Annual Congress and Medicare Expo on Trauma & Critical Care March 07-09, 2016 Madrid, Spain

Biography:

Willy Aasebo is a Specialist in Internal Medicine and Nephrology and Leader of section of Nephrology (Medical Department), Akershus University Hospital, Norway. He has published a few scientific articles about alcohol intoxication, deaths in police cells and some nephrological topics including transplantation.

Abstract:

Unexpected deaths in police cells are always tragic for the next of kin and custodial officers, but may also cause several problems both in a local society as well as in a larger community/country. Thus minimizing the number of deaths in police custody is desirable in many countries for obvious reasons. One of the aims of my research has been to find and compare death rates in police cells from as many countries as possible. However, as only a few reports have been published in medical literature, I searched for such reports in other databases using google, and even google translate. I found, only few reports on death rates from 15-16 different countries and the death rates varied between 0.14 deaths to 4-5 (and even higher) deaths per million inhabitants per year. The methodological difficulties in obtaining these death rates and the methodological differences between the reports as well as cultural and organizational differences between countries make it very difficult to compare death rates between countries. In 2002, a project was initiated in Norway aiming at reducing deaths in police cells. During the 90’s, a mean of 4 persons died each year. 81% of the deaths happened in persons arrested for drunkenness. In 1/3 of all deaths alcohol intoxication was the only cause of death. The project then recommended that a doctor should examine all persons before they were being placed in a cell if they were considered unable to take care of themselves. The intention was that dead drunk persons should not be placed in police cells, but, preferably, in a health facility unit. In 2013, we again investigated all deaths in Norwegian police cells during the previous 10 years period and compared with numbers from the first period (the 90’s). In the second period a mean of 1.1 deaths occurred each year in the police cells. The total death rate was reduced from 0.83 deaths per million inhabitants per year in the first period to 0.20 in the second period. Deaths caused by alcohol intoxication, including cerebral traumas in drunken persons, had almost been eliminated (one death in the second period). The most common cause of deaths in Norwegian police cells in period two was mixed intoxications (6 deaths during the second period) and suicides (3 deaths).

Biography:

David Fuchs, BARN, is a Trauma Co-ordinator of Ziv Medical Center. He has worked in Trauma Care and Emergency Medicine for over 20 years. He is a Senior Nurse in the Emergency Department and responsible for Acute Trauma Care, the Trauma Room, training in Trauma and Trauma research.

Abstract:

Since February 2013, Syrian citzens injured in the civil war have been treated in Israel. The closest hospital to the Israel-Syria border, Ziv Medical Center, has treated over 600 patients. Patients arrived initally with war related injuries, but, as word spread of the care they received, patients also came for the treatment of chronic medical conditions. As civil war continues, reports indicate a collapse of health services in many parts of Syria. The care provided in Israel has been life-saving for men, women and children; and yet, they are accepting care from people they have regarded for generations to be their enemy. Crossing the border into Israel may be regarded in Syria as an illegal or punishable act. The identity of the patients is, therefore, carefully protected. Crucial to their reception, orientation and reassurance as soon as they arrive in the hospital, is the communication, in Arabic, between the social worker and the patients. As such the social worker is a crucial member of the team. Initially, some of the patients arrived unaware that they had been transported to Israel. They were afraid, reluctant to eat the food and weary of the staff. Patients, however, were extremely grateful for the high level care that they received, and staff at the hospital were at pains to welcome them and put them at their ease. Children arrived with relatives or sometimes alone. The hospital organised radios and access to computers and books and received donations of clothing and games.

Biography:

Wisam Matanis is a surgical resident in Ziv Medical Center. He gained his basic Medical degree from the Technion- Israel Institute of Technology in Haifa, Israel. In addition to training in operative surgery, he has an active interest in undergraduate teaching and research.

Abstract:

Medical students may believe that Acute Trauma Management is the last thing they need to learn but in conflict and disaster zones, medical students play an important role in the trauma team. Rather than simply taking blood, fetching equipment and assisting in the transportation of patients, students need to understand trauma as a disease and the principles and practice of Acute Trauma Care. As part of their surgical rotation, medical students at Ziv Medical Center spend time in the trauma room learning, how monitoring and ventilation equipment works, how to connect these correctly, how to administer oxygen, work the suction, intubate, obtain venous access, apply limb splints and pelvic binders and to lead their own student teams (in turns) in trauma management for one hour drills twice weekly. These drills complement tutorials they have in trauma care (including molecular mechanisms) as part of their surgical teaching. At the end of the rotation, they have an examination in the trauma room (assessed drills which they take turns to lead) as well as a written and oral examination in trauma care and surgery. Some of the students work as paramedics, some as physician assistants, and on qualification in two years time, of course, as doctors. This training is vital to them, builds their confidence, enables them to participate fully in the resuscitation of trauma and critically ill septic patients or patients with massive gastrointestinal or obstetric haemorrhage. Students understand exactly what decisions are taken by seniors in the trauma room and why.

Biography:

Raphael Fedidat is a surgical resident in Ziv Medical Center. He gained his basic Medical degree in the Technion-Israel Institute of Technology in Haifa, Israel. He researched, designed and developed this technology himself.

Abstract:

The recording of morbidity and mortality amongst surgical in-patients in the departments of surgery is universal. Yet, the collection of accurate data for review, discussion and research is frequently retrospective and may even be at the last minute in preparation for departmental morbidity and mortality meetings. The surgical team at Ziv Medical Center has designed a database for the real time recording of complications which utilises the Clavien-Dindo classification and grading system. This enables surgical outcome to be compared with national and international data and for data to be easily retrieved. The database was designed and constructed from first principles by a surgical resident, charged with the responsibility for recording patient data in preparation for weekly departmental morbidity and mortality meetings. It is easy to use, all on one page, has a series of short drop down menus, and is comprehensive in terms of co-morbidity, procedure and complication. Its simplicity has been its success and complications may be recorded in a matter of seconds during or just after ward rounds. Data may be analysed within the database as well as exported in to Excel. Further applications for the database are being planned as a means for recording data used for research in all aspects of departmental surgical practice (rather than complications only) such as trauma, cancer resections and procedures for benign disease. The program also has great potential in the daily evaluation of critically ill patients.

Biography:

Dr Noman Shahzad is General Surgery Resident at The Aga Khan University Hospital (AKUH) Pakistan. AKUH is JCIA accredited hospital with state of the art trauma facility and intensive care unit. He has recently completed his licensure requirement to practice general surgery in Pakistan - Fellowship of College of Physicians and Surgeons of Pakistan. He is also Member of Royal College of Surgeons of England. He has keen interest in trauma surgery and critical care management and has published in this field.

