Biography:

M Habeeb Ghatala has completed his Bachelor’s degree from Osmania University followed by Masters in Kansas, PhD in Wisconsin and MHA in Texas. He was the Professor of Sociology at universities in the USA. He has over 25 years of experience in tertiary care hospitals in USA, Saudi Arabia and India. He is currently, serving as a Member of Board of Directors of Hospitals, India.

Abstract:

Neurology is the study of nerves or the medical specialty related to human nervous systems. According to WHO, there are over 600 diseases of the nervous system. Neurological diseases in developing geographies including rural India present public health challenges. It is estimated that for the current population of India of 1.36 billion (2018), there are over 30 million people who suffer from neurological disorders. There is need for more neurologists in India as the current ratio of one neurologist for 1,250,000 population is very low. One of the known reasons for the shortage of neurologists and neurosurgeons is due to the fact that, at least in the USA, almost one in five neurosurgeons (19.09%) each year risk malpractice suits followed by cardiothoracic/vascular surgeon (18.9%) each year. There is need to initiate preventive programs to reduce the risk factors as cardiovascular diseases, hypertension and stroke. The aim of the study is to briefly review the neurological scenario in India discuss the mal-distribution of neurologists and neurosurgeons and its relevance to adoption of telemedicine, major reasons for neurological disorder are medico-legal issues, Doctrine of Res Ipsa, Loquitur protection against litigation, vicarious liability, brain death, important medical negligence cases, challenges in neurological practice and organization of neurology services, unmet needs and way forward. Neurological disorders affect all groups. There is evidence of physicians, hospitals and healthcare organizations ignoring the importance of malpractice insurance and vicarious liability. Furthermore, there is lack of basic knowledge of how judicial forums deal with cases relating to medical negligence. Neurological disorders are clinical, economic and public health issues mandating immediate attention. The efforts of Indian Council of Medical Research (ICMR) must be supported and strengthened so that the needs of the patients even in the most underserved remote and rural areas are met.

Biography:

Dipesh Raj Panday has completed his Master’s in Pharmacology from B.P. Koirala Institute of Health Sciences, Nepal.

 

Abstract:

Statement of the Problem: Ischemic Heart Disease (IHD) is a condition resulting from reduced blood supply to the myocardium. An accurate documentation and analysis of IHD clinical profile, investigation, prescription pattern and resulting Adverse Drug Reactions (ADRs) in a specified population is essential for the implementation of education and better treatment. The study was carried out with the objective of describing the clinical profile, investigation findings, prescription-pattern and ADRs of IHD inpatients of a tertiary hospital of eastern Nepal in the previous year.

Method: It was a record-based descriptive cross-sectional study carried out during 19th April to 16th May, 2017. 165 physician-diagnosed IHD were the sampling frame. CCU files of past one year were obtained from hospital record section. Any inpatients with IHD in the hospital were included. Patient Leaving Against Medical Advice (LAMA) were excluded. Data entry software epidata ver. 3.1 was employed for data-entry and analysis was done using Microsoft excel sheet and the latest available SPSS software.

Findings: Most patients were from Dharan (29%) where the hospital was located, mostly male (60.37%) and dependent (62.42%). ST Elevation Myocardial Infarction (STEMI) was the most common diagnosis (58.79%). Median age was 62 years with IQD 54-70 and patients stayed mostly for 4 days with IQD 2-6.7. Tobacco consumption (50.3%), alcohol use (22.8%), diabetes (25%) and hypertension (43.1%) were frequent among the patients. Typical chest pain (60.6%), dyspnea (42.0%) and diaphoresis (23.7%) were very common. 54.0% patients had anemia and 41.6% had leukocytosis. Aspirin (100.00%), Clopidogrel (97.55%) and HMG-CoA inhibitor (97.55%) were used in almost all patients.

Conclusion & Significance: Our study established conventional clinical profile, investigation findings and prescription pattern among the IHD inpatients of the hospital. However, adequate ADR documentation and reporting could not be appreciated.

