Day 2 :
Keynote Forum
Knox Van Dyke
West Virginia University, USA
Keynote: An inexpensive and effective treatment for Retroviruses like HIV and HTLVand also FIV and feline leukemia virus which can possibly lead to a cure
Time : 9:00-9:20
Biography:
Knox Van Dyke completed his PhD in Biochemistry in the Nobel Prize Department of Dr. Edward A Doisy at Saint Louis University in 1966. He began to study about malaria at West Virginia University Medical School and developed the first high throughput screening system for antimalarial drugs identifying mefloquine and halofantrine which were commercially developed. He and Associate Professor Zuguang Ye recognized bisbenzylisoquinolines synergize with chloroquine causing resistance reversal to chloroquine as demonstrated in Aotus monkeys creating a malarial cure. He edited and published 7 books for CRC Press, Boca Raton Florida and has written over 300 manuscripts.
Abstract:
Shreck and Bauerle in 1991 demonstrated that antioxidants and substances that inhibit the nf-kappa b transcription factor inhibit the replication of the human immunodeficiency virus in vitro (EMBO J 1991). Van Dyke and Owens studied the effect of anti-inflammatory steroids, and antioxidants-- vitamins C and E, N-acetyl cysteine and feline vitamins/ minerals on 6 cats (infected in the wild) with feline immunodeficiency virus (FIV) or feline leukemia (FL) or both. The serum from each cat was assayed before and after combinational treatment via SNAP ELISA for both FIV and FL. Positive virus assay is confirmed via blue color. After the cats were treated with the combination, they would be tested weekly for a period of several months. Depo-Medrol was the steroid used requiring injection every other week but the antioxidants were placed daily in the food or given by mouth. The animals were confined to prevent reinfection. After 3- 4 months, the animals produced a negative test for FIV/FL. Negative tests (PCR) were confirmed at Upjohn Pharmaceuticals and the cats gained weight and were healthy. An untreated but infected (control) cat died . When a similar treatment was used by a very ill 10 year human HIV survivor, he gained weight started feeling better after several months. Blood assay for HIV revealed undetectable levels at a year. All treatments for HIV have a latent untreatable state. Currently,we have found a substance which will activate the latent state with little toxicity raising the possibility of a cure with multiple combined treatments.
Keynote Forum
Knox Van Dyke
West Virginia University, USA
Keynote: An inexpensive and effective treatment for Retroviruses like HIV and HTLVand also FIV and feline leukemia virus which can possibly lead to a cure
Time : 10:00-10:30
Biography:
Knox Van Dyke completed his PhD in Biochemistry in the Nobel Prize Department of Dr. Edward A Doisy at Saint Louis University in 1966. He began to study about malaria at West Virginia University Medical School and developed the first high throughput screening system for antimalarial drugs identifying mefloquine and halofantrine which were commercially developed. He and Associate Professor Zuguang Ye recognized bisbenzylisoquinolines synergize with chloroquine causing resistance reversal to chloroquine as demonstrated in Aotus monkeys creating a malarial cure. He edited and published 7 books for CRC Press, Boca Raton Florida and has written over 300 manuscripts.
Abstract:
Shreck and Bauerle in 1991 demonstrated that antioxidants and substances that inhibit the nf-kappa b transcription factor inhibit the replication of the human immunodeficiency virus in vitro (EMBO J 1991). Van Dyke and Owens studied the effect of anti-inflammatory steroids, and antioxidants-- vitamins C and E, N-acetyl cysteine and feline vitamins/ minerals on 6 cats (infected in the wild) with feline immunodeficiency virus (FIV) or feline leukemia (FL) or both. The serum from each cat was assayed before and after combinational treatment via SNAP ELISA for both FIV and FL. Positive virus assay is confirmed via blue color. After the cats were treated with the combination, they would be tested weekly for a period of several months. Depo-Medrol was the steroid used requiring injection every other week but the antioxidants were placed daily in the food or given by mouth. The animals were confined to prevent reinfection. After 3- 4 months, the animals produced a negative test for FIV/FL. Negative tests (PCR) were confirmed at Upjohn Pharmaceuticals and the cats gained weight and were healthy. An untreated but infected (control) cat died . When a similar treatment was used by a very ill 10 year human HIV survivor, he gained weight started feeling better after several months. Blood assay for HIV revealed undetectable levels at a year. All treatments for HIV have a latent untreatable state. Currently,we have found a substance which will activate the latent state with little toxicity raising the possibility of a cure with multiple combined treatments.
Keynote Forum
Robert Michael Davidson
The American Institute of Stress, USA
Keynote: The ascorbate radical as a universal biological group transfer catalyst in inflamed tissue
Time : 10:30-11:00
Biography:
Robert Michael Davidson completed his PhD in Pharmaceutical Chemistry at the age of 26 from UCSF, NSF postdoctoral fellowship at the National Bureau of Standards, Center for Analytical Chemistry, MD degree at St Louis University School of Medicine, Nuclear Medicine residency at Baylor College of Medicine, Houston, Texas, and Internal Medicine residency in Phoenix, Arizona. He was Associate Medical Director for DuPont Pharma’s Radiopharmaceutical Division 1990-1992. He has published more than 30 papers in peer-reviewed journals. He is a Fellow of The American Institute of Stress (2012-present) and recently retired from complementary/alternative/integrative internal medicine practice in East Texas (USA).rnrn
Abstract:
We propose that the Ascorbate radical and its 2-O-substituted-L-ascorbate radicals provide lifelong modulators of redox kinetics and universal group transfer catalysts in inflamed tissue during the Sanarelli-Shwartzman Phenomenon, DIC syndrome, cancer, sepsis, neurodevelopment, and atherosclerosis. We propose that the Ascorbate radical is capable of catalyzing biological group transfer of sulfuryl, phosphoryl, nitrosyl, acyl, and glycosyl moieties in a biosemiotically- and biophysically-concerted, quantum coherent manner which is well-suited to proceed urgently under inflammatory conditions of low pH and high oxidative stress. We propose that the Ascorbate radical provides the biophysical basis for the high degree of temporal and spatial regiospecificity of the multitude of posttranslational modifications of HSPGs, acid mucopolysaccharides, which play essential roles in the inflammatory state, including recycling, proofreading, and editing of biomacromolecules. Human diseases may be characterized by derangements of transcriptional, translational, and posttranslational modifications of biomacromolecules. The reported inhibition by copper and ascorbate of plasmin, tPA, aryl sulfatases, and many serine proteases is mechanistically-generalizable, and plays an essential role in the modulation of redox kinetics, in vivo, throughout our lifetimes. Under our hypothesis, the Ascorbate radical sits at the nexus of biological group transfers and redox kinetics, with profound epigenetic, supramolecular, and biophysically-pleiotropic consequences. Importantly, its concentration is renewable and can be modulated orthomolecularly and biophysically. We will explore the detailed supramolecular basis and clinical implications, in a series of papers to follow.
