Day 1 :
Keynote Forum
Alexander D Verin
Augusta University, USA
Keynote: Extracellular purines in acute lung injury preservation
Biography:
Alexander D Verin has completed his PhD from Moscow State University, Moscow, Russia and Post-doctoral studies from University of Indiana, USA. Currently, he is a Professor in Vascular Biology Center and Pulmonary Division at Augusta University, Augusta, GA. He has published more than 150 papers in reputed journals and serving as an Editor-in Chief of Vessels Plus, and as Editorial Board Member in several other journals in the field of cardiovascular research. In addition, he was a Reviewer for a number of highly regarded journals (ex. Circulation Research, Critical Care Medicine, Physiological Reviews, PNAS).
Abstract:
Endothelial cells (EC) form a semi-permeable barrier between the interior space of blood vessels and the underlying tissues. In acute lung injury (ALI), the EC barrier is weakened leading to increased permeability. The mechanisms involved in the preservation of barrier integrity are largely unknown. Recently, attention has been given to the therapeutic potential of purinergic agonists in the treatment of cardiovascular and pulmonary diseases. We have demonstrated that extracellular ATP (stable analog, ATPγS) and its degradation product, adenosine can strengthen EC barrier via activation of P2Y and P1 type 2A receptors, respectively. We also demonstrated that, ATPγS and adenosine induce activation of small GTPase, Rac 1 and this correlates with a significant attenuation of lipopolysaccharide (LPS)-induced EC permeability increase. Conversely, introduction of active Rac1 into EC strengthens EC barrier. In parallel, extracellular purines induce activation of protein kinase A (PKA)/myosin light chain (MLC) phosphatase (MLCP) cascade and this also correlates with attenuation of LPS-induced EC permeability. Therefore, the ability of ATP and adenosine to strengthen EC barrier appears to be dependent on Rac1 and MLCP activation. Further, introduction of active MLCP subunits into the lung endothelium reduces LPS-induced lung inflammation strongly supporting the positive role of MLCP activity in EC barrier preservation against ALI in murine model. Collectively, our data strongly suggest that EC barrier preservation induced by extracellular purines is dependent upon activation of specific purinergic receptor/G-protein complexes. Further, purine-induced EC barrier preservation requires the coordinated activation of Rac1 and PKA/MLCP cascade leading to EC cytoskeletal changes.
Keynote Forum
Mohammed Ranavaya
Marshall University, USA
Keynote: Occupational lung disease--- Challenges and opportunities for the 21st century
Biography:
Mohammed is a Professor of Occupational and Environmental Medicine at the Marshall University School of Medicine in West Virginia and currently serves as the Director of the Appalachian Institute of Occupational & Environmental Medicine in West Virginia. He is a consulting physician and American board certified in Occupational and Environmental Medicine. Prof. Ranavaya is also trained in Law and earned his Juris Doctor (JD) degree from School of Law in Virginia.
Abstract:
Despite the scientific and technical innovations of the 21st century, occupational and environmental lung disease continue to be a major challenge for physicians all over the world. While occupational and environmental exposure to asbestos, silica and coal dust have decreased leading some clinicians to think of the occupational and environmental lung disease as “diseases of the bygone era” these classic occupational lung diseases remain very much a problem and the emerging new lung disease manifestations from the work and environment provide opportunities for research, prevention and intervention.
The overall burden of all current lung disease related to occupational or environmental exposure is not well estimated despite its significant global burden. This is so because the lungs are the major interface between environment and the body. With every breath, particles, fibers and gases most of them relatively harmless but others with a potential to cause acute or chronic lung disease exists. The injurious inhalants and their associated health outcomes continue to be present in many workplaces despite legally mandated surveillance programs and preventative strategies.
The primary focus of this presentation is to examine the changing features of the occupational lung disease. While in modern research the primary focus on mineral dust is being replaced by organic dust and chemicals, unresolved issues remain regarding aspects of various occupational and environmental lung diseases creating both the challenges and opportunities for a clinician in the 21st century.
