Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 5th European Conference on Clinical and Medical Case Reports Paris, France.

Day 1 :

  • Case Reports on Psychology |Neurology| Ophthalmology |Dentistry |Cardiology |Pulmonology |Gastroenterology |Diabetes |Obstetrics and Gynaecology |Epidemiology |Surgical | Paediatrics| Public Health | Dermatology |Emergency Medicine and Critical Care |Forensic and Legal Medicine |Internal Medicine |Orthopaedics & Rheumatology |Pharmacology and Therapeutics |Womens Health |Radiology |Anaesthesiology |Pathology- Anatomic & Clinical |Sexual Health |Cancer Science| Clinical Pathology |Geriatric Medicine |Veterinary |Vascular and Endovascular Surgery
Speaker
Biography:

Dr. Velinov is an Associate Professor at Albert Einstein College of Medicine 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:

A 15 years old female patient was referred for genetic evaluation because of dysarthria and muscle hypotonia. Her early motor development was delayed. She did not start walking until 2.5 years. Reportedly her early speech development was not delayed. However at her first visit with us she was noted to have dysarthria. She was also reported to have academic difficulties, possibly associated with her dysarthria. This patient had prominent muscle weakness. She had great difficulty getting upright from squatting position. She could not run and sometimes had impaired balance. The patient’s parents were first cousins. Screening laboratory tests and molecular testing for Friedreich ataxia were normal. Whole exome sequencing was done because no specific etiology was apparent. The patient tested positive for homozygous pathogenic sequence change in gene DOK7 (c.1124_1127dupTGCC). Homozygous mutations in this gene were previously associated with Congenital Myastenic Syndrome type 10 (CMS10).
Previously reported Albuterol treatment in 15 patients with DOK7 mutations led to improvement in these patients’ muscle strength. Treatment of our patient was initiated with 4 mg P.O. Albuterol daily. She initially developed borderline increase in her blood pressure and the Albuterol dose was decreased to 2mg alternated with 4 mg daily. At this regimen no adverse effects were observed. Monthly fatigue tests examining the muscle strength were conducted and a significant improvement of muscle strength of hands, abdominal muscles and legs was recorded. In addition the patient’s parents reported improvement in her speech. The patient continues to receive Albuterol treatment. Personalized medicine is a relatively new developing medical approach that already has wide application in cancer care and clinical genetics. This new field was greatly empowered by the development of technologies for massive nucleic acid sequencing. Identifying specific somatic or constitutive mutations helps the physicians develop patient-specific treatment plans that demonstrate better efficiency.

Speaker
Biography:

Dr. Ehab M. Esheiba completed his Postgraduate Diploma in Internal Medicine and Master Degree in Cardiology in 2004. Later he completed his MRCPUK and he is a Fellow of the Royal College of Physicians of Edinburgh. He is a Member of the European Society of Cardiology and European Association of Cardiovascular Imaging. He has several publications and presentations at national and international levels. He is currently involved in several Clinical Research projects as a Principal Investigator and also as a Supervisor and Co-Supervisor. He is an Editorial board member of a reputed cardiology journal. Currently, he is heading the Cardiology Department of Thumbay Hospital, Gulf Medical University, Ajman, UAE.

Abstract:


Chronic thrombo-embolic pulmonary hypertension (CTEPH) is defined as an elevation of the mean pulmonary arterial pressure above 25 mmHg that persists six months after an episode of pulmonary embolism (PE).  It occurs an about 2-4% in survivors from PE. The clinical picture, natural history and prognosis may vary from one patient to another.

Venous thromboembolism (VTE), including both deep vein thrombosis (DVT) and PE is the third most common cardiovascular illness after acute coronary syndrome and stroke.

A 29 year old male patient presented with gradually progressive shortness of breath and fatigue for several months. He had one episode of loss of consciousness. Clinical examination revealed picture of pulmonary hypertension. Further laboratory and imaging confirmed the presence of recent pulmonary embolism and markedly elevated pulmonary arterial pressure, consistent with the diagnosis of CTEPH.
.
In this article, we discussed this clinical case, the diagnostic pathway and the management plan that was followed with the patient till his last follow-up, focusing on guidance on management in the same context.

