Conference Schedule

Day1: March 26, 2018

Keynote Forum

Biography

Areerat Suputtitada MD is a Professor of Rehabilitation Medicine from Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand. She is the Director of Excellent Center for Gait and Motion at King Chualongkorn Memorial Hospital and Chairperson of Neurorehabilitation Research Unit of Chulalongkorn University. She has been involved in education, residency training, research, and clinical treatment related to rehabilitation medicine for more than 20 years. She was invited as international speaker more than 80 times around the world. She received 18 national and international awards, and published more than 60 national and international articles in several areas of Rehabilitation Medicine including Neurological Rehabilitation, Spasticity and Dystonia, Pain, Gait and Motion, and Sport and Exercise Medicine. She has been elected and appointed to important positions in the ISPRM such as the Chairperson of ISPRM Women and Health Task Force and ISPRM International Exchange Committee.

Abstract

Rehabilitation management of musculoskeletal pain conditions are challenges. Most patients developed chronic pain conditions since inadequate management during acute pain phase. Currently, extracorporeal shock wave therapy (ESWT) and Class IV lasers or high-power laser therapy are novel therapy for these conditions. Interestingly that both therapies with different actions and mechanisms have same benefits on musculoskeletal pain conditions and considered as regenerative medicine therapies. The evidences of safety, efficacy and good patient compliance made both therapies to be increasing popular in the worldwide. ESWT has become one of the best investigated treatment modalities for various conditions of the musculoskeletal system such as myofascial pain syndrome, tendinopathies and osteoarthritis, etc. An optimum treatment protocol for ESWT appears to be three treatment sessions at one-week intervals, with 2000 impulses per session and the highest energy flux density that can be applied. The proposed mechanisms for the benefit of ESWT on musculoskeletal tissue include direct effects on tissue calcification, alteration of cell activity through cavitation, acoustic micro streaming, hyper vascularity and blood flow increment, alteration of cell membrane permeability and effects on nociceptors through hyper stimulation, blocking the gate control mechanism. Class IV lasers or high-power laser therapy offers better therapeutic outcome compared to Class III lasers as follows: (1) larger dosages of therapeutic energy. (2) deeper penetration into the body. (3) larger treatment surface area. This is important when treating large regions, such as the lumbar spine, quadriceps or hips. (4) greater power density. (5) continuous power supply. (6) superior fiber optic cables: Fiber optic cables transmit laser energy from the laser to the treatment probe (wand) at the end of the cable. The beneficial effects of ESWT and high-power laser therapy on musculoskeletal tissues are anti-Inflammation, analgesic, accelerated tissue repair and cell growth, improve vascular activity, release trigger points and desensitization, reduce fibrous tissue formation. In conclusion, ESWT has been proven for more than 20 years as effective and safe noninvasive treatment option for tendon and other pathologies of the musculoskeletal system in a multitude of high-quality RCTs. High power laser therapy is by far the most exciting new clinical treatment to advance physical medicine in the 21st century antiinflammatory and analgesic effects. It offers better therapeutic outcome compared to Class III lasers which has been used for a long period of time with little impressive outcome. High power laser therapy is newer therapy with increasing evidences.

Biography

Michael S. Bronze, M.D. was appointed Professor and Chairman, Department of Medicine, University of Oklahoma Health Sciences Center effective July 1, 2000. He was named the Stewart G. Wolf Professor in Internal Medicine in 2004 and David Ross Boyd Professor in 2011. He is board certified in Internal Medicine and Infectious Diseases. He completed his medical school training at the University of Tennessee, Memphis in 1982. His internship and residency were completed at the University of Tennessee, Memphis and served and additional year as Chief Medical Resident.

Abstract

Hepatitis C (HCV) is a global infection due to Hepacivirus, a member of the Flaviviridae family. Parenteral routes including blood transfusion, injecting drug 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 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 hostgenome. However, HCV does dysregulate cellular proliferation and differentiation pathways, creates chronic inflammation and inhibits tumor suppressor gene activity. Our laboratory hasfocused on two aspects of HCC carcinogenesis, namely cancer like stem cells and chronic inflammation. Hepatoma cells expressing a HCV subgenomic replicon express several cancers like stem cell markers, especially doublecortin-like kinase (DCLK1), 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 proinflammatory 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

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 implementa-tion 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 valuesthe 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 myocarditis. A lack of medical guidelines has been identified by the majority of responders asthe 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 sci-entific, clinical, social, and educational projectsin the area of PM to elicit the content of the new branch.

Abstract

Sergey Suchkov graduated from Astrakhan State Medical University and was awarded with MD and maintained his PhD and Doctor’s degree. He was working for Helmholtz Eye Research Institute and Moscow Regional Clinical Research Institute. He 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. Currently, he is a Director of Center for Personalized Medicine, Sechenov University; Chair of the Department for Translational Medicine, Moscow Engineering Physics University and Secretary General of United Cultural Convention, Cambridge, UK. He is a Member of the New York Academy of Sciences; American Chemical Society; American Heart Association; AMEE, Dundee, UK; EPMA, Brussels, EU; PMC, Washington, DC, USA and ISPM Tokyo, Japan.

