1Euromedik General Hospital, Serbia
2Sant Eugenio Hospital, Italy
3Clinical Center, Serbia
Gastrointestinal system is an organ essential for digestion end extraction of nutrients, but itʼs also bodyʼs largest endocrine organ. There are more than 20 different regulatory hormones secreted by 10 different enteroendocrine cells found in stomach, small and large intestines such as incretins (glucose dependent insulinotropic polypeptide, glucagon like peptide 1), peptide YY, ghrelin, ohyntomodulin, obestatin, cholecystokinin and others. Intestinal epithelial cells are the key players in maintaining metabolic and immune homeostasis, forming a surface area up to 40m2, which makes them bodyʼs most important interface with external environment, with a role to allow efficient nutrient absorbtion while maintaining barrier function and modulating immunity. Enteroendocrine cells, capable of “chemosensing” nutrients, bile acid, various tastes and bacterial products interacting with their surface receptors are scattered throughout the gastrointestinal tract and as a response to stimuli they secrete hormones. They are an important link in energy homeostasis, as a crosstalk between gut and brain and gut and immune system. Microbiota is so called “organ within an organ”, which contains a great number of bacteria (101). Obese patients have altered fasting and postprandial secretion of gastrointestinal hormones and changed microbiota, which leads to progression of weight gain, insulin resistance, metabolic syndrome, inflammation and cancerogenesis. Over the last few years we developed a therapy based on gut hormones as a target for obese patients and researchers are still exploring new possibilities. Recent studies have shown positive results on weight loss in obese patients on probiotics and prebiotics therapy due to microbiota changes.
Biography:
Nevena Ilic has completed her MhD studies in Reproductive endocrinology in 2011 and MhD studies in Thyroid diseases in 2014, in Italy. She completed her subspecialization in Endocrinology at Belgrade University Medical School in 2009 and Internal medicine specialization at Military Medical Academy Hospital, Belgrade in 2002. From 2015 she works as Prime Endocrinologist at Euromedik General Hospital. She is a scientific associate at S. Eugenio Hospital in Rome where she organized several International Conferences. She spoke at several International congresses. She has published 23 papers in reputed journals. She is a member of European and Italian
1R&D Dept Laboratori Baldacci SpA, Italy
2Unit of Paediatrics, University Magna Grecia, Pugliese-Ciaccio Hospital, Italy
3Medical Laboratory, University Magna Grecia, Pugliese-Ciaccio Hospital, Italy
Background: Coeliac Disease (CD) is an immune mediate disorder largely focused in the proximal small intestine mucosa. Reduced iron absorption because of duodenal mucosa villi atrophy is often present in coeliac patients making every kind of oral iron treatment unuseful because of malabsorption. FERALGINE™ is a new patented co-processed 1 to 1 ratio compound between Ferrous Bysglicinate and Sodium Alginate that has been demostrated to be almost four times more oral bioavailable than Ferrous Sulphate.
Methods: 25 Adults affected by Iron Deficiency Anemia (IDA) of which 14 affected also by Coeliac Disease (aged 33 years, Hb 11.5 g/dl) and 11 without Coeliac Disease (aged 32.16 years, Hb 11.3 g/dl) has been enrolled in the trial. Oral Iron Absorption Test (OIAT) by using only 60 mg of elemental iron belonging to FERALGINE™ has been acutely used in every patients and serum iron was evaluated at baseline (T0) and after 2 hours (T1) from the oral iron ingestion.
Results: OIAT was well tolerated in every patients and surprising, an equivalent statistically significative improvement in serum iron occurred after two hours in the two groups of patients (IDA plus CD: T0 = 28.21μg/dl vs T1 = 92.71μg: p = 0.004 T Studentʼs Test and IDA without CD: T0 = 37.09μ vs T1 = 125,54μg: p = 0.001 T Studentʼs Test)
Conclusions: These results obtained by OIAT clearly demostrated the high bioavailability of FERALGINE™ also in coeliac patients only after two hours of treatment confirming the previous data obtaining with Ferrous Bysglicinate alone and with FERALGINE™.