We believe that addressing VTE as a possible regional public health problem should take a multi-dimensional approach targeting the epidemiology of the disease with implementation of cost-effective preventive and therapeutic programs.

Speaker
Biography:

Vasiliki E. Kalodimou MSc, Ph.D. is the director of the Flow Cytometry-Research and Regenerative Medicine Department at IASO Hospital in Athens, Greece. She has studied and worked with progenitor cells from placenta, umbilical cord, and adipose tissue along with their applications in regenerative medicine and flow cytometry, with publications in the field, including research fellowships. She has published 2 books about flow cytometry, the Greek edition was published in 2010 and in 2013 the book was published from AABB Press USA (Bestseller). In 2015 she was published her 3rd book, a handbook to mesenchymal stem cells in regenerative medicine by Specg.co
She is a Flow Cytometry/Stem Cell Specialist, Leader at AABB CT Subsection: CT Product Manufacturing and Testing-USA, Scientific Consultant in Regenerative Plastic Surgery Institute / Pure Aesthetics, Brazil, AABB Assessor-USA, editor in 12 scientific journals, editor-in-chief in 4 scientific journals, and her biography was included in Who Is Who in the world 2014, 2015 & 2016 edition.

Abstract:

The rejuvenation of their genitalia and the vagina will help to dramatically improve the quality of their lives.
Our aim is to prove that the infusion of mesenchymal stem cells contained in adipose tissue  has an important contribution and long-term results:
1. In appearance and function of the skin and mucosa of the external female genitals and the vagina.
2.To reduce pain in women with dyspareunia
3. At the entrance of the vagina showing thinning of the epithelium and adhesions of granulation tissue.
4. To  reduce urinary incontinence (from stress incontinence)
5. The improvement or treatment of  lichen sclerosus of the vulva to restore the quality of life and sexual function in the affected women.
 

Speaker
Biography:

Maria Voyatzi completed her Phdat the age of 26 years from the Aristotle University of Thessaloniki, Greece and postdoctoral studies from the hospital of dermatological and venereological diseases of Thessaloniki , state clinic. she has published more than 15 papers in reputed journals and participated in many hellenic, European and world congresses.

Abstract:

Our purpose is to study the efficacy of the Alexandrite laser (755nm) and the fractional laser when treating pigmentary lesions , the efficacy of the NdYAG Laser ( 1064 nm ) when treating telangiectasias and hemangiomas and the efficacy of the NdYAG Laser and fractional laser on rejuvenation.We used the data from our private office from the past five years  (2011-2015). We treated 1000 patients with freckles with Alexandrite laser, 200 patients with melasma with fractional laser, 100 patients with postinflammatory hyperpigmentation with Alexandrite laser and 60 patients  with postinflammatory hyperpigmentation with fractional laser. We also studied the side effects of the therapies. Alexandrite laser had excellent results on freckles, while the combination of chemical peels and fractional laser was satisfactory for the treatment of melasma. Post inflammatory hyperpigmentation had an intermediate response. The recurrence rates were higher in melasma and the side effects were generally minimal. We also treated 500 patients with telengiectasias and 300 patients with hemangiomas with NdYAG Laser. As far as telangiectasias were concerned, the results were much better when  the face was treated . In contrast, the recurrence rates were much higher when the legs were treated. The results were impressive in almost all cases of cherry hemangiomas. The combination of NdYAG Lasers and fractional lasers on a monthly basis had satisfactory results in rejuvenation

Speaker
Biography:

Reis PEO is specialist in Vascular Surgery and Endovascular Surgery . Adjunct Professor of Vascular Surgery and Professor, Graduate Course in Cardiovascular Sciences. He is coordinator of the Vascular Surgery Service, University Hospital Antonio Pedro, Federal University Fluminense. Brazil / Rio de Janeiro / Niterói .He is also Editor-in-Chief-Journal of Vascular & Endovascular Surgery . EJVES Short Reports Editorial Board - Associate Editor

Abstract:

This case report describes a case of abdominal aortic stenotic disease treated with covered balloon- expandable stent with absence of the celiac trunk artery. Technique: Patients are selected for this strategy if they have a lesion without bifurcation involvement located at the mid segment of the infrarenal aorta or stenosis with unfavorable aortic anatomy, or severely diseased and calcified distal aorta. Conclusion: Our result in this case supports the feasibility, safety, and efficacy of stenting for stenosis of the distal infrarenal aorta.
Keywords: aortic stenosis, endovascular procedures, angioplasty, endovascular surgery, celiac trunk variation

Speaker
Biography:

Dr Ali Moghimi graduated from the Iran University of Medical Sciences, Tehran, with his medical degree in 2002. He worked as both a General Practitioner and Research Assistant for few years in Iran before moving to Australia. Dr Moghimi began his specialty training in Anatomical Pathology in 2009 and obtained his Fellowship of the Royal College of Pathologists of Australasia early in 2014. He is currently a member of the International Academy of Pathology and has over 10 publications to his name. Dr Moghimi joined Dorevitch Pathology in 2014 and his special interests are obstetrics and gynaecological, perinatal and renal pathology.

Abstract:

Bartholin gland cyst results from dilatation of the Bartholin duct due to obstruction. Pigmentation in an external genital cyst, such as median raphe cyst, has been previously reported. However, presence of melanocytes or melanin pigment in the cyst wall of Bartholin duct cysts is an extremely rare finding, with only one case reported in the literature. Herein, I report the second case of pigmented Bartholin duct cyst with a brief review on pigmented cystic lesions in anogenital area. 

An 18-year-old lady presented with small pigmented papule in vulva, clinically resembling haematoma. The biopsy identified squamous mucosa with underlying stroma showing cystic spaces, lined by single or double layers of cuboidal to flat epithelium. Some epithelial cells contained brown pigment granules in their cytoplasm and there were also pigments within the surrounding stroma as well as the lumina of cystic spaces. The melanocytes within the epithelium of the cyst were stained by Melan-A, SOX10, MIT1 and S100 immunoperoxidase stains. A diagnosis of pigmented Bartholin duct cyst was rendered.

This is the second documented case of pigmented Bartholin duct cyst in the literature. The first was a 41-year-old Japanese female who presented with an asymptomatic nodule in the external genitals, showing features similar to this case.  The mechanism of pigmentation has not been elucidated and there are no malignant features associated with this finding. However, it is important for reporting pathologist to be aware of this variant in order to avoid misinterpretation of the findings as an atypical melanocytic lesion. 

Speaker
Biography:

Dr. Abascal-Garcia completed the Emergency Medicine program and Critical Care specialization at the National Autonomous University in Mexico. He is part of the Intensive Care Staff at Hospital Espanol, a renowned institution in Mexico. He has published several papers in reputed national journals focusing in Intensive Care.

Abstract:

Case: A 29 years old obese and diabetic pregnant woman (29 weeks of gestation) presented to the emergency room with 200/120 of blood pressure nonresponsive to oral medication nor sulfate magnesium infusion. Laboratories and other vasospasm manifestations confirmed an overt HELLP syndrome. She underwent an emergency C-section and was admitted into the Intensive Care unit (ICU) afterwards. She was started on intravenous Labetalol and mechanical ventilation due to respiratory failure. She evolved with oliguria (KDIGO Stage 1) despite of a fluid accumulation of 6% in a 6-hour period. Despite hemodynamic stability was achieved and renal biomarkers being unaltered, continuous renal replacement therapy (CRRT) was initiated in a full convection modality. Clinical and biochemical normalization occurred after 48 hours and mechanical ventilation was withdrawn. She was disconnected from renal support 24 hours after extubation, and discharged from the ICU 72 hours after the admission. Urinary flow remained adequate during the whole ICU stay. She and her baby were discharged healthy to home.
Discussion: Proinflammatory Cytokines damaging the endothelium is part of the still not fully understood HELLP syndrome pathogenesis. These cytokines (IL-2, TNF) have a molecular weight compatible with convection clearance. CRRT has been used without severe kidney injury in Acute Respiratory Distress Syndrome, pancreatitis and other syndromes with good outcomes. The early use of CRRT might have accelerated patient´s recovery.
Conclusion: CRRT exhibited benefit in a case of HELLP syndrome with KDIGO stage I AKI. This pathology should be explored as a non-renal indication for CRRT.