- Diagnosis, Treatment and Management of Blood Disorders
Chair
Rania A Zayed
Cairo University, Egypt
Session Introduction
John Batchelor
Central Manchester Foundation Trust, UK
Title: Risk factors for intracranial haemorrhage in elderly patients with blunt head trauma
Biography:
J S Batchelor is currently a Consultant in Emergency Medicine at Central Manchester Foundation Trust, England UK. He graduated from Leeds University England, in 1982. He has written extensively on the subject of minor head injuries. He was one of the first investigators to identify the importance of headache and vomiting in patients with minor head injury. He has also recently published a meta-analysis on the effect on mortality of platelet transfusions in adults with spontaneous or traumatic anti-platelet associated intracranial haemorrhage. His current research interest lies in the area of risk factors for intracranial haemorrhage in TBI, particularly in patients on warfarin and antiplatelet agents.
Abstract:
Falls in the elderly are a common problem with an ever aging population. Head injury causing intracranial haemorrhage from a fall from standing is the major cause of mortality in the elderly age group. A meta-analysis by Batchelor et al. (2012) studied the effect of warfarin on mortality in patients with blunt head trauma. Eleven papers were identified, which met the criteria for the meta-analysis. Despite the heterogeneity between the studies (Q test: 27.421, 10 DF, P=0.002), the fixed effects model was the preferred model based on the fact that 10 out of the 11 studies had an odds ratio greater than one. The results showed that warfarin anticoagulation increases the mortality from blunt head trauma by an odds ratio of 2.008 (95% CI 1.634 - 2.467). The risk of intracranial haemorrhage from blunt head trauma in patients on aspirin agents is approximately 1.5 and the mortality is OR =2.435 (95% CI: 0.637-9.314). The result is not statistically significant and the level of evidence for this is poor. Previous investigators have published case series advocating the use of platelet transfusions in patients with blunt head trauma with intracranial haemorrhage who are taking antiplatelet agents. The evidence for this approach is poor. Desmopressin may be the preferred option. This paper aims to discuss these areas in more detail.
Annie Viallat
University Aix-Marseille, France
Title: Characterization of RBC mechanical properties by microfluidic techniques
Biography:
Annie Viallat is engineer of Ecole Polytechnique (Paris, France). She received her PhD in Physics from the University of Grenoble (France) in 1987, working on polymer gels and NMR. After a theoretical postdoctoral work on conjugated polymers in the Materials Departments (UC Santa Barbara), she joined the Spectrométrie Physique lab (Grenoble) in 1989, studying polymer gels and heterogeneous polymer solutions. Her research moved to biological physics in 1999. Since 2005, she is a group leader in Marseille (France). She works in The Interdisciplinary Center for Nanosciences (CINaM). She is interested in the dynamics in microflows of vesicles and blood cells. Her recent work focuses on the dynamics of red and white blood cells in shear flow and in biomimicking capillary networks. She is currently working on RBC mechanical properties and margination phenomenon in sickle cell anemia and on RBC elimination in the spleen. - See more at: http://hematology.conferenceseries.com/scientific-program.php?day=2&sid=972&date=2015-11-03#sthash.dz697VkX.dpuf
Abstract:
Red blood cell (RBC) deformability is postulated to be a major determinant of impaired perfusion, increase of blood viscosity and occlusion in micro-vessels. Deformability refers to the ability for the RBC shape to change in response to external mechanical stresses. For instance, current deformability tests such as ektacytometry1 measure global parameters related to shape changes at the whole cell scale. But for large surface area-to-volume ratios, many shapes can be found for a given set of values of cell surface area and cell volume. Shape change is obtained by redistribution of the inner cytoplasmic volume of the cell and involves only a small perturbation of the membrane energy due to local changes of the membrane curvature. However, strong shear deformation of membrane elements can occur without shape change, for instance after a displacement of the membrane elements along the discocyte shape. These local deformations are typically involved during the tanktreading motion of RBCs in blood flow. They are governed by the viscoelastic properties of both cell membrane and cytoplasm. Finally, the term deformability is also often used to evoke the propensity of the cell membrane to rupture under a tension, for example in a vessel constriction or in the spleen. Despite strong advances in our understanding of the molecular organization of RBCs, the relationships between the global deformability tests, the cell behavior both in micro-flows and in vivo and the rheology of each element of RBCs composite structure are still not elucidated.We propose microfluidic tools to assess the mechanical parameters of RBCs at both suspension and single-cell level. We believe that these tools can be exploited to probe cellular-scale changes to environmental factors. We first show that i) the critical shear rate of the tanktreading-to-tumbling transition and ii)the variation of the swinging frequency with the shear rate of RBCs in shear flow enable the determination of two mechanical parameters2. First, an effective viscosity that accounts both for the cytoplasm and the membrane viscosity, and, second, an effective shear elasticity that accounts both for the shear modulus of the membrane and the stress-free shape of the cell. The stress-free cell shape is the shape for which the membrane elements are not deformed. Recently it was suggested that this shape is close to the sphere for healthy cells. The existence of other possible stress-free shapes in pathological cells has never been investigated and is still an open question. We also show that, in less viscous fluids, the orientation of RBCs versus the shear rate is a signature of the cell shear modulus. We then show that the entrance of RBCs in narrow channels enables the characterization of the fragility of RBCs to membrane rupture. Finally, we show that microfluidics enables to subject flowing RBCs to various environmental factors (such as oxidative stress or variation of dioxygenation) and to measure their mechanical response in-situ. - See more at: http://hematology.conferenceseries.com/scientific-program.php?day=2&sid=972&date=2015-11-03#sthash.dz697VkX.dpuf
Rania A Zayed
Cairo University, Egypt
Title: Indoleamine 2,3 dioxygenase and regulatory T cells in acute myeloid leukemia
Biography:
Rania Zayed is Assistant Professor of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Egypt. She completed the Doctorate degree at the age of 31 and is an imminent member of the hematology department team. She participated in several national and international conferences in hematology and stem cell research.