Biography:
Marco Bertini was born in Pisa, Italy, in 1960. He graduated in Medicine & Surgery in Pisa University in 1987. He has a PhD in Paediatrics and a PhD in Clinical Pharmacology. He was working in Pharmaceutical Companies as Medical Manager since 1990 and He was teaching Clinical Pharmacology as Contract Professor in Pisa University. He was Editorial Board Member of several international Journals and He was Author of more than 100 impacting international scientific articles. He was attending a lot of international Congresses like “invited speaker” all over the world in different scientific topics (cardiology, gastroenterology, metabolism and Diabetes, Alcoholism, Iron Deficiency Anemia). He was actually employed in Laboratori Baldacci SpA, Pisa, Italy as Medical Affairs Manager.
Institute of Liver & Biliary Sciences, India
Background: Culture negative neutrocytic ascites is a variant of spontaneous bacterial peritonitis. But there are conflicting reports regarding the mortality associated with culture negative neutrocytic ascites. Therefore we aim to determine the predictors of mortality associated with culture negative neutrocytic ascites in a larger sample population.
Methods: We analysed 170 patients consecutively admitted to intensive care unit with diagnosis of culture negative neutrocytic ascites. The clinical laboratory parameters, etiology of liver cirrhosis was determined along with the scores like model for end stage liver disease, child turcotte pugh were recorded.
Results: The 50 day in-hospital mortality rate in culture negative neutrocytic ascites was 39.41% (n=67). In univariate analysis, means of parameters like total leucocyte count, urea, bilirubin, alanine aminotransferase, aspartate aminotransferase, international normalized ratio, acute kidney injury, septic shock, hepatic encephalopathy and model for end stage liver disease were significantly different among survived and those who died (P value ≤0.05). Cox proportional regression model showed the hazard ratio (HR) of acute kidney injury was 2.212 (95% CI: 1.334-3.667), septic shock (HR = 1.895, 95% CI: 1.081-3.323) and model for end stage liver disease (HR = 1.054, 95% CI: 1.020-1.090). Receiver operating characteristics curve showed aspartate aminotransferase had highest area under the curve 0.761 (95% CI: 0.625-0.785).
Conclusion: Patients with culture negative neutrocytic ascites have a mortality rate comparable to spontaneous bacterial peritonitis. Aspartate aminotransferase, alanine aminotransferase, acute kidney injury, model for end stage liver disease and septic shock are the independent predictors of 50 days in-hospital mortality in culture negative neutrocytic ascites.
Biography:
Dr. Chinmaya Kumar Bal has completed his MD in Internal Medicine. His career interest include gastroenterology and hepatology. He has worked as research assistant at Roger Washingtonʼs Clinic, Santa Clara, CA, USA. He was previously engagaged as observer in gastroenterology department at Clevelend Clinic, FL, United States and Stanford University School of Medicine, CA. He has done his clinical research training in epidemiology and clinical trial concentration from Harvard Medical School, USA. He has also worked as Junior resident doctor at All India Institute of Medical Science, New Delhi, Safdarjung Hospital, New Delhi, Institute of Liver & Biliary science, New Delhi. He also worked as Emergency Medical Officer at Moolchand Hospital, New Delhi. He has several publications in various pee
Interessengemeinschaft Endoskopie, Austria
Over the last 20 years, we have seen a rapid evolution of knowledge gained, the resulting demands and associated investments compared to other areas.
Today, we have clear ideas of quality in endoscopy with objective parameters such as adenoma coverage rate, caecum proliferation, complete removal of lesions, the complication rate, just to mention a few.
There are more requirements today that are a prerequisite for these quality guidelines, such as hygiene regulations, complication management, etc.
Strikingly, the investment costs of a simple endoscopy system, compared between 1995 and 2015, the investment costs increased by 1047%! And thatʼs why some of todayʼs indispensable features have not even been considered. The inflation rate between the years 1995 and 2015 averaged 2% each year, thus a total of 40% and since 1995 the fees have been rising by the rate of inflation.
