Scientific Program

Day 1 :

Keynote Forum

P Umesh Prabhu

Edge Hill University, United Kingdom

Keynote: Patient safety in nephrology

Time : 09:45-10:30

Biography:

Umesh Prabhu is a senior lecturer at Edgehill University, England. He has been a consultant Paediatrician (1992-2010); Clinical Director of Paediatrics (1992-1998); Medical Director of Bury NHS Trust (1998-2003); Board Member of National Patient Safety Agency UK (2001-2003) (Now part of NHS Improvement); National Adviser for National Clinical Assessment Service (2003-2015) (Now part of NHS Resolution); National Adviser for Paediatric Complaints (CHAI – now called Care Quality Commission); Medical Director of Wrightington, Wigan and Leigh FT (2010-2017). He was twice nominated as the top 50 Influential/ Pioneering BME leader 2013 and 2014. In 2017, he received Life Time achievement Award for work on Patient Safety. He has been also an adviser to GMC, DOH, BMA, NCAS at various stages of my career on BME issues and inclusion and diversity.

Abstract:

Health is the wealth of the nation. To create a thriving economy every nation needs healthy people to work with skills and jobs. It is the duty of each and every nation to create an excellent healthcare which is safest and the best and is affordable. NHS is a great Institution and each year 360 million patients are seen by 1.3 Million staff. Most staff work hard and most patients receive safest and the best care. However, sadly culture of bullying is common in NHS. Staff survey shows that 20 to 30% of staff report being bullied or seen someone being bullied in the NHS. Bullying culture is common not only in NHS but throughout the World in healthcare sector. There are complex reasons for the culture of bullying. When I was the Medical Director of Wrightington, Wigan and Leigh FT (2010-2016) I had to deal with culture of bullying and we transformed the culture of bullying to kind caring compassionate learning and supportive culture, we reduced harm to patients by 90% over 8 years. We empowered staff to speak up and 70 staff raised concerns with me and other Directors and this helped us to transform the culture. The Trust appointed kind caring compassionate leaders to each and every department, created good team working, implemented good governance and duty of candour. Trust received 45 awards and 450 more patients survive each year and for staff happiness Trust improved from bottom 20% in 2011 to third best by 2016. In my presentation I will be presenting as to how we transformed the culture and I will be focusing on some of the nephrology cases like Diabetes, renal surgery and acute kidney injury and how we reduced harm and how we learnt lessons. Leadership is honesty, sincerity, integrity and courage to protect patients and to support staff. Happy staff – Happy patients is the culture we created to transform the Trust.

Keynote Forum

Dipak P Ramji

Cardiff University, United Kingdom

Keynote: Atherosclerosis: Mechanisms, current therapies and the potential of natural products in the prevention and treatment of the disease

Time : 14:30-15:10

Biography:

Dipak P Ramji is Professor of Cardiovascular Science at the School of Biosciences in Cardiff University. He received his BSc (Hons) degree (Biochemistry) and his PhD (Molecular Biology) from the University of Leeds. This was followed by post-doctoral research at the European Molecular Biology Laboratory (Heidelberg) and the Istituto di Ricerche di Biologia Molecolare P. Angeletti (Rome) with fellowships from the Royal Society and the EU. He joined Cardiff University in 1992 and completed 25 years of service in August 2017. His research is focused on understanding how the immune and inflammatory responses regulate cellular processes in heart disease with the goal of attaining deeper mechanistic insight and identifying preventative/therapeutic agents. His research has been funded by several organisations and received continuous funding from the British Heart Foundation since 1997. He has published over 150 research articles (h index 34 and i10 index 68 with over 5700 citations). He is an Editorial Board member of 16 international journals; regular organising committee member, speaker and track/session chair at international conferences on heart disease; involved in grant evaluation for over 20 organisations; and supervised over 25 PhD students. In addition to research, he is involved in teaching and administration, including Postgraduate Tutor for the Biomedicine division at the School of Biosciences and external examiner for Biochemistry and Biomedical Sciences at the University of Reading and King’s College London.

Abstract:

Atherosclerosis, a chronic inflammatory disorder of medium and large arteries and the underlying cause of heart attacks and stroke, is responsible for more global deaths than any other disease. A slight reduction in morbidity and mortality from atherosclerosis and its complications has been seen recently, at least in the western world, due to lifestyle changes and pharmaceutical interventions (e.g. statins). However, the global burden from this disease is expected to worsen in the near future because of recent increases in risk factors such as diabetes and obesity. Current pharmaceutical treatments for atherosclerosis are associated with considerable residual risk for cardiovascular disease together with various side effects. With the exception of few successes (e.g. ezetimibe, PCSK9 inhibitors), many pharmaceutical leads against established targets have proved disappointing at the clinical level. It is therefore important that further research is carried out on the molecular basis of atherosclerosis together with alternative therapies for its prevention and treatment. Natural products have received substantial recent interest in the prevention and treatment of atherosclerosis. However, more research is required that addresses the molecular mechanisms underlying the beneficial effects of natural products together with large clinical trials that evaluate their efficacy. We have recently initiated studies on the effects of many natural products, including certain polyunsaturated fatty acids, polyphenols and probiotics, on several key monocyte/macrophage processes associated with atherosclerosis in vitro and various risk factors in vivo together with the underlying mechanisms. These will be presented in the context of molecular mechanisms underlying atherogenesis together with current therapies and those that are being developed.

