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.
- Case Reports: Obstetrics and Gynecology | Gastroenterology | Pulmonology | Dentistry Epidemiology | Public Health | Pediatrics | Cancer Science
Session Introduction
Sergey Suchkov
I.M. Sechenov First Moscow State Medical University, Russian Federation
Title: Predictive, preventive and personalized medicine (PPPM) as an upgraded model of national and international healthcare services to secure a future of clinical research and practice
Time : 09:00-09:30
Biography:
Sergey Suchkov is a Researcher-Immunologist, a Clinician graduated from Astrakhan State Medical University, Russia in 1980. He has been trained at the Institute for Medical Enzymology, The USSR Academy of Medical Sciences, National Center for Immunology (Russia), NIH, Bethesda, USA and British Society for Immunology to cover 4 British university facilities. Since 2005, he has been working as Faculty Professor of I.M. Sechenov First Moscow State Medical University and of A.I. Evdokimov Moscow State Medical & Dental University. He is the First Vice-President and Dean of the School of PPPM Politics and Management of the University of World Politics and Law. He was a Scientifi c Secretary-in-Chief of the Editorial Board of the International Journal “Biomedical Science” (Russian Academy of Sciences and Royal Society of Chemistry, UK) and The International Publishing Bureau at the Presidium of the Russian Academy of Sciences. He was a Director of the Russian-American Program in Immunology of the Eye Diseases. He is a Member of EPMA, NY Academy of Sciences and an Editorial Board Member for Open Journal of Immunology and others.
Abstract:
Predictive, Preventive and Personalized Medicine (PPPM) as the Healthcare Model of the near future, as well as its associated tool, i.e., Translational Medicine (TraMed), represent an innovative model of healthcare services to consolidate advanced healthcare and robust platform for relevant industrial branches of predictive diagnostics, personalized therapeutics and preventive drugs. To achieve the implementation of PPPM concept into the practice, it is necessary to create a fundamentally a new strategy based upon the subclinical recognition of biomarkers long before the disease clinically manifests itself. Th is strategy would give a real opportunity to secure preventive measures whose personalization could have a signifi cant influence on demographics! Meanwhile, penetration of new technologies into the market would demand the implementation of reforms not only in the area of healthcare, but in medical education as well. Th erefore, the problem of the preparation of specialists of the newest generation to secure priority in growing up medical doctors as creative artists, is becoming particularly urgent and would require signifi cant revision of training programs and curricula of the higher education as applicable to the medical schools. Modernization and integration of widely accepted medical and teaching standards require consolidation of both the natural (life) sciences and medicine that may become the conceptual basis for the medical school curricula. Th e main goal of this training is not simply to achieve advanced training and expansion of technological skills, but to provide development of novel multifaceted approaches to build academic schools of the newest generations and to thus outline curricula and courses to suit markets of the newest medical platforms. PPPM consists of a wide variety of tests and tools including so much complicated areas as networking, mathematic modeling, nanotools and nanotechnologies, cloudy and mobile technologies to suit the requests and standards of the new healthcare model. Coordinated measures to optimize the progress should be well-focused on solving the accumulating problems in healthcare and the concomitant economic burden that societies across the globe are facing more and more. Taking into consideration the current trends and personal experience, we have made fi rst steps towards direct involvement in the modernization of the healthcare model. Group and individual vectors as part of the basic inventory are represented by translational medicine, bioinformatics, drug design, translational tools and regulatory courses). Our model for accelerated development of continuous vocational education (CVE) in the sphere of PPPM and TraMed is based on the combinatorial approaches (competence, module-type approach, personal activity, program-design and problem-oriented) to the elucidation of innovative processes of modernization of the existing educational model. Th e application of the accelerated model for development of CVE has required a new type of the infrastructure of the Curricula. PPPM whilst secured by the upgraded educational system would off er great and real promise for the future. And the next generations will speak about the XXI century as a time, when healthcare services became predictive and preventive and its outcomes secured and guaranteed!
Moorkath Nandakumaran
University of Kuwait, Kuwait
Title: Maternal-fetal transport of L-leucine in pre-eclamptic pregnancies in vitro
Time : 09:30-10:00
Biography:
Moorkath Nandakumaran Obtained Doctorate Degree in Reproductive Physiology from University of Paris VI in the year 1979 and later did post-doctoral training as a Research Consultant for about 4 years at the famous St Vncent de Paul Hospital, Paris in fi eld of Biochemical Pharmacology. He is currently Professor in Obstetrics &Gynecology Depoartment of Kuwait medical Faculty, Kuwait University. Dr Nandakumaran specializes in research relating to maternal-fetal exchange of nutrients and drugs in control and disease state including pre-eclampsia and diabetes mellitus , using isolated human placental perfusion technique as well as using experimentally induced diabetic rats. Has published nearly 100 research papers and presentations in international scientifi c journals and conference proceedings and has been Invited Speaker in many International Conferences.
Abstract:
Introduction: Previous reports from our laboratory had shown that maternal-fetal transport kinetics of model nutrients and reference markers were altered in toxemia model placenta in vitro. Th is study was meant to explore whether transport kinetics of a model amino acid L-Leucine were altered in placenta from pre-eclamptic pregnancies in vitro. Methods: Human placenta from pre-eclamptic pregnancies were collected post-partum.14-C labeled L-leucine (specifi c activity: 54 uCi/mmol, Amersham, UK) along with tritiated water (specifi c activity 5 mCi/mmol, Amersham, UK) as reference marker were then injected as a single bolus (100 ul) into the maternal arterial circulation of perfused placental lobules and perfusate samples collected from maternal and fetal circulations over a period of 5 minutes. National Culture and Tissue Collection medium, diluted with Earle's buff ered salt solution was used as the perfusate. Concentration of labeled substances in perfusate samples in control and toxemia model perfusion phases was assessed by scintillation spectrometry (LKB Wallac Scintillation Spectrometer, Denmark) using preadjusted double window counting. Transport kinetics of substances studied was computed using established permeation parameters. Results: Diff erential transport rates of L-leucine and tritiated water in 8 perfusions diff ered signifi cantly (Student's t-test; p<0.05) for all transport fractions studied in control perfusions and perfusions from three pre-eclamptic pregnancies. Transport Fraction index of L-leucine compared to reference marker averaged 35.2% in control perfusions (n=8) and 22.20% in perfusions from pre-eclamptic pregnancies (n=3) respectively. Th e diff erence observed in TF index of L-leucine in control and study groups was statistically signifi cant (Student's t-test, p<0.05) Indices of transport fraction and certain pharmacokinetic parameters such as area under the curve, absorption rate, elimination rate of deoxy glucose compared to reference marker were signifi cantly diff erent (p<0.05) between control and pre-eclampsia groups. Absorption rate: Elimination rate indices of model amino acid diff ered signifi cantly between control and study groups (Student's t-test; p<0.05). Conclusions: Our studies show for the fi rst time that transport behavior of a model amino acid leucine is compromised in preeclamptic pregnancies and that the altered behavior of placental membrane in amino acid transport in such pregnancies has the potential to cause undesirable sequelae for the fetus and neonate.
Deanne S Saores
Royal Prince Alfred Hospital, Sydney, Australia
Title: Papillary Renal Cell Carcinoma Seeding Along a Percutaneous Biopsy Tract
Time : 10:00-10:20
Biography:
Deanne Soares is a senior surgical resident at Concord Repatriation General Hospital in Sydney, Australia. She has completed a Masters of Surgery from The University of Sydney and a Masters of Health Leadership and Management from the University of Wollongong. She is currently engaged in multiple research projects in the fields of surgery and training and education
Abstract:
The use of percutaneous biopsies is useful in the diagnosis and management of renal masses with a complication rate of <0.01%. However, a potential hazard of this is tract tumor seeding but this is so rare in renal cell carcinoma (RCC) that its frequent use in the assessment of indeterminate renal masses has been justified. We report a case of tumor seeding caused by percutaneous biopsy of a papillary renal cell carcinoma detected on pathological assessment of the partial nephrectomy specimen in a 50-year-old male. Literature review found that up until 1991, there were only 5 reported cases of RCC tract seeding and in 2013 there were a further 3 cases reported. In general, tract seeding will relate to the amount of disruption of the tumor capsule (needle caliber, number of punctures), pressure of egress at the puncture site (for example, cystic masses or escaping hematoma), whether tumor cells are dropped from the needle on its withdrawal (failure to maintain negative pressure, burred needle tip) and the ability of tumor cells to survive when deposited into a scar. This is one of only a few contemporary case reports of RCC seeding along a percutaneous biopsy tract. Whilst this complication is so rare that it does not warrant a need to cease the use of percutaneous biopsy of renal masses, it certainly highlights the possibility of tract seeding as a potential hazard. As such, certain considerations such as appropriate patient selection, the use of correct equipment and suitable biopsy technique, should be made to minimize the risk of this complication.
