3^rd International Conference on Internal Medicine & Hospital Medicine October 15-16, 2018 Ottawa, Ontario, Canada

Biography:

Badrie ELDaou has completed her PhD from Saint Joseph University. She has BSN,TD,MA from AUB. She published more than 10 papers in reputed international journals and has been serving as an editorial board member of repute. She works as an assistant professor at the Lebanese University, faculty of education since 2010.

Abstract:

Oxygen therapy is the administration of oxygen as a medical intervention, which can be for a variety of medical conditions. Patients can be harmed by receiving too little or too much oxygen. In addition, assessment of need for oxygen in most cases is a nursing responsibility. Therefore, the aim of this study was to assess knowledge and practice of nurses regarding oxygen therapy.  This is a quantitative descriptive, hospital-based study conducted between June 2016 and August 2017 on a convenient sample of 87 participants working in several different departments. The study covered 87 nurses in three hospitals; standard closed-ended questionnaire was used to collect the data that considered of 56 questions: 11 questions that focus on the demographics of the participants and 45 questions about clinical data divided into clinical Part I, II, and III where clinical Part I was about nurses’ knowledge regarding assessment of oxygen therapy, clinical Part II was about nursing interventions pre, intra and post-oxygen therapy and clinical Part III was about nurses’ awareness related to the complications of oxygen therapy. The current study showed that 9 out of 87 participants had high level of awareness (10.3%), 14 had moderate level of awareness (16.1%) and 64 had low level of awareness (73.6%) regarding the part related to clinical data. Moreover, the clinical data was divided into 3 parts where the awareness of clinical Part I about nurses’ knowledge regarding assessment of oxygen therapy was (55.1%) which is low level of awareness; whereas, the awareness of nurses related to clinical Part II about nursing interventions pre, intra & post-oxygen therapy was (45.11%) which is low level of awareness. Also, the awareness of nurses related to the complications of oxygen therapy was (77.2%). Using P-Value and Chi-Square test statistical results revealed that the clinical data Part I related to nurses’ knowledge regarding assessment of oxygen therapy (0.004 <0.05) had relation with the awareness of the nurses. In addition, nursing interventions pre, intra & post-oxygen therapy with P-Value (0.034) revealed a strong relation with nurses’ awareness. Moreover, results indicated that nurses’ awareness is related to the complications of oxygen therapy. Future recommendations were discussed.

Biography:

Abstract:

Therapeutic Patient Education is the patient’s/ family’s capacity building process on the basis of integrated actions to care project. It is also the set of practices to allow the patient skills, to support actively the illness, care and monitoring, in partnership with the healthcare team. This is a co-construction between the treated and the caregiver, a comprehensive care most optimal in a cognitive behavioural perspective and psycho-emotional through which the evaluation of quality patient's life is paramount.

Introduction: The study DAWN2 France showed that people with diabetes have an impaired quality of life. A alteration efficiency of the management of this pathology. This study also showed that French patients seem more anxious than in most other countries, the fear of hypoglycemia is a very important point, as the fear of injections and that the transition to insulin is seen as a penalty. By giving patients educational sessions, group and individual, medically, dietary, physical, psychological and social, the ETP has significantly improved the management of patients.

Methods: An observational study is to evaluate the evolution of the quality of life and the metabolic balance of a cohort of 100 patients who completed a personal ETP program, developed about 18 educational workshops, full hospitalization. A day hospital monitoring is proposed at 3, 6 and 9 months. The desired main criterion is the quality of life. The questionnaire used to assess the quality of life is the SF-36. The biological and anthropometric parameters also measured.

