11^th Annual Congress on Pulmonology & Respiratory Medicine March 18-19, 2020 Amsterdam, Netherlands

Biography:

Bryson sifuma completed his Bachelor of arts Degree (Economics  and Business studies) at age of 24 years from Kenyatta University and Certificate in Human Resources and Personnel management from Cambridge International college,certificate in Monitoring and Evaluation and Practical project management from Amref Health Africa and Certificate on Management in Health from the university of washington. He is the project officer of Amref GsK infectious diseases and Non communicable diseases project, a non government organization in kenya. He has published more than 2 papers on management of non communicable diseases.

Abstract:

The world health organization confirms that Pneumonia is the leading cause of morbidity and mortality in children under 5 years. Pneumonia poses risk factors e.g. undernutrition, sub optimum breastfeeding and zinc deficiency.   Through Amref & GsK Partnership, Amref Health Africa trained community health workers on diagnosis, management and control of Pneumonia. The project had both protective and preventive strategies at the community level. Advocacy initiatives also in place to increase public awareness for management monitoring and evaluation to generate data for practice and policy change. Both face to face and m-Learning approach was used to train community health workers on effective management of Pneumonia in kasarani and Embakasi sub counties. An evaluation of the training project wanted to find out the effect of training community health workers as well as document lessons learnt and best practices. 6591 pneumonia infected children under 5 years enrolled on treatment and 55% of them on follow up through CHVs. 814 health care workers were trained on Pneumonia through a blended approach. 2396 people were reached through Pneumonia education. There is improved adherence to treatment by community members. Observed reduction in admissions because of complications of pneumonia. There is also improved patient tracing and referral to the health facility. Training of community health workers is essential towards effective management and control of Pneumonia. Community dialogue days are important for information sharing & education among caregivers on prevention and management of Pneumonia.Community engagement is key in identification, education, referral and follow up of patients.

Biography:

Sarah Kosgei has a masters in Global Health (Leadership and Management) from United States international University (USIU- Africa). She is is the programme Manager at the Institute of Capacity Developemnt at Amref Health Africa. Amref health Africa is an international NGO head-quartered in Nairobi Kenya with a vision of lasting health change in Africa. Amref has offices in 10 countries in Africa and provides training and health services to over 36 countries in Africa through the regional programmes and the Institute of Capacity Development. Amref Health Africa’s Institute of Capacity Development (ICD) was founded on the need to continuously produce and develop Human Resources for Health (HRH) in Africa. It focuses on building the technical, leadership and management skills of health sector staff and decision makers in Governments, Parastatals, NGOs, the Private sector and CBOs

Abstract:

The Ministry of health (MOH) indicates that 10% of the population in Kenyan have Asthma. Asthma, is not clearly classified in the MOH registers and hence the data is scanty. Frontline health workers have challenges in distinguishing asthma from other obstructive airway and respiratory illness. This poses a clinical challenge for diagnosis, treatment and clinical audits. Amref Health Africa in partnership with GSK, trained health workers on diagnosis, management and control of Asthma towards quality management. A blended training approach of face to face and e & m-Learning was used to train health workers on effective management of Asthma. End term evaluation was conducted to find out the effect of these trainings. Quantitative data was analyzed by descriptive statistics and bivariate analysis techniques using SPSS V.20 and qualitative data analyzed using NVivo 11. A total of 2613 health workers were trained. In 2018, 23,884 Asthma patients were put on treatment. Clinical mentorship and continuous medical education was intensified post the evaluation with 28,056 new cases put on treatment. The health facility with appropriate Asthma management equipment and commodities increased from 24.7% to 37%. There was reduced hospitalization and 97% of patients were on appropriate inhaler controlled treatment. Adherence to treatment improved from 52% to 77% and community awareness of Asthma signs improved from 25.5% to 92.2% with 88% aware of at least 3 triggers. Therefore, training of health workers and equipping clinics is essential towards quality Asthma care. Patient support groups are important for information sharing & health education and psycho-social support. There is however need to strengthen diagnostic and reporting tools for asthma.