Mahmoud Shafei
Ain shams University, Egypt
Title: Extraordinary case of perforated meckel’s diverticulum with a pathological abruptness of GIST (Gastrointestinal stromal tumor) in 74 years old man
Time : 10:20-10:40
Biography:
Mahmoud El-Shafei has completed his MD degree in General Surgery, Faculty of Medicine, Ain Shams University (1994) and completed the ISO Training course-Quality system documentation-Atlantic Engineering-Management Academy (AEMA). He is currently working as a Professor of General and Laparoscopic Surgery, Ain Shams University, Egypt. He is also a Consultant of General, Laparoscopic & Oncosurgery in Ain Shams Specialized Hospital & Eldemerdash University Hospital. He is a Visitor Consultant of General, Laparoscopic & Oncosurgery, Shobra Health Insurance Hospitals and General Transportation Hospitals from 2006 to till date.
Abstract:
A Meckel’s diverticulum is a vestigial remnant of the omphalomesenteric (vitello-intestinal) duct. As a congenital anomaly, it is a true diverticulum that includes all three coats of the small intestine. Generally, a Meckel diverticulum ranges from 1 to 12 cm in length and is found 45-90 cm proximal to the ileocecal valve. It frequently contains heterotropic tissue; when it does, gastric mucosa accounts for 50%. It is no exaggeration to say that tumors within Meckel’s diverticulum are very uncommon with particular concern to GIST which is very rare finding. Fortunately we reported a case of 74 years old man with acute right iliac fossa pain and shock. On examination the patient had tachycardia and hypotension with tenderness and rebound tenderness in the hypogastrium suggestive of pelvic peritonitis. Chest X ray revealed air under diaphragm, ultrasound abdomen showed right iliac fossa mass. Diagnosis of perforated hollow organ was established. After rapid resuscitation, he was operated on via a lower midline incision and surprisingly we found perforated tumor mass in Meckel’s diverticulum. We resected the Meckle’s divertivculum containing the mass with 4 cm of small bowel on either side and primary restoration of bowel continuity was done. Histopathological assessment of the mass confirms GIST. According to our analysis we recommend all surgeons to consider tumors of Meckel’s diverticulum as one of differential diagnosis of intra-abdominal neoplasms.
Samar Abbas
St. Luke’s Hospital, Ireland
Title: Familial early onset paget’s disease: A case report
Time : 10:40-11:00
Biography:
Dr. 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: Familial Early - Onset of Paget’s Diseases is an Autosomal dominant disorder associated with Mutation in gene TNFRSF11A which encode the Receptor Activator of Nuclear Factor Kappa (RANK).It is rare in Asians and usually presents in teens or twenties. Its features are similar to those of the classic form of the disease, although it is more likely to affect the skull, spine, and ribs (the axial skeleton) and the small bones of the hands. The serum alkaline phosphatase urinary hydroxyproline and serum C- telopeptide are elevated. Case We report a case of 21 years old boy who presented with complain of generalized bone pain for 12years, multiple bone fractures on slight trauma leading to progressive bone deformities for 5years and gradual hearing Loss for 4 years. His parents are cousins and one of their cousin had a similar problem but she died undiagnosed at 40.Patient‘s younger sister (20years) has similar problem since the age of 10 yrs. On investigation his CBC, UCE, LFTs , Uric acid, Ca, PO4, PTH, vit D3 levels were all normal, but his Alkaline phosphatase was markedly elevated at 2526 U/L (100 – 290).His sister also had similar laboratory results. His bone biopsy was consistent with Familial early – onset paget ‘s disease. Conclusion: Familial Early onset Paget's disease is a rare disease in Asians and usually presents in young age in which alkaline phosphatase is markedly raised, confirmation of diagnosis is by bone biopsy and gene studies, in our case we were unable to do genetic studies because of lack of funding, and Treatment of choice is bisphosphonates. Long-term follow-up is mandatory in these patients in order to identify and treat any subsequent complications
Noha Behairy
Cairo University, Egypt
Title: Diagnostic value of MRI in fetal urinary tract anomalies
Time : 11:15-11:35
Biography:
Noha Behairy is working as a Professor of Radiology, Radiology Department, Cairo University. She is the reviewer for the European Radiology Journal, Journal of Radiology case reports, Egyptian Journal of Radiology and Nuclear Medicine
Abstract:
Objective: To evaluate the contribution of adding MRI findings to sonographic data when assessing fetal urinary tract anomalies and to determine how this addition may affect the management of pregnancy. Methods: We examined 26 fetuses with sonographically suspected congenital urinary tract anomalies by 2D/3D ultrasound, Doppler and MRI. The gestational age range was 18-36 weeks. 40% of the women were in the second trimester while 60% were in their third trimester. The diagnosis was confirmed by postnatal ultrasound in born babies and autopsy in still born or aborted fetuses. Results: We found different urinary tract anomalies. MRI changed the US diagnosis in 6 cases and added information in 5 cases, hence changing the patient’s management in 34.6% of cases. MRI confirmed US diagnosis in 16 fetuses. Ultrasound was superior to MRI in one case of renal failure. Associated extra renal anomalies were detected in ten cases (38.4%). 13 lethal renal anomalies were included in this study. The diagnosis was confirmed by postnatal US or CT in viable babies and autopsy in still birth or aborts. Conclusion: Fetal MR imaging should be used as a complementary modality to US in diagnosing fetal urinary abnormality in which US findings are inconclusive or equivocal.
Mohamed Touni
Nasser Institute Hospital, Egypt
Title: Marcus Gunn Syndrome “Jaw Winking Phenomenon†. based on a case report
Time : 11:35-11:55
Biography:
Mohamed Touni has completed his Dental degree from Ain Shams University (Egypt), and then he attached to a 5 years residency in oral and maxillofacial surgery at Nasser institute hospital. He has a very good log book and he has done and assisted in many surgeries. He has a lot of experience in the fields of trauma, orthognathic surgeries and computer guided surgeries. He has done a lot of presentations and has 3 case reports in progress and other type of publish.
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 unpreviously reported before. Review of literature didn’t reveal any case reports of sublingual hematoma following deep neck infection of fascial spaces. A case of deep neck infection of odontogenic origin with subsequent sublingual hematoma with ultimate fatal outcome will be described in this conference.
Amer Al Ani
Sheikh Khalifa Hospital, KSA
Title: Testicular seminoma invading the dudenum. misdiagnosed as duodenal tumor. A case report
Time : 11:55-12:15
Biography:
Amer Hashim Hassan Al Ani has graduated from Baghdad Medical School. He has completed his Arab Board in General Surgery (2000), GIT Surgery subspecialty (2005), FRCS from The Royal College of Physician and Surgeon Glasgow (2011). He is currently a GIT & General Surgeon in Department of General Surgery of Sheikh Khalifa Hospital, UAE. He has published more than 15 papers in reputed journals and has been serving as an article Review Member of reputed journals. He has participated as speaker in more than 35 national and international conferences.
