Conference Schedule

Day1: March 25, 2019

Keynote Forum

Biography

Dr. Nassiri is a former Associate Dean of Global Health at the Michigan State University (MSU).  He also served as MSU director of Institute of International Health.  He is currently Professor of Pharmacology and Toxicology, Professor of Family and Community Medicine, and, lecturer in Global Health, Infectious Diseases and Tropical Medicine.  He currently works on international public health issues relating to chronic diseases and has expertise in global health. 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 chronic infectious diseases including HIV/AIDS, TB as well as antimicrobial resistance and human gut microbiome, he developed clinical research programs in Brazil, South Africa, Haiti, Dominican Republic and Mexico. He had served as editorial board member for the journal of HIV and AIDS Review.  He is currently on editorial board member for AIDS Patient Care and STDs.  Prof. Nassiri has delivered seminar presentations on Tropical Medicine, HIV/AIDS, TB, Global Health and public health interventions in numerous national and international conferences and workshops. He is internationally recognized for his work in the areas of building effective international partnerships particularly in global health, community health, clinical care capacity building, and technical assistance mechanism. He is the founder of Michigan State University Osteopathic and Primary Health Clinic in Merida, Yucatan, Mexico.  He has developed academic and research partnership programs with Federal University of Para Institute of Tropical Medicine in Belem, Brazil.

 

 

His research interests are Clinical Pharmacology of HIV/AIDS & TB, human gut microbiome, antibiotic resistance, prevention and control of infectious diseases, neglected tropical diseases, community health, global health, socio-ethical determinants of health, and community-based public health interventions.  In collaboration with his Brazilian colleagues, he conducts research in the eastern Brazilian Amazon population on incidence and prevalence of HIV, TB, Hepatitis C, HPV, and antimicrobial resistance.

 

 

Abstract

The global medical community is witnessing incredible trends in globalization, increase in population, which provides grounds for emergence and reemergence of viral epidemics throughout the world.  These epidemic can potentially overwhelm the healthcare delivery systems for provision of a comprehensive medical care delivery.  In the past two decades, we have witnessed some of the deadly viral epidemics of the 21st century such as the Ebola virus epidemic in West Africa, the 2009 flu pandemic, dengue fever and Zika outbreak especially in Brazil.  From such outbreaks occurring unpredictably around the world, global health experts acknowledge viruses now have evolved to rapidly cross international borders.     

In 2014, an outbreak of Ebola occurred in West Africa, primarily in Liberia, Sierra Leon and Guinea.  The virus took the lives of more than 11,000 people in three countries.  Recovery from Ebola is dependent on early disease onset, adequate supportive care, and the patient’s immune system.  The virus causes internal hemorrhage and has a remarkable capability to rapidly spread through contact with a miniscule amount of bodily fluid.  In Congo, the epidemic was often transmitted to humans by contact with an infected animal.  Ebola continues to be a threat - the virus has killed 26 people in a recent epidemic in the Democratic Republic of Congo. 

Influenza outbreaks take place during the winter months.  The virus has genetically evolved to continuously modify itself by what is known to be antigenic shift and drift.  In the case of antigenic shift, the virus evades immune system.  Annual fatality of influenza is well established and elderly are more prone to this virus.  Clinical characterization of influenza is well documented in practice of respiratory medicine which are associated with morbidities and mortalities.  The first flu pandemic was recognized in 1918 known as the Spanish flu which killed an estimated 50–100 million people worldwide, and has been referred to as “the mother of all pandemics.”  There have been two major deadly outbreaks namely the 2005 avian influenza - Bird Flu H5N1, and the H1N1 (Swine flu) pandemic of 2009.  Both H5N1 and H1N1 subtypes are highly contagious.  The highly pathogenic avian H5N1 was initially discovered in South Africa in 1961.  Migratory shore birds were determined to be affected by the virus which is often deadly.  In 1997, serious illness occurred in Hong Kong – the H5N1 was responsible for 18 documented cases of severe respiratory illness with 6 cases of fatalities. The affected individuals were investigated to be in close contact with contaminated poultry.  The Spanish flu along with H5N1 and H1N1 have been attributed to produce specific type of cytokine response which is termed cytokine storm with significant mortality.  The H1N1 pandemic occurred on June 2009.  One of the most important lessons of H1N1’s pandemic was its impact on the healthcare system.  There are general consensus worldwide that it had caused the signs of stress in the developing and resource-limited countries.  It overwhelmed the healthcare system especially the intensive care units (ICUs). 

