Scientific Program

Day 1 :

  • Neurodegenerative Disorders

Session Introduction

Dr. Esther Lim

Division of Research, College of Osteopathic Medicine USA

Title: Nanodiagnostic Approach to Detection of Plasma Biomarkers: Potential Screening tool for Early Diagnosis of Alzheimer’s Disease

Time : 10:00 - 10:40

Speaker
Biography:

Esther Lim, MD, MBA is currently an associate professor of radiology at PCOM and works in collaboration with Dr Hui Mao, PhD, Professor of Radiology and Biomedical Engineering and the Director for the Molecular Imaging, Biomarkers, and Probe Development at Emory University.  Dr Yuanchen Li, PhD is a staff scientist at Emory University School of Medicine with expertise in anti-biofouling polymer synthesis for nanomaterial coating and biomarker targeted imaging, drug delivery and therapy. 

Abstract:

Alzheimer’s Disease (AD) imposes a huge economic burden with its diagnostic and therapeutic challenges.  The currently available diagnostic tools are expensive, invasive, and insufficient for early screening.  At present, levels of amyloid-β (Aβ) in the brain can only be assessed reliably via Positron Emission Tomography (PET) imaging or by measuring amyloid-β (Aβ) levels in the cerebrospinal fluid. However, such invasive and expensive approach is impractical for patients with no obvious symptoms. Recent literature demonstrating the potential clinical utility of plasma biomarkers in predicting brain amyloid-β (Aβ) burden has drawn increasing interest among nanoparticle researchers. Development of minimally invasive and ultrasensitive detection system for early diagnosis of AD is critical for formulating optimal therapeutic strategies early in the progression of the disease.  Using anti-biofouling magnetic nanomaterials, we have constructed a novel, simple and efficient method that could serve as a screening tool.

The anti-biofouling polymer coated Iron Oxide Nanoparticles and their targeting antibody conjugates were prepared as described in the literature.  The Fluorescein Isothiocyanate (FITC) labeled amyloid-beta peptide 1-40 [Aβ(1–40)] and Tetramethylrhodamine-5-(and6)-isothiocyanate (TRITC) labeled peptide 1-42 [Aβ(1–42)] were dissolved in Phosphate Buffered Saline (PBS) with Fetal Bovine Serum (FBS) at 50mg/mL to mimic the human serum environment.  They were then incubated with antibody (Ab)-conjugated IONPs (at final iron concentration of 0.2 mg/mL) or antibody- conjugated Dynabeads for 3 hours before magnetic separation of particles.  The separation efficiency (SE) was calculated as the weight ratio of captured peptide to spiked.  The protein quantification was verified using micro bicinchoninic acid (BCA) protein assay kit.  Furthermore, insulin was purposely added to PBS with FBS as interference to demonstrate the capture specificity of Ab-conjugated IONPs.

The SE of anti-biofouling IONP for Aβ(1–40) in PBS with FBS at 0.1, 0.2, 0.5, 1, 2, 5, and 10 microgram/mL were.in the rage of 86-97% using fluorescence signal and with microBCA protein assay kit.   When insulin was added to Aβ(1–40) mixture, the separation efficiency of insulin for IONP was only 4.5, 4.7, 6.2, 6.5, 7.7, 9.8, and 12.3% while dynabeads showed no difference in the separation efficiency for both Aβ(1–40) and insulin.  Similar results were obtained for Aβ(1–42) and IONP with minimal isolation of insulin.  Dynabeads again showed indiscriminate separation of Aβ(1–42) and insulin.   The sensitivity for our antibody conjugated IONP detection system is calculated at 88-98.5% and false positive rate of 7.5-11.2%.  The commercial dynabeads, however, showed sensitivity of only 27-39% and false positive rate of 48.3-55.4%. 

We have developed a highly sensitive and specific Iron Oxide Nanoparticle (IONP) based system with potential application for early AD diagnosis in human serum.  Its ability to selectively detect AD markers at minute concentration and with additional benefit of low cost and scalability, it can serve as a non-invasive tool for population-wide screening for AD.  

Speaker
Biography:

Assistant Lecturer at the Future University of Egypt (FUE) and NODCAR {National Organization for Drug Control and Research}. Reviewer at Bioscience reports journal, Biochemical Society (neuroscience). Eight years’ experience as QA&QC. Highly trained and qualified to deal/work on: Mesenchymal stem cells homing and developing techniques, PCR, western blotting technique, electrophoresis, Elisa, spectrophotometer, HPLC, dissolution and disintegration. Successfully trained & passed the QMS ISO 9001:2008 documentation, implantation training & internal audit.

