Day 2 :
Keynote Forum
Matthew B Carroll
Ocean Springs Hospital Singing River Health System, USA
Keynote: Tocilizumab in the treatment of acute myocardial infarction: A review of what we know with a look to the future
Biography:
Matthew B. Carroll is a board-certified Rheumatologist who is clinically active and currently employed by the Singing River Health System. He has had a passion for clinical research and has been an active member of the growing research team at his community hospital. He retired from the United States Air Force in 2017 but during his active duty service developed over 15 protocols and has published over 20 articles. A recent passion has been exploring the possible beneficial role of an IL-6 blockade on acute myocardial infarction. He launched an ambitious protocol studying the short-term effects on major adverse cardiac events which though it was eventually ended after futility analysis suggested no benefit, did enroll over 20 subjects and provided 180-day follow-up of data collection. He continues to actively lobby the study of an IL-6 blockade in other areas of Cardiology.
Abstract:
Statement of the Problem: Tocilizumab (TCZ) is an important biologic response modifier that Rheumatologists routinely employ in the treatment of several systemic autoimmune diseases. TCZ binds to interleukin (IL)-6 receptors, inhibits cellular activation, and mitigates inflammation by IL-6. In mid-2017 TCZ was approved by the U.S. Food and Drug Administration for its first non-rheumatologic condition, the treatment of chimeric antigen receptor (CAR) T cell-induced severe or life-threatening cytokine release syndrome in patients 2 years of age or older. With this approval and with the increasing use of TCZ off-label for other nonrheumatologic conditions such as Castleman’s Disease and its variant TAFRO syndrome, where else might TCZ be successfully utilized as treatment? Recently interesting data has been published regarding the possible use of TCZ in the treatment of myocardial infarction. This review will focus on the role of IL-6 and it’s receptor in myocardial inflammation and association with adverse clinical outcomes. Discussed are results from one animal study and two human trials have been published that studied the effect of TCZ in patients with acute myocardial infarction. Finally, this review summarizes the current data and makes recommendations for future clinical trial development in what hopefully will be a promising application of TCZ for a serious non-rheumatologic condition.
Keynote Forum
Anthony Galea
Galea Professional Medical Inc., Canada
Keynote: Cytorich: A novel anti-inflammatory/catabolic and regenerative autologous blood-derived product for osteoarthritis treatment
Biography:
Anthony Galea practices sport medicine in Toronto and is considered one of the pioneers in the uses and applications of platelet rich plasma in musculoskeletal disorders. He has functioned as a sport physician for many professional and Olympic competitions and his clients includes some of the worlds best athletes. He is also an author and researcher, his current research focuses on autologous cytokines for the treatment of osteoarthritis. He is married with seven children.
Abstract:
Statement of the Problem: Osteoarthritis (OA) is degenerative joint disease characterized by cartilage damage and synovial inflammation. Autologous blood-derived products target special inflammatory molecular pathways and have a beneficial therapeutic effect for inflammatory pathologies. The purpose of this study was to assess the in vitro and in vivo anti-inflammatory/catabolic and regenerative potential of a novel autologous blood product (Cytorich).
Materials and methods: Blood samples from healthy donors were incubated using different techniques for 24h and analyzed for the presence of anti-inflammatory (IL-1ra), anti-catabolic (tissue inhibitors of metalloproteinases, TIMPs), regenerative, pro-inflammatory (TNF-α, IL-1) and catabolic (matrix metalloproteinases, MMPs) molecules. Double-blinded controlled clinical study was conducted to evaluate clinical effectiveness and safety of the final product using VAS and WOMAC scales.
Results: The highest concentration of therapeutic molecules targeting inflammatory and degeneration pathways in OA, as well as platelet-derived growth factor, was found in 24h 37C incubated blood. However, the increased production of catabolic MMP9 and TNF-α and IL-1 was detected in the product. We have found that this negative effect could be blocked by adding citric acid making future OA treatment more safe and effective. Double-blinded controlled clinical study has shown a safety and efficiency of this new product. The analysis of WOMAC and VAS scores revealed improvement in pain and daily activities parameters.
Conclusion & Significance: Cytorich is an efficient and safe autologous product for OA treatment since it has been reported a a source of human bioactive molecules playing a key role in the fundamental processes stimulating tissue repair and regeneration.