Biography:

Bashar Hanna Azar has completed his MBChB from Mosul Medical College, Mosul University Iraq and Postdoctoral studies from Iraqi council of medical specialization Baghdad University School of Medicine. He is the Head of Department of Thoracic and Cardiovascular Surgery, Hawler College of Medicine, Hawler Medical University. He is the Director of Erbil Center of Kurdistan Board for Medical specialties. He has published more than 10 papers in reputed journals and has been serving as an Editorial Board Member of repute

Abstract:

Objectives: Fine needle aspiration cytology and biopsy provides a highly accurate diagnostic method which can be performed rapidly with minimal risk. It provides a definitive diagnosis in most patients at low cost with minimal trauma. Aim of this study is to assess the value of fine needle aspiration cytology (FNAC) in the diagnosis of chest lesions.

Methods: FNA specimens from 57 patients with suspected pulmonary neoplasms were subjected to immediate cytology assessment. Direct smears were prepared in the radiology department and fixed in ethanol alcohol in four slides. The cellular content was assessed and, if possible, a provisional diagnosis offered. A second FNA was requested if the initial aspirate seemed of doubtful adequacy. The diagnostic accuracy was examined by review of clinical and radiological data in all patients.

Results: Satisfactory diagnostic material was obtained in 53 patients on a single aspirate and following a second FNA in 4 patients with inadequate specimens. Of the 57 aspirates, 37 were malignant. Most of tumors occurred in the age ranged between (50-59) years old. The male constitute the 2/3rd of malignant tumor. Adenocarcinoma constitute the majority of primary lung cancer 61.8%, this is indicated the benefit of FNAC for diagnosis of peripheral lesions of the chest, as this tumors tend to occur peripherally.

All malignant diagnoses were confirmed on clinical and/or pathological review. FNA accurately distinguished primary small cell and large cell carcinomas in those patients with pathological follow up. Complications were recorded in four (7%) patients, all of them were developed pneumothorax, a chest drain was required in one patient. The others managed conservatively.

Conclusions: Percutaneous FNA cytology provides safe, simple and accurate diagnosis in the investigation of chest lesions.

Biography:

Maryam Radan has completed her PhD at the age of 30 from Jundishapur University of Medical Sciences, Ahvaz, Iran. She is the faculty member (Assistant Professor) of Physiology Department-Jundishapur University of Medical Sciences,Ahvaz, Iran. She is an integrative cardiopulmonary physiologist focusing on understanding the integrated mechanisms underlying the pulmonary, hypertension and heart failure utilizing animal models. Her expertise includes pulmonary circulation, isolated perfused heart and echocardiography to understand in vivo function at cell-to-organ levels. she combine these approaches with cell culture and immunohistochemistry.

Abstract:

            Pulmonary arterial hypertension (PAH) is a severe and multifactorial syndrome that restricts flow through pulmonary arterial circulation The pathogenesis of pulmonary arterial hypertension  involves reactive oxygen species and inflammation. The eukaryotic oxidation resistance gene1 (OXR1) is involved in protection against oxidative stress. The cyclin-dependent kinase inhibitor 1A (P21) and nuclear factor (erythroid-derived 2)-like 2 (Nrf2) play important roles in controlling ROS levels by regulating antioxidant enzymes. It is documented that degraded or diminished Nrf2 activity contributes to oxidative stress which, in turn, leads to many pathological conditions. P21 can stabilize and activate Nrf2 and consequently, activated Nrf2 upregulates several antioxidant enzymes. mechanism underlying the possible prevention of oxidative damage by OXR1 pathway is not clear in pulmonary system disorders. The present experiment focused on the role of OXR1-P21-Nrf2 signaling pathway in pulmonary hypertension model with emphasis on the oxidative stress. The rats were divided into groups, receiving: Saline; MCT; Crocin (7.5, 15 and 30 mg/kg); MCT+Crocin. Twenty-one days after substance administration, we evaluated the pulmonary hemodynamic (PAP), arterial blood gas analysis, bronchoalveolar lavage fluid, total protein in BALF, cytokines production, pulmonary edema and cardiac hypertrophy, lung histopathology, antioxidant enzymes activity and gene expression of OXR1, P21 and Nrf2 using the RT-PCR. The Nrf2 localization also evaluated immunohistochemically. The obtained results showed that the pulmonary hypertension caused to changes in oxidative stress profile which is associated with decreases of OXR1-P21-Nrf2 gene expression. Co-treatment with crocin preserved pulmonary hemodynamic parameters by improving antioxidant statues. the signaling pathway identification in pulmonary hypertension and the protective effect of Crocin as an antioxidant agent can be used in future basic and clinical supplemental studies.

