors are asymptomatic and are accidentally discovered on radiographic examination. We report a rare case of large complex odontoma of the maxilla in a young boy. The tumor was treated by surgical excision under general anesthesia, using merely an intraoral approach without any additional incisions. The lesion was also delivered as one whole mass together with the associated impacted tooth. Although the bone defect was large, uneventful healing was achieved.
Mostafa samy
MUST University, Egypt
Title: Management of rhino-orbital mucormycosis
Time : 14:10-14:30
Biography:
Mostafa has completed his dental degree at the age 23 from MUST University (Egypt ), Then at the age 26 he has attached to Military for 1year and after that he has attached to 5years oral and Maxillofacial board as resident. Now he in last 5 months in this residency. He has very good log book and experience specially trauma, infection and reconstruction and has a capability for work a good oral and Maxillofacial specialist. He has published about 3case reports and another 4casereports in progress and other type of publish
Abstract:
Mucormycosis also known as zygomycosis and phycomycosis is an uncommon, opportunistic, aggressive fatal fungal infection caused by fungi of the order Mucorales, frequently among immunocompromised patients. This fungal infection begins from the sinonasal mucosa after inhalation of fungal spores; the aggressive and rapid progression of the disease may lead to orbital and brain involvement.1-4 In the past, the mortality rate of the rhino-cerebral type was 88%, but recently the survival rate of rhino-cerebral mucormycosis averages 21-73% depending on the circumstances.1 Mucormycosis is classified according to anatomical site into rhino-cerebral, which is the most common, central nervous system, pulmonary, cutaneous, disseminated, and miscellaneous.1,2,4-6 The rhino-orbito-cerebral is the most common form of mucormycosis.3 The most common predisposing factor is uncontrolled diabetes mellitus (DM), especially when the patient has a history of ketoacidosis, these species thrive best in a glucose rich and acidic environment.3,4,6,7 Immunosuppressive drugs such as steroids, neutropenia, acquired immune deficiency syndrome, dialysis patients on deferoxamine, malnutrition, hematologic malignancy, and organ transplant patients are also at risk of affection by the fungi.1,4-7 This case report describes a case of rhino-orbital mucormycosis affecting a diabetic female with good prognosis and satisfactory healing. Our objective in presenting this particular case is to emphasize that early diagnosis and proper management leads to good prognosis and high survivability
Samar Abbas
St. Luke’s Hospital, Ireland
Title: Amnesic Confusion, Apyrexic, Murmurless, Acute Bacterial Endocarditis with Overt Cutaneous clinical manifestation
Time : 14:30-14:50
Biography:
Samar Abbas Jaffri, born in 31st August 1984, in Karachi Pakistan, did my primary schooling in Brooklyn secondary school karachi, did my SSC examination from gulistan school karachi in 2000, did my HSC examination in 2002 from DJ sindh Government science college karachi, recieved my primary medical education from baqai medical university up til 2008. I joined Jinnah Postgraduate Medical centre in 2009 did my internship over there for 1 year, entered in FCPS (Pak)/MRCP(UK) training program Medical Unit II, (Ward 6), Jinnah Postgraduate Medical Centre Karachi, Pakistan in 2011, completed my UK membership in 2015, Joined St. Lukes Hospital Ireland in July 2014 as Medical Registrar, being promoted to Cardiology Registrar in July 2015
Abstract:
Introduction: Bacterial endocarditis is an infection that typically presents with constitutional symptoms such as raised temperature. A murmur or the changed or changing character of a murmur is well described. We describe the case of a 34 year old Polish man who presented to the Acute Medical Unit in an aggressive confused state where against a history of significant binge drinking his CPK was grossly elevated. Because of his agitated and confrontational state full clinical examination was precluded. He was subsequently found to have many cutaneous clues to the underlying illness. Case: The patient was 35 years old male from Poland and had been living in Ireland for 10 years. He had no past medical history but was known to drink vodka in binges. He was the father of two children and was estranged from his family and living with an Irish female partner. He was well until 3 days back when he presented to AMAU, brought in by ambulance with acute confusion, with h/o binge drinking of alcohol with no other significant history. O/e his blood pressure 140/90 mm Hg, Pulse 136/min, temperature 37.5, respiratory rate 22/min, janeway lesion, splinter hemorrhages, clubbing, Osler nodes, conjunctival hemorrhages. On cardiovascular exam he has no murmur initially then developed early diastolic murmur after 2 days of admission. Basic investigations such showed normal Hb, with hypernatremia (121), raised CPK, urine analysis showed hematuria, blood alcohol not detected and urine toxicology was positive for benzodiazepines. Blood culture showed growth of Staphylococcus aureus, Echocardiography showed vegetation around aortic valve with preserved left ventricular function. He was commenced on intravenous broad spectrum antibiotics. He deteriorated and AVR (tissue) was performed, histopathology of tissue AVR showed growth of Staphylococcus aureus. After surgery, he does not remember the event, he has no memory for the past event & throughout the whole stay in the hospital he never had a temperature except the day of admission which showed around 37.5o C. Conclusion: This patient has a very rare presentation of Acute Infective Endocarditis, in this case we exactly do not know the source of Staphylococcus aureus but it could be due to poor dental hygiene, early diagnosis and appropriate treatment can prevent him from life threatening complications.
Mohammad bukhetan alharbi
Imam mohammad bin saud islamic univeristy, KSA
Title: Medication trojans and surgical mismanagment
Time : 14:50-15:10
Biography:
Mohammad Bukhetan Alharbi has completed his MD and Saudi Board of General Surgery in 2004. He has worked in King Abdudlaziz Medical City in Riyadh and then started working as an Associate Professor of Surgery in Medical College, Imam University in Riyadh. He has also worked as Vice Dean of Administrative Affairs in Medical College.
Abstract:
Adverse events in surgical practice are not uncommon; many measures are applied to prevent such events. The worst case scenario, when patient medications are contributing to wrong surgical decision. The gray zone of many surgical clinical scenarios like, sepsis, hemorrhagic shock, cardiogenic shock during surgical catastrophe, etc are frequent events that are faced frequently in surgical price, which may be initiated or manipulated by medication adverse events; medications have its own effects on the body. Sometimes the medications themselves are causing worsening condition instead of improvement. Others are causing new clinical complains which does not relate to the presenting complaint and make more challenges to the treating team, some studies explained that there are misdiagnosis in acute events, but they never address the medication history and its impact in the condition, assuming its faultless area. More studies should be addressed to consider medication; trojans and their effects in our unexplained clinical scenario, especially in case of morbidity and mortality.
Jesus Alcaraz
Hospital Mesa del Castillo, Spain
Title: Platelet-rich plasma in a patient with cerebral palsy
Time : 15:10-15:30
Biography:
Jesus Alcaraz is currently associated with Department of Hematology and Oncology at Hospital Mesa del Castillo in Spain.
Abstract:
Background: The use of platelet-rich plasma is a now a common medical technique known as regenerative medicine, through power cell activation and diff erentiation, which produces growth factors called platelets derived both locally and systematically. Here, we report the case of a cerebral palsy patient who received intravenous platelet-rich plasma. Case report: We administered an intravenous injection of concentrated platelet-rich plasma (25 cc) in a 6 year old boy with perinatal cerebral palsy, cognitive impairment and marked and severe generalized spasticity. We performed follow-up at 3 and 6 months aft er the injection. All serum samples for determination were obtained by ELISA technique. Cognitive scales (Bayley, Battelle, M.S.C.A, Kaufman ABC and Stanford-Binet Intelligence scale) were used before and aft er treatment. Th e determination protocol that was applied before the analysis was performed manually and the auto transfusion was considered suitable for treatment. We determined the plasma levels of factor similar to insulin-1 (IGF-1), platelet-derived growth factor (PDGF), vasculo-endothelial growth factor (VEGF) and transforming growth factor B (TGF-B) before and during treatment monitoring. Conclusions: No adverse eff ects were observed in the patient except for a small hematoma in the area channeling venous access. We observed a clear improvement in the cognitive sphere (memory, ability to perform more complex tasks and acquisition of new skills) and in language, maintaining stable levels of growth factor in plasma 3-5 times higher than average for his age group at both 3 and 6 month follow-up. Positron emission tomography (PET) images showed an evident increased demarcation in the cerebral cortex. We propose that this therapy is useful in these patients to harness the neurostimulative and neuroregenerative power of endogenous growth factors derived from platelets.
Jamila
King Fahad Specialist Hospital-Dammam, KSA
Title: A rare complication resulting in a rare disease; A case report of radiation induced male breast cancer
Time : 15:45-16:05
Biography:
Dr. Jamila works is currently working in the Division of Surgical Oncology at Department of Surgery in King Fahad Specialist Hospital- Dammam
Abstract:
Introduction: The increase in survival after childhood radiation therapy for some blood malignancies has led to increase in the diagnosis of radiation induced secondary solid malignancies (SSM). Case report: Herein we report a young man presenting with invasive breast cancer 19 years after receiving radiation therapy and bone marrow transplant (BMT) for acute lymphocytic leukemia (ALL) in childhood. Conclusion: Survivors of radiation treated primary cancer should be closely monitored for breast cancer for the rest of their lives.
