Day 2 :
Keynote Forum
Hatem H. AlMasri
King Abdulaziz Medical City, Saudi Arabia
Keynote: The outcomes of atrial fibrillation (AF) between Cut and Sew Technique for the Cox-maze Procedure & Comparison with Bipolar Radiofrequency Ablation
Time : 10:00-10:45
Biography:
Al-Masri H Hatem is a cardiac critical care intensivist and consultant of cardiac surgery. He completed his medical degree (MD-Doktorate) at Charles University – Faculty of Medicine and holds a degree in Biochemistry from the University of Waterloo – Canada. He completed his residency training in Germany (Leading Facharzt) and holds training fellowships in Cardiac Surgery from IJN KL Malaysia, Switzerland and Canada. He is the author of an award-wining medical research paper titled “Hemodynamic Support Requires Integrated Approach Comparing pl.VAD vs. IABP in Patients Experiencing Left Ventricular Failure” (Best Paper of Young Cardiac Surgeon) at the 8th International Congress of Update in Cardiology and Cardiovascular Surgery (UCCVS 2012) awarded by European Society for Cardiovascular Surgery, World Society of Arrhythmias (WSA) and the Society of Cardiology and the International Academic of Vascular and Endovascular Surgery (ISCP). He is a member of the Medical German Association, Malaysian Medical Association and the Saudi Medical Council.
Abstract:
Background: Persistent atrial fibrillation leaves patients symptomatic and at increased risk of thromboembolism even after otherwise successful cardiac surgery. Majority of the patients who present to us have organic cardiac disorders predisposing to AF, surgery for the underlying lesions alone usually fails to abolish AF, leaving patients symptomatic and at an increased risk of thromboembolism. Effective treatment procedure surgically of atrial fibrillation is cut-and-sew Cox maze procedure which is widely established. The clinical experience using alternate energy sources is with radio-frequency ablation, which uses alternating current to transfer energy to atrial tissue. Success of this technology has led surgeons to apply RF directly to the heart during cardiac surgery. The effectiveness of RF compared with the standard CS maze procedure is not known .We evaluate the impact of radiofrequency ablation technology by direct comparison with the CS technique
Methods: To treat AF secondary to cardiac lesions requiring surgery, we combined a full Cox-maze using RFA procedure in 184 patients simultaneously undergoing valvular procedures (87), repair of congenital anomalies (12), and other procedures (2), including 24 repeat operations between 2012 and 2016. Matched variables were gender, age, New York Heart Association (NYHA) class, AF type, and concomitant mitral valve. Additional variables potentially affecting out-come, including hypertension (RF vs CS) left atrial size, and preoperative duration of AF were similar between groups.
Results: Procedures performed simultaneously with the maze operation were relevant to the diagnoses. Mean aortic crossclamp time varied from 64 to 235 minutes, with bypass time ranging from 91 to 297 minutes. There were three early deaths (2%), no late deaths, and one episode of transient neurological ischemic attack in follow-up ranging from 1 to 4 years, for a total of 184 patients. Postoperative AF disappeared in 110 patients, rhythms were sinus in 95 patients (80%), junctional in 15 (7%), and persistent AF in 15 (14%), each of whom had mitral valve disease. Three patients (2%) who had never been defibrillated. Patients with other underlying pathology had complete recovery of atrial rhythm. After discharge, patients were followed monthly for adjustment of medication, rhythm, signs of myocardial ischemia, and control of anticoagulation. Doppler echocardiography and chest radiography were scheduled for 1, 3, 6, and 12 months after surgery. Among 36 patients without mechanical valves, 45 (85%) with atrial rhythm and contraction have been taken off anticoagulation therapy or electrocardioversion, including 12 who are free of all medication, leaving 20 patients with persistent AF. Rhythms after the combined procedures were sinus, persistent AF or atrial flutter , and the junctional who eventually required atrial pacemaker implantation. Anticoagulation was discontinued only in patients with atrial rhythm and documented contraction 3 to 6 months after reparative surgery. Antiarrhythmics were tapered after anticoagulation was discontinued or after cardiac rhythm was considered stable.