Abstract:
Testicular cancers are the most common malignancies in men aged 15-35 years. Their incidence constitutes 0.8% of all men cancers worldwide, with a mortality rate of 0.1%. Testicular malignancies rarely metastasize to the retroperitoneum and involve upper gastrointestinal tract. Complications like intestinal obstruction, hemorrhage and ulceration of bowel mucosa are usually present. . We report here a 30 year old man presented with severe anemia due to upper gastrointestinal bleeding from ugly duodenal growth diagnosed by endoscopy. Biopsy revealed a moderately differentiated adenocarcinoma of the duodenum. The patient was referred to our unit for possible surgery (Whipple’s procedure). A thorough examination documented left testicular masses, slide review and immune stains showed duodenal metastatic lesion from a testicular germ cell tumor. Patient was treated by left orchidectomy (biopsy showed seminoma) and chemotherapy. One year later no gastrointestinal complaints or anemia were detected and patient was overweight. Following completion of chemotherapy, endoscopy showed no evidence of tumor in duodenum. CT scan abdomen showed normal retroperitoneum.
Adel M Mishriky
Professor, Suez Canal University, Egypt
Title: Teachers’ awareness of learning difficulties in primary school children in Al-abnaa schools, Saudi Arabia
Time : 12:15-12:35
Biography:
Adel M Mishriky has graduated from Ain-Shams University Medical School, Egypt in 1976 and completed his 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 has completed her 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 he is currently an Emirates Professor. He has published more than 60 papers in reputed journals and has been serving as the Editorial Board Member of Saudi Medical Journal
Abstract:
Learning difficulties (LD) are hard for the public to understand and for educators to treat. This study aim is to contribute to improvement of the learning difficulties problem in primary schools in Saudi Arabia through measuring the awareness of primary school teachers of this problem, its identification and the role of teachers and describing its teachers’ reported prevalence. A cross sectional study design was used in this study carried out at Al-abnaa schools (boys and girls) in Riyadh city on a sample of 200 teachers. Data collection was through a self administered questionnaire to assess awareness of the term: “Learning Difficulties” (LD), its definition, causes, manifestation in reading, writing and math associated socio behavioral problems and the role of the teacher. The response rate was 73%. According to teachers’ opinions, the median of estimated percent of children with LD in their classes was 5.7% with inter quartile range 1.5-10.0%. Most teachers (77.4%) reported being aware of the term LD but only 23.3% could define it and 24% had correct knowledge of its causes. In total, the median score of knowledge was 3 out of a maximum 8 points. Teachers’ knowledge was significantly related to their gender (p<0.001), having a degree in education (p=0.006) and having attended training in LD (p<0.005). In multivariate analysis, female gender and the training courses were the statistically significant independent factors positively influencing the knowledge score. In conclusion, the primary school teachers in the study setting have deficient knowledge regarding learning difficulties, particularly the male teachers. The study recommends such training to all elementary school teachers to be able to early identify cases needing assistance
Nadia H. Rizkalla
Professor, Suez Canal University, Egypt
Title: Pap smear screening in a primary care setting in Saudi Arabia
Time : 12:35-12:55
Biography:
Nadia H Rizkalla has 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 has completed her 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 she is currently an Emeritus Professor. She has published more than 20 papers in reputed journals and has been serving as WHO Consultant
Abstract:
Objective: To report the findings of an organized Pap smear screening program in a primary care setting and describe the pattern of women’s compliance to screening. Methods: The study was conducted in the Department of Family and Community Medicine at Prince Sultan Military Medical City in Riyadh, Saudi Arabia. The data were the archives of women registered in the Papanicolaou (Pap) smears testing program at the Maternal Care Centers from the start of the program in 2003 to 2010. Results: Of 2184 women, age between 16 and 81 years, 74.1% had their first Pap smear done and 37 (2.4%) had abnormalities. Only 6.7% had their second smear and 5 (3.1%) had abnormalities. Among 23 women who had their third smear, 1 (4.3%) had atypical squamous cells and 1 (4.3%) had Human Papilloma Virus (HPV) changes. In multivariate analysis, woman working status was the most important predictor of her having a Pap smear done along with intake of oral pills and higher parity. Abnormal test finding is predicted by intake of oral contraceptive pills. Conclusion: This study shows low women’s compliance with screening, particularly at the extremes of age and among housewives. Pap smear changes are low and are related to use of contraceptive pills. More effort is needed to increase women's compliance with Pap smear screening guidelines
Vaishali Narayen
Government Dental College and Hospital, India
Title: immunohistochemical labelling of phospho-histone h3 for histoprognostic grading of oral squamous cell carcinomas
Time : 12:55-13:15
Biography:
Vaishali Narayen has completed her Bachelors of Dental Surgery from Rajiv Gandhi University and Masters in Oral Pathology from Dr NTR University of Health Sciences. She is a recipient of gold medal for the best outgoing student in graduation and for securing the 3rd rank in the University in the specialty of Oral Pathology. She is serving as an Assistant Professor of Oral Pathology at Government Dental College and Hospital, Hyderabad, India. She has 5 publications in both national and international journals and has given lectures in various forums.
Abstract:
Background & Objective: The hallmark of oral cancer is excessive proliferation of cells, which is attributed to abnormally increased mitosis. An antibody directed to phosphorylated histone H3 was recently proposed for counting mitotic figures which is one of the most essential factors for determining the histologic grade of OSCC. The aim of the present study was to identify the presence of PHH3 antigens in sections of proven cases of OSCC with immunohistochemistry, also to distinguish mitotic figures from apoptotic bodies and karyorrhectic debris for faster identification and accurate labeling of mitotic figures. Method: 45 tissues of histologically diagnosed cases of OSCC and 10 of normal oral mucosa (controls) were evaluated for the selectivity of H&E and PHH3 immunohistochemical marker. Results: In all the tissues tested with PHH3, mitotic figures were easily detected and the mean number of mitotic figures was highest in PHH3 labeled sections in both the study and control group when compared to H&E. In different grades of OSCC the mean number of mitotic figures using PHH3 was found to be higher in PDSCC as compared with MDSCC and WDSCC. Conclusion: Increased mitotic figures and identification of prophase nuclei with rapid detection of mitotic figures even at low power magnification was possible by PHH3 staining making it a sensitive marker as compared to H&E. PHH3 is a relatively new marker and to the best of our knowledge, no study has been conducted so far to show the correlation between PHH3 mitotic indexing (MI) and recurrence-free survival in a large cohort of oral squamous cell carcinomas.
Sonu Acharya
SOA University, Odisha, India
Title: Platelet concentrates-A viable option for an enviable result
Time : 14:00-14:20
Biography:
Dr. Sonu Acharya completed his BDS in 2003 from the first dental college of India, namely,Dr.R.Ahmed Dental College,Kolkata and completed his Masters (MDS) in Pediatric Dentistry from prestigious Manipal College of Dental Sciences, Manipal in 2006. He is presently working as a Professor in Institute of Dental Sciences, SOA University, India. He is editorial member of American Journal of Public Health, Nigerian Journal of Experimental and clinical biosciences, Journal of Applied dental and medical sciences, Asian Journal of Pharmacy
Abstract:
Development of the bioactive surgical additives is one of the great challenges of clinical research which has been used to regulate inflammation and increase the speed of healing process. Recent scientific development in the concept of tissue engineering has brought about a drastic improvement in the healing response of tissues. Various pathological entities result in dysfunction of the oral tissues and creation of bony defects, thus affecting the quality of life in these patients. The pivotal goal in endodontic, periodontal and maxillofacial tissue regeneration is to reconstruct these defects which led to the search of a bio-fuel. There has always been a focus on devising a “wonder material” that is most effective in its regenerative potential. Various platelet-derived products or platelet concentrates have been introduced that act as biological mediators aiding the healing response. Platelet-rich fibrin (PRF) is one such product that has proved its worth and has edged past the others. The Choukroun’s platelet rich fibrin has opened lot many avenues in the field of dentistry, majorly focusing on the improved healing and regeneration. PRF is a second-generation platelet concentrate widely used to accelerate soft and hard tissue healing and is a strictly autologous fibrin matrix containing a large quantity of platelet and leukocyte cytokines. The basic idea of this paper is to assess the potential use and benefits of Platelet-Rich Fibrin for wound healing and regeneration which are the essence of regenerative dentistry.