Biography:

Abstract:

We report the case of a 36 year old woman, diagnosed with arterial hypertension at the age of 34, with difficult control of blood pressure values under treatment with beta-blocker, ACE and diuretics. She was referred to us for evaluation. No history of cardiac problems or family history of hypertension. The clinical examination showed an overweight woman, a blood pressure of 165/80 mmHg in the right arm and 100/60 mmHg in the left leg, large pulsations in the suprasternal notch, normal heart sounds, 60 bpm. A systolic murmur was audible at the parasternal right and left area and at the paravertebral interscapular area bilaterally. The radial pulses were palpable but femoral pulses were extremely weak and at transthoracic echocardiography, showed mild LVH. From the suprasternal view, we found the signs of an aortic coarctation, without significant systolic gradient but diastolic run-off at Doppler evaluation. Confirming the diagnosis CT angiography examination showed very tight coarctation with interruption just distal to the left sub clavian artery, with post-stenotic dilatation of the descending aorta, with some collateral vessels. After multiple trials to cross retrograde the trials of antegrade, recanalization of the interrupted aorta was performed using a rigid coronary wire and we managed to cross the lesion. The guide wire was captured with a snare and kept fixed. This allowed crossing with MP4 F catheter was interchanged and angiography was performed in the proximal arch of the aorta. Measurements were confirmed and a rigid guide wire was used to allow interchanging the angiographic catheter to 14-F Cook sheath (Cook Medical, Bloomington, Indiana). A covered Cheatham was implanted. Angiography post stent showed successful stent of the COA and the residual gradient of 2-3 mm across the stent. The patient was transferred to the CCU, she was stable clinically. Next morning, pallor was observed and we asked for urgent blood picture which showed hemoglobin dropped 2 grams compared to before the procedure and follow up after 2 then 4 hours showed continue of the dropping in the blood hemoglobin. Blood replacement and urgent CT thoracic and abdominal showed a nice stent without dissection or aneurysm but a large left perinephric hematoma (7×8 cm) was detected. That has put us in a conundrum since the procedure was smooth and there was no apparent injury to any renal vessel; on asking the patient gave history of falling down in the toilet on her side without telling someone or asking for help. After discussing with the surgical team, she was managed conservatively and she was safely sent home after 7 days. Dropping hemoglobin after stenting COA has many causes which include dissection, aortic rupture, bleeding during the procedures and injury of vascular structure. Meticulous history taking, careful examination and multi-disciplinary imaging modalities would pretty much help detect the cause of the bleeding early and prevent its incidence in future cases.

Biography:

Pandey K R is an Assistant Professor in the Department of Basic and Clinical Physiology at B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Her areas of research interests are on neurophysiology, cardiovascular physiology and respiratory physiology.

Abstract:

Statement of the Problem: Nicotine in tobacco smoke causes demyelination. Again, hypoxia in long-term smokers is linked to neuropathy. Visual receptors are considered to be early sufferer of this neuropathy. Visual-Acuity and other ocular tests often fail to detect subtle changes of neuropathy which, however, can be detected by VEP test. Literature review shows that changes in Visual Evoked Potential (VEP) come earlier than PFT changes in smokers. Ironically, smokers claim that smoking improves their reaction time which can be assessed by VRT. Our study, therefore, was performed to relate smoking status with VEP as well as Visual Reaction Time (VRT). We also tried to correlate PFT variables with VEP and VRT, respectively.

Method: 56 subjects (smoker group=28 and non-smoker group=28) whose age and sex were matched, were included in the study (9^th May-17^th July 2016). Their PFT, pattern VEP of both eyes and VRT were recorded. The data were compared between the two groups using unpaired t-test, considering statistical significance at p<0.05. Pearson’s correlation was applied to correlate PFT variables with VEP and VRT, respectively.

Findings: The Forced Vital Capacity (FVC) (4.35±0.83 vs. 5.32±1.18 l, p=0.022), FEF 25% (7.40±2.38 vs. 8.74±3.90 l/s, p=0.019) and FEF 50% (6.11±1.52 vs. 7.74±2.57, p=0.010) were significantly lower in smokers compared to non-smokers. There was no significant difference in P100 wave latency of VEP between the groups. But, VRT of smokers were significantly shorter (431.69±60.29 vs. 441.14±123.54 ms, p=0.010). Pearson’s correlation did not reveal any correlation between PFT variables and VEP or VRT.

