University of Glasgow, UK
It has been estimated that almost 8 million people in the UK live with chronic pain and from those only about two thirds respond positively to current analgesic treatments. Chronic pain, therefore, represents a major unmet clinical need. A major reason for the lack of effective treatments for this disease is the limited knowledge and understanding of the neuronal circuitry regulating pain transmission at the spinal cord level, and one thing we should seriously consider is that revealing and understanding the complexity of neuronal populations and the diversity of receptors and signalling mechanisms in this region should provide numerous targets for the development of new drugs that can alleviate pain more effectively. This can be done by identifying and characterizing specific neuronal populations that might be responsible for transmitting and processing noxious stimuli.
We are currently using different neurochemical markers to identify distinct populations of interneurons, the largest neuronal group within the superficial dorsal horn. We have identify four non-overlapping populations of excitatory interneurons and we have confirmed that at least, two of those, are completely separate, differing in anatomical, electrophysiological and pharmacological properties.
Our results have been mostly confirmed by recent research done using transcriptomics, supporting the neurochemical approach to detect individual populations of interneurons. Each of this population can be individually targeted and their function altered in ready available genetically modified mice to fully understand their role in the neuronal circuit processing pain.
University of Texas McGovernʼs School of Medicine, USA
The objective of this lecture is to discuss the theory of behavioral economics and its applications in modern medicine. Behavioral Economics describes human cognitive behavior in the context of the cognitive model that utilizes system one and system two. The first is reflexive and efficient, the second is deliberate, but less prone to cognitive biases. Humans operate most of the time under system one because of its efficiency, this introduces irrational choices subject to cognitive biases that influences behaviors to operate sub-optimally. This understanding has been well utilized in marketing to create choice architecture that influences our purchasing choices.
Medicine is based on decision making, and itʼs not immune from the effects of cognitive biases. There are few well described types of cognitive biases in medicine. However, there are many examples in modern day medicine where ‘nudges” are used to construct choice architecture that can positively influence our decision making even when our minds are under high cognitive demand and time constraints. These examples have been very successful, and include the WHO checklist in the OR, our personal institutional experience with the ICU daily checklist, modification to our EMR system to physician documentations and physicianʼs nudges to improve patient satisfaction in our hospital.
Biography:
Wamda Ahmed, MD is an assistant professor. Wamda Ahmed, completed Neurology Residency at Mount Sinai School of Medicine in NY and a Fellowship in Neurocritical Care at Emory University in Atlanta, Georgia in the USA. Currently she serves as the Neuro ICU director and Comprehensive Program Stroke Director at Memorial Hermann Southwest in Houston Texas for the past two years. Dr. Ahmed has been nominated as the physician of the year in her hospital for two years in a row. She had authored and co authored numerous publications and three book chapters in area of neurology.
Banaras Hindu University, India
Introduction: The sarcoglycan (SG) complex in muscle consists of at least four glycosylated transmembrane proteins: Alpha, Beta, Gamma and Delta. These proteins are part of the large dystrophin-associated glycoprotein (DAG) complex, which is essential for maintaining the link between the cytoskeleton and the extracellular matrix and muscle membrane integrity. Mutation in any of these Protein leads to Sarcoglycanopathy.
Material and Method: Patients Sample was collected from Outpatient department of Neurology and muscle biopsy was done for immunohistochemistry. Gamma sarcoglycan deficient samples are selected for genotyping. Genetic analysis was done through PCR and Sequencing. Real Time PCR was also done to detect Expression analysis of Gamma Sarcoglycan.
Result: Immunohistochemistry of muscles how myopathic pattern and deficiency for Gamma sarcoglycan Protein. In mutational analysis several synonymous and nonsynonymous variations were reported. These variations are tested through Polyphen2 and Mutation taster to determine the impact of sequence variation on protein function. Expression analysis shows reduced expression of Gamma Sarcoglycan protein.
Conclusion: These variations may be responsible for protein alteration and many variations are responsible for splice site change for Gamma sarcoglycan protein that results to muscle degeneration in affected patients. Further functional studies are necessary to demonstrate the pathogenicity of these variant.
