International Conference on Internal Medicine November 01-02, 2016 San Francisco, USA

Biography:

Filomena Pietrantonio has completed her medical degree from Catholic University of the Sacred Heart of Rome and she has completed residencies in Internal Medicine (Catholic University of Sacred Heart, Rome), Clinical Psicology (University “Sapienza” of Rome) and Cardiology (Torvergata University of Rome). She is co-Director in internal Medicine Department in S. Eugenio Hospital in Rome. She has published  28 papers in reputed journals and has been serving as an editorial board member of International Journal of Community & Family Medicine.

Abstract:

Chronic diseases are the major cause of death (59%) and disability, 46% of global disease burden. According to the Future Hospital Commission of the Royal College of Physicians, Medical Division (MD) will be responsible for all hospital medical services, from emergency to specialist wards focusing on  the management of acute medical patients. Methods. To better manage polypathological patients requiring hospitalizationl we propose the hospital counterpart of Chronic Care Model (CCM), the Acute Complex Care Model (ACCM).  Target population are acutely ill complex and poly-pathological patients (AICPPs), admitted to hospital and requiring continuous monitoring and  high technology resources. The mission is to improve the AICPPs management through pre-defined intra-hospital tracks and a global, multidisciplinary, patient centered approach. The ACCM leader is internal medicine specialist (IMS) who summarizes health problems, establishes priorities and restores health balance in AICPPs. Admitted patients, evaluated according to validated  criteria, should be allocated in High Dependency Areas (HDAs) to receive more frequent clinical and  nursing  monitoring  than in ordinary wards, even if less than in Intensive Care Unit. ACCM  advantage is patient safety, thanks to a more favorable nurse/patients ratio, quicker responses to changes in clinical conditions, and more functional allocation of resources. Results. Preliminary data collected in  two Rome MD (50 patients)  showed:  mean age 73 years, more than 4 active comorbidities, need of continous monitoring,  high technology resources, an average of 4 urgent investigations  and 2 specialists consultations performed during the first 72h from admission.  Conclusions: Epidemiological transition leading to a progressive increase in “chronically unstable” patients needing frequent hospitalizations, enhances the role of hospital IMS. ACCM represents a practical response to this epochal change of roles

Biography:

Odia Obadan is a Medical resident at St John‘s Episcopal Hospital in New York.  After completing Medical School in 2007, he completed his Masters in International Health Policy and Management in Boston, MA. He has been involved in Medical research for the last 8 years and was also an adjunct Instructor for Anatomy and physiology for a Licensed Professional Nursing Program .

He is currently doing his Medical residency in Internal Medicine.

Has 4 siblings and is interested in writing research papers.

He likes making friends and seeking adventures in the outdoors, likes to listen, likes yoga, music and plays soccer in his down time.

Abstract:

Introduction

Hodgkin lymphoma (HL) exclusively in the accessory spleen has been seldom reported in the literature. We report a case of a HIV positive man with Classic Hodgkin lymphoma with B symptoms and positive Epstein Barr Virus (EBV) LMP.

Case report

A 51 -year-old Nigerian man with undisclosed HIV status, non-compliant with antiretroviral therapy presented with complaints of fever, abdominal pain, jaundice, bone pains, diarrhea and weight loss of 2 years duration. He denied history of use of hepatotoxic or intravenous drugs.  His workup done in Nigeria, India and Dubai included a bone marrow biopsy which revealed hypocellular bone marrow with fibrosis and plasmacytosis.  As his symptoms worsened, he decided to seek treatment in the United States. Initial physical examination was unremarkable but his mental status deteriorated. Laboratory tests showed pancytopenia, elevated liver enzymes, coagulation profile and HIV positive (CD4 count 235 cells/mm³ and undetectable viral load). Hepatitis, malaria parasite tests and cerebrospinal fluid tests were negative. CT abdomen showed accessory spleen and hepatomegaly. Laparoscopic wedge liver biopsy and excision of accessory spleen was done. Pathology of accessory spleen revealed Classical Hodgkin lymphoma, mixed cellularity  type, CD15 +ve, CD30 +ve, Fascin +ve, MUM-1 +ve, PAX 5 +ve, EBV LMP positive in atypical cells.  He showed symptomatic and laboratory improvement on antiretroviral therapy and was referred to an Oncology Center for ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) treatment with outpatient follow up.

Discussion

HL is the most common non AIDS defining malignancy in HIV patients. The nodes are commonly involved (75%) while spleen is the most common extranodal site (20%). This case is unusual because lymphoma was only seen in the accessory spleen. Though incidence of AIDS defining cancers has declined, the incidence of HL in AIDS has increased, possibly due to the use of combination antiretrovirals and therefore improved immunity. Nearly all cases in HIV patients are associated with EBV (70-80%), B symptoms, and histologically, half of cases are mixed cellularity as seen in the patient above.  EBV is suggested as an important etiological factor in the development of HIV associated HL. The incidence of HL peaks at CD 4 counts between 150 to 199 and HL with CD4 counts less than 200 associated with a poorer prognosis. Currently, ABVD is the standard of treatment for AIDS related HL as well as HL.

Biography:

Dr . Seemin Afshan Shiraz completed her MRCP(UK) in 2007 and then European Diploma in Critical Care in 2009. She has extensive experience in internal medicine and critical care. She has been invoved in teaching of medical students at University of Sharjah along with the training and teaching of post graduate students of family medicines, internal medicine and critical care medicine. She as an ACLS instructor.  She has been taking part in several oral and poster presentations both at national and international level. Currently, she is working as an incharge of a critical care fascility in Dubai, United Arab Emirates.

Abstract:

The number of  patients with atrial fibrillation is anticipated to increase.The  prevalence of AF increases with age. Its more common in Male gender.AF is more common among Caucasians. Patients with cardiac conditions. like Congestive heart failure , Valvular heart disease, MI and those having Diabetes mellitus,Hypertension are prone to have AF. Pathological changes associated with AF include atrial fibrosis and loss of atrial muscle mass. AF is thought to be triggered by ectopic foci, or the generation of multiple wavelets, that lead to uncoordinated atrial contraction.Ectopic foci are found in the pulmonary veins and elsewhere (e.g. superior vena cava). .Electrical and structural remodelling in the atria may be responsible for progression from paroxysmal to persistent or permanent AF.Typical symptoms of AF include ,Palpitations, Fatigue, Chest pain Dizziness,Syncope,Dyspnoea. AF may also be asymptomatic.Approximately 38% of patients with AF are asymptomatic. AF has serious consequences.Its an independent risk factor for stroke, mortality and heart failure. In the management of AF, its  important  to Identify cause and then to establish a strategy to avoid strokes and to treat symptoms – if there are any. Oral Anticoagulation is the only treatment for AF which improves prognosis. It prevents 60% of strokes in AF and 75% of embolic strokes. It reduces mortality by 25% and 20% of strokes are preventable. All patients with AF and with CHA2DS2 VASc score 1 for male and 2 for females should be considered for anti-coagulation.
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Other measures are rate control, cardioversion and ablate therapy including pace & ablate

Biography:

Kuladeep Krishna Gidda is currently working in DMH, Decatur, Illinois, USA

Abstract:

A 50-year old female presented with two days of progressively worsening of shortness of breath, cough and muscle cramps in the lower limbs. She had the history of frequent flare up of asthma, 30 pack years of smoking history. Review of systems was remarkable for dry cough and shortness of breath for two days partially relieved with the rescue inhaler. She denied chest pain, excessive sweating, palpitations and passing out. Vitals, Blood pressure 110/68, Pulse 90bmp, Temp 98.2 F recorded orally, Respiratory rate 24/min with saturation 94%. She had wheeze at both the lung bases. CVS examination was normal. EKG showed normal sinus rhythm. She used 8 to 10 times a day the rescue inhaler containing Levalbuterol in the past three days. Labs revealed WBC of 11 with 10% Eosinophils, CPK was 98 U/L, her serum electrolytes Na 140 mEq/L, K 3.3 mEq/L, Ca 9.2 mEq/L, Cl 100 mEq/L, HCO3 22 mEq/L, Chest X-ray showed non-specific findings related to obstructive lung disease. Peak flow meter readings were low. Ankle brachial index score of 1.2, arterial Doppler lower extremities showed no abnormalities. All the above lab workup revealed no abnormalities except increased Eosinophil count and low potassium levels. She was not on any drugs which are known to lower serum potassium levels, after doing all the work up she was prescribed with starting dose of 40mg oral prednisone tapered in one week, Tudorza inhaler and asked her to hold the rescue inhaler and follow-up in 1 week. During her follow-up visit, she told that her symptoms were relieved and repeated electrolyte labs were normal.
Learning Objective:
1: Understanding the side effects of the drugs of asthma.
2: Emphasizing on detailed history taking for precise diagnosis.
Discussion:
Shortness of breath and cough are the common problems encountered by the Internist. But muscle cramps in patients taking beta agonist inhaler are usually rare. Even though she has 30 pack years of smoking history, normal ankle brachial index and arterial Doppler ruled out the peripheral artery disease. Normal CPK ruled out inflammatory causes of her complaint. The point is, an orderly approach is imperative in determining the less common causes of this problem. One approach is taking a detailed history and sorting out the reasons for the problem so that the possibility of missing the rare causative factors can be minimized, and also the unnecessary diagnostic workup can be prevented. In this patient with known history of asthma presenting with worsening shortness of breath and cough clearly indicates as an asthmatic flare up. But with detailed history it became evident that she used rescue inhaler an excessive number of times a day than suggested, giving the clues for her lower limb muscle cramps. Levalbuterol, a short-acting beta agonist, is the drug present in her rescue inhaler which can rarely lower the serum potassium level causing the muscle cramps. Physicians should be proficient in addressing rare possibilities.
Conclusion:
Understand the side effects of the drugs of asthma. Although widely studied in the literature, recognize that short-acting beta agonist (SABA) in an inhaled quantity is an uncommon cause of muscle cramps. SABA causing muscle cramps should be suspected in a patient with decreased serum potassium levels, with no other known factors for lowering potassium and when rest of the workup is normal. This case illustrates that SABA even in inhaled amounts can cause muscle cramps mostly when taken more than six times a day.

Biography:

Mohamed Elmutasim Abd El Bagi is a Consultant Radiologist at the National Guard Hospital of King Abdulaziz Medical City in Riyadh. He is a Fellow of the Royal College of Radiologists, London and a Fellow of the Faculty of Radiologists at the Royal College of Surgeons, Ireland. He has obtained a Master degree in Total Quality Management from Ribat University and was previously a Professor of Radiology at the National University in Khartoum.

Abstract:

This presentation aims to report the outcome of plain abdominal radiographs PAR’s when used as initial test for acute non-traumatic abdominal pain (ANAP). This retrospective study was conducted at an Emergency Department (ED) of a tertiary care centre. We included all patients aged 15 years and above who have presented to our ED with ANTAP and referred for PAR’s during the period from 01-06-2014 to 30-06-2014. 15140 patients visited our ED with a variety of presentations. PAR’s were requested for 756 of them due to ANTAP. 379 (49.6%) of those were males and 385 (50.4%) were females. Age range was 15 to 92 years. Mean age was 46 years. Commonest presentation was unclassified abdominal pain in 679 (89.8%). PAR's alone were requested for the vast majority of cases 594 (78.57%). In 103 (13.6%) conventional dose contrasted CT was added and in 33 (4.3%) low dose CT was added. Abdominal ultrasound (US) was added in 52 (6.8%). MRI was added for only one patient. When both PAR's and CT were used, there was a poor diagnostic congruence of 68.9% in non-specific or non-significant cases and only 35.7% in abnormal cases. Despite availability of CT and other modalities, PAR’s are still the commonest one stop shop imaging test requested by the ED for ANTAP. When both CT and PAR’s were used, there was a poor congruence of findings indicating lower accuracy of PAR’s. Controlled trials are necessary to see if PAR’s can be replaced by CT. Our finding matched other workers except for higher sensitivity of our PAR’s for urolithiasis.

Biography:

Md Shahidul Islam is a Swedish board certified Specialist in Internal Medicine and a Senior Consultant Physician at the Uppsala University Hospital, Uppsala, Sweden. He did his PhD at the Karolinska Institutet in 1994 and he is an Associate Professor, Principal Investigator and Research Group Leader at the Karolinska Institutet, Stockholm, Sweden. He has published over 40 research papers, edited five books including one on Thrombosis and Embolism. He has received several Swedish and international awards for his research

Abstract:

Clinicians need to decide about the use of thrombolytic (fibrinolytic) therapy for pulmonary embolism (PE) after carefully considering the risks of major complications from bleeding, and benefits of the treatment for each individual patient. They should probably not use systemic thrombolysis for PE patients with normal blood pressure. Treatment by human recombinant tissue plasminogen activator (rt-PA), alteplase saves lives of high-risk PE patients, i.e., those with hypotension or shock. Even in the absence of strong evidence, clinicians need to choose the most appropriate regimen for administering alteplase for individual patients, based on assessment of the urgency of the situation, risks for major complications from bleeding and patients body-weights. In addition, invasive strategies should be considered when absolute contraindications for thrombolytic therapy exist, serious complications arise or thrombolytic therapy fails.

Biography:

Dr Khalil Ahmad did graduation (MBBS) from Punjab Medical College Faisalabad, Pakistan in 1998. He then moved to FPGMI Shaikh Zayed Hospital Lahore, Pakistan for residency programme in internal medicine. He passed fellowship exam in Internal medicine (FCPS) from College of Physcians & Surgeons in 2005. He moved to Dubai, UAE in 2006 and joined Rashid Hospital Dubai Health Authority. He passed membership exam from Royal Colleges of Physcians UK (MRCP) in 2011. He passed European Diploma in Intensive Care Medicine (EDIC) conducted by European Society of Intensive Care Medicine in 2013. Recently, Dr Khalil Ahmad has done decent research work on hyponatremia and has presented his work in the international conferences.

