Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 5th International Conference on Clinical & Experimental Cardiology Philadelphia, USA.

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Day 3 :

  • Track 7: Current Research in Cardiology
    Track 8: Cancer and Heart
Speaker

Chair

Sergey Suchkov

A.I.Evdokimov Moscow State University of Medicine and Dentistry, Russia

Speaker

Co-Chair

Karlheinz Seidl

Klinikum Ingolstadt, Germany

Session Introduction

Sergey Suchkov

A.I.Evdokimov Moscow State University of Medicine and Dentistry, Russia

Title: Modern trends in stem cell technologies as applicable to ischemic heart diseases

Time : 09:00-09:20

Speaker
Biography:

Sergey Suchkov, MD, PhD, male, was born in 11.01.1957, researcher-immunologist, clinician, graduated from School of Medicine, A.V.Lunacharskii Astrakhan State Medical University, Russia, in 1980. Suchkov has been trained at the Institute for Medical Enzymology, The USSR Academy of Medical Sciences, National Center for Immunology (Russia), National Institutes of Health Bethesda, USA) and British Society for Immunology to cover 4 British university facilities. Dr Suchkov worked for the Central Laboratory at Lenin’s Mausoleum, then at the Institute for Medical Enzymology, The USSR Academy of Medical Sciences, for the Institute of Developmental Biology, Russian Academy of Sciences (RAN), Helmholtz Institute of Eye Diseases, and for Moscow Regional Clinical Research Institute including a position of the Immunologist-in-Chief of the Health Services of the Moscow Region. Since 2005, he has been working as Professor of A.I.Evdokimov Moscow State Medical & Dental University and I.M.Sechenov First Moscow State Medical University. From 2007, Suchkov was the First Vice-President and Dean of the School of Preventive and Personalized Medicine of the University of World Politics and Law. In 1991-1995, Dr Suchkov was a Chief Scientific Secretary of the Editorial Board of the International Journal “Biomedical Science” (issued by the Russian Academy of Sciences and Royal Society of Medicine, UK). In 1995-2005, Suchkov was a Director of the Russian-American Program in Immunology of the Eye Diseases. Dr Suchkov is a member of the Advisory Board, EPMA (European Association of Predictive, Preventive and Personalized Medicine), Brussels, EU, member of the Editorial Boards, Open Journal of Autoimmunity, EPMA J., Personalized Medicine Universe, American J.Cardiovascular Res. Dr Suchkov has published more than 500 papers. He is known as an author of the Concept of postinfectious clinical and immunological syndrome, co-author of the concept of abzymes and their impact into the pathogenesis of aotuimmunity conditions, and as one of the pioneers in promoting the Concept of Predictive, Preventive and Personalized Medicine.

Abstract:

Cardiovascular atherosclerotic and ischemic diseases constitute the leading cause of morbidity and mortality throughout middle- and high-income countries since following significant injury, the heart undergoes induced compensation and gradually deteriorates towards impending heart failure. But current and canonical therapy slows and does not halt the resultant adverse remodel-ing. So, novel therapeutic strategies are required to protect the heart from acute attacks in order to reduce myocardial infarction size, preserve cardiac function and improve clinical outcomes in patients with ischemic heart diseases. And the discovery of coronary risk factors and targets of newer generations have led to the development of personalized cardiology whilst providing the basis for prevention of atherosclerotic vascular disease. For instance, myocardial infarction (MI) is accompanied by a significant loss of cardiac myocytes (CMs) which, in turn, differentiated from human embryonic stem cells (hESCs), offer a potentially unlimited cell source for cardiac disease therapies and regenerative cardiovascular medicine. So, successful use of SC therapy in the prevention and treatment of heart failure fol-lowing cardiac infarction is so much promising! For instance, the putative endothelial progenitor cells (EPCs) can efficiently promote angiogene-sis and restore perfusion of ischemic tissues whilst representing a biomarker to guide preventive or therapeutic interventions in this disease. A recently discovered cell source for cardiac repair has emerged as a result of a breakthrough reprogramming somatic cells to induced pluripotent stem cells (iPSCs). Preclinical studies using a variety of cell preparations generated from iPSCs have shown great evidence of cardiac repair. The cells mentioned derived from the patient’s own cell types, including fibroblasts, have be-come particularly attractive. Moreover, mesenchymal SC (MSC) transplantation would be a promising new therapy to im-prove cardiac function after MI whilst ameliorating interstitial fibrosis and the remodeling of gap junction as well as attenuating focal heterogeneity of repolarization. Meanwhile, today signaling pathways that regulate pluripotency and secreted soluble factors as key players in communication to local and distant tissues have been the major focus of SC trans-lational research as applicable to cardiology. For example, actively secreted membrane vesicles, including exosomes, are being recognized as new candidates with important roles in intercellular and tissue-level communication. We would critically assess the emerging role of exosomes in local and distant communicative mechanisms after MI. A comprehensive understanding of the role of exosomes in postinfarction cardiac repair could bridge a major gap in knowledge of the repair mechanism after myocardial injury. Thus SC-based therapy can become a realistic option in regenerative processes for replacing lost cells and reconstituting the damaged organ, as before. Meanwhile treatment of heart failure, although greatly improved, remains a big challenge. And, to our mind, new promising therapeutic strategies for cardiac protection would have to include novel aspects of mitochondrial function, epigenetics, the immune system, growth factors, and SC therapy in terms of targeting and clinical application, in particular!. It is likely that in the future, a greater emphasis will be placed on prevention.