The main characteristics of the patients included in this study were:

• Age between 18 and 70 years;
• Type 2 diabetes diagnosed for at least 6 months;
• HbA1c> 7%;
• BMI> 30;
• Patient treated by at least two oral antidiabetics;
• No severe proliferative diabetic retinopathy;
• Associated metabolic syndrome;
• Lack of thyroid dysfunction;
• No modification therapy (treatment) for at least 2 months

Results: 
Quality of Life: The study demonstrates a significant improvement in the quality of life of patients who have taken the ETP program between 0 and nine months, clarified by the same patients, by improving their knowledge, improved self-assessment (knowledge, skills). An improvement in all dimensions but also we see a profile change: patients experience fewer limitations on the mental plane (Δ = 65.8) and physical (Δ = 82). In addition, there is an increase important in the relational aspect (Δ = 38, 2). Changes in physical activity are also important (Δ = 48,6)

Improving Balance Glycaemic: The change in glycated hemoglobin percentage was statistically significant, explained, firstly through regular physical activity can reduces HbA1C by 0.6%, by increasing muscle glucose uptake independently of insulin metabolism, affirmed via several randomized studies. And on the other hand, weight loss and decrease in insulin resistance, as demonstrated by the meta-analysis of various clinical studies. A significant decrease in mean HbA1C (- 3.2 point). The initial average HbA1C is 10.10% (± 2.5).

Improvement of other Metabolic Parameters: A significant decrease in triglycerides (- 2 g / l), also a decrease in LDL-cholesterol (1.4g / l), an increase of HDL-cholesterol (0.22 g / l), a decrease of GGT were demonstrated, meaning a significant reduction in the potential cardiovascular risk already well demonstrated by the study Look AHEAD Research Group.

Concerning the Physical Activity: Physical testing performed at each check-up showed an improvement in muscle strength, adaptability to physical exertion, balance and flexibility. The interview with patients noted a steady and sustainable physical activity, respects the duration and recommended frequency that helped to improve both glycemic control and also the metabolic parameters including lipid profile correlation with the meta-analysis of several studies.

Behaviour and Comfort food: The study showed over time, following the assessment at each visit, improvements in the comfort, feeding behaviour and reproduction of food, which is the first line of the management of type 2 diabetes.

Body Weight: decreases significantly over 10%.

Therapeutic Change:
Conclusion:

• ETP personalized, adapted to the educational diagnosis, has a positive and significant impact on the quality of life of the patient.
• Improved self-esteem and self-confidence is up a total change patient profile.
• The importance of structured outpatient follow in patient care (HDJ, network care ... etc ..).
• It is also an effective method for improving glycemic control, the prevention of diabetes
• Complications as well as in reduction of cardiovascular risk factors.
• Improved biological and anthropometric parameters and changes treatment during followup,
• potentially have an impact on reducing the total cost of management of this chronic disease.

Biography:

Ahmed T Alahmar is a lecturer at the College of Pharmacy, University of Babylon, Iraq. He obtained MBChB degree (Hons.) in Medicine in 2004 and MSc in Medical Physiology (Hons.) in 2009 from University of Babylon, Iraq. Dr Alahmar also received training course at University of Manchester, UK and published many articles in the area of reproductive Medicine, Endocrinology and public health in PubMed and high impact journals.

Abstract:

Background: Reduced visual acuity and anaemia have been implicated in students poor academic performance along with other medical conditions. The aim of this study was to estimate the prevalence of reduced visual acuity and anaemia among pharmacy students at the University of Babylon, Iraq and their effects on students academic performance

Methods: Ninety-five students (25 males and 70 females) who met the inclusion criteria were screened for refractive errors using the Snellen chart. A subset of forty-eight students (18 males and 30 females) were also screened for anaemia and RBC indices were estimated by haematology autoanalyzer. Students average grades of four subjects (out of 40) were compared between different subgroups.

Results: The prevalence of refractive errors among students was 10.5% and the prevalence of anaemia was 18.7% (average Hb 11.26 ± 1.13 g/dl). Students average grades did not differ among students with reduced visual acuity as compared to those with normal visual acuity (24.69 ± 3.16 vs. 25.65 ± 4.01 respectively). Students grades also did not differ between students with anaemia in comparison with those without anaemia (26.50 ± 3.73 vs. 25.77 ± 3.83 respectively).