Abstract:

Dysnatremia is commonly seen in intensive care setting. If it is not timely diagnosed and corrected, can lead to serious consequences. Early detection and correction may improve prognosis especially in neurocritical care.  It can be hypo or hypernatremia, both have worst effect on overall prognosis if not corrected timely.           Hypernatremia is defined if serum sodium is > 145 mmol/liter. It is due to relative water depletion with total body sodium content either normal, low or high. Diabetes insipidus is one of the most common causes of hypernatremia in neurocritical care. Hyonatremia is the other entity which accounts about 15-20% of all emergency admissions, and can affect on prognosis significantly. In spite of much understanding of the topic, its management remains still problematic. Hyponatremia is defined as if serum sodium < 135 mmol/liter, and it is classified as mild, moderate & severe on the basis of serum level. On the basis of onset duration, it is defined whether acute or chronic hyponatremia. Broadly speaking dilutional & volume depletion are the two most common causes of hyponatremia, remaining are endocrinal, use of diuretics and certain drugs leading to hyponatremia. The management of either entity depends upon the cause leading to hypo or hyernatremia. It is of prime importance to avoid overcorrection, during management of hyponatremia or hpernatremia. Different calculations are used to calculate total sodium deficit and total water deficit before starting correction. Special care is needed in neurocritical care like patients with acute traumatic brain injuries and acute stroke for early detection and correction of serum sodium levels to avoid adverse effect on overall prognosis. Hyponatremia is broadly classified into hypotonic, hypertonic or isotonic based on measured serum osmolality.

Biography:

Filomena Pietrantonio has completed her medical degree from Catholic University of the Sacred Heart of Rome and she has completed residencies in Internal Medicine (Catholic University of Sacred Heart, Rome), Clinical Psicology (University “Sapienza” of Rome) and Cardiology (Torvergata University of Rome). She is co-Director in internal Medicine Department in S. Eugenio Hospital in Rome. She has published  28 papers in reputed journals and has been serving as an editorial board member of International Journal of Community & Family Medicine.

Abstract:

Background. International guidelines demonstrate the importance of nutrition and lifestyle as risk factorsin chronic diseases (CD). In order to validate the INS first realized through a pilot study in the race Strafadoi Lazio, the same questionnaire (CRF) was administered to a total of 157 athletes during 3 races in 2014.Methods. CRF was realized to identify, through a composite index, modifiable risk factors in causing CD taking into account: weight, diet and physical activity. Weight was measured using BMI according to the WHO stratification, physical activity as weekly frequency and average activity duration. Foods were evaluated qualitatively enhancing their effect on metabolism and food combination. Results.  INS was calculated by multiplying: nutrition index, BMI index and physical activity index. Maximum INS value is 0.92 stratified in 4 ranges between 0.01 and 0.92 (very low-low-high-very high). The athlete sample, selecting individuals with normal BMI, doing regularly exercise and following balanced diet, shows high INS value:0.47-0.69  (75% of the sample) and very high value: 0.69-0.92 (23%). INS seems to be direct correlate with physical activity index (moderate direct correlation: 0.756) and less linked to nutritional index (0.408) and  to BMI Index (0.472). Conclusions. The INS is the first composite index that combines nutritional status with other factors such as BMI and diet. The validation shows how it can be able to relate adequately to fundamental health determinants and can be a useful tool in evaluation of CD risk factors.

Biography:

Mr Bang Zheng is a master candidate  of Peking University School of Public Health, Department of Epidemiology and Biostatistics. He has strong research interest in various aspects of Epidemiology, including sleep medicine and cardiovascular disease

Abstract:

Purpose: To investigate the relationships of overall and domain-specific physical activities with sleep disorders among Chinese men and women.
Methods: The data of 452,024 Chinese adults aged 35-79 years from The China Kadoorie Biobank Study was analyzed. Sleep disorders were classified as having disorders in initiating and maintaining sleep (DIMS), early morning awakening (EMA), daytime dysfunction (DDF), and any sleep disorders (ASD). Self-reported physical activity was divided into domains of occupational, commuting-related, household and leisure time activities. Gender-specific multiple logistic regression analysis was conducted to identify effects of overall and domain-specific physical activities on risk of sleep disorders.
Results: The mean age at baseline was 50.5±10.4 years, with 40.2% male participants. In total, 12.9% of men and 17.8% of women participants reported having ASD. Moderate to high levels of overall activity were associated with lower risks of DIMS and DDF in both sexes (ORs range: 0.87-0.94). Beneficial effects of occupational, household and leisure time physical activities on sleep disorders were identified only in women (ORs range: 0.84-0.94). However, both moderate and high levels of commuting-related activity were associated with increased risks of DIMS and ASD in men and women (ORs range: 1.07-1.17).
Conclusion: This study confirmed that moderate to high level of physical activities have beneficial effects on sleep among Chinese adults. However, different domains of activity may have varied effects with gender differences, which needs to be taken into consideration in policy making.

Biography:

Dagmar F. Hernandez-Suarez, MD is third-year Internal Medicine Resident at the University of Puerto Rico-Medical Sciences Campus, School of Medicine, San Juan, Puerto Rico. Dr. Hernandez-Suarez completed his medical degree at the “Instituto de Ciencias Medicas de La Habana”, Cuba in 2011. In 2015, Dr. Hernandez-Suarez joined the Post-Doctoral Master in Clinical and Translational Sciences (NIHR25MD007607) and was recognized with the receipt of a CRECD Scholar Research Award for Phase I. He is currently working in the development of a research proposal in pharmacogenomics of antiplatelet drugs.

Abstract:

A case to illustrate the clinical utility of ethno-specific pharmacogenetic testing in warfarin management of a Hispanic patient is reported. A 37 year-old Hispanic Puerto Rican, non-gravid female with past medical history of abnormal uterine bleeding on hormonal contraceptive therapy was evaluated for abdominal pain. Physical exam was remarkable for unspecific diffuse abdominal tenderness and general initial laboratory results were unremarkable with a PT and PTT of 10.0 and 26.6 sec., respectively and INR of 0.9. A contrast-enhanced computed tomography showed a massive thrombosis of the main portal vein, splenic vein and superior mesenteric vein. Upon admission patient is started on oral anticoagulation therapy with warfarin at 10mg/day and low molecular weight heparin. Strikingly, the prediction of 7.5 mg/day of maintenance warfarin, which was estimated by using a recently developed pharmacogenetic-guided algorithm for Caribbean Hispanics, coincided with the patient’s actual effective warfarin dose. We speculate that the slow rise in patient’s INRs observed upon the initiation of warfarin therapy, the resulting high risk for thromboembolic events and the final maintenance warfarin dose of 7.5 mg/day, are attributable in some part to the presence of the NQO1*2 (g.559C>T, p.P187S) polymorphism, which seems to be significantly associated with resistance to warfarin in Hispanics. By adding the genotyping result of this novel variant, the predictive model can now inform clinicians better about the optimal warfarin dose in this medically underserved population with lack of representability in most clinical studies. The results highlight the potential for pharmacogenetic testing of warfarin to improve patient care.