Keynote Forum

Francesco Lippi

University of Pisa, Italy

Keynote: Autoimmune thyroid diseases

Time : 15:10-15:50

Biography:

Francesco Lippi has completed his M.D degree from the University of Pisa Medical School in 1978 and has completed his speciality degree from University of Pisa Postgraduate School of Endocrinology in the year 1983. He also holds a speciality degree in nuclear medicine from the University of France. He is currently the Professor of Endocrinology in the School of Endocrinology, University of Pisa. He is also the Editorial Board of EC Endocrinology and Metabolism

Abstract:

The autoimmune chronic thyroiditis or Hashimoto' thyroiditis is an inflammatory autoimmune disease of the thyroid, characterized by a lymphocytic chronic infiltration. This pathology is frequently silent, often hands to a gradual but progressive and irreversible hypo-function of the thyroid. It is the most frequent cause of hypothyroidism in the guilty ones of the world to enough contribution of iodine, while it is relatively being rare in the zones to lack iodine. The greatest incidence is the women it is calculated around 3,5 cases for 1000 inhabitants a year. At the base of the pathology there is an inflammatory autoimmune process that brings to the destruction of the thyroid follicles, caused both from a cells-mediate mechanism and from organ specific antibodies. Once activated the lymphocytic T helper it produces different cytokines that perpetuates and the inflammatory process they make autoimmune chronic. Therefore, both the inflammatory process and the lymphocytic infiltration leads to a reduction of the synthesis of the thyroid hormones. The bio-humoral mechanism seems to have a secondary role. Sometimes in some occasions we can also be found some antibodies anti TSH receptor blocking (TSHRblokingAb) responsible of the atrophy variant (idiopathic myxedema) or even more rarely anti Receptor of the TSH antibodies (TRAB) responsible of the condition of transient hyperthyroidism or at times permanent that rarely can be found in patients with Hashimoto' thyroiditis (Hashitoxicosis) due to the release of the thyroid hormones from the destroyed thyroid cells. Often the chronic thyroiditis can be are associated with other autoimmune diseases (polyglandular autoimmune syndrome). The diagnosis founds him on the data of laboratory that underline elevated values of specific antibodies (overall AbTPO). Nevertheless in a low percentage of cases 5- 10%, we can find a condition of chronic thyroiditis in absence of specific antibodies. In such case the diagnosis is sustained by the aid of the sonography. The typical picture in fact it is peculiar with a markedly hypoechoic thyroid with poor intra-thyroidal vascularization. In many cases is not in demand some treatment because the gullet is small the patient it is often asymptomatic with levels of TSH in the range of the norm and in absence of antibodies. In that case it is not required any therapy a part the use of selenium as anti-oxidant agent and Vitamin D. In patients with hypothyroidism (both subclinical than clinical) the pharmacological treatment was mandatory as the administration of the substitutive therapy with levo-thyroxine especially in children and in the women that are in pregnancy or to the search of pregnancy. The purpose of the hormone-therapy is that to normalize the TSH values with a first control to 45-60 days and once reached the therapeutic remuneration they are enough hormonal controls TSH and FT4 every 6-12 months. Lasting the therapy in the 50- 90% of the cases is assisted to a reduction of the thyroid volume and consistence both for the normalization of the values of TSH and for the reduction of the lymphocytic infiltrate. Besides it is also assisted to a reduction of the antibodies title, to which has been shown the association it contributes using selenium and vitamin D.

  • Workshop
Location: Bayswater - Sheraton Heathrow Hotel

Session Introduction

Mingxia Yuan

Capital Medical University, China

Title: More sustained combined target control leading to less cardiovascular events and all-cause mortality in patients with type 2 diabetes mellitus

Time : 10:30-11:20

Speaker
Biography:

Mingxia Yuan is the chief physician and vice-director of department of Endocrinology, Beijing Tongren Hospital, Capital Medical University and vice-Director of the office of diabetes prevention and control in Beijing. She has completed her master’s degree from Capital Medical University in 1998.

Abstract:

Chronic complications are the major causes of disabilities and death for diabetic patients. It is well-established that intensive glycemia, blood pressure and lipid management in people with diabetes reduces the risk of microvascular and macrovascular complications, mainly on the basis of evidence from large randomized clinical trials. Yet, translation of these interventions to day-to-day-life settings remains a major challenge. Meanwhile, the GPs from the local healthcare community remain a relatively untapped pool of resources in China. An urgent problem is whether the quality of diabetes care will be compromised as diabetes care shifts increasingly from specialist to primary level. We thus launched the 10-year Beijing Community Diabetes Study (BCDS), to develop a community-hospital integrated management system, with the purpose of translating optimal care to the real-world clinical practice by increasingly involve community GPs in diabetes management.
 
