2^nd International Conference on
Chronic Diseases

Background and aim: Diabetic foot is the most common infectious complication in diabetic patients that requires hospitalization and surgical interventions, affecting one in ten patients with diabetes. Osteomyelitis is one of the complications of diabetic foot infection that can be diagnosed by radiography, isotope scan, MRI and CT scan; however, these diagnostic modalities are costly and are not always accessible. Hence, the present study aimed to evaluate the diagnostic value of inflammatory markers (ESR, CRP) in detection of osteomyelitis in patients with diabetic foot referring to the emergency department or endocrinology, infectious and surgery clinics at Shohadaye Tajrish Hospital. Materials and Methods: In this case-control study, participants were categorized into two groups of patients with and without diabetic foot and osteomyelitis. In order to measure the serum level of ESR and CRP along with white blood cell (WBC) count, venous blood was drawn from the patients. Gathered data were entered into statistical software and the diagnostic value of these markers were assessed through calculation of area under the ROC curve, sensitivity, specificity, positive predictive value and negative predictive value. Results: The findings of this study showed that ESR and CRP have relatively favorable diagnostic values for detection of osteomyelitis. Sensitivity and specificity of ESR was calculated to be 74.6% and 57.7% and these figures for CRP were found to be 76.0% and 54.9%, respectively. A combination of an ESR≥49, a CRP≥35 and a WBC≥8500 increased the diagnostic value. Conclusion: The results of the present study showed that inflammatory markers have relatively favorable diagnostic values for osteomyelitis, which can be improved by combining them together.

I am SEVIDZEM Silas Lendzele, a Researcher in Entomology and Virology from Cameroon. I am author of 20 populations, 1 book chapter and four posters in my area of specialization. I am currently involved in the molecular epidemiology of trypanosomosis and Foot and Mouth Disease in Cameroon, developing new traps for blood-hungry flies as well as test the efficacy of fly-management options.

Background: The pasture area of the Adamawa Plateau is heavily infested with haematophagous vectors of haemoparasites of medico-veterinary importance. Field trials to suggest an efficient biting flies control method to farmers as well as molecular screening data of cattle from Ngaoundere to show-proof the Trypanosoma spp. circulating in the apparent absence of glossines is lacking. Objective: The present trial aimed at evaluating the efficacy of Deltamethrin manually coated screens in the control of flies as well as screen the animals for trypanosomes. Methods: To realise this study, biconical and nzi traps were used to monitor the population of vectors pre and post screen installations. Parasitological and molecular screening of cattle blood was carried out using the buffy coat and PCR techniques respectively. Results: Overall, 06 families of vectors were identified into: Stomoxyidae, Tabanidae, Culicidae, Ceratopogonidae, Muscidae and Simuliidae as well as others (non-biting muscids). In total, 11 genera were identified, Stomoxys, Tabanus, Ancala, Atylotus, Haematopota, Chrysops, Culex, Anopheles, Simulium, Culicoides and Haematobia. More than 21 species were regrouped under the 11 genera. The overall apparent density (AD) of vectors was 14.7 flies/trap/day with Stomoxyidae being the most abundant biting vectors with an AD of 5.8 stomoxes/trap/day. The abundance and diversity of vectors varied with season and pre/post screen installation periods. The overall screen reduction rate was 84.2% and was taxonomic group (family, genus and species) dependent. The Industrial Impregnated Screen reduction rate was 84.8% while that of Manually Impregnated Screen was 83.5%. The trapping system of choice for the trapped flies was the Nzi trap. Based on the evolution of the packed red blood cell volume (PCV) of the zebu cattle (N=24) considered for this trial, the overall PCV2 (post screen installation) (34.04±3.29) was greater than the mean PCV1 (pre-screen installation) (33.21±3.29) even though there was no statistical significant difference (P˃0.05). The haemoparasites parasitologically diagnosed in the cattle herd were: Setaria spp (16.7%), Anaplasma marginale (9.5%), Trypanosoma spp (4.8%), Anaplasma marginale + Babesia bigemina (4.8%), Babesia bigemina (2.4%). Trypanosoma Theileri (4.76%) and T. vivax (2.38%) were molecularly confirmed. Conclusion: The presence of Deltamethrin 5% S.C. coated screen on the pasture area of Vina du Sud reduced the biting vectors pressure and slightly improved the PCV of cattle naturally harboring trypanosomes, tick borne pathogens and filarial worms.

Francisco Jose Amo Setien gained a PhD in Health Sciences (University of Cantabria, UC) in 2017, holds an inter-university Master's Degree in "Genetic, nutritional and environmental conditioning factors of growth and development" (UC) and a Nursing Degree (UC). Francisco Jose has gained research experience in the field of nutrition, obesity in children and adolescents with intellectual disabilities, as well as in health related quality of life in patients with chronic diseases, and he has been a full-time teaching assistant in the area of community health in the nursing department of the University of Cantabria since 2014.