Speaker
Biography:

Mohammed Alfawareh currently works in Spine Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia

Abstract:

Background:
Early onset scoliosis (EOS) has higher risk of large curve because have because they have longer growth potential, casting and braces can be used to delay surgery.
When progressing surgery may be needed, growth-friendly procedures, three categories were identified: distraction-based like growing rods, tension-based like staples and guided-growth like Shilla.
Growing rod has advantage of correcting spine deformity while preserving the growth but frequent surgeries may increase the complication rates.
Recently magnet expandable rods (MER) have been introduced as solution to overcome the need for frequent elongation surgeries; it has magnate gear that can be elongated remotely by external remote controller.
Methods
Case report of early onset scoliosis that was managed by MER, developed unique complication; catastrophic failure of both MER, after initial distraction, initial height was lost subsequently, never regained with subsequent distractions.
Results
MER failed and revised, both rods failed through the magnet gear, it was elongated and shortened in telescoping movement by simple hands power and couldn’t maintain distraction. To our knowledge this complication never been reported before, Akbarnia et al reported loss of the initial height after distraction in three patient but non failure.
Conclusion:
MER promising technology, allow spine growth while correcting the deformity, no need for subsequent surgeries and few reported complications, catastrophic failure never been reported.

Speaker
Biography:

Osman A Hamour is currently working in the Department of General Surgery, King Faisal Specialist Hospital and Research Center, Saudi Arabia

Abstract:

Abstract Background: Thyroidectomy is a common and safe surgical procedure and is typically associated with low
morbidity and mortality. Delayed tracheal rupture after thyroidectomy has only infrequently been reported. Here we are
reporting a case in which a number of rare complications of total thyroidectomy and neck dissection happened over a
very short period of time with a review of existing literature.
Case presentation: A 48-year-old man, diagnosed as metastatic papillary thyroid cancer. Underwent total
thyroidectomy and bilateral modified neck dissection complicated by severe bronchospasm, bilateral pneumothorax,
pneumomediastinum, pneumopericardium managed by underwater seal drainage of his chest cavities. On the
10th postoperative day he developed spontaneous tracheal rupture which compromised his airway. He was coded,
eventually intubated resuscitated. In the operating room he had his neck explored, neck haematoma evacuated,
tracheal tear debrided and a tracheostomy tube was inserted.
Conclusion: Thyroidectomy remain a commonly performed safe surgery typically associated with low mortality
and morbidity. However other rare and serious complications as observed in this case can sometimes take plac and can be life threatening. Bilateral pneumothorax, pneumomediastinum and pneumopericardium are examples of such serious complications. Multiple contributing factors include heavy smoking, alleged barotrauma, and extensive electrocautery dissection. In our case the late spontaneous rupture of the trachea most likely been predisposed to by the excessive explosive smokers cough.

Speaker
Biography:

Prof. Adel Mishriky graduated from Ain-Shams University Medical school in Egypt in 1976, and completed her Doctoral degree in Occupational Medicine in a joint program between the University of California at Los Angeles (UCLA), and Suez Canal University (SCU) in Egypt. She had postdoctoral studies at London School of Hygiene and Tropical Medicine. He was the chairman of the department of Community Medicine at the Faculty of Medicine, SCU, and is currently an Emiratus Professor there. He has published more than 60 papers in reputed journals and has been serving in the editorial board of the Saudi Medical Journal.