Conclusion & Significance: P100 wave latency, the VEP parameter, was shorter (better) in smokers but was not significant. Smokers have faster visual reaction time.

Biography:

Statement of the Problem: Nicotine in tobacco smoke causes demyelination. Again, hypoxia in long-term smokers is linked to neuropathy. Visual receptors are considered to be early sufferer of this neuropathy. Visual-Acuity and other ocular tests often fail to detect subtle changes of neuropathy which, however, can be detected by VEP test. Literature review shows that changes in Visual Evoked Potential (VEP) come earlier than PFT changes in smokers. Ironically, smokers claim that smoking improves their reaction time which can be assessed by VRT. Our study, therefore, was performed to relate smoking status with VEP as well as Visual Reaction Time (VRT). We also tried to correlate PFT variables with VEP and VRT, respectively.

Method: 56 subjects (smoker group=28 and non-smoker group=28) whose age and sex were matched, were included in the study (9^th May-17^th July 2016). Their PFT, pattern VEP of both eyes and VRT were recorded. The data were compared between the two groups using unpaired t-test, considering statistical significance at p<0.05. Pearson’s correlation was applied to correlate PFT variables with VEP and VRT, respectively.

Findings: The Forced Vital Capacity (FVC) (4.35±0.83 vs. 5.32±1.18 l, p=0.022), FEF 25% (7.40±2.38 vs. 8.74±3.90 l/s, p=0.019) and FEF 50% (6.11±1.52 vs. 7.74±2.57, p=0.010) were significantly lower in smokers compared to non-smokers. There was no significant difference in P100 wave latency of VEP between the groups. But, VRT of smokers were significantly shorter (431.69±60.29 vs. 441.14±123.54 ms, p=0.010). Pearson’s correlation did not reveal any correlation between PFT variables and VEP or VRT.

 

Conclusion & Significance: P100 wave latency, the VEP parameter, was shorter (better) in smokers but was not significant. Smokers have faster visual reaction time.

Abstract:

Biography:

Samer Ellahham has served as the Chief Quality Officer for SKMC. He has worked as a Chief Quality Officer and Global Healthcare Leader, focusing on ensuring that that implementation of the best practices lead to breakthrough improvements in clinical quality and patient safety. He is a Certified Professional in Healthcare Quality (CPHQ) by The National Association for Healthcare Quality (NAHQ). He is certified in Medical Quality (CMQ) by The American Board of Medical Quality (ABMQ). He is the recipient of the Quality Leadership Award from the World Quality Congress and Awards and the Business Leadership Excellence Award from World Leadership Congress.

 

Abstract:

The cost of heart failure care is 1-2% overall healthcare spending in developed countries. In the United States, heart failure consumes more medicare dollars than any other diagnosis. Diabetes mellitus and preserved ejection fraction are independent predictors of higher lifetime costs. Costs are accrued more rapidly at the time of initial diagnosis and in the final months of life. The incidence of heart failure is high and increases with age. Readmission is an issue with heart failure. The burden of hospitalization is increasing. Heart failure is deadly and costly with much of the cost due to the burden of hospitalization. Effective evidence-based interventions should address gaps in care and promote effective transitions across sites and clinicians (e.g. single point person throughout episode of illness, transfer of information, focused patient/family caregiver education, coordinated follow-up services) and root causes of poor outcomes with a focus on longer-term value for both the patient and health care system. A heart failure readmission checklist before admission, during hospitalization and related to discharge. In summary a checklist and disease management program are key in reducing heart failure hospital readmission.

Biography:

Arghya Jana is a Paramedic in Cathlab and has his expertise in both pediatric and adult cardiac interventions. He is currently working on onco-interventions.