- Lung Disease
Location: USA
Chair
Alexander D Verin
Augusta University, USA
Co-Chair
Mohammed Ranavaya
Marshall University, USA
Session Introduction
Dmitry Kulish
M. AERO LLC, Russia Federation
Title: Paradigm shifting surgical mask replacing filtering with air flow rerouting for medical and public respiratory protection
Biography:
Dr. Dmitry Kulish has completed his PhD at the Russian Academy of Sciences and postdoctoral studies from Harvard Medical School. He is the director of M.AERO, a company producing paradigm shifting respiratpry protection masks. He has published more than 10 papers in reputed journals and has been serving as both insudtry consultant and university professor.
Abstract:
All current surgical masks designed for respiratory protection of both medical personell and public are built on the filtering mechanism. Filtering is fundamentally inconvenient: it prohibits free breath, creates moist area near face, and the filter performance deteriorates quickly. In the meantime, most medical applications, from surgery and GP to citizen protection in the areas of people concentration, do not require filtering. WHO claims that only direct aerosol breathing should be prevented to protect health in most cases.
Medical professionals report suffering discomfort and decreased alertness from the filtering masks. M.AERO LLC solves this acute pain by building the device that reroutes air flow through firm esthetically looking plastic mask. M.AERO masks equally serve as universal environmental and hygienic protection to both doctor and patient in the provision of medical care of any level of complexity, from lengthy surgical operations and infectious ward checkups to individual protection of the civilian population from airborne infection.
By changing the geometry of the canal and installing additional elements, M.AERO LLC can produce masks for various purposes, such as “Surgical”, “Clinical” and “General Purpose”, for mass use. We are developing a whole line of masks for various usage conditions, with a general functional purpose of protection against airborne infections.
The design of M.AERO masks is patented through PCT in the form of an impenetrable barrier and a hollow frame, which allows capture and venting of all exhaled air behind the user's back. Standard PCT Application includes the USA, Europe, Japan, China, and many other countries. M.AERO seeks strategic partnership in establishing pilot production and promotion.
Mohammed Ranavaya
Marshall University, USA
Title: Impairment and disability assessment for occupational lung disease claims - How to evaluate them?
Biography:
Mohammed is a Professor of Occupational and Environmental Medicine at the Marshall University School of Medicine in West Virginia and currently serves as the Director of the Appalachian Institute of Occupational & Environmental Medicine in West Virginia. He is a consulting physician and American board certified in Occupational and Environmental Medicine. Prof. Ranavaya is also trained in Law and earned his Juris Doctor (JD) degree from School of Law in Virginia.
Abstract:
Mrinmayee Koltharkar
Hinduja National Hospital & Medical Research Centre, India
Title: Pulmonary rehabilitation in interstitial lung disease
Biography:
Mrinmayee Koltharkar has 11 years of extensive experience in the field of Physiotherapy. She is a merit holder in Masters of Cardio-Pulmonary Physiotherapy from KEM Hospital. After completion of Master’s Degree in 2010, she worked at Dr. Balabhai Nanavati Hospital under guidance of Dr. Ali Irani, where she dedicatedly handled ICU patients, undertook the role of a guide for post graduate students and, provided her expertise in various case presentations. Due to her exemplary knowledge, she was invited to present Telemedicine CMEs for African countries. In 2011, she joined P D Hinduja National Hospital & MRC as a Research & Pulmonary Physiotherapist. She is a Research Assistant to India’s best Chest Physicians Dr. Zarir Udwadia & Dr. Ashok Mahashur. She conducted Pulmonary Rehabilitation research for ILD patients under guidance of Dr. Udwadia and co-authored the findings in American Thoracic Society.
Abstract:
Introduction: Interstitial lung disease (ILD) is a diverse group of over 150 disorders characterized by varying degrees of fibrosis and inflammation of the lung parenchyma or interstitium. At present, the available pharmacotherapeutic modalities are ineffective in stopping the natural course of ILD, have plenty of side effects and remain only as palliative measures making lung transplantation the sole modality to show benefit in terms of mortality. The need of pulmonary rehabilitation in ILD has only been recently realized. Much of the work on pulmonary rehabilitation work has been done on COPD and data has been applied to other chronic respiratory conditions. While ATS/ERS joint committee in their statement on ILD subgroup have given weak positive recommendation on pulmonary rehabilitation due to lack of strong evidence, as more research in this field is desired.