Conclusions: The standard cut and sew Cox-maze procedure remains the gold standard for the surgical treatment of AF. The results suggest that the combined approach is safe, effective, and indicated in patients who are judged capable of tolerating the procedure and likely to regain atrial rhythm .the risk of death, cerebrovascular events, and reoperation for bleeding. Superiority of cut-and-sew technique for the Cox maze procedure in reducing the prevalence of atrial flutter during follow-up, but bipolar RF shortens the aortic cross-clamping time and cardiopulmonary bypass time, and decreases the risk of permanent pacemaker implantation.
Keynote Forum
Azzam A. Maghazachi
University of Sharjah, UAE
Keynote: Updates on Cancer Immunotherapy with Emphasis on Innate Immune Cells
Biography:
Azzam A Maghazachi received a master degree from NYU Medical School and a PhD degree in Immunology from the University of Manitoba/Canada in 1984. Between 1988-2005, he held several senior positions at various institutes and universities in the USA, Canada and Norway. In 2005, he was the director of research at Bio-Quant, Inc. in San Diego, and between 2007-2015 he was a professor of Physiology in the faculty of Medicine at the University of Oslo. Currently, he is a professor at the College of Medicine, University of Sharjah. He published more than 100 papers and book chapters and is an editor or editor-in-chief on more than 15 medical journals.
Abstract:
Cancer immunotherapy protocols represent the most novel exciting therapeutic modality for treating cancer. This is evident in the recent attention paid to checkpoint inhibitors for treating melanomas as well as other forms of cancer. Natural killer (NK) cells stand at the cross road among treatment of autoimmune diseases and immunodeficient diseases. We reported a new mechanism of action for the drug Copaxone (glatiramer acetate or GA; TEVA Inc.). NK cells isolated from patients dosed with GA lysed dendritic cells isolated from the same patients as well killing tumor target cells. Similarly, vitamin D3 or FTY720 (Gilenya; Novartis) augmented IL-2-activated NK cells lysis of tumor cells. Dimethyl fumarate (DMF; Biogen Inc.) is a new drug for treating multiple sclerosis patients. We have examined the effects of DMF and the metabolite monomethyl fumarate (MMF) on various activities of NK cells. We demonstrated that MMF induces resting CD56+ NK cell lysis of the NK-sensitive K562 cells and the NK-resistant RAJI cells. More recently, we observed that GA, MMF and DMF up-regulate the expression of CCR10 on the surface of activated NK cells. This is corroborated with the ability of NK cells to migrate towards the concentration gradients of CCR10 ligands, namely CCL27 and CCL28. These observations are the first to show that drugs used to treat autoimmune diseases can be used to direct the anti-tumor effector cells towards the sites of tumor growth, particularly those secreting the chemokine CCL27 such as melanomas or squamous cell carcinoma, or those secreting CCL28 such as colorectal carcinoma. Hence, drugs used to treat autoimmune diseases can be used to harness NK cells for the purpose of using them in cancer immunotherapy.
- Case Report on Respiratory and Cardiac Diseases | Chest Infections
Location: Boardroom 350
Chair
Azzam A. Maghazachi
University of Sharjah, UAE
Session Introduction
Mazen Abdulrahman Elyahia
King Fahad Specialist Hospital ,KSA
Title: A case of Mesenteric Vasculitis
Biography:
Mazen ElYahia medical Intern was born in Alkhobar on November, 15th 1992. Member in Saudi Diabetes And Endocrine Association (SDEA) Since 2015. Member in Sanad Children’s Cancer Support Association Since 2014. has participated and organized several events and campaigns as the annual pre-conference public education activity “Neurosurgery public Awareness Campaign” , “Save a Life” section at the annual Scitech Emergency Medicine Exhibit, 7th and 8th medical career day. Currently work on several researches as cardiovascular response to aerobic exercises in children with type one diabetes mellitus and functional barriers experienced by patients after long- term clubfoot surgery.