Speaker
Biography:

Karlheinz Seidl has completed his Ph.D. at the age of 27 years at the University of Heidelberg. He is a member of the teaching staff at the University of Heidelberg. His scientific interest is in cardiology especially cardiac arrhythmias. Since 2010 he is the director of the department of cardiology at the teaching hospital of Ingolstadt. He has published more than 25 papers in reputed journals and has been serving as an editorial board member of repute

Abstract:

The estimated number of individuals with AF globally in 2010 was 33.5 million (20.9 million men] and 12.6 million women. Burden associated with AF, measured as disability-adjusted life-years, increased by 18.8 in men and 18.9% in women from 1990 to 2010. In 1990, the estimated age-adjusted prevalence rates of AF (per 100 000 population) were 569.5 in men and 359.9 in women. Mortality associated with AF was higher in women and increased by 2-fold and 1.9-fold in men and women, respectively, from 1990 to 2010. There was evidence of significant regional heterogeneity in AF estimations. The incidence of atrial fibrillation is twice as high in developed countries compared to the developing countries. The increase of AF incidence was 70% in the developed countries compared to only 11 % in the developing countries. There are several risk factor for atrial fibrillation which could be influenced: obesity, diabetes, hypertension, inflammation, and sleep apnea. Weight reduction and cardiometabolic risk factor management can reduce the burden of atrial fibrillation. In addition the recurrence rate could be reduced with an intensive cardiometabolic risk factor management either after pharmacological treatment or after catheter ablation of AF These findings provide evidence of progressive increases in overall burden, incidence, prevalence, and AF-associated mortality between 1990 and 2010, with significant public health implications. Cardiometabolic risk factor management can further reduce the burden of atrial fibrillation in addition to conventional treatment options.

S. Jamal Mustafa

West Virginia University, USA

Title: Molecular mechanisms of coronary flow regulation by adenosine

Time : 09:40-10:00

Speaker
Biography:

S. Jamal Mustafa is an Assistant VP for Research at HSC at West Virginia University (WVU). I received Dean’s Award for Excellence in Research from SOM and became a Robert C. Byrd Professor in 2010 received Chancellor’s Award for Outstanding Achievement in Research and Scholarly Activities from HSC, in 2013. I have published over 190 manuscripts. Our past work has led to the approval of an A2A selective AR agonist (Lexican®) for myocardial perfusion imaging. Currently, we are using AR and β adrenergic receptor KOs to better understand the relationship between these receptors in coronary flow regulation.

Abstract:

Adenosine acts through its receptors (A1, A2A, A2B, and A3) via G-proteins and causes an increase in coronary flow (CF) mostly through A2A AR. However, the role of other ARs in the modulation of CF is not well understood. Using KOs, we investigated the role for each AR in the regulation of CF. Using the isolated heart from A3 KO mice; we reported an increase in A2A-mediated CF. Similarly, we found an increase in CF in A1 KO mice with A2A agonist (CGS-21680). Also, in A2A KO mice, response to CGS was abolished. On the other hand, A2A KO mice showed a decrease in CF to NECA (non-selective agonist). BAY60-6583 (A2B selective agonist) was without an effect on CF in A2B KO mice; however, it increased CF significantly in A2A KO. CGS also caused a significant increase in CF in A2B KO mice. Also, exogenous adenosine-induced increase in CF in WT, A2A KO, and A2B KO mice were significantly reduced with catalase. BAY-induced increase in CF in WT was significantly inhibited with glibenclamide. Overall, our data support stimulatory roles for A2A and A2B and inhibitory roles for A1 and A3 in the regulation of CF. These observations provide new evidence for the presence of all four ARs in CF regulation. We propose, that activation of A2A/B may release H2O2 which then activates KATP channels, leading to vasodilation. These studies may lead to better understanding of the role of ARs in coronary disease and may lead to better therapeutic approaches.

Mahazarin Ginwalla

University Hospitals Case Medical Center, USA

Title: Sickle cell cardiomyopathy: Past, present, and future

Time : 10:20-10:40

Speaker
Biography:

Mahazarin Ginwalla, MD, MS is an Assistant Professor and Medical Director of Mechanical Circulatory Support at the University Hospitals Case Medical Center in Cleveland, Ohio. She received her medical degree from Lokmanya Tilak Medical College in India. She completed her Masters in Medical Microbiology and Immunology at the University of Wisconsin-Madison, and subsequently completed her Internal Medicine residency at the Medical College of Wisconsin. She trained in cardiology at Case Western Reserve University/ Metrohealth Medical Center, and in Advanced Heart Failure and Cardiac Transplantation at Stanford University Medical Center. She has been actively involved in clinical work, education, and research in the areas of heart failure especially sickle cell cardiomyopathy, mechanical circulatory support, and cardiac transplantation.