Another medical concern is dengue virus which is an acute febrile illness.  It is transmitted by mosquitos of the genus Aedes.  This virus was discovered in 1943 by two Japanese scientists in Nakasaki.  It is an old virus that has reemerged during the latter half of the 2oth century.  The infection primarily is caused by four serotypes; DEN-1, DEN-2, DEN3, and DEN-4.  All serotypes can be found worldwide.  It is a major health issue throughout the tropics and subtropics with more than 100 countries at risk of endemic.  The incidence of dengue has increased dramatically in the recent years.   There are more than 50 million cases occurring annually.  Nearly 40% of the world’s population is at risk of dengue virus transmission.  Some individuals who have developed infection with one dengue serotype, they may develop bleeding and endothelial leak upon infection with another dengue serotype which is termed dengue hemorrhagic fever as well as dengue shock syndrome.  In the viremic phase, dengue virus becomes a blood-borne infection, which can also be transmitted from mother to fetus in utero or to infants at the delivery – perinatal transmission.  According to the CDC, dengue has become the leading cause of acute febrile illness in US travelers retuning from the Caribbean, South America, and Asia.  One of the largest outbreaks occurred in 2018 in Thailand with 126 fatalities.  Thailand also recorded its worst dengue epidemic in 1987 with 174,000 infected cases and with a fatality of 1,007.  The lack of selective antiviral agents and an effective vaccine results in approximately 500,000 affected individuals, mainly children, being hospitalized each year throughout the world let alone dengue produces significant economic losses for both households and whole nations.     

Another virus that has crossed international boundaries is Zika virus.  This virus was first described in a febrile rhesus monley in the Zika forest of Entebbe, Uganda.  Shortly thereafter, it was reported in a field worker.  Zika is known to widely cross international boundaries outside Africa. Zika epidemics have also been described in Micronesia and French Polynesia.  The transmission to human takes place through the bite of an infected Aedes aegypti mosquito.  In 2015, the outbreak of this virus was reported in Brazil, the illness for which, was characterized by skin rash and absent or low grade (short-term) fever.  Based upon clinical presentation, it was challenging to diagnose Zika from dengue or Chikungunya virus.  Brazil has also experienced epidemics of Chikungunya virus.  Because of the mild nature of the disease, more than 80% if Zika virus infection cases likely go unnoticed.  Zika maculopapular rash is the predominant presenting symptom which is likely immune-mediated involving the face, trunk, and extremities, including palms and soles.  In few affected individuals, Zika virus can cause neurological complications such as Guillain-Barre syndrome.  Of greatest clinical concern over the complications of Zika virus infection is over congenital malformations which is primarily due to transplacental transmission of the virus causing microcephaly complications.  Zika epidemic of Brazil highlighted an unequal burden on healthcare delivery system.

Most recently, Venezuela is facing a resurgence in dengue, Zika, Chagas disease and malaria due to its ongoing political and humanitarian crises which have already further compromised it’s already existing broken down health system and is seriously threatening its public health infrastructure.  The World Health Organization has alarmed the global community that diseases transmitted by insects in Venezuela can lead to a significant loss of life. The incidence of dengue increased by more than four times from 1990 to 2016.  Furthermore, the frequency of Zika outbreaks with epidemic potential appear to be increasing as experts found 2,057 cases of Zika virus per 100,000 people.  The high prevalence of such diseases is further compounded by the lack of public health standards, shortage of food, medicine, and vaccine in Venezuela.    

Although tremendous progress has been made in the past years to improve epidemiological surveillance and rapid detection of viruses that cross international borders, yet capacity-building for rapid detection and optimal care delivery are just examples of few obstacles and challenges that global health faces especially in resource-limited countries.  The emergence and reemergence of deadly viral outbreaks are major international public health concern.  As reemergence of deadly outbreak can take place again, viruses without borders highlighted in this keynote address will continue to get the attention of healthcare professionals, international media, infectious diseases epidemiologists, NGOs, and national/international public health sectors.  It must be emphasized while hand washing which presents the basic principle of prevention and control, such preventive measure may not be adequate for the spread of deadly viruses in the communities.  A “One Health” perspective can help to address these complex issues of preparedness and response.  A comprehensive framework such as One Health approach encompasses a systemic perspective which is fundamental to understand, address, and tackle the consequences of viral epidemics.  To meet the global challenges in the context of deadly viral infections, interdisciplinary collaborations facilitate synergism with respect to an optimal healthcare delivery system.