Conclusions: Refractive errors and anaemia are prevalent among pharmacy students. Our study demonstrated no difference in students grades among students with refractive errors or anaemia in comparison with normal students which could be due to mild forms of these conditions in students. 

Biography:

V.A. Shiva Ayyadurai, the inventor of email and polymath, holds four degrees from MIT and is a world-renowned systems scientist. He is a Fulbright Scholar, Lemelson-MIT Awards Finalist, First Outstanding Scientist and Technologist of Indian Origin (STIO), Westinghouse Science Talent Honors Award recipient, and was nominated for the U.S. National Medal of Technology and Innovation. In 1982, the US government recognized Ayyadurai as the inventor of email by awarding him the first Copyright for “Email” at a time when Copyright was the only way to protect software inventions. His interest in human health also began early, when as a child, he observed his grandmother, a village farmer and healer, practice Siddha, India’s oldest system of traditional medicine.  This motivated his future study and research in systems biology at MIT, leading to his discovery of Systems Health®, a major breakthrough that provides an integrative framework linking eastern and western medicine. His latest invention CytoSolve®, emerging from his doctoral research at MIT, provides a revolutionary platform for modeling complex biological phenomena, to support the development multi-combination medicines without animal testing. Here is a video link to the State of the Art Lecture Dr. V.A. Shiva Ayyadurai delivered at the 2017 Annual Meeting of the American Society for Clinical Pharmacology and Therapeutics (ASCPT).

Abstract:

There is a growing and critical need for integrating molecular systems science with computation to model complex disease processes for accelerating drug discovery, drug repurposing, validation of complementary and alternative medicine (CAM) therapies, and identification of efficacious multi-combination therapeutics, while ensuring a personalized and precise medicine. Such needs cannot be advanced without collaborative integration of knowledge across biological disciplines. This talk will share the recent successes, through multiple case studies, in the use of CytoSolve, a computational systems biology collaboratory, developed at M.I.T., that provides an integrative approach to address these critical needs.

Previous approaches, largely based on statistical techniques, have been unscalable and largely useless to scientists who seek to understand complex biological mechanisms. CytoSolve’s successes have been published in peer-reviewed journals and have received recognition in Nature for its potential to develop multi-combination therapies. These successes including: FDA allowance for a multi-combination pancreatic cancer therapeutic; the Department of Defense (DoD) and the United States Pharmacopeia (USP) understanding of toxicity and adverse reaction multi-combination nutritional supplements; and, modeling of rare diseases in orphan drug domains such as Neuromyelitis Optica (NMO) and Hereditary Angioedema (HAE) have inspired major nutraceutical researchers, cancer centers such as MD Anderson, National Cancer Institute and others to explore the use of CytoSolve for integrating CytoSolve’s collaboratory with modern in vitro and in vivo methods to accelerate the development of multicombination therapeutics. This talk that will provide an introduction to a disruptive platform that will likely revolutionize development of therapeutics in the 21st century.

Biography:

Amani waheed has completed her PhD at the age of 34 years from Suez Canal University and postdoctoral studies from Suez Canal University, Faculty of Medicine. She is the chair of Community Medicine dept., Faculty of Medicine. She has published more than 25 papers in reputed journals and has been serving as an editorial board member of some Egyptian journals.    

Abstract:

Background: Medical nutrition therapy (MNT) is an integral component of diabetes management. Its main goals are to attain and maintain normal blood glucose levels and to prevent and treat the chronic complication of diabetes. Survey studies have revealed that doctors feel uncomfort­able advising diabetic patients on the sensitive issue of weight loss and diet. Based on the evidence, it is recommended for all the health professionals working with diabetics to have that required an updated nutritional knowledge and practice skills in order to support the patient in adopting a healthy lifestyle.

