Conference Schedule

Day1: March 26, 2018

Keynote Forum

Biography

William J. Rowe M.D. FBIS ( Fellow British Interplanetary Society ), FACN ( Fellow American College of Nutrition ), 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. During that time he supervised over 5000 symptom - limited maximum hospital-based treadmill stress tests. He is a former Assistant Clinical Professor of Medicine at the University of Ohio, School of Medicine at Toledo. He studied 3 world class extraordinary endurance athletes and published their exercise---related magnesium deficiencies. This triggered a 20 year pursuit of the cardiovascular complications of Space flight. He has published in LANCET that extraordinary, unremitting endurance exercise can injure a perfectly normal heart. 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, 2017.

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 0.03% in S, during the Euromir 94 missions, levels, over 10 times higher (0.5-0.7% 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. Bronze has been Chair of the Department of Medicine since July 2000.  He also holds the Stewart G. Wolf Endowed Chair in Medicine and serves on a number of national committees, including several for the National Board of Medical Examiners (USMLE).  He is treasurer of the Association of Professors of Medicine and serves on its Board of Directors as well as Chairs the Board of Directors of Academic Physicians Insurance Company.  He is a Fellow in the American College of Physicians and the Infectious Diseases Society of America.  He has won a number of teaching awards and most recently the Founders Medal from the Southern Society for Clinical Investigation.

Abstract

Hepatitis C (HCV) is a global infection due to Hepacivirus, a member of the Flaviviridae family. Parenteral routes including blood transfusion, injection drug use and exposure to medical procedures usually transmit infection; however, the virus can be transmitted maternally and in some patients, no known risk factor is identifiable.    Over 170 million persons worldwide are infected and chronic infection leads to cirrhosis, hepatocellular carcinoma and an increased all-cause mortality.  The majority of infected patients maintain a chronic infection leading to several hepatic and non-hepatic complications.   Linked to progressive infection is the presence of significant fibrosis within the liver and several risk factors predict which patients are likely to develop complications such as cirrhosis, hepatocellular carcinoma (HCC), and increased all-cause mortality.  HCC is the fifth most common cancer in males, seventh in females and is a major cause of cancer related death.  Eighty-five percent of cases occur in the developing world and HCV is a leading predisposition.  The pathogenesis of HCV related HCC is complex and unlike hepatitis B virus, HCV does not integrate into the host genome.  However, HCV does dysregulate cellular proliferation and differentiation pathways, creates chronic inflammation and inhibits tumor suppressor gene activity.  Our laboratory has focused on two aspects of HCC carcinogenesis, namely cancer like stem cells and chronic inflammation.  Hepatoma cells expressing a HCV subgenomic replicon express several cancer like stem cell markers, especially DCLK-1, a microtubule kinase that is a putative marker for intestinal and pancreatic cancers.  Expression of DCLK-1 is linked to HCV replication and tumorigenesis in xenograft models, and DCLK-1 is identifiable in tissue and plasma derived from patients with HCV associated cirrhosis and HCC.  SiRNA knockdown of DCLK-1 inhibits tumor growth in animal models suggesting that DCKL-1 might be a therapeutic marker.  Additionally, total RNA analysis of FCA4 cells, which also express a HCV subgenomic replicon, reveals upregulation of DCLK-1 and a number of pro-inflammatory markers including S100A9 and SMARCA.  These cells generate tumors in xenograft models that express DCLK-1, AFP and S100A9 and siRNA knockdown of DCLK-1 abrogates tumorigenesis and S100A9 expression. Over the last several years, there has been significant progress in the treatment of HCV infection.  New, pan-genotypic direct antiviral agents (DAA) have vastly improved our treatment strategies not only achieving cure in a large percentage of patients, but also showing promise in reducing the complications of HCV infection. 

 

Biography

Sergey Suchkov was born in the City of Astrakhan, Russia, in a dynasty of medical doctors, graduated from Astrakhan State Medical University and was awarded with MD. Then maintained his PhD and Doctor’s Degree. And later was working for Helmholtz Eye Research Institute and Moscow Regional Clinical Research Institute (MONIKI). Dr Suchkov was a Secretary-in-Chief of the Editorial Board, Biomedical Science, an international journal published jointly by the USSR Academy of Sciences and the Royal Society of Chemistry, UK. At present, Dr Sergey Suchkov is: (i) a Director, Center for Personalized Medicine, Sechenov University, (ii) Chair, Dept for Translational Medicine, Moscow Engineering Physical University (MAPhI), and (iii) Secretary General, United Cultural Convention (UCC), Cambridge, UK. A Member of the: New York Academy of Sciences, American Chemical Society (ACS), American Heart Association (AHA), AMEE, Dundee, UK; EPMA, Brussels, EU; PMC, Washington, DC, USA and ISPM, Tokyo, Japan

Abstract

A new systems approach to diseased states and wellness result in a new branch in the healthcare services, namely, personalized medicine (PM). To achieve the implementation of PM concept into the daily practice including clinical cardiology, it is necessary to create a fundamentally new strategy based upon the subclinical recognition of bioindicators (biopredictors and biomarkers) of hidden abnormalities long before the disease clinically manifests itself.