Abstract:

Introduction: Though short term survival advantage of damage control laparotomy in management of critically ill trauma patients is established, there is little known about the long term quality of life of these patients. Facial closure rate after damage control laparotomy is reported to be 20-70 percent. Abdominal wall reconstruction in those who failed to achieve facial closure is challenging and can potentially affect quality of life of these patients. Methodology: We conducted retrospective matched cohort study. Adult patients who underwent damage control laparotomy from Jan 2007 till Dec 2013 were identified through medical record. Patients who had concomitant disabling brain injury or limb injuries requiring amputation were excluded. Age, gender and presentation time matched non exposure group of patients who underwent laparotomy for trauma but no damage control were identified for each damage control laparotomy patient. Quality of life assessment was done via telephonic interview at least one year after the operation, using Urdu version of EuroQol Group Quality of Life (QOL) questionnaire EQ5D after permission. Wilcoxon signed rank test was used to compare QOL scores and McNemar test was used to compare individual parameters of QOL questionnaire. Study was approved by institutional ethical review committee. Results: Out of 32 patients who underwent damage control laparotomy during study period, 20 fulfilled the selection criteria for which 20 matched non damage control group patients were selected. Median age of patients (IQ Range) was 33 (26-40) years. Facial closure rate in damage control laparotomy group was 40% (8/20). One third of those who did not achieve facial closure (4/12) underwent abdominal wall reconstruction. Self-reported QOL score of damage control laparotomy patients was significantly worse than non-damage control group (p = 0.032). There was no statistically significant difference in two groups regarding individual QOL measures. Significantly more patients in damage control group were requiring use of abdominal binder, and more patients in damage control group had to either change their job or had limitations in continuing previous job. Our study was not adequately powered to detect factors responsible for worse QOL in damage control group. Conclusion: Quality of life of damage control patients is worse than their age and gender matched patients who underwent trauma laparotomy but not damage control. Adequately powered studies need to be conducted to explore factors responsible for this finding for potential improvement.

Biography:

Hassan Ravari has completed his General Surgery from Shiraz University of Medical Sciences and Vascular Surgery from Tehran University of Medical Sciences. He is the Director of Vascular and Endovascular Surgery Research Center. He has published more than 28 papers in PubMed central.

Abstract:

Treatment of the elderly trauma patients in special centers can result in better treatment of potentially fatal injuries and satisfactory conditions at the time of discharge. The mortality rate in elderly trauma patients was reported 15-19%, which is twice as much as trauma patients with younger ages and 80% of spared trauma patients require long-term or permanent care. From September 2013 to August 2015, of 47425 patients who referred to Mashhad general trauma center 19527 patients were admitted according to the cause of trauma and ISS. During the study, 825 injury and trauma patients over 65 years were admitted, 166 of whom expired, which was 24.1% of all expired cases of all ages. There was a significant difference between elderly and other ages for causes of accident, strike of foreign body and quarrel but the difference was not significant for fall, bite, gunshot wound and self- striking. In our study, 2 major causes of trauma in the elderly were accident 52.7% and fall 33.2% . Although, a small proportion of injury and trauma patients as in this study in which 3.4% of those referred and 4.2% of the admitted patients consisted of the elderly, but a great proportion of trauma mortality in this group, which was 24.1%. This can be largely attributed to inattention to the elderly during driving and crossing streets, which are potential dangers for the well- being of the elderly. In conclusion, to decrease the mortality rate of this age group, extensive association of general surgeons, neurosurgeons, internist and orthopedist are required. Hospitalization of these patients in special units with skilled nurses can diminish the mortality rate. So, multidisciplinary special triage protocols, managements and discharge planning are needed.

Biography:

Akram M Fayed has completed his training in Egypt and USA and earned his Doctorate degree in Critical Care Medicine as well as the ABIM in 2005. Since then, he contributed by giving talks and presenting research activities in many national and international conferences. He is the Founder and Member of the Egyptian Society of Critical Care and Emergency. He is also a Member of SCCM, ESICM and others. He has a number of publications in CCM in elite journals. He is currently an Associate Professor of Critical Care Medicine, Faculty of Medicine, University of Alexandria, Egypt.

Abstract:

Trauma to the gravid uterus is the most common non obstetrical cause of death in pregnant women. It is important to suspect pregnancy in any female in the childbearing age presenting with trauma. Specific anatomical and physiological changes develop during the varying stages of pregnancy to the mother and the uterus make the likelihood of injury during pregnancy high. A number of mechanisms are involved in the blunt trauma of the gravid uterus incluing road traffic accidents, falls and domestic violence. Causes of death identified following trauma of the gravid uterus include: hypovolemic shock, head and neck injuries and respiratory failure. Important steps in management include: resuscitation and stabilization of the mother which takes a priority of the fetus. When vital signs cannot be stabilized, an emergency cesarean section could save the fetus. Prevention of gravid uterus trauma include public awareness of the magnitude of the problem, counseling regarding safety during driving and encouraging prompt reporting of domestic violence to the authority

Biography:

My name is Mai Badreldin Abdelaziz Helal. I am an assistant lecturer of Oral Biology, Faculty of Dentistry, Tanta University, Egypt. In 2009, I got my Bachelor of Dental Medicine and Surgery, Faculty of Dentistry, Tanta University, Egypt with general grade Excellent, Honor. In 2015, I got my Master of Science in Oral Biology with general grade excellent, Faculty of Dentistry, Tanta University Egypt. The title of my Master thesis is "The putative role of epithelial rest of Malassez in alleviation of traumatic occlusion effect on denervated rat periodontium". As a biologist, my main field of research focuses on periodontal homeostasis. Largely, the dynamic role of epithelial rest of Malassez to sustain, repair and regenerate para-dental tissues, under different physiological conditions. Also, I am interested on isolation, characterization of dental epithelial stem cell, hopefully, to help in mediating dental tissue repair and/or regeneration.

Abstract:

Traumatic occlusion provides a trauma that distresses the whole tooth and its supporting tissues. Epithelial cell rests of Malassez (ERM) are odontogenic epithelial cells located throughout life within the periodontal ligament (PDL) matrix. Recent studies suggested that ERM may have their role not only in maintaining the normal width of the periodontium but also has a significant manner in periodontal regeneration and homeostasis. Aim of Study: The aim of the present study was to investigate the role of ERM in alleviating the deteriorating effect of traumatic occlusion on normal and denervated rat periodontium. Material and methods: Sixty, 7 month old male rats were used in this study. They were randomly and equally divided into five groups. Control, sham, denervated, traumatic occlusion and traumatic-denervation groups. In the latter group, the right inferior alveolar nerve (IAN) was exposed and transected before getting inside the mandibular canal through a 2.5 cm skin incision made along the posterior border of the mandible. Then, after one week recovery, the occlusal surface of the right maxillary first molar was unilaterally raised 1-2 mm with our innovative 7/8 nickel chrome stainless steel crown with free distal surface. Three rats, from each group, were euthanized at 1, 3, 6, and 9 weeks. Half of their right mandibular first molars specimens were dissected, processed for light microscope (LM) and the other half were processed for transmission electron microscope (TEM) using routine and pop-off techniques. Results: Histological observations after one and three weeks, revealed disorganization of PDL fibers of the mandibular first molars of all rats in the denervated and/or traumatic occlusion groups in contrast to those of the control and sham groups, which disclosed normal structured PDL with few clusters of ERM cells throughout the study periods. Remarkably, traumatic occlusion group depicted rise in ERM clusters that disclosed secretory apparatus by EM whereas denervation and traumatic-denervation groups illustrated reduction in size of ERM clusters and cells which revealed apoptotic and karyolitic cells with rarified cytoplasm. On the other hand, after six weeks both traumatic occlusion and traumatic-denervation groups illustrated reorganization of PDL in association with increase in ERM clusters whereas, denervation group revealed further decline in ERM cells numbers and features together with PDL hyalinization and signs of dentoalveolar ankylosis. Interestingly, healing signs were observed after nine weeks in all experimental groups that was marked by the existence of secretory ERM cells. Conclusions: ERM is not a vestigial functionless remnant but it is an active dynamic groups of cells that portray the condition of the periodontium. There are resting ERM in quiescent PDL, apoptotic ERM in traumatized and or denervated ERM and secretory ERM in recovering periodontium.