Objective: To evaluate the effect of the training program on the family physicians’ knowledge and practice regarding medical nutrition therapy for diabetes mellitus.

Methods: This was a pre-post intervention study. Thirty-five family physician working in family practice centers affiliated to Suez Canal University, Ismailia, Egypt were participating. A structured questionnaire and observation checklist to assess the family physicians' knowledge and practice towards MNT for diabetes mellitus.  An MNT training program was conducted by a specialized nutritionist.  Knowledge and practice of family physicians regarding MNT in diabetes were evaluated before and after training.

Results: There were highly statistically significant improvements in the physicians’ median scores of knowledge (35%–85%) and practice (20%–70%) regarding pre-post intervention respectively.  There was a statistically significant positive correlation between scores of knowledge and practice of family physicians and their qualifications and past training courses.

Conclusion: Knowledge and practice skills regarding medical nutrition therapy for diabetes among family physicians were markedly improved after implementation of the interventional training program.

Biography:

Amani waheed has completed her PhD at the age of 34 years from Suez Canal University and postdoctoral studies from Suez Canal University, Faculty of Medicine. She is the chair of Community Medicine dept., Faculty of Medicine. She has published more than 25 papers in reputed journals and has been serving as an editorial board member of some Egyptian journals.   
 

Abstract:

Health and wellbeing are the ultimate goals in life. With the infinite nature of human wants, there is still finite or limited nature of resources available. The scarcity of resources has a measurable weight working on a production of health care. The situation in healthcare industry is challenging. There is a dynamic change all over the world regarding changes in the age structure, increasing real incomes and improvements in medical technology. All these factors have a great impact on the healthcare market.

Although the available resources are limited, the alternative uses of these resources are unlimited. Therefore, there is some maximum quantity of health care that can be produced at any one time.  So, resources reallocation among health care activities and others as well as other systems should be directed towards the most needed ones. Priority settings are the difficult issue and the society has the influence to allocate resources efficiently with the lowest possible costs i.e. productive efficiency.  Resources allocation should be based on solid evidence considering point views of the society, patients, payers and providers. Health care services and benefits should be fairly distributed with equity, effectiveness and efficiency. This is very difficult to achieve within various communities differing in the valuation of health and their ability to pay for their health.

All the above challenges could be faced with Evidence-based medicine which provides us with keys for proper decision making about health care provided to patients and communities in health research as well as in health economics. 

Biography:

My name is Adila Chamavaliyathil, I am a final year MBBS student studying in RAK Medical and Health Sciences University. I have done 5 researches so far and presented them in the conferences held in my university and other universities of UAE. I have conducted this research along with my colleagues, also final year medical students – Nanadana Nair, Lakshmi Sudhakaran and Anila Aravindan under the supervision of Dr. Gowri Devdas.

Abstract:

Introduction: UAE has a high prevalence rate of diabetes and its complications too are on rise. Data regarding the awareness of diabetic patients about the complications of diabetes is very less.

Aims & Objectives: To assess the awareness of type2 diabetes patient regarding its complications & to analyze the factors associated with awareness.

Methodology: The study was a quantitative cross-sectional survey-based study. Diabetic patients visiting outpatient’s department in the study sites and were included in the study on the voluntary basis. A self-administered/interviewer assisted 15 item questionnaire was used to measure awareness of the complications of diabetes.

Results: Out of the 400 diabetic patients surveyed, the majority were males (59.5%); in the age group of 50-69 years; and most common nationality was Emirati (n=242,60.5%). 79.4% of respondents mentioned that they were aware of complications of diabetes. However, only 4% of respondents were aware of all seven complications mentioned in the questionnaire and 27.8% cited just two complications. The most commonly known (70.3%) & experienced (58.3%) complications were ophthalmic. Control of blood glucose and blood pressure level was the most commonly cited preventive measure (84.48%). 91.8% of the respondents received information on diabetes from the doctors. Parameters such as age, gender, nationality, education, blood glucose level and duration of diabetes were significantly (p<0.05) associated with diabetes-related complications.  