Tracks

  • Internal Medicine and Patient Care | Primary Care | Intensive Care Medicine | Infectious Diseases | Emergency Medicine | Adult Diseases | Epidemiology | Geriatrics | Telemedicine | Sports Medicine | Fundamentals to Pain Management | Epidemiology and Classification | urrent Diagnosis and Scoring Systems | New Frontiers in Neuropathic Pain | Anesthesia as Pain Treatment | Current Therapies in Pain Management | Various Aspects of Opoids | Pain Medications
Location:
Speaker

William Rowe,

Medical University of Ohio, USA

Chair

Speaker

Sergey Suchkov,

I M Sechenov First Moscow State Medical University, Russia

Co Chair

Biography

Areerat Suputtitada MD is a Professor of Rehabilitation Medicine from Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand. She is the Director of Excellent Center for Gait and Motion at King Chualongkorn Memorial Hospital and Chairperson of Neurorehabilitation Research Unit of Chulalongkorn University. She has been involved in education, residency training, research, and clinical treatment related to rehabilitation medicine for more than 20 years. She was invited as international speaker more than 80 times around the world. She received 18 national and international awards, and published more than 60 national and international articles in several areas of Rehabilitation Medicine including Neurological Rehabilitation, Spasticity and Dystonia, Pain, Gait and Motion, and Sport and Exercise Medicine. She has been elected and appointed to important positions in the ISPRM such as the Chairperson of ISPRM Women and Health Task Force and ISPRM International Exchange Committee.

Abstract

Rehabilitation management of musculoskeletal pain conditions are challenges. Most atients developed chronic pain conditions since inadequate management during acute pain phase. Currently, extracorporeal shock wave therapy (ESWT) and Class IV lasers or high-power laser therapy are novel therapy for these conditions. Interestingly that both therapieswith different actions and mechanisms have same benefits on musculoskeletal pain conditions and considered as regenerative medicine therapies. The evidences of safety, efficacy and good patient compliance made both therapies to be increasing popular in the worldwide. ESWT has become one of the best investigated treatment modalities for various conditions of the musculoskeletal system such as myofascial pain syndrome,tendinopathies and osteoarthritis, etc. An optimum treatment protocol for ESWT appears to be three treatment sessions at one-week intervals, with 2000 impulses per session and the highest energy flux density that can be applied. The proposed mechanisms for the benefit of ESWT on musculoskeletal tissue include direct effects on tissue calcification, alteration of cell activity through cavitation, acoustic micro streaming, hyper vascularity and blood flow increment, alteration of cell membrane permeability and effects on nociceptors through hyper stimulation, blocking the gate control mechanism. Class IV lasers or high-power laser therapy offers better therapeutic outcome compared to Class III lasers as follows: (1) larger dosages of therapeutic energy. (2) deeper penetration into the body. (3) larger treatment surface area. This is important when treating large regions, such as the lumbar spine, quadriceps or hips. (4) greater power density. (5) continuous power supply. (6) superior fiber optic cables: Fiber optic cables transmit laser energy from the laser to the treatment probe (wand) at the endof the cable. The beneficial effects of ESWT and high-power laser therapy on musculoskeletal tissues are anti-Inflammation,analgesic, accelerated tissue repair and cell growth, improve vascular activity, release trigger points and desensitization, reduce fibrous tissue formation. In conclusion, ESWT has been proven for more than 20 years as effective and safe noninvasive treatment option for tendon and other pathologies of the musculoskeletal system in a multitude of high-quality RCTs.High power laser therapy is by far the most exciting new clinical treatment to advance physical medicine in the 21st century antiinflammatory and analgesic effects. It offers better therapeutic outcome compared to Class III lasers which has been used for a long period of time with little impressive outcome. High power laser therapy is newer therapy with increasing evidences.

Biography

Prof. Gao Xinyan has completed her PhD from China Academy of ChineseMedical Sciences (CACMS), and postdoctoral studies from Baptist University of Hongkong 2009 and Medical University of Graz 2011. She is the director of Department of Physiology, Institute of Acupuncture. She has published more than 30 papers in reputed journals and has been serving as an editorial board for several peer reviewed journals. Her research has been supported by National Natural Scientific Foundation of China for 4 times.

Abstract

Pain relief is a puzzle. Though no possible single theory can clarify the mechanism for acupuncture analgesia, acupuncture analgesia is the most acceptant treatment field clinically and basically. In recent years, we have studied the effect of acupuncture on inhibition of C-fiber reflex or RIIIreflex as a quantitative sensory test for acute pain or chronic pain to investigate the mechanism of acupuncture analgesia. Based on this methodology, we investigated homotopic and heterotopic acupuncture mediated by gate of spinal level and diffuse noxious inhibitory controls (DNIC) of supraspinal level.Additionally, we studied influential factors as caffeine and adenosine system and mechanism of glia-mast cell crosstalk on acupuncture analgesia. Our research demonstrated acupuncture is characterized by irreplaceable advantages but with limitationson pain management.