Noha Behairy
Cairo University, Egypt
Title: Pena-Shokeir syndrome in three consecutive pregnancies: Prenatal diagnosis by 3D/4D ultrasound, fetal MRI and multislice CT scan
Time : 14:20-14:40
Biography:
Noha Behairy is currently working as a Professor of Radiology, Cairo University, Egypt. She is the Reviewer for the European Radiology Journal, Journal of Radiology Case Reports and Egyptian Journal of Radiology and Nuclear Medicine
Abstract:
The Pena-Shokeir phenotype represents an autosomal recessive syndrome characterized by neurogenic arthrogryposis, facial anomalies and pulmonary hypoplasia. Th is condition was fi rst identifi ed by Pena and Shokeir in 1974 and was subsequently included among the phenotypes associated with the fetal akinesia deformation sequence (FADS). We present a rare case of recurrent Pina-Shokeir syndrome in a 24 year old primigravida and the application of three-dimensional (3D/4D) ultrasonography, fetal magnetic resonance imaging and (3D) multislice computerized tomography in prenatal diagnosis. .
Josaphat Ndelo-di-Phanzu
University of Kinshasa, DR Congo
Title: Surprising unknown H. pylori epidemic in Democratic Republic of Congo (Hp-EDRC)
Time : 14:40-15:00
Biography:
Josaphat Ndelo-di-Phanzu is a Congolese Toxicologist. After completing his graduation as Pharmacist at the Faculty of Pharmacy of the University of Kinshasa in 1975, he moved to Belgium at the Katholieke Universiteit Leuven and obtained Master’s degree in Pharmaceutical Sciences followed by a Doctorate degree in Pharmaceutical Sciences, Branch Toxicology in 1984. He became an Associate Professor in 1986, Professor in 1998 and Ordinary Professor in 2005. Considering the administrative level, he was the Head of the Laboratory of Food and Drug Control of the University of Kinshasa, Head of the Department of Biopharmaceutical Sciences, Vice-Dean of the Faculty of Pharmacy of the University of Kinshasa, Dean of the Faculty of Pharmacy, Rector of the University of Kinshasa and the Head of the Laboratory of Toxicology. He is the President of the Ethics Committee of Central Africa and Vice President of National ethics Committee of DR Congo in the fi eld of ethics of biomedical research.
Abstract:
Since a few decades, numerous suspicions of massive criminal poisonings do exist within the population, in the Democratic Republic of Congo. Th e poison in concern, named “Karuho poison”, is supposed from vegetal or animal origin, located principally in the East region of the country, where the poisoners are also supposed from. According to popular belief, the “Karuho poison” cannot be managed by the modern medicine. Traditional practitioners are recognized as the only specialists of Karuho poisoning. Our research work on “Karuho poisoning” in DR Congo started in 1990. Aft er 20 years of trying, we surprisingly observed in 2010 that, blood specimens from “Karuho poisoning” patients were positive to H. pylori. A poster has been presented at Jackson University, in USA in 2012, on 65 collected blood samples. Since 2012, the number of blood samples has increased signifi cantly with the same positive result concerning the presence of H. pylori. Symptoms presented by the patients, were much diversifi ed, not only digestive but also general and even nervous, indicating a free and massive passage of H. pylori toxin to the blood. About the origin of the H. pylori contamination, we suppose the existence of a natural primary reservoir of the bacterium in the East region of the DR Congo, principally, at or around the Kivu Lake. Th e H. pylori epidemic disease in concern looks like a large opened book, providing to the international scientifi c community an interesting opportunity to learn more about H. pylori infection. Strong international collaboration and suitable fi nancial means are needed for that.
Jignesh Kothari
UN Mehta Institute of Cardiology and Research Centre, India
Title: Excision of multiple cardiac hydatid cysts: A rare clinical entity
Time : 15:00-15:20
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:
We herein present a case of successful removal of multifocal, multiple cardiac hydatid cysts: One arising from the left ventricular (LV) postero-lateral wall and another compressing superior vena cava (SVC) & aorta, presented with atypical chest pain in a young male patient. Both the cysts were removed using CPB via midline sternotomy. Superior cyst was removed in mass; while inferior cyst opened, daughter cyst and germinal membrane removed & cavity marsupialized aft er instillation of 3% hypertonic saline as it was densely adhesive to posterior wall of left ventricle (LV). Patient was successfully discharged on 8th post-operative day with albendazole therapy and on regular follow-up without any complications.
Lyubov Chernova
Moscow Regional Clinical Diagnostic Center for Children, Russia
Title: On the verge of a breakthrough in pediatrics
Time : 15:20-15:35
Biography:
Lyubov Chernova graduated from Russian National Research Medical University named after N.I. Pirogov in 2012. She is a Pediatrician at Moscow Regional Clinical Diagnostic Center for Children.
Abstract:
It is now clear that standard protocols for examining pediatric patients do not provide proper level of medical care. Th e latest advances in genomics, proteomics, metabolomics and bioinformatics allow creation of a fundamentally new integrated approach, which applies a ‘predictive, preventive and personalized’ model of care to pediatric practice. Personalized medicine successfully utilizes data obtained from an individual’s genome sequencing. Next generation sequencing has shift ed genetic research from the analysis of separate genes to the parallel studying of hundreds of genes and pathological ways of diseases. Th is same technique provides breakthrough possibilities in molecular diagnostics such as a quick identifi cation of causal mutations, comparative genomic analysis, ability to search for non-random associations between a disease and mutations and identifi cation of new pathological pathways. Th is review, based off of specifi c clinical cases, demonstrates the relevance and practicability of using PPPM concepts in pediatrics. Application of the PPPM approach in pediatrics will help ensure successful prenatal diagnosis of diseases, improve the methods of neonatal screening, promote wider implementation of genetic counseling and develop personalized treatment plans and management of pediatric patients, hence improving prospective results of treatment. Results of such an approach will inevitably lead to a reduction of morbidity and mortality among children. However, the actual question is how to best integrate data obtained from NGS with the personalized medicine approach. Th is question directs us to bioinformatics, which applies high-throughput modeling to support the clinical diagnosis and development of novel treatment strategies in pediatrics.
Rawan Abdul Razack Amir
Medical Student, University of Dammam, Saudi Arabia
Title: Malignant phyllodes tumor of the breast with metastasis to the pancreas: A case report & review of literature
Time : 15:35-15:50
Biography:
Rawan Abdul Razack Amir is a 5th year medical student in the University of Dammam. She had a strong interest in medical literature at a very early stage and had her first publication when she was in her second year of medical school. She currently has a few publications, including a book chapter entitled “Hepatitis C Infection in Kidney Transplantation”, and has many more in the pipeline. She is also very active in raising awareness in her community in a variety of important topics including how to lead a healthy lifestyle, how to live a normal life with chronic diseases, and how to protect from infectious diseases that are constantly on the rise.
Abstract:
Phyllodes tumor is a rare tumor of breast accounting for approximately 1% of all breast neoplasms. Back in 1838, J. Muller coined the term “Cystosarcoma Phyllodes” based on the leaf-like projections of the tumor extending into the cystic spaces and sacromatous stromal growth. However, seeing as up to 70% of all phyllodes tumors are benign, “cystosarcoma” was dropped, and the tumor is now recognized simply as phyllodes tumor. It is mainly seen in females between the ages of 35 and 55. Although most phyllodes tumors are benign, malignant cases do uncommonly occur, 22% of which have distant metastasis typically to the lungs and bones. Rarely, this tumor metastasizes to other locations. Herein we report a case of malignant phyllodes tumor with metastasis to the pancreas. This is a case of a 34 year old woman who presented to the hospital with a large irregular mass of the right breast initially diagnosed to be fibroadenoma. The patient had multiple recurrences which subsequently showed features of malignant phyllodes tumor. Two years after the initial presentation, she suffered multiple bouts of pancreatitis. Workup showed metastatic tumor to the pancreas which took a fatal course and lead to her death one year later. According to our knowledge, only 3 case reports of pancreatic metastasis from malignant phyllodes tumor have been reported in literature thus far.