Sameh Mohammed
Nasser Institute Hospital, Egypt
Title: Severe sublingual hematoma as a complication of deep neck space infection
Time : 16:05-16:25
Biography:
Sameh Mohammed works as an Oral and Maxillofacial Surgeon at Nasser Institute Hospital
Abstract:
"Life threatening infection of odontogenic Origin May Extend To Potential spaces formed by fascial planes of lower head and upper cervical area. The incidence of these space infections has been gradually reduced by modern antibiotic therapy. Sublingual hematoma is a rare complication usually seen after oral anticoagulant use. Sublingual hematoma secondary to deep neck infection is rare un previously reported before. Review of literature didn’t reveal any case reports of sublingual hematoma following deep neck infection of facial spaces. A case of deep neck infection of odontogenic origin with subsequent sublingual hematoma with ultimate fatal outcome will be described. "
Ashraf Abdallah
Nasser Institute Hospital, Egypt
Title: Management of syndromic odontogenic keratocysts: A report of two cases
Time : 16:25-16:45
Biography:
I am an oral and maxillofacial surgeon. Graduated in 2007 from Cairo University Faculty of Oral and Dental Medicine, Egypt. Started residency in Oral and Maxillofacial Surgery at Nasser Institute Hospital in Cairo, Egypt in 2011 till 2016 and hold the Certificate of the Arab Board of Oral and Maxillofacial Surgery.
Abstract:
Gorlin-Goltz syndrome is an autosomal dominant condition with prevalence varying from 1/60000 to 1/256000 and a male to a female predilection of 1:1. We report two previously undiagnosed cases of Gorlin-Goltz syndrome, which originally presented with multiple odontogenic keratocysts (OKC). We report the management protocol followed for these two cases of bimaxillary OKC. Both patients were treated at the Department of Oral and Maxillofacial Surgery, Nasser Institute Hospital in Cairo, Egypt. Lesions smaller than 2 cm in diameter were enucleated with peripheral ostectomy while lesions larger than 2 cm were marsupialized and enucleated at a second stage; clinically, both patients were followed up for 18 months with no reported complications. Radiographically, both patients exhibited satisfactory resolution and bony ingrowth of the previously radiolucent cystic cavities.
Jignesh Kothari
UN Mehta Institute of Cardiology and Research Centre, India
Title: Surgical repair of multiple congenital left ventricular aneurysms with rupture into left atrium
Time : 16:45-17:05
Biography:
Jignesh Kothari completed his Medical Graduation (MBBS) from M S University, Baroda in June 1991 and completed Masters of Surgery in the year 1995.He is certifi ed with the Degree of M.Ch. and also DNB from National Board, India in Cardiovascular and Thoracic Surgery in the Year 2001.He later joined as Junior Surgeon at Madras Medical Mission (MMM), Chennai in April 2002 and worked for Year and Quarter. He is currently working at U N Mehta Institute of Cardiology and Research Centre affi liated to B.J.Medical College, Ahmedabad since July 2003 as Assistant Professor (CVTS) and as Associate Professor from May 2013. He is also working as a Post Graduate Teacher for Cardiothoracic and Vascular Specialty in Gujarat University. During this tenure he have operated 6500 cases of various adult cardiovascular surgeries and complicated Cardiac cases as well as Pediatric surgery and vascular surgery independently. He has published 7 research papers in various reputed journals and many complicated cases have also been published in journals.
Abstract:
Congenital left ventricular aneurysm (CLVA) is a rare disease. Patients with multiple congenital LVAs are even rare. Clinical presentation of CLVAs varies and is usually diagnosed by exclusion. Very few cases of successfully operated multiple congenital aneurysms with rupture into left atrium (LA) have been reported. We report a case of 17 year old male who presented with progressively increasing breathlessness of congestive heart failure. He was diagnosed to have two CLVAs with one rupturing into LA, for which he underwent aneurysmectomy and closure of LA perforation. Aft er aneurysmectomy, the lateral wall aneurysm (aneurysm A) was closed linearly in two layers over tefl on felt; while the inferior wall aneurysm (aneurysm B) was closed using patch at neck of aneurysm and linear closure of walls of aneurysm over the patch. We discuss the diagnostic process, the surgical correction and a brief review of the medical literature of this extremely rare disease.
Luo Guangnan
Luohu Hospital, Shenzhen ,China
Title: Peritoneal vaginoplasty and trachelectomy (luohu iii operation)for patient with congenital cervical and vaginal atresia:a case report and treatment options.
Time : 17:05-17:25
Biography:
Prof.Luo Guangnan has completed hisMD from Xianya Medical University . He is the director of OB/GYN department of Luohu Hospital. He has published more than 30 papers in reputed journals and has been serving as an editorial board member of Chinese Journal of Minimally Invasive Surgery
Abstract:
Objective: The aim of this study was to explore (demonstrate) a feasible treatment for patient with congenital cervical and vaginal atresia using peritoneal vaginoplasty and trachelectomy. Materials & Methods: A 14-year-old patient with congenital cervical and vaginal atresia was treated with laparoscopic peritoneal vaginoplasty and trahelectomy and uterine body-neovagina anastomosis also was performed for this patient. Catheters with an IUD are utilized in the deployment of stents in the connection of the neovagina and the uterine body. Results: This treartment has given excellent results over a period of 8 months of follow-up. The patient has a resembling normal vagina and has normal mense one month later after the treatment. Conclusions: Our finding suggests that peritoneal vaginoplasty and trachelectomy might be an effective option for patient with congenital cervical and vaginal atresia. The postoperative management, neovagina dilation and uterine stent are also imperative for the surgical success. However, a long term observation for this new treatment needs to be followed up.
Chenglu Qin
Luohu Hopsital,Shenzhen, China
Title: Clinical cases report on treatment of patient with congenital vaginal atresia with different type peritoneal vaginoplasty(luohu i and luohu ii operations) : a study of 750 cases.
Time : 17:25-17:45
Biography:
Dr. Chenglu Qin has completed her MD from SEN YA –SEN Medical University . She is the chief physician of the department of OB/GYN of Luohu Hospital, She has published more than 20 papers in reputed journals
Abstract:
Background: Many reconstructive surgical procedures have been used for vaginal agenesis. Almost all of them are surgically challenging, multi-staged, time consuming or leave permanent scars on abdomen or skin retrieval sites. But laparoscopic peritoneal vaginoplasty proved to make a simple and effective way for those patients. Objective: This study was to survey the role of peritoneal vaginoplasty with the assistant of laparoscopy for the treatments to 750 patients with congenital vaginal atresia. Material & Methods: Total of 750 patients with congenital absence of vagina (including 708 cases of MRKH syndrome, 40 cases of androgen insensitivity syndrome, 2 cases 17-hydroxyulase deficiency) were treated with laparoscopic peritoneal vaginoplasty between 2001 and 2015. And we followed up 362 cases (post-operation times is from 3 months to 14 years), all patients have excellent normal vaginal function. 55cases got biopsy of neovignal wall and show stratified squamous epithelium resembling normal vagina and having acidic pH. The vaginal microecology in the women with peritoneal vaginoplasty can be either normal or abnormal. Conclusion: Laparoscopic peritoneal vaginoplasty can be performed for MRKH, AIS and 17-hydroxyulase deficiency patients with congenital vaginal atresia and got excellent normal vaginal function.
Debkumar Chowdhury
University Hospital Ayr, UK
Title: Case report on a unique case of intra-abdominal desmoid tumor
Time : 17:45-18:05
Biography:
Debkumar Chowdhury has completed his MBChB degree from the University of Bristol following his Foundation training in Scotland. He is currently a Clinical Teacher and Research Fellow in Breast and General Surgery at University Hospital Ayr, UK. He has a strong passion for teaching and currently holds the post of Clinical Lecturer at the University of Glasgow, UK.
Abstract:
Desmoid tumors (DT) are benign tumors that arise from the proliferation of well diff erentiated fi broblasts. Although they are benign, they have the potential to be locally aggressive and can recur post excision. DTs can present both intra-abdominal and extra-abdominal locations, however prognosis is worse intra-abdominally. Here we present the case of a 59-year-old gentleman previously fi t and well who presented with a 4-week history of right abdominal mass associated with mild discomfort to the surgical outpatient clinic. Th ere were no associated gastrointestinal symptoms noted. It was initially thought that it could represent an incisional hernia or Richter’s hernia. He had previous undergone open appedicectomy at the site of the lesion. He underwent a CT scan which revealed a 6.5 cm soft tissue mass. Following ultrasound guided biopsy, histology revealed fi brous connective tissue and bundles of spindled cells with no evidence of malignancy. Th e decision to excise the lesion was taken having been discussed at our local MDT meeting. Intra-operatively 3 lesions were identifi ed with all 3 lesions embedded in the mesentery and located at serosal juxta positions. Histology of frozen section was consistent with DT. Th e margins were clear with no post-operative complications. Th ere is an association of intra-abdominal DT with FAP. Intra-abdominal DTs are more prevalent in females with history of previous surgery. Our case is unique as our patient does not fall into any of the above categories. Th e basic management of intra-abdominal desmoid tumors is primary resection with any adjuvant therapy as deemed appropriate by the MDT specializing in soft tissue tumors..