Each decision-maker values the impact of their decision to use PM on their own budget and well-being, which may not necessarily be optimal for society as a whole. It would be extremely useful to integrate data harvesting from different databanks for applications such as prediction and personalization of further treatment to thus provide more tailored measures for the patients and persons-at-risk resulting in improved outcomes whilst securing the healthy state and wellness, reduced adverse events, and more cost effective use of health care resources. One of the most advanced areas in cardiology is atherosclerosis, cardiovascular and coronary disorders as well as in yocarditis. A lack of medical guidelines has been identified by the majority of responders as the predominant barrier for adoption, indicating a need for the development of best practices and guidelines to support the implementation of PM into the daily practice of cardiologists!

Implementation of PM requires a lot before the current model “physician-patient” could be gradually displaced by a new model “medical advisor-healthy person-at-risk”. This is the reason for developing global scientific, clinical, social, and educational projects in the area of PM to elicit the content of The new branch.

Tracks

  • Internal Medicine and Patient Care
  • Adult Diseases
  • Endocrinology
Location: Vienna, Austria

Biography

https://internalmedicine.euroscicon.com/registrationTara Swami is a final year medical student at University College Cork in Ireland. She completed a

Bachelor of Science at McGill University in Montreal, Canada and a Master of Biotechnology in

Toronto, Canada and has a keen interest in Rheumatology.

Abstract

Studies indicate that <50% of Polymyalgia Rheumatica (PMR) patients receive glucocorticoid-induced osteoporosis (GIOP) prevention when nearly all should be prescribed bone protective therapy (BPT) according to current guidelines.

Our objective is to determine if PMR patients in Cork are adequately protected from GIOP by examining bone densitometry (DXA) scan results, BPT use, and adherence to guidelines.PMR patients with a documented history of glucocorticoid use who underwent a DXA scan at CUH from 01/01/2016 and 27/10/2017 were included in the analysis. Patient demographic information,use of BPT, and DXA T-scores were obtained from chart review.153 patients were identified, of whom 69% were female. 73 (47.7%) were taking BPT consistent withcurrent guidelines and 42 (27.5%) were not taking any BPT. At the most recent DXA scan, 42 (27.5%) had normal BMD, 84 (54.9%) were osteopenic, and 27 (17.6%) were osteoporotic. The mean T-score of patients receiving BPT, -1.76, is significantly lower than the mean T-score of patients not receiving BPT, -1.41 (p=0.04). In a regression analysis, BMI and BPT were significantly associated with osteoporosis or osteopenia (p=0.007 and p=0.049 respectively). In 91 individuals who underwent ≥2 DXA scans, patients not receiving bisphosphonates were more likely to have BMD loss over time(p=0.022).

Despite guideline recommendations, many patients are not prescribed adequate BPT, demonstrated by a high rate of osteoporosis and osteopenia. The results suggest that PMR patients in Cork are not optimally protected from GIOP, uncovering an opportunity to improve the current management of PMR.

Biography

Sementeeva Mariia  is 6th year student of the Novosibirsk state medical university, Russia. She is the scholarship student of the Novosibirsk Government for achievements in science. She has published more than 38 papers and abstracts in Russian’s journals.

Abstract

Among the elderly, cardiovascular diseases often meet and ischemic heart disease is quite common. Coronary artery bypass grafting (CABG) is one of the most effective surgical methods of treatment of coronary heart disease. Owing to the improvement of the surgical technique, methods of protecting the myocardium and methods of anesthesia, there was a reduction in postoperative complications and mortality after CABG. There are methods of CABG by off-pump and on-pump. Despite the fact that off-pump CABG is characterized by an easier rehabilitation period for the patient, about 80% of operations are performed on a stopped heart. The study purpose is estimate and compare the frequency of the occurrence of postoperative complications, and the revascularization effectiveness off-pump and on-pump CABG. In assessing the beating-heart revascularization detected the following benefits: shorter duration of operation, less operative bleeding, usually performed early extubation, absence postoperative postperfusion syndrome, avoiding complications caused by heart-lung machine, such as hypoxia of vital organs, hematological complications (SIRS), vessels microembolisms, advantageous postoperative period, a decrease in the frequency of complications, especially neurological. Its appears to produce better results in high-risk patient populations and elderly patients.

 

Biography

The writer is a medical doctor who has completed her undergraduate study in Faculty of Medicine, Universitas Indonesia. She also has completed her postgraduate study with the degree of Master by Research in Cancer from Newcastle University Medical School, the United Kingdom. In this project, she was supervised by Dr. Gareth Veal from Newcastle Cancer Centre Pharmacology Group, Northern Institute for Cancer Research.

Abstract

Background: Mitoxantrone is an anthracenedione derivative, which functions as DNA intercalating agent. Mitoxantrone has been proven effective to treat Acute Myeloid Leukaemia (AML) through topoisomerase-II inhibition. Previous studies suggest that challenges still emerge due to the side-effects of therapy and the possible involvement of ATP-binding cassette family of membrane transporters in mitoxantrone resistance.