Biography:

Muhammad Miftahussurur has completed his PhD from Oita University, Japan and recently as a postdoctoral fellow at Baylor College of Medicine. He has published 15 papers in reputed journals

Abstract:

Information about antibiotic resistance for Helicobacter pylori infection in Indonesia was missing; we therefore aimed to determine the antibiotic susceptibility of H. pylori in Indonesia and determined the association of virulence genes with antibiotic resistance rate also the presence of genetic mutations associated with antibiotic resistance.  We recruited 849 patients with dyspeptic symptom who underwent endoscopy at 11 cities of Indonesia. E-test method was used to determine the minimum inhibitory concentration (MIC) of five antibiotics. Only 9.1% had clarithromycin resistance. The low prevalence was also found in amoxicillin and tetracycline resistance (5.2% and 2.6%, respectively). In contrast, metronidazole and levofloxacin demonstrated high resistance rate (46.7% and 31.2%, respectively). Strains taken in Sumatera island had significantly higher metronidazole resistance than other locations (P = 0.006). Ambonese had higher metronidazole and tetracycline resistance than other ethnics (both P = 0.01). There was significant association of tetracycline resistance with positivity of cagA (P = 0.004). We identified 95.5% of metronidazole resistant strains had highly distributed rdxA amino acid substitution. We also found the A2143G mutation of 23SrRNA in clarithromycin resistant strains (42.9%). However, one strain with the highest MIC value was related with novel mutated sequences of hp1314 (rpl22) without involvement of A2143G mutation. Additionally, 86.7% of levofloxacin-resistant strains had gyrB mutation at Asn-87 and/or Asp-91. The gyrB mutation had steady relationship with the gyrA 87-91 mutations. Clarithromycin- or metronidazole-based triple therapy should be taken with caution or culture-based therapy should be taken into account in some regions/ethnics of Indonesia.

Biography:

Dr.Reinaldo Ramirez Amill has completed his BS in Biology from University of Puerto Rico, Mayaguez Campus and his MD from the University of Puerto Rico, School of Medicine, receiving in both occassions Magna Cum Laude honor award. He is currently completing a subspecialty in internal medicine in University of Puerto Rico, Internal residency Program. Current interests include preventive medicine, scientific research, and mentoring the youth interested in the field of science and medicine

Abstract:

Kodamaea ohmeri has only been identified as the causative agent of infections in humans in a scarce amount of cases.

 A 43 year old male patient who was sent to the Emergency Room after routine laboratories showed leukocitosis and a blood culture grew up yeast. Patient recently finished a course of 42 days of intravenous empiric antibiotic therapy with Vancomycin and Zosyn for a left foot osteomyelitis via a peripheral inserted central catheter. Upon evaluation, vital signs were stable and there was a right arm peripheral inserted central line catheter in place, without nearby erythema, induration or suppuration. Laboratory tests revealed leukocitosis. Patient was empirically administered caspofungin. A yeast-like organism was isolated from the patient’s blood and from the tip of the catheter, which was later identified as K. ohmeri. Transthoracic echocardiogram revealed a mobile echodense structure associated to the aortic and tricuspid valve, suggestive of vegetation. On follow up blood cultures the same yeast was isolated from her blood. Therapy was changed to Fluconazole. Transesophageal echocardiogram was then performed and was negative for vegetations. Subsequent blood cultures were also negative. Upon completion of therapy, patient was discharged home in a stable condition. 

This case illustrates a rare cause of fungal endocarditis and fungemia, which was successfully treated with with fluconazole. K. ohmeri is an uncommon human pathogen, with only a few case reports in the medical literature. Due to its rareness, data regarding optimal treatment regimens is limited. Further studies are needed to establish the optimal antifungal regimens.

Biography:

Dr.Pedro Blandon finished his MD at University of Guadalajara in Jalisco, Mexico in 1996;  his internal medicine residency  at Texas Tech University Health Sciences Center in El Paso, TX in 2000 and his Nephrology fellowship at University of New Mexico in 2002. He was the director of the Internal Medicine Residency program from 2009 to 2015,  at Texas Tech University Health Sciences Center, El Paso, TX. He has published papers in protein turnover in dialysis patients, chronic kidney disease in third world countries and most recently profiles of GI diseases in urinary metabolomics

Abstract:

Diabetic nephropathy affects one third of all diabetics. Evidence has shown that a multi prong approach usually started at the primary care level decreases but does not completely eliminate this problem. It is important for patients to be informed of this silent complication at every stage of the disease since damage is mostly irreversible when physical symptoms are noticed. Nephrologists are usually consulted late when the eGFR is 30 or less and at that point, the management of complications such as anemia, hypertension and bone and mineral metabolism disorders, along with preparation for dialysis is the tasks at hand. We will present a strategy to help patients and primary care physicians develop a partnership in aborting the progressive renal damage that ends up in renal replacement therapy, a life changing and very expensive proposition. Diabetic and blood pressure control, avoidance of nephrotoxic drugs, detection of reversible renal damage that may coexist with diabetes are at the core of this strategy. Many patients when confronted with possibility of dialysis start paying more attention to their neglected diabetes care. This places the Nephrologist in a privileged position when addressing the above named interventions, as such the astute clinician works with patient, primary care and consultants in the management of several of these complications. It is not uncommon for patients to become funded or insured until they start dialysis and nephrologists round on these patients on weekly basis, allowing for a continuous feedback loop that encourages them to prevent additional diabetic complications.

Biography:

Dr. Piriyawat is an Associate Professor of Neurology at Texas Tech University Health Sciences Center.   He completed his neurology residency at Saint Louis University where he also served as a faculty member.  He joined the then newly established Department of Neurology, Texas Tech University Health Sciences Center El Paso in 2014.  He was tasked to start a neurology residency program for which he has assumed the position of program director.

Abstract:

Diabetic neuropathy is one of the most common complications of diabetes mellitus. Presentations may be either focal (asymmetric) or generalized (symmetric); either sensory or motor or sensorimotor; either painful or painless. Autonomic nervous system can also be affected. Foot ulcers may result as a complication from diabetic neuropathy and may lead to amputations due to ischemia or infection. Studies have been conducted to gain better knowledge about pathophysiology of diabetic neuropathy and several hypotheses have been proposed. While tight glycemic control may help delay the progression of the diabetic neuropathy, medical therapy may be used for certain neuropathy-related symptoms such as neuropathic pain, erectile dysfunction and orthostatic hypotension. Patients should have their glycemic control closely monitored. Feet should be inspected daily by patients and on every visit at the physician’s office. Confocal microscopy is another useful tool in assessing the status of neuropathy.

Biography:

Dr.William J. Rowe M.D.  is a board certified specialist in Internal Medicine. He received his M.D. at the University of Cincinnati and was in private practice in Toledo, Ohio for 34 years.  He is a former Assistant Clinical Professor of Medicine at the University of Ohio, School of Medicine at Toledo. Of only 4 space syndromes, he has published 2: "The Apollo 15 Space Syndrome" and "Neil Armstrong Syndrome." He published Neil Armstrong's probable lunar acute heart failure. He has been listed in the Marquis Whos Who of the World from 2002-2009,2013, 2014, 2015, 2016.

Abstract:

“Neil Armstrong Syndrome” applies both to Earth with common magnesium ( Mg) deficits and with Mg deficits invariably  occurring in Space (S); this can trigger acute temporary heart failure i.e. catecholamine (C) cardiomyopathy). Whereas the normal CO2 levels on Earth are .03% , in S, during the Euro Mir 94 missions, for example, levels, over 10 times higher ( .5% - .7% CO2 ). It has been postulated that there is, with S flight, an intracellular shift of calcium (Ca) conducive to vasospasm and damage to mitochondria. Mg is a Ca. blocker and strong antioxidant and is required for thermoregulation; with loss of Mg in sweat and renal Mg loss and dehydration, this will increase potential for heart failure and hypertension. C levels in S are twice supine levels on Earth. Armstrong, during his last 20 lunar minutes, notified Houston twice during a 4 minute interval that he was  “short of breath” along with heart rates up to 160;  tachycardia will intensify oxidative stress in S from Mg ion deficits, high C, high free fatty acids and vicious cycles. This syndrome: severe dyspnea, severe thirst, severe tachycardia corrected by fluid replenishment, applies to  Earth as well; it would be more likely to occur in post-menopausal women, with 90% of cases of C cardiomyopathy reported in this group, marathoners particularly at the finish line and those in the tropics, particularly with water shortages. It is likely to be corrected, relatively quickly either by intravenous fluids or a subcutaneous Mg injection.  