Abstract:
Vasculitis is an inflammatory disorder of blood vessels, can affect vessels of any type in any organ. Gastrointestinal (GI) manifestations of vasculitis are considered rare and the presentation is often nonspecific ranging from gastrointestinal dysfunction such as motility disorders to ischemia that may result in ulceration and perforation. GI involvement is frequent in polyarteritis nodosa (PAN), Henoch-Schönlein purpura and also often noted in microscopic polyangitis and Takayasu arteritis. The diagnosis and classification of vasculitis depends on a combination of clinical, serological, radiological and histological findings. In this report we describe a new case of localized vasculitis of the gastrointestinal tract involving the celiac trunk.
Khalid Al Ansari
Hamad Medical Corporation, Qatar
Title: Bronchiolitis: Different Practices, but Does it really Work
Biography:
Khalid Al Ansari has done his MBBS from King Faisal University, KSA in 1997 and has completed his Residency and Fellowship training from the Hospital for Sick Children, Toronto. He is an AAP at Royal College of Physician and Surgeon of Canada certified in General Pediatrics and Pediatric Emergency. He has completed his Master of Health Care Management from Royal College of Surgeon Ireland in 2014. He is the Medical Director of a well-renowned Pediatric Emergency Services in Qatar, a Division Chief of Emergency Medicine in Sidra Medical and Research Center Doha, Qatar and an Associate Professor at Weill Cornell Medical College, Qatar. He is actively involved in research studies and has published various international publications.
Abstract:
Bronchiolitis is the most common serious lower respiratory tract illness in young infants affecting mainly children between 2 and 5 months of age. It is also a common cause for admission to inpatient especially in infants less than 6 months of age. After decades of research, the recommended treatment remains supportive care. Different practices and many pharmaceutical have been studied with different outcomes. In this presentation, I will talk about the significance of this disease, health impact, and will discuss different tested modalities of treatment and the evidence to support or discourage their use.
Souheil Hallit
Lebanese University, Lebanon
Title: Exposure in utero and early infancy to toxic substances and association with asthma in Lebanese children: A case-control study
Biography:
Souheil Hallit has a Doctor of Pharmacy, Masters in Pharmacology and Therapeutics, Masters in research in Clinical Pharmacy and Pharmaco-epidemiology. He is currently a PhD candidate in Public Health and Epidemiology in Bordeaux Segalen University, France. American Board certified in 2 states (Florida and New Jersey). Part-time faculty member in Holy Spirit University Kaslik (USEK), (Saint Joseph University (USJ) and Lebanese University. Teaches didactic and experiential courses. His main research interests focus on asthma, allergic and atopic diseases in children, along with medical epidemiology, clinical pharmacy and public health researches.
Abstract:
Introduction & objective: Environmental factors, pesticides, detergent use, drug intake, alcohol and smoking are linked to asthma in children. While we know that these exposures are common during pregnancy, and subsequently during young childhood, the association of toxic substances exposure with asthma has not been evaluated. Our objective is to assess such associations among children in Lebanon.
Methods: This is a case-control study, conducted between December 2015 and April 2016, using a sample of Lebanese students from private schools from all districts of Lebanon. Cases were chosen from a specialized asthma center in Lebanon. 1503 questionnaires out of 1680 (89.46%) were returned to us. Verbal informed consent was also obtained from all parents prior to participating in the study.
Results: The fact that the child lives with a person who works with pesticides or in an area with frequent use of pesticides during childhood increased the risk of asthma significantly by 50% (ORa=0.5; CI 3.37-7.44; p=0.001) and more than 3 times (ORa=3.307, CI 1.848-5.918, p<0.001), respectively. Smoking waterpipe by the mother during pregnancy would increase the risk of asthma in children 6 times (ORa=6.11; CI 1244-30008; p=0.026), while cigarette smoking by the mother during lactationwould increase that risk by more than 3 times (ORa=3.44; CI 1024-11554; p=0.046).
Conclusion: Asthma seems to be affected by several risk factors in our population of Lebanese school children across Lebanon. Spreading awareness by health professionals about these preventable environmental factors can help educate the parents and children to prevent asthma and its exacerbation.