Aims: We aim to develop a High Performance Liquid Chromatography (HPLC) assay, initially, to quantify mitoxantrone in plasma and cell extracts. This assay will be used to investigate whether differences in sensitivity of a panel of AML cell lines towards mitoxantrone is related to mitoxantrone uptake and/or efflux.

Methods: Stability of mitoxantrone in different conditions was investigated in validation of the drug with simple, precise, and reproducible HPLC assay. Initially, growth curves of HL-60, U-937, AML-3, and HEL were generated to determine incubation time and seeding densities for in-vitro cytotoxicity assay with Alamar Blue. Intracellular mitoxantrone uptake experiment was performed through incubating cells with different mitoxantrone concentrations for four hours before analyzing the results with HPLC assay.

Results: 1) Mitoxantrone showed no significant differences of stability in plasma (p=0.714) and in plasma with ascorbic acid (p=0.993) after four weeks. 2) HEL   showed the highest mitoxantrone accumulation despite displaying the least sensitivity towards mitoxantrone compared with HL-60, U-937, and AML-3.

Conclusions: Intracellular mitoxantrone concentration does not appear to be related with sensitivity of a panel of AML cell lines towards mitoxantrone. Further studies are necessary to confirm the existence of resistance mechanisms independent from membrane transporters.

 

Biography

Zahra alibabaei  is student of biology- genetic  and will complete  his MSC  from IAUCTB University of tehran-iran. She is studing on her thesis about RLS in iran  in pastor  institute(tehran).she have an reviwe article about duplication in genome plant and attend in 17th plant genome evalution(1-3 october 2017) in spain.she is member of the young researchers and elite club of azad university(bpj).she also is member of isic.she also attended a conference on assisted reproductive techniques in Advanced Fertility Therapy in Tehran in 2016 as a collaborator and participant, and received a certificate.she has certificate from iranian biotechnology society for attend in The 1th symposium on research and career opportunities around  DNA molecules in Iran and the world in shahid beheshty university –tehran 2015

Abstract

Restless Legs Syndrome (RLS) is a functional disorder of the genital tract that is characterized by an unpleasant sensation and constant movement of the legs. The syndrome is one of the most commonly diagnosed sleep disorders that affects about 3-15% of the general population, and about 2-3% of people have visible clinical symptoms. The incidence of this disease in women is more than that of men. Precise statistics on the prevalence of the disease in Iran are not available, but on average, 15% of the recipients have mild to severe symptoms. In this article, we study the effects of renal and dialysis diseases and depression in the elderly on the prevalence of this syndrome in Iranian society. As well as health care to reduce the symptoms of the disease.and specialy Effect of Hot Water Bag on Severity of  Restless Legs Syndrome in Hemodialysis Patients.

 

Location: Vienna, Austria

Biography

Goncharova Veronika is 6th year student of the Novosibirsk state medical university, Russia. She is the scholarship student of the Russian Federation President for achievements in science. She has published more than 38 papers and abstracts in Russian’s journals.

Abstract

Coronary Artery Disease (CAD) is the leading pathology of the elderly. In spite of pharmacotherapy and the development of Percutaneous Coronary Intervention, the Coronary Artery Bypass Graft (CABG) is the required for patients with hemodynamically significant coronary atery-stenoses. Operation outcomes depend on the conduit-selection. The study purpose is clinical result-assessment of CABG to elderly patients, depending on the conduits-variety. Patients belong to the high-risks group (Duke index); the average patient's age is 71.4 years old. The surgery results are satisfactory and independent on the chosen conduit immediate. Examinations of patients show change in the angina pectoris’ functional class and tendency to increase need for nitrates in a quarter with autovenous conduits through three – five years after treatment. With the use of internal thoracic arteries, the angina pectoris’ functional class didn't reach preoperative level in 83% of cases after five years. The best results were achieved with bimammary aortocoronary bypass: no cases return of angina pectoris’ within three years after the surgery, there is no need for nitrates, but the operations performed by this method are the least recorded. When assessing the quality of life of patients (WHOQOL-BREF method) higher values were obtained in patients who underwent CABG using an arterial conduit.

Location: Vienna, Austria

Biography

Eman H.EL-Adawy has completed his MD from Mansoura University. She is associate professor of Internal Medicine and Endocrinology department in Spescialized Medical Hospital,Faculty of Medicine, Mansoura City, Egypt. She has published more than 10 papers in reputed journals.