Biography:

Dr.Tamis Bright, MD is an Associate Professor of Medicine and has been the Chief of Endocrinology at Texas Tech University for 21 years, with focus on diabetes and thyroid diseases.  She graduated from Loyola Stritch Medical School, Maywood, IL and completed her Internal Medicine Residency and Endocrinology Fellowship at the University of Colorado in Denver.  Dr. Bright is also the Associate Program Director for the Internal Medicine Residency, and has been honored with awards for her teaching of residents and medical students. She has published numerous articles on diabetes and is a frequent lecturer on diabetes management

Abstract:

In 2014, there were 29.1 million diabetics in the US or 9.3% of the US population and 422 million diabetics worldwide. Diabetes and its complications account for a large fraction of the health care expenditures for every nation. Controlling the glucose prevents complications and decreases costs. However, according to the National Health and Nutrition Examination Survey (NHANES) data only about half of the diabetics in the US have a Hba1c<7% and only 14% have met the goals for glucose, cholesterol, BP, as well as a non-smoking status. There are a number of new medications, insulins and delivery systems which providers can use to improve overall control in their diabetic patients. Methods of combining the newer oral medications and recently developed concentrated insulins in the armamentarium for controlling DM2 will be discussed. Diabetics with nephropathy and/or gastroparesis are frequently some of the most challenging cases for obtaining adequate glucose control without hypoglycemia. Techniques of managing these patients, including insulin pumps and continuous glucose monitors, will be described.

Biography:

Dr.Irene Sarosiek, M.D., AGAF, FACG, CCRP is a Professor of Medicine and the Director of GI Motility Neurostimulation Research at Texas Tech University Health Sciences Center in El Paso.She is a Fellow of the American College of Gastroenterology and the American Gastroenterological Association, and a member of the American Neurogastroenterology and Motility Society, the Association for Women in Science-Texas Chapter, Association of Clinical Research Professionals, the Academy of Clinical Research Professionals and Society of Clinical Research Associates. She is also a Founding Member of Laura W. Bush Institute for Women’s Health Scientific Advisory Committee and the Founding Chair of Mentoring Committee of Women in Medicine and Science Organization at TTUHSC, El Paso

Abstract:

Gastroparesis (GP), which affects up to 10 million individuals in the United States, is characterized by the presence of chronic, often debilitating upper gastrointestinal symptoms such as nausea, vomiting, early satiety, postprandial fullness, bloating and abdominal pain, while diagnosis is confirmed by documenting delayed emptying of the stomach. The majority of GP patients are idiopathic, whereas in 30% others it represents a serious complication of long-standing type 1 and 2 diabetes mellitus (DM). The past ten years have shown substantial progresses in our understanding of the pathophysiology of gastroparesis as well as its diagnostic tests. However, the pharmacological choices with FDA approved and investigational agents have been limited and often less than optimal. Moreover, in 50-60% of GP patients who are refractory to medical therapy, surgical implantation of gastric electrical stimulation (GES) system improves the symptoms, while addition of pyloroplasty accelerates rate of gastric emptying. Recently introduced concept of needleless transcutaneous electro-acupuncture (TEA) is shoving promising clinical results, while besides controlling symptoms; it improves quality of life in DMGP patients. In this talk, the standard diagnostic tests of GP, including scintigraphy and wireless motility capsule methodologies of gastric emptying test with pharmacological treatment options and their safety, as well as our recent findings on TEA, the surgical approaches of GES plus pyloroplasty and total gastrectomy will be discussed.

Biography:

Fraer Monyis currently working as a Clinical Associate Professor, Internal Medicine Nephrology, University of Lowa Carver College of Medicine

Abstract:

Background
• Diabetes is a high cost chronic disease
• 42% of Iowans have prediabetes or diabetes
• Outcomes are determined by self-management activities occurring in the 5K annual waking hours outside of clinic visits
• In diabetes management, glucose measurement directly correlates to diabetes control

Purpose
Addressing the question;

 Can
• addressing barriers to diabetes self-management
• remote monitoring &
• continuous decision support

Help:
•  reach goals of care &
•  reduce unnecessary health care expenditures

Strategy and Implementation
• Enrolled 41 patients over span of 6 months with Type 1 or Type 2 diabetes with the following criteria:
• 3 or more ED visits or hospitalizations over a 12 month period OR
• 1 ED or hospitalization over previous 12 months with a HgA1c > 9%
• Targeted patient education based on the following validated survey measurements to assess and understand barriers to self-management care
• PHQ9
• Patient Activation Measure (PAM) - 13™
• Morisky Medication Adherence Scale
• Michigan DTRC Brief Diabetes Knowledge Test
• Incorporated web-enabled blood glucose meter for ease of testing and remote monitoring
• Glucose reading is transmitted over HIPAA compliant FDA approved cloud to care team web portal allowing for real-time decision support  

Key Findings
• Improvements in clinical measures and utilization
• Reduced cost of ED visits and admissions by $102K
• Improved efficiency & lower cost of clinical decision support
• Value from the patients’ perspective

Biography:

Allehyani S H has worked at Army Hospital in the Radiotherapy Department after his graduation from Umm al-Qura University in Medical Physics in 1987. He did his Msc in Medical Physics from Surrey University (1993) in UK and PhD degree in Imaging Processing from Wales University (1997) in UK. From 1998 to 2015 he was teaching radiotherapy, laser medicine, radio-isotopes and radiation physics courses as well as supervising number of students (M/F) in their training field in different hospitals like Army Hospital, King Abdullah Medical City and Al-Noor Specialist Hospital. He is a peer Reviewer in the Editorial Boards of Canadian Medical Society. He has about 18 scientific papers in medical journals listed below and he is currently a full Professor in Physics Department Medical Physics Group at the College of Applied Science in Umm al-Qura University, KSA. His field of interest is in radiation therapy (treatment planning) and medical imaging. His papers are published in refereed journals. He is an active Member in the Institution of Research (Applied Science Center UQU) and Academic Accreditation of College Science. He has contributed numbers of electronics books in different web-educations website and constructing physics website.