Abstract:

Sickle cell disease (SCD) is an inherited chronic hemolytic anemia whose clinical manifestations arise from the tendency of the hemoglobin to polymerize and deform red blood cells into the characteristic sickle shape due to a single nucleotide change in the beta-clobin. This leads to vascular occlusion of small and large vessels which leads to chronic damage to several organs including the brain, lungs, kidneys, liver, and spleen. Chronic sickle cell anemia leads to several cardiovascular manifestations. These include high cardiac output, cardiomegaly, and progressive iron overload in patients after multiple blood transfusions leading to secondary hemochromatosis. These patients develop right and left sided systolic and diastolic dysfunction. Pulmonary hypertension is another complication of chronic sickle cell anemia which is a poor prognostic factor and in turn may lead to worsening right heart failure. Treatment strategies include limiting blood transfusions, iron chelation, and exchange transfusions. We present data from our center depicting the proportion of systolic dysfunction in our patients with sickle cell disease. We also present a case series of patients from our center with improvement in secondary hemochromatosis after iron chelation. Work is underway to assess the benefits of cardiac medications in patients with sickle cell cardiomyopathy, novel agents that target the biology of vasculopathy to prevent the cardiac complications of sickle cell disease, as well as gene therapy in the near futures.

Break: Networking & Refreshments Break 10:40-10:55 @ Independence Foyer
Speaker
Biography:

John E. Strobeck, MD is a practicing Cardiologist (Heart Specialist) in Hawthorne, NJ. Dr. Strobeck graduated from University of Cincinnati College of Medicine in 1974 and has been in practice for 40 years. He completed a residency at Brigham & Womens Hospital. Strobeck also specializes in Internal Medicine. He currently practices at Sovereign Heart & Lung Center and is affiliated with Christian Health Care Center, Ramapo Ridge Psychiatric Hospital and St Joseph's Regional Medical Center. Strobeck accepts multiple insurance plans including MagnaCare, Great West and Cigna. Strobeck is board certified in Internal Medicine. Dr. Strobeck also practices at Cardiac & Endovascular Associates LLC in Ridgewood, NJ.

Abstract:

Many physicians treating patients with heart failure utilize the serum B-Natriuretic Peptide (BNP) as a guide to determine the presence of fluid retention and the quantification of diuretic therapy. The manufacturers of BNP testing equipment make no claim that it is a surrogate for blood or plasma volume measurements. Since BNP is predominantly released by the ventricular myocytes in response to stretch or increases in wall tension caused by intrinsic myocardial abnormalities, its common use as a surrogate marker for fluid retention and/or decisions regarding the need for diuretic adjustments therapy, requires careful re-examination. The correlation between time-related venous BNP and Iodine-131 labeled Albumin measurement of blood volume (BVA-100, Daxor, NY) was made in 151 patients admitted to the heart failure service of a community hospital over the past 2.5 years. The patients entered in the study had ejection fractions by echocardiography, MUGA, or cardiac MRI that varied from 10% to 80%. There were 65 females and 86 males enrolled and the ages of the patients ranged from 38 to 94. There was no exclusion of patients or correction of the data for intrinsic renal function or body mass index. The results indicated that there was no significant correlation between serum BNP and Total Blood Volume measurement expressed either as a % deviation from Ideal Blood Volume or as the Absolute Blood Volume measurement. In addition, there was no correlation between serum BNP measurements and Total Blood Volume or the % deviation from Ideal Blood Volume when the data was stratified by gender or age. Over 60% of the patients enrolled had measured reductions in Red Cell Volumes of greater than 10% from the Ideal Red Cell Volume indicating the high prevalence of anemia in these patients. These data represent the largest study to date correlating serum BNP to Iodine-131 labeled Albumin blood volume measurements. Previous studies have shown a lack of correlation between BNP and Blood Volume in acutely ill post-surgical patients and in a small cohort of patients undergoing pulmonary artery catheterization. In both studies, hemodynamics correlated significantly with Blood Volume measurements. These findings lend new credence to the use of Blood Volume measurements in conjunction with clinical assessment to guide diuretic therapy or other forms of renal replacement therapy in heart failure patients.