Aim: The aim of this study was to determine whether pulmonary rehabilitation (PR) is effective in improving the exercise capacity, dyspnoea scores and quality of life of the patients with interstitial lung disease (ILD).
Methods: We have studied 26 consecutive patients diagnosed with ILD (idiopathic pulmonary fibrosis or non-specific interstitial pneumonia) who consented to undergo an individualized PR program including patient education and exercise training for 12 weeks with three sessions/week. Exercise training included endurance training (cycle ergometer and treadmill walking), strength training (weight cuffs, dumbbell), breathing and flexibility exercise (stretching) under a trained cardiopulmonary physiotherapist. Exercise capacity was assessed by six minute walk test (6MWT), dyspnoea score by Borg’s scale rating resting and post 6MWT and quality of life by SGRQ. Assessment was done in pre- and post-program.
Results: Out of 26 patients, 24 were able to complete the prescribed 12 weeks program. Of 26 patients, 10 patients had diagnosis of NSIP and rests were IPF. There were 10 males (38.5%) in the study. Mean baseline 6 MWD was 340 meters (+/- 47.21 SD) with mean post 12 week 6MWD of 387 meters (+/-63.57). Mean improvement was 47 meters, 6 MWD is significantly increased (p<0.0001). Mean value of the baseline post 6MWT Borg’s scale rating was 2.57 (+/-1.094 SD) with median value of three and range from 1-4. Mean value of the post 12 week post 6MWT Borg’s scale was 1.82 (+/-0.983 SD) with median value of two, range of 1-2, was significantly reduced (p=0.0056). Mean baseline SGRQ scores were 50.28 (+/-12.42 SD) with mean post 12 week SGRQ scores 36.90 (+/-10.84) was significantly reduced (p=0.0013)
Conclusion: Pulmonary rehabilitation significantly improved the exercise capacity, dyspnoea perception and quality of life in the patients with ILD and should be considered as a standard of care for patients with ILD.
Wondu Reta,
Jimma University, Ethiopia
Title: The value of individual variables of BODE index and GOLD spirometry in stratifying the severity of COPD
Biography:
Wondu Reta was graduated from Jimma University, Institute of Health in BSc degree in Junior Anesthesiology professional in June 2012 GC and Master’s degree in Medical Physiology in October 2017 G.C. He was currently serving Jimma University, Institute of health as Anesthesia care provider, researcher and lecturer of Medical Physiology and Anesthesiology. He was also reviewing different papers related to his professionals on different journals.
Abstract:
Background: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by partially reversible airflow limitation. BODE index is a multi-dimensional tool stands as pneumonic composing the four individual variables {B-the body mass index (BMI), O-the degree of airway obstruction (post-bronchodilatorFEV1% predicted), D-Dyspnea scale and E- exercise capacity measured by 6-minute walk distance test (6MWDT)}; giving the total points of 10; divided into four quartiles. It is used to diagnose, grade the severity, evaluate systemic comorbidities, evaluate the response to intervention and predict the mortality due to the disease.
Purpose: The main purpose of this study is to assess the severity of COPD by using BODE index and its individual variables, and GOLD stage; correlate their values to each other and determine their validity in stratifying the severity of COPD.
Patients & Methods: A hospital based cross-sectional study was conducted among a sampled 80 consecutive COPD patients visiting chest clinic of Jimma University Medical Center (JUMC) located at Jimma town, South west Ethiopia; from May 18 to August 18, 2017 G.C; and the measurement of all individual variables of BODE index were performed according to the American Thoracic Society (ATS), their results were entered into EPI data (3.1) and exported to SPSS (20) for further analysis. Chi square (X2) test, Spearman correlation, kappa measure of agreement, receiver operator characteristic (ROC) and area under curve (AUC) was applied to determine the correlation and validity of variables/tools in grading the severity of the disease.