The offer of endoscopy in private practice can only be upheld seriously if it is rewarded economically under quality-assured conditions. Compromises serve neither the patient, nor the method, nor the state of the medical profession as a whole. We have to convince our opposite:
1. There is a problem - without and if; 2. This problem must be solved honestly - without ulterior motive; 3. We have a common social goal - the health of our population;
Biography:
Dr. Gerald Oppeck is a outpatient practice, specialist in internal medicine, specialist in nuclear medicine and also a advisory council at ÖGGH. He also participated as a delegate at “United European Gastroenterology”. He is a president of (IG Endoskopie) Interessengemeinschaft Endoskopie, Austria official at Endoskopiereferat at Ärztekammerfür Niederösterreich.
Morbid Obesity Unit, Department of Surgery, University of Patras, Greece
Conventional treatment does not treat obesity and metabolic syndrome definitely and the complications cannot be controlled, on the long run. On the other hand, bariatric surgery results on remarkable and sustainable weight loss, alongside the remission of the major components of metabolic syndrome.
Looking specifically at diabetes type II, metanalyses of retrospective studies have been reported remission rates around 80%. These sustainable findings have driven to a worldwide change: from bariatric to metabolic surgery.
Nowadays metabolic surgery is considered as an effective tool for the treatment of T2DM and metabolic syndrome. There are many data, based on well - designed RCTs, suggesting that metabolic surgery results to significant remission of T2DM, compared to conventional treatment. These RCTs have demonstrated the superiority of surgery on diabetes remission or glycemic control even on patients with BMI ≤35 (Level 1a evidence). Based on these findings, international diabetes organizations inserted metabolic surgery in the treatment algorithm of type 2 diabetes.
Conclusively bariatric/metabolic surgery is nowadays the only treatment that achieves sustained weight loss in severely obese patients, which additionally induces the most effective control of hyperglycemia in obese patients with T2DM.
Biography:
George Skroubis, MD is an Associate Professor of Surgery, Department of Surgery, University of Patras, Greece and he is also Director of Morbid Obesity Unit, University Hospital of Patras, Greece
1Hepatobiliary Surgery, National Liver Institute, Menoufiya University, Egypt
2Anaesthesia, National Liver Institute, Menoufiya University, Egypt
3Hepatology and endoscopy, National Liver Institute, Menoufiya University, Egypt
4Radiology, National Liver Institute, Menoufiya University, Egypt
Objectives: Laparoscopic cholecystectomy (LC) - associated bile duct injury (BDI) is a clinical problem with poor outcome. The study aimed to analyze the outcome of surgical management of these injuries.
Patients and Methods: We retrospectively analyzed 69 patients underwent surgical management of LC related major BDIs (MBDIs), in the period from the beginning of 2013 to beginning of 2018.
Results: Regarding injury type; the Leaking, Obstructing, leaking + obstructing, leaking + vascular and obstructing + vascular injuries were 43.5%, 27.5%, 18.8%, 2.9% and 7.2% respectively. However, the Strasberg classification of injury was as follow: E1=25, E2=32, E3=8 and E4=4. The definitive procedures were as follow: End to end biliary anastomosis with stent, hepaticojejunostomy (HJ) with or without stenting and RT hepatectomy plus biliary reconstruction with stenting in 4.3%, 87% and 8.7% of patients respectively. According to time of definitive procedure from injury; the immediate (before 72 h), intermediate (between 72 h and 1.5 months) and late (after 1.5 months) management were 13%, 14.5% and 72.5% respectively. The hospital and 1 month (early) morbidity after definitive treatment was 21.7%, while, late biliary morbidity was 17.4% and the overall mortality was 2.9%, on the other hand, late biliary morbidity free survival was 79.7%. On univariate analysis, the following factors were significant predictors of early morbidity; Sepsis at referral, higher Strasberg grade, associated vascular injury, RT hepatectomy with biliary reconstruction as a definitive procedure, intra-operative bleeding with blood transfusion, liver cirrhosis and longer operative times and hospital stays. However, the following factors were significantly associated with late biliary morbidity: Sepsis at referral, end to end anastomosis with stenting, reconstruction without stenting, liver cirrhosis, operative bleeding and early morbidity.
Conclusion: Sepsis at referral, liver cirrhosis and operative bleeding were significantly associated with both early and late morbidities after definitive management of LC related MBDIs, so it is crucial to avoid these catastrophes when doing those major procedures.