Biography:

Füsun Terzioğlu is graduated in first place from Hacettepe University School of Nursing in 1989. She won the İhsan Dogramacı Superior Merit Award and Student Science Incentive Award. She earned her pilot’s license from Republic of Turkey Ministry of Transport. She studied about counseling on assisted reproductive techniques at Liverpool Women’s Hospital Reproductive Medicine Unit in United Kingdom on the British Council Research Scholarship. She earned a certificate in management and leadership in nursing. She is an active member of Thematic Network leadership work group. She studied as a research scholar at Kent State University College of Nursing in 2006. In 2007, she worked on a project named “Development of Leadership Skills in Nursing Doctoral Students” at University of Michigan Faculty of Nursing on an international research scholarship which was supported by International Network for Doctoral Education in Nursing (INDEN) and Sigma Theta Tau and provided to only three people around the world every year. She worked as a Co-Head of Nursing Department, Erasmus Department Coordinator, Head of Strategic Planning Group and board member of Hacettepe University Women’s Research and Implementation Center (HUWRICH). Her interest subjects are simulation education, sexuality and reproductive health and management and leadership in nursing. She is member of national and international nurse’s organizations such as INDEN and Sigma Theta Tau. She has been working as a Director of Nursing Services at Hacettepe University Hospitals since 2012 and was Founding Dean of Faculty of Nursing between 2012- 2013.

Abstract:

Background: Recently, an innovative teaching strategy, scenario-based full-scale high-fidelity simulation in nursing education is gaining more attention to improve nursing students’ clinical skills and competencies. Although previous researches showed that simulation-based teaching contributed to nursing students’ learning outcomes, satisfaction, and self-confidence, there is no study related to using high-fidelity simulation in nursing education and its effects on students’ learning outcomes in Turkey. Aim: A quasi experimental design was used determine the effects of high-fidelity simulation experience on students’ learning outcomes, self-confidence, and satisfaction. Methods: The sample consisted of 40 volunteer undergraduate nursing students who studied at one university in Turkey and took part in a high-fidelity simulation session related to the care of trauma patients. Students were randomly allocated to either a control or an experimental group. Students from the experimental group, as well as following their normal curriculum, were exposed to scenario-based full-scale simulation training. Subsequently, both experimental and control groups were re-tested and completed a Trauma Case Questionnaire; experimental group students also completed a Student Satisfaction Questionnaire and a Patient Intervention Self-Confidence/Competency Scale. The data was collected between January 2012 and May 2012. Results: There were no statistical differences between experimental and control group learning outcome scores (p>0.05). After the simulation session, the mean score of the experimental group students’ satisfaction was 114±5.09 (out of 135) and confidence/competency score was 76,35 ±5.69 (out of 90). There was a statistically significant strong positive correlation between students’ satisfaction score and confidence/competence scores (r=0.974, p< 0.000). Students also reported that high-fidelity simulation was an effective method to improve their clinical skills and competencies. Conclusion: This study indicated that students’ satisfaction and confidence/competency were high after participating in high-fidelity simulation sessions. According to the study results, it is recommended to use high-fidelity simulation in nursing education as an innovative teaching strategy to develop students’ clinical competencies and confidence.

Biography:

Wei Gu has completed her PhD at the age of 28 years from the Third Military Medical University. She is now an asoociated professor of State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery of the Third Military Medical University, China. Her research is focuse on the genetic mechanisms and early diagnosis of complicaitons after severe trauma, especially sepsis and MODS. She has published more than 32 papers in reputed journals.

Abstract:

Recent evidence indicates that small noncoding RNA molecules known as miRNAs can function as important negative gene regulators and are implicated in the pathogenesis of various diseases. We conducted a 2-stage study to examine the impact of 9 selected SNPs with potential functional significance on the susceptibility to sepsis of 1268 trauma patients in China. Among the 9 selected SNPs with potential functional significance,only 1 (miR-608 rs4919510) was found to be strongly associated with a higher risk of developing spsis and multiple organ dysfunction in all 3 independent study cohorts. An even stronger association was observed for the rs4919510 polymorphism when combining these 3 study cohorts together. In addition, the rs4919510 polymorphism showed a significant correlation with a higher production of proinflammatory cytokines and a lower production of antiinflammatory cytokines. In vitro experiments further indicated that the G→C variant of this polymorphism could significantly increase the expression of mature miR-608. Furthermore, we illustrated that miR-608 downregulated ELA2 mRNA and protein by directly binding exon of ELANE in monocytes based on expression genechip and several in vitro experiments. Our data showed that miR-608 and its target, ELA2, maybe potential biomarkers or targets of sepsis in severe trauma patients.

Biography:

Nguyen Huu Tu graduated from Hanoi Medical University (1984-1990). He obtained PhD (2000-2003) and became an Associate Professor of Hanoi Medical University in 2007 and Professor in 2014. He held Academic Positions of increasing importance: Vice President of Hanoi Medical University (2009-present), Primary Trauma Care Instructor and Local Coordinator (2004-present); Chairman, Anesthesia and Critical Care, Hanoi Medical University (2009-present). He has following hospital appointments: Anesthesist-Intensivist, Viet Duc University Hospital (1994-2008); Attaché Associé, Hotel Dieu Hospital, Lyon, France (1994-1995); Henri-Mondor University Hospital, France (1997-1998); Chef de clinique, Chercheur, Centre Nationale de Recherche Scientifique de Paris (CNRS), University Paris XII, Henri-Mondor University Hospital, France (2001-2002); Visiting Anesthetist, North-West Tasmania Hospital and Adelaide Royal Hospital, Australia (2006); Anesthetist-intensivist in Chief, Hanoi Medical University Hospital (2008-present). His major clinical and research interests are in trauma anesthesia and resuscitation, regional anesthesia, postoperative pain management, airway complications during anesthesia and pharmacology of neuromuscular relaxants. He is the author and co-author of 109 scientific publications published in the local and international journals including Anesthesiology, Anesthesia & Analgesia journals.

Abstract:

Objectives: To evaluate changes of Jugular bulb oxygen saturation (SjvO2) during surgery for severe head injured patients. Methods: A prospective study was conducted with 50 severe head injured patients undergoing craniotomy surgery. Preoperative SjvO2 in jugular bulb was measured after anesthesia induction by a catheter connecting to CeVOX monitor. SjvO2 was observed continuously during sugery and recorded at different phrases: before surgery (T1), after craniotomy (T2), after durotomy (T3), after removing hematoma (T4) and in 30 minutes after sugery (T5). Main Results: SjvO2 was in the normal range in 52% of patients, reduced in 32% and increased in 16% of patients. SjvO2 increased significantly during sugery, especially after craniotomy and durotomy compared to preoperative phrase (69.1±13.2% and 70.3±13.1% vs. 61.8±15.6%, p<0.05). SjvO2 did not change significantly in the patients with preoperative SjvO2>75% (85.1±4.9% and 85.3±5.6% vs. 84.4±4.0%, p>0.05). Conclusion: SjvO2 increased significantly after craniotomy and durotomy in severe head ịnjured patients with low or normal preoperative SjvO2 values.