Objective: To assess the quality and effort of the community-hospital integrated diabetes care model, focusing on the effect of the 10-year combined target control on all-cause mortality and cardiovascular events for the patients with type 2 diabetes mellitus (T2DM)．
 
Methods: The patients aged 20 to 80 years with T2DM from 15 community health centers among five urban districts were recruited at the baseline (between August 2008 and July 2009), and were followed up to September 2018. Management adjustment strategies on guidelines have been applied by a group of collaborative team members consisting of 15 specialists from tertiary hospital and 120 community GPs. A systemic scheduled training course, including hand-by-hand tutor at the outpatient clinic, were applied to the GPs. The followup visit for the patients was completed on schedule. All the metabolic variables were detected. HbA1c was measured at a central laboratory by high-pressure liquid chromatographic assay. To ensure the integrity and also quality of data collection, a supervision team which includes four trained specialists has been checking the study progress and data records in every community center once or twice yearly. The primary outcome was defined as the proportion of patients reaching an optimal control of glycaemia, blood pressure and lipids. The clinical outcomes such as the incidence and progress of diabetic complications, including cardiovascular events and all-cause mortality were recorded. All of the endpoint events were evaluated and approved by the specialist committee. The database has been established using Epidata version 3.0 and audited for accuracy.
 
Results: 1. 3581 patients with T2DM were recruited in 2008, 2940 (82.1%) patients completed the study. 2. By updated analysis in 2018, 23.5% met all the HbA1c, blood pressure, and LDL-C target values after 10- year intervention, which showed a significant increase compared with that 13.1% in 2013, and 5.9% at the baseline. 3. A total of 1801 patients who went through 10-year follow-up visit and have complete information were analyzed. Among them 613 patients (34.04ï¼…) reached combined target equal to or more than 3 times during the 10 years, while the rest of 1188 patients (65.96ï¼…) were up to standard less than 3 times. The incidence of all-cause deaths, cardiovascular events and total composite endpoint events in patients who were up to standard more than 3 times was significantly lower than that of patients who were up to standard less than 3 times (P<0.001). The log-rank test showed that the cumulative risks of all-cause deaths, cardiovascular events and the total composite endpoint events in patients who were up to standard more than 3 times were significantly lower than that of patients who were up to standard less than 3 times (P<0.001). The community GPs improved their familiarity with expertise and experience in diabetes management by systematic training. 49 research papers written by the GPs were published.
 
Conclusion: The community-based community-hospital integrated care system was proved to be more effective. The incidence of all-cause deaths and cardiovascular events were significantly reduced by constant combined target control．
 
Funding: The project was supported by the Capital Medical Development Foundation (2007-1035); The Capital Health Research and Development of Special (2011-2005-01, 2016-1-2057); and the IDF-BRIDGES funding (ST12-024).

 

Guang-Ran Yang

Capital Medical University, China

Title: Neck circumference, an ignored anthropometric indicator, was related to cardiovascular events in Chinese type 2 diabetes

Time : 11:40-12:30

Biography:

Guang-Ran Yang is the Chief Physician & Associate Professor of Department of Endocrinology, Beijing Tongren Hospial, Capital Medical University in china. His research interest is in the area of Diabetes and its complications.

Abstract:

Objective: Neck circumference (NC) was litter reported to be associated with the risk factors of cardiovascular disease (CVD). However, there was lack of studies about whether NC could predict the CVD events in the Chinese type 2 diabetes people.
 
Methods: Beijing Community Diabetes Study was a prospective, multi-center study conducted at Beijing communities. In this study, CVD events included heart attack, unstable angina pectoris, coronary stent implantation, coronary artery bypass graft, hospitalization for heart failure, and stroke.
 
Results: At baseline, 3,009 diabetic patients were enrolled. After eight-year management, 211 CVD events (105 in men, 106 in women) occurred. All patients were divided into two groups according to the upper quartile of NC (43cm in men and 39cm in women). The incidence of CVD in the NC >43cm group in men was higher than that in the NC ≤43cm group (16.48% vs 8.16%, p<0.05). Similar result was found in women (p<0.05). The longitudinal incidence of CVD events increased with the increasing of follow-up (p<0.05). Cox regression analysis showed that higher NC was related to the incidence of CVD events (adjusted HR=2.325, p<0.05).
 
Conclusions: NC was associated with the incidence of CVD events in type 2 diabetes in Chinese communities.