 

 

Tracks

  • Nephrology
  • Internal Medicine and Patient care
  • Endocrinology
Location:

Biography

Katerina Ristoska, MD is a graduate of Medical Faculty, Skopje, Republic of Macedonia, where she also attended her specialization in internal medicine. Dr.Ristoska trained at Medical Faculty, Skopje, at the Department of Nephrology during her residency. During her residency, she was able to provide superior care and consulatation that resulted in an overall improvement of the department's patient satisfaction quotien. She complited training in dialysology and focused on the patient treatment and reevaluated several methods of therapy management dependent on individual patent history and efficacy of previous treatment. Dr.Ristoska has been practicing and attended her undergraduate studies in the Department of Cardiology at Medical Faculty in Skopje. She is currently author and coauthor of 57 publication at the international congresses at home and abroad, as same in the several other journals. She was contributor on two multicentric studies of pharmaceutical company"Krka-Farma" DOOEL Skopje. Dr.Ristoska is  Fellow of New Westminster College, Vancouver, British Columbia, Canada. She is the Member of The Macedonian Association of internal medicine, ESC, EAPCI, HFA, EACVI, EAPC, ACCA. She is also the Member of ESC Council on Cardiovascular Nursing and Allied Professions,  ESC Council on Hypertension,  ESC Council on Valvular Heart Disease, the Member of Working Group on Grown-up Congenital Heart Disease, the Member of Working Group on Aorta & Peripheral vascular disease. Dr.Ristoska is the Member of ERA – EDTA Diabesity Group, ERA – EDTA EUREKA -M Working Group of European renal and Cardiovascular medicine, ERA - EDTA CKD- MBD Working Group. She is also an accredited examiner of a doctor's professional exam for obtaining a work license and editor-in-chief in the International Journal of Medicine and Healthcare and Section Editor in the Interdisciplinary Studies, for Healthcare in International Journal Anglisticum. After her extensive work experience in a children's dispensary, emergency unit, surgery unit, private health sector, she is currently working in the hemodialysis center of Sistina nephroplus. Ristoska acts as a volunteer in many humanitarian organizations dealing with women's health, child health, animal protection. Currently, Dr.Ristoska holds certification from the Macedonian Board of Internal Medicine.
 

Abstract

Background:

Cardio renal syndrome (CRS) is used to describe clinical conditions in which coexist cardial and renal dysfunction. First were classified in 2008 and divided into five subtypes. Its pathogenesis is not fully understood. Additionally available therapeutic strategies are challenged to manage this syndrome.

Case presentation:

We report the case of 60-year-old diabetic man, hypertronic, with adipositas permagna, previous myocardial infarction (1998), LVH and diastolic dysfunction, with implanted St. Jude’s prosthesis and the aneurysm of ascending aorta. In 2013, he was diagnosed with bilateral renal cysts, with a worsening of renal function, which was characterized as chronic renal failure stage 3 (GFR 39mll / min according to MDRD formula), with albuminuria of 90mg/L and an increased quotient albumin/creatinine of 164mg /dl. Same year, after enterococcus faecalis bacteremia, without the development of endocarditis, he develop atrial thrombus, which is resumed by conservative treatment. Due to the development of Stanford B aortic dissection and aneurysmal endoleak, with the tendency of aneurysm growth, was performed the stenting with prosthesis of the thoraco-abdominal transition of the aorta and of truncus coeliacus. He is suffering from restrictive, moderate peripheral obstructive ventilatory insufficiency, with the development of respiratory acidosis, dependent on oxygen therapy and CPAP mask (SAP syndrome). Infectiously affected by gastroenteritis and right-side pneumonia,2016 he develops an acute decompensation of chronic renal failure, with a worsening of heart failure, develops pulmonary edema, with an increase in degradation products, and commences hemodialysis three times a week. In December 2016, during dialysis he develop VF with a state of unconsciousness, which was treated with CPR with electro shock therapy. After that he developed bradycardia, AF and AV block third degree, therefore AICD was implanted. In december 2017 was diagnosed that stentprotheses in the thoracolumbar junction with supply of the celiac trunk via a stent with a retrograde restoration of the truncus was compromited.  Development of new atrial thrombus.