Biography

F Cal Robinson is a Medical Psychologist with an extensive career in pain management and pain medicine. His early private practice in Indiana, USA centered on the assessment and treatment of behavioral medicine disorders. In addition, he was Clinical Director and Co-owner of the Spine & Rehabilitation Institute. He was recruited in 2001 to the Elliot Health System and hospital in Manchester, New Hampshire as clinical director of their interdisciplinary pain program. He led the organization to obtain full accreditation with accommodation from CARF, the Commission on Accreditation of Rehabilitation Facilities for the Interdisciplinary Pain Program. While in New England, he was active in the New England Pain Association (NEPA) the regional affiliate society of the American Pain Society. He became the state representative for New Hampshire, then Vice-President and eventually President of NEPA for the 2005-2006 year. During that time frame, he wasalso the President of the state pain initiative representing New Hampshire, funded by the American Cancer Society.He was recruited in 2006 to the Marshfield Clinic in Wisconsin as pain psychologist for the western division. He accepted a one-year contract with the Department of Defense at Elmendorf Hospital in Anchorage, Alaska as the Behavioral Health Consultant in 2010. He was subsequently recruited to become the director of  hronic Pain and Addiction at the Yale affiliated psychiatric hospital, Silver Hill Hospital, inConnecticut. Seeing the opportunity to be closer to his daughter and grandchildren who lived in Oakdale, Minnesota, he rejoined the pain management program at Marshfield Clinic in 2011 as pain psychologist for the western division.His most recent publication was feature article for the Carlat Psychiatry Report (November 2012), “Chronic Pain, Comorbidity and Treatment Complexity.” His clinical interests center on the theory and practice of Acceptance and Commitment Therapy (ACT) especially for chronic pain, suffering, abuse and affective disorders. He is Board-Certified in Medical Psychology from the American Board of Medical Psychology.Join Dr. Robinson for one

Abstract

The Institute of Medicine’s report on relieving pain in American has guided pain assessment and treatment in profound ways. It is also attempting to provide guidance regarding the importance of multidisciplinary pain care, recognizing the primary focus of pain relief from biomedical interventions have left much of the population without improved skill at managing pain sensation. The historical shift that emerged a generation ago moved pain management from a joint involvement with the patient as participant to the patient as recipient of care, to physician as primary care provider and responsible pain control manager. This of course was further reinforced by the multiple pain medications developed and marketed to alleviate pain, reduce pain intensity and design a chronic pain cohort dependent on opioid therapy as their life tool. The evidence of a failed trajectory is obvious, and much back pedaling is required in order to more effectively assist patients with skills and tools designed to assist them on their path. Responsible and ethical physicians or pain management providers are not basing care on the primary goal of pain reduction. This year has redefined pain management care in the United States and many laws now restrict the liberal availability of opioid analgesics, although the conditioning that took place over the past twenty years is now having to be addressed. As the pendulum shifts towards patients confronting the unreasonable if unattainable desires of total pain relief, the culture is also recognizing that being dependent on ineffective opioid analgesia presents with costly social risks. Additionally, for many patients with neuropathicpain complaints, opioid analgesia is not recommended. The realization that offering pain medication as primary pain treatment response, is being challenged. I would like toacknowledge the barriers that interfere with offering cognitive behavioral interventions as first line interventions, and the attitudes, practices and professional responsibilities that are necessary for integrating such options.

Biography

Dominique Batifol has completed her PhD and Profersor University Hospital of Montpellier, France. She is currently working in the Maxillo-Facial SurgeryDepartment in the University Hospital of Montpellier. She has published 15 papers in reputed journals, has written a book in french  “injections in temporo-mandibular disorders’’ (EUE) and has presented 2 books in the english language.

Abstract

To describe the treatment by botulinum toxin type A (BoNTA) for seven painful pathologies of head and neck: cervical neuralgia, trigeminal neuralgia, migraine headache, articular pain, hypertrophic scars pain and inflammation, postoperative muscular pain of the cervical spine and muscle pain due to stiffness of the cervical spine following hypertonia and hyperactivity of the manducatory muscles. BoNTA has been used for forty years by its action on muscles. During the last decade new indications have been added, following the proof of the effect of the BT on numerous neurotransmitters. Technically, we inject into the muscles to relax them, into the keloid scars or immediately around to stop the inflammation, to relieve pain, we simply follow it, by topping of the skin, the scalp or the oral mucosa, depending on the pathology and the painful zone. For the temporo-mandibular joint, the injection is directly placed in the articulation. The toxin is very efficient on paroxysmal pain and for all these indications, we note a real decrease of the VAS (Visual Analogue Scale) score. For some indications, the dosage can be high, but there are no side effects or very limited. Except migraine headache, the other indications are new and there are not so many teams doing it.