Abstract

Background:In Egypt, it seems that adolescent girls are candidate for vitamin D deficiency (VDD), mostly due to inadequate sun exposure as a result of the culture and social dress codes. Curently there is growing evidence that VDD and iron deficiency anemia (IDA) are associated . Aim; investigate the frequency of VDD in adolescent females with IDA and demonstrate whether VD level was correlated with serum iron indices.  Methods: Forty adolescent with IDA and 30 healthy control were compared to determine the degree of VD level; where VDD ( ≤20 ng/mL), VD insufficiency  ( 20-30 ng/Ml) and VD sufficiency ( >30 ng/Ml). BMI, CBC, TIBC, serum ferritin, ionized calcium and 25(OH)D  were measured. Results:  Subnormal VD was more frequent in the IDA group (75%) than control (40%); where 19 adolescent female patients (47.5%) were VD deficient, 11 (27.5%) were insufficient and 10 (25%) were sufficient; in control group VDD was present in 4 (20%), VDI in 4 (20%) and VDS in 12 (60%) respectively. The mean level of VD was significantly lower in winter than summer (16.87 vs. 31.57 mg/dL, P <0.001). Analysis of the factors potentially associated with D levels was performed, including BMI, season and serum iron profile, and we found no significant independent predictors of VD levels. Conclusions. VDD has a high frequency in Egyptian adolescent females with IDA, however it is not significantly correlated with iron indicies. Measurement of VD level in such patients, a procedure that is not currently a part of routine investigation, could be necessary.

 

Day2: March 27, 2018

Keynote Forum

Biography

My research focuses on the genetic mechanisms and regulatory pathways involved in pulmonary disease.  In my graduate study I had focused on the role of microRNAs and epigenetic regulators in disease pathology. Specifically, we had identified alterations in gene regulation that correlates with clinical severity of disease in IPF. This has allowed us to target potential therapies, some of which have shown significant promise in our small animal models.  While my current focus is on patients with IPF, these pathways allow diverse application too many fields of study.  We have developed several collaborations with clinicians and researchers a like examining epigenetic regulation in diseases such as breast cancer, sepsis and acute respiratory distress syndrome. The central theme of my research is to identify epigenetic mechanisms by which prolonged macrophage survival can amplify the immune response and contribute to  cancer, metastasis, Autophagy, chronic lung inflammation in idiopathic pulmonary fibrosis (IPF) and other inflammatory lung diseases. Thus, my research focuses on two projects involving microvesicles and epigenetic regulation. We currently are examining the interplay of DNA methyltransferases and microvesicles in cancer and inflammation. We have several collaborative efforts with colleagues within the University and my former mentors as well with the Institute for Systems Biology.

 

 

Abstract

Sepsis microvascular dysfunction embraces different cellular components including endothelial cells, in which it increases its permeability and activation to shed extra microparticles (MPs) to transport a unique cellular signaling to the recipient cells. In this study, we observed that microparticles can retain different epigenetic components as miRNA, mRNA of DNMTs and HDACs from parent cells that can transfer to naïve target cells. Importantly, in sepsis, MPs production is increased. Increased expression of DNMTs results in promoter hypermethylation which can suppress transcription of not only a single gene but networks of genes with systemic effects. Sepsis is an inflammatory insult which can result in vascular dysfunction leading to systemic shock and eventual death. The aim of this study is to distinguish the role of sepsis microparticles in Systemic immunosuppression process and the impact of these particles upon cellular targets and survival mechanisms to allow better diagnostic tools and potential novel therapeutic approach during infection and trauma.

RESULTS.

We found that MPs from patients with septic shock and septic had significantly increased mRNA for DNMTs compared to MPs from patients with critical illness without sepsis and from normal healthy adults over the course of 5 days. Remarkably, we noticed that DNMT1 and -3a mRNA has the highest gene expression in sepsis MPs compared to other DNMTs. Additionally, naïve monocytes treated with MPs from patients with sepsis demonstrated increased expression of DNMTs. At the same time decreased expression at 24 hours. Endothelial cells ( HUVEC) and naïve monocytes treated with MPs from patients with sepsis demonstrated dramatically reduced of anti-inflammatory genes, TGF-β, TNF-α expression and some of autophagy molecules (ATG5, ATG7 and LC3) due to hypermethylation of their promoter. These data demonstrate that mRNAs of epigenetic regulators including DNMTs are highly expressed in plasma MVs in patients with sepsis and can be transferred to naïve cells through MVs and cause pro-inflammatory cytokine gene silencing and autophagy repression in monocytes. Further, MVs per mL plasma on day 1 alone significantly correlated with death by day 5 (r=0.7125 and p=0.0042). Using immunostaining techniques and flow cytometer, we found the major source of plasma MVs in the critically-ill, non-septic control patients shifted from monocytes (Mo) to endothelial cells (EC) in the SS patients (Control: Mo 63.6% and EC 7.4% and SS: Mo 12% and EC 58.7% qualitatively). Focusing our study on SS patients who lived and SS patients who died by day 5, our data shows that while total DNMT mRNA copy numbers per plasma MV are significantly higher over days 1 and day 3 in those SS patients who lived, the ratios of DNMT1 (maintenance DNA methylation) and the combination DNMT3A and DNMT3B (de novo DNA methylation) are reversed on days 1 and 3 (SS Lived: DNMT3A/3B-to-DNMT1: day 1=0.68 and day 3=0.87; SS Died: DNMT3A/3B-to-DNMT1: day 1=2.49 and day 3=2.94). Finally, MV DNMT3A/3B mRNA from day 1 samples positively correlates with reduced survival (r=6261 and p=0.0165). Targeting of circulating MVs with commercially available inhibitors of DNMTs may be a therapeutic strategy in specific patients with deregulated epigenetic mechanisms to limit both early and chronic consequences.  