Abstract:
Background & Objectives: The microenvironment of acute myeloid leukemia (AML) is suppressive for immune cells. Regulatory T cells (Tregs) have been recognized to play a role in helping leukemic cells to evade immunesurveillance. The mesenchymal stem cells (MSCs) are essential contributors in immunomodulation of the microenvironment as they can promote differentiation of Tregs via the indoleamine 2,3-dioxygenase (IDO) pathway. The aim of the present work was to evaluate the expression of IDO in bone marrow derived MSCs and to study its correlation to percentage of Tregs. Methods: 37 adult bone marrow samples were cultured in appropriate culture medium to isolate MSCs. Successful harvest of MSCs was determined by plastic adherence, morphology and positive expression of CD271 and CD105; negative expression of CD34 and CD45 using flowcytometry. MSCs were examined for IDO expression by immunocytochemistry using anti-IDO monoclonal antibody. CD4+ CD25+ cells (Tregs) were measured in bone marrow samples by flowcytometry. Results: MSCs were successfully isolated from 20 of the 37 bone marrow samples cultured. MSCs showed higher expression of IDO and Tregs percentage was higher in AML patients compared to control subjects (p=0.002 and p<0.001 respectively). A positive correlation was found betweenIDO expression and Tregs percentage (p value=0.012, r=0.5). Conclusion: In this study we revealed an association between high IDO expression in MSCs and elevated levels of Tregs which has an important role in the pathogenesis of AML, providing immunosuppressive microenvironment.
P K Sasidharan
Govternment Medical College Kozhikode, India
Title: ‘Kozhikode Criteria’ for diagnosing SLE as a haematological disorder
Biography:
P K SasidharanP. K. Sasidharan Professor of Medicine& Head, Department of Medicine & Hematology, Government Medical College, Calicut, He had been the best outgoing student of the University of Calicut and took M.D General Medicine, from Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. He was recipient of several awards and fellowships. 72 publications in journals including two land mark studies on Vitamin D deficiency and on SLE. Author of two books DOCTORS POCKET COMAPININON and HEALTHY INDIA. Written chapters in text books of Medicine and Hematology. Actively involved in health promotion in India. He had held before posts like Chairman PG Board of studies Kerala University of Health Sciences; Member, Editorial Board “Indian Journal of Hematology and Transfusion Medicine”, PhD research Guide for University of Calicut, President Association of Physicians of India (API) Kerala State Chapter, Scientific Advisory committee Member- National Institute of Immuno Hematology, Mumbai, Vice President Hypertension Society of India, Dean Faculty of Medicine, University of Calicut, Director Malabar Cancer Center- additional charge, State President, Kerala Govt. Medical College Teachers Association.
Abstract:
Systemic Lupus Erythematosus (SLE), is an autoimmune disease in which cells and tissues undergo damage mediated by tissue binding auto antibodies. At its onset it may involve any one organ alone or more than organs simultaneously; over a time additional manifestations due to involvement of multiple organs may occur. The criteria used till 2012 was the American College of Rheumatology (ACR) Criteria, which is only a classification criteria and not really for diagnosis; if we rely on ACR criteria, the diagnosis is often delayed denying the benefit of early treatment. Time required for satisfying all 4 of the 11 criteria is variable and prolonged. Moreover hematological manifestations, which are commoner than other manifestations, are underrepresented in the ACR criteria. Based on the clinical observations made on patients evaluated in our tertiary center in North Kerala, an alternate diagnostic criteria named the ” Kozhikode Criteria” was proposed. The present study was an attempt to validate the same and to look for any association of diet and lifestyle to the disease
Rehman Suhailur
Aligarh Muslim University, India
Title: Blood transfusion reaction in pediatric age group: A tertiary care centre based study
Biography:
Dr Suhailur Rehman, known for his experience in Hematology, Transfusion Medicine, Histopathology and Cytopathology, was born in 1st May 1984 in District Bijnore. He belongs to a very small town NOORPUR and with his hard work and consistenty, reached the present position. He has done his MBBS and MD Pathology from JN Medical College, AMU, Aligarh. He worked in world famous Institute SGPGIMS, Lucknow, India as a Senior Resident in Transfusion Medicine. At present he is working in JNMCH, AMU, Aligarh, India. His wife, Dr Sana Siddiqui is also a good and meritorious student. She got gold medal in Pediatrics and honours in Anatomy during MBBS examinations. His 13 papers are published, out of which 11 are published in International and 2 in National Journals. He presented 10 Oral papers and 24 poster papers in various Conferences/CMEs attended. He got First prize in one Oral paper and one poster paper presentation. He attended 37 conferences/CMEs/symposium and 15 workshops/training programmes. He is a sincere, enthusiastic and a dedicated young Doctor, who has a strong inclination towards research work. His approach to diagnostic work is logical and he is able to correlate his knowledge with patient’s clinical information properly. He loves to teach and his teaching style is very much appreciated by undergraduate and postgraduate students.