Elena Tonni
Cognitive Behavioural Psychotherapist, Italy
Title: A case of juvenile idiopathic arthritis plus dermatitis similar in two siblings treated by different remedies. How Homeopathy applies to the healing process
Biography:
Elena Tonini, has completed her Medical Degree from Milan University (1995) and a postdoctoral Flahnemannian Homeopathic Degree (1996). She received a Cognitive Behavioural Psychotherapist Degree from Cognitive Psychology Association (APC) Verona (2011), and is a researcher in homeopathic and quantum medicine. She was in the board of teachers of the School of Homeopathic Medicine in Verona (2000-2013), in charge for the relative ECM program (2004-2006). She has published papers, as co-author, in reputed journals and has contributed to organize scientific meetings and to conduct a clinical study comparing homeopathic and allopathic treatment for diabetic polyneuropathy.
Abstract:
Introduction: a paradigmatic familial case demonstrating the rules of Homeopathy in curing illnesses. Case description: a two-year-old girl, suffering from a juvenile idiopathic arthritis and her eight-year-old brother, affected by a serious genital and retroauricolar haernorrhagic cheratotic dermatitis, were both cured exclusively with homeopathic remedies. Interestingly the girl's joint disease has improved with Bryonia remedy together with the orsening and spreading of her skin eruption (typical evolution from internal to external and from head, peripherally), which partly resembled the hallmarks of her brother's manifestations. Particularly the girl's skin eruption, its timing and site of appearance has given the key for choosing between two different homeopathic remedies (Medorrhinurn alternate with Sulphur iociatum), necessary for the disappearance of the symptoms in one-year-time. Discussion: these two cases could give the cue of a profound analysis regarding the practice of the complementary medicine in serious chronicicomplicated cases, but homeopathy can specially contribute to the understanding and treatment of a chronic disease, beginning from the concept of illness as an individually-specific dynamic process. The homeopathic treatment can be seen as an individually-specific epigenetic reprogramming, aimed to the eradication of the chronic disease (E.. Burgin " Atti del X congresso F.I.A.M.O. 2012" ),The epigenetic programming is indeed a progressive and constant process of cellular and tissue genomic adaptation to the local and systemic environment.The homeopathic remedy would give a coherent information, able to directly modify the morphology of the system's electromagnetic field.
Roger Williams
Director, Institute of Hepatology, London
Title: The lancet commission on liver disease in the UK
Biography:
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Abstract:
The presentation will present and discuss the 2014-2015 reports of the Commission. First report was entitled: “Addressing the Crisis of Liver Disease in the UK: A blueprint for obtaining excellence in health care in liver disease and reducing premature mortality from the major lifestyle issues of excess alcohol consumption, obesity and viral hepatitisâ€. 10 key recommendations were selected for urgent implementation on the basis that they were most likely to have a major effect. The second report examines the progress made over a twelve month period in the implementation of these recommendations. It describes a considerable increase in awareness of liver disease in the public arena, with much media attention, although Government has not yet agreed on the necessary regulatory actions. Interactions with Public Health England on their work on improving public health have increased and new working parties are considering the value of liver function tests in the triage of cases found to have abnormal findings in primary care. The new organisation and availability of the new and much more effective anti HCV agents for all cirrhotic cases are considered in relation to the prospects for eradicating HCV infection in the UK in the foreseeable future. Finally in the presentation, I describe important new cooperation with the European Association for the Study of Liver Disease in tackling the disease burden in the European Union (29 million individuals suffering from a chronic liver condition) with their new research road map for liver disease, HEPAMAP.
Nadia Jessel
INSERM (French National Institute of Health and Medical Research), France
Title: Smart and living implant equipped with active therapeutics and stem cells for regenerative nanomedicine
Biography:
Nadia Benkirane Jessel is a Research Director and Head of the Osteoarticular and Dental regenerative Nanomedicine Laboratory at INSERM (French National Institute for Health and Medical Research), France. She was the Leader of Active Biomaterials and Tissue Engineering team INSERM 977. She has received her PhD from University Louis Pasteur, France. She has then worked as Postdoctoral fellow in collaboration with the Institut Pasteur, France and another Postdoctoral position at Plum Island Animal Disease Centre, ARS-USDA, USA. She has 138 publications (h index: 36) in peer-reviewed high impact factor journals (Proc. Nat. Acad. Sci. USA; Adv. Mater.; Adv. Funct. Mater.; Small; Nanoletters, Biomaterials and ACS Nano), 5 chapter reviews and 5 international patents. She is a regular Referee for a number of scientific journals (Nature nanotechnology, Nature Materials, ACS nano, Biomaterials, Nanoletters).
Abstract:
Recently, we have reported an active nanostructured collagen implant reinforced with human stem cells for bone regeneration. In our group, we have reported a "Smart Hybrid Materials Equipped with Nanoreservoirs of Therapeutics and stem cells". This unique nanotechnology strategy is used to entrap, protect and stabilize therapeutic agents into polymer coatings acting as nanoreservoirs enrobing nanofibers of implantable membranes. Upon contact with cells, therapeutic agents become available through enzymatic degradation of the nanoreservoirs. As cells grow, divide and infiltrate deeper into the porous membrane, they trigger slow and progressive release of therapeutic agents that, in turn, stimulate further cell proliferation. This constitutes the first instance of a smart living nanostructured hybrid membrane for regenerative medicine. The cell contact dependent bioerodable nanoreservoirs described here will permit sustained release of drugs, genes, growth factors, etc., opening a general route to the design of sophisticated cell-therapy implants capable of robust and durable regeneration of a broad variety of tissues.
Bilkis Vissandjee
University of Montreal, Canada
Title: Diabetes type 2 among recent immigrants in Canada: the complex endeavor towards building inclusive and collaborative bridges
Biography:
Bilkis Vissandjée is a Full Professor in the School of Nursing at the University of Montreal. She is a Fellow of the Canadian Academy of Health Sciences. She is a researcher at the Institute of Public Health Research at the Université de Montréal. Her research work is carried out in partnership with frontline community health services organizations attending to the needs of migrant populations in Montreal as well as at the provincial and national levels. Her contributions to the scientific community along with nationally and internationally-based partners highlight the importance of accounting for sex, gender, migration and ethnicity when deriving strategies for providing quality and equity sensitive care within a diversified socio-cultural context. Her research work’s focus is to address the challenges associated with providing quality of care in a multiethnic context within a gender, migration and equity sensitive perspective. Dr. Vissandjée has conducted research on fundamental health issues of women from both Canada and other countries. Dr. Vissandjée is also involved in educational projects abroad to reinforce nursing skills seeking to enhance frontline line and public health nursing profession to a level of excellence. She is involved in encouraging student mobility and collaborative research on issues such as TB, T2DM and training with overseas partners
Abstract:
Diabetes affects 7.6% of the Canadian population, of which over 90% constitutes type 2 diabetes mellitus (T2DM). Results from linked administrative health and immigration records in selected provinces in Canada indicate that recent immigrants experienced higher odds of developing T2DM. The increased risk of T2DM among recent immigrants is attributed to multiple and interconnected factors including genetic predisposition, low income, nutritional transition, acculturative stress, social isolation, limited physical and health care services which are not linguistically and culturally sensitive. Recent immigrants are also more likely to develop complications associated with T2DM such as arthrosclerosis and renal failure. Reducing the illness complications and economic burden of T2DM requires effective self-management practices. Diabetes self-management practices include physical activity, smoking cessation, the consumption of a healthy diet, regular foot care and glycemic checks. Recent meta-analyses have clearly demonstrated the value of self-management yet no consistent pattern has been evidenced across a number of outcome variables based on strategies used to deliver sustained education. Strategies involving interactions with healthcare providers, either face-to-face or by phone have been demonstrated to produce larger effect sizes than other strategies. The proposed case study aims to demonstrate that sustained education combined with specific behavioral change strategies by advanced practice nurses based in a community organization would lead to the greatest benefits. Sessions are provided within the ‘familiar’ environment where migrant women and men are more likely to be seeking general information including legal and health issues. Behavior change and improvements in self-management are not self-sustaining; initial benefits may fade by the time of follow-up. In addition, the lifelong and progressive nature of T2DM require ongoing effective self-management interventions and follow ups. Our previous work has identified structural impediments in putting in place sustainable partnership between tertiary, primary health care settings and community-based outreach organizations. Yet, it is well documented that effective partnerships can overcome health inequities by building greater collaboration across health and social sectors on enhanced and tangible interventions as well as political advocacy. Our arguments are grounded on an ethical commitment: that such collaborative approach in the prevention and management of T2DM is carried out ethically and offers the prospect of raising the standard of health for everyone.