Tracks

  • Internal Medicine And Patient Care
  • Geriatrics
  • Diagnosis and case reports reports
  • Infectious Diseases
  • Endocrinology
Location: Vienna, Austria

Biography

Reza Nassiri is an Associate Dean of Global Health, Director of Institute of International Health, Professor of Clinical Pharmacology, Professor of Family and Community Medicine and Lecturer in Global Health, Infectious Diseases and Tropical Medicine at Michigan State University College of Osteopathic Medicine. His research interests focuses on Clinical Pharmacology of HIV/AIDS & TB, prevention and control of infectious diseases, neglected tropical diseases, community health, global health and socio-ethical determinants of health. He works on international public health issues and has expertise in global health education, research, policy and governance. He has made contributions in various fields of medical sciences including clinical investigation and health education. On the basis of his extensive experience and expertise in HIV/AIDS and TB, he developed Clinical Research Programs in Brazil, South Africa, Haiti, Dominican Republic and Mexico.

Abstract

Global consumption of antibiotics has increased nearly 40% in the last decade.  The incredible rapid antibiotic resistance which is taking place worldwide is not only a serious threat to the practice of modern medicine, but also a threat to global public health.  This issue of bacterial resistance is so alarming that it caught the attention of G-20 Summit in both China (2016) and Germany (2017), let alone the U.N. Assembly in 2016 had called for a special meeting of “superbugs” which focused on the escalating drug resistance with respect to the sexually transmitted disease gonorrhea and carbapenem resistant Enterobacteriaceae.  While the causes of antibiotic resistance are complex, certainly human behavior play a significant role in the spread of antibiotic resistant genes.  In addition to the human behavior, the drivers of resistance include agriculture sector, animal husbandry, household and industry – these factors contribute significantly to the spread of the resistant genes within the ecosystem.  Such resistant mechanisms are continuously emerging globally, which threatens our ability to treat common infections, resulting in increased death, disability and costs.  Since the development and clinical use of penicillin, nearly 1000 resistant-related beta-lactamases that inactivate various types of antibiotics have been identified.  There is also a global concern about the emergence of antibiotic resistant carried by the healthy individuals, the commensal bacteria.  The CDC and WHO surveillance data shows that the resistance in E. coli is generally and consistently the highest for antibacterial agents in both human and veterinary medicine.  Within communities, resistant bacteria circulate from person to person or from animals and environment to person, or vice versa.  With 1 billion people travelling each year, bacteria is becoming more mobile.  The bacterial resistance can kill 700,000 worldwide each year and it’s been estimated to kill 10 million by 2050.  The WHO estimates 78 million people a year get gonorrhea, an STD that can infect the genitals, rectum and throat - there is a widespread resistance to the first-line medicine ciprofloxacin as well as increasing resistance to azithromycin.  The emergence of resistance to last-resort treatments known as extended-spectrum cephalosporins (ESCs) is now eminent

 

Biography

I was born in Çankırı/Turkey in 1976. I was graduated in 2009 from Ankara University School of Medicine Pulmonary Diseases Department and since 2011, I have been working as an interventional pulmonogist in Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital.

I am a member of ERS, ATS, EABIP, WABIP, Turkish Thoracic Society and Turkish Respiratory Society. Also I am still a member of Turkish Respiratory Society 39th YEAR National Congress Organizing committee and in charge of the courses. 