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Session Introduction
Nataliia Grygorieva
Chebotarev Institute of Gerontology NAMS of Ukraine, Ukraine
Title: Bone mineral density, vertebral pain syndrome, physical performance indices in women of older age groups with vertebral fractures depending on their localization
Biography:
N Grygorieva received Medical Degree in 1994 and PhD degree in 1999 at Odessa Medical University (Ukraine). Since 2000, she worked in the Department of Clinical Physiology and Pathology of Musculoskeletal System at DF Chebotarev Institute of Gerontology NAMS Ukraine. She completed primary training in rheumatology and is now a rheumatologist of the highest qualification. Since 2017, she is Full Professor of medicine. Her researches focused on experimental modeling of bone and joint diseases, bone and joint pathology and women aging, premature aging, and rehabilitation. She is a Secretary of the Ukrainian Scientific and Medical Society of Gerontology and Geriatrics and a President of "Ukraine without osteoporosis and fractures" Patients Association. She is a member of Editorial Board of Ukrainian and foreign journals, author and co-author of over 350 publications in national and international journals, more than 10 monographs, more than 30 national guidelines, newsletters, and patents.
Abstract:
Purpose: The purpose was to study the bone mineral density (BMD), vertebral pain (VP) and physical performance indices (PPI) in women of older age groups with vertebral fractures (VF) depending on their localization.
Materials & Methods: 139 women aged 50-89 years old were examined and divided into 2 groups: I – patients without any history of osteoporotic fractures (WF), II – women with VF at the thoracic and/or lumbar spine. Subsequently, patients of the second group were divided into subgroups depending on the localization of VF (at thoracic (TF), lumbar spine (LF) or combined fractures (CF)). The assessment of the severity of VP was performed using an 11-component numerical rating scale, the physical capabilities - using static and dynamic functional tests (Thomayer, Schober tests, chest excursion, lateral trunk lean, 3-, 4-, 15-meter tests, "stand up from the chair" etc.), BMD was detected using Dual X-ray absorptiometry(DXA).
Findings: It was found that BMD indices in women with VF were significantly lower than controls (without any previous fractures) regardless of their localization. Most of the VP indices at the thoracic spine in women with TF and CF were significantly higher compared to controls, in contrast to patients with LF. It was shown that for women with TF results of breath holding and 15-meter tests were significantly worse compared with control, whereas in persons with LF results of Schober index, lateral trunk lean, hand grip strength and test "stand up from the chair" were worse. In patients with CF, most of PPI (lateral trunk lean, chest excursion, hand grip strength and 15-meter test) were significantly worse in comparison with the control group. Conclusion: Indices of vertebral pain and physical performance in women of older age groups have their peculiarities depending on the localization of VF, which should be taken into account when developing rehabilitation programs for people with fractures.
Masoud Mirkazemi
Shafa Orthopedic Hospital, Iran
Title: Proximal tibial osteotomy in patients with varus knee deformity using M-W technique: Evaluation of results
Biography:
I am Dr Masoud Mirkazemi, orthopedic oncology surgeon. I work in Iran University of Medical Sciences and Mashhad University of Medical Sciences. in this study, we decided to implement a detailed evaluation of our experiences on proximal tibia osteotomy through W-M technique. One main concern in this method is the possibility and extension of osteotomy into the knee joint, which may be catastrophic. However, this complication was not observed in any of the patients treated with this technique.
Abstract:
Statement of the Problem: Genovarum is the most common knee deformity for which a variety of surgical techniques have been proposed.
Objectives: We decided to share our experiences through a detailed presentation of a new and simple method called proximal tibia osteotomy using M-W method.
Methodology & Theoretical Orientation: In this study, 68 patients (128 knees) with proximal tibia osteotomy with an average age of 34 years, who had undergone W-M osteotomy surgery in a community hospital during 2001 and 2014, were studied using knee society score (KSS) and functional KSS questionnaires, and their clinical results were analyzed.
Findings: No significant difference was obtained between patients undergoing surgery by this method in KSS before (78.8) and after (89.6) the surgery. Although the mean score was improved, functional KSS improved significantly after surgery. None of the patients had peroneal nerve complication, infection, osteomyelitis, or nonunion postoperative infection. Moreover, no recurrence was detected in a mean of 2.7 years follow-up.
Conclusions: Considering the advantages of this method, it is recommended that knee varus deformity is treated using this method, as its rate of complications is low. However, further studies should be conducted on the effectiveness of this method in the future.