Conclusion: Even though the overall awareness regarding the diabetes-related complications was high (79.4%), it’s a matter of concern that only 4% knew about all the seven complications This signifies the continuous patient education regarding diabetes-related complications & its prevention 

Biography:

Carina Dalay Dizon has completed her  MD at the age of 22 years from the University of Sto. Tomas School of Medicine and trained in Internal Medicine and Nephrology in St Lukes Medical Center Quezon City. She is the current Resident Training Officer of the Internal Medicine Department of St. Lukes Medical Center. 

Abstract:

Contrast-induced nephropathy (CIN) is a reversible form of acute kidney injury that occurs soon after administration of contrast media. Current accepted methods for prevention of CIN include intravenous (IV) hydration, administration of oral n-acetylcysteine, and use of atorvastatin. Nicorandil, a novel anti-anginal drug has been studied to have a beneficial effect as well in preventing CIN. This paper aims to determine the efficacy of nicorandil in the preventing the incidence of contrast-induced nephropathy in patients who will undergo coronary angiography. Search for randomized controlled trials was done, evaluating the efficacy of nicorandil in preventing contrast-induced nephropathy in patients undergoing coronary angiography. Articles were critically appraised for inclusion. Pooled analysis revealed a Chi² value of 4.32, dF=3 (P=0.21),  I² of 31%. Computed relative risk for incidence of CIN following Nicorandil administrations was 38% (CI: 0.19, 0.71). Administration of Nicorandil showed absolute risk reduction in incidence of CIN by 8% as compared to iv hydration seen in the Forest plot with a number needed to treat  of 12. It showed a trend favouring nicorandil for the prevention of contrast-induced nephropathy. The studies also showed that nicorandil together with IV hydration significantly caused reduction in cystatin C levels and change from baseline eGFR as compared with standard intravenous hydration.

Biography:

Bohan Xiao has completed her MBA from Jilin University School of Management in the summer of 2017, and postgraduate diploma studies from University of Southampton School of Medicine in 2012. After worked for the District Level Center for Disease Control for three years, she has been focusing on hospital management in the past three years. She takes an active part in management process reengineering in The China-Japan Union Hospital of Jilin University. 

Abstract:

Background: The China-Japan Union Hospital of Jilin University (CJUH) supervised by the National Health Commission of the People’s Republic of China and affiliated to Jilin University. The annual number of patient with cardiovascular diseases in CJUH is nearly 200 thousand. This research will discuss the impact of CJUH hospital management process reengineering on pre/in-hospital treatment effect of STEMI patients during 2015 to 2017.

Method: 1. We divided all 605 STEMI patients were divided into three groups based on 2015, 2016, and 2017. We conducted ANOVA and chi-square tested of data including age, ratio of gender, SO-FMC, FMC2B, cardiogram to diagnosis time, D2B, hospital days, pass ED and/or CCU, and in-hospital mortality. 2. All STEM patients were divided into groups according to methods they transported to CJUH (by oneself or by ambulance) in the three years respectively. Then analyzed with the same analysis method and indexes as above.

Statistical results: 1. No statistical differences of the average age or racial of gender among STEM patients in the three years. FMC2B, cardiogram to diagnosis, D2B, and racial of pass ED and/or CCU decreased (p<0.05). The average hospital days of 2017 was 3.5 days less than which of 2015 (p=0.00). SO-FMC and ratio of in-hospital mortality decreased but no statistical differences. 2. Considering how STEM patients come to CJUH, we found time-indexes of patients by ambulance show much positive trends comparing with whom came by themselves. But in-hospital mortality has no statistical differences.

Conclusion and Discussion: According to statistics analysis, our reengineering does have some achievements. However, there is still much to be improved. After our first milestone: the founding of chest pain center in January 2015, we successfully founded an in-hospital first aid station with the ambulance in July 2017. Moreover, CJUH began to ally with other hospitals in Jilin province, to improve communication and to provide support when meet with high-risk patients, and the ally becomes stronger. We are working on and seeking more possibilities of high quality, effective and prompt rescue process for STEMI patients.