Barbara Wilson
Cognition and Brain Sciences Unit, England
Title: My Brain Doesn’t Know Me Any More: Prosopagnosia, An Insider’s Point Of View
Biography:
Barbara Wilson is a neuropsychologist who has worked in brain injury rehabilitation for 40 years. She has won many awards for her work including an OBE for services to rehabilitation in 1998 and three lifetime achievement awards. She has published 23 books, 280 journal articles and chapters and 8 neuropsychological tests. She is editor of the journal “Neuropsychological Rehabilitation†which she founded in 1991. In 1996 she founded the Oliver Zangwill Centre for Neuropsychological Rehabilitation. A rehabilitation centre in Quito, Ecuador is named after her. She is currently president of the Encephalitis Society and on the management committee of The World Federation of Neuro Rehabilitation. The Division of Neuropsychology has named a prize after her, the Barbara Wilson prize for distinguished contributions to neuropsychology. She is a Fellow of The British Psychological Society, The Academy of Medical Sciences and The Academy of Social Sciences. She holds honorary professorships from the Universities of Hong Kong, Sydney and East Anglia.
Abstract:
Imagine having good eyesight, being able to read well, name objects and know whether someone’s emotional expression signifies, happiness, sadness, fear, anger, disgust or surprise and yet be unable to recognise your spouse, your children or even yourself. This is what Claire, a wife, mother and former nurse experiences every day. Claire survived an illness, encephalitis, in 2004, which did not affect her physical ability, her language or her basic vision but left her with face blindness also known as prosopagnosia. Part one of this presentation consists of a detailed description of prosopagnosia, including a summary of the differences between those who can recognise people by voice or name and those, like Claire, who have lost semantic knowledge of people. Part two is a personal account from Claire herself, who explains what it is like to be unable to recognise her family and friends and how this has affected her identity. At first she felt she was in an unknown world, one where all the parameters had changed. She did not know herself or anyone else. She was very confused with her own feelings of ‘self’ and how and where she fitted in. Even now Claire feels that nobody knows very much about the person she is, least of all Claire herself, who observes that she is alone, a stranger to herself. Claire concludes by telling her story, including a little about her rehabilitation and her situation ten years after the illness.
Aleksandra Czerw
University of Warsaw, Poland
Title: Congenital anomalies of the genitourinary system can help in diagnosis of the primary site of metastatic cancer – case report
Biography:
Aleksandra Czerw, PhD, Expert in the field of health economics, organisation and management in the protection of health, medical services marketing. Assistant Professor at the Public Health Faculty of the Medical University of Warsaw. Author of numerous developments in the field of the strategic management including strategic analysis in the health protection sector. Member of the Regional and Local Analyses Centre. Co-operates with the pharmaceutical sector. Medicinal products marketing strategies consultant. Author of more than 100 national and international publications. Active member of numerous associations including: Polish Public Health Society, Polish Health Science Society, Polish Pharmaceutical Society, Polish Pharmacoecomic Society, Polish Economic Society.
Abstract:
Background: Congenital anomalies of the genitourinary system (GUS) are very common and predispose patients to many complications, including infection, obstruction, stasis, calculus formation, and impaired renal function. Congenital GUS anomalies may be also accompanied by specific types of cancer, and therefore, their presence could help in the diagnosis of the primary site of a metastatic tumor. Case presentation: In this article, the authors present a patient 58-year old man with metastatic adenocarcinoma, in whom congenital anomalies of the GUS proved helpful for the diagnosis of the primary site of cancer originating in seminal vesicles. Conclusion: We are reporting an extremely rare case of primary adenocarcinoma arising probably from the left seminal vesicle associated with ipsilateral renal agenesis. The lesion was detected on ultrasound and contrast enhanced CT and confirmed histologically with ultrasound guided biopsy. Serum markers i.e. CA19-9 and CA125 were elevated, while PSA and CEA were within normal limits. Such a constellation of markers strengthened the diagnosis. Our patient unfortunately presented very late in the course of the disease, we decided to initiate anti-androgen therapy and best supportive care in a hospice setting. Only early detection seems to be the key factor which may result in improved cure rates for cancer of the seminal vesicles. We also perform a literature search for current concepts related to the diagnosis and clinical management of primary adenocarcinoma of seminal vesicles.
Sofia
University Hospital of Heraklion, Greece
Title: A rare case of mixed Neuroendocrine tumor and adenocarcinoma of the pancreas.
Biography:
Sofia currently working in the Department of General Surgery, University Hospital of Heraklion, Crete, Greece
Abstract:
Neuroendocrine carcinoma (NEC) of the pancreas is a rare tumor with aggressive progression and poor prognosis. It’s co-existence with adenocarcinoma poses significant clinical problems and has not been addressed in the literature. Herein, we describe a case of a 51 year old male who underwent pancreatoduedonectomy for a pancreatic head tumor 1.5 x 1 x 1.4cm. Histological examination of the specimen revealed a mixed neoplasm: 1) a well differentiated Cytokeratin 7(+), Cytokeratin 20(+), CEA(+) adenocarcinoma, neoplastic blasts of which are extended focally to the submucosa without invading the muscular layer and 2) a low differentiated NEC consisting of solid clusters and pagetoid formations. The neoplastic cells of the former tumor are homogenous without obvious cytoplasm and a high number of mitoses. Immunohistochemical staining showed that the latter tumor was Cytokeratin 7(-), Cytokeratin 20(-), CEA(-), Cytokeratin MNF 116(+), CD56 (+), NSE (+), Synaptophysin (+), Chromogranin (-). Carcinomatous lymph embolus was obvious as well, but all 18 lymph nodes of the specimen were free of neoplastic disease and the surgical margins of the specimen were tumor free. Two months after the operation the patient developed liver metastasis. Ocreoscan revealed a region with moderate scintillation in the left hepatic lobe. FNA cytology of the hepatic lesions revealed low grade carcinoma with neuroendocrine characteristics and the patients received first line chemotherapy treatment with VP and CDDP. After 2 months CT of the abdomen showed progressive disease (PD) and received 2nd line chemotherapy with paclitaxel, ifosfamide, Mesna and CDDP. Three months later due to PD the patient received 3rd line treatment with Folfox and Avastin but he did not responded and after two months received Folfiri and Avastin. Four months later again the patient had PD and received 5th line treatment with CAV. The patient experienced grade four myelotoxicity without evidence of any response to chemotherapy and denied further treatment. He was discharged from the hospital and succumbed to his disease 13 months after the operation. Co-existence of NEC with adenocarcinoma of the pancreas is a very rare entity, may be resistant to various chemotherapeutic regimens and have very poor prognosis.
Ilson Sepulveda
General Hospital of Concepción, Chile
Title: Head and neck sarcomas: imaging diagnosis and treatment, our experience
Biography:
Ilson Sepúlveda, DMD, has completed his Specialization in Oral and Maxillo Facial Radiology from Chile University; Fellow in Head & NecK Imaging Diagnosis from ENT and Head & Neck Surgery Service, University of Concepción, School of Medicine and Training in Radiotherapy Planning Unit, Oncology Service, General Hospital of Concepcion. He is Member of Head & Neck Tumor Board; Planification´s Committee, Radiotherapy Unity; Ear Committee, ENT Service and Thyroid Pathology Committee, Endocrinology Service, General Hospital of Concepción. He has published more than 20 papers in reputed journals and has been serving as an Editorial Board Member of repute; and presented more than 30 clinic cases in national and international congress.
Abstract:
Sarcomas are very rare among head and neck neoplasms and represent only 1% of all primary tumors. They occur in a wide range of age groups but most often in children, adolescents, and young adults. Several environmental exposures have been proposed as causative agents in the development of sarcomas. Current classification schemes attempt to group sarcomas into subtypes that are useful for determining prognosis and formulating treatment strategies. The vast majority of tumors, approximately 80% are of soft tissue origin, while the remaining 20% are of bony or cartilaginous origin. The histologic grade is a consistent predictor of prognosis and its importance is illustrated in the American Join Committee on Cancer (AJCC) staging system for sarcomas. Imaging studies, Computed tomography (CT) and magnetic resonance imaging (MRI) complement the physical examination in order to more accurately assess the size and location of the tumor. Since sarcomas are frequently associated with soft tissue invasion and bone destruction, CT and MRI are essential for preoperative staging and surgical planning in patients with these tumors. The general protocols for the management of sarcomas are not universally applicable to the head and neck region. The delicate anatomy of the head and neck limits the ability to obtain wide surgical margins. This may be the reason for higher local recurrence rates and worse disease-specific survival of head and neck sarcomas compared to sarcomas arising at other sites.
Mohammed Atef El Naggari
Sultan Qaboos University, Muscat, Oman
Title: Nocardia asteroides peritoneal dialysis-related peritonitis; First Case in Pediatrics, Treated with protracted Linizolid.