Xue-Lian Zhang

Capital Medical University, China

Title: Analysis of the effect of nine consecutive year’s intensive management and number of achieving the target control on endpoint events in T2DM in Sanlitun Community Health Service Center in Beijing

Time : 12:30-13:20

Speaker
Biography:

Xue-Lian Zhang is from the Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China

Abstract:

Objective: To investigate the effect of achieving the target control more than 3 times on endpoint events during 9 consecutive year’s annual assessment in T2DM in Sanlitun Community Health Service Center in Beijing, including blood glucose, blood pressure, lipids profiles and the joint target control.
 
Methods: In Beijing Community Diabetes Study (BCDS), 224 patients with T2DM from Sanlitun community Health Service Center were enrolled in 2008. All patients were randomly assigned to the intensive management group (n=113) and the standard management group (n=111). All patients were followed up for nine consecutive years from January 2009 to December 2017. Systolic blood pressure (SBP), diastolic blood pressure (DBP), glycosylated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C) were detected as the main indexes, and the endpoint events were also carried out at the same time. The endpoint events were analyzed by using survival analysis (Kaplan-Meier method) based on management grouping and whether achieving the target control more than 3 times or not.
 
Results: During the nine-year follow-up, the abscission number is 35(14.29%), among which 14 (12.39%) is in the intensive management group, and 21 (18.92%) is in the standard management group. The incidence of diabetic retinopathy (6 cases, 5.41%) and diabetic nephropathy (13 cases，11.71%) in the standard management group were significantly higher than that of intensive management group (1 case，0.88%; 5 cases，4.42%) respectively (P<0.05). However, there were no significant differences on the other endpoint events between the two groups (P>0.05). All-cause death is 23 cases, in which patients who achieved the target control (HbA1c, LDL-C) and the joint target control more than 3 times were significantly lower than that of less than 3 times (P<0.05). As far as death caused by cardiovascular events, cerebrovascular events and newly onset coronary heart disease is concerned, there were no significant differences on the afore endpoint events between the two groups based on target control more than 3 times or not (P>0.05). There were less incidence of new onset cerebrovascular events, stenosis or occlusion of large arteries and diabetic microvascular complications in patients who achieved target control (HbA1c, LDL-C) and the joint target control more than 3 times than those with target control less than 3 times (P<0.05).

 

  • Poster Presentations
Location: Bayswater - Sheraton Heathrow Hotel

Session Introduction

Chih-Chiang Chien

Chi-Mei Medical Center, Taiwan

Title: The comorbidity scoring systems for predicting survival in elderly dialysis patients
Speaker
Biography:

Dr. Chien Chih-Chiang, Associate Professor and attending physician, department of nephrology, Chi-Mei Medical Center, Taiwan. He grew up in Taichung, Taiwan and received his Bachelor`s degree of medicine from the Chung Shan Medical University in 2001. After graduation, he received resident physician and fellow physician training in division of nephrology, department of internal medicine, Taipei Veterans General Hospital, Taiwan. Since 2006, he works as an attending physician in department of nephrology, Chi-Mei Medical Center, Taiwan. In the meantime, he began his life long investigation of epidemiology and mortality of patients with end-stage renal disease and dialysis.

Abstract:

The worldwide elderly dialysis population has grown significantly and is expected to have more comorbid conditions and shorter life expectancies than the general elderly population. Predicting outcomes for this population is important for decision-making. Our study is to examine the comorbidity index for outcome predictability in elderly dialysis patients. In this population-based cohort study, we enrolled elderly patients who started maintenance dialysis in Taiwan. Further analyses of all-cause mortality and life expectancy in these groups with different comorbidity index score were performed. As results, a total of 21,043 incident dialysis patients divided into 4 groups by the comorbidity index score (intervals ≤ 3, 4-6, 7-9, ≥ 10) were analyzed. During a 10-year follow-up, 11272 (53.55%) patients died. Kaplan-Meier curves showed significant survival differences between groups (log-rank: P < 0.001). After stratification by age, life expectancy was significantly longer in groups with lower the comorbidity index scores. In conclusion, the comorbidity index is a strong predictor of mortality in elderly dialysis patients.

Chia-Ling Wang

Chi-Mei Medical Center, Taiwan

Title: Upper gastrointestinal bleeding in end-stage renal dialysis patients with chronic liver disease
Speaker
Biography:

Chia-Ling Wang, Nurse Practitioner, department of internal medical, Chi-Mei Medical Center, Taiwan. She grew up in Tainan City, Taiwan and graduated from Chinese Medical University in 2001 major in Nursing. After graduation, she works in the cardiovascular surgery ward as a nurse in Taipei Veterans General Hospital, Taiwan, 2001-2007. Since 2007 she works in the department of internal
medicine, Chi-Mei Medical Center, Taiwan as a Nurse Practitioner. In the meantime, she is devoted to the nursing care for the patient with end-stage renal disease and dialysis.

