Day 1 :
Keynote Forum
David Kopsky
Institute for Neuropathic Pain | Netherlands
Keynote: From case-series to a placebo-controlled n-of-1 ‘clinical trial’ of topical analgesics in the treatment of peripheral neuropathic pain. How to enhance the level of evidence of a case-report?
Time : 09:45-10:25
Biography:
As a medical student, David J. Kopsky wanted to expand his knowledge in the medical field and got skilled as an MD in acupuncture and hypnotherapy. He gained experience in READE, the Amsterdam Rehabilitation Centre in treatment and research. Together with Jan Keppel Hesselink, he founded the Institute for Neuropathic Pain, committed to the slogan: “pain free without side effects”. Keeping this slogan in mind, the use of topical analgesics was born. Since 2010 he published many publications on topical analgesics and set up double-blind randomized placebo-controlled trials to objectify its effects. Since 2016 he is patent holder of patents related to the topical formulations of phenytoin in the treatment of pain. He founded the company Topical Innovations BV to develop topical analgesics on a global scale.
Abstract:
Case reports have been identifi ed as relevant and important elements in advancing medical scientifi c knowledge. At our Institute for Neuropathic Pain, we treat patients suff ering from symmetrical peripheral neuropathic pain, oft en resistant to most therapies. Since 2010, we have developed a number of compounded topical formulations containing classical co-analgesics such as ketamine, baclofen and phenytoin in treatment-resistant patients and reported the results in case-reports and case-series. We were able to optimize dose and formulations based on the feedback given by the patients. Most of our patients reported a quick analgesic effect, within 20-30 minutes after applying analgesic creams. Case-reports or case series are seen as the lowest level of evidence; therefore, we adapted our approach to the n-of-1 ‘clinical trial’, seen as the ultimate strategy for individualizing medicine. This is possible for symmetrical neuropathic pain states, as a patient can compare the analgesic response on treatments (or placebo) between both feet. We developed first a single-blind placebo-controlled responder test, and currently are designing a double-blind placebocontrolled response test. These tests helped us to better identify responders and exclude placebo responders. Using a placebo in a practical setting however is not done frequently, and the ethical justifications of using such placebo will be presented, as well as the results of single-blind and double-blind response test evaluating the safety and efficacy of phenytoin cream in peripheral neuropathic pain. The above serves to underline the importance of case-reports in the emergence of new insights in medicine.
Keynote Forum
Syed Muhammad Ali
Hamad Medical Corporation | Qatar
Keynote: Gallbladder volvulus with segmental right liver lobe hypoplasia/atrophy: A preoperative diagnostic dilemma
Time : 10:25-11:05
Biography:
Syed Muhammad Ali is a Consultant General Surgeon in Hamad Medical Corporation, and Assistant Professor in Clinical Surgery in Weill Cornell Medical School in Qatar. He graduated from Sindh Medical College, Karachi, Pakistan with honours and finished his residency in General Surgery from Jinnah Postgraduate Medical Centre, Karachi. He earned his fellowship in General Surgery from College of Physicians and Surgeons, Pakistan and worked as Assistant Professor in Surgery in Baqai Medical University, Pakistan. He is a member of Royal College of Surgeons, England and holds the fellowship in General Surgery from Royal College of Surgeons, Edinburgh. He got his fellowship in Colorectal Surgery from European Board of Medical Specialties. He is also a fellow of American College of Surgeons. He has interest in rectal cancers and fi stula in and along with hernia surgery. He is an excellent academician and received many awards for his best teaching. He has many publications under his name and reviewer of many journals.
Abstract:
Gallbladder Volvulus with segmental right liver lobe hypoplasia/atrophy: A preoperative diagnostic dilemma
Gallbladder Volvulus (GBV) due to rotation of the gallbladder (GB) around its own mesentery, is rare surgical emergency and often identified intraoperatively. Typically, cholecystitis is the initial clinical diagnosis but a high index of suspicion on imaging can alert the physician for the possibility of GBV requiring urgent surgical intervention. We describe a case of a young female patient with hypoplasia/atrophy of posterior segment of right liver lobe and a GB with no hepatic attachments but only mesenteric pedicle; an anatomical variant combination which has not been classified before. She presented with first episode of sudden onset severe right subcostal pain. The ultrasonogram and magnetic resonance cholangiopancreatogram findings were suggestive of GBV. She underwent laparoscopic exploration that confirmed GBV of a free-floating GB with a thrombosed cystic artery. The GB was detorted and cholecystectomy was performed. She had an uneventful postoperative course and was discharged with no complications. Histopathologic examination showed intramural hematoma of GB with wall necrosis.
Keynote Forum
MIA Qureshi
Worcestershire Royal Hospital | UK
Keynote: Demonic posession or something else
Time : 11:20-12:00
Biography:
MIA Qureshi is a qualified GP as well as consultant Physician in Acute Medicine. He has presented in numerous hospital grand rounds and local meetings including journal clubs. He has participated in several QIP projects and completed many audits which have helped signifi cantly in improving patient care and safety. He has also contributed towards literature by writing case reports and participation in research projects.
Abstract:
Acute confusional state is a challenging condition especially when present in young patients. I am presenting a challenging case of acute confusion in young patient which was not diagnosed in timely manner. Thirty three years old pleasant lady was initially admitted with fits and managed with sodium valproate. There were no past medical problems. No cause was found and she was discharged with outpatient neurologist follow up. One week later she was re-admitted with confusion, bizarre behaviour and personality change. Her confusion got worse and her personality was changed to that extent that her family and other ward members including nursing staff felt about demonic possession. Th is presentation was considered secondary to sodium valproate which was changed to phenytoin. Aft erwards she went through extensive investigations including CT head, MRI head and spine, lumbar puncture, septic and autoimmune screen. Her pregnancy test was negative. LP results confirmed leucocytosis and EEG showed diff use abnormality. MRI head and MRV were normal. CSF culture did not grow any organism. She was treated with 14 days course of IV acyclovir for encephalitis which did not help and her condition deteriorated further and she was transferred to ITU. Neurologist subsequent review advised for VGKC, NMDA, GAD and paraneoplastic antibodies. NMDA receptor antibodies result later came back positive. She had a CT TAP and TV ultrasound which ruled out any ovarian malignancy. She was treated with immunoglobins and IV steroids and her condition improved slightly however later she aspirated during fi tting and was intubated and transferred to tertiary hospital where she received plasma exchange and got almost full recovery.