Biography:
Dr. Naggari graduated from University of Alexandria on 1998 and completed his chief pediatric residency at Shatby's University Hospital, Egypt. He holds a Master of Science degree in Pediatrics (2004) Alexandria University; Egypt. Currently, Dr. Naggari is a Senior Specialist Pediatric Nephrologist in Sultan Qaboos University (SQU). Prior to joining SQU in September 2008, he was working for 3 years in Division of Pediatric in Ministry of Health, State of Kuwait. Dr. Naggari’s clinical practice includes the care of patients with disorders of the kidney including chronic kidney disease, nephrotic syndrome, glomerulonephritis, tubular disorders, cystic kidney disease, kidney malformations, kidney stones and hypertension. He also participates in the care of patients with end-stage renal disease on dialysis. He has a special interest in the management of patients with complex glomerular diseases, urinary tract infection, dialysis and dialysis related infections, as well as chronic kidney disease. He had many published peer reviewed articles and conference presentations. Also, Dr. Naggari is a reviewer in many international journals
Abstract:
Peritonitis is a common problem in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and represents the most frequent cause of peritoneal catheter loss and discontinuation of CAPD. Common bacteria, particularly staphylococcal species are the usual causative agents. Fungi and higher bacteria such as Nocardia asteroides as etiological agents have been infrequent in patients undergoing CAPD. We report a 13 years old female with chronic renal failure, who was on CAPD for the last 3 years. She presented with peritoneal catheter exit site and tunnel infection. The condition progressed to frank clinical and laboratory evidence of peritonitis. The course of infection was stormy not responding to several combinations of antibiotics and then progressed to septic shock and cardiac arrest. Nocardia asteroides was isolated after two weeks after high index of suspicious. This is first case report in pediatrics which was complicated by an intra-abdominal abscess that required ultrasound guided drainage and a protracted long course of linizolid antibiotic. Linizolid was given IV for 3 months in hospital then orally for 5 months with close monitoring of side effects. Patient discharged home after 3 month of hospitalization on hemodialysis. In literature, a total of 11 adult patients reported with Nocardia peritonitis. None of the reported cases used linizolid as an option in the treatment. So, this is the first report of using linizolid in Nocardia species related peritonitis. Diagnosis and management can be problematic due to the slow growth and difficult identification of Nocardia species. The optimal duration of treatment for Nocardia peritonitis is not known. Finally, protracted linizolid can be used for treatment of Nocardia peritonitis in trimethoprim-sulphamethoxazole resistant cases. Linizolid can be used for pediatric age group with close monitoring of side effects.
Alexander Vaiserman
Institute of Gerontology, University of Kiev, Ukraine
Title: Association between early-life undernutrition and adult health: A quasi-experimental evidence
Biography:
Alexander Vaiserman has completed his PhD at the age of 27 years from University of Kiev, Ukraine and postdoctoral studies from Instiute of Gerontology, Kiev, Ukraine, in 2004. He is the head of Laboratory of Epigenetics of the Instiute of Gerontology, Kiev,Ukraine. He has published 6 book chapters and more than 60 papers in reputed journals and has been serving as an editorial board member of the journals Biogerontology, Frontiers in Genetics and Gerontology & Geriatric Research. He served as an editor of the books “Early Life Nutrition and Adult Health and Development. Lessons from Changing Diets, Famines, and Experimental Studiesâ€. L.H. Lumey and Alexander M. Vaiserman (Eds.). 2013. Nova Science Publishers, Hauppauge, New York, USA. “Life extension: Lessons from Drosophilaâ€. Alexander M. Vaiserman, Alexey A. Moskalev, Elena G. Pasyukova (Eds.). 2015. Cham-Heidelberg-New York-Dordrecht-London, Springer International Publishing Switzerland. “Anti-aging drugs: from basic research to clinical practiceâ€. Alexander M. Vaiserman (Ed.). 2016. RSC Publishing, Cambridge, Great Britain (In preparation)
Abstract:
Early-life malnutrition is important determinant of metabolic disorders and associated cardiovascular disease in later life. To examine whether a link exists between early-life exposure to famine and adult health, we determine the risk of developing type 2 diabetes (T2D) in Ukraine residents born before, during, and after the famine of 1933. The sample studied consisted of 28,358 T2D patients born in 1930-1938 and living in Ukraine regions that suffered significant demographic losses due to famine. Reference populations were based on the Ukraine census 2001 (n = 2,153,335). It was appr. 1.5-fold increase in the risk of developing T2D in both men and women who were born in the first half of the 1934 year as compared to the individuals who were born in the pre-famine and post-famine cohorts. These differences are highly significant compared to the appropriate reference cohorts born in 1938 [odds ratios are 1.48 and 1.52 for men and women, respectively]. Remarkably, those individuals who were born in the first half of 1934 and who have higher risk of developing T2D, were exposed to the peak of the famine periconceptionally. The findings obtained in our research are similar to those found in studying other famine episodes such as Dutch famine of 1944-45 and suggest that periconceptual exposure to the famine may result in induction of persistent epigenetic changes that predispose to metabolic disorders in the later life
Margaret Wong
Eye Consultants of Atlanta in Georgia, USA
Title: Acute retinal necrosis: A comparison of cases
Biography:
Margaret Wong is a board-certified Ophthalmologist specializing in uveitis and surgical vitreoretinal diseases. She is a graduate of Northwestern University Feinberg School of Medicine in Chicago, Illinois. She has completed a General Surgery Internship and Ophthalmology Residency at Northwestern Memorial Hospital in Chicago, Illinois. She has also completed a Uveitis Fellowship at University of Illinois in Chicago and a Surgical Vitreoretinal Fellowship at Eye Consultants of Atlanta in Georgia where she is currently practicing.
Abstract:
Acute retinal necrosis (ARN) progresses quickly to severe vision loss with delayed diagnosis. This comparison of ARN cases shows one diagnosed early and the other misdiagnosed and treated late. A 42-year-old Caucasian male had a respiratory infection treated with prednisone. Facial shingles developed two weeks later treated with Valtrex. Vision was 20/20 and 20/25, respectively. Right eye was normal. Left eye showed anterior chamber inflammation and retinal necrosis. ARN was diagnosed and treated with Valtrex and Durezol. The disease completely resolved and medications discontinued. Two months later, anterior segment inflammation and cystoid macular edema developed in the left eye. This was treated with Valtrex, Pred Forte and Prolensa. Eye drops were discontinued and Valtrex will continue indefinitely. Patient’s vision remains 20/20 bilaterally. A 40-year-old Caucasian male presented with one week of rapidly decreasing vision in the left eye. He had a history of herpes treated with Valtrex. An outside physician diagnosed optic neuropathy and retinopathy and started prednisone; vision was 20/200. On presentation to our institution, vision was hand motions and ARN diagnosed. Prednisone was discontinued and started Valtrex and Durezol. Two intravitreal ganciclovir injections were given. Vision improved to counting fingers. He later presented with light perception vision due to retinal detachment. This was repaired and vitreous fluid sent for PCR, which was herpes simplex positive. Vision improved to 20/400 and prophylactic Valtrex continued. This highlights devastating visual consequences with delayed diagnosis of ARN. It is important to have a high index of suspicion for early treatment administration to prevent vision loss.
Christian T. Braun
University Hospital Bern, Switzerland
Title: Lazy lips: Hyperkalemia and acute tetraparesis, a case report from an urban emergency department
Biography:
A 58 year old male patient was admitted to our emergency department at a large university hospital due to acute onset of general weakness. It was reported that the patient was bradycardic at 30/min and felt an increasing weakness of the limbs. At admission to the emergency department, the patient was not feeling any discomfort and denied dyspnoea or pain. The primary examination of the nervous system showed the cerebral nerves II-XII intact, muscle strength of the lower extremities was 4/5 and a minimal sensory loss of the left hemisphere was found. In addition the patient complained about lazy lips. During ongoing examinations the patient developed again symptomatic bradycardia, accompanied by complete tetraplegia. The following blood test showed severe hyperkalemia probably induced by use of aldosterone antagonists as the cause of the patient’s neurologic symptoms. Hyperkalemia is a rare but treatable cause of acute paralysis that requires immediate treatment. Late diagnosis can delay appropriate treatment leading to cardiac arrhythmias and arrest.
Abstract:
Christian T Braun is currently working in the Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland.
Zeynep Guldem Okem
TOBB University of Economics and Technology,Turkey
Title: The health care reforms in Turkey: the success and some unfinished agenda
Biography:
Zeynep Güldem Ökem, PhD, is an Associate Professor at University of Economics and Technology, Department of International Entrepreneurship in Ankara, Turkey with extensive experience on international and nationally funded research projects working as a coordinator and a researcher in the field of social security, social innovation in health and long-term care systems
Abstract:
Turkey has made significant progress in health status indicators and access to health services during the past ten years. This has been achieved through comprehensive reforms in the health system known as the Health Transformation Program (HTP) that was started in 2003. Changes in health financing and provision improved financial and physical access. A universal and compulsory health insurance was introduced to the whole population and existing insurance schemes were unified and the family medicine was widened to the whole population. Payment methods to health service providers were also changed to improve efficiency, quality and patient satisfaction. The reform implementations were based on evidence and therefore the correct remedies could be introduced accordingly. While Turkey’s reform experience is shown as one of the successful implementation there are still some unfinished issues. The financial and physical accesses to health services have been improved. Government’s ability to control increased health expenditures due to improved access is as another successful aspect of the reform process. However, controlling health expenditures has been achieved through ad-hoc changes in reimbursement rules and payment methods to health service providers. These implementations have been adversely affecting health service utilization and causing uncertainty for health services providers, namely hospitals, drug and medical devices’ companies. This presentation gives an overview about the main achievements of the HTP by taking into account the extent of improvements in equity, efficiency, financial sustainability and quality in health services. The analysis is based on evidence that is done through a comprehensive review of published literature since 2003. The key lessons for countries with similar problems and some unfinished issues are given accordingly.