Biography:

Rola TOUT has completed his Master in Physical therapy at Saint Joseph University of Beirut, she gets her University Diploma in cardio Vascular and respiratory Rehabilitation from Rene Descartes University (Paris V). She is a PhD candidate in Science at Saint Joseph University of Beirut (Lebanon).

Abstract:

Objective: Expose the electromyography and spirometry relationship and establish the chronology of the contraction of Scalene and Rectus abdominis which works together in synergy antagonism in physiological breathing

Methods: 128 electromyographic tests were performed during the respiratory cycle on 43 healthy adults. EMG signals of Scalene, Rectus abdominis were recorded. The breathing was recorded by using a spirometer (vernier®).

Results: The duration of the contraction of Scalene are superior to Rectus abdominis 82% p-value = 0.000058, the amplitude of Scalene is superior of Rectus abdominis, p-value = 0.000000073. 109 tests of Scalene contraction begin before that of Rectus abdominis (63.74%), p-value = 0.000012. RMS is 0.02 ± 0.011 μv for Rectus abdominis and 0.04 ± 0.021 μv for Scalene, p-value = 6.76591E-06. Duration of inspiration is 1.25 s ± 0.19, the expiration is 1.04 s ± 0.19. The mean frequency of Rectus abdominis is 54.19 Hz ± 6.35, it is 57.21 Hz ± 7.08 for Scalene, p-value is 9.84081E-08. The median frequency of  Rectus abdominis is 51.05 Hz ± 6.51, it is 52.72 Hz ± 6.94 for Scalene, p-value is 0.0098. The muscle fatigue of Rectus abdominis decreased from 60.40 ± 0.45 to 19.98 ± 4.32. For Scalene it decreased from 60.41 ± 0.4 to 23.52 ± 4.41.

Discussion:  There is a synergistic - antagonism relationship between Scalene and Rectus abdominis during respiration. Scalene is a main inspiratory muscle, its contraction is important in amplitude, duration and frequency. Both muscles are fatigable during the inspiratory cycle

Biography:

Sarah Kosgei has a masters in Global Health (Leadership and Management) from United States international University (USIU- Africa). She is is the programme Manager at the Institute of Capacity Developemnt at Amref Health Africa. Amref health Africa is an international NGO head-quartered in Nairobi Kenya with a vision of lasting health change in Africa. Amref has offices in 10 countries in Africa and provides training and health services to over 36 countries in Africa through the regional programmes and the Institute of Capacity Development. Amref Health Africa’s Institute of Capacity Development (ICD) was founded on the need to continuously produce and develop Human Resources for Health (HRH) in Africa. It focuses on building the technical, leadership and management skills of health sector staff and decision makers in Governments, Parastatals, NGOs, the Private sector and CBOs.

Abstract:

We loose approximately 2400 children a day due to Pneumonia which is responsible for about 16 percent of under-five mortality. This means if not combated, our children especially in the subsaharan Africa have no chance of seeing their 5th birthday. In Kenya, according to the county integrated development plans, health facilities lack adequate essential commodities to treat pneumonia and health workers have limited capacities to tackle respiratory illnesses. Like asthma, pneumonia is often misdiagnosed and data is recorded under other respiratory diseases. This causes challenges in diagnosis, management and data for decision making. Amref Health Africa implemented a pneumonia management and control project funded by GSK in sellected counties in Kenya from May 2018 to date. The project seeks to build the capacity of frontline health workers to effectively manage and control pneumonia, strengthen community health systems to increase public awareness, improve the supply chain for increased access to medicines and use evidence for advocacy and to influence action.Thus far, 2,835,038 people have been reached with health education on prevention, control and management of Pneumonia.Already 21,422 put on treatment and manged succesfully. There is improved integrated community case management of pnemonia and other childhood illnesses.Health facilities are actively putting requisitions for commodities and equipment for management of pneumonia. Women of reproductive age have formed mother to mother support groups that enable them to continously share experiences on matterrs health and improving their livelihoods through initiation of income generating activities. In conclusion, capacity building of health workers should be supported with community awareness and matched with supply of the services at health facility level for better health outcomes

Biography:

Hana Douafer was born in Guelma, Algeria. In 2017, she obtained her diploma from the Faculty of Medicine, Annaba (Algeria) and went to Marseille (France), where she is currently working on her  doctoral thesis at the Faculty of Pharmacy (UMR-MD1, U1261 INSERM) under the supervision of Dr. V. Andrieu and Dr. J. M. Brunel

Abstract:

During the last decades, multiple approaches have been developed to combat bacterial resistance. One of them involves combination therapies of existing antibiotics with potentiating adjuvants, reempowering the activity of the antibiotic against resistant strains.