Biography:

Carlos Montufar Salcedo, former research professor University of Otavalo - Ecuador.  Specialized in International Public Health and History of Religions at the Catholic University of Louvain-La-Neuve Belgium. Postgraduate in Local Development UCA Nicaragua and Marketing Mix EENI Spain. PhD in Cognitive Anthropology at Atlantic I. University of the United States. Author of Globalizations (in) governable, Political anthropology, Gender, sexuality and society, Health and ecology, Epistemology and language, Parasitological profile Ecuadorian Amazon and other scientific works. Lima International Essay and Ana María Agüero Melnyczuk Awards for scientific research 2016.

Abstract:

The study presents the alternative experience of applying the two theoretical management models that the Ministry of Health of Ecuador proposes, facilitating the analysis of information, its relevance, the technical support of the teams, the management of costs and finances in the exercise of health care and organizational climate. The methodology applied was quantitative in relation to global performance indicators and qualitative to assess the level of district organizational climate. This study uses as research techniques, the analysis of indicators, participant observation, open interviews and discussion groups, which generate the following reports: baseline and epistemology of the local health system. The study concludes that the local system of ministerial health, compromises of managerial dyslexia that would cause organizational dysfunction, due to the practice of two models of management not necessarily complementary, that is, the classic vertical bureaucratic system and the process management model that obeys a participatory system by objectives. However, the application of this last model improves the organizational climate and coverage results.

Conclusion:

The local health system compromises of a managerial dyslexia that causes organizational dysfunction, due to the practice of two management models that are not necessarily complementary, that is, the classic bureaucratic system and the process management model that obeys a participatory system by objectives.

The management vision is focused almost exclusively on the search for efficacy and efficiency, disregarding the importance of the conception of an appropriate organizational climate that generates confidence and productivity in the local health system.

The fragile use of health and financial information, produced by the vertical management system, in the analysis, reflection and decision-making at the local level, hinders the process of continuous learning of the health organization.

The development of long-term processes of training and continuous training in management is essential for the coordination staff at all levels, empowering learning from real scenarios, in the daily practice of management that the local system of health produces.

It is recommended that these processes be designed and implemented at a regional or national level, taking into account the particularities of each of the local systems, seeking the pertinence of the decisions and actions in each specific context.

The segmentation of the health system, conceived as the coexistence of subsystems with different financing, compartmentalized, that cover diverse segments of the population, generally according to their capacity to pay (IESS, private sector, insurers) requires establishing complementarity and synergy to avoid duplicating actions and generate unnecessary bureaucratic expenses such as the cost-covering program among state health institutions. Similarly, the fragmentation of the local health system, that is, the coexistence of several units or establishments that are not integrated into the health care network, that is, the private sector with aims and non-profits, which in certain spaces, work in parallel with the national health system.

Biography:

Davood Bashash is currently associate professor and faculty member of Hematology and Blood Banking department at Shahid Beheshti University of Medical Sciences. He has published more than 30 papers in reputed journals related to the treatment of hematologic malignancies and contributed to a book chapter (Reciprocal Interconnection of miRNome-Epigenome in Cancer Pathogenesis and Its Therapeutic Potential, published in Epigenetics Territory and Cancer, pp 101-135).

Abstract:

Field of research: Targeted therapy in cancer

Statement of the problem: Among signaling pathways involved in the pathogenesis of hematologic malignancies, constitutive activation of phosphatidylinositol 3-kinase (PI3K) has been observed in a high proportion of patients, largely as a result of genetic mutation. Here, we have evaluated and compared the effects of two different classes of PI3K inhibitors, which are currently being tested in clinical trials.