Abstract:

Objective: To evaluate the impact of a multidisciplinary care program for patients with uncontrolled type 2 diabetes (T2D). Methods: We conducted a before-and-after study among patients with uncontrolled T2D and/or comorbidities at a primary care center in Riyadh, Saudi Arabia. The intervention consisted of intensified and patient-specific multidisciplinary care. The team included a senior family physician, nurse, clinical pharmacist specialist, dietician, diabetic educator, health educator, and social worker. Outcomes measured were HbA1c, fasting blood glucose (FBG), lipid profile, and blood pressure (BP). Results: 41 patients were included in the study. Mean age was 56.2 years. HbA1c, FBG, triglycerides, and total cholesterol were significantly reduced in the post-intervention stage (reductions of 18.5%, 21.0%, 16.0%, and 10.5%, respectively). The reduction in HbA1c was highest among patients with uncontrolled diabetes without comorbidity (25.7%), moderate among patients with cardiovascular disease and/or dyslipidemia (12.6%) and minimal among those with renal problems (0.3%, p < 0.05). LDL cholesterol was also reduced (10.5%, but not significantly). HDL cholesterol and BP did not show any significant changes in the postintervention stage. Conclusion: Integrated care was associated with a 20% improvement in glycemic control and up to a 16% reduction in serum lipids but no change in blood pressure among patients with T2D at high risk of cardiovascular disease.

Luis Antonio R. Balajadia

Southern Philippines Medical Center Davao City, Philippines

Title: Primary adrenal hemangiopericytoma: The first reported case
Speaker
Biography:

Luis Antonio R. Balajadia  has completed his Doctor of Medicine at the age of 26 years from Davaao Medical School Foundation  and  3 year General Surgery Residency Training at Davao Doctors Hospital. He is currently the Chief Resident of the Section of Urology in the Southern Philippines Medical Center.

Abstract:

Hemangiopericytomas are rare tumors originating from pericytes in the wall of capillaries. It is a type of soft tissue sarcoma which commonly involves the lower extremities, pelvic retroperitoneum, and head and neck. The age of initial diagnosis of HPC is 40.3 years-old (range 16-86) usually presenting as a painless mass. A 32-year old female presented with a 5 year history of slowly-growing right flank mass. She denied any history of hematuria, dizziness, headaches or hypertensive episodes. Physical examination findings showed a bulging right flank and an approximately 15 x 15 cm, palpable, nontender mass on bimanual examination. CT-scan with IV contrast was requested and revealed a large suprarenal mass, right. She underwent adrenalectomy with en-bloc nephrectomy, right with uneventful post-operative course. Histopathology of the specimen was read as hemangiopericytoma. Further testing by Flourescence In-Situ Hybridization confirmed the diagnosis. Metastatic work-up was done and was negative. Hence, this is the first reported case of primary adrenal hemangiopericytoma. Surgical removal is the mainstay of treatment of hemangiopericytomas. Radiotherapy and chemotherapy have no role in the management of the disease. The lesson learned from this case is that behind every mask there is a face, and behind that, a story. What seemed to be a simple and ordinary as an adrenal mass turned out to be as special and unique as a hemangiopericytoma.

Speaker
Biography:

Nadia Rizkalla graduated from Cairo University Medical school in 1976, and completed her Doctoral degree in community medicine in a joint program between the University of California at Los Angeles (UCLA), and Suez Canal University (SCU) in Egypt. She had postdoctoral studies at London School of Hygiene and Tropical Medicine. She was the chairman of the department of Community Medicine at the Faculty of Medicine, SCU, and is currently an Emiratus Professor there. She has published more than 20 papers in reputed journals and has been serving as WHO consultant.

Abstract:

The Egyptian Ministry of Health and Population (MOHP) endorsed the screening program for congenital hypothyroidism (CH) using TSH assay method. The aim of the study was to evaluate the impact of CH on growth and development of treated cases, compliance of the healthcare providers' (physician and nurse) to the current program, compliance of the target families' to the current protocol of management program, and the coverage rate for 3 years (2007-2010). The study was carried out through descriptive, cross-sectional and follow-up approaches in pediatric clinic of Insurance Students' Hospital in Ismailia Governorate. The setting is responsible for management of positive CH cases detected by screening test within the national program. The tools used for data collection included a structured interview questionnaire for mothers of CH infants in addition to physical examination of infants including anthropometric measurements. An open interview questionnaire was used for healthcare providers, and an abstraction checklist form to assess the coverage rate of the program from records of live births and positive cases. Results: The coverage rates of the program were 92.4%, 91.7%, and 90.9% for the years 2007, 2008, and 2009 respectively. Screening was done for 86.7% of studied subjects at age range 7-14 days, and 53.3% of cases were confirmed at this age. Sixty percent of cases started therapy at age 14-21 days; 20% and 26.7% of cases showed improvement for wt/age and ht/age respectively, and 40% and 26.7% in personal-social and problem solving areas respectively. Only one third of mothers were informed about the test during pregnancy, and their compliance rates to therapy, scheduled visits, and investigations were 53.3%, 26.7%, and 86.7% respectively. Although studied physicians were aware of the national program, they had deficient knowledge about CH diagnosis and therapy, whereas nurses were not aware of the importance of health education to mothers. In conclusion, the program coverage is high and the outcomes of therapy are promising. Healthcare providers’ awareness and knowledge need to be improved.