Abstract:
Pediatric transfusion concerns are usually divided into two periods: Neonates from birth through 4 months and older infants (>4 months) and children. Neonate and infants in this age group are considered separately, not only because of their small blood volume but also due to unique physiological factors such as decreased production of endogenous Erythropoietin (EPO) in the premature infant in response to anaemia and physiological anaemia of infancy. Similarly the transfusion associated reactions also differ in neonates and children from adult. While analyzing the transfusion reaction, it was found that febrile non hemolytic transfusion reaction was the most common transfusion reaction encountered during study period. Transfusion reactions were most commonly seen in whole blood as compared to other components. Febrile reactions were more common in whole blood and Platelet transfusion. Also comparison of whole blood and Packed RBC transfusion was done in terms of mean rise in haemoglobin and transfusion reaction.
- New Drug Development in Hematology
Session Introduction
Knox Van Dyke
West Virginia University, USA
Title: Development of a new approach to treat children and pregnant women infected with falciparum malaria using effective antimalarial drugs and supplements which stimulate the immune system
Biography:
Knox Van Dyke completed his PhD in Biochemistry in the Nobel Prize Department of Dr. Edward A Doisy at Saint Louis University in 1966. He began to study about malaria at West Virginia University Medical School and developed the first high throughput screening system for antimalarial drugs identifying mefloquine and halofantrine which were commercially developed. He and Associate Professor Zuguang Ye recognized bisbenzylisoquinolines synergize with chloroquine causing resistance reversal to chloroquine as demonstrated in Aotus monkeys creating a malarial cure. He edited and published 7 books for CRC Press, Boca Raton Florida and has written over 300 manuscripts.
Abstract:
Despite the availability of adequate preventatives, falciparum malaria is still responsible for the deaths of hundreds of thousands of people yearly. The majority of these victims are young children and pregnant women. The key question is why does this occur? The vulnerability of these populations is likely caused by a deficiency in nutrition affecting the host immune system. Scientists have demonstrated that falciparum malaria patients (FMP) have a biochemical deficiency caused by insufficient amounts of the amino acid L-arginine (L-arg). L-arg is substrate for the enzyme- nitric oxide synthase 2 (NOS2) which generates large amounts of nitric oxide (NO). NO reacts with a form of oxygen which generates a substance which can kill the malarial parasite. The parasite protects itself by producing and releasing L-arginase which degrades the l-arginine of the host thus preventing the NO-based toxicity. Children need L-arginine as an essential amino acid to be healthy so the parasite depletes this amino acid and prevents a needed substance from being used by their body and it also prevents the production of this key ingredient to fight the parasite. This same scenario likely occurs to the unborn child in pregnant women. In addition, pregnancy produces a somewhat immunosuppressed state causing increased morbidity and mortality. We plan to study the combination of artemether and lumefantrine with several types of sustained release nitric oxide nutritional supplements compared to drugs alone in these two populations.
Biography:
Erhabor Osaro completed his Ph.D. in Immuno-hematology at Rivers State University of Science and Technology at Rivers State, Nigeria. He is a fellow of the Institute of Biomedical Science London. He has many scientific awards including the British Blood Transfusion Society and Margaret Kenwright- young scientist’s awards. He has written more than 140 articles, 4 books and 5 book chapters. He is reviewer and editor of several scientific journals from around the world.
Abstract:
Despite the availability of adequate preventatives, falciparum malaria is still responsible for the deaths of hundreds of thousands of people yearly. The majority of these victims are young children and pregnant women. The key question is why does this occur? The vulnerability of these populations is likely caused by a deficiency in nutrition affecting the host immune system. Scientists have demonstrated that falciparum malaria patients (FMP) have a biochemical deficiency caused by insufficient amounts of the amino acid L-arginine (L-arg). L-arg is substrate for the enzyme- nitric oxide synthase 2 (NOS2) which generates large amounts of nitric oxide (NO). NO reacts with a form of oxygen which generates a substance which can kill the malarial parasite. The parasite protects itself by producing and releasing L-arginase which degrades the l-arginine of the host thus preventing the NO-based toxicity. Children need L-arginine as an essential amino acid to be healthy so the parasite depletes this amino acid and prevents a needed substance from being used by their body and it also prevents the production of this key ingredient to fight the parasite. This same scenario likely occurs to the unborn child in pregnant women. In addition, pregnancy produces a somewhat immunosuppressed state causing increased morbidity and mortality. We plan to study the combination of artemether and lumefantrine with several types of sustained release nitric oxide nutritional supplements compared to drugs alone in these two populations.
- Young Researchers Forum
Session Introduction
Nikhil Mukhi
SUNY Downstate Medical Center, USA
Title: Adult T-cell leukemia/lymphoma (ATLL): Where we are in 2015
Biography:
Nikhil Mukhi has received his MBBS degree from Gandhi Medical College, India. He has completed his Internal Medical Residency from New York Medical College, NY and he is currently in his Hematology/Oncology Fellowship at State University of New York Downstate Medical Center, NY. His clinical interests are in T-cell lymphomas. He has been doing research on effective first line therapy in Adult T-cell leukemia/lymphoma (ATLL) and optimal regimens in relapsed/refractory setting.
Abstract:
ATLL is an aggressive peripheral T-cell lymphoma (PTCL) associated with clonal proviral DNA integration of human T-cell lymphotropic virus type 1 (HTLV1) with T-lymphocyte. Despite enormous advances in our understanding and treatments of aggressive lymphomas, the progress in ATLL has lagged behind. The acute and lymphomatous types have a poor prognosis with median survival of 6-13 months. Molecular and genetic characterization of this malignancy has been limited due to their rarity and often non-specific morphologic and immunophenotypic features. Currently gene expression profiling and gene sequencing studies are underway for better characterization of genetic abnormalities in this disease. Traditional chemotherapy agents are not very effective in this disease and recently the role of epigenetic dysregulation has been recognized in this disease, which may explain its sensitivity to histone deacetylase (HDAC) inhibitors. In the last 6 years, 4 new drugs have been approved by FDA for patients with relapsed/refractory PTCL: Pralatrexate and 3 HDAC inhibitors (romidepsin, belinostat & vorinostat). Multiple trials are currently underway to explore the integration of these agents in first line setting with standard chemotherapy. These recent advances are changing how we view this disease and hopefully have prepared us to change the future of this disease.