Biography:
Emad Hamdy Gad MD, Currently working as an associate professor of surgery in the Department of Transplantation, Hepatobiliary & Pancreatic surgery. National Liver Institute, University of Minoufiya, Shibin El-Kom, Minoufiya, Egypt and Consultant, general surgery, hepatobiliary surgery in King Faisal hospital, Taif, KSA. He worked as a specialist in general surgery in Alganzoury private hospital in Cairo, Egypt from 2008 to 2014 (part time). He worked as consultant hepatopancreatobiliary and laparoscopic surgery in King Khaled hospital (General surgery and trauma hospital) in Hail in KSA for 6 months (Locum) from 2/2015 to 8/2015. He worked as consultant general surgery in Alnile hospital, Gherghada, Egypt from 3/2016 until 8/2016.
Acibadem Mehmet Ali Aydinlar University, Turkey
The cholinergic anti-inflammatory pathway is a neural mechanism, which inhibits pro-inflammatory cytokine release via α7 nicotinic acetylcholine receptors (α7 nAChR). It has been established that vagus nerve signaling inhibits cytokine activities and improves disease endpoints in experimental models of sepsis, ischemia/reperfusion, hemorrhagic shock, myocardial ischemia, ileus, experimental arthritis and pancreatitis.
It is accepted that the vagus nerve and cholinergic. The mechanism for inhibition of cytokine synthesis is attributable to acetylcholine (ACh), the major vagus nerve neurotransmitter. Macrophages and other inflammatory cells releasing cytokines express ACh receptors, which transduce an intracellular signal to suppress cytokine synthesis and release. The mechanism of signal transduction probably involves ligand-receptor interaction on cytokine-expressing cells to decrease nuclear translocation of nuclear factor (NF)-κB as well as activation of the transcription factor signal transducer and activator of transcription (STAT)-3 via phosphorylation by janus kinase (JAK)2, which is recruited to the α7 nAChR agonists activate the sympathetic noradrenergic splenic nerve to control systemic inflammation. Splenic nerve stimulation mimics vagal and cholinergic induction of norepinephrine and re-establishes neuromodulation in α7nAChR-deficient animals. Thus, vagus nerve and cholinergic agonists inhibit systemic inflammation by activating the noradrenergic splenic nerve via the a7nAChR nicotinic receptors.
In contrast to the spleen, a direct vagal communication between the gut wall and the central nervous system has been experimentally proven in the gastrointestinal tract recently. Using anterograde tracers injected into the dorsal motor nucleus of the vagus, efferent vagal nerve terminals were shown to directly synapse with postganglionic neurons located in the enteric nervous system. These researches opened a new debate on the action mechanism of cholinergic anti-inflammatory pathway on gastrointestinal system. Some researchers have claimed that interaction between gastrointestinal system and cholinergic anti-inflammatory system is different and unique. So we investigated interaction and action mechanism of cholinergic anti-inflammatory pathway on different gastrointestinal inflammation models. Ulcerative colitis, acute panrceatitis, endotoxemia induced gastroenteritis models have been investigated by our group. In this speech some results of our researches will be discussed to elucidate the effects of cholinergic pathway on gastrointestinal inflammation.
Biography:
Meltem Kolgazi is working as an Assistant professor in Acibadem Mehmet Ali Aydinlar University, Department of Physiology (2014--…) and he worked as an Instructor – Eastern Mediterranean University with Dr. FazılKüçük Faculty of Medicine (2013-2014). He is a Research Assistant in Physiology Department, Marmara University School of Medicine (2009-2
Shiv Shraddha Nursing Home, India
Statement of the Problem: Grade III and IV highly vascular haemorrhoids with Secondary haemorrhoids - (between the anal cushions) and Circumferential and Circumferentially Protruding Haemorrhoids with external haemorrhoids is a challenging problem for both surgeon and patient. Surgery is the only option Open haemorrhoidectomy (Milligan Morgan) remains the gold standard for surgical intervention for haemorrhoids and is the still most popular technique. Other popular options are closed hemorrhoidectomy (Ferguson), Submucosal technique of Parks and many other. However, haemorrhoidectomy is recognised as a painful procedure with a risk of significant complications and remains unpopular. Primary and secondary haemorrhage, retention of urine, wound infection, incontinence and anal stenosis are common.
