Conference Schedule

Day1: May 28, 2018

Keynote Forum

Biography

Dr Dolaszynska is an Ophthalmology trainee in North East of England . She has got special interest in medical and surgical education in which she presented several projects before in those topics.Dr Eltayeb is a surgical trainee in Newcastle Upon Tyne with interest in neurosciences and surgical education.

Abstract

Pappilloedema is a common  condition often addressed by ophthalmology and neurology/neurosurgery departments.  All patients with papilloedema should be suspected of harbouring an intracranial mass. Usually presentation of this condition has specific picture
Etiological factors such as metastatic tumours,  hydrocephalus, brain bases are useful to know about as they guide us to immediate, specific treatment. However, majority of the cases are widely named - “idiopathic”.
Series of investigations of different varieties may aid us with diagnosis but management has been always and still a controversial dillemma.
In this poster, we are presenting few not fully understood cases of papilloedema which presentation might be challenging for departments involved as well as the management in which might be exhaustive for both clinicians and patients.
Hereby we adopted an approach in order to summarise the investigation- pathway-  and treatment of papilloedema in our practice in the trust and hoefully to highlight this and add to literature pool. 

Biography

Dr Kiranpreet Gill MBBS BSc (Hons) AICSM graduated from Imperial College London in 2017. She won the John Adamson Prize, as well as passing finals with a Distinction in Clinical Practice. She is currently practicing as a FY1 Doctor in General Surgery at West Middlesex University Hospital in London. She is working with Mr Constantinos Simillis, a consultant in General Surgery and Colorectal Surgery

Abstract

A 77-year-old female who underwent uncomplicated laparoscopic mesh sacrohysteropexy (LMH) in 2009 for uterine prolapse presented with features of small bowel obstruction (SBO), confirmed on abdominopelvic CT scan. At laparotomy, the sacrohysteropexy mesh was seen to have eroded into the small bowel causing complete obstruction complicated by ischaemia and perforation. No adhesions were present. Following resection and primary anastomosis, the patient was transferred to the intensive care unit (ICU). Although rare, cases have been reported of SBO occurring secondary to the use of a synthetic mesh in LMH. To our knowledge, we report the first case of SBO directly attributable to erosion of mesh into the small bowel itself, occurring several years after LMH. Given the increasing frequency of women opting for the surgical management of pelvic organ prolapse (POP) which involves techniques using synthetic mesh, it is important to consent patients appropriately of such life-threatening risks and to equally focus on the development of surgical techniques and mesh materials which aim to minimise such complications.

Biography

Dr. Acharya has completed his MD degree in medicine from Tribhuvan University, Kathamndu, Nepal. He is the head of the department of evidence based medicine and epidemiology, biostatistics and preventive health in Avalon University School of Medicine (AUSOM), Willemstad, Curacao, Netherland Antilles. He has published more than 20 papers in reputed journals and is currently the university research chair in AUSOM

Abstract

Leser-trélat sign is a rare but alarming cutaneous sign of the internal malignancy. It possesses a significant difficulty in differentiating between a benign seborrheic keratosis in the elderly patients. We report a case presentation with an incidental skin manifestation resembling seborrheic keratosis, associated with an underlying adenocarcinoma of lung. A 62-year-old-male chronic smoker and heroine abuser who visited the regular drug rehabilitation program was found to have several well-circumscribed, hyper pigmented lesions with stuck on appearance over the chest, abdomen and lower back. These cutaneous lesions were ranging from 8 to12 mm in size consistent with seborrheic keratosis (Fig: 1 and 2). Patient was provided with hydrocortisone cream for it 3 months before that initially decreased the itching. But patient over the course of time noticed more such nodules. He did not have any significant past medical history and maintained normal appetite and weight. The patient was evaluated for possible unknown primary malignancy, and computed tomography (CT) of the chest revealed a mass measuring 3.8x2.9x2.6 cm on the left upper lobe that was encasing the pulmonary artery. He underwent the lung biopsy consistent with moderately differentiated adenocarcinoma. Surgical consultation was done and surgical resection performed followed by chemotherapy. After one year of the diagnosis, the patient has been doing well and is on remission. Although the definitive diagnostic role of Leser-trélat sign is limited, it can be used as a predictor of occult malignancy. It is recommended that the sudden onset widespread seborrheic keratosis should undergo a thorough evaluation.

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  • Clinical & Medical Case Reports | Case Reports Conferences | Case Reports Events | Case Reports Expo | Case Reports Meetings
Location: London, UK

Biography

Xin Wang has completed his PhD &MD from Tianjin Medical University. He is the Head of the department of internal medicine, a premier research organization. He has published more than 5 papers in reputed journals and has been serving as an editorial board member of reputed journals.