Abstract

Biography

Abstract

Background Cerebral palsy is a common pediatric problem encountered in about 1:3 per 1000 born children and causing variable mental, motor and behavioral s dilemmas. Newly introduced trials of neurogenesis with different agents are now extensively evaluated. Objective our study was conducted to evaluate the neurotrophic response to B12 vitamin and omega-3 fatty acids in children diagnosed early with variable forms of cerebral palsy. The response was monitored both clinically and with C.T Scan as being a highly predictive tool for assessing cerebral palsy. Design The study was carried out on 40 cerebral palsy pa1ents; 26 (65%) out of them were girls, and 14 of them were boys, aged from 0 to 5 years old; from outpa1ent clinic at Zakho/Duhok General Hospital in Kurdistan Region-Iraq. Patients were treated and followed
Up to 6 months to one year. They were represented and adjusted by full history taking and clinical examination. Brain C.T scans were done for every patient to assess the degree of brain atrophy before starting this combined therapy, and every month for six months to one year. There was an improvement in general health of children after interventional therapy. Results The study revealed that early interven1on of both omega 3 and B12 vitamin in children under 5 with cerebral palsy (cp) shows great response based on clinical examination and CT
scan findings. Almost, after combined therapy, 80% of children with delayed speech delay have very good response and improvement, 77% of children with delayed milestone and hypertonia, and 87% with delayed walking have posi1ve clinical outcomes. Both sexes have equal response to combined therapy. Such findings were obtained as a result of early treatment and diagnosis of children with (CP). In addition, among the treated children with CP, improvement in CT scan results was obtained. 84% of treated children have great improvement in their neuroimaging results from moderate/severe forms of brain atrophy to A mild form of brain atrophy after being treated and followed up for 6 months- 1 year.
Conclusions
The damaged brain sites based on CT scan results, showed progressive improvement in response to B12 and omega-3 fa?y acids upon daily supplement throughout 6 months to one year. However, combining these 2 drugs showed preservative synergistic consequences. B12 vitamin and omega- 3 faty acids are valuable therapy for children with various forms of cerebral palsy particularly when being linked. The greatest improvement in speech and motor development was significantly observed in about 32 patients (80%) of treated children with B12 vitamin and omega- 3 faty acids. Others have less response to combine therapy as being presented and diagnosed beyond 1 year of age (16%) Key words: Cerebral palsy, early intervention, B12 and omega 3, Brain, Motor and speech development, C.T Scan and clinical improvement, outpatient clinic

Biography

https://internalmedicine.euroscicon.com/registrationStamatis Karakonstantis is a resident of Internal Medicine. He graduated from the Medical Faculty of the University of Crete, in Heraklion. He has completed an MRes degree from the University of Birmingham. He is a new author and has so far published 8 manuscripts.

Abstract

Background: G6PD deficiency is common in Mediterranean countries [1]and is associated with favism, i.e., hemolytic anemia following consumption of fava beans. Given it is an x-linked recessive inherited disorder, it is uncommon in women. Case report: A 74-year-old female presented due to jaundice that developed the past 24 hours. Her oxygen saturation on pulse oximetry was 86%, while her arterial blood gases showed a saturation of 94.7%. Lab tests revealed a hemolytic anemia (hemoglobin 9.4 mg/dl, 2.5% reticulocytes, LDH 582U/l, total bilirubin 8.4mg/dl, conjugated bilirubin 1.25mg/dl, normal coagulation times, normal platelet count and negative direct coombs).  She denied taking any new medications. She reported consumption of fava beans the day before, although she reported uneventful prior consumption 2 years ago. Family history taking revealed that she had a son diagnosed with G6PD deficiency. G6PD deficiency was confirmed with quantitative testing (enzyme activity 6.7U/g Hb, normal range 7-16). During the first day the hematocrit fell to 21.8%, with 25% reticulocytes. She was managed with intravenous hydration and blood transfusion. The hematocrit rapidly rose, pulse oximetry saturation normalized, and she was discharged with a diagnosis of favism.  Discussion: Favism may occur in elderly women with heterozygous G6PD deficiency despite normal prior consumption of fava beans. This may happen due to skewed X-chromosome inactivation with aging, affecting the wild-type allele [2]. The low oxygen saturation on pulse oximetry can be explained by favism associated methemoglobinemia, as previously described [3, 4].

Biography

Luiza Lazarescu has graduated at Carol Davila University.of Medicine, Bucharest, specfialist in Internal Medicine from 2008 and mayor in Internal Medicine from 

Abstract

Case report: We report a case of a 30-year- old woman known with Crohn disease from the age of five, who was hospitalised for pain and sweling in the sacroiliac joints. She had been in treatment with Adalimumab 40 mg twice daily, prior to hospital admission. The MRI investigation of sacroiliac joints revealed bilateral reduction in joint spaces, but no bone edema or other significant changes. Blood tests showed chronic anemia (Hb 11,4 g/dl and Ht 35,7 %),  with normal ESR and C-reactive protein and negative HLA- B27 phenotyping. The diagnosis of seronegative spondylarthritis was made by excluding other joint patholgy, based on the European Group cryteria for this condition.

Based on the clinical, immunological and imagistic findings, I believe that the patient has developed reactive spondylarthritis, most likely secondary to Crohn disease.

NSAIDs are the medication of choice for spondylarthritis, however we chose to avoid them while IBD is active and refer the patient for physiotherapy. The patient has concomitantly continued her treatment with Adalimumab. She has had a good result after the first sessions of physiotherapy, with reduced swelling and recovered mobility in her joints.

Biography

Hemda Weiss  she is currently working in Hasharon Hospital, Israel.

 

Abstract

Background: Recently lowering upper limit of normal (ULN) values of serum alanine aminotransferase (ALT) was suggested.

Aim: To investigate the prevalence of significant liver disease among community dwelling elderly (>65 years) in central Israel, whose ALT level fell in the range between the former and the new range ('delta range').