Conclusion: Since renal function is the single most important factor in the outcomes of patents with heart failure, the importance of early recognition, after adjusting the differences in baseline data, etiology and severity of disease, as much of early therapeutic strategy have impact of long life outcomes.

Location:

Biography

William J Rowe is a FBIS (Fellow British Interplanetary Society), FACN (Fellow American College of Nutrition, Retired Fellow Royal Society of Medicine), is a board certified specialist in Internal Medicine. He has received his MD at the University if 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 studied three 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.

Abstract

Of 12 moon walkers, James Irwin on day after return from Apollo 15 mission, showed extraordinary bicycle (B) stress test (ST) hypertension (275/125) after three minutes exercise; supervising >5000 maximum treadmill ST, author never witnessed ST-blood pressure approaching this level. Symptom-limited maximum B stress test showed “cyanotic fingernails”; possibly venous blood trapped peripherally, supporting author’s “Apollo 15 Space Syndrome,” postulating that severe fingertip pain during space walks, triggered by plasma fluid, trapped distally; mechanism could be related to endothelial dysfunction, providing “silent ischemia”warning. Neil Armstrong returned to Earth with severe diastolic hypertension (160/135), consistent with ischemic left ventricular dysfunction; 50 mm increase in comparison with resting BP 110/85. With inhalation of unar dust, brought into habitat on space suit, with high  lunar iron (I) this dust inhalation, along with reduced (R) space flight- transferrin, R antioxidant, calcium (Ca) blocker-magnesium, conducive to severe oxidative stress, Ca overload with potential endothelial injuries. Using moon walker studies as example, author’s recent editorials show that I dust, released from brakes, with over 90% of brakes made of I, is a major hypertension factor and may also contribute to myocardial infarctions.

Biography

Dr. Mayank Ohri graduated medical school from American University of Antigua. Currently a full time Internal Medicine Physician at Kendall Regional Medical Center in Miami Florida. Participated in multiple research projects including quality improvement, oral and poster presentations at National Internal Medicine Conferences. He is anticipated to complete his MBA majoring in Healthcare Administration in 2019.

Abstract

Introduction: Transient cortical blindness after contrast-induced media is an extremely rare occurrence. It has been estimated that approximately 1% of the patients suffer cortical blindness after undergoing a cerebral or vertebral angiography. Based on our literature review only 18 documented cases have been reported of transient cortical blindness secondary to coronary angiography using modern, non-ionic, low-osmolality based contrast agents. We present a case of an elderly man with symptomatic bradycardia who underwent dual-chamber permanent pacemaker implantation that had transient contrast induced cortical blindness.

 

Case Report:  Patient is a 77-year-old male truck driver with a past medical history of hyperlipidemia that presents to our hospital after a syncopal episode that resulted in left rib pain.  He reported loss of consciousness after drinking several beers and felt as if the room was spinning around him. He denied any postictal confusion, loss of urinary or bowel incontinence.  CT scan of the chest was done which showed 4th and 5th rib fractures. On EKG his heart rate was 47 beats per minute with a new onset of right bundle branch block with no ST segment changes. His 2-D echocardiogram and troponins were within normal limits. He underwent a tilt table study, which showed classic mixed cardioinhibitory and vasodepressor response, with heart rate in 20’s, consistent with neurocardiogenic syncope. Based on these findings, a dual chamber cardiac pacemaker was implanted successfully, without any complications.  Agents that were used during the procedure-included lidocaine for local anesthesia, and low osmolality, non ionic iodine based contrast. Approximately 1 hour after the procedure the patient started to experience blurred vision, which soon progressed to bilateral blindness. On examination, his fundoscopic examination was normal, and no neurological deficit was present except for blindness. Since he was not a candidate for an MRI, he underwent head/neck CTA that was within normal limits. Next day at 1:30 am the patient started to notice improvement in his vision and by 9:00 am his vision was restored back to normal. Based on this clinical picture it was concluded that his transient bilateral loss of vision was contrast induced. Patient was soon after safely discharged from the hospital.