Abstract:

End-stage renal disease (ESRD) and chronic liver disease (CLD) both increase the risk for upper gastrointestinal (UGI) bleeding. The prevalence of ESRD and CLD are high in Taiwan. The aim of this study was to evaluate the incidence, risk factors, and categories of UGI bleeding in ESRD dialysis patients. We enrolled 42,457 incident ESRD incident dialysis patients. These patients were followed until death, dialysis cessation, or end of database. Cumulative incidence of UGI bleeding after initiation of dialysis was calculated using Kaplan-Meier methods. Predictors for UGI bleeding were determined using Cox models. During the follow-up period, 5,528 patients had a UGI bleeding. Male, elderly, receiving hemodialysis (HD) and patient with comorbidities had a higher rate of UGI bleeding. The 1-, 3-, 5- and 7-year cumulative incidence rate of UGI bleeding were 9.8%, 21%, 25.3% and 28% in patients with liver cirrhosis (LC) on HD, 5.8%, 16.2%, 22.2% and 24.4% in patients with LC on PD, 3.7%, 9.2%, 13.2% and 16.4% in patients without LC on HD, and 2.1%, 5.5%, 8.2% and 10.4% in patients without LC on PD (log-rank: p <0.001). After multivariate adjustment, prior gastrointestinal bleeding (HR 1.731, 95% CI, 1.635-1.834), LC (1.682, 95% CI, 1.524-1.856), alcoholism liver disease (1.536, 95% CI, 1.635-1.834), and receiving HD (1.316, 95% CI, 1.153-1.502) were independently risks for UGI bleeding in ESRD dialysis patient. Gastric ulcers were found to be the most common source of bleeding (50.3%), while bleeding resulting from a gastrojejunal ulcer was least frequent. In conclusion, ESRD dialysis patients had a higher risk for UGI bleeding, especially those with prior gastrointestinal bleeding, LC, and alcoholism liver disease. In addition, receiving HD is a strong predictor for UGI bleeding. More attention should be paid to select dialysis modality, especially in high risk patients.

Chia-Ying Lin

Chi-Mei Medical Center, Taiwan

Title: Spinal tuberculosis in end-stage renal disease dialysis patients
Speaker
Biography:

Chia-Ying Lin, Nurse Practitioner, Department of internal medicine, Chi-Mei Medical Center, Taiwan. She grew up in Tainan City, Taiwan, and graduated from National Cheng Kung University in 2005 with a major in Nursing. After graduation, she works in a cardiology ward as a nurse in National Cheng Kung Hospital, Taiwan, 2005-2007. Since 2007 she has been working in the department of internal medicine, Chi-Mei Medical Center, Taiwan, as a Nurse Practitioner. In the meantime, she is devoted to the nursing care for patients with end-stage renal disease on dialysis.

Abstract:

Patients with end-stage renal disease (ESRD) have an increased risk of tuberculosis (TB). Approximately, 10–20% of patients with extrapulmonary TB are skeletal involvement. In addition, spinal TB accounts more than half of skeletal TB cases. Aim of this study was to determine the rate, risks and outcome of spine TB in ESRD patient. We examined records of ESRD patients who initiated dialysis between 1999 and 2007. Patients were followed from the initiation of dialysis to spinal TB, death, end of dialysis, or December 31, 2008. The cumulative proportion of patients with spinal TB and of survivors after spinal TB were calculated using the Kaplan-Meier method. Cox proportional hazards models were used to identify the risk factors for spinal TB. A total of 67,993 incident ESRD dialysis patients were examined in this study. During the follow-up period, 89 patients had a spinal TB. The overall incidence of spinal TB in ESRD dialysis patient was 32.43 / 10,000 patient-years. Being female was associated with 85% higher risk (HR 1.85, 95% CI: 1.19-2.90). Patients ≥ 65 years old had more than 2 times the risk than did those 18-44 years old (HR 2.35, 95% CI: 1.04-5.34). The strongest predictor of spinal TB after dialysis was prior TB history (HR 3.86, 95% CI: 1.56-9.55). Overall in-hospital mortality was 19.1 %. The cumulative survival rates after spinal TB was only 65.5% at one year. In conclusion, being female, elderly and prior TB history were independent risk factors for spinal TB in dialysis group. The mortality was high after spinal TB. Clinicians should be aware of back pain in ESRD patients, especially in TB endemic areas such as Taiwan, because of high mortality rate of this disease.

 

Sapna Chandgadkar

Goa Engineering College

Title: Physical and mental fitness in hemodialysis patients: A systematic review
Speaker
Biography:

Sapna Chandgadkar is a master’s Student at Goa Engineering College. She is working with Dr Virani, HOD, Electronics Engineering and Dr Mahaldar, HOD, Nephrology, Manipal Hospital. Their research focuses on improving the quality of life of patient on hemodialysis, in emerging markets. The objective is to develop a Markov Model of the interventions that could help patients on Hemodialysis to improve their fitness levels a step at a time.