Sylvia Pytraczyk
Sunnybrook Health Sciences Centre, Canada
Title: Long-Term Maintenance of Weight-Loss Following Removal of Intragastric Balloon (IGB)
Biography:
Abstract:
John Bowman
USF Morsani College of Medicine, USA
Title: During hospitalization for preseptal cellulitis, Hutchinson’s sign emerges with a clot twist
Biography:
John works in the School of Biological Sciences at Monash University as a Professor
Abstract:
Introduction:
Herpes zoster ophthalmicus (HZO) is characterized by radicular pain and a vesicular eruption in the distribution of the ophthalmic nerve. The underlying cause is reactivation of the varicella zoster virus. The most common neurological complication of herpes zoster is post-herpetic neuralgia; however, cranial nerve palsies, meningoencephalitis, and other sequelae have been reported in rare cases (1). Herein we present a case that was initially diagnosed as uncomplicated preseptal cellulitis, but over the ensuing days revealed HZO and multiple rare sequelae.
Case Report:
A 57-year-old male with a history significant for cryptogenic organizing pneumonia on chronic corticosteroids presented with a left fronto-parietal headache and swelling of his left upper and lower eyelids for four days. He denied any visual symptoms, fevers, or other complaints. His physical exam revealed marked periorbital edema with mild associated tenderness. There was no overlying rash, lesion, or erythema. There was some thin, watery eye discharge. After opening the left eye further, one could see his pupils were equal, round, and reactive and he had full extraocular movements without pain. His visual acuity was intact. Routine labs including a complete blood cell count were unremarkable. A computed tomography (CT) scan revealed the edema was limited to the preseptal soft tissues. He was begun on intravenous clindamycin for preseptal cellulitis and admitted to the hospital.
On hospital day 2, vesicles emerged in the V1 dermatome, including the tip of the nose. This was concerning for Hutchinson’s sign for HZO. He was started on intravenous acyclovir, and antibiotic coverage was escalated to vancomycin and piperacillin-tazobactam for broad coverage of bacterial superinfection. Over the next few days, his pain and swelling improved, the vesicles scabbed over, and the switch to oral antimicrobials was imminent.
However, on hospital day 5, the patient was keeping one eye closed to combat dizziness, and complained of seeing double. Physical exam revealed a new left-sided lateral rectus palsy. Magnetic resonance imaging (MRI) of the brain and orbits was obtained which showed a filling defect in the lateral aspect of the left cavernous sinus suggestive of thrombus.
Discussion:
This immunocompromised patient who was found to have corneal-sparing HZO subsequently developed an abducens nerve palsy. Rare case reports have documented this occurrence (4). After obtaining the MRI and discussing the case with the neuroradiologist, a careful look at the images revealed evidence of thrombus in three images of the series. It is unclear exactly when this developed during his clinical course.
Sixth nerve palsies have previously been reported in the setting of cavernous sinus thrombosis as well as in the setting of V1 zoster alone. Extraocular muscle palsies associated with both HZO (2) and with cavernous sinus disease (3) are usually a transient and self-limited phenomenon.
Veral Vishnoi
University in Queensland, Australia
Title: Acute chylous peritonitis as a result of jejunal volvulus and small bowel obstruction from a congenital band adhesion
Biography:
Veral Vishnoi graduated with a Bachelor of Medicine, Bachelor of Surgery with Honours from James Cook University in Queensland, Australia. He is currently working part-time as a surgical registrar at the John Hunter Hospital in Newcastle whilst completing his Ph.D. with the University of Newcastle in New South Wales, Australia. His research interests lie in colorectal surgery in particular diverticular disease.
Abstract:
We present an 80-year-old gentlemen (with a virgin abdomen) who was admitted with acute chylous ascites in the context of a closed loop small bowel obstruction. Acute chylous ascites is characterized by extravasation of lymphatic fluid into the abdominal cavity. Just over 100 cases have been reported in the literature since 1910. Cases are described as either obstructive, traumatic or idiopathic. Acute chylous ascites often presents as an acute abdomen with the majority of the reported cases progressing to either a laparotomy or laparoscopy, during which copious amounts of chyle was encountered on entering the abdomen, a precipitating cause was not always apparent. Our patient clinically had a small bowel obstruction with radiological evidence of thickened loops of small bowel in the abdomen and free fluid. The patient required a laparotomy as conservative management failed. On entering the peritoneum copious amounts of chyle was unexpectedly encountered. The patient had a congenital band adhesion causing a closed loop jejunal obstruction, there was no other pathology identified. In the absence of any obvious lymphatic obstruction, we hypothesized that the venous congestion associated with a closed loop small bowel obstruction caused increased lymphatic pressures leading to extravasation of chyle into the abdomen. This case highlights the diagnostic uncertainty associated with an acute chylous abdomen as well as short and long-term management goals.