Biography

Tara 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-inducedosteoporosis (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 with current 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

Robert Julius Almasi is from University of Pecs Medical School, Hungary.

Abstract

The brachial plexus blockade with ultrasound guidance became popular for upper limb surgery. Peripheral nerve blockade (PNB) avoids complications of general anaesthesia, provides better postoperative analgesia, and lowers the risk of local anaesthetic systemic toxicity. The quality of ultrasound guide (UG) PNB can be characterized by many factors. The evaluation of the onset of sensory and motor blockade sometimes challenging. Even if the naesthesiologist defined the complete onset of sensory blockade the patient can feel some disturbing sensation during surgery. The evaluation of the quality of the blockade alone doesn’t assess the whole intraoperative condition of the patient. To the best of our knowledge there is no any simplified tool for the assessment of the quality of UG PNB from the aspect of sensory, motor, coping and postoperative pain. An easy-to-use, GCS (Glasglow Coma Scale)-like scale was developed and tested in our clinic. Ninetyfive patients, ASA (American Society for Anaesthesiologist) I-III were scheduled for unilateral upper extremity surgery using standardized UG PNB anaesthesia. Patients were randomized into 3 groups (G1 lidocaine; G2 bupivacaine; G3 bupivacaine+ lidocaine) with standardized dose of 0.4 ml/kg BW, and 30 ml maximal volume. The sensory motor, coping of patient and postoperative pain qualities are measured with a five point scale from 0 to 4 points respectively. There was no difference in the quality of PNB measured by tolerance scale between the three groups. No any operation was abandoned and none of the patients needed GA due to failed PNB. More than 90% of the patient were defined as Good or Excellent. A single pinprick and touch test may fail to define complete loss of sensation because of the possibility of differential block. The satisfactionof patients with the overall care they have received can be evaluated by this new tool.

Biography

Goncharova Veronika is a 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 journals).

Abstract

Coronary artery disease (CAD) is the leading pathology of the elderly people. In spite of pharmacotherapy and the development of percutaneous coronary intervention, the coronary artery bypass graft (CABG) is 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’sage 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 anginapectoris’ 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 obtainedin patients who underwent CABG using an arterial conduit.

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 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 offpump 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 to estimate and compare the frequency of the occurrence of postoperative complications and the revascularization effectiveness of off-pump and onpump 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, avoidingcomplications 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, especiallyneurological. It appears to produce better results in high-riskpatient populations and elderly patients.

Biography

Miss Tang Shuk Kwan is a PhD student and student member of Centre for Gerontological Nursing in the School of Nursing, The Hong Kong Polytechnic University. Her research interest is on pain management in working population and older adults, aromatherapy and use of information technology in health promotion. She published a study using aromatherapy to reduce chronic pain in community-dwelling older adults.

Abstract

Pain affects human in physical and psychological aspects, as well as the work performance and absence from work. With the busy working schedules, the working population might not be able to seek medical advice and or attend clinics in managing their pain. Acute pain refers to pain persisted less than three months and chronic pain exists more than three months. Acutepain can progress to chronic pain if left untreated. Chronic pain brought long-term disabilities and negative emotions. Starting pain management at early stage is essential. An online survey was done to examine the pain situation andpreference of pain education among working population in Hong Kong. It was hoisted on Google Forms from 1st to 31st August 2016. Adults aged 15 or above, performed a formal job or worked for pay or profits during the seven days before the survey were recruited. There were 210 participants in the study (148 females and 62 males). Their mean age was 38.02. 141 participants (67.1%) suffered pain, 40 had acute pain and 101 had chronic pain. In terms of pain intensity, the pain scores for participants with acute pain was 2.46±2.35 while those with chronic pain was 3.01±1.62 on a 0-10 point scale. Chronic pain sufferers experienced longer pain duration (4.48 hours per attack) than acute pain sufferers (1.95 hours per attack).Although both groups took analgesics, chronic pain sufferers did not perceive the analgesics more effective than the acute pain sufferers. Regarding mood and quality of life, chronic pain sufferers experienced a higher level of depressed mood and declined quality of life. Over 80% of all participants chose to continue working even when they were in pain. Concerning pain management education, participants preferred to get pain information on webpage (63.3%). Both groups agreed that they did not receive adequate pain education with insufficient public pain service in Hong Kong. The survey revealed that the working population in Hong Kong are in need of pain service as evidenced by their pain profile. Online pain  anagement education programme offered by healthcare professionals could be a good option to ease the problem..

Biography

Maria Satya Paramitha is a Medical Doctor who has completed her  ndergraduate study in Faculty of Medicine, Universitas Indonesia. She has completed her Master’s degree by Research in Cancer from Newcastle University Medical School, 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 quantifymitoxantrone 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 HL60, U937, AML-3, and HEL were generated to determine incubation time and seeding densities for in-vitro cytotoxicity assay with alamarBlue. Intracellular mitoxantrone uptake experiment was performed through incubating cells with different mitoxantrone concentrations for four hours before analyzing the results with HPLC assay. Results: Mitoxantrone showed no significant differences of stability in plasma (p=0.714) and in plasma with ascorbic acid (p=0.993) after four weeks. HEL showed the highest mitoxantrone accumulation despite displaying the least sensitivity towards mitoxantrone compared with HL60, U937,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

Eman H EL-Adawy has completed her MD from Mansoura University. She is a Associate Professor of Internal Medicine and Endocrinology Department in Specialized Medical Hospital, Faculty of Medicine, Mansoura City, Egypt. She 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 (vitamin D) 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.