Christ University, India
Epilepsy is a group of neurological disorder characterized by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain. Nearly one-third of patients with epilepsy do not benefit from medical treatment. Electroencephalography neurofeedback therapies have been becoming recognized as one of the promising treatment for the different types of epilepsy patients. Through EEG neurofeedback training, itʼs possible to train the brain to de-emphasize brain electrical activity that leads to generation and propagation of seizure and emphasize rhythms that make seizures less likely to occur. This key-note session is focusing the current practice and my experience on the effect of EEG neurofeedback to reduce seizure frequency and duration. It is clear that EEG neurofeedback training had a positive impact on most of the studies reviewed as on date, these findings are limited due to multiple confounding factors in their techniques and protocols. Despite these limitations, the promising role of neurofeedback as a treatment to reduce the seizures is well recognized.
Keywords: Electroencephalography, neurofeedback therapy, epilepsy, seizures childhood epilepsy
Psychiatric Hospital of Havana, Cuba
There is increasing evidences that favor the prenatal beginning of schizophrenia. These evidences point toward intra-uterine environmental factors that act specifically during the second pregnancy trimester producing a direct damage of the brain of the fetus. The current available technology doesnʼt allow observing what is happening at cellular level since the human brain is not exposed to a direct analysis in that stage of the life in subjects at high risk of developing schizophrenia. Methods. In 1977 we began a direct electron microscopic research of the brain of fetuses at high risk from schizophrenic mothers in order to finding differences at cellular level in relation to controls. Results. In these studies we have observed within the nuclei of neurons the presence of complete and incomplete viral particles that reacted in positive form with antibodies to herpes simplex hominis type I [HSV1] virus, and mitochondria alterations. Conclusion. The importance of these findings can have practical applications in the prevention of the illness keeping in mind its direct relation to the aetiology and physiopathology of schizophrenia. A study of the gametes or the amniotic fluid cells in women at risk of having a schizophrenic offspring is considered of being observed the same alterations that those observed previously in the cells of the brain of the studied foetuses, it would intend to these women in risk of having a schizophrenia descendant, previous information of the results, the voluntary medical interruption of the pregnancy or an early anti HSV1 viral treatment as preventive measure of the later development of the illness.
Biography:
Dr. Segundo Mesa Castillo, as Specialist in Neurology, he worked for 10 years in the Institute of Neurology of Havana, Cuba. He has worked in Electron Microscopic Studies on Schizophrenia for 32 years. He was awarded with the International Price of the Stanley Foundation Award Program and for the Professional Committee to work as a fellowship position in the Laboratory of the Central Nervous System Studies, National Institute of Neurological Diseases and Stroke under Dr. Joseph Gibbs for a period of 6 months, National Institute of Health, Bethesda, Maryland, Washington D.C. USA, June 5, 1990. At present he is member of the Scientific Board of the Psychiatric Hospital of Havana and give lectures to residents in psychiatry.
Masaryk University, Czech Republic
Based on our observations the patients with AD suffer more severe degree of malnutrition in comparison with control group of vascular dementia patients. Patients with AD who died suffered from severe malnutrition in the last three months of their life. In our next group we observe a total of 83 AD patients who received increased amount of protein via nutritional support in the form of polymeric entreat nutrition by sipping a total of 655 kcal per day = 2520 kJ, 48.9 g protein, 72.09 g carbohydrates, 21.1 g of lipids once a day to their regular diet always outside of the main meals, We monitored MNA and anthropometric parameters body weight, BMI, triceps skin fold thickness, calf and arm circumference and mental status using MMSE performed every 3 months with monitoring daily spontaneous food intake.
Intake of all macronutrients during nutritional support was increased and did not interferate with food intake. We have found statistically significant increase in BMI, weight and arm circumference, and MNA. We did not find any cognitive decline, no statistical change in MMSE during nutritional support. Nutritional intervention significantly decreased the progression of the deterioration of the AD patientsʼ mental function.
AD patients need higher amount of energy and macronutrients to keep their mental function. Nutritional support should be an integral part of the treatment of AD patients and should be initiated not at an advanced stage of AD but as soon as possible after determining dg AD to prolong the current quality of life.