Abstract:

Abstract

Background: Memory and learning disorders have been characterized by being a devastating long term incurable diseases with a huge social and economic impact on worldwide society in addition to a diminished efficient available medical treatments with the potential for restoring and modifying memory defects onset and drawbacks. Deep Brain stimulation via using neuroprotective inducers for restoring destructive degenerative brain structural diseases such as AD can be considered as being a promising successful therapy due to its various targets and underlying mechanisms for improving brain dysfunction by increasing synaptic plasticity and transmission. Objectives: The main aim of this study is to suggest therapeutic medical protocol with a neuroregenerative potentials having the ability to restore normal brain mechanisms and mental functions in addition to understanding triggering pathways via which normal neurons diverse population restoration process can occur. Materials and Methods: Rats were divided randomly into nine groups:(G1) control group; (G2) rats received lipopolysaccharide (LPS) injection;(G3) LPS induced rats received NaHS ;(G4) LPS induced rats received MSCs intracerebrally; (G5) LPS induced rats received MSCs+ NaHS ;(G6) LPS induced rats received kefir+Ginko Biloba (GB) ;(G7):LPS induced rats received MSCs+kefir+GB;(G8) LPS induced rats received NaHS+kefir+GB; (G9) LPS induced rats received MSCs+NaHS+kefir +GB. Results: AD induction by LPS in rats resulted in downregulation of CBS and GSH brain tissue level accompanied with overexpression in amyloid β, MAPK, Tau, ACAT and MDA brain level in addition to elevated Caspase-3 serum activity level. Conclusion: The administration of suggested medical protocol composed of MSCs and/or NaHS and/or kefir+GB resulted in relieving AD pathological deposited hallmarks with restoring the normal inflammatory brain excitatory levels by functioning as a potent neuroregenerative with the advantage of being easily implemented on human subjects as a result of its safety but with more clinical care obligations during conducting experimental design to minimize unpredictable drawbacks.

Mr. Ibraham Bukenya

Stroke Foundation, Uganda.

Title: DIAGNOSIS AND AWARENESS ON STROKE

Time : 14:40 - 15:10

Speaker
Biography:

Ibrahim Bukenya is the Principal Physiotherapist of Stroke Foundation Uganda (SFU) ages 36 years. Stroke Foundation Uganda is in partnership with Stroke Rehabilitation Centre. We offer physiotherapy, Occupational therapy, Speech and Language therapy, Counseling, Nutrition and Follow-up assessment.

Abstract:

Stroke is a “brain attack”. It can happen to anyone at any time. It occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost. There are a number of methods stroke is diagnosed. One is through a brain computed tomography (MRI) scan (brain CT scan) which can show bleeding in the brain or damage to the brain cells from a stroke. The test also can show other brain conditions that may be causing the symptoms. One can also use Medical history where the Doctor will ask you or a family member about your risk factors include high blood pressure,diabetes,heart disease and a personal or family history about stroke. Your Doctor also will ask about the signs and symptoms when they began. Diagnosis can also be done through physical examination, your doctor will check your mental alertness and your co-ordination and balance, he or she will check for numbness in your face, arms, legs, confusion, and trouble speaking and seeing clearly. Awareness of stroke can be made through the media such as TV show, radio   programs, Facebook, whatsapp, internet, YouTube; Instagram. Results may either be positive or negative. If positive the client is referred for rehabilitation and If negative further tests and scans can be done to identify the case. Diagnosis and stroke awareness has greatly helped to prevent or control stroke.

  • Stroke Rehabilitation and Recovery

Session Introduction

Mr. Omer Dursun

University School of Physical Therapy, Turkey.

Title: Temporomandibular Joint Dysfunction in Patients with Stroke

Time : 10:40 - 11:20

Speaker
Biography:

Ömer DURSUN has his expertise in neuromusculoskeletal disorders. His special focus of interest is stroke, Parkinson’s disease and spinal disc herniations. His current research is based on developing new method for spinal disc herniation diagnosis.