Biography

Natarajan Venkatesh is currently working as Professor in Faculty of Physiotherapy, in Sri Ramachandra University, Chennai, India. He has been in Clinical and Teaching Physiotherapy for the past 25 years. He is PhD Scholar. He is working on influence of yoga on autonomic nervous system. He received Honor Awards for: Distinguish Service Award by the Indian Association of Physiotherapists on 23.01.2005; Best Teacher Award (Chosen by Vice Chancellor, The Tamil Nadu Dr. MGR Medical University on 05.09.2011); Fellowship Award – 51st by The Indian Association of Physiotherapists 2013 (FIAP).

Abstract

movements undergoes incisional trauma following median sternotomy. The incisional pain causes inhibition thereby reducing the pulmonary function. Transcutaneous Electrical Nerve Stimulation (TENS) is an effective low frequency current which reduces pain in various conditions. Objectives: The objective of this work is to evaluate the effectiveness of TENS in reducing incisional pain and improving pulmonary function. Methodology: This experimental prospective study was carried out in an institutional setup involving 35 patients who underwent cardiac surgeries through median sternotomy. The patients were randomized into control and experimental group. The groups were comparable with respect to age, sex, intensity of pain before treatment. Patients performed PFT (Pulmonary Function Test) preoperatively, on fourth Postoperative day(POD) and sixth Post-operative day and their pain score was calculated through Visual analogue scale(VAS). The control group received the routine post-operative physiotherapy management and the experimental group along with routine treatment received TENS for six sessions. Results: We found a significant difference In FEV1 (Forced expiratory volume) between control and experimental group.The experimental group showed significant changes in FEV1 from 4th POD (46.67±10.46) with application of TENS to 6th POD (61.78±15.45) when compared to control group of 4th POD (48.82±13.64) to 6th POD (53.94±12.13). There was significant reduction of VAS in experimental group when comparedto control group. This reduction could be the reason for improvement in pulmonary function in these patients. Conclusions: TENS is the most effective management in reducing pain thereby it improves the pulmonary function in patients who underwent median Sternotomy.

Biography

Zahra Alibabaei is student of Biology and Genetics and will complete her MSc from IAUCTB, University of Tehran, Iran. She is studing on her thesis about RLS in Iran in Pasteur Institute, Tehran. She have an review article about duplication in genome plant and attended 17th Plant Genome Evalution (1-3 october 2017) in Spain. She is member of the Young Researchers and Elite Club of Azad University. She is also a member of ISIC. She have 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 attending the 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  onstant 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  en. 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 specially effect of hot water bag on severity of restless legs syndrome in hemodialysis patients.

Day2: March 27, 2018

Keynote Forum

Biography

Christopher F Tirotta has been an active Member of Miami Children’s Hospital medical staff since 1991, practicing with the Department of Anesthesiology; he has served as the Director of Cardiac Anesthesia since 2002. He has served as Chief of the Department of Anesthesia since July 2017. He also has a clinical appointment with the Department of Anesthesiology at The University of Miami School of Medicine. He received his BA from Cornell University (USA) in 1982 and his MD from New York University School of Medicine (USA) in 1986. He also received an MBA degree from Columbia University in 1999. He completed his internship in Internal Medicine at State University of New York, Stony Brook in 1987. He completed his residency training in Anesthesiology at the University of Miami/Jackson Memorial Hospital in 1990; he sub-specialized in pediatric and cardiovascular anesthesia, including heart transplantation.

Abstract

Post-operative pain control continues to be a problem in surgical patients. A novel formulation of an ultra-long acting local anesthetic is now available in the US: Exparel or liposomal bupivacaine. Liposomal bupivacaine is made up of microscopic polyhedral particles. The liposomes encapsulate the drug, bupivacaine hydrochloride, without altering molecular structure. This provides the reliable low dose release of the bupivacaine over time, providing long-lasting, post-surgical pain relief over the course of 2-3 days. This eliminates the need for titration of a single dose or the need for external devices or pumps to prolong analgesia. Plasma bupivacaine levels may persist for 96 hours after injection. Peak plasma concentrations are lower in magnitude and occur later in time than after a similar injection with bupivacaine HCl. Plasma bupivacaine concentrations are not correlated with local efficacy. Safety profile was evaluated in 10 clinical trials in patients undergoing a variety of surgical procedures. Most common adverse events were nausea, constipation and vomiting. Exparel demonstrated a favorable cardiac profile. There was nocardiac toxicity and no QTc prolongation, even a supra-therapeutic dose. Rate of absorption is dependent on total dose administered, route of administration and vascularity of the surgical site. Efficacy has been established. Multiple trials demonstrated a significant reduction in pain intensity scores and a reduction in overall opioid consumption as compared to placebo. Liposomal bupivacaine is a safe and effective novel drug to treat post-surgical pain.