Paulo Eduardo Ocke Reis

Fluminense Federal University, Brazil

Title: Embolization for visceral artery aneurisms
Speaker
Biography:

Reis PEO is specialist in Vascular Surgery and Endovascular Surgery . Adjunct Professor of Vascular Surgery and Professor, Graduate Course in Cardiovascular Sciences. He is coordinator of the Vascular Surgery Service, University Hospital Antonio Pedro, Federal University Fluminense. Brazil / Rio de Janeiro / Niterói .He is also Editor-in-Chief-Journal of Vascular & Endovascular Surgery . EJVES Short Reports Editorial Board - Associate Editor

Abstract:

De Bakey and Cooley did the first successful operation for a visceral artery aneurysm (VAA) in 1953. They are relatively rare and the risk of rupture is associated with high mortality .The majority of patients are asymptomatic prior to rupture and the main indication of elective treatment is size, now a days endovascular procedures as embolization or covered stents have increased the treatment options available to comorbid patients not suitable for open repair. VAAs are seen more often these days with the more widespread use of computed tomography. Coil embolization techniques are often used to “trap’” the aneurysm between coils placed proximally and distally within the normal part of the parent artery. This technique is well suited for aneurysms in larger arteries but requires adequate collateral circulation to the end organ. VAA can often be excluded from the circulation in this way by coil embolization of first the distal and then the proximal segment of the parent artery. Modern endovascular techniques with promising short- and long-term results could broaden indications to treat asymptomatic VAA. The promising results of endovascular treatment in elective settings could lead to broader indications, thus reducing life-threatening rupture. The advances with embolization techniques in the last decades are quite evident, and the field of endovascular surgery and minimally invasive techniques has accompanied this development, aiming at overcoming its limitations. Keywords: visceral artery aneurysm, aneurysm rupture, embolization, coil embolization.

Speaker
Biography:

Youssef Abo Elwan works as a Professor of Obstetrics & Gynecology, Faculty of Medicine, Zagazig University, Egypt. He is the head of High Risk Pregnancy Unite. Faculty of Medicine; Zagazig University, Egypt. He is the member of High council Supreme for Professor Promotion in Egyptian Universities. He is also the Reviewer in many national & international journals.

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 all over 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 vit 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 vit B12 deficiency should be considered as a cause of severe thrombocytopenia although it is rare.

Speaker
Biography:

Mehmet Hüsamettin AKKÜÇÜK currently works in the  Department of Emergency, Alanya Training and Medical Research Center, Başkent University Faculty of Medicine, Antalya, Turkey

Abstract:

Objective: Describing a case of a patient with presumed massive pulmonary embolism with
cardiac arrest and successfull resuscitation with fibrinolysis during CPR using rTPA.
Case summary: A 74-year-old man presented to the emergency departme for head trauma
due to syncope. On arrival, initial examination was suspect for myocardial infarction, and
cardiogenic shock but there were no signs of pulmonary overload. Cardiac ECHO showed a
dilated right heart and additional analysis turned the differential diagnosis to pulmonary
embolism.. Thrombolytic therapy was considered. His condition rapidly deteriorated and
progressed to cardiopulmonary arrest.During advanced cardiac life support, empirical
alteplase 50 mg was administered intravenously over 15 minutes with return of spontaneous
circulation (ROSC) The diagnosis of massive PE using computed tomography angiography
was confirmed after fibrinolytic therapy. During hospitalisation gastrointestinal bleeding
developed requiring transfusion, but no further complications occurred. Patient was
discharged after 15 days without any neurological sequelae.
Discussion: Diagnosing pulmonary embolism may be difficult. Massive pulmonary embolism
has a high mortality and early treatment is essential. Return of spontaneous circulation
(ROSC) is very rare in patients with cardiac arrest following massive PE. Clinical guidelines
recommend fibrinolytic therapy for patients with PE and cardiac arrest. It has classically been
contraindicated because of a concern for fatal bleeding. Current literature based on
retrospective studies and case reports however, seems to favor fibrinolytic treatment in PEassociated
cardiac arrest due to an increased chance of ROSC and improved survival.
CONCLUSION: Fibrinolysis may be beneficial in achieving ROSC, reducing mortality, and
preserving neurological function in PE-associated cardiac arrest patients, even in cases of
prolonged CPR and delayed fibrinolytic administration without increased risk