Chonicity management is the greatest challenge that the Spanish national health system faces, having to invest 80% of health expenditure to deal with this problem. Complex chronic patients (CCPs) are those patients in which several chronic pathologies coexist with frequent decompensation and high risk of functional loss. CCPs represent between 3-5% of the Spanish population and consume a high percentage of the resources. Objective: To describe the level of dependence and cognitive impairment experienced by chronic complex patients in the urban area of Santander (Cantabria) and Palma (Balearic Islands). Methods: A multicenter, cross-sectional study involving over 18-year-old CCPs located at 3-4 level of the risk pyramid in the care model to chronicity. They are located in the urban area of Primary Care in Santander (Cantabria) and Palma (Balearic Islands). Barthel Index was used to assess dependence and cognitive deterioration was assessed through the Pfeiffer test. Results: 20 Health Centers from Santander (n = 2885) and 16 from Palma (n = 1631) participated in the study. The average age of the selected chronic patients was 77 years (SD = 12.3). 27.4% presented moderate, severe or total dependence and 23.6% moderate or significant cognitive impairment. A linear relationship was observed between the scores in the Pfeiffer test and the Barthel index (r=-0.47, p <0.001). The hospital admission rate correlated with the score in the Pfeiffer test (r = 0.2, p <0.001) and in the Barthel index (r = -0.19, p <0.001). Conclusions: Age, dependency level, cognitive deterioration and hospital admission rate are intimately related in complex chronic patients. Therefore, it is important to continue promoting care models aimed at reducing dependency.

Francisco Jose Amo Setien gained a PhD in Health Sciences (University of Cantabria, UC) in 2017, holds an inter-university Master's Degree in "Genetic, nutritional and environmental conditioning factors of growth and development" (UC) and a Nursing Degree (UC). Francisco Jose has gained research experience in the field of nutrition, obesity in children and adolescents with intellectual disabilities, as well as in health related quality of life in patients with chronic diseases, and he has been a full-time teaching assistant in the area of community health in the nursing department of the University of Cantabria since 2014.

Nurses often perform interventions aimed at improving the health-related quality of life (HRQOL) in patients with chronic diseases. However, the amount of information generated, sometimes contradictory, makes it difficult to interpret the results. This systematic review allows empirical evidence to be summarized. Thus, the purpose of this study is to determine, through a systematic review and a meta-analysis, the characteristics of the nursing interventions, performed in people/patients over 18 years old with chronic diseases, which involve an improvement in their HRQOL. A literature search was performed in six electronic databases (Pubmed, Scopus, WOS, CINAHL, Web of Science and Cochran) from September until December 2017. Also, bibliographies of relevant papers and publications were hand searched. Study Selection: Randomized controlled trials (RCTs) and cluster-RCTs, with at least two groups of patients in which a nurse was involved. Data Extraction and Synthesis: Two authors independently reviewed studies for inclusion, extracted data, and assessed study quality with discrepancies being solved through discussion. In the meta-analysis, Effect Sizes (ESs) were calculated for each outcome by calculating the standardized mean change for each sample. Findings: This systematic review synthesizes data from 38 studies, published between 2003 and 2015, that provided a sample of 6480 people with a mean age of 68.4 years (SD = 8.7). In 60.6% of the interventions a single component was used, being education the one most commonly used. 72.5% of the interventions were not based on a theory. The duration of the interventions ranged from 4-104 weeks, with a mean of 12 sessions and 54.2 minutes/session. SF-36 questionnaire was the most often used to evaluate HRQOL.

Afagh Alavi has completed her M.Sc. and Ph.D. studies at the University of Tehran. She is currently an assistant professor in the University of Social Welfare and Rehabilitation Sciences in Iran. Her research field is the genetic of neuromuscular disorders. She has published more than 17 papers in reputed journals.

Statement of the problem: Parkinson’s disease-(PD) is a common neurodegenerative disorder characterized by motor (resting tremor, bradykinesia, and rigidity) and nonmotor features. The incidence of PD increases with age. Five principal genes have been identified for this condition, naming: SNCA, LRRK2, PRKN, PINK1, and DJ-1. Mutations in these genes account for the disease in a few percent of patients, suggesting other PD-causing genes remain to be identified. rnThe purpose: To identify the potential genes responsible for PD in a highly consanguineous Iranian family, showing no deleterious mutation in any of the previously identified genes. Age-at-onset of symptoms was in the second decade of life, and the inheritance was autosomal recessive. rnMethodology: Genotyping was performed in unaffected parents, two unaffected and two affected siblings. Exome sequencing was done on two affected and two unaffected siblings. Homozygous regions common to all affected and absent in non-affected were sought. Preliminary filtering of sequence variations was done to identify all (nonsynonymous, stopgain, stoploss, deletion, and insertion) homozygous changes present in both affected that were absent in unaffected siblings in homozygous state and were positioned within the locus identified by homozygosity mapping. Subsequently, variations with a reported MAF<0.01 in public databases were removed to finally find the disease-causing variations.rnFindings: The disease status in the family was linked to a large homozygous region (15Mb) on chromosome-6, containing 130 genes. The filtering criteria used for WES revealed seven variations that had been located in the homozygous region. One of these variants segregated with the disease status in the family and was not detected in 500 Iranian healthy controls. Our ongoing functional studies on the candidate gene suggest a promotion in apoptosis upon overexpression of this gene in Hela cells. Conclusion and significance: Our finding can provide insight into the etiology of dopaminergic neuronal death in the midbrain as the principal hallmark of Parkinson's disease.rn