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.

Abstract

Background: Sepsis microvascular dysfunction embraces different cellular componentsincluding 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  hat 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  roduction is increased. Increased expression of DNMTs results in promoter  ypermethylation 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. Aim: 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.Methodology: Endothelial cells ( HUVEC) and naïve monocytestreated 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 cluding 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   utophagyrepression 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  mmunostaining techniques and flow cytometer, we found the major source of plasma MVs in the critically-ill, nonseptic 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  ethylation) and the combination DNMT3A and DNMT3B (de novo DNA methylation) are reversed on days 1 and 3 (SS Lived:T3A/3Bto- DNMT1: day 1=0.68 and day 3=0.87; SS Died: NMT3A/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 ommercially available inhibitors of DNMTs may be a therapeutic strategy in specific patients with deregulated epigenetic mechanisms to limit both early and chronic nsequences. 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.  emarkably, 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.

Tracks

  • Chronic Disease | Diagnosis And Case Reports | Internal Medicine and Healthcare | Nephrology | Oncology | Endocrinology | Genomic Medicine | Clinical Trials | Emergency Medical Services | Electronic Medical Record and Disease Management | Pharmacological Approaches for Pain | Non Pharmacological Approaches | Pain Management Specialist | Orofacial Pain Management | Pain Management through Nursing
Location:
Speaker

Sergey Suchkov

M Sechenov First Moscow State Medical University, Russia

Chair

Speaker

William Rowe

Medical University of Ohio, USA

Co Chair

Biography

Nassir, R. (Keynote Address). Antibiotic Resistance: A Global Crisis. 2017 OMED International Seminar, October 7, 2017. Philadelphia, Pennsylvania, USA. Departments of Pharmacology and Toxicology, and, Family and  ommunity Medicine, Michigan State University, East Lansing, Michigan, USA.

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 betalactamases 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 am Natarajan Venkatesh (N. VENKATESH) working as Professor in Faculty of Physiotherapy, in Sri Ramachandra University, Chennai – 600 116, India. I have been in clinical and teaching Physiotherapy for the past 25 years. I am PhD scholar. I am working on Influence of Yoga on Autonomic Nervous System. Honor of Awards received: Distinguish Service Award by the Indian Association of Physiotherapists on 23.01.05. ----“Best Teacher Award” (Chosen by Vice Chancellor, The Tamil Nadu Dr. MGR Medical University on 05.09.2011) --- Fellowship Award – 51st by The Indian Association of Physiotherapists 2013 (FIAP).

Abstract

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or injury, or described in terms of such damage or injury. Physical rehabilitation emphasizes the use of modalities such as heat, cold, and electricity to relieve pain. Heat, one of the oldest modalities to relieve pain, can also decrease muscle spasm and improve function superficial heat can be provided by means of hot packs, hot water bottles, hot moist compresses, electrical heating pads, or chemical or gel packs. Deep heating (diathermy) is achieved by converting another form of energy to heat. In shortwave diathermy, high-frequency electrical currents are converted to heat, while microwave diathermy uses electromagnetic radiation as the source. Electricity has been a pain treatment modality since ancient times. The most common mechanism for applying therapeutic electricity is ranscutaneous Electrical Nerve Stimulation (TENS), Interferential therapy (IFT). Electro galvanic stimulation (EGS), electrical muscle stimulation (EMS) and neuroaugmentative stimulation are other rehabilitative methods that employ electrical current. TENS involves the delivery of electrical energy across the surface of the skin to stimulate the peripheral nervous system is based on the gate control theory of pain modulation. TENS is most effective in neuropathic pain such as complex regional pain syndromes (reflex sympathetic dystrophy and causalgia), phantom pain, and post herpetic neuralgia. Empirical and experiential evidence indicates that TENS, in selected patients, can provide an alternative to medications and improve the individual’s function. However, several trials and systematic reviews indicate that a large, perhaps major, component of pain relief after TENS is due to a placebo effect.. Ultrasound, first introduced for medical use in the United States in the late 1940s, uses high-frequency acoustic vibration that is converted into heat. Deep-heating modalities increase temperature to depths of 3–5 cm. Ultrasound is the preferred treatment in most painful disorders, especially those arising from soft tissues and ligaments, as it has greater penetration and also nonthermal effects, such as increasing extensibility of tissues. Conclusion: Ultrasound has greater penetration effect hence used widely for pain relief for soft tissue and ligament injuries and TENS for neurological conditions.

Biography

Maitreyee Rai Michigan State University, USA.