Abstract

The aim of this study is to develop a new method that is able to accurately predict the 28 day hospital mortality in patients with severe community acquired pneumonia (SCAP) at an early stage. Methods: Weselected 37,348 SCAP patients in ICU from173 hospitals during 2011.1–2013.12. The predictive factors for 28 day hospital mortality were evaluated retrospectively. All cases underwent intensive care, blood routine, blood biochemical tests and arterial blood gas analysis. Under the Classification and Regression Tree (CART) analysis, a new clinical scoring system was developed for early prediction in SCAP patients. The receiver-operating characteristic (ROC) curve was plotted to calculate the area under the receiver operating characteristic curve (AUC). Results: A novel clinical model named CLCGHscoring system, including Serum creatinine (Cr) ≥259.5 μmol/L, leukocyte (WBC)≥ 17.35 × 109 /L, C-reactive protein (CRP) ≥189.4 μg/mL, GCS ≤ 9 and serumHCO3− ≤ 17.65mmol/L, was carried out and each index as an independent factor for hospital mortality in SCAP. In the validation cohort, the AUC of the new scoring system was 0.889 for prediction of hospital mortality, which was similar to SOFA score 0.877, APACHEII score 0.864, and was better than the PSI score 0.761 and CURB-65 score 0.767. Conclusions: The new scoring systemCLCGH is an efficient, accurate and objective method to predicate the early hospital mortality among SCAP patients.

Biography

Bolormaa.B has completed his MBA from Mahidol University in Thailand and doctorate NMU Mongolia. She is worked anaesthesia department of NCC of Mongolia since 2000. She has published more than 15 papers in reputed journals. She studied in Thailand, South korea, Switzerland, Egypt.

Abstract

Anesthesia process:The patient's back and place the O2 mask using the 20 G intravenous IV Fentanyl 100 μg. We reported successful anesthesia retrograde tracheal intubations in NCC. Case I. 03 June 2015. A 30 year-old male patient was posted for elective surgery head and neck department. The surgery required to recurrent tumor (d= 6cm) of Rt. Sub mandible gland T2N1M0 do MND tumor remove. On examination of the airway, all parameters such as mouth not opening (he had big accidence and neck surgery in 2002, 2007, 2012). Chin-thyroid distance: less than 2 cm. Dentures, removable teeth.

Case II. 19 Sep 2015. A 66-year-old male patient posted for emergency case head and neck surgery department. The patient had two surgeries NCC. First elective surgery was 17 Sep 2015 (required to big tumour resection and reconstruction by ALTFF in cancer mandibles) with normal intubation. Second emergency surgery was 19 Sep 2015(free plat to restore the blood supply and airway oxygen supply to increase) with retrograde intubation. He was breathing periodically interrupted.

Case III. 06 Feb 2016. A 57 year-old male patient posted for elective case head and neck surgery department. The surgery required to the recurrent tumor (d= 5cm) of tongue (near epiglotic and trachea almost closed ). On examination mouth normal opening but he was breathing difficult . We cannot put retrograde intubation, our surgeons put tracheostomy.
 

Biography

Dr. Gustavo Pradilla is a Colombian native who finished his medical training with honours in the first class of medicine at the Universidad Industrial de Santander (UIS) in Bucaramanga. He did his neurology residency at the Universidad Javeriana in Bogotá, later returned to his alma mater and was dean of the faculty of health. Currently, he is a UIS medicine laureate professor and head of the neurology service at the Hospital Universitario de Santander.

Abstract

A 54-year-old man with chronic exposure to carbamates and organophosphates was referred from the otorhinolaryngology outpatient section in 2014, because of 3 years of dyspnea and dysphonia of spasmodic features, phonasthenia without respiratory distress or dysphagia; associated to progressive weakness in lower limbs. Brain magnetic resonance, angioresonance and chest X-Ray had no alterations; laryngeal electromyography revealed a bilateral neuropathic pattern without denervatory activity, with some signs of reinnervation and decreased recruitment. Lambert test displayed motor and sensory distal latencies of median nerves prolonged. Repetitive stimulation test evidenced a decrease greater than 10% in the trapezium, concluding an abnormal repetitive stimulation test, concluding a conduction disorder in the neuromuscular junction. With a diagnostic impression of Myasthenia gravis, the patient started a therapeutic test with pyridostigmine worsening the symptoms, so he ws switched to Azathioprine and corticosteroids. His Anti-MUSK antibodies <0.05 mmol/L and antibodies against acetylcholine receptors <15% were interpreted as negative. Due to the worsening of the bulbar symptoms, plasmapheresis was performed; after the first session he showed improvement in lower limbs weakness, so five sessions were carried out with continuous improvement. Myasthenia gravis and its subcategories are major diseases that affect the neuromuscular junction. The diagnosis is confirmed by the combination of relevant symptoms and signs, neurophysiological studies and a positive test for specific autoantibodies. About 10% of patients with generalized myasthenia gravis do not have detectable antibodies to acetylcholine receptors or muscle specific kinase (double seronegative myasthenia), so neurophysiological tests and a positive response to therapy secure the diagnosis.

