Day 2 :
- Epidemiology | Pediatrics | Geriatrics | Intensive Care Medicine | Surgery
Chair
Tarek Hamed Attia
Zagazig University, Egypt
Co-Chair
Takeshi Nishimura
Hyogo College of Medicine, Japan
Session Introduction
Tarek Hamed Attia
Zagazig University, Egypt
Title: Cerebral venous sinus thrombosis in heterozygous prothrombin G20210A mutation in Egyptian child, with an excellent outcome
Time : 10:00-10:30
Biography:
Tarek Hamed Attia has completed his MBBCh, Masters in Pediatrics and MD in Pediatrics from Zagazig University School of Medicine, Egypt. He is currently a Professor of Pediatrics, Zagazig University, Egypt. He is a Member in Research Board Pediatrics and Hematology and he has many publications in Pediatrics and Hematology. He is also a Chairman for Postgraduate Education and Examination Board in Pediatric Department, Zagazig University. He has published many papers in reputed journals and has been serving as an Editorial Board Member of reputed journals. He has attended many international conferences as speaker and as chairperson.
Abstract:
Prothrombin gene G20210A mutation is a risk factor for the development of deep vein thrombosis. We present a 6 year old Egyptian boy who had vomiting associated with headache and dizziness. His conscious level was normal with neither focal neurological signs nor papilledema. Brain computed tomographic scan, magnetic resonance imaging and magnetic resonance venography (MRV) revealed thrombosis of the superior sagittal and left transverse sinuses. The patient was heterozygous for prothrombin gene G20210A mutation. He has received enoxaparin and warfarin. Brain imaging follow-up, after 1 month, showed complete resolution of the thrombus. The child was followed up for 1 year and he was very healthy. Cerebral venous thrombosis must be considered in the differential diagnosis of any neurological symptoms, even mild symptoms and prothrombin gene G20210A mutation must be considered in the screening of Egyptian children. Early diagnosis and treatment can be a good prognostic index.
Takeshi Nishimura
Hyogo College of Medicine, Japan
Title: Gastric perforation due to non-invasive positive pressure ventilation: Review of complications in NIPPV
Time : 10:30-11:00
Biography:
Takeshi Nishimura was graduated from Okayama University in Japan in 2009. He was trained for 5 years as Surgical Clinician and has worked as Emergency Clinician for two years. He is specialized with traumatology and gastroenterology. He has published more than 5 papers in journal about emergency medicine and emergency surgery.
Abstract:
Non-invasive positive pressure ventilation (NIPPV) is widely used in patients with respiratory failure due to neuromuscular disease. NIPPV is safe and effective device that might be able to avoid potential complications associated with invasive mechanical ventilation such as nosocomial pneumonia and tracheal trauma. NIPPV can be used intermittently, the equipment is portable and ventilation does not interfere with eating and speaking. The most frequent trouble that might occur is ulcer at face in fitting mask. However, time consuming, some lethal complications associated with NIPPV had been reported in recent years. A 23 year old man was admitted to our hospital complaining of severe abdominal pain. He has a history of congenital hypomyelination neuropathy. Because of respiratory trouble due to neuropathy, doctor had prescribed NIPPV and increased end respiratory pressure before five days. Abdominal computed tomography revealed free intra-abdominal air leading to emerging laparotomy. Intra operative findings showed a gastric perforation and hematoma at gastric anterior walls. Patient recovered after obstructive bowel obstruction and transferred to pediatrics post admission on Day 26. Previous study associating with complications of gastrointestinal perforation has rarely been reported ever. We emergent clinicians should be aware of these complications. NIPPV is not always non-invasive equipment. Acknowledgement of prevention and recognition related to complications with NIPPV leads appropriate use of it depends on patient’s condition.
Reena Bansal
Crozer Chester Medical Center, USA
Title: Fenestration of false lumen to reverse acute limb ischemia in type B aortic dissection
Time : 11:15-11:45
Biography:
Reena Bansal has completed her MBBS from Mysore Medical College and Research Institute in the year 2008 and Masters from Rajiv Gandhi University of Health Sciences in the year 2011. She is currently associated as Resident Physician with Crozer Chester Medical Center since 2014.
Abstract:
Introduction: Aortic dissection (AD) is one of the most serious medical emergencies encountered in clinical practice. The incidence in general population is estimated to be 5.9 per 100,000 persons annually. The commonly used Stanford system classifies AD in to type-A (involving ascending aorta) and Type-B (all other). Type-A AD is considered a surgical emergency due to potentially fatal complications like cardiac tamponade and myocardial infarction. Type-B AD is managed medically with tight blood pressure control. However, the associated complication of limb or visceral ischemia due to extrinsic compression by false lumen or occlusion by intimal flap, necessitates a more aggressive surgical versus percutaneous approach. The percutaneous fenestration is not a very commonly performed procedure because of the paucity of exposure. We report this case of lower limb ischemia with type-B aortic dissection, managed successfully with percutaneous fenestration. Case presentation: 59 year old man with past medical history of hypertension and smoking presented to the emergency room with chief complaints of sudden onset of right sided chest pain and right lower limb pain. Physical exam was significant for absent right femoral pulse. Cardiac enzymes were negative. A CT scan and lower extremity angiography were performed. The imaging revealed aortic dissection distal to the left subclavian artery with significant occlusion of the right iliac artery by compression thru false lumen. A percutaneous fenestration approach was chosen. 5 F angle tapered Terumo 0.35 wire was passed into the false lumen. Fenestration of the false lumen was performed to return the blood flow to the right iliac artery. Patient tolerated the procedure well and at a 30 day follow up he was still doing well. Discussion: Type-B aortic dissection is generally managed medically. Critical limb or visceral ischemia is a medical emergency that demands a more aggressive management. The options in such scenario are surgical repair versus percutaneous fenestration. Percutaneous fenestration technique is a less invasive option in such medically treated patients in whom this complication arises.