Mikaela Poling
FSRG deGruyter-McKusick Institute of Health Sciences, USA
Title: Freeman-Sheldon syndrome: what one illustrative, severe case tells us about pathophysiology and needed research
Biography:
Mikaela I Poling has completed her BA in history, with specialisation in modern Western military medicine and surgery 1850-1945, doing her undergraduate thesis on the history and ethics of military stress physiology research. She is currently doing her maters thesis in clinical and applied physiology on Freeman-Sheldon syndrome. She is the main author of the first therapeutic guidelines for Freeman-Sheldon syndrome and co-founder of FSRG, the only orginisation in the world focused on the syndrome. She has multiple peer-review publications and conference presentations and has been serving as a journal peer reviewer.
Abstract:
Freeman-Sheldon syndrome (FSS) reported, of which we are aware, recent basic science research on pathophysiology is described and possible ways these findings compliment each-other and resultant implications considered during recent clinical practice guideline development is addressed. While fulfilling Stevenson's 2006 diagnostic criteria, the patient described presented with several previously unreported and rare findings that may serve as 'missing links' in the effort to better appreciate pathophysiology in FSS. Previously unreported findings include: thyroid and cricoid cartilage hypoplasia, a vertical ridge of ossified elevation (right dorsal mid-clavicular line from inferior scapular border to inferior costal margin), left atrophy and right hypertrophy of the latissimus longus and right atrophy and left hypertrophy of the latissimus dorsi muscles, paroxysmal resting tachycardia of typically 110-130 bpm, with a range of 56-215 bpm, without evidence of pathology, severe hyperhidrosis, post-traumatic stress disorder, undersised external auditory canals, and secondary limitation of extra ocular movement. These findings are all consistent with a myopathic aetiology, which was suggested by previous authors and studies. Patient described also experienced subjectively high energy expenditures, estimated to be on the order of 10-25% above normal range. This clinical hypothesis may be at least partially substantiated by recent in vitro muscle fibre studies showing impaired cross-bridging in two patients with one of the more common mutations. Mutations for FSS were previously suggested to impair adenosine triphosphate binding at the embryonic myosin head. Physiological appreciation is critical for FSS outcomes.
Gamal Kassem
Zagzig Univeristy, Egypt
Title: Importance of case reports in advancing clinical knowledge and treatment strategies
Biography:
Gamal Abdel-Ghany Kassem Omar is currently Professor in Department of Obstetrics and Gynecology, Zagazig University, Egypt. He is the member of Institutional Review Board and responsible for development of scientific research in the Department of Obstetrics and Gynecology, Zagazig University. He is also the member of Scientific Research Council of the Faculty of Medicine, Zagazig University. He is peer reviewer of international journals.
Abstract:
Research in case reports should not only discuss rare cases but also confirm the common practice. Really the common is common but the rare is present. When I was junior resident, when we faced a rare case, we exhaust ourselves to check in the references or asking our senior colleagues. The time elapsed from facing such cases to find the most appropriate management may endanger the patient health. Nowadays management of difficult as well rare cases is a part of the curriculum of postgraduate teaching. Another point, medicine is ever a changing and growing science; many diseases which were considered to be rare in the past are now part of practice. Placenta accreta, a life threatening condition, was mentioned in the literature to be a rare disease. Nowadays, due to rapid increase in the rate of cesarean section, placenta accreta became a relatively common disease. There is international consensus that all units of Ob-Gyn should have a clear protocol for management of such serious condition. A third point; case reports as research are not suffering from statistical errors. Really such errors may lead to inaccurate conclusions and recommendations. Case reports can introduce an easily digestible knowledge.
Moustafa Elsheshtawy
Tanta University, USA
Title: Hypothyroidism and Congenital long QT: Additive effect causing torsades?
Biography:
Dr. Elsheshtawy earned his degree in Medicine from Tanta University, Tanta, El-Gharbia Governorate, Egypt, and completed his Residency Training at Coney Island Hospital, Brooklyn, New York, USA. He is currently beginning his Fellowship in Cardiovascular Medicine at Maimonides Medical Center, in Brooklyn as well. Dr. Elsheshtawy has always been interested in clinical medical research and has participated in many National and International Clinical Trials, most notably with the National Heart, Lung and Blood Institute (NHLBI), Roche Pharmaceutical, Boehringer Ingelheim Pharmaceutical, Hospital Quality Foundation among others. Dr. Elsheshtawy’s academic work has been recognized at the national American Medical Association (AMA) 2015 Conference in Atlanta, Georgia.
Abstract:
Hypothyroidism can result in a myriad of cardiovascular effects. We present a rare instance of a young female patient with torsades de pointes (TdP), a fatal ventricular tachyarrhythmia, potentiated by hypothyroidism superimposing a congenital long QT syndrome. Although hypothyroidism has been linked to torsades de pointes in few case reports, none of the reported patients have been tested for congenital long QT syndrome. Reversing cardiovascular risk has been documented when patients regained their euthyroid state after Levothyroxine replacement therapy. Patients should be given stress dose glucocorticoids while levothyroxine dose increases gradually to avoid precipitating acute coronary syndrome especially in patients with underlying coronary artery disease. Clinicians should be aware of life-threatening complications of hypothyroidism. Prompt diagnosis and treatment can lead to absolute recovery and a favorable long-term prognosis.
Sowmya Nanjappa
University of South Florida College of Medicine, Florida
Title: Histoplasmosis in its various forms and different people
Biography:
Sowmya Nanjappa is an Assistant Member in the Department of Internal Medicine, Moffitt Cancer Center and Assistant Clinical Professor of Medicine in the University of South Florida, College of Medicine, Tampa, Florida. She has received Excellent Intern 2010 Award and also received Excellent Resident Award for the year 2011 at the Wyckoff Heights Medical Center Nursing Department, academic affiliate to Cornell Presbyterian University, New York.
Abstract:
Introduction: Histoplasmosis/Ohio valley disease is associated with exposure to soil contaminated with bird or bat droppings. It presents as acute/chronic pulmonary and disseminated forms. It is associated with very high mortality among immunocompromised patients. Possible complications include ARDS, Meningitis, pericarditis and adrenal insufficiency. Diagnosis is by direct tissue staining, serology, cultures and detection of antigen. We studied 18 cases of culture positive histoplasmosis at SLUH (St Louis University Hospital), a 356 bed teaching hospital from 2009-2013. Methods: Using EMR, we retrospectively studied patients >18 years with culture positive Histoplasma. We collected data regarding demographics, underlying immunodeficiency states, clinical features, lab findings, treatment and outcomes. Results: The average age at diagnosis was 49.1 years. 15/18 (83.3%) were males. 8/18 (44.4 %) had AIDS and 8/18 (44.4%) were immunocompromised with transplant and cancer. 16/18 (88.8%) had disseminated histoplasmosis. Common presenting symptoms included, fever 13/18 (72.2%), GI symptoms 12/18 (66.6%), fatigue 10/18 (55.5%). Positive blood cultures were found in 15/18 (82.2%). Of the 18, we tested 15 (82.2%) for urine histoplasma antigen of which 9 (60%) tested positive. The most common radiological findings were nodules 11/18 (61.1%) and lymphadenopathy 9 (50 %). Of 18 patients, 15 were treated and amongst them 13 (86.6%) were adherent to IDSA guidelines. In hospital mortality was 16.6%. 80% patients followed up in ID clinic were treated successfully at one year. Conclusion: The study suggested that histoplasmosis is more common amongst middle aged men. Importantly, patients with histoplasmosis should be a screened for Immunocompromised states like HIV or immunosuppressive drugs. Common symptoms are fever, GI symptoms and fatigue. Blood culture was the best test for the diagnosis of histoplasmosis. Main radiological findings were pulmonary nodules and lymphadenopathy. Majority of the treated patients were adherent to the IDSA guidelines of treatment. In hospital mortality was found to be 16.6%. Most (80%) of the patients followed up in ID clinic were treated successfully at one year.
Moaize Chechi
clinical doctor in Wales, UK
Title: A case report of an 80 year old man with mesenteric panniculitis, a raised lactate and hyperglycaemia
Biography:
Moaize Chechi has completed an MBBS degree at Barts of the London, University of London in 2014. He intercalated in Global Public Health and Primary Care in 2013, being awarded a BSc (Hons). Now working as a clinical doctor in Wales, he is actively involved in high quality research alongside his clinical duties in a variety of medical and surgical roles.