Day2: May 29, 2018

Keynote Forum

Biography

Leul Adane  has completed his Doctorate in medicine at the age of 24 years from Jimma University and doing post graduation study in Radiology in Saint Paul Hospital Millenium Medical college, Addis Ababa, Ethiopia.

Abstract

Pentalogy of Cantrell consists of an extensive defect of the thoracoabdominal wall, which has nearly always a lethal prognosis. The defect is characterized by the association of five anomalies: omphalocele, cardiac ectopia, absence of the distal portion of the sternum, absence of the anterior diaphragm and absence of the parietal diaphragmatic pericardium. It has a rare frequency of about 5.5 per 1,000,000 live births. There is a common association with intracardiac anomalies such as ventricular septum defect, tetralogy of Fallot, and transposition of great vessels .The pathogenesis remains unclear.

Here i present an imaging findings with antenatal Two Dimensional (2D) and Three Dimensional (3D) ultrasound and fetal Magnetic Resonance Imaging (MRI) in a 20 weeks of gestation with a multiple anomalies, based on which the diagnosis of complete Pentalogy of Cantrell was given; with a brief literature reviw .Post mortem radiography, 3D Computed Tomography (CT) and clinical autopsy were performed additionally to enhance the visualization of fetal anomalies and to confirm the diagnosis.

Extensive imaging of cardiac, thoracic and abdominal malformations by ultrasound and MRI is complimentary for a clear diagnosis and counselling of the patient.

Biography

Mahdi Rostamizadeh has completed his Ophthalmology Residency at Case Western Reserve University. He is currently a surgical retina fellow the Valley Retina Institute in Mcallen Texas. He has published previous work in endophthalmitis and masquerade syndromes of the eye.
 

Abstract

A 30 year old male with a history of diabetes, hypertension and hyperlipidemia initially presented to our clinic to receive floucinolone acetonide implant for his diabetic retinopathy. On the day of treatment with fluocinolone acetoninde implant the patient's uncorrected visual acuity was 20/60. After the injection, the patient was prescribed ciprofloxacin three times a day for 5 days and advised to return to clinic in 2 days for an IOP check as is standardized at our practice for intravitreal steroid implants. On post op day 2 patient had complaints of new pain (5/10) and floaters. Uncorrected visual acuity of 20/150 and IOP of 18 in the right eye. Dilated fundus exam revealed +1 haze in the vitreous, otherwise the exam was unchanged. Monitoring with close observation was recommended and patient was advised to return to clinic immediately if there is worsening of his symptoms.  Patient returned to clinic 3 days later complaining of seeing floaters, "blurry clouds" and "black lines". Uncorrected visual acuity was CF@3ft and intraocular pressure of 21. New exam findings showed +1 cell in the anterior chamber and an increase in haze to +2 in the vitreous. Clinical diagnosis of endophthalmitis was made and the patient underwent an intravitreal tap and inject of 1 mg in 0.1 ml of vancomycin and 2.25 mg in 0.1 ml of ceftazidime. Over the course of 7 days the patient's uncorrected visual acuity improved to 20/80 and 3 months later the patient's uncorrected visual acuity improved to 20/50 which was better than baseline. Cultures did not grow any organism. Fluocinolone acetonide intravitreal implant was approved for use in the US by the FDA in September 2014. In the FAME trial that evaluated its efficacy, there was a 0.26% (2/768) incidence of endophthalmitis. This is the first case report of endophthalmitis following the implantation of a fluocinolone acetonide implant.

Biography

Allison Landa has completed her MFA from St. Mary’s College of California. She is a speaker, writer, and editor in Berkeley, Calif., and is represented by Miriam Altshuler of DeFiore & Co. She has published in The Guardian US, The Washington Post, The Mighty, You and Me Magazine, and Salon Magazine, among other venues. Landa is a MacDowell Colony Fellow and has held artist residencies at Playa Summer Lake, Kimmel Harding Nelson Center for the Arts, and The Julia and David White Artists’ Colony.

Abstract

Studies suggest that psychosocial factors – in addition to physical barriers – work to impair fertility and successful childbirth in women with Congenital Adrenal Hyperplasia. This includes a reluctance to consult medical professionals as to the scope of the problem and possible solutions. This was the case with Allison Landa, who was not even successfully diagnosed with CAH until the age of 30 due to parental negligence and the terror of discussing her symptoms with a doctor. When successful intervention finally took place, Landa was not only able to stabilize her condition but become pregnant at the age of 40 following a short-term disruption of birth control. Her son Baz was born on Sept. 6, 2015. Landa offers a personal perspective as both a patient and an advocate for fellow CAH sufferers.

Conclusion and Significance: Increased outreach to CAH sufferers on the part of the medical community is indicated in order to reach those who might otherwise not be served.

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