Abstract:

Statement of the Problem: Although stroke and stroke related symptoms had been investigated in wide spectrum, yet variety of knowledge stands behind the curtain to be found. We consider that the temporomandibular joint dysfunction (TMJD) is one of the symptoms that mentioned above due to stroke related outcomes such as orofacial dysfunction, facial paralysis and mastication problems. Despite the orofacial symptoms due to stroke had been investigated separately these symptoms are originated from one system entitled with stomatognathic system. From this point of view our aim was to assess TMJD in patients with stroke. Methodology & Theoretical Orientation: Total 100 participants, 50 healthy and 50 who had stroke were recruited into this study. Digital caliper and algometer were used in order to assess temporomandibular joint range of motion and masticatory muscle pressure pain threshold. Labial comissure angle measurement was used for assessing facial paralysis severity. Fonseca questionnaire was used for TMJD assessment and categorization. In addition, dominant mastication shift was measured by the question that asks the pre-post stroke dominant mastication side. Findings: In intergroup comparison significant decrease was found in all temporomandibular range of motion parameters in favor of stroke group. Despite the fact that no significant difference was found between groups for the pain threshold in masticatory muscles except for middle part of the left temporalis muscle, values were higher in healthy group. As a result of intergroup examination of labial comissure angle degree, Fonseca questionnaire score, it was found that labial comissure angle and Fonseca questionnaire scores were higher in stroke group. Intragroup examination of stroke patients showed that dominant mastication side shift was seen in stroke patients. Conclusion & Significance: It was concluded that, TMJD prevalence was higher in stroke group compared to healthy group and use of modalities specific to TMJD treatment would be beneficial.

Speaker
Biography:

She is working as Speech and Language therapist at Faculty of Medicine University of Kelaniya Ragama Sri Lanka.

Abstract:

Background

Early identification and referring for adequate treatments of aphasia is essential as it may cause for limitations in daily life and functional communication. But there are no currently available standardized aphasia screening tests in Sri Lankan Sinhala speaking context. The dissertation mainly focused on adapting Frenchay Aphasia Screening Test (FAST) for patients with post-stroke aphasia in the Sri Lankan Sinhala speaking context.

Materials and method

The descriptive cross-sectional study design was implemented for adapting FAST into Sri Lankan Sinhala speaking context. A purposive sampling of 90 non- impaired people and 35 aphasia patients from government hospital speech and language therapy clinic settings in the western province enlisted for the study. Study instruments were the self-administrative questionnaire for adapting and translating the tasks and interviewer administrative adapted screening tool.

Results

There was a significant negative correlation between age and total scores in non- impaired population (A Spearman's rank-order coefficient [r s ] = -.701, p< .001) and a high degree of inter-rater reliability of the adapted screening test was found (intraclass correlation coefficient [ICC]= 1.000, p<.001).

Conclusion

The newly adapted Sinhala version of FAST is a reliable and sensitive screening tool for aphasia detecting in Sri Laankan Sinhala speaking context. The elicited cut values are 28 (age 20-60), 19 (age 61-70), 14 (above 71) for each age group.

  • Dementia

Session Introduction

Dr. Richa Tripathi

Banaras Hindu University, India

Title: Brahmi Ghrita: A potential drug for comprehensive treatment of Alzheimer’s Disease

Time : 12:10 - 12:40

Speaker
Biography:

Richa Tripathi, M.D. (Ayurveda) is persuing her PhD in Department of Kayachikitsa, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India. She earned MD degree in Panchakarma from Bharti Vidyapeeth University, Pune, Maharashtra in 2012. She served as assistant professor in Ayurved College, Shree Baba Mast Nath University, Asthal Bohar, Rohtak, Haryana from Aug 2012 to Feb 2014. She has served the society as an Ayurvedic physician and cancer counselor at D.S. Research Center, Varanasi, Uttarpradesh, India from feb 2014 to dec 2014. She actively campaigned for early diagnosis and cancer prevention in Varanasi and is a well-known face in local newspapers. She has done a lot of health campaign through All india Radio Pradeshik Seva for Cancer and Alzheimer’s Disease prevention. She has published many research papers in national and international journals like International Ayurvedic Medical Journal, World Journal of Pharmacy and Pharmaceutical Sciences, International Journal of Ayurveda and Pharmaceutical Chemistry, IJAAS, Medha International Interdisciplinary journal. She has presented numerous papers in national and International seminars. Her current research on Alzheimer’s Disease got noticed in Alzheimer’s Association International Conference, Chicago 2018. 