Speaker
Biography:

Silva has a Master Degree in Medical Sciences at the Federal University of Santa Catarina and in Epidemiology at Federal University of Rio Grande do Sul, and a Doctorate degree in Medical Sciences at the Federal University of Santa Catarina. He also attended a Post-Doctoral Fellowship in Perinatal Research in the Wayne State University,in Michigan, USA, and in the Georgetown University,in Washington DC,USA, where his focus was the fetal cardiac function, related to infections and placental function. His research field is on cardiovascular risk factors in diseases like AIDS and others with systemic inflammatory compromise, analyzing mainly the cardiac and endothelium functions by means of ultrasonography. Dr. Silva served his presidency of the Pediatric Society of Santa Catarina and concurrently was an effective member of the Scientific Department of Pediatric Cardiology of the Brazilian Society of Pediatrics in 4 periods. He is currently professor in the Medical School of the Santa Catarina South University, in Brazil.

Abstract:

The cardiac abnormality most commonly seen among HIV-infected children is dilated cardiomyopathy. Mild depression of left ventricle (LV) and LV mass were risk factors for death, independent of age, duration of illness, CD4 count, HIV-1 viral load, neurologic disease or malnutrition. Subclinical cardiac abnormalities develop early in HIV-infected children, even among those with asymptomatic HIV disease and those who are asymptomatic for cardiac dysfunction. In a research conducted at our Institution, among 94 patients, fifty (54.3%, 95% CI, 44.1% to 64.5%) children showed diastolic dysfunction. Left ventricular dysfunction occurred in 38.7% (95%CI, 28.8% to 48.6%) of the children, and the prevailing dysfunction type was decreased myocardial compliance. Right ventricular dysfunction was apparent in 29.4% (95%CI, 20.1% to 38.7%) of the children, and on this side, the abnormal relaxation type was most prevalent. Simultaneous biventricular dysfunction occurred in 14.1% (95%CI, 7.0% to 21.2%) of children. Ventricular dysfunction was not associated with the immunological status of the children. So, cardiac diastolic dysfunction occurs in children with selected characteristics and is not associated with immunological status. The myocardial compliance impairment was the most common dysfunction occurring on the left side, and abnormal relaxation was the most common dysfunction occurring on the right side.

Speaker
Biography:

Krzysztof Piotrowski was born in 1963, a specialist in obstetrics, gynecology and clinical genetics, Krzysztof Piotrowski completed his Ph.D. with a dissertation on fetal echocardiography. Putting his knowledge into practice, he performs about 3,000 USG investigations of gravidas annually for prenatal diagnosis. He has published many scientific papers and chapters covering prenatal diagnosis. Having introduced the BACs-on-BEADsTM technology to Polish diagnostics, at present he is focused on applying molecular genetics prenatally. For the last nine years he was the Manager of Cytogenetic Unit for Pomeranian Medical University, Szczecin, Poland. Lately, he has founded a new independent genetic centre, DIAGEN.

Abstract:

Congenital Heart Diseases are the most common malformations both as an isolated form and a part of genetic syndromes. Extraordinarily fast development of molecular genetics confirms that almost all CHD are genetically dependent in terms of micro aberrations in different regions of a chromosome or single gene mutations, and many formerly recognized as teratogenic are actually gene-dependent. Many mechanisms of heart development are based on the balance between apoptosis, proliferation and migration. The genes participating therein are located nearly on each chromosome, mainly on pathways, along with ligand genes and co-factors, transcription factors or individually. There are at least 80 such confirmed genes. Crucial genes controlling fetal development, including the creation of heart tube and, e.g. the forming of left and right ventricular outflow (LVOT and RVOT), are primary “home box” genes grouped in 4 clusters. Other genes condition the forming of different structures. Moreover, in numerous functional disorders, e.g. the long Q-T conducting, and most intrauterinal fetal and sudden infant deaths, the reason is also genetic, namely the mutation of ion-channel gene placed in 6 chromosomes. Many genes of cardio genesis were identified through the investigation of other genetic disorders, e.g. PTPN11 in Noonan and Holt-Oram Syndromes. Heart development is also affected by imprinting and the inactivation of the X chromosome in the 21st day of development. We propose a classification of genetic pathologies connected to CHD – often the sole syndrome confirmed by USG in prenatal diagnosis. The above genes and mechanisms constitute a mere representation of the complex issue of cardio genesis.

Speaker
Biography:

Galina Belostotskaya was born in 1947 in St. Petersburg (former Leningrad), graduated from Leningrad State University in 1970 and defended her thesis in 1984 on a specialty "Radiobiology". From 1986 to the present day she is working in the Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian academy of sciences as a Senior researcher and the Head of Cytoanalysis centre. In recent years, she has been studying the resident muscle stem cells and published more then 10 papers in Russian Journals and 2 articles in “Cell Cycle” (2014) and Bioelectromagnetics (2014). Being the head of investigations she released 7 specialists and 2 graduate students. The works have been supported by the 10 Russian grants.