The Purpose of this Study is: To describe a unique method called Personalized, Purposeful, Predictable and Precise Fibrosis (4PF) focusing on decreasing haemorrhoid vascularity, reducing redundant tissue and promoting haemorrhoid fixation to the rectal wall. This method is reproducible, has a short learning curve and consistently predictable result and useful in any and all type of grade III and IV highly vascular haemorrhoids with Secondary haemorrhoids -(between the anal cushions) and Circumferential and Circumferentially Protruding Haemorrhoids with external haemorrhoids. Presenting 156 patients over the period of 30 years with a maximum follow up of 30 years and minimum follow up of 5 years.
Conclusion & Significance: Almost all patients are discharged after 24 hours with no need to follow up except have a problem. No case of postoperative bleeding or reexploration or wound complications was reported. Even on the long-term study of 5 to 30 years incontinence, anal fissure, external haemorrhoids, mucosal prolapse, recurrence of haemorrhoids, anal stenosis /stricture were not reported. This new method has the potential to replace all surgical methods available now. It has an excellent short term and long term results.
Various Steps of Operation:
A- Before, B and C –Internal Haemorrhoids, D and E –External haemorrhoids, F –Final look (Note multiple low power cauterizations with 24 gauze needles),
B- Note nothing is dissected or cut in internal Haemorrhoids except terminal part that to if needed. In external Haemorrhoid small extra tissue is cut so there are no skin tags. Goal is to decrease vascularity and induce fibrosis and fixation.
Biography:
Parshottambhai B Patel MS is Surgeon and Cancer specialists. He was practicing from last 34 years. Primary focus is on anorectal diseases, breast and head and neck cancer. Primary focus is prevention and early detection of cancer. He has written one book and more than 15 educational booklets. He has taken more than 1000 lectures all over state of Gujarat. He is also distributing educational information with actionable information in a way which is easy to understand.
Albert Einstein College of Medicine, USA
Colorectal cancers (CRC) is one of the major causes of death in a westernized community where the 5-year survival rate is around 65%. New treatments are being investigated worldwide including through the inhibition of a number of chaperones of the Heat Shock Proteins (HSP) family. In 2011, a mutation was discovered for one such heat shock protein, HSP110, in colorectal cancer with microsatellite instability (MSI). Patients bearing this mutation have a reduced expression of HSP110 and an excellent response to adjuvant chemotherapy, with a 5-year disease free survival rate over 90%. Interestingly, the absence of HSP110 was not compensated by the expression of other heat shock proteins. In the present study, we show that HSP110 translocates to the nucleus after a genotoxic insult. There, it interacts with the Ku heterodimer and contributes to efficient DNA repair through the non-homologous end joining pathway. The inhibition of DNA-PK in colorectal cancer cells expressing HSP110 is enough to restore the sensitivity of these cells to oxaliplatin. Finally, our study confirms that HSP110 might be a good therapeutic target for the treatment of colorectal cancer using genotoxic drugs.
Biography:
Sebastien Causse carried out his PhD at the Ecole Normale Superieure in Paris, France, under the supervision of Dr. Xavier Darzacq. There he worked on the dynamics of transcription by RNA Polymerase 2. He then went on to work in the team of Dr. Carmen Garrido at the University of Burgundy in Dijon, France. He worked on HSP110 and its role in the resistance of colorectal cancer to chemotherapy. He is now working with both the teams of Dr. Garrido and Pr. Ana Maria Cuervo (at the Albert Einstein Co
Hepatitis Foundation of Ghana, Ghana
Background: Ghana belongs to the areas where the prevalence of chronic Hepatitis infection is high. We are engaged in several community intervention programs across the country. One of these interventions is Hepatitis B and C Screening, awareness and education, which was held in Tarkwa (Mining Community) in the Western Region of Ghana. More people are living with Hepatitis in the Tarkwa as a result of influx of galamsey activities. A lot of people engaged in unprotected sex as galamsey activities boom in the area, making it one of the districts in the Western region with high Hepatitis prevalence rate. Because of commercial activities, likely galamsey, people move all the way from different communities, some even donʼt have accommodation yet you find sexual activities going on. Hepatitis is on the rise so we can pin it on galamsey.