Abstract:

Background: In the anticipation of disease modifying treatments for Alzheimer’s disease, Brahmi Ghrita, a polyherbal Ayurvedic medicine traditionally used for enhancing memory and cognition, was tested on 30 diagnosed patients of mild cognitive impairment (MCI) due to Alzheimer’s disease. Donepezil, a contemporary treatment, often results in vivid side-effects. The study was conducted to compare the effect of Brahmi Ghrita and Donepezil in MCI due to Alzheimer’s.

Objectives: The objective was to investigate the cognitive response of Brahmi Ghrita on Mild Cognitive Impairment due to AD. The trial was conducted on 30 diagnosed patients of MCI due to AD. The cases were compared with same number of patients undergoing allopathic treatment of MCI (Donepezil 10mg/day and the data was evaluated with respect to score changes in ADAS- Cog scale.

Materials and Methods: It was an open label, single centered, comparative, prospective, pragmatic trial. The trial protocol and related documents were reviewed and approved by the Institutional Ethical Committee, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P., India. The study was conducted in accordance with Indian Council of Medical Research (ICMR) ethical guidelines for biomedical research on human participants. Trial had registered in the clinical trial registry of India (CTRI/2017/07/009171).Primary outcome measure of study was to evaluate efficacy of Ayurvedic formulation Brahmi Ghrita in the subjects suffering from Mild cognitive impairment due to Alzheimer’s Disease by assessing change in ADAS- cog scale and 3MS (Modified Mini Mental Examination Score) total Score. The secondary outcome measures was to evaluate the changes in inflammatory markers TNFa and IL10 in all the samples.

Total 84 patients (>40 years, either sex), with progressive decline in cognition (>6 months), a 3MS score of 79-100, without severe depressive disease were enrolled in the study. They were randomly divided into two groups - Donepezil group (DzG) and Brahmi Ghrita group (BGG). Donepezil’s dose of 5mg/day and Brahmi Ghrita’s dose of 12gm BD empty stomach were administered orally up to 12 weeks to both the groups, respectively. The efficacy of both the groups were assessed through the changes from baseline ADAS-Cog11 scores and were compared.

Results: 60 patients were part of the study. Out of which 30 patients were treated with Brahmi Ghrita and the rest 30 with Donepezil (5mg/day). Statistically significant change from baseline ADAS-Cog11 was observed for BG after 3 months. At week 12, 23 patients (76.6%) had stable and improved ADAS-Cog11. The group where ADAS BG (p value = 0.01) was administered showed significant impact on the patients. Also, the group where ADAS DZP (p value = 0.001) was administered showed significant impact as well but diarrhea, vomiting, cramps were some associated symptoms with Donepezil. The objective parameters TNF a and IL 10 were also performed but they did not show any gross significant changes in this short duration of treatment.

Conclusions: Although the trail was of short duration but Brahmi Ghrita was found to modestly improve cognition, activities of daily living and global clinician rating of patients with mild to moderate cognitive impairment due to Alzheimer’s. The stabilizing effect of Brahmi Ghrita on cognitive ability from this explorative study suggests its promising efficacy and should be further evaluated in future studies.

  • Neuroscience

Session Introduction

Mr. Vijayprakash Manickam

Bharathiar University, India

Title: Iron Oxide Nanoparticles Alters Monoamine Levels in Mice Brain

Time : 16:10 - 16:40

Speaker
Biography:

He is currently doing his Ph.d. in Molecular Toxicology Laboratory, Department of Biotechnology, Bharathiar University, Coimbatore.

Abstract:

The magnetic and paramagnetic properties of iron oxide (Fe2O3) nanoparticles (NPs) attract the attention of clinicians for its various biomedical applications including neurodiagnostics and therapeutics. The neurotoxicity of Fe2O3-NPs in association with behavioural changes has already been proved, but the neurochemical changes underlying such events have not been investigated so far. Thus, this research is focused to understand the levels of monoamines such as dopamine (DA), norepinephrine (NE) and epinephrine (EP) upon exposure to Fe2O3-NPs.  In this study, mice were exposed to Fe2O3-NPs by oral intubation daily for 30 days.  The levels of DA, NE and EP were found to be altered in the subjected brain regions in correspondence to the expression of monoamine oxidases (MAO). In addition, increased intracellular calcium (i[Ca2+]) and decreased expression of growth associated protein 43 (GAP43) indicate the impaired vesicular exocytosis. Further, enormous lipid peroxidation of the treated brain regions and axonal demyelination might affect the normal impulse conduction. This background information accounting all these events could open further avenues to unravel the entire nexus between Fe2O3-NPs and neurotoxicity and behavioural changes.