 

Conclusion: Contrast induced cortical blindness is an extremely rare finding. This is an excellent case to inform healthcare professionals of a potential serious side effect from a commonly used agent. There is no specific measure that needs to be taken for protection against this unusual and alarming complication. Careful neurological assessment and consultation accompanied by MRI or CT scanning can confirm the diagnosis. When these agents cause cortical blindness it is anticipated it takes 24-72 hours for resolution back to normal vision.

 

Biography

Abstract

Eye pain is common and initially managed by primary care physicians.  Questions to consider when examining patients: 1) Are there any alarming eye findings that need an urgent ophthalmology referral? 2) Is this particular eye condition part of a larger systemic disorder or one of a primary eye disease? 3) Is there a need for additional testing such as HIV or HPV screening?  4) Should a biopsy be performed?  Meticulous patient history and risk factor analysis combined with a clinical examination will help formulate a differential diagnosis and inform further management.  By doing so, it obviates the need for unwanted testing, early specialist referral, and improves patient outcome.  Familiarization with the typical presentation and appearance of a pterygium will portend an opportunity for the comprehensive practitioner to treat with conservative therapy, thus saving the patient time and discomfort.  In the rare refractory case or atypical appearance, consultation with ophthalmology is needed.     A 35-year-old Hispanic male patient with a history of pterygium presented with complaints of worsening left eye pain for months.  Prior to these symptoms, the patient had been treated for pterygium for years without eye pain.  Over the past two weeks, the patient had also noticed more redness and soreness that occured all day.  He noticed darkening in the medial vision of his left eye, persistence of left eye pain and visual changes. An excisional biopsy of the lesion was performed.  The final biopsy reports revealed an ocular surface squamous cell carcinoma in situ causing pterygium.

Location: Rome, Italy

Biography

Dr Nevena Ilic has completed her subspecialization in Endocrinology at Belgrade University Medical School in 2009 and Master’s degree in Thyroid Diseases in Italy 2014. She completed Internal medicine specialization at Military Medical Academy Hospital, Belgrade in 2002. From 2014 she works as Prime Endocrinologist at Euromedik General Hospital, Belgrade where she organized endocrinology service and several Symposiums in Belgrade and Rome where she was a speaker. She spoke at several international congresses. She has published 23 papers in reputed journals. She is a member of European and Italian Endocrinology Society.

Abstract

Epidemiological studies in last ten years have shown that 30-50 % of obese men have lower testosterone levels for age. Patophysiological mechanisms of so called “dysmetabolic hypogonadism” are complex and they involve cytokine (TNF , IL 1, IL 6) and adpokine (leptin) secretion, insulin resistance, abnormal turnover of many hormones due to an endocrine axis changes (GNRH-LH-testosterone, GH-IGF-1, TSH-T4,T3, ACTH-cortisol) and obstructive sleep apnea with disturbed REM sleep phase. Low testosterone level causes body composition changes with higher total body fat percentage and loss of muscle mass. High body fat worsens insulin resistance which increases weight gain and obesity, creating a “vicious cycle”. Consequences of low testosterone level in obese men are higher risk of type 2 diabetes, metabolic syndrome and cardiovascular diseases, cancer, infertility, erectile dysfunction, bone loss, bone marrow changes depression, Alzheimer disease and higher overall mortality. The dilemma is weather to treat these patients with hormone replace therapy or not. Recent studies have shown positive results in metabolic response such as better lipid status and increased insulin sensitivity, weight loss, body composition changes with a decrease of fat mass and increase of muscle mass in patients treated with testosterone replacement therapy. Further studies are required to prove if this kind of treatment decreases mortality risk.

Day2: March 26, 2019

Keynote Forum

Tracks

  • CHRONIC DISEASE
  • Cardiovascular Disease
  • Diagnosis And Case Reports
  • Intensive Care Medicine
  • Emergency Medicine
  • Internal Medicine and Patient care
Location: Rome, Italy
Location: Rome, Italy
Location: Rome, Italy

Biography

Dr Ivan Jeremic has completed his research master's degree in rheumatology from Belgrade School of Medicine and Clinical medicine PhD candidate at Novi Sad University. 