 

Abstract:

India with 1.30 billion population stand at the 2^nd position as the most populous country in the world after China. Children of today are tomorrow’s citizen. Hence it is very necessary to provide better healthcare facilities to them. Malnutrition and mortality among children are the two faces of a single coin. About 15%-23% of the present mortality may be accounted for congenital heart disease. From 1950 balloon angioplasty and device closure of ASD, VSD have been accepted as the procedure of choice in several congenital abnormalities. New generation of cathlabs, experience and technology also help in extremely difficult transcatheter interventions such as ductul stenting, RVOT stenting, hypoxia management after Glenn surgery, Norwood stage I. RF ablations and device therapies are done for to prevent sudden cardiac death from arrhythmia. Health systems and policies have a critical role in the manner in which healthcare services are delivered and its outcome. Pediatric cardiac interventions, decision and its complication management is a joint effort of the surgeons, interventionalists, paramedics and nurses.

 

Biography:

Hilla Ben-Pazi is a Child Neurologist and Medical Entrepreneur, Director of the Movement Disorders Clinic at Shaare Zedek Medical Center in Jerusalem and Founder of NeuroCan. She has completed her studies at Hebrew University Medical School and was trained in Pediatrics at Hadassah. She has completed her Fellowship in Pediatric Neurology at Shaare Zedek. She is specialized in Pediatric Movement Disorders from Stanford University, California, USA in Telemedicine (FutureMed, Singularity University; Telemedicine Management, University of Alaska).

Abstract:

Background: Most children have uncomplicated streptococcal tonsillitis. A minority develops Sydenham's Chorea (SC), a post-streptococcal, neuropsychiatric disorder associated with anti-neuronal antibodies. While several autoantibodies such as anti-Dopamine receptor antibodies were found elevated in children with SC compared to controls their existence and role in uncomplicated tonsillitis has not been studied. We hypothesized that unique autoantibodies would be detected in children with Sydenham's chorea and not in children with tonsillitis.

Method: We examined autoantibody profile from children with acute (aSC; n=35) and persistent (pSC; n=11) SC compared to age-matched controls with streptococcal tonsillitis within the past month (ST; n=28) and healthy children (HC; n= 32). Sera were examined for Anti-Streptolysin-O (ASLO) Anti-Dopamine-1-receptor (D1R), Anti-Dopamine-2-Receptor (D2R), anti-tubulin and anti-Lysoganglioside (LG) titers in respect of time for clinical presentation.

Result: ASLO titers were high but similar in children with tonsillitis and aSC (p=0.071-0.51). Anti-D1R antibody was higher in aSC than in tonsillitis after 2 weeks (p=0.02-0.078). Anti-D2R antibody titers were similarly high in aSC and tonsillitis (p=0.59) participants compared to controls. Anti- LG was higher among children with aSC compared to tonsilitis after 2 weeks (p=0.0081-0.026). Anti-tublin was lower in aSC compared to the tonsillitis group during the first 2 weeks only (p=0.01). Combined titers were higher in children with SC compared to controls from 2 weeks and beyond (Composite Measure of ASLO+ D1R+D2R+ LG was p=0.005-0.049).

Conclusion: Autoantibodies are higher in children with SC compared to children with tonsillitis beyond two weeks. A composite test may have implications on diagnosis and treatment of this autoimmune disorder.

Figure-1: Composite Measure (D1R+D2R+LysoGN) over time (months)

Recent Publications

1. Ben-Pazi H, Stoner J A, Cunningham M W (2013) Dopamine receptor autoantibodies correlate with symptoms in Sydenham's chorea. PloS One; 8(9): e73516.

2. Dale R C, Merheb V, Pillai S, Ben-Pazi H, et al. (2012) Antibodies to surface dopamine-2 receptor in autoimmune movement and psychiatric disorders. Brain: A Journal of Neurology; 135(11): 3453-3468.

References

1. Teixeira A L Jr, Maia D P, Cardoso F (2005) UFMG Sydenham's chorea rating scale (USCRS): reliability and consistency. Mov Disord; 20(5): 585-591.

2. Cardoso F, Vargas A P, Oliveira L D, Guerra A A, Amaral S V (1999) Persistent Sydenham's chorea. Movement disorders official. Journal of the Movement Disorder Society; 14(5): 805-807.

3. Garvey M A, Snider L A, Leitman S F, Werden R, Swedo S E (2005) Treatment of Sydenham's chorea with intravenous immunoglobulin, plasma exchange or prednisone. Journal of child neurology; 20(5): 424-429.