  • Clinical trials and case reports

Session Introduction

Dr. Zuhal Kadhim

Emory University School of Medicine, Atlanta, GA.

Title: Acquired non-thyrotoxic hypokalemic periodic paralysis: A case report

Time : 12:40 - 13:10

Speaker
Biography:

Abstract:

Introduction: Periodic paralysis is a group of rare neuromuscular disorders presenting with episodes of painless paralysis often incited by stress such as exercise. Differentiating hypokalemic periodic paralysis (HPP) from secondary hypokalemia can present a challenge. Case Report: A 26-year-old Hispanic male with no significant past medical history presented with periodic muscular weakness, areflexia, and paralysis. The patient’s potassium level on admission was 1.6 mEq/l with no other electrolyte abnormalities or electrocardiogram changes. There was a complete resolution of symptoms with IV and oral potassium. The diagnosis of acquired non-thyrotoxic HPP was given based on the patient’s history, his presenting symptoms, ruling out secondary causes of hypokalemia, and resolution with correction of potassium levels. Conclusion: Hypokalemic periodic paralysis most commonly affects Asians, and is tightly associated with thyrotoxicosis. Treatment of HPP relies on rapid identification and understanding of underlying cause. In an acute disabling attack, as seen in this patient, oral potassium and 24 hour cardiac monitoring for rebound hyperkalemia are recommended. We report an uncommon case of acquired non-thyrotoxic HPP, as indicated by the patient’s history, presentation, initial laboratory values, and resolution after potassium correction. Keywords: Muscular weakness, Non-thyrotoxic hypokalemic, Periodic paralysis, Potassium level.

  • Preventive Stroke Strategies

Day 2 :

  • Neurotherapy

Session Introduction

Prof. Miroslav Pohanka

University of Defence, Czech Republic.

Title: Celecoxib inhibits acetylcholinesterase: an importance for neurological disorders

Time : 10:00 - 10:40

Speaker
Biography:

Prof. Dr. Miroslav Pohanka graduated from chemistry in Masaryk University Brno (Czech Republic) in 2003. In the Masaryk University, he achieved doctor of natural science (RNDr) from biochemistry in 2006 and PhD from biochemistry in 2008.  After that, he achieved associated professor (from toxicology at University of Defense, Czech Republic (2012) and doctor of sciences from analytical chemistry at Academy of Sciences, Czech Republic (2014) and professor from analytical chemistry at University of Pardubice (2016). He is an author of more than 200 papers in journals with IF and his works were more than 2000 times cited according web of science.

Abstract:

Celecoxib is a nonsteroidal anti-inflammatory drug which was introduced in the 1990s. It is known as an inhibitor of enzyme cyclooxygenase-2. The drug was introduced in 1990s. In the work presented here, affinity of celecoxib to enzyme acetylcholinesterase (AChE) is inferred because of structural motives in the celecoxib that make it resembling some inhibitors of AChE. Practical impact of properties coming from pertinent inhibition of AChE are proposed. .

Inhibition of human AChE by celecoxib was tested using standard spectrophotometric method and Dixon plot for inhibition constants calculation. Interaction between AChE and celecoxib was also predicted by molecular docking using Swiss dock software. 

A non-competitive mechanism of inhibition was revealed and equilibrium inhibitory constant equal to 313±40 µmol/l was determined. Comparing to AChE, inhibition of butyrylcholinesterase by celecoxib was not found. The lowest DG for complex celecoxib-AChE was equal to -7.78 kcal/mol. In this case, sulfonamide moiety of celecoxib was stacked between TYR 337 and TYR 341 of alfa anionic subsite of active site in the AChE. Cation-Π interactions appears to be responsible for the binding of celecoxib in the active site of AChE.

Though the here revealed and characterized inhibition has lower effect in real conditions than inhibition of cyclooxygenase. The finding is relevant for therapy of neurodegenerative disorders and some other specific pathologies. The inhibition of AChE by celecoxib can be utilized in the therapy of degenerative disorders like Alzheimer disease or it can be used as a prophylactic for poisoning by nerve agents.