Biography:

Keva Bethell is an avid researcher who grew up in Nassau, Bahamas. In 2008, she earned her Bachelor of Science degree in Biology (with a minor in Biochemistry) from Oral Roberts University in Tulsa, Oklahoma. In 2012, she earned her Master’s in Public Health from the University of Oklahoma, where she was inducted into the Xi chapter of Delta Omega Society, the public health honorary society. Her duties included abstracting Medical Examiner reports and entering data related to violent deaths into the National Violent Death Reporting System. She started working along with Dr. David Allen, in two months she collaborated with the Central Detective Unit to abstract all suicide cases that occurred in a 14 year period. Her report is now a published paper in the Global Journal of Human Social Sciences and her thematic analysis in the Emergency Medicine Open Access Journal. For the last two years, she has been the Director of Research for ‘The Family: People Helping People’ project, a community based free offering program group therapy in inner city communities. During her tenor, she has abstracted over 700 reports. She aspires to pursue a PhD in Epidemiology, she is a young lady of faith, and enjoys spending time with her family.

Abstract:

The Family: People Helping People project is a supportive group process modality involving the sharing of personal stories, self examination, reflection and transformation using psychotherapeutic principles. The group process was developed to confront the prevailing social fragmentation in the Bahamas associated with or caused by the continuing effects of the country-wide crack cocaine epidemic of the 1980s and the fall-out due to the recent international financial downturn. Facing community disintegration, high youth unemployment and burgeoning rates of violent crime and murder, many persons have been severely traumatized. This paper reviews the major themes presented in 776 group process sessions indicating the pervasive nature of the negativity of the shame process expressed in the high incidence of anger, violence, grief, relationship issues and abuse. This innovative project has been proven to enhance the re-socialization of many participants in the program.

Biography:

Benjamin KASAO has completed B.A at the age of 35 years from Great Lakes School of Theology of Bujumbura as a part of George Fox University, State of Oregon/USA and High School studies from Nyabiondo Institute, Masisi Territory in North-Kivu Province of DRC. He is the Founder and Coordinator of CO.PA.D ″ Collectif “Paix et Développement” located in Goma Town, a Trauma and Hearing the Memories Organization in the Province. He has published 5 papers in reputed journals and has been serving as a Pastor, Peace artisan, Trauma Healer and Manager. These are the published papers: 1.″Trauma″ a sickness which must be healed by people 2. Healing is Yourself 3.Peace “ The content of the Gospel of Jesus″ 4.The need of Hearing Survival of Memories in Congo 5.Begin the Step to Development

Abstract:

Democratic Republic of Congo is becoming a country which all several and critical situations of every bad things are. The situation of war in the East part of Congo is the target place of all army groups and all people who want to driver disorder in the country. The government is unable to stabilize the country and to stop war here. Several number of NGO’s and International Organization are working in the country to help memories but they fell because they don’t know the really problems which Congolese are traveling in. Several consequences are numbered and make people in ″Brain and Stress Disorders″. The Trauma situations are caused by sexual Violence’s, tortures, kidnapping and end by suicides. There are also other problems of poverty and cohabitation of ethnics in the Provinces and the need of Conflict Resolutions, mediation and Peace Building into communities here. Trauma in DRC is becoming a great and critical situation which all people ignore and no one is helping the memories. It’s in that way that I should like to participate to the conference of Trauma so I should have other skills to help the memories in the DRC.

Biography:

Mihailo Bezmarevic finished MSc postgraduate studies in 2009 at Belgrade University, School of Medicine. He finished residency in general surgery in 2014 at the Department of Hepatobiliary and Pancreatic Surgery, Military Medical Academy, Belgrade. He is PhD candidate and a member of the European Pancreatic Club, International Association of Pancreatology, American Pancreatic Association and European Society for Clinical Nutrition and Metabolism. He bases his research on inflammation and pathophysiology of acute pancreatitis, pancreatic cancer and clinical nutrition. He has published more than 30 papers in reputed journals and he is an Editorial Board Member and reviewer of several journals.

Abstract:

There is growing evidence in the literature that development of abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) has a strong impact on the course of disease. Incidence of ACS in patients with SAP is around 20%. In recent published review the mortality rate in patients who developed ACS during SAP is 49%, while it is 11% in patients without this complication. Due to more aggressive fluid resuscitation, a bigger proportion of patients treated conservatively or by a minimal invasive approach, and efforts to delay open surgery, the number of patients with ACS has increased. The development of organ failure in SAP is in correlation with presence of intra-abdominal hypertension (IAH). IAH can deteriorate already compromised pancreatic perfusion and perfusion of gut in early stages of SAP. It may increase the necrosis of pancreatic tissue and could contribute in bacterial translocation from gut with a higher incidence of infective complications and sepsis. The existence of ACS complicates the treatment of SAP itself including fluid resuscitation, nutritional support and planning for minimal invasive approach for necrotizing pancreatitis. If conservative treatments do not alleviate IAH, interventional procedures should be considered. So far, there have not been standard recommendations for surgical or some other interventional treatment of patients who develop ACS during the course of SAP. Several interventional procedures were proposed but the surgical technique used should be individualized in each patient. The complexity associated with ACS management calls for the multi-disciplinary team approach involving interventional radiologists, surgeons and intensivists.

Biography:

Aleksandar R Karamarković currently works as a Professor in General Surgery, Faculty of Medicine University of Belgrade and Director, Clinic for Emergency Surgery, University Clinical Center of Serbia, Belgrade/Serbia. He completed his medical education as a faculty and PhD at University of Belgrade. He was Elected as a Assistant Professor of Surgery, Faculty of Medicine University of Belgrade/Serbıa (1996-2004) and Associate Professor of Surgery, Faculty of Medicine University in (2004-2010). He was invited as an International speaker for 14th International and 15th and 16th International Postgraduate course of the International Association of Surgeons, Gastroenterologists and Oncologists at Greece, 7th Congress of Croatian Society of Digestive Surgery, Opatija, Croatia in 2007 and 18th World Congress of the International Association at Istanbul, Turkey, 2008. From 2007-2014 he attended many world congress meetings.