In the respiratory system, Pseudomonas aeruginosa is known as a frequent and virulent pulmonary pathogen and one of the leading causes of morbidity and mortality in cystic fibrosis (CF) patients.

In this context, the antibiotics pulmonary administration has become a precious tool in the management of respiratory infection.

The aim of our study is to develop a new potent pharmaceutical form intended for pulmonary administration, based on a combination of an antibiotic (Doxycycline) with an adjuvant: a polyaminoisoprenyl derivative NV716 allowing restoration of doxycycline efficacy against P.aeruginosa strains naturally resistant to doxycycline. The proof of concept of such a combination has been previously verified in vitro on various P. aeruginosa strains. (PlosOne, 2016)

Here we report the characterization of three different aerosols: doxycycline alone, NV716 alone and doxycycline/NV716 combination, using the Next Generation Impactor. Aerosols evaluation was carried out according to different concentration, duration of nebulization and nebulizers: The droplet size distributions and aerosol efficiency were expressed in terms of Mass Median Aerodynamic Diameter (MMAD) and Fine Particle Fraction (FPF).

Results showed MMADs (3,4-4,4 μm) in accordance with the standards recommended for therapeutic aerosols (< 5 μm) suitable for deep lung deposition, with a high FPF (> 50 %) required to maintain drug level above its Minimum Inhibitory Concentrations (MIC) at the infection site

Biography:

Gaurav Gupta has completed his MD, Medicine from All India Institute of Medical Sciences, New Delhi, 110029, India. He is currently working in the Department of Medicine and Infectious Diseases at All India Institute of Medical Sciences, New Delhi. He is Author of a book “Review of Medicine” for undergraduate students, and has participated in formation of INDEX-TB guidelines

Abstract:

Background: According to Global Tuberculosis Report 2017, there were an estimated 10.4 million incident cases of TB in 2016 in the world (140 cases per 100 000 population). Drug-resistant TB is a persistent threat, with 490 000 million cases of multidrug-resistant TB (MDR-TB) emerging in 2016 and an additional 110 000 cases that were susceptible to Isoniazid but resistant to Rifampicin (RR-TB). One of the major obstacles in achieving successful treatment outcomes in DR-TB is the adverse events affecting the adherence to the both first-line and second-line TB drugs. Aim of the present study was to evaluate adverse events due to the second-line drugs (SLDs) in MDR-TB patients during first year of treatment.

Methods: A prospective cohort study was conducted at DOTS Plus site at AIIMS, New Delhi. Eighty-one MDR-TB patients were recruited consecutively from June 2014 to May 2015 and were given standardized Category IV drug regimen under Revised National Control Tuberculosis Programme (RNCTP). Patients were followed-up till one year after initiation of treatment and adverse events were primarily recognized and documented with clinical evidence and/or laboratory investigations.

Results: A total of 91 adverse events were reported in 52 (64.2%) patients. The grouped adverse events were most commonly gastrointestinal (70.6%), arthralgia (10.9%), ototoxicity (6.4%), psychiatric (5.5%), and hypothyroidism (2.1%). Out of 81, 9 (11.1%) patients had serious adverse events requiring discontinuation or substitution of drugs which included psychiatric disturbances and ototoxicity.
Conclusions & Recommendations: Adverse events among MDR-TB patients are one of the major areas which is affecting cure rate of DR-TB patients. Further improvement in monitoring and management of adverse events may enhance the cure rate of MDR-TB patients.

Biography:

Maryam Radan has completed her PhD at the age of 30 from Jundishapur University of Medical Sciences, Ahvaz, Iran. She is the faculty member (Assistant Professor) of Physiology Department-Jundishapur University of Medical Sciences,Ahvaz, Iran. She is an integrative cardiopulmonary physiologist focusing on understanding the integrated mechanisms underlying the pulmonary, hypertension and heart failure utilizing animal models. Her expertise includes pulmonary circulation, isolated perfused heart and echocardiography to understand in vivo function at cell-to-organ levels. she combine these approaches with cell culture and immunohistochemistry.