Abstract:

The aim of this study is to compare 3DCRT to RapidArc planning systems using LNAC of 6 MV, 15 MV and 18 MV in terms of dosimetric outcomes of iso-dose distribution, dose volume histogram (DVH), PTV and at risk organs in 6 patients with breast cancer. Plans were created for 6 patients with breast cancer who had received radical RapidArc treatment from 2012 to 2014 at KAMC (King Abdullah Medical City). Dosimetric evaluation metrics were used to compare the two plans in terms of mean, maximum and minimum doses to PTV, Homogeneity Index (HI), Conformity Index (CI), Target Coverage Index (TCI) and mean and maximum doses to critical organs and normal tissue. Dose to 95% of the PTV (D95%) was used to quantify PTV coverage. Mean value of the PTV which was 51.38±2.172 in RapidArc compared to 52.21±1.963 in 3DCRT, which means that RapidArc plan achieved lower mean and maximum doses to the PTV. The maximum dose to the PTV in RapidArc was higher compared to 3DCRT with lower maximum dose to the PTV, (p=0.011). These results explain the statistical advantage in PTV coverage metrics in RapidArc modality. PTV dose coverage, as measured by the minimum dose and the dose to 95% of the volume was higher in the RapidArc plan. RapidArc plan also showed a more homogeneous dose distribution in PTV, achieving an HI of 1.262±0.037 compared with 1.271±0.024 in the 3DCRT plan however, RapidArc and 3DCRT achieved similar CI values and improvement in target coverage index (TCI) in which (TCI) in RapidArc was (0.006±0.003) and (0.008±0.006) in 3D-CRT,(P=0.202). Volumetric modulated arc therapy (VMAT) is better than 3DCRT in term of PTV, conformity and homogeneity for breast cancer.

Biography:

Bulent Saka is currently working in Istanbul University, Turkey

Abstract:

Introduction & Aim: Fever of unknown origin (FUO) is defined as prolonged fever over 38.3 oC in the last ≥3 weeks, without any known diagnosis at the end of one week of detailed clinical investigation. After detailed examination, the most frequent diagnosis is infectious, non-infectious inflammatory diseases and neoplasia; whereas a wide spectrum of diseases may be the cause as well. In this study, the role of 18F FDG-PET in FUO diagnosis was examined.

Material & Method: 52 patients, who were hospitalized with various complaints in Istanbul Faculty of Medicine, Department of General Internal Medicine between June 2008 and August 2014, examined and their 18F FDG-PET results were included in the study. All patients had FUO criteria (fever lasting 3 or more weeks, continuous or repetitive properties with over 38.3 oC body temperature, no causes of fever being found despite examination with at least one week of pre-hospitalization). During retrospective analysis, it was observed that all 18F FDG-PET's were done in Nuclear Medicine Laboratory with 6 dissection multidetector BT integrated in high-resolution scanner (Siemens Biograph LSO HI-RES PET-BT) and with at least 4 hours of starving before the process. All patients were observed to take 8-19th FDG injection through method IV. During the evaluation of the images, the FDG uptakes detected outside the physiological uptake regions of the body were accepted as pathological. The basic diagnosis tests of all patients made before 18F FDG-PET were analyzed.

Results: 26 female and 26 male patients with an average age of 54.2±19.5 years (18-93) were included into the study. The average fever duration was found as 5.5±13.6 months (4 weeks-96 months). In 49 patients (94%), it was determined that final diagnosis was reached with the help of 18F FDG-PET. 28% of the patients had (n=15) neoplasia, 36% had (n=19) infections, 26% had (n=14) non-infectious inflammatory diseases and 2% had (n=1) other diagnosis. 18F FDG-PET did not give any information in three patients (6%). 18F FDG-PET contributed to diagnosis in 69% of patients. In FUO diagnosis, the sensitivity of 18F FDG-PET was 100 and specificity was 71%.

Conclusion: 18F FDG-PET is a valuable imaging method used in the evaluation of FUO, especially with its high sensitivity and specificity.

Biography:

Dr Khalil Ahmad did graduation (MBBS) from Punjab Medical College Faisalabad, Pakistan in 1998. He then moved to FPGMI Shaikh Zayed Hospital Lahore, Pakistan for residency programme in internal medicine. He passed fellowship exam in Internal medicine (FCPS) from College of Physcians & Surgeons in 2005. He moved to Dubai, UAE in 2006 and joined Rashid Hospital Dubai Health Authority. He passed membership exam from Royal Colleges of Physcians UK (MRCP) in 2011. He passed European Diploma in Intensive Care Medicine (EDIC) conducted by European Society of Intensive Care Medicine in 2013. Recently, Dr Khalil Ahmad has done decent research work on hyponatremia and has presented his work in the international conferences.

Abstract:

Acute kidney injury (AKI) is defined as rapid reduction in kidney functions resulting in failure to maintain fluid, electrolyte and acid-base homeostasis. AKI is reported to occur in 15-20 % of all ICU patients and approximately 5% of them may require dialysis during ICU stay. Typically patients with AKI develop oliguria or anuria and may present signs & symptoms of fluid overload. Oliguria is defined as if urine output < 1ml/kg/hour in infants, and < 0.5ml/kg/hour in children & adults for consecutive 6 hours. While, anuria is defined as urine output < 50ml/24 hours in adult patients. Broadly speaking AKI is classified into pre-renal, renal & post-renal depending upon the initial insult leading to AKI. Among them pre-renal is the most common cause of AKI, approximately 55-90% in the ICU setting. Renal causes like acute vasculitis, interstitial nephritis, contrast nephropathy, severe rhabdomyolysis are also contributing to a small proportion of these patients. Post-renal causes accounts < 5% of all others. The main stay of management of AKI depends upon early recognition & early diagnosis of renal insults. To diagnose AKI, these is wide range of investigations, but recently some new biomarkers have been identified which pretty help to identify early onset of AKI. Among these biomarkers, neutrophil gelatinase associated lipocalin (NGAL) has been identified in early diagnosis of AKI due to cardiopulmonary bypass, contrast induced nephropathy, AKI due to sepsis, early recognition of AKI after renal transplant. Some other biomarkers also have been identified for diagnosis of early AKI like, IL 18, KIM 1, Cystacin C and L-FABP. The initial management step of AKI is to treat the offending factors leading to renal impairment, e.g, treating dehydration and sepsis, stopping offending drugs like NSAIDS, aminoglycosides & ACE inhibitors, well rehydration before & after intravenous contrast agents to prevent contrast induced nephropathy. A quite fair number of patients end up requiring dialysis and continuous renal replacement therapy (CRRT) is the most effective method for dialysis in these patients. It may improve survival rate by 30%. There is large debate about early vs late start of CRRT. But, all depends upon the clinical judgment and other associated parameters to make decision to start early CRRT in these patients. About 10% of all AKI patients may require chronic dialysis and further follow up. So, AKI is one of the serious problem in intensive care, its early recognition and management has a vital role in the management of critically ill patients.

Biography:

Suarez-Cuenca J A is currently working in National Medical Centre, Mexico

Abstract:

Background: Intense metabolic activity occurring in the visceral adipose tissue results in the production and release of pro-inflammatory mediators such as nitric oxide (NO), which plays an important role in the early stages of subclinical atherogenesis. Epicardial Adipose Tissue (EAT) is a type of visceral fat, accessible by echocardiographic measurement with potential for the non-invasive identification of high atherogenic risk population. However, characterization of EAT as a marker of subclinical inflammation and atherogenic progression has been explored in a limited way.

Purpose: To evaluate the relation between echocardiography determined EAT thickness with serum NO concentration and atherogenic progression.

Methods: The study population was constituted by subjects more than 18 years old who attended at the Department of Echocardiography from a reference Medical Center. Classical cardiovascular risk factors were balanced within the study population and subjects with heart surgery, pericardial effusion or peripheral artery disease were excluded. Serum samples were collected and NO serum levels were measured immediately by colorimetric tests for nitrite (Greiss reaction). EAT thickness was determined by echocardiography with a long axis of the sternum. Flow Mediated Dilation (FMD) was determined by following standard procedure and Carotid Intima-Media Thickness (CIMT) ultrasound, according to the consensus of Mannheim.