Biography:
Khalil Diab has his expertise in the diagnosis and management of COPD, Alpha 1 antitrypsin deficiency and lung cancer with a special focus on interventional pulmonology. He is the director of the only alpha 1 clinical resource center in Indiana and is conducting several clinical trials on COPD and Alpha 1 antitrypsin deficiency.
Abstract:
Statement of the Problem: COPD is expected to be the third leading cause of death worldwide in 2020. The direct and indirect costs of COPD were 49.9 billion dollars in the United States in 2010. During the past decade in the United States, 1 in 5 hospital admissions over the age of 40 had a diagnosis of COPD with a 30-day readmission rate of 21%. As of October 2014, hospitals in the U.S. could receive a 1% payment reduction for high risk-adjusted readmissions. We will discuss the risk factors for COPD readmissions and ways to decrease them. Methodology & Theoretical Orientation: We herein will review and summarize the current literature pertaining to reduction of COPD readmissions, including COPD self-management, pulmonary rehabilitation, and integrated management. Findings: COPD self-management decreases respiratory-related and all-cause hospital readmissions significantly (OR 0.57 and 0.60 respectively), and is associated with a significant improvement in quality of life measures. Pulmonary rehabilitation after a COPD-related hospital admission leads to decreased all-cause hospital readmissions (OR 0.08-0.71). It is also associated with improvements in mortality and six-minute walk distance. Integrated management leads to a significant decrease in respiratory-related hospital readmissions at 3-12 months with an OR of 0.68, and decreases hospital days by 3.78 days over 3-12 months. Conclusion & Significance: COPD is one of the leading causes of death worldwide with a very high burden on society, and a high rate of hospital admissions. Decreasing readmissions is important for both patients and society. Predicting the types of patients to be readmitted remains difficulty. COPD selfmanagement, post exacerbation pulmonary rehabilitation, and integrated disease management are promising interventions which could lead to decreased readmissions and improvement in quality of life.
Yazan Chaikh
University of Sharjah, UAE
Title: The prevalence of snoring and its risk factors in adults in the UAE
Biography:
Yazan Chaikh is the medical student born on October, 14th 1995. He completed his high school in the Helwan Secondary School Sharjah, UAE and started his medical studies in the University of Sharjah.
Abstract:
Snoring is increasingly being recognized as a public health concern with serious health consequences, but little information regarding its specific risk factors is known. Our main objective was to determine the prevalence of snoring among adults (20-60 years) in Sharjah and assess the major risk factors as well as the general knowledge among the population. A selfadministrated questionnaire that included both the Berlin and Epworth scales was given to a randomly selected population in Sharjah between the ages of 20-60 years. Data was analyzed using SPSS 22.0. 34.2% (n=139) of our population was reported to be as snorers, 45.5% (n=185) were non-snorers and 20.4% (n=83) didn’t know whether they snored or not. 43.2% of snorers were at high risk for sleep apnea based on the berlin questionnaire. Gender (P=0.038) was also significantly associated with snoring as 40.8% of males were reported as snorers while only 28.7% of the females were reported as snorers. The elderly (50-60 years) were at a higher risk than the younger ages as well as obese people (BMI>30) in which, 46.8% (n=49) of them reported snoring. Those who scored higher on the Epworth scale were more likely to be snorers (P=0.001) and were likely to fall into the high risk category in the Berlin (p=0.035). In addition, smokers, chronic conditions like nasal septal deviation (15.1% (n=61)), hypertension (n=31) and diabetes (4% (n=16)) were also the risk factors. Prevalence and major risk factors within the UAE are similar to that in other countries. Campaigns should be held to raise awareness about habitual snoring and its risk factors.
Mustafa Osama
University of Sharjah, UAE
Title: Awareness and knowledge of heart attacks among adults in the UAE
Biography:
My name is Mustafa Usama Mahmoud. I am a 3rd year medical student at University of Sharjah, college of medicine. I am 20 years, from Egypt. We aimed in our study to assess the knowledge of heat attacks in the UAE which is very crucial especially with the increased incidence in the population. The participants’ knowledge was assessed through multiple sections, including the definition, signs and symptoms, complications and preventative measures against heart attacks
Abstract:
Background: With one in every four cardiovascular disease related death in the UAE attributed to heart attacks, this study aims to determine the current level of awareness of heart attacks among adults in the UAE. In doing so, economical, medical and voluntary resources may be utilized more effectively in creating beneficial educational programs/facilities that specifically target the knowledge gaps and misconceptions among the UAE population.