Suresh Manapuram
Allegheny General Hospital, USA
Title: Post-ERCP pancreatitis: A rare cause of atypical hemolytic uremic syndrome
Biography:
Suresh Manapuram has received his M.B.B.S degree from Rangaraya Medical College affiliated to N.T.R University of Health Sciences, India. He then served Ministry of Health, Govt of India for 2 years as a medical officer in Primary Health Care Center. Out of his interest in Academic medicine, he pursued a 2 year Clinical Teaching and Research fellowship program at St. George’s University, Grenada. He served as a faculty member in the Department of Neurosciences and Physiology for 3 years at Xavier University School of Medicine, Aruba. He then joined Allegheny Health Network in July 2014; currently he is a resident in Internal Medicine residency program at Allegheny General Hospital, Pittsburgh. His career interests include Academic Medicine, Hematology and Oncology.
Abstract:
Introduction: Atypical hemolytic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA). It involves dysregulation of the alternate complement pathway affecting multiple organ systems. Here, we present a previously unreported case of aHUS developing after post-ERCP pancreatitis. Case report: A 52-year-old female with a history of cholelithiasis presented with abdominal pain and jaundice. Physical exam revealed RUQ tenderness without guarding. Laboratory findings showed normal cell counts with elevated bilirubin and liver enzymes. MRCP revealed gallstones with biliary sludge and she underwent ERCP with sphincterotomy. Post-ERCP, she developed severe epigastric pain with vomiting and worsening jaundice. Labs revealed elevated lipase consistent with ERCP induced pancreatitis. After four days, she developed acute anemia, thrombocytopenia and acute renal failure requiring hemodialysis. Laboratory data showed elevated bilirubin, LDH and low Haptoglobin levels. Kidney biopsy confirmed thrombotic microangiopathy. Atypical HUS was diagnosed based on low ADAMTS 13 activity, thrombocytopenia and hemolytic anemia in the presence of pancreatic and renal dysfunction. Therapy with eculizumab was initiated and laboratory findings after 10-weeks of eculizumab therapy showed improvement of platelet count, anemia and renal recovery. Conclusion: Differentiating aHUS from other causes of TMA is challenging, though ADAMTS 13 activity and stool testing can exclude TTP and HUS from aHUS. aHUS needs to be accurately diagnosed since different pathology will necessitate different therapies. Prompt diagnosis and treatment of aHUS is very essential as early initiation of therapy with eculizumab has a major impact on survival and preservation of renal function
Debipriya Banerjee,
Sinha Institute of Medical Science & Technology, India
Title: The role of different aggregating agents in the inhibition of nitric oxide synthesis in platelet aggregation
Biography:
Debipriya Banerjee is a PhD student recently submitted her thesis under Department of Physiology, University of Calcutta, India. Her work focuses on understanding the interplay between nitric oxide and the increased occurrences of acute coronary syndromes. She is a Master degree topper with a gold medal. She has received financial support from Government of India to present her findings in the conference.
Abstract:
The aggregation of platelets is by the activation of cyclooxygenase (COX) that catalyzed the conversion of arachidonic acid to prostaglandins and to thromboxane A2 (TXA2). No mechanism of release of arachidonic acid from the platelet membrane is currently available. The candidate for the first time ever reported that the inhibition of nitric oxide (NO) synthesis ultimately resulted in increased aggregation of platelets that has been reported to result in the development of acute coronary syndrome (ACS). NO was measured by methhemoglobin method. The purified nitric oxide synthase (NOS) was prepared by repeated gel electrophoresis using of the platelet cytosolic fraction by SDS-PAGE and the amino acid sequence of the purified protein was determined by mass spectrometry. Incubation of platelet rich plasma (PRP) with 8.0µM ADP resulted in increased platelet aggregation (~90%) with simultaneous reduction of basal NO level to 0nmol/108 platelets, PË‚0.0001, n=10). It was found that different aggregating agents reduced the basal NO synthesis in platelets by ~50%. This reduction resulted in the appearance of Ca2+ in the platelet cytosol and in the release of arachidonic acid from the platelet membrane for TXA2 synthesis. This novel NOS was identified to be α-1 anti trypsin (AAT), a 47kDa protease inhibitor as determined by amino acid sequence. The results demonstrated that the reduction of NO level in platelets is a priori event in the activation of COX leading to the aggregation of platelets. The identification of the NOS as the AAT can be a therapeutic target for the treatment of ACS.
Ayesha Mahmud
Birmingham Women’s NHS Foundation Trust, UK
Title: Haemostatic techniques for laparoscopic management of cornual pregnancy: The double impact devascularization technique
Biography:
Ayesha Mahmud is a Member of the Royal College of Obstetricians and Gynecologists, UK. She is an Obstetrics and Gynecology Trainee in the West Midlands region and she is currently undertaking research in maternity outcomes as part of her PhD research at the University of Birmingham. She has completed her MBBS with Honors and Distinctions from Foundation University, Pakistan. She is Co-chair of the MROG (Midlands Research Collaborative for Obstetrics & Gynecology trainees), a trainee led research organization. She has published several papers in reputed journals and she has been serving as part of the Editorial Board for StratOG; the RCOG's interactive eLearning resource.