Results: 60 patients of mean age 59 years old (33-86) were included. Hypertension was the cardiovascular risk most frequently found, followed by dyslipidemia and type 2 Diabetes Mellitus. Echocardiography determined EAT thickness was 6.6±2.42 mm. NO serum concentration was 35.6±8.13 uM/mL, FMD was 22.9±21.2% and CIMT was 0.87±0.24 mm (right carotid) and 0.91±0.252 mm (left carotid). EAT thickness significantly correlated with CIMT (rho=0.51; p<0.01). EAT thickness did not significantly correlate with serum NO (rho=-0.26; p=0.11) for the whole study population; nevertheless, the sub-population presenting classical cardiovascular risk factors showed a significant negative correlation between EAT thickness and serum NO (rho=-0.56; p=0.04).

Conclusions: Echocardiography determined EAT thickness positively correlated with subclinical atherogenesis markers such as CIMT and negatively correlated with serum NO concentration, selectively in subjects at higher cardiovascular risk. Echocardiography determined EAT thickness may be clinically useful to estimate advanced atherosclerosis, eliciting further stratification of higher cardio-ischemic risk based on NO availability.

Biography:

Oladele Vincent Adeniyi has completed his Master of Medicine in Family Medicine and Fellowship Program from Walter Sisulu University and College of Medicine of South Africa in 2015. He currently holds a joint appointment as Lecturer and Consultant in the Department of Family Medicine at the Cecilia Makiwane Hospital, Walter Sisulu University, East London, South Africa. He is studying towards a PhD degree at the University of Fort Hare in South Africa. He has several publications in reputable international journals to his credit. He is a Reviewer for a number of reputable journals internationally

Abstract:

Objectives: South Africa has pledged to the sustainable development goal of promoting good health and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of health care services across the country. This study examines the socio-demographic and clinical determinants of uncontrolled diabetes mellitus type 2 (T2DM) in individuals attending primary health care in OR Tambo district, South Africa.

Design: A cross-sectional analytical study.

Setting: Primary health care setting in OR Tambo district, South Africa.

Participants: Patients treated for T2DM for one or more years (n=327).

Primary Outcome Measure: Prevalence of uncontrolled T2DM.

Secondary Outcome Measure: Determinants of uncontrolled T2DM (glycosylated haemoglobin ≥7%).

Results: Out of the 327 participants, 274 had HbA1c ≥7% (83.8%). Female sex (95% CI 1.3-4.2), overweight/obesity (95% CI 1.9-261.2), elevated LDL-C (95% CI 4.4-23.8), sedentary habits (95% CI 7.2-61.3), lower monthly income (95% CI 1.3-6.5), longer duration of T2DM (95% CI 4.4-294.2) and diabetes information from non-health workers (95% CI 1.4-7.0) were the significant determinants of uncontrolled T2DM. There was a significant positive correlation of uncontrolled T2DM with increasing duration of T2DM, estimated glomerular filtration rate and body mass index. However, a significant negative correlation exists between monthly income and increasing HbA1c.

Conclusion: We found a significantly high prevalence (83.8%) of uncontrolled T2DM among the patients, possibly attributable to overweight/obesity, sedentary living, lower income and lack of information on diabetes. Addressing these determinants will require re-engineering of the primary healthcare in the district.

Biography:

Omech B is currently working in Department of Internal Medicine,University of Botswana, Gaborone, Botswana

Abstract:

Background: Low- and middle-income countries, including Botswana, are facing rising prevalence of obesity and obesity-related cardiometabolic complications. Very little information is known about clustering of cardiovascular risk factors in the outpatient setting during routine visits. We aimed to assess the prevalence and identify the determinants of metabolic syndrome among the general outpatients’ attendances in Botswana.
Methods: A cross-sectional study was conducted from August to October 2014 involving outpatients aged ≥20 years without diagnosis of diabetes mellitus. A precoded questionnaire was used to collect data on participants’ sociodemographics, risk factors, and anthropometric indices. Fasting blood samples were drawn and analyzed for glucose and lipid profile. Metabolic syndrome was assessed using National Cholesterols Education Program-Adult Treatment Panel III criteria.
Results: In total, 291 participants were analyzed, of whom 216 (74.2%) were females. The mean age of the total population was 50.1 (±11) years. The overall prevalence of metabolic syndrome was 27.1% (n=79), with no significant difference between the sexes (female =29.6%,males =20%, P=0.11). A triad of central obesity, low high-density lipoprotein-cholesterol, and elevated blood pressure constituted the largest proportion (38 [13.1%]) of cases of metabolic syndrome, followed by a combination of low high-density lipoprotein, elevated triglycerides, central obesity, and elevated blood pressure, with 17 (5.8%) cases. Independent determinants of metabolic syndrome were antihypertensive use and increased waist circumference.
Conclusion: Metabolic syndrome is highly prevalent in the general medical outpatients clinics. Proactive approaches are needed to screen and manage cases targeting its most importantpredictors.

Biography:

Dr. Manimala Rao is currently working as Head Anaesthesiology & Critical Care,Director Crtical Care,Yashoda Hospitals,Hyderabad,India.She did her MBBS: 1966 from OSMANIA Medical College, HYD, India. D.A.(LOND): 1968,UK. MD: AIIMS 1972, New Delhi; FCCM 1988, New Delhi;FICCM 2014 DELHI. Consultant: Iran from 1975to 1979. Assistant Prof:from 1979 to 86 at Gandi Medical College,AP,India Assocaite Prof: NIMS from 1986to 1987. Prof & HOD: NIMS for the period of 1987 to 2004. Dean: NIMS from 1996 to 1999. President: RSACP, Emergency Med and State Chapter ISA. Vice President: ISA & Critical Care. Chair person at MOHAN foundations from 2000 to 2006. Published 100 Papers at National & International Journals. Editorial Board Member for many National Journals. DELIVERED 14 ORATIONS and many Guest Lectures,Key Note Addresses. Conducted Many National & International Conferences Workshops.

Abstract:

Cardiac disturbances are quite frequent in a stroke patient be it arrhythmia or LV dysfunction. It is becoming quite common to observe the heart and brain interaction in the ICU. Critical care at its core takes into consideration the human body in its entirety. Hence the clinical management of the brain and heart disorders cannot be isolated. The care of neurologic patient is influenced by cardiac diseases, and likewise neurological consideration is essential in many types of heart diseases. Cardiologists and Neurologists cannot view heart and brain alone respectively and ignore the other. There is a lot of literature with evidence regarding the importance of brain – heart interactions. These relationships in terms of physiological, clinical and management issues on a daily basis are utmost in critical care.  Can we consider and coin Neurocardiology in critical care. What are the interactions between the brain and the heart and what is the pathophysiology and how does it influence the management and outcome. In the setting of Critical care, time & proper decision making is a crucial factor. How hemodynamic & intracranial dynamic monitoring helps to determine the immediate and long term management of the patient and how it influences the outcome will be discussed.