Yameen Ali
Maternity and Children Hospital, KSA
Title: Spondylodiscitis challenging diagnosis in immune competent child: A case report
Time : 16:05-16:20
Biography:
Yameen Ali has completed his MBBS from King Faisal University, Saudi Arabia. He has obtained Saudi and Arab Board Certifi cate in General Pediatric, completed his Fellowship and Certifi ed in Pediatric Infectious Diseases in 2015 and Certifi cation in Infection Control (CIC) 2015. He is working as a Consultant in Pediatric and Pediatric Infectious Diseases and Head of Infection Control at Maternity and Children Hospital.
Abstract:
Spondylodiscitis, a combination of spondylitis and discitis, is an infection of the spine that involves the intervertebral disc and the vertebral body. Patients presented with little specifi c symptoms and suspicion for diagnosis is required. Th is report aimed to describe a female child patient with spondylodiscitis and to describe the diagnostic and therapeutic tools of such patient. Th is report recorded 2 year-old female child presented by fever, pain associated with standing and sitting and 10 days history of refusal to walk in Prince Sultan Medical City, Riyadh, Saudi Arabia. Laboratory investigations as well as hip and knee ultrasound showed no abnormalities. However, and hip and lower back Magnetic Resonance Image (MRI) showed evidence of abnormal hyper intensity with enhancement of the bone marrow involving the vertebral bodies and adjacent endplates of 5th lumber (L5) and 1st sacral (S1) vertebrae with involvement of intervertebral disc space and paravertebral soft tissue component. Spondylodiscitis was suggested in the child and conservative management by medical team of pediatrics and orthopedics consultant has immediately started. Th e treatment included antibiotics non-steroidal analgesia and physical rehabilitation. Th e patient was completely evolved from condition within days. MRI taken 6 weeks later showed signifi cant interval improvement of signs of spondylodiscitis and the girl has been seen in the clinic aft er 4 months from discharge in good condition. Spondylodiscitis has to be considered in young children with acute ambulation changes. Prompt diagnosis and treatment involving the entire multidisciplinary team is emphasized in order to improve the prognosis of such patients.
Sara Sohail
Jinnah Post Graduate Medical Centre Karachi, Pakistan
Title: Large invasive retroperitoneal paraganglioma mislabelled as hypertrophic obstructive cardiomyopathy
Time : 16:20-16:35
Biography:
Sara Sohail (main author) graduated from Dow University of Health Sciences (DMC) in 2010 at age of 23years ,internship in 2010-2011, cleared part 1 of Fellowship exam of Pakistan in 2011 at age of 24 and started postgraduate training at Jinnah Postgraduate Medical Centre in 2012, cleared part 1 and part 2 Membership exam of Royal College of Physicians UK in 2013. Due to knowledge, clinical skills and patient management received Scholarship by College of Physician and Surgeon Pakistan and currently completing remaining training in Ireland in Medicine on scholarship.
Abstract:
Paraganglioma originates from chromaffin cells of adrenal medulla and autonomic paraganglia, which are derived from the neural crest cells. Paragangliomas are half as common as pheochromocytomas; 69% occurring in head & neck, 22% in abdomen & pelvis and 10% in the thorax. About 70% paragangliomas are sporadic, 30% are hereditary having identifiable germline mutations of Succinate Dehydrogenase Enzyme (SDH). 13 years old male, hypertensive for 3 years, diagnosed as having Hypertrophic Obstructive Cardiomyopathy (HOCM) 1 year back, presented with complaints of altered consciousness and blurring of vision for 2 hours. On examination, blood pressure was 220/110 mmHg. He had a grade III intensity ejection systolic murmur at L lateral sternal border & grade II Pansystolic murmur at mitral area radiating to axilla. GCS was 5/15 with Rt plantar equivocal & Lt plantar up going. Hypertension was persistent in nature with acute elevation occurring especially in morning hours, controlled by intravenous vasodilators during acute elevations and alpha and beta blockers. There was no family history of hypertension. Hormonal workup revealed elevated urinary VMA levels of 68.3 mg/24 hours, suggestive of pheochromocytoma/paraganglioma. Ultrasound and CT-scan of abdomen confirmed large, retroperitoneal soft tissue mass, measuring 6.4×3.5 cm, involving R ureter and R renal vein, invading into the IVC with tumor thrombus with in it. His thyroid function tests, parathyroid hormone (PTH) and calcitonin, ultrasound neck and renal doppler were normal. Echo showed moderate asymmetrically hypertrophied LV and interventricular septum (non-obstructive). A percutaneous biopsy of mass had been done previously and had confirmed paraganglioma. A diagnosis of severe hypertension leading to hypertrophy of myocardium secondary to paraganglioma was made. Tumor was removed in total along with extension in the inferior vena cava from the entrance into R atrium up to R renal vein. Six months post-operative, patient remains well and has resumed his normal day to day activities. He remains normotensive and off all medications. His post-operative urinary VMA levels have also normalized (4 mg/hr). Repeat echocardiographic findings showed regression of changes with only mild asymmetrically hypertrophied left ventricle. This case report together with few others in literature indicates that HOCM like features can be induced by this tumor with complete or partial resolution of these features following successful tumor removal; this in contrast to classic HOCM which is a life-long irreversible disease.
Saba Hashim
Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Title: Fluorosis, causing paraplegia.mutilating life
Time : 16:35-16:50
Biography:
Dr.Saba Hashim has completed MBBS from Dow Medical College Karachi and Postgraduate FCPS training in Internal Medicine from Jinnah Postgraduate Medical Centre.She is also doing MRCP from Royal College Of Physicians Of London
Abstract:
Fluorosis is thought to be rare in Pakistan but endemic in various parts of the world, especially in India and China. In Pakistan only a few cases have been reported from Thar, Sibbi and Manga Mandi with probability of fluorosis on MRI findings supported by high drinking water fluoride content. Neurological manifestations of skeletal fluorosis may vary from radiculo-myelopathy to neuropathy. A case of 26 years old female from Thul, Sindh, who presented with paraplegia is reported here. Her MRI showed extensive classical degenerative changes throughout the spine, consistent with fluorosis, leading to cord compression at multiple levels. No such case with confirmed fluorosis has been previously reported from Pakistan.
Shazma Khan
Aga Khan University Hospital, Pakistan
Title: Sporadic Creutzfeldt-Jakob disease: A case series from Aga Khan University Hospital
Time : 16:50-17:05
Biography:
Dr. Shazma Khan completed her M.B.B.S from Liaquat University of Medical & Health Sciences in 2007; followed by internship in 2008-9. Beginning her residency in 2011, she is currently working as a Neurology resident at Aga Khan University Hospital.
Abstract:
Creutzfeldt-Jakob disease (CJD) is a transmissible disease of the central nervous system caused by transformation of normal prion proteins into abnormal prions spontaneously and runs a rapid course till death once the disease sets in. This rare, degenerative disease is just one type of a group of prion diseases. Amply described in Western literature, Creutzfeldt-Jakob disease is scarcely reported in Asia. Whether this scarcity is because of missed diagnosis, unavailability of diagnostic procedures, under-reporting of diagnosed cases or because of actual rarity of the disease remains debatable. We found 4 reported cases of CJD in our literature of Pakistan; one each in 2007 and 2012 and two reported together in 2014. Key to diagnosis lies in interpreting the clinical data in light of work up including brain imaging, electroencephalogram, cerebrospinal fluid testing and biopsy of infected brain. The disease invariably progresses to demise and no treatment can arrest the process. We did a retrospective record review of Aga Khan University Hospital Neurology department from 1994 till 2015 and found 12 cases labeled as CJD. Based on the MRI-CJD European Consortium criteria, this case series will illustrate details of one biopsy proven definitive case and 5 probable CJD cases. To the best of our knowledge, we are reporting the biggest case series of this rare disease from Pakistan. With alternative diagnoses ruled out; brain MRI (excluding the biopsy proven case that had a CT brain done in 2001), electroencephalogram and testing of cerebrospinal fluid helped reach the diagnosis of CJD.