Abstract

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe, potentially life-threatening idiosyncratic drug reaction, usually caused by antiepileptics, antibiotics or nonsteroidal anti-inflammatory drugs, after a latency period of three weeks to three months. Typical clinical features include mucocutaneous rash, fever, lymphadenopathy and internal organ involvement. We report a patient with systemic sclerosis, rheumatoid arthritis and osteoporosis, who developed possible DRESS syndrome to lamotrigine, used to treat epilepsy. Clinical features suggesting DRESS syndrome included severe rash, fever, lymphocytopenia and thrombocytopenia. The condition was initially unsuccessfully treated as an acute allergic reaction to ibandronate with parenteral glucocorticosteroid and antihistamine. This report aims to increase the awareness of this rare entity in the rheumatology community.

Location: Rome, Italy

Biography

Ryan Duffy has completed his Bachelors in Science from Appalachian State University. He is currently a fourth year medical student at Virginia Tech Carilion School of Medicine, a research intensive medical school in Roanoke, Virginia.  After obtaining his MD in May, he will begin his residency training in Internal Medicine in June 2019.

Abstract

Patients with sepsis often require large volumes of intravenous fluids during resuscitation.  Historically, normal saline (NS) has been the default fluid for these patients.  However, the composition of NS does not reflect physiologic concentrations of electrolytes and recent studies have associated NS administration with increased risk of hyperchloremic metabolic acidosis and kidney injury.  In 2015, our institution’s Emergency Department (ED) began using normosol, a more balanced crystalloid, as their default resuscitation fluid. We performed a retrospective before-and-after cohort study of all patients admitted through our facility’s ED with a diagnosis of sepsis, severe sepsis, or septic shock during two 6-month periods, when either NS or normosol was used as the default resuscitation fluid. Regression modelling controlling for baseline characteristics and 24-h fluid intake volume found no differences between groups for the primary outcomes of acute kidney injury (P = 0.99) and renal replacement therapy (P = 0.88). Patients in the NormosolTM-R cohort were found to have a lower rate of hyperchloremia at 72 h postadmission (28% vs. 13%, P<0.0001).

Location: Rome, Italy

Biography

Nikoletta Daoulari is a Internal Medicine Resident at General Hospital of RIO, University of Patras, Greece. Her research interestis Internal Medicine. She also worked as Assistant in Emergency Department at Hospital Brugmann Bruxelles.

 

 

Abstract

Background: Deficiency of vitamin B12 (cobalamin) is a well-known cause of megaloblastic anemia. It is a reversible cause of bone marrow failure and demyelinating nervous system disorder, hence early detection and prompt treatment of vitamin B12 deficiency is essential. Documented symptomatic pancytopenia related to B12 deficiency is very rare representing less than 5% cases making the diagnosis in Emergency Department more challenging.

Clinical case: A 52-year -old woman with a history of Graves Basedow disease is sent by her generalist to the emergency department to be transfused for severe anemia found in blood test without any other information. She complaints of extreme tiredness and dyspnea at the least effort aggravated this past week without signs of melena or hematemesis. She describes having lost 13 kilos in a 3-month period and loss of appetite. No chest pain but sometimes palpitations. She has been put on propylthiouracil stopped 2 months ago. No others medications, no drugs but consummation of alcohol 2-3 glasses per day the last 25 years. In physical examination she is pale and icteric but the rest is normal. She has no fever and her electrocardiography reveals sinus rhythm without evidence of myocardial ischemia.

Laboratory testing reveals a profound pancytopenia with severe macrocytosis, no blasts, LDH  4860 UI/L and indirect bilirubin 1,6 mg/dL. The rest was normal.

Further workup for the cause of pancytopenia revealed non-measurable levels of B12 and folic acid. Direct Coombs was negative

Treatment with intramuscular injection of B12 and folic acid pos was started and control with abdominal scanning and gastroscopy were scheduled during hospitalization to investigate the cause of B12 deficiency

After one week of treatment laboratory testing control shows retreat of pancytopenia

Conclusions: Vitamin B12 deficiency is a rare condition and the presentation with severe pancytopenia is challenging for the emergency physicians. Prompt treatment in emergency department without waiting the results of levels of B12 must be considered to avoid deterioration of neurological condition with serious consequences for the quality of patient’s life.

 

Location: Rome, Italy

Biography

Leanne Price currently works for the Acute Hospital At Home(AHAH) department at Dorset County Hospital.