Abstract:
Introduction Mesenteric panniculitis is a rare condition which presents as abdominal pain. It involves benign inflammatory or fibrotic changes affecting the mesentery of the bowel. Presentation of case An 80 year old man presented with severe abdominal pain of acute onset. He was found to have a high lactate and high blood glucose. He was not a known diabetic. A computed tomography (CT) scan revealed a diagnosis of mesenteric panniculitis, and the patient rapidly responded to steroid treatment. Discussion Mesenteric panniculitis has been known to present as an acute abdomen. However, an associated high lactate and hyperglycaemia is hitherto unreported in the literature. With no obvious precipitant for an increased lactate, we propose it is potentially caused by the subsequent fat necrosis and regional ischaemia associated with mesenteric panniculitis. Conclusion This case report underlines the importance of further research into the relationship between mesenteric panniculitis, a high lactate, and diabetes. In addition, short term steroid treatment (one month) seemed to confer the same benefit as long term steroid treatment.
Biography:
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Abstract:
Education must be interactive and development is being followed process. In this process it is possible to follow improving by assessment activities. Measurement and assessment is indispensable factor in instructional curriculum. Because students want to know about their success and mistake in the process of education. Thus they will study more consciously and the study became more effectively. Assessment gives feedback about education process to teachers, students and parents. It is so important point fair treatment in assessment process as well. In this situation there is a question “how can be possible measure adequately whether or not learning has really occurred?â€. Students’ learning level can measure not only by exam tests but also other alternative evaluation tools (concept map, performance tasks, project, self-evaluation, structured grid, rubric, branched tree, drama, observation, control list, portfolio) extensively (Birgin, 2003; Corcoran, Dershimer & Tichenor, 2004; Leithner, 2011). Complex mixture of assessment models are taken into consideration in higher education. Exam tests, presentations, tasks, assignments which prepared by students can use together in education for comprehensively assessment (Gülbahar & Köse, 2006; Powell, 2013). In addition to students develop themselves by organizing work. Thereby students can track their own growth and determine their own deficient ( Baturaya & DaloÄŸlu, 2010). Systematic and purposefully collection of students’ working documents on their course is defined as portfolio (Arter & Spandel, 1992; Chang, 2008). Portfolio has a major role in teaching, learning and assessment activities. Portfolio acts as a mirror in the education process. Because it reflects students’ progress. It can be said that portfolio is an evidance about summative evaluation (Baume & Yorke 2002; Brown, 2003). Elwood & Klenowski 2002 point out that summative evaluation not enough in education. Formative and summative evaluation metods must use together for effective assessment. Portfolio can use as a formative evaluation tool. Protfolio enable to student became active in learning and assessment process (Güven & AydoÄŸdu, 2009). Because students carve works out frequently. Students research, write reports and present their work to create portfolio. Portfolio supports permanent learning (Ä°zgi & Gücüm, 2012) and improves students’ ability of creativity (Katırcı &Satıcı, 2010). Plus Chang, Liang and Chen’s (2013) view portfolio is useful for teachers. Because teachers can determine interest and ability of their students and guide them well. In accordance with this view Klenowski, Askew and Carnell, (2006) specify portfolio is very considerable learning and assessment tool in the higher education. Additionally portfolio is valuable tool for higher education. Because they help students and teachers to know what is occurring in their teaching program and help them unroll on their own failures and inadequacy as well as successes (Winsor, 1994). The data which obtained by portfolio must be reliable and valid for acceptance as a assessment tool (Dubrovich, 2002). Kan (2007) refers that the data which obtained by portfolio must be evaluated not only by a teacher but also other teachers and experts. Teachers’ and experts’ results must be consistent. In this direction Oskay, Schallies, and Morgil (2008) defined that portfolio is reliable and valid tool in the assessment process
Pariessa
University of Santo Tomas Hospital, Philippines
Title: Post-Varicella acute demyelinating polyradiculoneuropathy in a 51-Year old filipino male
Biography:
Pariessa D Dadgardoust has completed her medical degree at the University of Santo Tomas Faculty of Medicine & Surgery in Manila, Philippines and graduated in 2009. She is currently a resident-in-training at the Department of Neurology and Psychiatry of the University of Santo Tomas Hospital.
Abstract:
Background: Primary Varicella zoster infection is commonly observed in school-aged children. There are increasing reports of adults being affected. Varicella zoster infection has a myriad of clinical complication. The rarer of these complications is Guillan Barre syndrome (GBS) or acute inflammatory demyelinatimg polyradiculoneuropathy (AIDP), with less than 50 cases in reported literature. Objectives: Our aim is to highlight a rare case of post-varicella infection GBS happening in an adult. Methods: This is a case report with a concise history and adequate ancillary work-up. Results: We report a case of a 51-year-old Filipino male who presented with weakness and numbness of both upper and lower extremities two weeks after a primary varicella infection. CSF analysis for this patient showed elevation of CSF protein (69 mg/dl). CSF Varicella virus IgG was 1.8 mIU/ml and IgM was at 1 mIU/ml. Nerve conduction velocity studies showed delayed latencies or absent response, prolonged conduction velocities or absent response, temporal dispersion, and partial conduction block at both median, ulnar, tibial and peroneal nerves. Conclusion: The objective finding in this case as well as the clinical history is indicative of a demyelinating sensorimotor polyneuropathy after a varicella infection.
Youssef Abo Elwan
Zagazig University, Egypt
Title: Methotrexate overdose to a patient with ectopic pregnancy under medical management
Biography:
Youssef Abo Elwan currently working as Professor of obstetrics & gynecology, Zagazig University
Abstract:
A 24 years old Saudi Patient G3 P2 +0.35 weeks pregnancy was admitted as an emergency case complaining of dizziness and fatigability; she also suffered of nausea during her pregnancy. She had history of delivery of anencephaly; she was a known case of hypothyroidism. Upon admission she was pale but not jaundiced. Her Hb was 4.9 gm/dl, MCV 82.30 fl (80-101), MCH 28.80 pg (27-33), Retics% 0.18 (0.2-2), her platelet count dropped from 40,000 to 27,000 /mm3 after 3 days from admission LDH 5175. Her B.P 120/80, no proteinurea, her ALT and AST was within normal. She received 3 units of packed RBCs on admission. Based on thrombocytopenia, high ESR and splenomegaly, she was through to have connective tissue disease and she received pulse methylprednisolone for 3 days, however with no response. Later on we repeated blood film and serum B12 level which showed hypersegmented neutrophil and serum B12 was very (31.9 pmol/L; N= 148-616). It was clear at that time; the cause of severe thrombocytopenia was vitamin B12 deficiency. So cyanocobalamine injection started which showed within few days marked improvement in platelet count up to 260.000/mm3, Hb 11.7 g/dl, retics % 10.9, after less than 10 days from starting vit B12 injections. Patient continued her pregnancy and delivered spontaneously 2270 gm with good Apgar score. We concluded that vitamin B12 deficiency should be considered as a cause of severe thrombocytopenia although it is rare.
Joseph Butterworth
University Hospital Coventry and Warwickshire, UK
Title: Acute myeloid leukemia in Jehovah’s witnesses
Biography:
Joseph Butterworth has completed his degree in Biomedical Sciences in 2009 from Newcastle University before completing a Postgraduate Medical Degree from Warwick University in 2013. He is currently an Acute Medical Clinical Fellow at University Hospital Coventry and Warwickshire.
Abstract:
To induce disease remission and cure in acute myeloid leukemia (AML) requires highly myelosuppressive chemotherapy. Treatment typically necessitates supportive measures including blood product transfusions during the marrow aplasia associated with treatment. The refusal of Jehovah’s Witnesses (JW) to accept transfusions makes the application of intensive chemotherapy a practical and ethical challenge. Within the remit of acute leukemia there is a variable need for blood product support. Acute lymphoblastic leukemia or acute promyelocytic leukemia (APL) are responsive to less myelosuppressive therapy such as vincristine and prednisolone or all-trans retinoic acid, respectively and their treatment in JWs incurs less risk than treating a JW with acute myeloid leukemia. Such cases and cases of JWs with AML treated with individually tailored less myeloablative regimens are reported, however, there remains no documented case of AML where complete remission (CR) has been achieved with standard intensive chemotherapy without blood product support. We present the case of an 18 year old female Jehovah’s Witness diagnosed with de novo AML who achieved and maintained CR following intensive induction chemotherapy and three subsequent cycles of consolidation chemotherapy without blood product support.
Biography:
Waqas Hussain is working on different international research based projects and presenting his research work all over the world. Waqas, who is also an ACM and IEEE fellow, worked for World Wide Fund which is the world's largest conservation organization. After working in computer science, he has turned his attention to medical science, particularly bacteria attacking the white blood cells, Nattokinase effects on blood pressure (Hypertension) and Alzheimer’s disease.
Abstract:
The cause of Alzheimer's disease is poorly understood. About 70% of the risk is believed to be genetic with many genes usually involved. Other risk factors include a history of head injuries, depression, or hypertension. The disease process is associated with plaques and tangles in the brain. The brain maintains high levels of ascorbic acid (AA) despite a concentration gradient favoring diffusion from brain to plasma. Although Alzheimer's disease is considered to be a degenerative brain disease, it is clear that the immune system has an important role in the disease process. New immunotherapies using humoral and cell-based approaches are currently being investigated for the treatment and prevention of Alzheimer's disease.