Abstract:
Cornual pregnancy is a rare form of ectopic pregnancy, accounting for up to 2% to 4% of all ectopic pregnancies with a mortality range of 2.0% to 2.5%. Hemorrhage is a key concern in the management of such pregnancies. Traditional treatment options include a conservative approach, failing which patients are offered surgical options such as cornual resection at laparotomy which carries a high risk of hysterectomy. In recent years newer laparoscopic cornual resection or cornuotomy techniques have been used successfully to achieve better outcomes with fewer complications. We present the double-impact devascularization (DID) technique for laparoscopic management of cornual ectopic pregnancies. This technique permits hemostatic control by compression effect, which in turn allows reduction in procedure-related patient morbidity and mortality. We also provide an overview of other reported methods of hemostatic control used in similar laparoscopic procedures. DID is a useful, safe and minimally invasive technique that can be used in both laparoscopic and open surgical procedures
Suhailur Rehman
Aligarh Muslim University, India
Title: Correlative study of Mentzer’s index, RDWI and Hb electrophoresis for β- thalassemia trait
Biography:
Dr Suhailur Rehman, known for his experience in Hematology, Transfusion Medicine, Histopathology and Cytopathology, was born in 1st May 1984 in District Bijnore. He belongs to a very small town NOORPUR and with his hard work and consistenty, reached the present position. He has done his MBBS and MD Pathology from JN Medical College, AMU, Aligarh. He worked in world famous Institute SGPGIMS, Lucknow, India as a Senior Resident in Transfusion Medicine. At present he is working in JNMCH, AMU, Aligarh, India. His 13 papers are published, out of which 11 are published in International and 2 in National Journals. He presented 10 Oral papers and 24 poster papers in various Conferences/CMEs attended. He got First prize in one Oral paper and one poster paper presentation. He attended 37 conferences/CMEs/symposium and 15 workshops/training programmes. He is a sincere, enthusiastic and a dedicated young Doctor, who has a strong inclination towards research work. His approach to diagnostic work is logical and he is able to correlate his knowledge with patient’s clinical information properly. He loves to teach and his teaching style is very much appreciated by undergraduate and postgraduate students.
Abstract:
The two most frequent types of microcytic anemia are beta thalassemia trait (β-TT) and iron deficiency anemia (IDA). Differentiation between the two is very important as individuals with the β-TT are usually asymptomatic and may be unaware of their carrier status unless diagnosed. It is estimated that about 50% of the world’s population with β-TT are in Southeast Asia. Electronic cell counters have been used to determine Mentzer’s index and Red cell distribution width index (RDWI) as a screening tool for β-TT. However, a definitive diagnosis of β-TT is based on the level of HbA2 on Hb electrophoresis. Considering the importance of diagnosing β-TT at an earlier stage, this study was carried out to determine the effectiveness of mentzre’s index and RDWI as a screening tool for β-TT. All those patients who are having MCV< 80, Mentzer’s index < 13 and RDWI< 220 were included in this study. A total of 1418 patients were having MCV< 80, out of which 58 patients were having mentzer’s index <13 and 54 patients having RDWI <220. Hb electrophoresis was done on patients having mentzre’s index <13 and RDWI <220. Hb A2 level between 3.5% and 8% was seen in 86% of the patients in mentzer’s index group and 92% of the patients in RDWI group. This study showed that RDWI was a better and more accurate predictive marker for β-TT as a screening tool, in comparison to mentzre’s index. The importance of mentzre’s index and RDWI lies in the fact that both the screening methods can be used to determine the patients who are the best candidates for Hb electrophoresis. This will ease the diagnosis of β-TT, especially in developing and under developed countries where the facilities are not available so easily. Keywords: Mentzer’s index, RDWI, Hb electrophoresis, β- thalassemia trait
Olivia Ndjib
Antananarivo University, Madagascar
Title: Hemophilia- Evolution and challenges in Madagascar
Biography:
Olivia Ndjib is a third year medical student in the School of Medicine of Antananarivo, Madagascar. Since 2012, she has been facilitating meaningful and open discussions on health issues like AIDS, blood diseases, and autism in the General hospital of Madagascar, where she volunteers as a blood giver and works as a Medical Assistant (on internship). Her ambition is to work as a researcher to develop sustainable scientific method to prevent and cure blood related diseases in Africa
Abstract:
During the last past 5 years, there has being a growing concern on the increasing number of patients suffering from blood diseases in Madagascar. Regardless of illnesses such as Leukemia, Polycythemia and Sickle cells diseases, Hemophilia is the most observed. As a fact, 7 patients out of 10 received in the Hospital of Antananarivo (Hopital Joseph Ravoahangy Andrianavalona) do not survive. This precarious situation could be linked to the lack of specialists to ensure a good treatment, the ignorance of the medical personnel, the lack of sensitization of the population, cultural barriers, poverty and lack of research on these diseases in Madagascar. According to Pr Olivat RAKOTO, (only Hematologist Specialist in the Indian Ocean) but also my lecturer, there is not a reliable databank on the number of people suffering from Hemophilia and other related blood disorder in Madagascar. From her personal research, observations and clinical cases, more than 1700 of people suffering of hemophilia are not receiving adequate follow-up in the only town of Antananarivo. The impact of the situation described above on the mortality rate and the economic balance of the country is alarming. There should be a raise of awareness on this plague, which is becoming a critical public health issue in Madagascar.
- Poster presentation
Session Introduction
Vera-Aguilera Jesus
Texas Tech University Health Sciences Center, USA
Title: Bilateral orbital myeloid sarcoma preceding acute myeloid leukemia in an adult: Case report and review of the literature
Biography:
Vera-Aguilera Jesus is a physician of Internal medicine and oncology at Texas Tech University Health Sciences Center, USA. Cancer biology is his area of expertise.