Abstract:

People with End Stage Kidney Disease (ESKD) on Hemodialysis (HD) experience multiple catabolic processes, including loss of albumin and amino acids during dialysis, metabolic derangements, and changes in skeletal muscle associated with conditions of muscle disuse. These changes result in muscle atrophy (loss of lean muscle mass). The presence of neurogenic (muscle atrophy or loss associated with nerve disorder), myogenic (damage intrinsic to the muscle), and mixed (neurogenic and myogenic) changes intrinsic to the skeletal muscle in people with ESKD on HD may further compromise the integrity of the motor-unit complex and contribute to muscle atrophy. The paper is a systematic review of the interventions to improve fitness levels of patients on maintenance HD. The results of the meta-analysis indicate the following: The survival of patients on maintenance haemodialysis is increased by improving their physical performance. Chronic Dyspnoea is one of the most common symptoms of patients on haemodialysis and is intractable to therapy due to its multifactorial origin. Dyspnoea is due to systemic inflammation and is caused by a combination of – anaemia, malnutrition and muscle wasting. The 6-minute walk test can be used to classify patients into various fitness levels as an OPD procedure and help patients get an objective evaluation of their fitness

Day 2 :

Keynote Forum

Ruth Kander

Imperial College Healthcare NHS Trust & Your Diet Matters, United Kingdom 10:

Keynote: Faddy diets, vegan diets and healthy eating in CKD: Which do you choose for your patient?

Time : 10:00-10:40

Biography:

Ruth Kander qualified with a BSc in Nutrition from Kings College London in December 1994 and went on to study a postgraduate diploma in dietetics at Kings College London and graduated December 1995. She started her career at St George’s Hospital in Tooting and worked there for 6 years. During that time, she was involved with general medicine and general surgery. In April 1999 Ruth started a role in renal dietetics. Ruth went on to work at Imperial College healthcare in 2002 and continues to be a dietitian at The West London Kidney and transplant centre. She currently specializes in haemodialysis and nephrology patients. She has a 300-dialysis caseload and a large nephrology population. She is passionate about helping people be the best they can be through nutrition and lifestyle. She has been involved with national guidelines for salt and fluid management in haemodialysis patients and dietary management of kidney stones. She is a reviewer for the Journal of Kidne Care. Aside from the NHS, she has a busy private practice in central London. In the past 6 months she has started a social media account called Kidney dietitian trying to educate the public and people not within a renal unit on Nutrition and the kidney.

Abstract:

There are millions of people in the world with CKD. About 1 in 10 people have some form of CKD. People with chronic kidney disease stages 1-4 do often do not have access to dietetic / specialised nutrition care and they can be searching around for special diets to help “cure” their kidney disease. In the vast world of the world wide web with many websites and videos on how and what to eat, it can be dangerous and confusing for the CKD patient. Nutritional advice for the CKD patient from a trained renal dietitian can help delay in CKD progression, by improvement in co morbidities such as obesity, diabetes and hypertension, the patient can learn how to self-manage by eating the corrects foods and having a lifestyle that helps the patient to perhaps delay their progression of CKD and allow them to be as healthy as they can be for as long as possible. This session will discuss the various diets that exists, what patients should be doing to help themselves and what the current literature advocates. In the early CKD stages 1-4 it’s all about self-management and helping patients to feel empowered to self- manage and for them to know where to look for information and what information is useful to them.

Keynote Forum

Meg Mangin, R N

Chronic Illness Recovery, USA

Keynote: Intracellular bacteria cause chronic disease by altering the immune response

Time : 10:40-11:20

Biography:

Meg Mangin, R.N. is the founder and Executive Director of Chronic Illness Recovery. She has served on a National Institutes of Health State of the Science panel and an NIH Data, Safety and Monitoring Board. Ms. Mangin has presented at numerous conferences, including Days of Molecular Medicine in Karolinska, Sweden, the International Conference on Autoimmunity in Porto, Portugal, the American Society of Hypertension Annual Meeting, Enabling Future Pharma, Perspectives in Rheumatic Diseases, Immunology Summit, ILADS and 8th Global Summit on Microbiology & Infectious Diseases. She is the co-author of a chapter in the medical textbook Vitamin D: New Research and the lead author of a ground-breaking review article on vitamin D, inflammation and infection published in the October 2014 issue of Inflammation
Research.

Abstract:

Patients with chronic diseases have elevated 1,25-dihydroxyvitamin-D and low 25-hydroxyvitamin-D. The absence of hypercalcemia, hypercalciuria, elevated parathyroid hormone, and chronic kidney disease indicates extra-renal production of excess 1,25 dihydroxyvitamin-D. In normal immune function, extra-renal 1alpha-hydroxylase (CYP27B1) catalyzes 25-hydroxyvitamin-D to 1,25-dihydroxyvitamin-D in immune cells, leading to transcription of antimicrobial peptides via the vitamin D receptor (VDR). CYP27B1 transcription in macrophages is regulated by cytokines (e.g., Interferon-y). L-form bacteria invade immune cells and use strategies to avoid phagocytosis. Parasitization of macrophages by these pathogens is the stimulus for persistent production of cytokines which induce CYP27B1 activity and excess 1,25-dihydroxyvitamin-D production. Down-regulation of the VDR by intracellular bacteria interferes with 1,25-dihydroxyvitamin-D production regulatory processes and thus, prevents transcription of antimicrobial peptides to allow bacterial persistence. Bacterial interference with enzymatic traffic patterns allows production of excess 1,25-dihydroxyvitamin-D and prevents normal 1,25-dihydroxyvitamin-D functions which inhibit the expression of inflammatory cytokines. In summary, non-resolving inflammation associated with many common chronic diseases is caused by survival strategies of intracellular bacteria and is evidenced by elevated 1,25-dihydroxyvitamin-D and depleted 25-hydroxyvitamin-D as markers of an infectious disease process.

  • Chronic Diseases | Chronic Illness and Mental Health | Chronic Diseases Diagnosis | Epidemiology
Location: Bayswater - Sheraton Heathrow Hotel

Session Introduction

Dipak P Ramji

Cardiff University, United Kingdom

Title: Cytokines and their signalling pathways as therapeutic targets in atherosclerosis

Time : 14:00-14:30

Speaker
Biography:

Dipak P Ramji is professor of cardiovascular science at the school of biosciences in Cardiff University. He received his BSc (Hons) degree (Biochemistry) and his PhD (Molecular Biology) from the University of Leeds. This was followed by post-doctoral research at the European Molecular Biology Laboratory (Heidelberg) and the Istituto di Ricerche di Biologia Molecolare P. Angeletti (Rome) with fellowships from the Royal Society and the EU. He joined Cardiff University in 1992 and completed 25 years of service in August 2017. His research is focused on understanding how the immune and inflammatory responses regulate cellular processes in heart disease with the goal of attaining deeper mechanistic insight and identifying preventative/therapeutic agents. His research has been funded by several organisations and received continuous funding from the British Heart Foundation since 1997. He has published over 150 research articles (h index 34 and i10 index 68 with over 5700 citations). He is an editorial board member of 16 international journals; regular organising committee member, speaker and track/session chair at international conferences on heart disease; involved in grant evaluation for over 20 organisations; and supervised over 25 PhD students; involved in teaching and administration, including postgraduate tutor for the biomedicine division at the School of Biosciences and external examiner for Biochemistry and Biomedical Sciences at the University of Reading and King’s College London.

Abstract:

Cytokines play crucial roles in the control of immune and inflammatory responses. Abnormalities in cytokines, their receptors or the downstream signalling they initiate are associated with a number of inflammatory disorders, including atherosclerosis. Approaches to limit the actions of pro-inflammatory cytokines include neutralization (blocking antibodies or decoy receptors),receptor antagonists and small molecule inhibitors of intracellular signal transduction pathways. Other avenues include use of antiinflammatory cytokines or agents that augment their expression/actions. A more thorough understanding of cytokine actions in disease, particularly signalling pathways, is essential for the identification of new therapeutic targets/approaches. A key area of research focus in my laboratory has been on cytokine actions and signalling in atherosclerosis. Atherosclerosis, the underlying cause of myocardial infarction and cerebrovascular accidents, is an inflammatory disorder of medium and large arteries and is responsible for most deaths worldwide. Cytokines such as interferon-γ and interleukin (IL)-1β promote atherosclerosis whereas others, particularly IL-10, IL-33 and transforming growth factor-β, attenuate the disease. Our research has provided novel insights into intracellular signalling pathways and molecular mechanisms underlying  the actions of such cytokines, particularly in macrophages in atherosclerosis. These will be presented in the context of current therapies and future drug discovery and development. Interesting, many conventional therapies, such as statins and nutraceuticals, also modulate cytokine signalling and these will be also discussed. Finally, the limitation of cytokine therapeutics and the possibility of approaches involving modulation of cells that produce antiatherogenic cytokines will be presented.

Elena Leonova

Federal Central Tuberculosis Research Institute, Russia

Title: Factors associated with right ventricular dysfunction among patients with hypersensitivity pneumonitis

Time : 14:30-15:00

Speaker
Biography:

Elena Leonova PhD is a researcher of the Department of differential diagnosis of Interstitial lung diseases (Federal Central Tuberculosis Research Institute). After defending her dissertation on clinical and functional characteristics of patients with COPD and atrial fibrillation, she has focused on studying cardiovascular problems among patients with interstitial lung diseases.

Abstract:

Statement of the Problem: Cardiovascular diseases are the most common comorbidities among patients with chronic lung diseases (CLD). As we know, right heart failure is very severe complications of CLD, which contributes significantly to morbidity and mortality. However, there is very little literature describing factors associated with right ventricle (RV) dysfunction among patients with chronic hypersensitivity pneumonitis (HP). The purpose of this study was to investigate factors associated with the RV systolic dysfunction among patients with chronic HP.
 