This work was supported by a Ministry of Defence of the Czech Republic - long-term organization development plan Medical Aspects of Weapons of Mass Destruction of the Faculty of Military Health Sciences, University of Defence.

Dr. Zuhal Kadhim

Mount Sinai Health System, US.

Title: Necrotizing Autoimmune Myopathy

Time : 10:40 - 11:20

Speaker
Biography:

She has completed her Bachelor degree in Neuroscience in the year 2011 from the university of Toronto.She served as student volunteer in the Distress centers of Toronto in the year 2010-2011. She served as aStudent research assistant in university of Manitoba in the year 2012. Currently she is working as a resident physician in Mount Sinai Health system from 2016

Abstract:

Introduction

Ever since their introduction, Statins have been among the most commonly prescribed medications. Their efficacy in reducing cardiovascular events is well documented and as medications, they are well tolerated by most patients. A recent meta-analysis shows that roughly 1/10,000 taking statins had serious muscle pathology with elevated muscle breakdown enzymes. Some of this pathology is autoimmune in nature.  Autoimmune antibodies against 3-hydroxyl-3-methylglutaryl coenzyme A (HMG-CoA) reductase rarely develop in patients on statins and results in muscle pain, weakness, elevated creatine kinase, and muscle death on biopsy.  According to the NEJM, the exact incidence of NAM is unknown but it is estimated to about 2-3 every 100,000 people on statins and the onset of symptoms is variable.

Case description

Mr. HR is a 50-year-old Hispanic male with a history of statin use who presented with a five month history of progressive weakness of upper and lower extremities.
He reported that 5 months prior to presentation, he was able to carry out Activities of Daily Living (ADL), however he became progressively weak to a point where he was not able to walk or lift heavy objects. He further reported functional incontinence, decreased appetite and weight loss. The patient denied any fever, chills, joint pain, dysphagia, skin rash or cold/heat intolerance. 
His medical history was significant for diabetes mellitus (Type II), essential hypertension and hyperlipidemia, for which he was initially treated with Lovastatin 40mg daily at night for over 5 years. Lovastatin was stopped 3 months prior to presentation as the patient was noted to have elevated creatinine phosphokinase (CPK) at the time.  His other home medications include Lantus 12 units at night, Lispro 4 units after meals, Hydrochlorothiazide 25mg daily and  Gabapentin 200mg three times a day. He denied smoking, drinking (however reported history of heavy drinking a year prior) or drug use. HR had no family history of autoimmune or neuromuscular disease. On physical examination, he had symmetric muscle weakness, with strength being 3 out of 5 in the upper extremities bilaterally and 2 out of 5 in the lower extremities bilaterally. His sensation, cranial nerves II-XII  and  deep tendon reflexes were grossly intact.   Laboratory studies showed a significantly elevated CPK level of  5733 IU/L (normal range: 30-223 IU/L), with normal TSH and ESR.  Anti-glutamic acid decarboxylase (GAD) antibodies, RNP antibodies, Scl-70 scleroderma antibodies, Rheumatoid factor and Acetylcholine Receptor antibody were negative.  Further, 3-hydoxy-3-methylglutaryl-coenzyme A reductase antibodies were detected at a level > 200 units (normal range: 0-19 units). Electromyography was performed on the right upper and lower extremity and demonstrated electrophysiological evidence of proximal myopathy along with a predominantly axonal sensory motor polyneuropathy. A muscle biopsy was subsequently performed on the left thigh and showed  areas of active myopathic changes with  focal necrosis and minimal perimysial lymphocytic infiltrate. 
The patient was then started on prednisone 60mg with little to no improvement. He was then discharged to a rehab facility with rheumatology follow up.