Abstract

Background: Coccidioidomycosis is caused by Coccidioides immitis and by C posadasii, approximately 60-65% of cases are asymptomatic, however, it may present with fever, sore throat, cough, headache, fatigue, and pleuritic chest pain. Here we present a case of back pain who was found to have an aneurysm, he was later found to have coccidioidomycosis. The only other risk factor that could have possibly contributed to this presentation was hypertension. Case: This is a 59-year-old male who presented with acute worsening chronic back pain which apparently started after he twisted his back while playing golf. On admission his blood pressure was elevated at 175/99 mm Hg, he was afebrile with a temp of 97.7°F, pulse was 59/min, respiratory rate was 16/min and SpO2 was 99% on room air. Physical exam was remarkable for Paraspinal tenderness at L4-L5 level. Labs were significant for initial troponin of 0.09. Initial EKG showed T wave inversion in the inferior leads. So the decision was made to start heparin, aspirin and carvedilol. Cardiology performed cardiac catheterization which showed mild, nonobstructive CAD with EF of 60% as well as an ascending aortic aneurysm without dissection. So we ordered computed tomography (CT) angiogram which showed ascending aorta pulmonary artery measuring 5.3 x 5.2 cm. There was no previous CT chest for comparison. Cardiothoracic surgery recommended outpatient follow up with CT in three months. Two days after the discharge of the coccidioidomycosis antibody test was positive with titer reactive at 1:2. A prescription for four weeks of fluconazole was then provided in the view of the diagnostic results. Discussion: The various etiological factors of ascending aortic aneurysms include Marfan syndrome, type IV Ehlers-Danlos syndrome, atherosclerosis, bacterial [mycotic or syphilitic], arteritis (i.e., giant cell, Takayasu, Kawasaki, Behçet), and trauma. Coccidioidomycosis has never been reported to have caused thoracic aneurysm making this a rare case. Even though underlying hypertension increases the risk of an aneurysm, the presence of coccidioidomycosis at the time of its discoverymakes it a possible etiological factor in this patient.

Biography

Ivet B Koleva, MD, PhD, DMedSc is a Medical Doctor (1986; Medical University of Sofia, Bulgaria), a Specialist in Physical and Rehabilitation Medicine /PRM/ (1990) and in Neurology (1995), with  ropean Certification in PRM (2008). She has completed three scientific theses: PhD in PRM (2004), PhD in Pedagogics (2013), Doctor of Medical Sciences in PRM (2009). She has worked as Associated Professor (from 2006) and as Professor in PRM (from 2010). She is Professor at the Medical University of Sofia, Bulgaria. She has published more than 100 papers in Bulgarian and international scientific journals, author of a lot of monographs and manuals in the field of Physical Medicine and ehabilitation, Neurorehabilitation, Neuro-ergotherapy, Grasp and Gait rehabilitation, Functional evaluation, Painmanagement. She is the Co-author of the Bulgarian National PRM Standard (2004). During the period 2007-2015 she was a Member of the PRM Section -European Union of Medical Specialist.

Abstract

The Declaration of Montréal of IASP recognizes chronic pain as a serious health problem. Access to pain management is a fundamental human right. The goal of current work is to prove and evaluate the efficacy of application of different modalities and methods of the physical and rehabilitation medicine (PRM) on independence and quality of life of neurological patients. We effectuate a composition, clinical application and approbation series of complex neurorehabilitation algorithms for functional recovery and amelioration of independence in activities of daily living (ADL) of 1029 patients with neurological diseases, and 516 patients with neurosurgical conditions. The total of 1545 patients was divided into a lot of groups and subgroups, in each one we applied a different neurorehabilitation complex, composed by a synergic combination of natural and pre-formed physical modalities (electrical currents, laser; cryo/thermoagents, hydro-/balneo-/peloido-therapy; physiotherapy and occupational therapy). Patients were controlled before, during and at the end of the neurorehabilitation course and one month after its end - using a battery of traditional and contemporaneous objective methods (including for pain assessment): tests and scales for motor deficiency, balance and coordination; tests of functional grip of the upper limb; tests of gait and independent motion; complex functional scales for independence in ADL (self service, family, professional & social life); scales for depression and anxiety; visual analogue scale of pain; vibroesthesiometry; thermosensibility; laser Doppler flowmetry; ICF asessment. Based on detailed qualitative and quantitative evaluation we proved the efficacy of application of different PhThReh complexes and programs – on different types and levels of sensory, motor and functional deficiency in patients with diseases and conditions of the nervous systems. Mechanisms of physical analgesia are discussed. In conclusion we must say that physical modalities improve significantly the quality of life of patients with diseases and conditions of the nervous systems.

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 ecommended. 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 7 cm 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 1 cm 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 patient with numerous risk factors and imminent operation, minimally invasive surgery for intracerebral haematoma is warranted.