Abstract:
Introduction: Acute myeloid Leukemia is typically a disease of the older population presenting mostly in the fifth decade of life. Myeloid sarcoma is rare presentation of acute myeloid leukemia previously well reported in children and younger population. We present an unusual case of retro-orbital myeloid sarcoma as an initial presentation of acute myeloid leukemia in a 43 year old Caucasian male. Case Report: In the present case, a 43-year-old male with prior unsuccessful retro-orbital masses biopsies presented with pancytopenia, further studies revealed the diagnosis of AML. The presence of retro orbital masses preceding AML is a rare, to our knowledge since 1993, a total of 11 cases of granulocytic sarcoma preceding AML in adults have been reported, most of them presenting with the cytogenic (8:21) feature with fair prognosis, in the present case we describe a very aggressive case of myelomonocytic leukemia positive for CD34 and CD117 and rearrangement of chromosome 11q23 involving MLL gene with fatal outcome. Differential diagnosis in adults who present with similar symptoms is broad and require a high index of suspicion; in a recent review performed by Priego 2012, differential diagnosis should include inflammatory/metabolic disease (orbital inflammatory pseudo tumor, thyroid orbitopathy, sarcoidosis) and neoplasm (lacrimal tumors, lymphoma and metastasis); however, the clinical behavior and response to therapy seem not influenced by age, sex, anatomic site, de novo presentation or clinical history related to AML, MDS or MPN, histotype, phenotype or cytogenetic findings. Conclusion: Granulocytic sarcoma or myeloid sarcoma is an uncommon malignant neoplasm associated with myeloid leukemia, the differential diagnosis in this age is broad and diagnosis is a challenge, therefore a multidisciplinary approach, an appropriate clinical exam and history accompanied by a high index of suspicion are needed for proper diagnosis and treatments to avoid fatal outcomes.
Divyaswathi Citla Sridhar
The University of Texas Health Science Center, USA
Title: Painful calf swelling: Think beyond deep vein thrombosis
Biography:
Divyaswathi Citla Sridhar is a Pediatric Resident at The University of Texas Health Science Center at Houston (UTHealth). She previously worked at Cleveland Clinic, PSG Institute of Medical Sciences & Research, The University of Texas Health Science Center at Houston (UTHealth).
Abstract:
Introduction: The differential diagnosis for unilateral painful swollen limb is broad; deep vein thrombosis (DVT), calf muscle tear, ruptured popliteal cyst, cellulitis, myositis, intramuscular hematoma, compartment syndrome and superficial thrombophlebitis. It is important to rule out DVT, considering the morbidity and mortality if it is unrecognized. Case Report: We present the case of a 4 year old Hispanic male with no past medical history, referred to our institution with left lower extremity pain and swelling after he tripped over a cord and fell one week prior to admission. On physical examination, his left mid-calf was edematous, non-erythematous and tender to palpation Left lower extremity (LLE) Doppler ultrasound (US) from the outside hospital was reported as left posterior tibial DVT and the patient was started on Enoxaparin (1 mg/kg/dose SQ every 12 hours). He was transferred to our institution for anticoagulation management. Repeat LLE Doppler US at our institution did not reveal DVT. In addition, D-dimer was not elevated and his hypercoagulable work up including protein C, protein S, anti-thrombin III, Factor V Leiden and prothrombin gene mutation was negative. On follow up examination, his left calf swelling had worsened and extended into the anterior aspect of the leg. Due to the absence of DVT by repeat Doppler US and clinical suspicion of intramuscular bleeding, Enoxaparin was stopped within 24-36 hours of initiation. MRI/MRV of the affected leg confirmed the presence of a large sub-acute on chronic hematoma identified within the deep muscular compartment of the mid left calf, interposed between the gastrocnemius and soleus musculature measuring 17 mm×26 mm×57 mm with no evidence of DVT. Further coagulation labs showed Factor VIII level at 24% and Factor IX level at 94%, confirming a diagnosis of mild hemophilia A. Hence, Factor VIII concentrate was administered for bleeding control. Discussion: A detailed clinical evaluation in addition to radiological evidence for DVT is warranted before initiating anticoagulation therapy, as it can aggravate non-thrombotic causes of painful calf swelling such as intramuscular bleeding. Between 10-20% of patients with hemophilia A can have an atypical initial presentation with an intramuscular bleed. Early identification and proper management of intramuscular bleeding with factor replacement is important to prevent re-bleeding, neurovascular compromise, permanent contracture and formation of pseudo-tumors. Therefore, a high index of suspicion is warranted in such cases.
Shereen Elazzazy
Hamad Medical Corporation, Qatar
Title: Clinical outcomes of implementing evidence-based practice on venous thromboembolism prevention for cancer patients in Qatar: A retrospective study
Biography:
Shereen Elazzazy has received her Bachelor’s degree in Pharmacy from Egypt in 1997 and her Doctor of Pharmacy degree at Purdue University, USA in 2011. She has extensive international experience working in Egypt, KSA and Qatar and recently completed Internship in Indiana, USA. She is currently an Assistant Director of Pharmacy-Clinical Services in NCCCR, Qatar, an Adjunct Clinical Faculty in College of Pharmacy, Qatar University, a Clinical Preceptor for College of Science, North Atlantic, Qatar, Local Mentor for Pharmacy School, Queen’s University, UK and a Clinical Sponsor, PharmD program, University of Colorado, USA. She has numerous peer reviewed publications and international conferences presentations.
Abstract:
Background: Venous ThromboEmbolism (VTE) is a serious condition; approximately 20% of VTE cases occur in cancer patients and it is a significant cause of morbidity and mortality. Hospitalized patients with cancer require VTE prevention. Breast cancer is considered a high risk for VTE due to different factors (malignancy, surgery, chemotherapy, hormonal therapy, hospitalization and female gender). Objectives: This study focuses on the assessment of clinical outcome in preventing VTE in cancer population in Qatar after implementation of evidence based VTE prevention guidelines. Methods: A retrospective study was conducted to evaluate the incidence of DVT by evaluating Doppler ultrasound, database for 364 cases of in/out-patients over 24 month (Jan 2011-Dec 2012) findings were analyzed by a hematologist to identify patients who developed DVT due to current or previous admission. Relationship between the incidence of VTE overtime and the compliance to VTE prevention protocol were established. Results: The study showed that the increase in the overall compliance to VTE prophylaxis protocol introduced to inpatients population (n=2595) increased from 61.5% to 84.6% (P=0.0297); led to decreased DVT incidence by 66.4% (P=0.0145). 50% of cancer cases developed DVT were breast cancer patients (n=24), 92% of them were outpatients.