Discussion and Conclusion

In the early 1980s when statins were first introduced to the market, their side effects of myalgia/myopathy were not considered as common adverse effects.
Muscle-related problems and myopathies related to Statin use have been shown to present in a wide range of variety, from the common myalgias to the recently described necrotizing autoimmune myopathy (NAM). Little is known about this devastating form of autoimmune myopathy.  As such: presentation, response to therapy, and prognosis remain incompletely defined and the evidence base for best-practice treatment is lacking. With greater understanding of this condition, it may also be possible in the future to implement guidelines for physicians recommending measuring a baseline CPK level on patients prior to the ignition of statin therapy as an attempt to stratify an individual’s risk for developing this complication prior to exposure

  • Stroke Rehabilitation and Recovery
Speaker
Biography:

Professor Carolyn Unsworth received her BAppSci(OccTher) (Bachelor of Occupational Therapy) (1989) and PhD (1994) from La Trobe University Australia, and is a registered occupational therapist in the USA (OTR) since (1994).  Dr Unsworth is an internationally respected researcher and educator, having provided undergraduate and post-graduate seminars, lectures and courses in Australia, USA, UK, Sweden and Singaopre in her specialty areas of community transport mobility and driving, cognitive and perceptual problems following acquired brain damage, and evidence-based practice.  Carolyn is currently Professor of Occupational Therapy at Central Queensland University and holds Adjunct Professorial appointments at La Trobe University, Melbourne, Jönköping University, Sweden, and Curtin University in Perth, Australia.  She also held the position of Visiting Professor at London South Bank University for the term 2010- 2011.  

Abstract:

Background:  An occupational therapy fitness-to-drive assessment may be required to determine if drivers in the early stages of dementia can continue to drive. Such assessments could be better tailored for clients with dementia if we had research evidence to support the

Location of assessment (open or local area), method (self-directed or directed) and whether repeat testing is required (opportunity to undertake a second test), or which combination of these factors is best for drivers with, and without navigational difficulties.

Objectives: To determine the effect of location of assessment (open or local area) and practice (undertaking more than one assessment) on pass or fail outcome for drivers both with, and without navigational problems.

Methods: 43 clients (mean age 77 SD 6.69) participated in a stratified randomised controlled trial in which the ordering and location of on-road driving tests were also randomised.  Client driving assessment outcomes were recorded as pass, condition, or fail.  Data were analysed using a generalized linear mixed effects model.

Results: Overall 9 (21%) of drivers failed and 34 (79%) passed.   The 43 participants undertook a total of 93 on-road assessments and for clients with no navigational problems 20% failed the local and 33% failed the open route tests, as opposed to 58% (local) and 55% (open) for clients with navigational problems.  Overall, participants with navigational problems were 6 times more likely to fail the on-road test: B = -1.793 (95%CI -3.265 to- 0.321), p<0.01.  The OT-Drive Home Maze Test was a significant predictor of outcome on the on-road test, with slower times predictive of fail: B = -1.14, z = -2.219, p = 0.012.

Conclusions:  Therapists can be confident that driver performance when undertaking a test is not influenced by practice or location.  However, drivers with navigational problems are more likely to fail their on-road test.

  • Dementia

Session Introduction

Ivan Pradhana

University of Indonesia, Indonesia.

Title: People With Dementia Who Have Higher Global Cognitive Scores Tend to Have Higher Depression Scores

Time : 12:10 - 12:40

Speaker
Biography:

Ivan Pradhana is a 4th grade medical student in the University of Indonesia. With the help from his colleagues, Ficky Huang and Edelyne Chelsea, also from his research supervisor, Martina Wiwie, he conducted this research as a requirement for getting his bachelor degree on medicine. Before this research, Ivan collaborated with other researchers and successfully published a research with the title of Correlation of Behavioral and Psychological Symptoms of Dementia and Caregivers' Physical and Mental Health in the 20th Asia Pacific Regional Conference: Alzheimer’s Disease International 2017.

Abstract:

It is estimated that 30-50% of people with dementia (PWD) suffer from significant depression. This fact indicates that for most PWD, depression occurs at the same time as cognitive decline. Research explains that this happens because PWD cannot run their daily activities independently and they (tend to) forget many essential memoriethings[A1] , such as their family. It is also known that the risk of depression is higher for  highly educated people. This research was conducted with the intention to find the correlation between depression score and global cognitive score in 42 PWD using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Mini Mental State Examination (MMSE) to assess the symptoms of depression and the global cognitive score, respectively. PWD included in this research were only those who have an MMSE score between 17 and 23 (mild cognitive impairment), and an MADRS score below 34 (no depression, mild depression, and moderate depression). Mild depression occurred in 41 out of 42 subjects (97,6%) and the global cognitive score mean was 19,53; Therefore, d. Depression score is strongly co[A2] rrelated to the the global cognitive score (r=0,647, p<0,001). It is assumed that many PWD are aware of their declining cognitive ability often leading to insecurities because of their condition. Some PWD experienced apathy, loss of appetite, and sleep disturbance. Because of these discoveries, it was concluded that PWD who have higher global cognitive scores also have higher depression scores.