Meral Abualjadayel
King Abdulaziz University, KSA
Title: Case of renal oncocytoma in a 14 year old young lady
Time : 17:05-17:20
Biography:
Meral Abualjadayel completed her medical education from King Abdulaziz University, KSA. She is currently Pediatric Students Club Co-founder , Academic Education Unit President At King Abdul-Aziz University-faculty of Medicine. She also Volunteers in the Clinical skills mentoring program. She is the Organizer In "World Kidney Day" Event Held in King Abdulaziz University Hospital.
Abstract:
Renal oncocytoma was fi rst described by Zippelin 1942 as a malignant entity, however, Klein and valensi were able to demonstrate its benign characters in the year 1976. Th e current the World Health Organization have classifi ed renaloncocytomas as benign renal neoplasms in 2004. Renal oncocytoma is the second most common benign renal neoplasm after angiomyolipoma, comprising 3-7% of all renal tumors, usually occur during the seventh decade of life varying from 20 to 86 years of age with males predominance. Zhou defi ned renal oncocytoma as a benign epithelial neoplasm composed of round-to polygonal-cells with abundant mitochondriarich eosinophilic cytoplasm, thought to arise from the intercalated cells in the kidney. Th e size of the tumors varies from 0.6 to 14 cm(7). Unfortunately, most oncocytomas are very diffi cult to be diff erentiated from renal cell carcinoma both clinically and radio graphically. Development of renal oncocytoma in pediatric age group is very uncommon with no cases found within our review of the world literature. We report herein the fi rst case of renal oncoytoma in a 14 year old young lady.
Zahra Sarafraz
Shahid Sadoughi University of Medical Sciences, Iran
Title: Soft tissue mucormycosis in immunocompetent patient: A case report
Time : 17:20-17:35
Biography:
Zahra Sarafraz is currently a Resident in Otolaryngology Department of Shahid Sadoughi University of Medical Science, Iran. She has completed her MD and has 10 published articles and many presentations in different conferences such as ISCOMS, Esc-Berlin and AIMS. She has received “The Best Researcher Award” in the university (2014) and won “the Best Peer Reviewing Award” in the sixth SICOBAIR (2015).
Abstract:
Mucormycosis is considered the third most common invasive fungal disease aft er candidiasis and aspergillosis and all such diseases are important causes of morbidity and mortality. Mucormycosis almost always develops in patients with defects in their host defense and it is rare in healthy people. It can manifest in diff erent clinical presentations. Th e most frequent form is the rhinoorbito-cerebral mucormycosis. Cutaneous disease is the third most frequent manifestation of mucormycosis. In this study we investigate a 6-years-old immunocompetent boy complained of a large (15-20 cm) itching mass that had been enlarging slowly in his neck region (submental) for 4 months. CT scan revealed a large submental mass without abscess formation and biopsy showed mucormycosis in soft tissue specimen. Patient’s parents refused to surgery. His treatment and prognosis with liposomal amphotericin B are investigated in this study.
Dr Marzan
General Surgery training program in Naga City, Philippines
Title: Neopenis: The first total penectomy with total penile reconstruction using an anterolateral thight free flap for penile carcinoma in the Philippines
Time : 17:35-17:50
Biography:
Juan Carlos Bello Marzan has completed his MD from the University of Santo Tomas. He is the current Chief Resident of the Accredited Consortium in Education for Surgery, an accredited General Surgery training program in Naga City, Philippines. In 2015, he was invited as a speaker in the American College of Surgeons Clinical Congress, Chicago, IL, USA on his video on Superficial Parotidectomy.
Abstract:
"An absent or inadequate penis is a devastating condition with significant psychological, sexual, social and physical impact. Penile carcinoma with invasion of the shaft with an inadequate length is usually treated with Total Penectomy with Perineal Urethrostomy. In the Philippines, there is no literature that can trace back the roots of penile reconstructive surgery or even a single case ever performed. This is the first documented case of total penile reconstruction for penile carcinoma in the Philippines. This is a case of a 48 year-old Filipino male with Squamous Cell Carcinoma of the penis who underwent total penectomy and the first total penile reconstruction using an anterolateral thigh flap in the Philippines. We are presenting our technique of penile reconstruction using an anterolateral thigh flap. Elliptical incision is made around the base of the penis, dissection is commenced in the plane between the tunica albuginea and Buck fascia dorsolaterally and the dorsal vessels are ligated and divided. Corporeal bodies are sharply transected and the urethra is divided at the same level. The corpora are then closed with interrupted horizontal mattress sutures. The dissection started, identifying the descending branch of the lateral circumflex femoral artery to its origin and then the lateral cutaneous nerve of the left thigh was identified at the proximal border of the flap and dissected 5 cm in length. During the dissection, two perforators within the flap were identified and maintained. The flap was harvested as an island flap based on both perforating vessels and the pedicle was dissected up to its origin. Urethra and neopenis was constructed using tube over tube technique. Inset of the neopenis was then made thru tunneling underneath the femoris muscle through an incision in the left groin region. Flap was then sutured to the periosteum of the pubic region. The neourethra was anastomosed to the remaining corpus spongiosum with adequate spatulation using chromic 4-0. Flap donor site closure was done with split thickness skin graft harvested from the hypogastric area. At present patient is able to urinate in a standing position. "
Jumana Amir
University of Dammam Medical School, KSA
Title: Mesenchymal hamartoma presenting as vocal cord paralysis: A case report and review of literature
Time : 17:20-17:55
Biography:
Jumana Amir is currently working as a Intern at University of Dammam Medical School, KSA
Abstract:
Hamartoma of the larynx is a rare benign developmental anomaly that must be distinguished from other neoplastic and non-neoplastic lesions of the larynx. Most cases come to medical attention due to symptoms related to airway obstruction. Only one case is reported in literature where the lesion was associated with vocal cord paralysis. We herein, present a 68 years old woman who was admitted to the hospital with hoarseness, dysphagia, and left vocal cord paralysis. A laryngeal lesion was identified and on biopsy was diagnosed to be mesuj
Shazma Khan
Aga Khan University Hospital, Pakistan
Title: Methicillin-resistant Staphylococcus aureus: Case report of acute sinusitis with orbital extension in a pregnant lady
Time : 17:20-17:55
Biography:
Shazma Khan has completed her MBBS from Liaquat University of Medical & Health Sciences in 2007 followed by Internship from 2008-2009. She is currently working as a Neurology Resident at Aga Khan University Hospital, Pakistan.
Abstract:
Recognized since 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has increasingly been recognized as a cause of soft tissue infections. Previously believed to be transmitted solely via health care systems in immunocompromised hosts, it is now believed that diff erent strains are responsible for spread of infection in immunocompetent individuals in community. Th is form is referred to as community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) which is mainly associated with soft tissue abscesses and cellulitis. Acute sinusitis due to MRSA can be one of the deadest presentations of this infection as it can quickly lead to orbitocranial involvement with complications including blindness, brain abscess and death. Seriousness of MRSA infection increases manifold when the infection occurs in pregnant women. While still not known in developing countries, the prevalence of MRSA colonization in pregnant women in western world is stated to be 0.5-4%. Early suspicion of infection is the key to better prognosis. Appropriate antibiotics should be started without delay and early drainage of abscess, if any, should be the target. Delay in treatment, medical or surgical, may lead to serious consequences including death. We present here the case of a 34-year-oldlady who was 31 weeks’ pregnant and presented with one day history of severe right sided headache. She was found to have acute sinusitis that involved right orbit in less than 24 hours of presentation. A diagnosis of sinusitis secondary to CA-MRSA was made. Promptly managed with intravenous antibiotics and drainage of maxillary sinus abscess, the patient made remarkably complete recovery without any complications.