Abstract:

Despite numerous studies on mammalian cardiogenesis, the mechanism of self-renewal of cardiac muscle cells and the causes of limited regenerative potential of adult heart are still an enigma. Considering this, the possibility of dedifferentiation of pre-existing cardiomyocytes and transdifferentiation of hematopoietic stem cells into cardiomyocytes is discussed. However, these data are inconclusive. The impact of resident cardiac stem cells (CSCs) on myocardium self-renewal is generally recognized, although the mechanism of the development of mature cardiac cells from cardiac stem cells is not fully understood. In addition, passive involvement of resident CSCSs into myocardium regeneration is unexplainable as well [Leri et al., 2015]. The discovery of the phenomenon of intracellular development of mammalian resident CSCs within mature cardiac cells via "cell-in-cell structure" generation both in vitro and ex vivo allowed to hypothesize about the significant role of this mechanism in the maintenance of homeostasis of healthy heart during the whole life cycle. Moreover, the presence of considerable amounts of closed and opened "cell-in-cell structures" (CICSs) in neonatal rat heart by the time of birth and their significant decrease by the end of the first week of life allow to hypothesize that embryonic CSC-CICSs deliver transit amplifying myocytes (TAMs) into neonatal myocardium. TAMs are actively involved into neonatal heart development. The presence of CSC clones and CSC-CICSs in adult and elderly mammalian myocardium demonstrates that myocardium self-renewal occurs during the whole life. However, resident CSC switch to intracellular development under hypoxia and acidosis (ischemia, myocardium infarction) accounts for their inactivity under pathological conditions. Hence, we suggest that free resident CSCs of several types as well as TAMs released from “cell-in-cell structures” immediately after the birth greatly contribute to neonatal heart development and its regeneration in the first days of life. These findings conflict with previous data published by Porello et al. [2011]. These authors claim that in the first days of life damaged heart regenerates by the division of pre-existing cardiomyocytes and deny the role of resident CSCs in this process. However, age-related decrease in resident CSCs and the blockade of their activity in acute pathology significantly reduce their involvement in damaged myocardium regeneration. We hope that the progress in the study of CSC intracellular generation in the damaged myocardium will promote a new strategy for the development of novel targeted drugs stimulating myocardial regeneration in cardiovascular diseases.

Speaker
Biography:

Silva has a Master Degree in Medical Sciences at the Federal University of Santa Catarina and in Epidemiology at Federal University of Rio Grande do Sul, and a Doctorate degree in Medical Sciences at the Federal University of Santa Catarina. He also attended a Post-Doctoral Fellowship in Perinatal Research in the Wayne State University,in Michigan, USA, and in the Georgetown University,in Washington DC,USA, where his focus was the fetal cardiac function, related to infections and placental function. His research field is on cardiovascular risk factors in diseases like AIDS and others with systemic inflammatory compromise, analyzing mainly the cardiac and endothelium functions by means of ultrasonography. Dr. Silva served his presidency of the Pediatric Society of Santa Catarina and concurrently was an effective member of the Scientific Department of Pediatric Cardiology of the Brazilian Society of Pediatrics in 4 periods. He is currently professor in the Medical School of the Santa Catarina South University, in Brazil.

Abstract:

Celiac disease (CD) is a chronic condition, which lasts for life and involves nutritional deficits, a broad spectrum of symptoms and constant dietary treatment. The impact of a gluten-free diet on nutritional and other biochemical and subclinical parameters have been systematically investigated, but further studies are still needed. We conducted an observational, cross-sectional, prospective study, with availability and not probabilistic samples, matched for sex, age and nutritional status, compounded of 30 participants with CD and 30 normal subjects. The study met all ethical principles.Total cholesterol and the LD-C were higher in the CD group (p= 0.0268 and 0.0253 respectively); the HDL-C was low in both groups; the mean of interleukin-10 was higher in the control (p= 0.0108); the increased intima-media thickness of the right carotid was more frequent in participants with CD (p= 0.0049); and indicators of ventricular functions did not show specific changes. Patients with CD, under a gluten-free diet for at least one year, have dyslipidemia, a cardiovascular risk factor, and the c-IMT increased, indicative of subclinical atherosclerosis. They also show changes in anti-inflammatory markers, showing that even without gluten, the body needs to maintain inhibitory mechanisms of inflammation, suggesting a process that permeates the absence of the aggressive stimulus, given the IL-10 is decreased in peripheral blood of the CD group, suggesting its recruitment by the gut mucosa, as well as IL-1ra was associated with participants with CD, being both anti-inflammatory cytokines.

Benedict Onoja

University of Nigeria, Nigeria

Title: Morphology of the grasscutter ovaries: A tool for a better heart function

Time : 12:35-12:55

Speaker
Biography:

Onoja, Benedict Onu has completed his MSc at the age of 38 years from University of Nigeria, Nsukka, Enugu State, Nigeria. He is a lecturer in the Department of Veterinary Anatomy, University of Agriculture, Makurdi, Benue State, Nigeria. He has 4 papers in reputed journals. He is a registered member of Nigerian Veterinary Medical Association, where he served for 4 years as the Publicity Secretary, and also a registered member of Veterinary Council of Nigeria. He has been the Secretary Genaral of University of Nigeria Alumni Association, Benue State Branch for 3 years. He is married with 2 kids.