Biography:

Juan Felipe Betancur Pulgarin is currently working in CES University, Colombia

Abstract:

The antiphospholipid syndrome (APS) is an autoimmune disorder characterized by venous and arterial thrombosis and recurrent fetal losses, frequently accompanied by a moderate thrombocytopenia and the presence of persistent circulating anti-phospholipid antibodies (aPL). The medical management of patients with APS aims mainly at avoiding the thrombotic and/or obstetric recurrences. To reach that, the current mainstay of treatment are: Bridge therapy for at least 5 days with heparin (un-fractioned or low molecular weight heparin) followed by long-term anticoagulation with vitamin K antagonist (VKA) such as warfarin with a recommended target international normalized ratio (INR) of 2.5. The intensity of continuous anticoagulation is still debated. Treatment with VKA is complicated because it has several pitfalls including numerous food and drug interactions (i.e., immunosuppressive agents such as azathioprine), which require frequent INR monitoring. Furthermore, the effective evaluation of the anticoagulation effect may be difficult by the variable response of thromboplastin reagents to aPL (particularly LA), that would make the estimation of anticoagulation intensity with prothrombin time (PT)/INR uncertain. To overcome these and other limitations, a group of relatively new class of drugs that inhibit a single enzyme of the coagulation cascade called direct oral anticoagulants (DOACs) has been introduced. Major phase III prospective and randomized controlled trials (RCT) have shown the efficacy and safe profile of DOACs for venous thromboembolism (VTE) treatment. However, these results are not generalizable to patients with APS, despite these trials probably included patients with this syndrome. There are many available case reports and case series that support the use of DOAC therapy for secondary thromboprophylaxis for APS patients with previous VTE who require an INR target of 2-3. The use of DOACs in patients with previous arterial thrombosis or in patients requiring a target INR >3 is still matter of discussion. It is unclear if DOACs can replace warfarin for the long-term secondary thrombosis prevention in APS patients with VTE. The necessity for controlled outcome trials of DOACs in APS patients will depend on the results of the ongoing trials.

Biography:

Mende has completed his Masters degree in Clinical pharmacy and at the age of 32 years from Jimma University and He is a senior lecturer and researcher. He is the coordinator of in-service training program of Arba Minch College of health Sciences, and head of the Department of Pharmacy in the college. He has published more than 2 papers in reputed journals and other two are under process for publication.

Abstract:

Background: Diabetes self-care behaviour adherence is considered to be the cornerstone in diabetes care. Inadequate diabetic self-management remains a significant problem facing health care providers and populations in all settings. Patients who have adequate self-management behaviour have better outcomes and higher quality of life.
Objective: To assess Levels and Predictors of Adherence to self-Care Behaviour and   Glycaemic Control among Adult Type 2 Diabetics at Arba Minch General Hospital, Southern Ethiopia.
Method: An institutional based cross sectional study was conducted from [15th-February to 15th-March, 2015] and data were collected by using interviewer administered questionnaires. The data were entered into EPI-DATA version 3.1, and analysed by Statistical Package for Social Science (SPSS) version 20.0. Descriptive statistics were used for most variables; a bivariate analysis was employed to determine the presence of association between adherence to self-care behaviour with other variables at P-value less than 0.05. Multi-variable logistic regression was performed to identify independent predictors of glycaemic control and self-care behaviour adherence.
 
Results: One hundred ninety four type 2 diabetics were participated in this study and 99 (51.0%) were Females. Mean age of participants was 50.3(±13.2) years, and 41.2% had good self-care behaviour adherence. Above one half (57.2%) had diabetes duration less than five years, with mean duration of diabetes 5.02 ± 3.8 years. Most of patients 169(87.1%) were on oral anti diabetics Age 35-44 years [AOR=13.4, 95% CI=1.582, 113.56], Monthly income <750.00 birr [AOR=0.340, 95% CI=0.119, 0.976] and age at diabetes onset 15-24 years [AOR=11.3, 95% CI=2.621, 49.065] were independent predictors of self-care behaviour adherence.
Conclusion: In our study area adherence to self-care behaviour of the study subjects were low. So strategies that can improve these discrepancies like provision of diabetes self-care education and counselling especially on importance of self-monitoring of blood glucose, physical activity and problem solving should be considered by responsible bodies.

Biography:

Ayda Javanbakht has completed her medical doctorate at the age of 25 years from Mashhad university of medical sciences, Iran

Abstract:

It is estimated that 15% of people are infertile in industrialized nations, and it has become a top priority for many health organizations and governments. The reasons of infertility are categorized in three different groups: genetic, anatomic and environmental factors. Infection is one of the environmental reasons that can cause infertility in male and female. human papillomaviruses (HPVs) can cause different malignancies in asymptomatic women. The role of HPVs in causing infertility in male and female is controversy. In this study, we compared the frequency of HPVs in fertile and infertile women. In this case control study from 2014-2016, both cervical and vaginal smears were prepared from infertile and fertile women in Mashhad, Iran. HPVs were detected by polymerase chain reaction. All data were analyzed by SPSS v.16 and p value <0.05 considered as statistical significant. In the current study, 115 infertile women with the mean age of 30.5±5.6 years and 90 fertile women with the mean age of 32.6±9.3 years were included (p=0.07). Among women who were infertile (cases), 121(52.6%) of 230 smears were positive, while in control group (who were fertile), 75 (41.7%) of 180 smears were positive (p=0.052). There was no significant differences between having history of previous abortion between groups (p=0.07). The frequency of HPV had no statistically significant association among infertile and fertile women. However, the prevalence of HPV in both groups of the participants was high.

Biography:

Dr Sultan Redi is a graduated from  jimma university. He is a surgical resident in black lion referral hospital.

Abstract:

Postinfectious glomerulonephritis in children commonly follows group a B hemolytic streptococcal infections. The infection usually occurs in the skin and nephritis follows. Development of nephritis following emyema is rare in children. Here we report a 6 year old female child with empyema thoracis,who developed acute glomerulonephritis as a complication. Its presentation diagnosis and management will be discussed

Biography:

Tanyi Samuel Tanyi has completed his BSc  and MSc from Usmanu Danfodio University Sokoto, sokoto state, Nigeria. He is currently an Assistant Lecturer at federal University Dutsinma, Dutsinma, Katsina state, Nigeria at the Department of Biological Science. He is involved in teaching and research in microbiology at the University.

Abstract:

Due to high cost, undesirable side effects of conventional antibiotics and emergence of multi-drug resistant bacteria, there is need to search for novel antibacterial agents from medicinal plants. In this study, clinical isolates of Staphylococcus spp, salmonella spp, Shigella spp., and  Escherichia coli were  obtained from Usmanu  Danfodio University Teaching Hospital Sokoto, Nigeria. The isolates were tested for susceptibility to crude leave extracts of E. hirta by agar diffusion methods. Minimum inhibitory concentration (MIC) of the extract was determined by broth dilution method. The results showed that the most susceptible bacterium to the extract was Shigella, with a zone of inhibition of 23.33 mm,   while the most  resistant bacterium was E. coli, with a zone of inhibition of 9.43 mm. MIC and MBC of the extract against Shigella was 21.87 mg/ml respectively. Alkaloids, saponsins, flavonoids, anthraquinones, tannins and polysterols were revealed in the extract by phytochemical analysis. Oral acute toxicity of the extract showed no mortality in Sprague Dawley rats at concentration of 50, 300, 2000 and 5000 mg/kg body weight. Result showed that the LD50 was>5000 mg/kg. The MBC: MIC ration>4, suggesting the crude extract was bactericidal.  This study showed that leaves of E. hirta can serve as a potential antibacterial agent.