Methodology: To define the effect of the isoform-specific PI3Kδ inhibitor CAL-101 and pan-PI3K inhibitor BKM120 in different types of hematologic malignancies, a panel of cell lines consists of multiple myeloma, acute lymphoblastic leukemia and acute myeloblastic leukemia were chosen. Cell viability, apoptosis and caspase-3 activity were determined during incubation with either the inhibitors. The molecular mechanism was also evaluated by RQ-PCR and western blot analysis.

Findings: Our results showed that both BKM120 and CAL-101 effectively reduced the cell viability of all malignant cells, independent of mutational status of PTEN and p53, by causing cell cycle arrest and promoting ROS-mediated apoptosis. Despite favorable cytotoxic effects, we found remarkable differences in the ability of CAL-101 and BKM120. As compared to CAL-101, lower concentrations of BKM120 blocked Akt phosphorylation and caused a more pronounced apoptosis through both p53- and NF-κB-dependent pathways; suggesting that probably complete inhibition of class I PI3K isoforms more effectively abrogates leukemic cell proliferation and survival.

Conclusion & Significance: Our data indicate a potential application for PI3K inhibitors in the treatment of hematologic malignancies, irrespective of the adverse prognostic markers, and support the clinical application of these inhibitors for patients.

Biography:

Eyob Gebretsadik has completed his MD at the age of 25 years from Jimma University medical college in 2004 and earned his postgraduate studies in masters of public health from Wollo University School of health science, Ethiopia. He has been served in the different position as mentor, and a regional director on HIV/AIDS care, treatment and support programs with several international partners for more than ten years. He has led several Quality improvement projects in hospital setting across the country worth mentioning of early detection of first-line HAART treatment failure and switching in resource-limited settings among others. He is currently working in the Ethiopian federal ministry of health as a national consultant and resource person for the national Quality of care for Maternal and neonatal health, and consultant for World Health Organization of Ethiopian country office. He has published more than 5 papers in reputed national and internal journals and has been leading a national technical working group for quality of care in the ministry of health. 

Abstract:

Increasing incidence of Fanconi, proximal kidney tubular damage and declining GFR are becoming more common in HIV positive pregnant women. Recently stronger evidence from the practice has drawn clinicians’ attention to monitor the toxicity of TDF before initiation and during follow up. The objective of the study to generate evidence-based laboratory monitoring of GFR using simple android based calculation of GFR to early identify and manage Chronic renal disease (CRD) among TDF based HAART users of pregnant and lactating women.. HIV+ pregnant and lactating women on TDF based HAART(n=111) enrolled from three general hospitals to be closely followed for incidence of CKD based on NKF K/DOQI .24.3% of subjects had a gfr of  90-131 ml/min, 16.2 % mild decline of GFR 60-89 ml/min while 3.6% (n=4) had stage-5 (< 15ml/min/m2) kidney failure that required dialysis. HIV+ lactating women had stronger association with RR of 0.918 and 95% CI of 0.845-0.998. Stage 5 CKD had been observed among WHO clinical stage-1 (P=0.014) with odds ratio of 5.4 and 95% CI (1.24-24.42), baseline CD4 > 500 with cohort risk estimate of 4.103 with 95 % CI (1.02, 16.54) (P=0.02). The prevalence of stage-2 kidney diseases is significantly associated lower BMI of below18.5, clinical stage-1, and CD4 > 500. Thus a close laboratory monitoring schedule for pregnant women and GFR calculation using simple android application, and early diagnosis of toxicity and management as to the WHO guide  is mandatory.

Biography:

Fazal Rehman is an upcoming graduate of Health Diploma from Udhyana Istitute of Medical Sciences, Swat, Pakistan. Also, he has published 4 papers in reputed journals. He is ardently engaged in efforts of bringing novel, innovative and radical biotechnologies to open access equally favoring the idea of responsible conduct, understanding the potential of biotechnology and synthetic biology. Mr. Fazal loves blogging for various life extension forums and volunteering as a scientific adviser for various biohacking projects.