Nevene Ramsis
Canal University Medical School, Egypt
Title: Assessment of CCAAT/enhancer binding protein α gene methylation in acute myeloid leukemia patients in Egypt: relation to response to induction therapy
Biography:
Nevene Ramsis Wissa was born in Cairo, on January 18th,1956. She is currently working as a professor at Canal University Medical School, Egypt.
Abstract:
Background: Global gene promoter studies, as well as gene-specific approaches, have revealed that aberrant promoter methylation is a common event in AML. One such gene, CCAAT/enhancer binding protein α (C/EBP α), is a key transcription factor involved in the regulation of cell proliferation and differentiation in a variety of cell types, particularly in the hematopoietic system. Because of the pharmacologic reversibility of epigenetic changes by drugs, such as the DNA-demethylating agent, epigenetic therapy seems prominently among novel leukemia treatment strategies. Purpose: The present work is a cohort study that aimed at assessing the frequency of promoter methylation of the CEBP α gene in 70 cytogenetically normal, newly diagnosed AML Egyptian patients. Furthermore, the relation between the methylation status of the CEBP α gene and the outcome of standard induction therapy on day 28 was evaluated. Patients and methods: purified genomic DNA samples from the 70 newly diagnosed AML patients were subjected to bisulfate modification before methylation-specific polymerase chain reaction was performed to assess the CEBP α gene methylation status. Clinical and laboratory assessment of patients after 28 days of induction of standard therapy was performed. Results and conclusion: fifty-four percent of AML samples showed CEBP α gene methylation at the promotor region. Positive methylation was seen associated with blast expression of T-cell markers and blast counts in peripheral and bone marrow samples; but did not privilege a particular FAB classification subtype or relate to age and gender. The positive CEBP α gene methylation status was seen acceptable to predict AML patients with resistant clone who did not respond to standard induction therapy and blast clearance at day 28 (95% CI: 0.466–0.985, p= 0.005). Assessment of CEBP α gene methylation in AML patients might lead to refined prognostic stratification and suggest differentially tailored treatment based on its methylation status.
Biography:
Amandeep Kaur has completed her Master’s degree in Medical Surgical Nursing (Oncology Nursing) from Baba Farid University of Health Sciences, Faridkot. She is currrntly pursuing Doctorate in nursing from Himalayan University, Arunachal Pradesh. She is teaching anatomy & physiology, Biochemistry, medical surgical nursing and oncology nursing since last four years. She is guiding graduate and master’s students in research work. She has published 3 papers in reputed journals and presented papers in national and international level. She is also a Blog Writer for concept research foundation.
Abstract:
Multiple myeloma is a deadly disease in which relapse is inevitable. Multiple myeloma is a B-cell malignancy of the plasma cells. Its three hallmarks include the presence of a serum or urine monoclonal immunoglobulins, monoclonal plasma cytosis and bony lytic lesions. According to SEER by NCI in 2015, 26850 new cases have been detected and 11240 deaths took place in USA alone. According to population based cancer registries, in India, incidence varies from 0.3 to 1.9 per 100000 for men and 0.4-1.3 per 100000 for women. Delhi has the highest incidence. According to research, translocation of immunoglobulin heavy chain (Ig H) locus (14q32) and deletion of chromosome 13 were found in 75% and 45% of patients with plasma cell disorders, respectively. Clinical manifestations include bone pain, particularly in the back and chest. Others are anemia, uremia and recurrent infections. The most common physical finding related to MM is pallor. Treatment options for patients with MM include primary induction therapy for transplant candidates, primary induction therapy for nont-ransplant candidates, maintenance therapy and salvage therapy. Innovative approaches in high-dose chemotherapy, use of biphosphonates, discovery of a novel proteasome inhibitor, liposomal doxorubicin and development of lenalidomide are among the most encouraging breakthroughs in therapeutics. Non-profit organizations are established for patient education services.
Hessah Alsulami
Arabian Gulf University, Saudi Arabia
Title: Does CD5 have an effect on the expression of ROR1 in Chronic lymphocytic leukemia?
Biography:
Dr. Hessah Alsulami has completed MRCPath at the age of 33 years and had fellowship in transfusion medicine from university of Bristol in UK. She is the director of Laboratory & Blood bank in IAAH
Abstract:
B cell chronic lymphocytic leukemia (CLL) is characterized by accumulation of monoclonal CD5+ mature B cells. The expression of CD5 plays a role in the malignant behaviour of CLL cells via controlling the expression of some genes that enhance the expression of: apoptosis inhibitors BCL-2, NF-κB, Wnt, and cytokine. By being naturally phosphorylated on tyrosines CD5 is chronically activated in CLL cells. Moreover, B CLL cell also characterized by the expression of ROR1. In this study we looked if CD5 has an effect on the surface expression of ROR1 in CLL cells via comparing the fluorescence intensity (MFI) of ROR1 between two groups of CLL cells, CD5 dim group and CD5 bright group. Materials: A retrospective of immune-phenotype results for 100 randomly selected patients diagnosed with CLL in the period from June 2012 till Jan.2014 was performed. 29 cases were excluded because ROR1 test was not performed for them. The study was carried out on 71 patients that divided into two groups depend on the fluorescence intensity of CD5 [dim and moderate to bright MFI]. Four degrees of fluorescence intensity were assigned negative 0 cases, Dim 16 cases (23%), moderate and bright 55 cases (77%). Then, the average ROR1 MFI was compared between the two groups using Wilcoxon-Mann-Whitney test for independent samples with 95% confidence interval Result The study showed that the average ROR1 MFI for CD5 dim group was 12.4 and 16.9 for CD5 moderate to bright group with a P- value of 0.003 which means a significant difference in the expression of ROR1 between the two groups. Conclusion The difference in the expression of ROR1 between the two groups might be due to the influence of CD5 on ROR1