Speaker
Biography:

Youssef Abo Elwan works as a Professor of Obstetrics & Gynecology, Faculty of Medicine, Zagazig University, Egypt. He is the head of High Risk Pregnancy Unite. Faculty of Medicine; Zagazig University, Egypt. He is the member of High council Supreme for Professor Promotion in Egyptian Universities. He is also the Reviewer in many national & international journals.

Abstract:

A 25-year-old female patient admitted via ER to Gynecology Ward. She was G2P0+1 with history of 5 weeks amenorrhea, complaining from mild PV bleeding since a day before admission. There was a history of previous ectopic treated by Laparoscopy.
The patient was vitally stable. On Examination,  the abdomen soft, lax. PV with os closed with mild bleeding. Her CBC and Blood chemistry was within normal range. Pregnancy test (in ER) was positive, her B-hcg was1088. TVS ,shows empty cavity, left adnexal mass, pouch of Douglas free.
Plan of management was Medical treatment by Methotrexate 50 mg IM stat with serial repeating B-hcg after counseling the patient and her husband.
The patient received 500 mg im instead of 50 mg im !!
Imediately, Blood samle taken and send to Toxocology Center to determine serum Methorexate level, CBC, LFT RFT.
Plan of management was as follows :
1. Calcium Folate " Leucovorine" as 15mg per amule/6 h iv.
2. Normal Saline 500ml +Sodium bicarbonate 8.4% 90 ml to be 20 cc/h by infusion bump.
3. Normal Saline 500 ml/ h to keep urine PH>7.
4. Repeat CBC, RFT, LFT Daily.
5. Serial Serum level of Methotrexate in Toxocology Center.
6. Close Observation.
Methotrexate Serum level before starting Antidote was 85 ( Toxic level 24 hours after injection >5 mol/ L). Serum level of Methotrexate start to decrease daily. All other investigations came within normal and the patient discharged in good condition with follow up in OPD after one week.
The case discussed in Sentinel Event Committee and a Policy of Adminsteration of these Cytotoxic Drug implemented.
In Conclusion ; Patient life saved from Toxic effect of Methotrexate by Rapid Antidote of LEUCOVORINE and Hydration of the patient. Multidisciplinary input is of paramount importance.

Speaker
Biography:

Hongwei wan has completed his PhD at the age of 45 years from ChiangMai University, School of Nursing. She is the director of Nursing Department, Shanghai Proton and Heavy Ion Center, China. He has published more than 20 papers in domestic and international journals and has been in charged of several research program.

Abstract:

Breastfeeding knowledge, attitude, subjective norm, and perceived control are significant determinants of breastfeeding, according to the theory of planned behavior (TPB). This study aims to investigate the effectiveness of the TPB-based intervention program in improving exclusive breastfeeding, and the interaction of time and intervention on these determinants of breastfeeding. 285 primiparous mothers were included, with 157 mothers in the experimental group and 128 mothers in the control group. The experimental group received the TPB-based intervention program delivered during 6 weeks postpartum, which focused on improving mohters’ breastfeeding knowledge, attitude, subjective norm and perceived control, while both the experimental and control groups received the standard obstetric care. Scores of breastfeeding knowledge, attitude and breastfeeding control increased with time from baseline to 6 weeks postpartum, while breastfeeding subjective norm decreased at 6 weeks both in the experimental and the control groups. Besides, scores of the four determinants were significantly higher in the experimental group than these in the control group at 3 days and 6 weeks, except for breastfeeding control at 6 weeks, which resulted in the higher exclusive breastfeeding rates at 3 days and 6 weeks in the experimental group than the control group. The TPB-based intervention was effective in promoting exclusive breastfeeding during 6 weeks postpartum. Future interventions are recommended to adjust intervention strategies with time, and give more focus on providing continued breastfeeding support after discharge.