Biography:
Dr. Miroslava Navratilova, Ph.D is Internal medicine and Nutrition Specialist in ICU, Head of Counseling for Disorders of Metabolism and Nutrition Dpt of Psychiatry, Postgraduate study Warsaw, Maastricht, Bonn, Working License F016 Artificial Nutrition and Metabolic Care, head of International Research, one of the first in Europe (first in Czech Rep.) described malnutrition in AD in Longitudinal Study (Grant Ministry of health XD/7964-3), Research Projects and Educational program “Malnutrition and The recent Findings” Dublin Galway, Donegal, Award of Czech Society of Internal Medicine for the Best Book Publication, Prof. Hanzlíček Award and Dr. Paul Jannsen Award for Best Scientific Work in the field of Psychiatry for the Monograph Clinical Nutrition in Psychiatry(the main author of the book) Supported by the project (Ministry of Health, Czech Republic) for conceptual development of research organization 65269705 (University Hospital Brno, Czech Republic)
1Max Institute of Neurosciences, India
2All India Institute of Medical Sciences, India
3Sir Ganga Ram Hospital, India
Purpose: To analyse the clinical and angioarchitectural features of Spinal Cord Arteriovenous Shunts, their management strategies and outcome. Compare our data with that of other authors.
Materials and Method: eurovascular disease database in our department was searched to identify patients with Spinal Cord Arteriovenous Shunts (SCAVS) documented by digital subtraction angiogram in the period between 1988 to December 2014. Rretrospective analysis of their medical, imaging and angiographic records was done.
Results: We identified 150 cases of SCAVS. Among these 64 (43%) had spinal cord arteriovenous malformations (SCAVMs), 86 (57%) had spinal cord arteriovenous fistulae (SCAVFs), which comprised of 71 microfistulae and 15 macrofistulae. Overall preponderance of males (72%) was observed. Peak incidence was seen in second (26%) and third (29%) decade of life, mean age being 28 years. Macrofistulae were predominantly seen in first two decades (87%) and filar fistulae were seen mostly above forty years of age (87%). No patient with microfistulae presented in first decade of life. SCAVMs had high incidence in second (34%) and third decade (41%). Dorsal cord was most common location (37%), followed by conus (26%), cervical cord (21%), filum (11%) and radicular (5%). Cervical cord lesions were not seen above fifty years of age. Majority of cases (68%) had progressive myelopathic symptoms of motor weakness, sensory deficits and sphincter disturbances. Majority (58%) of cervical cord lesions had presented with acute onset of symptoms. Imaging evidence of haemorrhage (hematomyelia or SAH) was seen in 45% of cases with acute symptoms and in only one patient with progressive myelopathy. Out of 116 treated cases 89 received endovascular treatment and 27 underwent surgery. Higher degree of obliteration (> 80%) could be achieved in SCAVF (80%) as compared to SCAVM (58%). Improvement or stabilisation of the lesion were seen in 42 (84%) embolised patients with SCAVF and 30 (77%) embolised cases with SCAVMs. Follow-up data available for 16 surgical patients showed improvement or stabilization in eleven and detoriation in five.
Conclusion: Most of the clinical and angiographic characteristics in this series were consistent with other large series, except the fact that we had higher number of microfistulae whereas AVMs constitute higher percentage in these series. Endovascular treatment is effective in treating spinal cord arteriovenous shunts. Surgery can be reserved for selective situations like filar AVFs, lesions which are unfavourable for endovascular embolizations and in failed embolizations.
Biography:
Dr. Himanshu Agarwal is actively practicing interventional neuroradiologist. He had his training of neurointervention from All India Institute of Medical Sciences, New Delhi then worked as an assistant professor in the same institute. Later he joined Max Institute of Neurosciences as a consultant. His interest includes vein of Galen Aneurysmal Malformation and Spinal cord arterio-venous malformations. He is actively involved in acute stroke interventions and awareness program. He also specializes in endovascular treatment of intracranial aneurysms, AVMs, DAVF and other vascular diseases. He was awarded university gold medal from President of India in year 2013.
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