Physiatrist, Dept. of Rehabilitation Medicine, Rehabilitation Hospital, Yonsei University Hospital, seoul

Objective: Taxane families are widely used in the management of patients with breast and ovarian cancers. Dose-limiting toxicity of taxanes is related to a distal sensory neuropathy, with symptoms of sensory loss and paresthesia in the extremities that can significantly impact quality of life in cancer survivors. However, the assessment of chemotherapy induced peripheral neuropathy (CIPN) is still based not on the objective findings of neurophysiologic study, but on clinical symptoms. Therefore, the aim of this retrospective study is to demonstrate neurophysiologic changes in symptomatic subjects and to compare clinical symptoms and neurophysiologic findings and to reveal the feasibility of neurophysiologic study.Methods: The medical charts of subjects with breast or ovarian cancers who visited university hospital between April 1, 2017 and January 1, 2018 were reviewed. Inclusion criteria were history of chemotherapy with taxane-containing regimen, sensory symptoms of glove and stocking distribution compatible with neuropathic pain (those with Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale ≥12), and those who had undergone nerve conduction study (NCS) twice during or after the chemotherapy. Subjects were excluded if they had predisposing condition for neuropathy, such as diabetes mellitus, thyroid disease, alcohol abuse history, and previous chemotherapy for other malignancies. Demographics and clinical features were acquired along with parameters of body mass index, body surface area, the regimen and the number of chemotherapy, LANSS Pain Scale, and the Sensory Nerve Action Potentials (SNAPs) recorded in the sural nerves. Results:Data from 23 subjects were collected. Baseline characteristics are described in Table 1. All subjects scored over 12 in LANSS Pain Scale, subjectively having symptoms compatible with neuropathic pain. Follow-up NCS was performed after 2.2 months on average (Figure). In the follow up study, sural SNAP amplitudes were significantly reduced compared with the first study. Among subjects who suffers from neuropathic pain after taxane-containing chemotherapy, only 10 out of 23 (43.5%) showed sural SNAP amplitude lower than 10uv in initial NCS. Additional five subjects developed sural SNAP amplitude lower than 10uv in the follow-up NCS (15 out of 23, 65.2%). Between the first and second NCS, 10 subjects showed more than 30% drop of sural SNAP amplitude (10 out of 23, 43.5%). The results are summarized in the Table 2. Conclusion: Considering the evidence of axonal injury in the sural nerve, maximum of 65.2% patients was determined as CIPN. However, including the subjects with more than 30% drop of sural SNAP amplitude, serial NCS results could support as much as 78.2%.Therefore, serial NCS studies during chemotherapy may be helpful in assessing the chemotherapy induced nerve damage and to attain the objective evidence of CIPN. Further study is needed to establish the proper timing of the follow up NCS study.

Anne Braun is currently working on her PhD thesis studying the effects of nutrition on an autoimmune disease. She obtained her Master of Science in Molecular Lide Science at the University of Lübeck, Germany, in 2015.

Statement of the Problem: Epidermolysis bullosa acquisita (EBA) belongs to the group of pemphigoid diseases, a family of chronic-remitting autoimmune skin blistering diseases (ASBD). These diseases are hard to treat with no specific medication available and are associated with an increased mortality rate. Methodology & Theoretical Orientation: In the last years, the gut microbiota has been shown to affect the immune system systemically. Disease severity of murine models of e.g. rheumatoid arthritis and gout can be modulated by treatment with acetate, a short chain fatty acid (SCFA) and main microbial fermentation product of dietary fibers. The production of microbial products, modulating immunity, is determined by the composition of the gut microbiota, which is largely effected by nutrition. Nutrition can also directly modulate the immune system, for example by polyunsaturated fatty acids (PUFA). Plasma levels of lipid mediators, known to modulate the immune system, are metabolites of PUFAs, which are components of fish oil. Dietary fish oil supplementation can increase serum PUFA levels. So far, the effects of nutrition and the gut microbiota on ASBDs were unknown. We therefore tested different diets and supplements in an antibody-transfer-induced EBA mouse model. Findings: We could show that neither a high fat nor a fish oil rich diet effect EBA disease severity. The same is true for a fiber-rich diet as well as oral treatment with the short chain fatty acids acetate, propionate or butyrate. Also, depletion of the gut microbiota using an antibiotic-cocktail does not affect disease severity. Conclusion & Significance: Nutrition does not seem to have a major impact on EBA disease progression in a mouse model of EBA.