Deanne Soares
Royal Prince Alfred Hospital, Australia
Title: Papillary renal cell carcinoma seeding along a percutaneous biopsy tract
Biography:
Deanne Soares is a Senior Surgical Resident at Concord Repatriation General Hospital in Sydney, Australia. She has completed her Master of Surgery from The University of Sydney and a Master of Health Leadership and Management from the University of Wollongong. She is currently engaged in multiple research projects in the fi elds of surgery and training and education.
Abstract:
The use of percutaneous biopsies is useful in the diagnosis and management of renal masses with a complication rate of <0.01%. However, a potential hazard of this is tract tumor seeding but this is so rare in renal cell carcinoma (RCC) that its frequent use in the assessment of indeterminate renal masses has been justifi ed. We report a case of tumor seeding caused by percutaneous biopsy of a papillary renal cell carcinoma detected on pathological assessment of the partial nephrectomy specimen in a 50 year old male. Literature review found that up until 1991, there were only 5 reported cases of RCC tract seeding and in 2013 there were a further 3 cases reported. In general, tract seeding will relate to the amount of disruption of the tumor capsule (needle caliber, number of punctures), pressure of egress at the puncture site (for example, cystic masses or escaping hematoma), whether tumor cells are dropped from the needle on its withdrawal (failure to maintain negative pressure, burred needle tip) and the ability of tumor cells to survive when deposited into a scar. Th is is one of only a few contemporary case reports of RCC seeding along a percutaneous biopsy tract. Whilst this complication is so rare that it does not warrant a need to cease the use of percutaneous biopsy of renal masses, it certainly highlights the possibility of tract seeding as a potential hazard. As such, certain considerations such as appropriate patient selection, the use of correct equipment and suitable biopsy technique, should be made to minimize the risk of this complication
Tesnim Besbes
University Hospital of Sahloul Sousse, Tunisia
Title: Takayasu arteritis presenting as preeclampsia and postpartum persistent high blood pressure: Case report
Biography:
Working as an Associate Professor
Abstract:
Takayasu arteritis is a chronic inflammatory disease and a common etiology for abdominal aortic coarctation. Hypertension is a frequent clinical manifestation and treatment is warranted to prevent major complications. This is a case of a 29-year-old woman with solitary kidney presenting with preeclampsia and diagnosed with Takayasu arteritis. Lesions included abdominal aortic coarctation, poststenotic aneurysm and severe renal artery stenosis. The patient was managed by surgical approach, postoperative period was uneventful and symptoms improved dramatically.
Narjiss Akerzoul
Mohammed V University, Morocco
Title: The use of free fibula flap in the mandibular reconstruction in case of ameloblastoma
Biography:
Resident Research Assistant at Department of Oral Surgery, Consultation Center of Dental Treatment of Rabat, Mohammed V University of Rabat-Morocco, School of Dental Medicine
Abstract:
Introduction: The ameloblastoma is a rare odontogenic tumor of the oral cavity. It affects more the mandible than the maxilla and has a predilection for the posterior region. Although this tumor is benign, its behavior is locally aggressive and requires the most often surgical resection margin. Clinical Observation: A young woman aged 28 has consulted the service of Surgical Dentistry of Rabat, complaining of right mandibular swelling lasting for eight months. Panoramic radiography revealed the presence of a multi-geodic picture at the right hemi-mandible. A biopsy was performed at the level of the lesion and entered the presence of aameloblastoma. The patient was subsequently sent to the Maxillofacial Surgery Service of the Hospital of Specialties of Rabat. Two teams, one of maxillofacial surgery and other vascular surgery collaborated to produce a hemi-mandibulectomy poses with a graft of the fibula. Discussion: The indication of radical or conservative treatment should be guided by the anatomical location of the lesion, the radiological aspect and especially macroscopic intraoperative. Conservative treatment is carried out for non extensive lesions with the assurance of a future clinical monitoring. Bone resection with or without immediate reconstruction is needed in extended forms breaking cortical bone, the periosteum and soft tissue invasiveness. The free fibula flap was the preferred graft for oromandibular reconstruction because of its versatility and the consistency in the size of the fibula bone and stability. The free fibula flap allows skin palette to be obtained that is up to 25 cm long and 5 cm wide. The fibula periosteal vascularization and thus can withstand multiple osteotomies without compromising significantly, when the periosteum is left set. The free graft of the fibula can be considered a reliable graft with low morbidity and also adapted for future dental rehabilitation.
Sanjeev Gupta
Banarsidas Chandiwala Institute of Physiotherapy, New Delhi, India
Title: Applications of IoT in Physiotherapy
Biography:
Sanjeev Gupta, is graduate from National Institute for the Orthopaedically Handicapped Calcutta, India; specializes in orthopaedics (MPT Ortho) Uttranchal University, India. He has been associated several premiere physiotherapy institutions in one or more capacities as Director, Principal, Consultant & Academician. He is chief editor of “The Physiotherapy Post†a registered Journal of Physiotherapy. He has supervised many Researchers and has contributed to several publications (including Cerebrovascular Diseases, S. Karger AG – Medical and Scientific Publishers, Switzerland). He has edited and reviewed many research publications. He has been product consultant with apex manufacturers in field of physiotherapy. He has invented a novel tool 'Bodygraph' for physiotherapy / orthopaedic assessment
Abstract:
The presentation has two parts (Discussion & Case Studies) besides introduction to the concept of IoT (Internet of Things). Initially it unveils the scope and potential of this IT based technology in the different domains of Physiotherapy. It discusses scope of Big Data Analysis (BDA), Information Communication Technology (ICT) and Ambient Intelligence (AI). In the later part of the presentation novel techniques to utilize existing IoT based gadgets & applications in the field of physiotherapy are showcased. The portion unfolds mobile to gaming all into the physiotherapeutic applications as enabler or adjunct. Late portion of the portion proposes game changing IoT possibilities in the dimensions not limited to prevention, treatment delivery- monitoring-modulation and EDP related issues. In-between presentation also touches local experiences and challenges faced in adoption of such technology. The presentation will also include a case study: Application of IoT in an Indian Context, an experience based roadmap to future.
Kapil
D Y Patil Dental School, India
Title: Assessment of Indian classical music in reducing pain during dental infiltration procedure.
Biography:
Kapil Kshirsagar has completed his Masters in Oral and Maxillofacial Surgery in 2010 from Dr. D Y Patil University. He is currently working as an Associate Professor at D Y Patil Dental School, Charoli Bk, Pune, India. He has published 12 papers in reputed journals.
Abstract:
In the treasury of human experience, no emotion leaves as vivid an imprint on man’s memory as one characterized by pain; a painful experience being one that is not only unforgettable, but also one that produces changes within that individual’s psyche as regards future painful experiences. Dental treatment has long been associated in mind of the patient with pain. Although local anesthetics work to prevent pain, the perception among all too many people is that the administration of local anesthetics is painful. The alleviation of pain therefore comprises one of the most important and satisfying duties of one engaged in health services. As an auditory stimulus, music activates a number of neurotransmitters and it can divert feelings of pain, fear and anxiety, thereby allowing people to gain more positive perceptual experiences. Indian music has a long tradition of thousands of years. It has been shown to be soothing and effective in providing relief in painful conditions such as arthritis. Also Indian classical music has soothing qualities that change the mood of dejected, depressed and distressed individuals facing stressful situations. Raaga-‘Todi’ was used in the study uniformly as the prism of raaga-‘Todi’ (from ecstasy to frolic to pathos to melancholy) has the capacity to refract every conceivable human emotion. This study aims to assess the efficacy of Indian classical music in reducing pain during local anesthetic infiltration.
Satish Anumula
Swami Vivekananda Yoga Anusandhana Samsthanam (s-vyasa) University, India.
Title: Reduction of jaw (t mj) dislocation with taping technique: A case report.