Abstract:

Fifteen female grasscutters, obtained from David Mark Farms, Otukpo, Benue State, Nigeria, were used for the study. They were randomly assigned to 3 groups of 5 each according to their ages; 1-3 months, 4-6 months and 7-9 months. The live weights of the grasscutters were obtained. They were then euthanized with chloroform in an air-tight container. The ovaries were carefully dissected out and observed for gross features. The morphometry was also obtained. The ovaries were sliced into bits and fixed in 10% Bouin’s Solution and 10% neutral-buffered formalin of equal volume for 24 hours and processed routinely for light microscopy. Photomicrographs of the sections were taken using Moticam MC 2001 digital camera. The data were subjected to one-way analysis of variance. Variant means were separated using Duncan’s multiple range test. Significance was accepted at p < 0.05. The mean organo-somatic indices of the ovaries at 1-3 months (0.51 ± 0.08) were significantly (p < 0.05) less than those at 4-6 months (1.09 ± 0.11), and these were also significantly (p < 0.05) less than those at 7-9 months (1.83 ± 0.14) of age. Graafian follicles, absent at 1-6 months, were present at 7-9 months. The female grasscutter could thus be said to attain puberty at 7 months of age. Earlier studies revealed that the grasscutter meat is white, with high protein but low cholesterol content. It could be inferred that as more grasscutters would be bred at 7 months, more cholesterol-free meat would be available for consumption. This improves heart function.

Break: Lunch Break 12:55- 13:40 @ Benjamin’s
  • Video Presentations

Session Introduction

Manuela Stoicescu

University of Oradea, Romania

Title: The cause of the left bundle branch block at a young patient
Speaker
Biography:

Manuela Stoicescu, Consultant Internal Medicine Doctor (PhD in Internal Medicine) now is Assistant Professor of Medical Disciplines Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania, Internal Medicine Hospital and Office. She is Member of Romanian Society of Internal Medicine, Member of Romanian Society of Cardiology, Chemistry, Biochemistry and Member of Balcanic Society of Medicine. She was invited as a speaker at 24 International Conferences, she is editorial board member in three ISSN prestigious Journal in U.S.A, she published 12 articles in prestigious ISSN Journals in U.S.A. she published four books: two books for students in English and Romanian language:” Clinical cases for students of the Faculty of Medicine”, one book in English language on Amazon at International Editor – Lambert Publishing Academic House in Germany- “Side Effects of Antiviral Hepatitis Treatment”, one monograph in Romanian language” High blood pressure in the young a ignored problem!”, two chapter books – Cardiovascular disease: Causes, Risks, Management CVD1- Causes of Cardiovascular Disease 1.5,1.6, U.S.A on Amazon.

Abstract:

The main objective of this clinical case presentation was to found the real cause of a young patient with major left bundle branch block. I present the clinical case of a young woman patient 26 years old, who performed an EKG like screening test and discover unexpected a major left bundle branch block. She was asymptomatic except weakness. At the objective examination she presented rush around the eyes and a few red patch on the hands around metacarpo-phalangeal joints. BP = 130/80mmHg, HR =78bates/min rhythmic, splitting S2, vesicular sound normal. Laboratory tests were in normal range. Echocardiography of the heart was normal. The main problem was that this major left bundle branch block was acute or chronic and the etiology of this block. 1.A congenital major left bundle branch block could be but mention that the patient had performed one other EKG in the past at 18years and was normal so this was an acute major left bundle brunch block and wasn’t congenital because in this situation must to be present on the EKG in the past. 2.An unknown congenital heart disease could be other cause of the left bundle branch block but the auscultation of the heart, except splitting S2, not detect any systolic or diastolic murmur heart and echocardiography and echo-Doppler of the heart was normal and excluded this possibility. 3. Acute myocardial infarction under left bundle branch block theoretical could be but the patient didn’t presented chest pain and the level of cardiac enzymes: Troponin T, CPKMB, LDH was in normal range. 4. Postreptococus infection with streptococcus betahaemolitic group B could be other possibility but naso faringian secretion was negative, titre ASLO = 150, ESR=12/20, fibrinogen =234mg%, hemoleucograma =normal. So also this cause was excluded. 5. The autoimmune disease ESR, fibrinogen, PCR, CIC, C3, C4, antibody AND double catena, lupus cells, ANCA negative. Because at the objective examination existed heliotrope rush and Gottron patch (spots) at the hands and she feel weakness I suspected dermatomiositis disease and was performed CPKMM, Autoantibody anti Mi2 was increase and anti Jo1was positives. A muscular biopsy was performed and after the histopathology examination was performed the result confirmed safe the diagnosis of dermatomiositis The presence of a major left bundle branch block at the young patients it is rare and unusual. The real cause sometimes it is difficult to found. In this clinical case report the etiology was a rare autoimmune disease-dermatomyositis. Sometimes when we discover in our medical practice a major left bundle branch block in the young we must to take into account also these rare but possible cause.- dermatomyosistis – a rare genetic disease who affected the striate muscle but also muscle of the heart and for this reason the conduction in the left branch of Hiss was blocked and develop major left bundle branch block.