Results: Eighty (80) COPD patients were enrolled in the study, Mean of Age (55.1±13.66), BMI (19.98±3.43), 6MWDT (283±84.5), BODE index point (6.17±2.55), FEV1% predicted (42.5±15.6) and Dyspnea scale (2.2±0.7) were achieved. Majority of COPD patients were belonged to quartile IV, relatively increased through the stages if classification was made by BODE index and its components (FEV1% predicted and 6MWDT) but was higher among stage 3/severe if it was based on GOLD stage and dyspnea score. All variables used to grade COPD were positively correlated with each other except with BMI score (inversely correlated). The validity of the variables/tools used in grading severity of the disease was ranked as BODE index, 6MWDT, FEV1%, GOLD stage and dyspnea score in descending order while BMI score had the least/poor validity to predict the aim of the study based on specific results of their sensitivity, specificity, AUC with 95% CI and p-value.
Biography:
Bashayer abahussain has completed her graduation from Imam Abdulrahman Bin Faisal University with a bachelor degree in Respiratory care , Allied Health college . Currently practicing Respiratory care as Respiratory critical care supervisor at king Fahad medical city in Riyadh – KSA since 2015.
Abstract:
Have you ever tried to sleep in a brightly lit room with tubes and wires attached to you? with people periodically talking, touching and moving you?Sleep is an important physiologic process, and lack of sleep is associated with a lot of adverse outcomes. sleep disturbances are common in critically ill patients with possibly serious consequences. ICU settings such as noise, light, mechanical ventilators, patient care activities, treatments and medications need to be monitored closely as sleep disturbance have been shown to be associated with reduced quality of life. Understanding the problem will require commitment on the part of ICU practitioners and hospital administrators, which in turn may lead to significant improvement in ICU care and patient outcomes.
Wondu Reta
Jimma University, Ethiopia
Title: Prevalence of cardiac arrhythmias among chronic obstructive pulmonary disease patients admitted to Jimma Medical Center
Biography:
Wondu Reta was graduated from Jimma University, Institute of Health in BSc degree in Junior Anesthesiology professional in June 2012 GC and Master’s degree in Medical Physiology in October 2017 G.C. He was currently serving Jimma University, Institute of health as Anesthesia care provider, researcher and lecturer of Medical Physiology and Anesthesiology. He was also reviewing different papers related to his professionals on different journals.
Abstract:
Background: Cardiac arrhythmias are common in COPD patients and are a major cause of morbidity and mortality.
Aim & Objective: The present study aimed to determine the prevalence of cardiac arrhythmias among patients with COPD
Materials & Methods: The study was conducted on COPD patients visiting chest clinic of Jimma Medical Center (JMC) located at Jimma town, South west Ethiopia; from May 18 to August 18, 2017 GC. A hospital based cross-sectional study was conducted among 80 sampled COPD patients; and an investigation for 12 lead resting supine ECG was performed. The results of ECG patterns and other variables were entered into EPI data (3.1) and exported to SPSS (20) for further analysis.
Results: The prevalence of arrhythmia accounted for 50% and the magnitude of its types were classified as Sinus origin arrhythmia (30%) specifically [Sinus bradycardia (16.3%), Sinus tachycardia (8.8%) and Sinus arrhythmia (5.0%)], Ectopic arrhythmia (20%) specifically [Premature ventricular contraction (7.5%), Atrial fibrillation (6.3%), Premature atrial contraction (3.8%), Atrial flutter (1.3%) and Multi focal atrial tachycardia (1.3%)], Conduction block arrhythmia (23.8%) specifically [Bundle branch block (17.5%) for instance: Complete right bundle branch block (3.8%), Complete left bundle branch block (5%), Incomplete right bundle branch block (7.5%), Incomplete left bundle branch block (1.3%), Hemi fascicular block (5%)] and Atrioventricular block (1.3%)], and Other arrhythmia (11.4%) like Prolonged QTc interval (8.8%) and Preexcitation syndrome or Wolf Parkinson white syndrome (2.5%) as a single COPD patient presented with more than one arrhythmias.
Conclusion: Routine ECG investigation should be performed at the setup to screen and initiate early management of cardio vascular diseases including cardiac arrhythmias for better prognosis COPD patients which was inevitable and very common