Day 2 :
Location: Ottawa, canada
Session Introduction
Eyob Gebretsadik
Ethiopian Ministry of Health /Health service Quality directorate, Ethiopia
Title: Evidence basred care on monitoring of toxicity of TDF among HIV positive Pregnant and Lactating mother who are on haart in Ethiopia
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.
Fazal Rehman
Udhyana Istitute of Medical Sciences, Pakistan.
Title: Heavy metals & Metal-organ frameworks for breast cancer patients: Curse or Treatment?
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.
Yiming Luo
Department of Medicine, Mount Sinai St Luke’s and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York
Title: Macrophage Activation Syndrome, Glomerulonephritis, Pericarditis and Retinal Vasculitis as Initial Presentation of Systemic Lupus Erythematosus
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.