Speaker
Biography:

Mais has completed her Master degree in clinical pharmacy at age of 25 years from Jordan University of science and technology/ Jordan. She is American Board certified pharmacotherapy specialist. She is a lecturer for at King Faisal University and preceptor of cardiology clerkship for PharmD students. She has published many articles in reputable journals. She is a member in different local and international heart and diabetes associations.

Abstract:

In real-world clinical practice, there is a wide gap between evidence based guidelines and their implementation. Therefore, the present study aimed to assess physicians’ and clinical pharmacists’ awareness about recently published guidelines for dyslipidemia. A structured questionnaire assessing participants’ knowledge about the most recent ACC/AHA (American college of cardiology/ American Heart Association) guidelines for dyslipidemia management was designed. After validation, the questionnaires were distributed to physicians and clinical pharmacists from different hospitals of Al-Ahsaa province in Saudi Arabia. After validation with ten participants (Cronbach’s alpha = 0.816), 150 questionnaires were distributed, 77 health care providers accepted to participate (acceptance rate=51.33%) and all of them completed the questionnaires. Most of participants had knew about the release of the ACC/AHA 2013 guidelines for dyslipidemia (77% of the physicians and 48% of the clinical pharmacist). However, knowledge and awareness with the major changes in the recommendations of dyslipidemia management were inadequate and nearly similar for both physicians and clinical pharmacists (The median score for physicians and pharmacists was 4 with a range of 1-9, Z= -0.15, p=0.88). Physicians and clinical pharmacists showed inadequate perception about major practice changes in the most recent ACC/AHA guidelines for dyslipidemia management. Interventions to increase awareness about these changes are needed.

Speaker
Biography:

Udaya Prashant Ponangi has graduated from JIPMER and did his DM cardiology training in Grant Medical College Mumbai, India. Currently he is working as interventional cardiology consultant in CARE Hospitalts, Banjara Hills, Hyderabad, India. He has around 10 international and national publications, 3 patents, and author of book on unexplained syncope. He did original research work on a new method of producing pulsatile flow from collapsible tubes, which has practical applications like producing hydroelectric power and novel laboratory simulator model of heart. Awarded Marquis Who`s Who in the World 2013 edition. He has contributed to new method of Guide Catheter selection in anomalous coronary arteries with critical stenosis.

Abstract:

During primary angioplasty, no reflow is one of the dreaded complications leading to poor procedural outcomes. The exact cause and treatment of this complication is uncertain. Sometimes due to large thrombus burden or delayed presentation wherein the thrombus becomes organized, it is difficult to improve thrombolysis in myocardial infarction (TIMI) flow by use of thrombus aspiration catheter alone or with adjuvant pharmacotherapy like infusing intracoronary Abciximab or thrombolytics. In such cases we cross the total occlusion containing thrombus by thombus aspiration catheter and perfuse the distal vessel with nicorandil mixed with contrast solution to assess the actual length of the lesion along with size and nature of distal vessel beyond totally occluded culprit artery. By this method not only distal microvasculature is protected by nicorandil before clot embolization but also appropriate sized stents can be deployed across the length of the thrombotic lesion trapping the thrombus against the vessel wall. This method minimizes intracoronary manipulations and reduces complication rates of no or slow flow during primary PCI. Between January 2013 and October 2014, 26 STEMI patients with no flow or TIMI I flow after thrombus aspiration during primary angioplasty were retrospectively analyzed. The results of using this novel method of infusing 2 mg intravenous nicorandil solutions mixed with 50% of iodine contrast in the distal culprit vessel through a coronary thrombus aspiration catheter (number of patients 14) were compared to those patients without use of this method (number of patients 12). Mean age of presentation was 52 years, more than half of the patients were males (60%) and the majority was anterior wall myocardial infarction (50%). The culprit vessel was left anterior descending artery LAD in the majority of cases (50%) right coronary artery RCA (40%) and rest (10%) had left circumflex artery involvement. The average window period of presentation is 10+/-2 hours. 12 patients were in cardiogenic shock and intra aortic balloon pump (IABP) was used in all these patients. In all MI patients thrombus aspiration catheter was used, and Gp2b3a inhibitors were used in all patients except 2 cases, which were rescue angioplasty cases. In 11 out of 14 patients, TIMI III flow was achieved when this novel method was used, whereas repeated attempts of thrombus aspiration and sometimes predilatation followed by blind stenting yielded adequate flow in only 4 out of 12 cases (p=0.0199). In nikorandil group 2 out of 14 patients succumbed, while in other group 4 out of 12 patients were dead at the end of 30 days after the procedure (p= 0.25) Our preliminary experience showed that use of this novel concept of infusing nicorandil mixed with contrast beyond the totally occluded culprit vessels in acute MI patients helps to helps to achieve better statistically significant TIMI flow rates following primary angioplasty. Even though mortality benefit was achieved it was not statistically significant. However larger scale multifactorial adjusted prospective randomized studies are required to confirm our initial observations.