Muhammad Akbar
Medicine Universitas Indonesia, Indonesia
Title: Alveolar soft part sarcoma metastases intracranial
Biography:
Muhammad Akbar is completing his Bachelor in Faculty of Medicine University Indonesia. He was entered Faculty of Medicine University Indonesia on year 2014. He has published more than 5 papers in reputed national journal anc scientific competition. When creating this case report, he is guided by dr. Tiara Aninditha, neurooncology consultant of cipto mangunkusumo hospital in Jakarta. She has published more than 100 papers in reputed journal and she has gived more than 30 lecture about neurooncology.
Abstract:
Alveolar soft-part sarcoma (ASPS) is rare neoplasma that usually found in extremities and it has high prevalence in adolescence and young adult. ASPS have tendency to metastases to intracranial area, including brain and orbita. Author describes 21-years-old patient with ASPS grade III in lower part of right upper extremity and it metastases to intercranial area especially orbita area causes right eye protopsis following with severe pain (Visual Analog Scale 6-7) with good condition of visus. Patient had been treated to take patient’s tissue by biopsy several times because it is hard to scoring histopathophysiologically and then patient had been treated with radiotherapy. Although, there is no significantly change in patient condition. Overall mass in orbita, intracranial, and upper extremity. So, patient is suffering significant patient and lowering visus. This is caused by lowering Karnofsky performance Scale (KPS). With this reason, patient cannot be treated by chemotherapy. Patient is rehospitalized for overall condition repairment and pain treatment, including giving radiotherapy to mass in patient’s upper extremity. ASPS patient survival rate with brain metastases is low. Patient can survive approximately only 12 month from patient had been positively diagnosed with ASPS.
Biography:
Magda Zelazowska is currently a PhD Student in Applied Linguistic at University of Warsaw, Poland. Her scientific interests include medical language and medical translation, translation studies, doctor-patient communication and scientific writing. She is an active member of national and international conferences, author and co-author of papers devoted to the medical language, English for Medical Purposes and case reports’ discourse.
Abstract:
In this poster, the issue of patient presentation in professional medical texts has been addressed from a linguistic perspective. To this aim a corpus of medical case reports has been compiled in order to examine both direct and indirect references to the patients described there. The studied tokens are investigated from two perspectives. First, the focus falls on patient textual presence/absence as conditioned by the type of information appearing in respective text-parts. Second, the analysis of patient reference in the sections of the case reports is discussed with respect to some of the facts from the history of the development of medicine, as, according to Bazerman (1988), scientific discourses are shaped by given disciplines (1988: 47). In the case of the texts in question, their form and content may also be influenced by the currently practiced model of medicine, i.e., the biomedical model. Furthermore, the analysis draws on the hierarchical levels of medical description as well as on the two models of disease presentation. The study reveals that as the texts progress, they become more patient-evacuated and focuses on his/her progressively smaller body-parts. In other words, patient reference changes from direct indexicality to indirect references to his/her body parts or the textual absence of the treated. This effect is achieved not only by the type of information imparted but also by the lexical and grammatical resources used to describe it. Consequently, the mode of writing as testified in the case reports at hand contributes to the presentation of mental/bodily experience, disease and treatment in abstraction from a patient.
Ertan Yetkin
Abant Izzet Baysal University, Turkey
Title: A female patient case report with varicose vein symptoms and ecchymosis on lower extremities
Biography:
Yetkin was born in Eregli-Konya, Turkey, in 1969. After graduating from medical school he worked as a physician in TYIH Hospital Ankara, Turkey. He was awarded by European Society of Cardiology in 2001 as a Young Investigator. He got his associate professorship at the Inonu University Hospital, and professorship at the Abant Izzet Baysal University, Bolu, Turkey. He worked at the Cardiovascular Research Institute of Maastricht, Department of Molecular Cardiology, in Maastricht the Netherland, as a research scientist. Currently he works in Middle East Hospital Department of Cardiology, Mersin, Turkey. His researches focused on dilating vascular diseases, endothelial function, arteriogenesis, and valvular heart disease. He is a member of European Society of Atherosclerosis, European Vascular Biology Organization, and president of Society of Vascular and Molecular Cardiology (Turkey)
Abstract:
Symptoms of peripheral varicose vein or chronic venous insufficiency include aching, itching, restless leg, edema, muscle cramps, leg ulcers, tightness, heaviness and cosmetic concern as well. Here I present a female patient with varicose vein symptoms and ecchymosis on lower extremities. Case: A 35 years old female presented with the symptoms of ecchymosis on her both legs and thighs for several weeks. Her detailed history revealed any known systemic disease, recent infection or malignancies. She denied using of any drugs such as anti-platelets or anticoagulants. Her physical examination was normal except the ecchymotic lesions and varicose vein on both lower extremities. There were several irregular shaped ecchymotic lesions on both extremities in different stages of healing from deep purple to brownish pigmentation. She was then queried for the presence of venous symptoms such as restless leg aching, muscle cramps, and itching. She noticed she had been suffering from muscle cramps especially in the night for several weeks, and she noticed new ecchymotic lesions mainly the day after she had muscle cramps. Her laboratory examination was normal. She was given to micronised purified flavonoid fraction treatment. After one month follow up period she was free of any symptoms and there were no ecchymotic lesions on her extremities. Although this is the first reported case, I believe that this is not the first case in clinical practice. Extravasations of blood components namely erythrocytes during the muscle cramps are likely for the mechanism of ecchymosis. Regarding the diagnostic challenge of venous leg symptoms, ecchymosis should be also taken into consideration in the differential diagnosis varicose vein or venous insufficiency
Ghanemi
China Pharmaceutical University, China.
Title: Animal models of Alzheimer’s disease: Limits and challenges
Biography:
Ghanemi completed his Bachelors degree in pharmacy from the country Algeria. He studied Pharma. D programme from Mentouri University of Constantine, Algeria. He also completed his Masters in Pharmacology from the China Pharmaceutical University, China. He has total 47 publications in different medical journals
Abstract:
Neurodegenerative diseases represent a hard challenge that the modern medicine andhealth care worldwide have to face due to the high social and economic incidences theyhave, especially among the aged populations. Within this context, Alzheimer’s disease (AD), the most common neurodegenerative disease in the elderly represents agood example. Understanding its pathophysiology and finding an effective and radical cureremain the purpose of researchers around the world. One of the biggest struggles facing anyadvances in understanding the pathophysiology of this disease is the lack of animal modelsthat allow us to both study AD itself and test therapeutic agents. Currently, differentanimal models (AMs) have been reported in the literature and each one has itsspecific features and disadvantages as well. Selecting an animal to develop an AD, the AM requires taking many factors into consideration.First, similarities between the animal and the human being in terms of thefeatures linked to AD should be considered (e.g. genetic profile, biochemical basis andpathogenesis manifestation). Second, the ability to evaluate and assess the symptoms andthe pathological variation of the disease should also be a detrimental element of selection.The approaches commonly used to develop the AM may subsequently limit the applicationand the reliability of the model. For instance, genetic methods areused to introduce AD-specific genes into the brain of the animal so it expresses ADspecificproteins such as amyloid and tau proteins. However, other non-suitable proteinsmay be expressed too. Furthermore, even the desirable proteins may be expressedoutside the suitable area when a virus is used as a vector for those genes. Elements may render the AM defective. Moreover, while validating an AD treatment for such transgenic animals, the possibility that the treatment would have just antagonized the genetic modification remains possible. On the other hand, the evaluation of the AM, the possibility of reporting the variation of symptoms before and after, then the development of the AM, and also the comparison of the symptoms of the same animal after the AM has been built; all this can lead to controversy. Indeed, some symptoms are linked to the memory and the cognitive functions, which cannot always be assessed in animals, due to the difference between human beings and animals in terms of brain functions (e.g. executive function, language, calculating, visual memory, working memory, etc). Another approach may be applied to design an AM, which is the use of chemicals shown or thought to play roles in the pathogenesis of AD such as formaldehyde. Such methodology may also lead to interference since the chemicals may result in symptoms similar to those seen in AD without in fact exhibiting AD pathogenesis, notably with what has been reported about the effects chemicals might have on live cells. Importantly, diet may influence AD development, thus leading to differences between AMs due to possible non-similar diets. Another challenge is the interactions that exist between the neurotransmitters within the nervous system that works as a network. This means that modifying the chemistry of one neurotransmitter within an AM could have an impact on the other neurotransmitters such as dopamine and lead to symptoms related to other neurological or psychiatric diseases (e.g. schizophrenia and Parkinson’s disease) instead of AD. Hence, this finally complicates furthermore the study of AD from a neurobiological viewpoint.However, designing an AM for AD that would mimic all thefeatures of the disease, including inflammation oxidative damage, personality changes and the loss of language skills remains far to achieve. One solution would be to have several AMs. Each one would be the best for one or for a number of symptoms. Therefore, only the summation of the results obtained from those AM would give a panoramic result for both pathway studies and drug evaluation tests, especially if reinforced with in vitro tests that combine a cell culture test with the animal model results.