Patients & Methods: The database was searched for those who underwent ≥ 1 ALT measurement (IU/L) in 2002-2012. In a previous study a new range of ALT has been proposed: men: 15-42, women: 10-26. In this study the prevalence of significant liver disease in the delta range: men 42-45, women 26-34 was investigated. APRI, FIB-4 and AAR were applied for evaluating liver fibrosis. Prevalence of significant liver diseases was set by Chi-Square tests, mean fibrosis scores were compared using ANOVA followed by Bonferroni post-hoc test. The receiver operating characteristic model was used to test the ability of the scores to predict cirrhosis.

Results: 2022 of 49634 (41% male, mean age of 83±6 years) were diagnosed with chronic liver disease (CLD) and 366 with cirrhosis. The two were more prevalent among men (15.3% vs. 4.9% and 4.2% vs. 0.9%, respectively) and women (7.8% vs. 3.3% and 1.5% vs. 0.4%, respectively) in the delta range compared to the new ALT range. Mean fibrosis scores of FIB4, APRI and AAR were significantly increased in the 'delta range' compared to the new ALT range.

Conclusion: Lowering the current ULN of ALT l may help detecting significant liver diseases.

 

Location: Vienna, Austria

Biography

Tomaz Velnar, MD, PhD is a neurosurgeon and assistant professor at Ljubljana medical centre. He is also active in research, cooperating regularly with the other two authors. They have started a multicentre study of vitamin D deficiency among older people.

 

Abstract

Spontaneous intracerebral haemorrhage has a high disability and mortality rate. In cases, when surgery is needed, minimally invasive approach is recommended.

A 59-year old patient was admitted due to progressive left sided arm and leg weakness. The neurological status started to deteriorate quickly. A computed tomography (CT) of the head revealed an ICH of 7cm in diameter with haematocephalus and cerebral oedema. The CT angiography was negative, classifying the haematoma as a primary one. Coagulation and aggregation values were deranged as a result of liver failure. The international normalised ratio (INR) and prothrombine time (PT) were lowered to 1.56 and 0.47, respectively. The platelet count was 33 and the platelet function tests were completely disturbed.  Injections of fresh frozen plasma, recombinant coagulation factor VIIa, protrombin complex, vitamin K and platelet plasma were applied. As a result of extensive intracerebral bleeding and consciousness decline, surgery was recommended despite unfavourable laboratory results. A minimally invasive approach was chosen for the ICH removal. A burr hole of 1cm in diameter was made in the right temporal area. Under the microscope, the liquefied blood was evacuated with aspirator and bipolar. The ICP values remained normal during the course of treatment. The control CT scan showed successfully evacuated haematoma and normal width of the ventricles. The sedation was gradually discontinued after a week. The patient was awake with persistent left sided haemiplegia.

In case of patent with numerous risk factors and imminent operation, minimally invasive surgery for intracerebral haematoma is warranted.

Location: Vienna, Austria

Biography

Paula Hernandez has completed her MD from the University of Puerto Rico Medical Sciences Campus. She is the currently in her first year of internal medicine residency at the University of South Florida Morsani School of Medicine in Tampa. She has published 4 papers in reputed journals and is currently engaged in diverse scholarly activities. She is interested in pursuing a cardiology fellowship and continuing research on imaging cardiology.

Abstract

Hyponatremia is the most common electrolyte imbalance managed by hospitalists. Although a rare entity, a relationship between hyponatremia and cardiac tamponade has been reported in a few published reports that highlight the normalization of sodium levels following pericardial drainage.
This is the case of a 57-year-old lady with rapidly progressive stage IV pulmonary adenocarcinoma who presented two months following diagnosis with findings of significant hyponatremia. Upon admission, she was afebrile, hypotensive and tachycardic. Her laboratory studies revealed a sodium level of 119 mEq/L, as well as hypokalemia and hypochloremia. Although her presentation was consistent with Syndrome of Inappropriate Antidiuretic Hormone, her hyponatremia did not improve despite adequate management with fluid restriction and salt tabs. During hospitalization, she was also found to have a large pericardial effusion with echocardiographic evidence consistent with tamponade physiology that required an emergent pericardial window. Her sodium levels normalized immediately following pericardial drainage, suggesting a correlation between her hyponatremia and cardiac tamponade.
A handful of published reports present a similar scenario in which pericardial drainage resulted in immediate resolution of the hyponatremia, particularly in patients with underlying malignancies. It is suggested that a decreased cardiac output stimulates antidiuretic hormone release and suppresses atrial natriuretic factor release, causing volume retention, increased heart rate and increased peripheral resistance. Following pericardiocentesis, there is marked diuresis and a normalization in sodium concentration. Cardiac tamponade should be included in the differential of hyponatremia in patients with active malignancy, since prompt management with pericardial drainage can result in marked improvement of hyponatremia.

Location: Vienna, Austria

Biography

The writer is a final year medical student who has completed his clerkship in Faculty of Medicine,

Diponegoro University, Indonesia. In this project, he was supervised by Dr. Muchlis Sofro from Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr Kariadi General Hospital.

 

Abstract

Background: The administration of Zidovudine (ZDV) has an important role in decreasing the number of mortality on HIV/AIDS patients, despite the side effect of anaemia. The incidence of anaemia can be influenced by several factors, e.g. age, sex, duration of treatment, CD4 count, and ALT level.