Speaker
Biography:

Amr Omar has completed his Ph.D. at the age of 32 years from Cairo University and was assigned a lecturer in critical care in Cairo university hospitals, Egypt. He has published more than 20 papers and more than 20 presentations in reputed journals and international conferences. He has been serving as a reviewer in reputed journals as well.

Abstract:

The importance of optimal postoperative glycemic control in cardiac patients remains unclear. Various glycemic targets have been prescribed to reduce wound infection and overall mortality rates. To assess glucose control, as determined by time in range (TIR), in patients with glycemic targets of 6.0 to 8.1 mmol/L, and to determine factors related to poor control. Methodology: This prospective descriptive study evaluated 227 consecutive patients, 100 with and 127 without diabetes, after cardiac surgery. Patients received insulin to target glucose concentrations of 6.0 to 8.1 mmol/L. Patients were divided into two groups, those who maintained > 80% and < 80 % TIR. Outcome variables were compared in diabetics and non-diabetics. Patients with >80% and <80% TIR were matched in age, sex, gender, and Euro score. Failure to maintain target glycemia was significantly more frequent in diabetics (p=0.001), in patients with glycated hemoglobin (HbA1c) > 8% (p=0.0001), and in patients taking dopamine (p=0.04) and adrenaline (p=0.05). Times of CPB and ACC, length of stay in the ICU and ventilation were significantly higher in patients with TIR <80% than >80%. The incidence of wound infection was higher in patients with TIR <80%. No significant differences were found between the two ethnic groups (Arabs and Asians). Patients with >80% TIR, whether or not diabetics, had better outcomes than those with <80% TIR, as determined by wound infection, lengths of ventilation and ICU stay. Additionally, they were not subject to frequent hypoglycemic events. Preoperatively high HbA1C is likely a good predictor of poor glycemic control.

Amr Salah Omar

Hamad medical university, Qatar

Title: Statins in critical care
Speaker
Biography:

Amr Omar has completed his Ph.D. at the age of 32 years from Cairo University and was assigned a lecturer in critical care in Cairo university hospitals, Egypt. He has published more than 20 papers and more than 20 presentations in reputed journals and international conferences. He has been serving as a reviewer for reputed journals as well.

Abstract:

Owing to its immune modulatory, anti-inflammatory, antioxidant, antithrombotic and endothelial function actions, statins widely used in the critical care settings in diverse disease scenarios Highlight the pearls and pitfalls in the intensive care utilization of statins when hyperlipidemia and or ischemic heart disease are not the initiatives for treatment. Permissive effects are found in cardiac surgery due to statins in terms of reduction of postoperative atrial fibrillation, cardiac and renal functions. However, no strong evidence found to globalize utilization of statins in sepsis, pneumonia prevention and treatment, subarachnoid hemorrhage, acute brain injury, deep venous thrombosis prophylaxis. The use in acute respiratory distress syndrome is still under evaluation. Beneficial effects noted with the use of statins in cardiac surgery; however no strong evidence supports its utilization in a variety of situations in critical care settings.

Speaker
Biography:

Abdulaziz U Joury is 25 years old, recently graduated from the medical school at King Saud University, Riyadh, Saudi Arabia. Currently, he is working as Scholar Cardiology Physician in King Fahad Medical City. Trained at numerous hospitals. He represents his country nationally and internationally on several occasions. Held several classes and workshops covering medical field. Coordinated numerous campaigns and participating in number of researches.

Abstract:

Easy access to pharmacies and self-medication is common in Saudi Arabia. The interaction of pharmacists with cardiac patients and their counseling in is unknown. In this study we sought to explore how pharmacists interact and counsel cardiac patients. A total of 600 community pharmacies in the two large cities were randomly selected and stratified by the region, and time of the day and week. Two investigators visited each pharmacy and simulated having a parent with either chest pain for the acute coronary syndrome (ACS) scenario or shortness of breath for acute heart failure (AHF) scenario. Further information was provided only if asked for by the pharmacist. Other investigator observing the conversation, and once the conversation over, the results of this interview were recorded immediately after leaving the pharmacy. Of 600 pharmacies, 380 (63.3%) pharmacists advised the simulated patient to seek medical care, more so with the ACS scenario (70.3% vs. 56.3%, p<0.001). The pharmacists were likely to advice patients to seek medical advice during weekdays than weekends, and during the morning hours than during the evenings or nights. Pharmacists sought more information regarding other symptoms and comorbidities with the simulated ACS patients (59.7% vs. 48.7%, p= 0.009 and 46.3% vs. 37.3%, p= 0.031 respectively). Assessment of simulated cardiac patients by community pharmacists was inadequate and the quality of provided counseling is extremely suboptimal. This indicates the need for the implementation of major practice changes to improve the quality of service worldwide.