Biography:
Dr.satish kumar anumula has completed his bachelor of physiotherapy (bpt) from Dr.NTR university of health sciences, Vijayawada, Andhra Pradesh, India and Msc in applied sports and exercise science at the age of 24 years from Unversity of Wolverhampton, United kingdom. He is the Assistant Professor& Chief of Physiotherapy department at Swami Vivekananda Yoga Anusandana Samsthanam, a deemed University, and the world class yoga university in the globe
Abstract:
The facial area is one of the most frequently injured areas of the body and the mandible is one of the most common maxillofacial bones dislocates because of its prominent position on the face, the powerful muscle attachments and the lack of support. Dislocations occur when two bones that originally met at the joint detaches. If the jaw is dislocated, it may cause severe headache, inability to concentrate apart from pain and incomplete opening of the mouth. Taping a very popular treatment for several health conditions over the last decade; Kinesio Tape is thinner and more elastic than conventional tape which is hypothesized to allow greater mobility and skin traction. A male aged 35 years was admitted to arogyadhama with pain in the face and inability to open his mouth from past 06 months. He has complained of constant mild pain in the face in front of the left ear that would get aggravated after eating solid food. We suspected Jaw dislocation and got an X-ray of the jaw and that showed grade 1 anterior dislocation. We planned physiotherapy treatment aimed at pain relief (ultrasound therapy), reduction of the dislocation (taping technique) and strengthening the jaw muscles (exercises). After 02 weeks of this therapy check X-ray of the jaw was taken which showed correction of the dislocation with normal appearance of the TMJ. The participant felt better, the pain has decreased and was able to open the mouth wider than before.
Bushra Tahir
Riphah International University, Islamabad. Pakistan
Title: Risk factors assessment for dry sockets: A logistic regression analysis study
Biography:
Bushra Tahir Khan has completed her BDS at the age of 22 years from Islamic International Dental College, Riphah International University, Pakistan
Abstract:
Aim: To investigate the effect of age, gender, address, type of extraction, type of operator and the arch of the tooth involved in the occurrence of dry sockets. A secondary aim of the study was to calculate the incidence of dry sockets in Islamabad, Pakistan Materials and Methods: This study was conducted in the Oral and Maxillofacial Surgery Department at Islamic International Dental Hospital from April 2013 till May 2013. Data was collected for any complaints of dry socket following tooth extractions, by means of a structured questionnaire. All patients above 18 years of age were included. Mean and standard deviation were calculated for age. Frequencies were calculated for gender, address, operator type, arch and the outcome (occurrence of dry socket). A binary logistic regression analysis was conducted to establish a risk model to relate the variables with the occurrence of dry socket. Pearson’s Chi Square test was applied to assess the frequency of occurrence with age. Results: Out of 1670 patients, 1563 adults fulfilled the inclusion criteria. 80 patients reported with dry socket, the incidence being 5.12%. Logistic regression analysis showed a statistically significant association between age and the development of dry socket (OR=0.953, 95% CI=0.926 – 0.961). None of the other factors had a significant association with the occurrence of dry sockets. Conclusion: A significant association exists between patient’s age and development of dry socket. An inverse relationship was seen between the increase in age and occurrence of dry socket. No such association is seen between patient gender, address of the patient, location of the tooth, operator and extraction type.
Abraham Getchew
Ayder Referral Hospital, Ethiopia
Title: Magnitude and associated factors of atopic dermatitis among children In Ayder Referral Hospital, Mekelle, Ethiopia
Biography:
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Abstract:
Background: Atopic Dermatitis (AD) is now a day’s increasing in prevalence globally. A Prevalence of 5- 25% have been reported in different country. Even if its prevalence is known in most countries especially in developing countries there is scarcity with regard to prevalence and associated risk factors of AD among children in Ethiopia settings. The aim of this study was to determine the magnitude and associated factors of atopic dermatitis among children in Ayder referral hospital, Mekelle, Ethiopia. Methods: A facility-based cross-sectional study design was conducted among 477 children aged from 3 months to 14 years in Ayder referral hospital from July to September,2014. A systematic random sampling technique was used to identify study subjects. Descriptive analysis was done to characterize the study population. Bivariate and multivariate logistic regression was used to identify factors associated with AD. The OR with 95% CI was used to show the strength of the association and a P value < 0.05 was used to declare the cut of point in determining the level of significance. Results: Among the total respondents, 237(50.4%) were males and 233 (49.6%) were females. The magnitude of the atopic dermatitis was found to be 9.6% (95% CI: 7.2, 12.5). In multivariate logistic regression model, those who had maternal asthma (AOR: 11.5, 95%CI:3.3-40.5), maternal hay fever history (AOR: 23.5, 95%CI: 4.6-118.9) and atopic dermatitis history (AOR: 6.0, 95%CI:1.0-35.6), Paternal asthma (AOR: 14.4, 95% CI:4.0-51.7), Paternal hay fever history (AOR: 13.8, 95%CI: 2.4-78.9) and personal asthma (AOR: 10.5, 95%CI:1.3-85.6), and hay fever history (AOR: 12.9, 95%CI:2.7-63.4), age at three months to 1 year(OR: 6.8, 95%CI: 1.1-46.0) and weaning at 4 to 6 months age (AOR: 3.9, 95% CI:1.2-13.3) were a significant predictors of atopic dermatitis. Conclusion: In this study the magnitude of atopic dermatitis was high in relation to other studies conducted so far in the country. Maternal, paternal, personal asthma, hay fever histories, maternal atopic dermatitis history, age of child and age of weaning were independent predicators of atopic dermatitis. Hence, the finding alert a needs of strengthening the national skin diseases prevention and control services in particular in skin care of children related to atopic dermatitis and others. In avoiding early initiation of supplementary feeding specially with personal and families with atopic problem needs further attention of prevention activities. Keyword: Atopic dermatitis, cross sectional study, magnitude, institutional based study. [01] Abraham Getachew Kelbore, Mekelle University, postgraduate in Tropical Dermatology, Mekelle, North Ethiopia [02] Workalemahu Alemu, Mekelle University, Dermatovenereology department, Mekelle, North Ethiopia [03] Ashenafi Shumye, Mekelle University, public health department, Mekelle, North Ethiopia [04] Sefonias Getachew, Addis Ababa University, school of Public Health, Addis Ababa, Ethiopia
Lambert Mugabo
DelAgua Health Rwanda Implementation Ltd, Rwanda
Title: Enhancement of training completion rate in rural Rwanda: innovations into an introduction to research course
Biography:
Lambert Mugabo holds a bachelor’s degree in Applied Statistics from National University of Rwanda. Following the completion of his undergraduate studies, He joined Digital Opportunity Trust-Rwanda where, through training on computer, business, and life skills; built capacities of women and youth at grassroots level to enable them transform their lives. Over the last 3 years Lambert’s career was mainly characterized by research work. He contributed to various research projects at different institutions such as East African Community Secretariat and Center for Development Research. In 2013 He obtained a Global Health Corps fellowship and worked as Research Fellow at Partners In Health-Rwanda where he supported research capacity building through developing a web-based research course and conducted research projects whose resulted were published in international peer-review journals. He currently works as Education Program Coordinator at DelAgua Health Rwanda Implementation Limited, where he coordinates the implementation of the training program and research activities
Abstract:
Introduction to research methods course developed by the research department at Partners In Health, Rwanda since 2013 contributes to laying a solid foundation for health research capacity building of health workforce and promotes the consumption of health research. To address the challenge of incompletion of the training observed during its first offering due to competing work responsibilities and attrition of health workers, innovations have been made into its second offering. The duration of the training was reduced from 11 months to just 2 ½ whereby a session was run on weekly basis instead of monthly basis. In addition, a web-based version of the course was developed to make the course flexible and enhanced comprehension of the course materials. Though innovations into the course increased the cost due to the introduction of technology and prompted a decrease of enrollment rate, on the other side, completion rate rose to 95% in the second offering compared to 48% in its previous offering and development of web-based course offers an opportunity to reach a wider audience. Further, there is a need to find suitable technologies for resource-limited settings that do not have good internet
- 3rd Day of the conference that is (July 2nd , 2016) is scheduled for Business to Business Meeting, Networking with Keynotes, speakers, moderator and lunch will be provided from 12:30 -13:30.
- Opthamology Case Reports