Yuhamy Curbelo-Peña
Vic University Hospital, Spain
Title: Endometriosis causing acute appendicitis complicated with hemoperitoneum- Case report
Time : 11:45-12:15
Biography:
Yuhamy Mitsahid Curbelo Pena has completed her Medicine grade from Central University of Venezuela and is currently pursuing Postgraduate program at Vic University Hospital in Vic, Barcelona, Spain. She is a Resident at General Surgery Department. She has published 2 papers in reputed journals and has presented 11 papers in national and international clinical and surgical congresses. She had an editorial experience from April, 2011 to August, 2011 as Member of the Editorial Committee of the (indexed) Magazine “Latin American Science and Science and Student Medical Investigation”. (CIMEL); published by FELSOCEM.
Abstract:
Endometriosis is a painful disorder characterized by endometrial tissue outside the uterine cavity. It usually affects the pelvis, but in rare cases it might extend to other parts of the body. The report is based on a case of a 39 year old woman, who presented symptoms of acute appendicitis and diagnosis confirmed with ultrasonography and a computed tomography scan procedures. Laparoscopic appendicectomy was performed. After entering the abdominal cavity, hemoperitoneum was discovered with no associated pelvic or abdominal lesions. Biopsy confirmed acute appendicitis with endometrial glands and stroma infiltrating its muscular tissue. Patient recovered without complications and was discharged 48 hours after surgery. The appendix is rarely affected by endometrial infiltration. The literature describes an incidence of 0.8%, just a few cases have been associated with acute appendicitis; however, none of them are described to present hemoperitoneum, being our patient the first one reported with such complication.
Tarek Hamed Attia
Zagazig University, Egypt
Title: Idiopathic arterial calcification of infancy: A rare autosomal recessive disease case report
Time : 12:15-12:45
Biography:
Tarek Hamed Attia has completed his MBBCh, Masters in Pediatrics and MD in Pediatrics from Zagazig University School of Medicine, Egypt. He is currently a Professor of Pediatrics, Zagazig University, Egypt. He is a Member in Research Board Pediatrics and Hematology and he has many publications in Pediatrics and Hematology. He is also a Chairman for Postgraduate Education and Examination Board in Pediatric Department, Zagazig University. He has published many papers in reputed journals and has been serving as an Editorial Board Member of reputed journals. He has attended many international conferences as speaker and as chairperson.
Abstract:
Idiopathic arterial calcification of infancy is a rare autosomal recessive disease, characterized by deposition of calcium along the internal elastic membrane of arteries, accompanied by fibrous thickening of the intima which causes luminal narrowing. Here we are reporting a case of idiopathic arterial calcification of infancy in a Saudi female newborn of non-consanguineous pregnant woman who had polyhydramnios. The newborn baby had severe respiratory distress, systemic hypertension and persistent pulmonary hypertension of newborn. She was admitted to Neonatal Intensive Care Unit, where she was ventilated and proper treatment was provided. Molecular genetic testing was positive for mutations of ectonucleotide pyrophosphatase/phosphodiesterase 1 gene which is reported in 80% of cases of idiopathic arterial calcification of infancy. The baby died at about 5 month of age because of myocardial ischemia and cardiorespiratory arrest. Idiopathic arterial calcification of infancy should be considered in any newborn who presented with persistent pulmonary hypertension of newborn, severe systemic hypertension and echogenic vessels on any radiological study. Calcifications of large and medium sized arteries are important diagnostic finding.
Reena Bansal
Crozer Chester Medical Center, USA
Title: Transaminitis with the use of HAART
Time : 13:30-14:00
Biography:
Reena Bansal has completed her MBBS from Mysore Medical College and Research Institute in the year 2008 and Masters from Rajiv Gandhi University of Health Sciences in the year 2011. She is currently associated as Resident Physician with Crozer Chester Medical Center since 2014.
Abstract:
Background: Atazanavir (ATV) is a protease inhibitor, which is an important component of the Anti-Retroviral Therapy (ART) for HIV. All ARTs have the potential side effect of deranged liver functions. But do we remember this while working up a patient for transaminitis? We report this case to remind physicians about this adverse effect of atazanavir. Methods: A 59 year old gentleman with past medical history of HIV on atazanavir, ritonavir, lamivudine/zidovudine combination and tenofovir, presented with nausea, vomiting, diarrhea and fatigue. He has had multiple admissions in the past for unrelated complaints, but has always had hepatitis work up done due to the abnormal LFTs. He has been on ARTs for 19 years and has been admitted to the hospital 8 times in this period, each time with deranged LFTs and each time ended up having a hepatitis panel checked. Results: The patient has a viral gastroenteritis, which resolved spontaneously with supportive treatment. However, the patient continued to have high indirect bilirubin due to use of atazanavir. Patient’s Highly Active Anti-Retroviral Therapy (HAART) regimen was therefore changed, leading to a slow improvement in bilirubin levels. Conclusion: Hyperbilirubinemia is a common side effect of atazanavir. There is no recommendation to stop ATV for up to grade III hyperbilirubinemia (serum bilirubin>2.5 with raised alkaline phosphatase and hospitalization due to drug induced liver injury), but cases need to be individualized. However, grade IV hyperbilirubinemia (grade III along with either prolonged jaundice for 3 months or more, signs of hepatic decompensation or other organ failure related to liver injury) is rarely found. The predictive value of ATV related hyperbilirubinemia needs to be further investigated.