Abstract:

Due to the hazardous effects on human health and the environment, toxic pollutants such as heavy metals (HM) and metal-organic frameworks (MOF) are creating a huge dilemma for the healthcare industry and throughout the world. The long-term exposure of these HM may precipitate several cancerous conditions, including the breast cancer. Recent studies reveal that HM and MOF that surpass the sorption capacities of the human body can cause breast cancer. But on the other hand, HM are essential nutrients and are a part of our body while several studies suggest that MOF may be helpful in the effective treatment and reversal of breast cancer. Moreover, gold and silver nanoparticles proved to be quite promising for the treatment of the breast cancer. This study focuses on the mechanistic approach of the exchange or sorption capacities of HF, MOF and their interaction with the breast cancer cells for the effective treatment of the disease. The future aspects regarding the research and development of MOF and HM-based nanoparticles, hydrogels, and other drug delivery systems are also discussed.

Biography:

Yiming Luo is currently an internal medicine resident physician at Mount Sinai St Luke’s and Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai. He is passionate in patient care, teaching and clinical research. His academic interest includes arthritis and systemic autoimmune diseases.

Abstract:

Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder which can involve almost all vital organs. The clinical heterogeneity of the disease presents a consistent challenge to clinicians. Macrophage activation syndrome (MAS), also known as hemophagocytic lymphohistiocytosis (HLH), is a rare and potentially fatal complication of several autoimmune diseases. The incidence of MAS associated with SLE is about 0.9–4.6%, while MAS as initial presentation of SLE is rarer with less than 30 cases reported in English literature. We report a rare case of a combination of MAS, glomerulonephritis, pericarditis and retinal vasculitis as the initial presentation of systemic lupus erythematosus.

Case Report: 37-year-old Caucasian male with no past medical history was referred for inpatient admission after being found to have pancytopenia. He endorsed fever with maximal temperature 101.2 F, generalized weakness, progressive right eye blurry vision and chest tightness for the past few weeks. There was no skin rash, joint pain, hair loss, heartburn, Raynaud’s phenomenon. Physical exam was only remarkable cervical nontender lymphadenopathy. Laboratory exam was notable for pancytopenia and elevated creatinine. Urine studies showed elevated leukocytes, dysmorphic erythrocytes and nephrotic range roteinuria. Subsequent work up revealed elevated ferritin 6542 ng/mL, high triglycerides 327 mg/dL, marked decreased complement levels (C3 14 mg/dL, C4 3 mg/dL), elevated ESR 137 mm/hr, strong positive for antinuclear antibody (ANA, 1:640) and anti double-stranded DNA antibody (anti-dsDNA, >1:1280). Transthoracic echocardiogram showed normal ventricular function but moderate circumferential pericardial effusion. Abdominal ultrasonography demonstrated hepatosplenomegaly. Funduscopic exam with fluorescein angiogram showed cotton wool spots with retinal hemorrhage consistent with retinal vasculitis. Based on the above findings, he was diagnosed with systemic lupus erythematosus, pericarditis, lupus nephritis and retinal vasculitis. Pulse steroid with methylprednisolone 1000 mg daily was started for 3 days, followed by oral prednisone 60 mg daily. His fever and chest pain resolved and his blood cell counts and creatinine improved after the treatment. He subsequently underwent bone marrow biopsy which showed increased histiocytes with focal evidence of hemophagocytic cells consistent with MAS. Renal biopsy was also performed and confirmed diffuse proliferative and membranous lupus nephritis (Class IV/V). His clinical condition continued to improve with systemic steroid and he was subsequently discharged from the hospital.

Conclusion: The diagnosis of MAS in SLE can be challenging, as the presentation can mimic the clinical features of SLE or an infectious complication. Bone marrow biopsy should be considered in cases that the clinical picture is not clear. This case also highlights the importance of multi-specialty collaboration in the management of systemic autoimmune diseases.