Biography

Christina Yuen Ki Leung completed two Bachelor’s Degrees in England, BSc Management Sciences Degree followed by the BPharm Pharmacy Degree. Following the registration as a pharmacist in the UK, she worked in different London Teaching Hospitals, UK for 16 years. In the last 12 years in UK, she specialized in Pediatrics (especially in PICU and Paediatric Liver), Obstetrics and Gynaecology. She published two articles relating to drugs use in pediatric liver diseases in the UK Children Liver Diseases Magazine. She is also a Registered Pharmacist in Hong Kong. Since 2012, she has been working as the Senior Pharmacist (Clinical Pharmacy in Charge) at the HKU-SZH in China. She is also the Honorary Tutor at the University of Hong Kong, Hong Kong. She delivers lectures to the Master and Undergraduate Pharmacy students relating to drugs use in Pediatrics, Obstetrics and Gynaecology.

Abstract

Buprenorphine and Fentanyl transdermal patches are used for the management of chronic intractable pain in both malignant and nonmalignant patients. Both buprenorphine and fentanyl are potent opioids, but they have different pharmacology and toxicology properties. It is important to understand the difference in these properties as this information is useful for clinicians and pharmacists to use the opioid patches safely and effectively. Opioid analgesics mimic endogenous opioid peptides by causing a prolonged activation of opioid receptors (usually μ receptor). This receptor medicates analgesia, respiratory depression, euphoria and sedation. Fentanyl is potent, highly lipid soluble, rapidly acting μ-opioid receptor full agonist. Buprenorphine is a highly lipophilic semisynthetic opioid. It has complex pharmacology which is different from Fentanyl. Buprenorphine is a partial μ-opioid receptor agonist which binds to and activates a receptor, but has only partial efficacy compared to a full agonist. This means that it may have ceiling effect and demonstrate both agonist and antagonist effects. In human studies using clinical effective analgesia doses, buprenorphine does not have a ceiling effect to analgesia. However, buprenorphine does have a ceiling effect for respiratory depression. Hence, higher doses can be given with fewer respiratory depression side effect compared with higher doses of fentanyl. The primary side effects of uprenorphine are similar to fentanyl (e.g. nausea, vomiting, and constipation), but the intensity of these side effects is reduced significantly compared to full agonist, fentanyl. The most severe and serious adverse reaction associated with opioid use is respiratory depression, the mechanism is behind fatal overdose. Buprenorphine behaves differently than fentanyl in this respect, as it shows a ceiling effect for respiratory depression. Buprenorphine has slowed off rate (half-life of association/ dissociation is 2–5 hours). The slow dissociation from μ-receptor accounts for its prolonged therapeutic effect for treatment of pain. Respiratory depression is rare with buprenorphine, but if occurs, it can be reversed by Naloxone, often larger doses are required than fentanyl because buprenorphine dissociates slowly from the receptors. In conclusions, the pharmacology profile of buprenorphine is complex but unique, and contributes to its distinct safety and efficacy when it is used under appropriate clinical indications.

Biography

Dr. Liu has completed her PhD in Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences. She has worked as assistant professor in Department of Physiology, Institute of Acupuncture and oxibustion. She has published more than 15 papers in reputed journals and her research has been supported by National Natural Science Foundation of China for twice.

Abstract

Acupuncture is a basic method for the treatment of painful disorders and symptoms. Acupuncture is especially good for acute pain and has limited effect on chronic pain relief from clinic practice. This problem has been troubling acupuncturists for a long time. Chronic pain is also a major difficulty in clinical medicine. At present, the effect of analgesic medication is limited. Morphine in the routine doses, in particular, has no good enough analgesic effect for chronic intractable pain and advanced cancer pain. Over the past decade, the reduced effect of conventional analgesia on the treatment of chronic pain is well understood as the endogenous pain modulation system is damaged. Due to the changes of endogenous pain modulation system induced by chronic pain, we carried on systemic basic animal and clinical researches. Our study finds that acupuncture analgesia effect that acts through DNIC was affected. The segmental gate control pathway through which acupuncture analgesia works remains normal. Therefore, in the cases of chronic pain, the best way is local painful regional acupoints acupuncture.

Biography

Khajik Sirob Yaqob, MA is a specialist in childs nutrition with interest in pediatric neurology. He has Associate Membership of the RCPCH; Membership of Oxford University Hospitals and he is a Member of American Academy of Nutrition and Dietetics; Member of Kurdistan Pediatric Society, Iraq.

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 dilemmas. Newlyintroduced 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 CT scan as being a highly predictive tool for assessing cerebral palsy. Design: The study was carried out on 40 cerebral palsy patients; 26 (65%) out of them weregirls, and 14 of them were boys, aged from 0 to 5 years old; from outpatient clinic at Zakho/DuhokGeneral 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 CT 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 intervention 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 have very good response and improvement, 77% of children with delayed milestone and hypertonia, and 87% with delayed walking have positive 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 fatty acids upon daily supplement throughout 6 months to one year. However, combining these 2 drugs showed preservative synergistic consequences. B12 vitamin and omega-3 fatty acids are valuable therapy for children with various forms f 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 fatty acids. Others have less response to combine therapy as being presented and diagnosed beyond 1 year of age (16%).