Methods: This research is an analytic observational with cohort-retrospective method used. The study was taken in VCT Clinic, Dr. Kariadi General Hospital Semarang. The data was collated among HIV/AIDS patients’ medical records from April 2014 to May 2015. 70 out of over 300 patients on Zidovudine were eligible: 35 belonged to case group, the other 35 as control. The data was analyzed by Chi-square and Fischer test.

Results: The average age of patients with and without anaemia in this study are 33.65 years old and 38.02 years old, respectively. However, age did not have any significant relation with the incidence of anaemia (p=0.075). A statistically significant relation was shown between sex and incidences of anaemia (p=0.027); indicated by 18 female HIV/AIDS patients (51.4%) suffered from anaemia. Duration of treatment (2.1 months average) was the most influential factor towards occurrences of anaemia (p=0.000). No significant relationship between low CD4 count (< 200 cells/mm3) and ALT level to the occurrence of anaemia (p=0.055 and p=1.000 respectively).

Conclusion: The incidence of anaemia on HIV/AIDS patients from Dr. Kariadi General Hospital Semarang is related to sex (gender) and duration of treatment as the influencing factors; Age, CD4 count, and ALT level do not appear to have any significant relation with it in response to the administration of Zidovudine.

 

Biography

Janet M. Colón-Castellano completed her Baccalaureate’s degree in Natural Sciences with a minor on Biotechnology from the University of Puerto Rico in Ponce. Following her growing research interests in Human Immunodeficiency Virus (HIV), she worked as a laboratory technician at one of the few HIV research centers of Puerto Rico. Afterwards, Dr. Colón-Castellano decided to pursue a doctorate in Medicine from the Ponce Health Sciences University which she completed on 2016. She is currently completing her Internal Medicine residency at the Veteran’s Affairs Caribbean Healthcare System located in San Juan, Puerto Rico.

 

 

Abstract

Case of a 68-year-old man with past medical history of dengue hemorrhagic fever who was admitted to the medical intensive care unit (MICU) with the diagnosis of Septic shock. His symptoms started the prior week with sudden onset of fever, polyarthralgia and skin rash over the abdomen extending to the back, buttocks and extremities. The patient visited a community primary care physician who recommended acetaminophen for symptom relief. After 2 days of no improvement and development of abdominal pain, nausea, non-bloody vomiting and dark-colored stools, the patient visited the emergency department. Physical examination was remarkable for hypotension, tachycardia, tachypnea and oxygen desaturation, and a non-blanching maculopapular rash over the abdomen, back, buttocks, and extremities. No evidence of acute neurological deficits or cardiopulmonary involvement. Laboratory workup showed hemoconcentration, thrombocytopenia, hepatic transaminitis, and acute renal injury, findings suggestive of circulatory compromise due to systemic capillary leak syndrome. Patient developed cardiorespiratory arrest requiring advanced cardiac support measures and mechanical ventilation for which he was admitted to MICU. While on MICU, he was initiated on broad spectrum antibiotics, aggressive fluid resuscitation, and vasopressors. He persisted with profound shock and died 7 hours after admission to MICU. Final laboratory reports were remarkable for RNA-PCR positive for Chikungunya virus and negative for Dengue virus. Chikungunya infection is usually a self-limited disease and only required supportive therapy. This case highlights an unusual presentation of chikungunya fever with systemic capillary leak syndrome, a well-known complication of Dengue hemorrhagic fever.

 

Location: Vienna, Austria

Biography

Cristian Funieru completed his PhD from “Carol Davila” University of Bucharest, Romania in 2010. He is Assistant Professor at Preventive Dentistry Department from “Carol Davila” Bucharest School of Dental Medicine and a specialist in oral surgery. He has published more than 28 papers in medical and dentistry journals (4 in PubMed).

Abstract

The association between oral lichen planus (OLP) and Hashimoto’s thyroiditis (HT) has been reported for several times but many details remain unclear. One hypothesis considers that HT antibodies could be the trigger for the autoimmune mechanism responsible for OLP lesions. Our study has as main role to analyse if there is any relation between OLP and HT in a group of Romanian patients. 211 medical records of OLP patients who addressed to the Department of Oral Medicine from Bucharest “Carol Davila” School of Dental Medicine between 2015 and 2017 were analysed in this study. It has been selected 99 patients who meet the OLP diagnostic WHO criteria (1978) modified by Meij and van der Waal in 2003 and they were tested for anti-thyroid peroxidase antibodies (ATPO). 30% of them were diagnosed with HT, the level of ATPO antibodies being higher than normal. 62% of OLP lesions associated with HT were symptomatic, patients complaining of local pain, burning sensation of oral mucosa and slight discomfort. The most common clinical form of OLP found in this study among patients with HT was the associated form (keratotic and atrophic lesions), followed by keratotic, ulcerative and atrophic forms OLP. As conclusion, it would seem to exist a link between OLP and HT that makes oral lesions and their symptoms more evident and severe.