Abstract:

Background: Severe liver injury in trauma patients still accounts for significant morbidity and mortality. Operative techniques in liver trauma are some of the most challenging. They include the broad and complex area, from damage control to liver resection. Materials & Methods: This is a retrospective study of 121 trauma patients with hepatic trauma American Association for Surgery of Trauma (AAST) grade III–V who have undergone surgery. Indications for surgery include refractory hypotension not responding to resuscitation due to uncontrolled hemorrhage from liver trauma; massive hemoperitonem on Focused assessment by ultrasound for trauma (FAST) and/or Diagnostic peritoneal lavage (DPL) as well as Multislice Computed Tomography (MSCT) findings of the severe liver injury and major vascular injuries with active bleeding. Results: Non-survivors have significantly higher AAST grade of liver injury and higher Injury Severity Score (ISS) (p = 0.000; p = 0.0001). Non-survivors have significant hypotension on arrival and lower Glasgow Coma Scale (GCS) on admission (p = 0.000; p = 0.0001). Definitive hepatic repair was performed in 62(51.2 %) patient. Damage Control, liver packing and planned re-laparotomy after 48 h were used in 59 (48.8 %). There was no statistically significant difference in terms of the surgical approach. There was significant difference in the amount of red blood cells (RBC) transfusion in the first 24 h between survivors and non-survivors (p = 0.001). Overall mortality rate was 33.1 %. Regarding complications non-survivors had significantly prolonged bleeding and higher rate of Acute respiratory distress syndrome (ARDS) (p = 0.0001; p = 0.0001), while survivors had significantly higher rate of pleural effusion (p = 0.0001). Conclusion: All efforts in the treatment of severe liver injuries should be directed to the rapid and effective control of bleeding, because uncontrollable hemorrhage is the cause of early death and it requires massive blood transfusion, all of which contributes to the late fatal complication.

Biography:

Manoj Joshi has completed his Postdoctoral degree MCh in paediatric surgery from SMS medical college Jaipur, State of Rajasthan, India in 2004 and is presently working in capacity of Professor and Head in department of Paediatric surgery at Pondicherry Institute of Medical sciences (PIMS) Pondicherry, which is a well-known tourist destination and educational hub located in south eastern coast of India. His areas of interest are pediatric minimal accses surgery, paediatric urology and pediatric trauma. He has about 15 publications and is a principle investigator of at least 5 ongoing research studies in department. He is a fellow of Indian association of paediatric surgeons and an executive member of its research section. He is also on editorial board and reviewer of many prestigious national and international journals.

Abstract:

Trauma is one of the major cause of morbidity and mortality in children. In this era of rapid growth and urbanization, child safety at home and on roads is getting jeopardized. Under 14 year incidence of childhood injuries are on the rise in India and it needs urgent application of preventive policies to ensure safety in childhood. We present our analysis on childhood injuries at a tertiary care Centre in south India, and compare our results with available series. Objective: To evaluate the pattern of pediatric trauma cases and their subsequent morbidity and mortality. Methods: Retrospective review of all cases (less than 12 years) referred to pediatric surgery unit of a teaching hospital over a period of 26 months (October 2011-November 2013). Burns, isolated head injury, ophthalmic injuries, and orthopedic injuries were excluded.The following parameters was assessed: Age group, sex, mode of trauma, and type of injury, place where the trauma occurred, time interval between injury and presentation and the overall morbidity as well as mortality. Results: A total of 218 cases of trauma were assessed and 24 cases, in which the details were incomplete, were excluded. Maximum number of cases (n= 84) involved the children in school going age. Male to female ratio was 2.3:1. Majority of the cases (74%) were trivial trauma. Road (36.5%), home (35%) and school/playground (28.3%) were almost equally unsafe in our series. The median time interval in presentation was 3 hours (Range 30 min- 7 days). In lieu with present management protocol, majority of patients were managed conservatively and 14 cases (7.2%) required operative intervention. Among them none had any major complications till last follow up. There was no mortality in the series. Limitations: The study is based on hospital data and hence the injury patterns and results cannot be generalized to the entire community. Conclusion: Preventive strategies are needed to make our roads and home safe for children, through better coordinated political and social efforts by means of execution / enforcement of legislation.

Biography:

Prakash Mohanasundaram has completed MBBS in Sree Siddhartha Medical College, Karnataka, India at the age of 25. He completed MD (Accident and Emergency Medicine) from Vinaya Missions University, Salem, Tamilnadu, India which is a reputed Institute for Emergency Medicine in the country. He is currently Assistant professor of Emergency Medicine at PSG Institute of Medical sciences and Research Hospital, Coimbatore, India. He is also member of the Editorial board for The “National Journal of Emergency Medicne”. He also held positions with the Society for Emergency Medicine, India. He is the present President of the “Federation of Emergency Medicine India [EPI]”.

Abstract:

The Impact of trauma in victims is a global concern. Most often they are the bread winners of family. A sudden change in the victim’s lifestyle after a trauma is a huge setback for the family. The concept of Platinum minutes and Golden hour is very important in trauma victims so as to treat the insults related to the second peak. The most important factors of secondary insults are Hypoxia, Hypotension and Hypercapnia. Approach to Shock in polytrauma can be complex. The role of ultrasound in ED for trauma patients to evaluate the cause and type of shock has proven extremely beneficial over the last decade, also guiding and monitoring the therapy. Ultrasound can give a clear analysis in situation where there are clinically diagnostic dilemmas.

Biography:

Engida has completed his MSc in Reproductive and Maternal Health Nursing at the age of 24 years from Addis Ababa University. He is a lecturer and researcher at the Department of Nursing and Midwifery, School of Alllied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. He has published more than 4 papers in reputed journals and has been serving as a reviewier of different international journals.

Abstract:

Background Road traffic injuries are the eighth leading cause of death globally, and the leading cause of death for young people. More than a million people die each year on the world’s roads, and the risk of dying as a result of a road traffic injury is highest in Africa. Methods We performed a prospective hospital based study to assess injury characteristics and outcome of road traffic accident among victims at Adult Emergency Department of Tikur Anbessa specialized hospital. The data were collected using structured pre-tested questionnaire and analyzed using SPSS Version 20.0. Results A total of 230 road traffic accident victims were studied. The majority of the study subjects were men 165 (71.7 %). The victims’ ages ranged from 14 to 80 years with the mean and standard deviations of 32.15 and ± 14.38 years respectively. Daily laborers (95 (41.3 %)) and students (28 (12.2 %)) were the majority of road traffic accident victims. Head (50.4 %) and musculoskeletal (extremities) (47.0%) were the most common body region injured. Fractures (78.0%) and open wounds (56.5%) were the most common type of injuries sustained. The overall length of hospital stay (LOS) ranged from 1 day to 61 days with mean (± standard deviation) of 7.12 ± 10.5 days and the mortality rate was 7.4 %. Hierarchical multiple regression analysis showed that age of the victims (ß = 0.16, p < 0.05), systolic blood pressure on admission (ß = -0.35, p < 0.001) and Glasgow coma scale (ß = -0.44, p < 0.001) were statistically significant predictors of fatalities among the victims. Conclusions There was diverse injury characteristics and high morbidity and mortality among the victims presented to Emergency Department of Tikur Anbessa specialized hospital and this reflect that road traffic accident is a major public health problem.

Biography:

Dr. Gilbert Abou Dagher will be appointed as Assistant Professor of Clinical Emergency Medicine effective February 1, 2012. He graduated with an MD degree from the American University of Beirut in 2005. After which, he completed his residency training in Internal Medicine at Henry Ford (2006-2009) and in Emergency Medicine (2009-2011). Dr Abou Dagher is board certified in Internal Medicine and board eligible in emergency medicine.