Abstract:

Pulmonary arterial hypertension (PAH) is a severe and multifactorial syndrome that restricts flow through pulmonary arterial circulation The pathogenesis of pulmonary arterial hypertension  involves reactive oxygen species and inflammation. The eukaryotic oxidation resistance gene1 (OXR1) is involved in protection against oxidative stress. The cyclin-dependent kinase inhibitor 1A (P21) and nuclear factor (erythroid-derived 2)-like 2 (Nrf2) play important roles in controlling ROS levels by regulating antioxidant enzymes. It is documented that degraded or diminished Nrf2 activity contributes to oxidative stress which, in turn, leads to many pathological conditions. P21 can stabilize and activate Nrf2 and consequently, activated Nrf2 upregulates several antioxidant enzymes. mechanism underlying the possible prevention of oxidative damage by OXR1 pathway is not clear in pulmonary system disorders. The present experiment focused on the role of OXR1-P21-Nrf2 signaling pathway in pulmonary hypertension model with emphasis on the oxidative stress. The rats were divided into groups, receiving: Saline; MCT; Crocin (7.5, 15 and 30 mg/kg); MCT+Crocin. Twenty-one days after substance administration, we evaluated the pulmonary hemodynamic (PAP), arterial blood gas analysis, bronchoalveolar lavage fluid, total protein in BALF, cytokines production, pulmonary edema and cardiac hypertrophy, lung histopathology, antioxidant enzymes activity and gene expression of OXR1, P21 and Nrf2 using the RT-PCR. The Nrf2 localization also evaluated immunohistochemically. The obtained results showed that the pulmonary hypertension caused to changes in oxidative stress profile which is associated with decreases of OXR1-P21-Nrf2 gene expression. Co-treatment with crocin preserved pulmonary hemodynamic parameters by improving antioxidant statues. the signaling pathway identification in pulmonary hypertension and the protective effect of Crocin as an antioxidant agent can be used in future basic and clinical supplemental studies.

Biography:

Chhaya Akshay Divecha has completed her undergraduate as well as Post-graduate (MD Pediatrics) from the reputed Seth G S Medical College & KEM Hospital at Mumbai, India. She has also obtained fellowships in Neonatal Intensive Care and Pediatric Intensive Care from the same reputed institution. She is currently working as an Assistant Professor in Pediatrics at College of Medicine, National University of Science and Technology (formerly Oman Medical College) at Sohar, Sultanate of Oman. She has more than 10 years of teaching experience and has published many papers in reputed journals as well as contributed to chapters in four textbooks

Abstract:

Aims & Objectives: Thrombocytopenia, commonly encountered in intensive care units, has been shown to be independent predictor of mortality and prolonged hospital stay in critically ill. We conducted a study in pediatric intensive care unit (PICU) to determine the causes and severity of thrombocytopenia as well as patient outcomes (bleeding and mortality).
Materials & Methods: Observational study was conducted in PICU of tertiary care hospital, India after ethics committee approval. Data was derived from routine examinations and investigations. Detailed information about demographic data, clinical data, length of stay (LOS), periodic platelet counts, primary diagnosis, complications, sites of bleeding (if any), use of mechanical ventilation and outcome in PICU were noted.

Results: The results indicated that the occurrence of thrombocytopenia in study population (N=491) was 60.3%. Mild, moderate, severe and very severe thrombocytopenia was seen in 27%, 32.1%, 34.1% and 6.8% patients respectively. Causes of thrombocytopenia were sepsis (27%), part of primary illness (25.7%), undetermined cause (24.7%), nosocomial sepsis (21.2%) and drugs (1.4%). Two hundred thirty-seven (48.3%) patients had bleeding during PICU stay. Maximum patients (26.1%) had respiratory system involvement. Risk factors associated with thrombocytopenia were sepsis, shock and mechanical ventilation. Patients with thrombocytopenia had longer PICU and hospital stay. Patients with infectious disease and haematological disorders had statistically significant chances of thrombocytopenia. Shock was significantly associated with increasing severity of thrombocytopenia. Presence of thrombocytopenia and increasing severity were associated with higher mortality.

Conclusions: This study confirms that thrombocytopenia is a readily available risk marker of mortality and increased PICU stay. Patients having sepsis, shock and mechanical ventilation are at higher risk of developing thrombocytopenia