Description of Model of Care/Intervention: Hepatitis testing was performed by trained staff from the Hepatitis Foundation of Ghana. Those screened positive were counselled and referred to the local government health center for confirmatory testing and management. Data from the programme were sent to the National Hepatitis Control programme at Ghana Health Service for linkage to Hepatitis care. There was an intensive awareness on the local radio and TV stations within community to draw their attention on the dangers viral hepatitis pose, prevention and management approaches. We used drama, music and dancing to raise awareness and increase their knowledge on hepatitis B and C and free Hepatitis screening.
Effectiveness: The community based mode of care intervention ensured that ‘hard-to-reachʼ individuals benefited from the event. Different people from different backgrounds and culture benefited from the event. The model ensured community participation as the local folks took active part during the awareness and education sessions.
Conclusion and Next Steps: It is a general observation that every place where there is mining activity, you tend to find that there is raising Hepatitis prevalence. The fight against viral hepatitis and its burden on the affected families and the nation as a whole cannot be won without proactive participation by go
1Hepatobiliary Surgery, National Liver Institute, Menoufiya University, Egypt
2Anaesthesia, National Liver Institute, Menoufiya University, Egypt
3Hepatology and Endoscopy, National Liver Institute, Menoufiya University, Egypt
4Radiology, National Liver Institute, Menoufiya University, Egypt
Objectives: For complicated large difficult CBD stones that cannot be extracted by ERCP, patients can be managed safely by open or laparoscopic CBD exploration. The aim of this study was to assess these surgical procedures of CBDE after endoscopic failure.
Methods: We retrospectively reviewed and analyzed 85 patients underwent surgical management of large difficult CBD stones after ERCP failure, in the period from beginning of 2013 to beginning of 2018. The overall male/female ratio was 27/58.
Results: Sixty seven (78.8%) and 18(21.2%) of our patients underwent single and multiple ERCP sessions respectively with significant correlation between number of ERCP sessions and post ERCP complications (P=0.009). Impacted large stone was the most frequent cause of ERCP failure (60%). LCBDE, OCBDE and the converted cases were 24.7% (n=21), 70.6% (n=60) and 4.7% (n= 4) respectively. Stone clearance rate post LCBDE and OCBDE reached 95.2% and 95% respectively (P< 0.05), Eleven (12.9%) of our patients had post operative complications (14.3% post LCBDE and 11.7% post OCBDE, P<0.05) without mortality. By comparing LCBDE and OCBDE groups; there was significant association between the former and younger age, shorter referral time, more frequent choledochoscopy and longer operative time with independent correlation regarding age and operative time. On comparing, T-tube and 1ry CBD closure in LCBDE group, there was significant longer operative time and hospital stay in the former. However, on comparing them in OCBDE group, there was significant correlation between 1ry CBD closure and smaller diameter of CBD, single stone, choledochoscopy, shorter operative times and hospital stays. Furthermore, in OCBDE group, choledocoscopy had independent direction to 1ry CBD repair and significant association with shorter operative time, hospital stay and higher stone clearance rate.
Conclusion: Large difficult CBD stones can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, Open choledocoscopy has a good impact on stone clearance rate with direction towards doing primary repair that is better than T-tube regarding operative time and hospital stay.
Biography:
Emad Hamdy Gad MD, Currently working as an associate professor of surgery in the Department of Transplantation, Hepatobiliary & Pancreatic surgery. National Liver Institute, University of Minoufiya, Shibin El-Kom, Minoufiya, Egypt and Consultant, general surgery, hepatobiliary surgery in King Faisal hospital, Taif, KSA. He worked as a specialist in general surgery in Alganzoury private hospital in Cairo, Egypt from 2008 to 2014 (part time). He worked as a consultant hepatopancreatobiliary and laparoscopic surgery in King Khaled hospital (General surgery and trauma hospital) in Hail in KSA for 6 months (Locum) from 2/2015 to 8/2015. He worked as a consultant general surgery in Alnile hospital, Gherghada, Egypt from 3/2016 until 8/2016.
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