Abstract:

Biography:

Noman Shahzad is a professor department of Surgery at Aga Khan University Hospital, Karachi,Pakistan

Abstract:

Introduction: Though short term survival advantage of damage control laparotomy in management of critically ill trauma patients is established, there is little known about the long term quality of life of these patients. Facial closure rate after damage control laparotomy is reported to be 20-70 percent. Abdominal wall reconstruction in those who failed to achieve facial closure is challenging and can potentially affect quality of life of these patients. Methodology: We conducted retrospective matched cohort study. Adult patients who underwent damage control laparotomy from Jan 2007 till Dec 2013 were identified through medical record. Patients who had concomitant disabling brain injury or limb injuries requiring amputation were excluded. Age, gender and presentation time matched non exposure group of patients who underwent laparotomy for trauma but no damage control were identified for each damage control laparotomy patient. Quality of life assessment was done via telephonic interview at least one year after the operation, using Urdu version of EuroQol Group Quality of Life (QOL) questionnaire EQ5D after permission. Wilcoxon signed rank test was used to compare QOL scores and McNemar test was used to compare individual parameters of QOL questionnaire. Study was approved by institutional ethical review committee. Results: Out of 32 patients who underwent damage control laparotomy during study period, 20 fulfilled the selection criteria for which 20 matched non damage control group patients were selected. Median age of patients (IQ Range) was 33 (26-40) years. Facial closure rate in damage control laparotomy group was 40% (8/20). One third of those who did not achieve facial closure (4/12) underwent abdominal wall reconstruction. Self-reported QOL score of damage control laparotomy patients was significantly worse than non-damage control group (p = 0.032). There was no statistically significant difference in two groups regarding individual QOL measures. Significantly more patients in damage control group were requiring use of abdominal binder, and more patients in damage control group had to either change their job or had limitations in continuing previous job. Our study was not adequately powered to detect factors responsible for worse QOL in damage control group. Conclusion: Quality of life of damage control patients is worse than their age and gender matched patients who underwent trauma laparotomy but not damage control. Adequately powered studies need to be conducted to explore factors responsible for this finding for potential improvement.

Biography:

Mohamed A Elhoseny have graduated in Faculty of Medicine, University of Alexandria, Egypt in 2004; where he joined the Critical Care Medicine Residency Program to finish his master of science in critical care and toxicology in 2009.He joined King Khalid University Hospital in 2010 as an intensivist. During his whole career, he always showed interest in spreading the message of how to save more lives. He is a distinguished instructor of the ATLS (advanced trauma life support) courses as well as a TCF (training center faculty) and instructor of ACLS; PALS; PEARS; ACLS EP; AHA ECG & Pharmacology courses. He is also a member of the royal colleges of physicians of the United Kingdom and a member of the royal college of physicians of Ireland.

Abstract:

The most common type of shock in trauma is hemorrhagic shock. Treatment entails two arms: source control as well as resuscitation. Blood transfusion is a corner stone in resuscitation and inspite of the fact that it is routine process since the evolution of modern medicine; but we are still trying to optimize it. Another important aspect in blood transfusion is the concept of ‘Balanced resuscitation’ which needs to be more clarified to those working on patient resuscitation. Fresh versus old PRBCs transfusion …. A debate between the theory and practice .while the theory might support the use of fresh transfusion; the studies failed to prove any difference in the outcome. Due to the shortage in blood supply all over the world; there has been an increasing international demand for the blood substitutes; which might be showing a promising future; how true can this be?

Biography:

Yuko Harding has completed Post-doctoral studies from Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of Ryukyus, Japan in 2014. She had been a Midwife/Nurse for 24 years. At present she is working as a Lecturer, Japanese Red Cross Toyota College Of Nursing, Japan.

Abstract:

Objective: To specify clinicopathological risk factors that influence sexual function after radiotherapy for cervical cancer. Methods: This observational and cross-sectional study includes a population of 60 adult women with stage I to III cervical cancer who underwent radiotherapy. Sexual function was assessed using a self-reported standardized questionnaire, the Female Sexual Function Index (FSFI). Age, clinical stage, tumor diameter, type of radiotherapy, use of hormone replacement therapy, and period of time elapsed since the completion of radiotherapy at the time of data collection were documented using participants' medical records. Multivariate logistic regression was used to identify independent risk factors for sexual morbidity. Results:　The median age of participants was 53 years (Interquartile range, IQR, 45-60 years). Using the FSFI total score compared by variable, sexual dysfunction was significantly more prevalent among women in FIGO stage III than those in stage I /II (P=0.038), and at ≥12 months after the completion of radiotherapy than at <12 months after completion (P=0.008). Multivariate analysis revealed that sexual morbidity was significantly more likely in stage III women (OR 4.60, 95% CI, 1.07-24.39, P=0.040), or where radiotherapy had occurred more than 12 months before (OR 4.78, 95% CI, 1.17- 25.20, P = 0.028). Conclusion: FIGO stage III and a period of ≥12 months after radiotherapy are associated with reduced sexual function. In medical consultations with women in these categories, adequate treatment should be provided where appropriate.

Biography:

Mahmoud A Alhussini is a lecturer in general surgery department, Alexandria faculty of Medicine in Egypt. He succeded to finish his Ms thesis in 2010 from Alexandria University. He completed his Md in 2014 from Alexandria University also. He was trained in Alexandria Main Universty Hospital which is a tertiary refferal hospital for more than 3 governates in Egypt including the second,capital.

Abstract:

Bilharzial hepatic fibrosis is an endemic disease in Egypt. This disease affects the liver both anatomically and functionally. There is portal hypertension together with bleeding tendency. Portal hypertension causes backflow in the portal circulation. Thus, collaterals are formed in many sites including the retroperitoneum and abdominal wall. Splenomegaly is another consequence. This enlarged spleen is more vulnerable to trauma and rupture. Conservative measures usually fail. Also, splenorraphy is unreliable. Furthermore, this enlarged spleen is complicated by hypersplenism in many cases. All these present a challenge in managing these patients if exposed to blunt abdominal trauma. Both conservative measures and interventions carry major risk to the patient. Hence, those patients should have special care during their managemnt.

Biography:

Seham A Elgamal has completed her Master’s and PhD from College of Nursing- Cairo University- Egypt. She is working as an Assisstant Professor at College of Nursing- King Saud Bin Abdulaziz University for Health Sciences. She is the Chairperson for the life support commitee and member in clinical simulation commitee. Her research intrest is emergency nursing, organ transplantation, critical care nursing, and clinical simulation.

Abstract:

Abdominal trauma is a leading cause of morbidity and mortality among all age groups. So, it is essential to understand the nature of injury (blunt/penetrating) and the affected abdominal organs to avoid complications in the recovery period. The aim of the study was to evaluate the effect of a designed triage management protocol on the complications and the length of hospital stay among patients with blunt abdominal trauma. The sample was comprised of 60 male and female patients (30 study and 30 control). Three tools were utilized for data collection in addition to structured interviews and direct nursing care for the patients were utilized. The results revealed that, in relation to traumatic complication`s signs and symptoms, the study subjects were having relatively low complications as compared to control group. The improvement was obvious in: nausea & vomiting (6.7% vs 26.7%), fever & wound infection (43.3% vs 76.7%), and abdominal distention & absent/diminished bowel sound (36.7% vs 67.7%), dyspnea (26.7% compared to 36.7%), and abdominal pain, rigidity, guarding and tenderness (73.3% vs 93.3%) respectively. In relation to length of hospital stay the mean number of hospital stay period is 4.9+2.9 & 5.8+3.7 of the study and control group subjects. Significant relationship was found between complications and hospital stay with (P<0.01, P<0.05) among study and control group subjects. Conclusion, despite the differences documented between the two groups, no statistical significant differences were found between the two groups in relation to complications and hospital stay.