Methods: A cross sectional study was conducted on a total of 403 participants aged 20-60 years old using self-administered questionnaires. All health professionals were excluded. The questionnaires were distributed at various locations within Sharjah. Collected data was then analyzed and interpreted using the SPSS program.
Results: Out of the 403 individuals who participated in this research, 57.6% of the respondents were female and 42.4% were male, 49.9% of which were below the age of 30, 34.7% of which were between the ages of 30-40 and 15.4% of which were above the age of 40. No significant correlation was found between the knowledge of heart attack and the following variables: age, gender, suffering from chronic diseases and educational level (p> 0.05). While people with previous heart attack experience were found to be more knowledgeable about all aspects of heart attack (35.7%), (p=0.001).Out of all the signs & symptoms listed, chest pain and shortness of breath were the most identified with 76% & 67.5% participants identifying them respectively. As for risk factors, the most identifiable were high blood pressure (86.6%), stress (81%) and smoking (80%). In general, reducing fat consumption (88.4%) was the most practiced preventative measure, while smoking cessation (78.9%) was the most practiced measure for the purpose of preventing heart attacks (63.1%). The targeted population’s knowledge was mostly attributed to the Internet (34%). On assessing total level of knowledge, 46.8% of the targeted population scored above 15 out 28 from the total knowledge score, and only 6.7% scored above 20.
Conclusion: The study indicates the dire need for further heart attack awareness among the UAE population, possibly by utilizing different platforms (i.e. cyber campaigns, community fundraisers, marathons, etc.).
Hadeel Awad
University of Sharjah, UAE
Title: Common Aeroallergens and Food allergens Seen among Allergic Children
Biography:
I am a Pediatrician with interests in allergy and asthma. I’m currently working at University Hospital Sharjah, running an allergy clinic dealing with allergic rhinitis, asthma, eczema and food allergy performing skin prick tests, spirometry lung function. I developed local effective clinical pathways for the management of asthma, eczema, food allergy, I believe in patient participation in their care.
Abstract:
Statement of the Problem: Allergy is an immunological hypersensitivity to various proteins (allergens) that can lead to a variety of different disease via different pathomechanisim and thus different approaches in diagnosis and therapy and prevention. For the confirmation of the presence of allergy, the most common diagnostic procedures available are the IgE specific test, food challenge test, and skin prick test (SPT) which are done according to the history of food or aeroallergen sensitivity. The purpose of this study is was to evaluate the prevalence of positive SPT to various aeroallergen and food allergens in children with allergic diseases in Sharjah. Methodology & Theoretical Orientation: The study design was retrospective crosssectional. Data was collected from the results of 206 patients that have undergone SPT during 2013 through 2015 in the allergy clinic at the University Hospital of Sharjah. SPT were performed with 15 aeroallergens selected based on the most common identifiable allergens in the region, and 27 individual food allergens according to patient history. A mean wheal diameter of at least 3mm greater than the negative control was taken as positive. Analysis was conducted via SPSS version 22. Findings: The most prevalent indoor aeroallergens were Dermatophagoides farinae (37.04%), Dermatophagoides pteronyssinus (36.51%), cat fur (32.25%), feather mix (31.68%) and the least common was cockroach (15.84%). Russian thistle (32.25%) was the commonest out door allergen followed by chenopodiacees (26.73%), alternaria (25.93%). Conclusion & Significance: The most common aeroallergens identified based on SPT in the allergy clinic in the University Hospital of Sharjah, was house dust mites in all allergic diseases followed by molds, which corresponds with the results of similar studies conducted in our region. Most common Food allergen was peanut, egg and then milk. Identifying allergens plays an important role in management, giving appropriate allergen avoidance, and possible immunotherapy.