C Wilson completed his Under Graduate Medical Degree from Bristol Univeristy in 2017. He currently works for the Acute Hospital At Home (AHAH) department at Dorset County Hospital

Abstract

The National Diabetes Foot Care Audit (NDFA) estimates that the cost of diabetic foot disease to the NHS in England is £1 billion per annum.1 Our service manages patients with diabetic foot ulcers in the community. This should result in financial gains and improved patient outcomes whilst in accordance with the national objective2 of managing patients in the community.

Our ‘Acute Hospital at Home’ (AHAH) service is run by a multidisciplinary team including Medical Consultants, Junior Doctors,  Microbiologists, Nurses, Physiotherapists and Healthcare assistants. A virtual ward round occurs daily in addition to a flexible ability to review patients either in hospital or at home.

We have performed a retrospective analysis from a snapshot of 20 patients to provide initial data, and are currently analysing an increased cohort of patients in this study. The primary clinical outcomes include length of hospital admission, amputation rates, readmission, patient satisfaction and potential cost implications.

The snapshot study showed patients managed through AHAH had shorter length of inpatient stays: 4 days compared to 15. This results in a saving of £1980 per patient per admission. We are confident our larger study will continue to prove equivalence in rates of amputations, readmissions and death.

To date, our results demonstrate clear benefits of managing patients with diabetic foot ulcers in the community. Not only clear cost advantages but also significantly improved patient satisfaction3. We believe that the AHAH service is a safe and hugely valuable clinical service which could be widely applied across healthcare.

Biography

Efstathios Koutsostathis has completed his PhD in Medicine from the Natonal and Kapodostrian University of Athens. He has completed his education in internal medicine at Attikon University Hospital. He is an internist, consultant at Kerameikos Health Center. He is Professor at the Kifissia and Ag. Demetrios public institutes of paramedic professions. He is also a post graduate student at the medical school of Athens in the field of Metabolic Bone diseases and in Public Health at the Natonal School of Public Health. He has published papers in medical journals.

Abstract

Efstathios Konstantinou Koutsostathis, Internist-Kerameikos Health Center

Post graduate student :’’Metabolic bone diseases’’National and Kapodistrian university of Athens’’, Greece

 

Gaucher disease, the most common of the lysosomal storage diseases, is classified in ‘’orphan diseases’’, that comprise rare disorders with prevalence of 1:50000 or lower in the general population. Gaucher disease results from mutations leading to impaired enzymatic activity of a lysosomal hydrolase called β-glucocerebrosidase and thus to the accumulation of glucocerebrosides in the lysosomes of the macrophages. This has as a result cytopenias due to hypersplenism and infiltration of bone marrow by Gaucher cells. Disease severity varies greatly from the invariably mortal infantile type 2 and the completely asymptomatic type 1. Clinical manifestations include splenomegaly, hepatomegaly and growth retardation.There are three types of Gaucher disease, type 1, 2 and 3. Type 1 accounts for the 95% of cases in patients of Caucasian origin. Also, the ‘’activated macrophages’’ excrete cytokines that affect the bones. Osteopenia, osteoporosis, painful bone crises, pathologic fractures, osteonecrosis may occur. In general, skeletal involvement is considered a sign of grave prognosis since it can lead to serious complications with elevated morbidity and mortality. There is significant consideration that disease clinical phenotype should be considered as a continuum and not as discrete clinical subtypes. Early diagnosis of the disease is crucial since most patients have significant splachnic involvement at the time of diagnosis (in types 1 and 3). The major diagnostic criterion is reduced enzymatic activity of β-glucocerebrosidase. Chitotriosidase levels and Chemokine CC (CCL18/PARC) are also measured. Therapy consists of β-glucocerebrosidase substitution and substrate reduction therapy.

 

Biography

Dr. Liakou has completed her MD, PhD degree from the University of Athens Greece. She completed her post-doctoral fellowship at University of Texas and medical residency at the University of Kentucky. She is certified in Evidence-Based Project Management from the Australian National University. She has published more than 10 papers in reputed journals and has been serving as an editorial board member of repute journals. She is the Scientific Director of LK Medical.

 

Abstract

A 27 year old female with not significant past medical history had a behind the ear swollen, painful lymph node for the duration of two months. She was initially treated with antibiotics for otitis or other non specific ear inflammation without any improvement. She continue to have symptoms and lymphadenopathy and she was hospitalized for further investigation. Imaging studies, infectious disease work-up and hematological work-up did not show anything specific. A lymph node biopsy was performed which showed Kibuchi lymphadenopathy.