Biography:

Amal Roshdi Ahmed has completed her PhD at the age of 33 years from Benha University on Maternal & Neonatal Health Nursing. she is the manager of Information Technology unit and quality management unit at the faculty of nursing Beni-Suef University.

Abstract:

Aim: The aim of the present study was to evaluate effect of exercise and self-care guidelines on relieving urinary incontinence among women in Beni-Suef. Methods: Design was intervention study. Sampling was purposive sample included 100 women attended at gynecological outpatient clinic of Ben-Suef University Hospital. Data collection tool consisted of an interviewing questionnaire sheet covering socio-demographic data, knowledge assessment, and exercise scale and self-care guideline regarding preventive measure urinary incontinence. Results: The results revealed that there was a lack of information regarding urinary incontinence in about 92% of study sample. The majority of women couldn't make proper self-care for relieving urinary incontinence before intervention in comparison (97%) gain knowledge and made proper self-care regarding Urinary Incontinence after intervention. Conclusion: The women’s knowledge and practices of self-care guideline regarding preventive measures of symptoms of urinary incontinence has marked positive effect on relieving it after utilization of self-care guideline carefully. Recommendation: Apply the same study on large sample in other setting to distribute awareness guideline regarding preventive measure of Urinary Incontinence.

Biography:

Mohamed Ibrahim Mohamed as PhD in Sport Psychology from Helwan university , lecturer of Psychology at pharmacy & Nursing faculties. He is the manager of quality management unit of Faculty of Physical Education,Beni-suef University.

Abstract:

The aim of the present study was to evaluate effect of exercise and Self-care guideline on relieving Urinary Incontinence among women in beni-suef. Design was intervention study. Sampling was purposive sample included 100 women attended at gynecological outpatient clinic of Ben-Suef University Hospital. Tool: Data collection tool consisted of an interviewing questionnaire sheet covering socio demographic data, knowledge assessment, and exercise scale and self-care guideline regarding preventive measure Urinary Incontinence. The results revealed that there was a lack of information regarding Urinary Incontinence in about 92% of study sample. The majority of women couldn't make proper self-care for relieving Urinary Incontinence before intervention in comparison (97%) gain knowledge and made proper self-care regarding Urinary Incontinence after intervention. Conclusion: The women knowledge and practices of self-care guideline regarding preventive measures of symptoms of Urinary Incontinence has marked positive effect on relieving it after utilization of self-care guideline carefully. Recommendation: Apply the same study on large sample in other setting in to distribute awareness guideline regarding preventive measure of Urinary Incontinence.

Biography:

Hiba Abdel Aziz received her Medical degree from the Royal College of Surgeons in Ireland. Her general surgery residency and fellowship in trauma/critical care were at the prestigious Institutes of Case Western Reserve University. She joined the staff at the Cleveland Clinic Foundation, University Hospitals of Cleveland and St. Elizabeth Medical Center, Ohio. She is working as an Assistant Professor at Northeast Ohio Medical University and a diplomate of the American Board of Surgery with added qualifications in Surgical Critical Care. She Chairs the Trauma guidelines committee and is program Director of the trauma critical care fellowship at Hamad General Hospital.

Abstract:

Introduction: Pulmonary embolus (PE) is thought to arise from lower extremity DVT. Lower extremity (LE) DVT surveillance is commonly used in trauma patients at risk for DVT. Methods: A comprehensive DVT surveillance literature review over the past 23 years was performed assessing: the effect of surveillance on DVT and PE rates; efficacy of chemoprophylaxis (CP) and mechanical prophylaxis (MP); and the relationship between DVT and PE. 24 publications including over 13,000 patients were found. Results: DVT rates are significantly higher with surveillance with a rate of 8.5% vs 2.6% without surveillance. PE rate without surveillance was 1.3% similar to a rate of 1.1% with surveillance (p=0.6093). There is no association between DVT rates and PE rates (P=0.7574). CP was associated with a reduction in DVT rate to 4.4%, no CP had a much higher DVT rate of 11.7%. Similarly, PE rate was lower at 0.8% on CP vs 1.5%. MP decreased DVT rate to 7.9% vs 13% without MP. PE rate was similar without MP, 1.5%, vs 1.2% with MP. With no CP and no MP, DVT rate was 13% and PE rate was 1.5% vs 7.8% and 1.2% respectively with CP and/or MP. Conclusions: DVT surveillance of the lower extremities appears to be very effective in diagnosing DVT; however the risk of PE is not decreased. Our data suggest that PE rates are not associated with (LE) DVT rates. The historical notion of their relationship may not be true. New paradigms need to be developed.

Biography:

Barclay Stewart is an alumnus of the Medical University of South Carolina and the London School of Hygiene and Tropical Medicine. He is senior general surgery resident at the University of Washington. Currently, he lives and works in Ghana as a US NIH/Fogarty Global Health Research Fellow. In Ghana, he is working with a number of stakeholders to improve trauma care Nationwide. He has worked in Belize, Nepal, Malawi, Kenya and South Sudan, giving him considerable understanding of trauma systems in low-income countries and trauma care during humanitarian crisis.

Abstract:

This study aimed to compare the availability of trauma care services and the resources necessary to provide them in Ghana between assessments in 2004 and 2014. By doing so, the effects of a decade of change in the trauma care landscape can be assessed and recommendations for potential interventions can be made. Trauma care capacity assessments of district and regional hospitals in Ghana were performed using the World Health Organization’s Guidelines for Essential Trauma Care. Trauma care item availability ratings were compared; Wilcoxon signed ranks test was used to determine if there was a difference in item availability ratings between the two assessments and within each hospital level. There were significant improvements in mean trauma care item ratings between 2004 and 2014 assessments at district and regional level hospitals (p=0.002 and p=0.01, respectively). However, a number of critical deficiencies remain (e.g. chest tubes, mechanical ventilators, cardiac monitors, diagnostics and essential orthopaedic and neurosurgical care). Most deficiencies were related to stock outs, having never been present at a facility or a lack of training; latter two were most often reported for items that did not have improved availability in 2014 compared to 2004. Re-assessment of trauma care item availability in Ghana demonstrated significant improvement over the past decade. However, important deficiencies remain, some for low-cost items. Serial capacity assessment is a valuable tool for monitoring the effect of efforts to strengthen trauma care systems in LMICs.

Biography:

Sanja Masnec works as an ophthalmologist at the Department of anterior segment of the eye, at the University Hospital Centre Zagreb. Her special interests are anterior segment eye surgery, cataract surgery, corneal transplantation surgery, and oculoplastic and reconstructive surgery. She has completed her PhD at the age of 34 years from Zagreb University and postdoctoral studies from Zagreb University School of Medicine. She has published 17 internationally indexed publications.