Methodology and Theoretical Orientation: We identified 86 patients with chronic HP, who underwent echocardiography, spirometry, plethysmography, diffusing capacity of carbon monoxide (DLCO), bronchoscopy and lung biopsy. Pulmonary high-resolution computed tomography (HRCT) was assessed by Kazerooni scale (ground glass and lung fibrosis). Aortic pulse wave velocity (PWV) and body mass index also were evaluated as well. RV systolic function was assessed among all subjects using different methods (tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI) and RV systolic excursion velocity by tissue Doppler (S′).
 
Findings: RV systolic dysfunction was found in 40.7% of subjects by TAPSE and 38.4% by RV MPI and S′.All parameters of RV systolic function correlated with total lung capacity (p<0.01), DLCO, HRCT (lung fibrosis and ground glass (p<0.001)), PWV (p<0.001). Multivariate regression analysis showed that the factors associated with RV systolic dysfunction were lung fibrosis (p=0.001), DLCO (p=0.003) and PWV (p=0.008).
 
Conclusion and Significance: Systolic function of the right ventricle is associated with lung fibrosis, diffusion disturbance and arterial stiffness among patients with chronic hypersensitivity pneumonitis.

Kaiss Jarkass

Ministry of Education, Syrian Arab Republic

Title: Chronic fatigue syndrome: A unifying hypothesis for an etiological diagnosis

Time : 15:35-16:05

Speaker
Biography:

Kaiss Jarkass graduated from Saint Petersburg State Medical University I.P. Pavlov (Formerly, First Leningrad I. P. Pavlov Medical Institute) in 1988. He has 20 years’ experience in field work both in government sector, as a school health physician, and in private practice as a GP. He has interest mainly in infectious diseases, chronic illnesses and ME/CFS.

Abstract:

Statement of the Problem: ME/CFS is a disabling complex chronic illness affecting millions of people around the world. It has a devastating impact on the lives of patients and their families, causing losses estimated at billions of dollars annually in medical bills and lost incomes. The present paper seeks to put forth a plausible unifying hypothesis for an etiological diagnosis of this debilitating illness. It begins with a summary of hypotheses that have been suggested for explaining ME/CFS. An attempt is then made to put together various pathogenetical and pathophysiological mechanisms into one hypothesis, suggesting a single etiological factor and linking all other mechanisms to one causality. Firstly, the paper defines several criteria that any diagnosis should meet in order to be considered plausible. Secondly, it suggests a clinical diagnosis that might meet the criteria and account for the constellation of symptoms associated with ME/CFS. It explains the plethora of pathophysiological mechanisms and manifestations in the light of the suggested diagnosis. Thirdly, it anticipates and attempts to answer some of the issues that may be raised. Fourthly, it pinpoints challenges that need to be addresses in the light of the suggested causality. Finally, the paper suggests a plan for diagnosing patients with ME/CFS and a plan for ex juvantibus treatment defining challenges and strategies for further study.

Lia Millanaise Jones

Warwick Medical School, United Kingdom

Title: HIV, Hepatitis B & Hepatitis C

Time : 16:05-16:35

Speaker
Biography:

Lia Millanaise Jones is a third-year medical student at Warwick Medical School with an interest in Obstestrics and Gynaecology, and surgical research. She graduated with a First Class Honours in Medical Science from De Montfort University in 2016.

Abstract:

Background: This mixed methods study consists of a literature review and a service evaluation of a leading fertility centre. The literature review identifies best practice in the avoidance of the transmission of viruses during assisted conception in patients carrying HIV and hepatitis B/C, and how this affects their pregnancy outcomes.
 
Aims: To identify best practice in avoiding transmission of viruses during assisted conception in people with HIV and Hepatitis B (HBV) and Hepatitis C (HCV). To evaluate current conception methods for viral positive families at the Centre for Reproductive Medicine (CRM), and compare them with published data to determine success and opportunities for improvement.
 
Methods: An online literature search amassed 116 studies for analysis and 10 papers were shortlisted. From these papers, data was collected such as author, viral illness, and which parent affected. For the service evaluation, a list of viral positive patients receiving treatment at CRM in the past 5 years was assessed for treatment method and outcome.
 
Results: The pregnancy rate for viral positive families at CRM was 43% and the live birth rate was 30.8%. The live birth rates for HIV, HBV and HCV were 13.3%, 35.9% and 33.3%, respectively. At p <0.05, the p-value was 0.32663, meaning there was not a statistically significant difference between pregnancy and live birth rates where the male was seropositive vs the female.
 
Conclusion: Assisted conception outcomes are worse when the female is seropositive, rather than the male, for HIV, HBV and HCV. Options for viral positive men, such as sperm washing, are safe and effective. Viral positive patients treated at the Centre for Reproductive Medicine have higher pregnancy and live birth rates than their viral negative counterparts.
 
Key words: Hepatitis B virus, Hepatitis C virus, HIV, intracytoplasmic sperm injection, in vitro fertilisation.