Jaewon Phee

Brighton and Sussex Medical School, UK

Title: An unusual presentation of Roth spots in Cogan’s Syndrome
Speaker
Biography:

Jaewon has completed her B.Sc. (Hons) Medical Sciences from the University of Edinburgh in 2013 with an award for academic excellence. She is currently a 4th year medical student in Brighton and Sussex Medical School (BSMS) with research interest in ophthalmology. Her research output to date includes four national poster presentations. Jaewon is currently the committee member of the BSMS Ophthalmology Society and she is a member of Brighton Institute for Healthcare Improvement (IHI) Open School Chapter. She is invovled in re-launching the leadership drive in Brighton with the junior doctors to create an educational community to facilitate multi-disciplinary discourse and education in patient safety, quality improvement, health care innovation, management, and leadership.

Abstract:

Introduction
Cogan’s syndrome is a rare chronic inflammatory disease that can lead to blindness, deafness and even death. It is described as “a syndrome of non-syphilitic interstitial keratitis (IK) and Ménière-like audiovestibular dysfunction”1. The cause is still unknown and the diagnosis is usually made on clinical grounds, as there is no specific investigation for the disease. Here we present a case of Cogan’s syndrome with a rare ocular manifestation.
Purpose
To present a case of Cogan’s syndrome with a rare ocular manifestation
Results
A 32-year-old man presented to the emergency department with a 10-day history of blurred vision and pain in his right eye. Preceding this, he had a two-week history of deteriorating balance and nausea.
On examination of his right eye, his visual acuity was 6/60. He had anterior chamber inflammatory cells with associated keratic precipitates, vitreous cells and multiple Roth spots. He later developed reduced hearing in both ears and a diagnosis of Cogan’s syndrome was made. He was promptly treated with oral prednisolone and cyclophosphamide.
A week later, the anterior chamber activity had resolved and his vitreous cells had completely settled. His Roth spots had also faded. However, he had ongoing balance issues and had developed bilateral moderate sensorineural hearing loss, tinnitus and true vertigo.
The patient responded well to systemic immunosuppression and two weeks later his visual acuity had improved to 6/18 and he had recovered most of his hearing.
Conclusions
This is a case of Roth spots caused by Cogan’s syndrome, an association that has not previously been described.

Małgorzata Stefaniak

Medical University of Warsaw Faculty of Health Sciences, Poland

Title: Osteosarcoma during pregnancy - case report
Speaker
Biography:

Małgorzata Stefaniak currently works in Medical University of Warsaw Faculty of Health Sciences

Abstract:

In Poland, sarcomas represent about 1% of all cancer diseases. Every year about 800 new cases are diagnosed. Osteosarcoma is the most frequently recognized  primary primary malignant bone tumor.
Osteosarcomas are diagnosed more frequently in children and adolescent males, whereas in pregnant women they are extremely rare. We present a case of a 29-year-old pregnant woman with a highly diverse osteosarcoma. A patient which was in 23rd week of pregnancy was treated with multiple doses of chemotherapy while fetal health was being monitored.
The plan for a therapeutic process included inducing a  pregnancy solution at the moment of the fetus reaching maturity, then continuing oncological treatment.
According to the established protocol of treatment in 34 week pregnancy was completed via cesarean section. The woman gave birth to a daughter in good condition. Surgical treatment was conducted after delivery until complete post-pregnancy healing. There was no reduction of dose or quantity of planned and conducted courses of chemotherapy due to pregnancy.
The paper offers an analysis of diagnosis and therapy of pregnant women with osteosarcoma based on own experience and on the basis of a relevant literature.