Abstract:

The effect of human gastric pentadecapeptide BPC-157 on healing of perforative corneal injury in rats was evaluated. The study included 100 Male Wistar albino rats, 280-320 g body weight, divided in 4 groups (n=25). The randomization protocol was generated by the Random Allocation Software Version 1.0, 2004 (M. Saghaei, MD, Department of Anesthesia, Isfahan University of Medical Sciences, Isfahan, Iran). Penetrant linear incision 2mm was performed under deep anesthesia with ketamine, 20 mg/kg i.p. and diazepam, 6 mg/kg , along with topical anesthetic oxibuprocaine 0.4%, 2 drops on left cornea paralimbal on five o'clock with incision knife 20 Gauge MVR (Bausch&Lomb) under 45°, under operating microscope. Left eye was operated in aseptic conditions by the same surgeon. Lesions were stained by standard 10 % flourescein and photographed. Animals were medicated as follows: distilled water (control group) or BPC 157 2pg/ml, 2ng/ml, 2µg/ml, 2 drops per rat' s left eye started immediately after injury induction, every 8 hours up to 120 hours . Lesions were photographed before application or sacrifice (at 24, 48, 72, 96, 120 h). Healing process was analysed clinically using Fluorescein test, Seidel test, image analysis software (SFORM software (VAMSTECH, Zagreb, Croatia)., slitlamp and pathohistologically using standard tissue analysis. Throughout 120h-period a steady recovery is noted in controls. Healing was significantly accelerated in eyes on µg- or ng-topical regimen of BPC 157 (p<0.05) during all intervals. BPC 157 was shown to be effective in promoting healing of corneal layers in rats. Results were dose dependent.

Biography:

MARCIN RZESZUTEK, PhD, is an Assistant Professor at the University of Finance and Management in Warsaw. He obtained his PhD title in psychology at the Warsaw University. He also has PhD title in economics (Warsaw School of Economics). Apart from being a researcher, he works also as an accredited Gestalt psychotherapists. His research refers to the personality and social determinants of PTSD ans posttraumatic growth in a situation of chronic medical illness (see: HIV/AIDS and chronic pain syndromes). Additional scientific interests revolve around the risk factors and consequences of secondary trauma and burnout among mental health professionals.

Abstract:

The aim of the current study was to investigate the relationship between the intensity of pain, treated as the explained variable, and the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), temperament traits postulated by the Regulative Theory of Temperament and aspects of social support among patients suffering from chronic pain (arthritis and low-back pain). To assess the intensity of pain among participants we used the Numerical Rating Scale (NRS-11). The level of trauma symptoms was assessed with the PTSD Factorial Version inventory (PTSD-F). Temperament was measured with the Formal Characteristics of Behaviour – Temperament Inventory (FCB-TI). Social support was tested with the Berlin Social Support Scales (BSSS). The results of our study suggest that significant predictors of pain intensity among chronic pain sufferers were trauma symptoms. We also noticed that some temperament traits (i.e., emotional reactivity) increased the level of global trauma symptoms, which, in turn, intensified the level of pain. In addition, we showed that global trauma symptoms decreased the support participants actually received.

Biography:

Tomaz Crochemore from Intensive Care Unit of Israelita Albert Einstein Hospital Brazil.

Abstract:

INTRODUCTION: Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening disease. AFLP is characterized by liver failure with different degrees of coagulopathy. Outcome and survival can be dramatically improved with prompt recognition and treatment. Thromboelastometry has been considered a point of care for the management of bleeding patients. It could, therefore, be an alternative tool to treat the complex cases of AFLP involving liver failure and coagulopathy. Through this study, we present our successful experience of an AFLP case that was submitted to an emergency cesarean section in which blood transfusion was guided by thromboelastometry. CASE PRESENTATION: We report the case of a previously healthy 28-year-old woman, Afro- Brazilian, in her first pregnancy with no medical records until the 36th pregnancy week. She presented to our emergency department with an acute onset of abdominal pain, jaundice, nausea and vomiting. The laboratory examinations revealed metabolic acidosis, acute kidney injury (serum creatinine 3.4mg/dL), platelets 97 Å~ 103/mm3, serum fibrinogen 98mg/dL and increased international nationalized ratio (INR 6.9) without acute bleeding. An emergency cesarean section was indicated. Based on the results of the thromboelastometric tests EXTEM and FIBTEM, prothrombin complex concentrate and fibrinogen concentrate were administered at the beginning of the cesarean section, which succeeded with no major bleeding and without need of further transfusion. CONCLUSIONS: Thromboelastometry may be considered a useful, feasible and safe tool to monitor and manage coagulopathy in obstetric patients with acute fatty liver of pregnancy, with the potential advantage of helping avoid unnecessary transfusion in such patients. BIOGRAPHY: Dr. Tomaz Crochemore is physician, a specialist in intensive care medicine, whose area of expertise is in Hemostasis and Thrombosis, with extensive experience in the study of rotational thromboelastometry. Doctor responsible for the Support Group in coagulation and hemostasis of the intensive care unit of the Hospital Israelita Albert Einstein, São Paulo - Brazil

Biography:

Dr.Cuong Tran Chi is a current Director of Stroke International Services System (S.I.S), Vietnam, Vice President of Vietnamese Interventional Radiology Society, President of Interventional Neuroradiology Society of HCM city, and Consultant of Interventional Neuroradiology of Vietnam. Professionally he is a Neurosurgeon – Neurointerventionalist. From May 2002 - April 2004: he had trained for Neurosurgeon specialist level 1 (Master Degree) in Ho Chi Minh Medical University and had worked in Neurosurgery Department in Cho Ray Hospital Ho Chi Minh. He is the member of WFITN (The World Federation of Interventional and Therapeutic Neuroradiology) and AAFITN (Asian-Australasian Federation of Interventional and Therapeutic Neuroradiology) in 2007. He studied advanced procedures for Stroke Management at USA. From 2006 - 2015: he has performed more than 1500 neurointerventional procedures including: carotid cavernous fistula, intracranial and spinal dural fistula, treatment aneurysm by coiling, treatment AVM, carotid stenting and intracranial stenting, flow-diverter stenting, percutaneous vertebroplasty.

Abstract:

Objectives: We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies. Methodology: Only type A CCF patients (Barrow’s classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fiatula. After the confirm angiogram, endovascular embolization would be performed im-promp-tu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization. Results: A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion un-der endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced sacrifice of the parent vessels and it was associated with sizes of the fistula. Total severe complication was about 2.4% which included 1 death (0.6%) due to vagal shock; 1 transient hemiparesis post-sacrifice occlusion of the carotid artery but the patient had recovered after 3 months; 1 acute thrombus embolism and the patient was completely saved with recombinant tissue plasminogen activator (rTPA); 1 balloon dislodgement then got stuck at the anterior communicating artery but the patient was asymptomatic. Conclusion: Endovascular intervention as the treatment of direct traumatic CCF had high cure rate and low complication with its ability to preserve the carotid artery. It also can supply flexible accesses to the fistulous site with various alternative embolic materials. The new classification of type A CCF based on angiographic features was helpful for planning for the embolization. Coil should be considered as the first embolic material for small size fistula meanwhile detachable balloons was suggested as the first-choice embolic agent for the medium and large size fistula.