 [A1]Probably ganti pake ‘memories’ instead of things?

 [A2]If you found this as evidence because of what you found in the previous sentence, I would suggest you write "Therefore, depression score is strongly..."

 

  • Preventive Stroke Strategies

Session Introduction

Kalyan Sapkota

Bharatpur Hospital, Chitwan, Nepal.

Title: Correlation of carotid artery intima-media thickness in patients with ischemic stroke and its risk factors.

Time : 12:40 - 13:10

Speaker
Biography:

He has completed his bachelor’s degree in medicine and Surgery from manipal College of Medical Sciences in the year 2007. He has been served as a Deputy Medical Superintendent and a Medical Officer in Myagdi from 2009-2012. Later he is working as MD Resident in Neurology in NAMS, Bir Hospital, Nepal from the year 2012.

Abstract:

Background

Atherosclerotic changes of the carotid vessel frequently underlie carotid-related cerebrovascular ischemic events. Carotid intima-media thickness (IMT) is a validated measure of atherosclerosis burden. Increased C-IMT and atherosclerotic plaques are associated with the subsequent risk of new or recurrent stroke and myocardial infarction.

This study aims to find out the carotid IMT in ischemic stroke patient and its correlation with the severity of the stroke and various risk factors of the stroke like diabetes, hypertension, dyslipidemia, family history of ASCVD, smoking etc.

Methods

A cross sectional, hospital based study was carried out from March 2014 to February 2015 at Tertiary hospital, Kathmandu. Carotid IMT was measured by high-resolution B-mode ultrasound.

Results

A total of 62 patients with ischemic stroke were enrolled in this study. The age distribution varied from 41 to 85 years. Mean C-IMT on Right side was 1.1468 mm (SD 0.375), whereas mean CIMT on left side was 1.137 mm (SD 0.35). Majority 85.5 % had Mean IMT > 0.8 mm. 51.6% had IMT between 1-1.5 mm. Patient with single risk-factor had CIMT of 1.0526mm (SD 0.3), with no risk factors 0.0912 (SD 0.4) and with multiple risk factors had CIMT of 1.2628 (SD 0.404), the difference was statistically significant. Change in IMT on the ipsilateral side of the stroke with the IMT of the opposite side was significant (p value <0.05). This study found the significant association of CIMT with severity of clinical presentation and presence of one or more risk factors, strong correlation was seen with hypertension, diabetes, dyslipidemia, raised total cholesterol and high LDL cholesterol.

Conclusion

Our study reveals the importance of carotid IMT evaluation at the patients with atherosclerotic risk factors and suggests a predictive role of increased carotid IMT for ischemic stroke with severe clinical presentation and presence of other risk factors. 

  • Stroke and Mental Health

Session Introduction

Dr. Muhammad Shabbir

Khyber Teaching Hospital , Pakistan.

Title: Prophylaxis against deep venous thrombosis in stroke patients; really required?

Time : 14:10 - 14:40

Speaker
Biography:

He is working as a Registrar in Department of Medicine, Medical  B Ward, Khyber Teaching Hospital, Peshawar- Pakistan.

Abstract:

Introduction

Deep vein thrombosis is one of the complication in stroke patients. They are at high risk of deep vein thrombosis (DVT) because of immobility and increased prothrombotic activity. Depending on the diagnostic methods, DVT occurs in up to 80% of patients with ischemic stroke not receiving prophylactic therapy most often between days 2 and 7 after stroke onset; almost 80% of all DVTs occur within the first 10 days. DVT prevalence in Asian patients is much lower than other ethnic groups while prophylaxis through heparinization is sometimes associated with significant intracranial bleeds. The prevalence rate of DVT in hospitalized medically ill patients found at a Thai tertiary care hospital was only 5%.

Materials and methods

This study was conducted in Department of Medicine in collaboration with department of radiology at Khyber Teaching Hospital Peshawar from Jan 2016 to December 2016. Incidence of deep venous thrombosis was measured in ischemic stroke patients. All patients with ischemic stroke not receiving prophylactic heparin underwent Doppler studies of the lower limbs at day seven of stroke onset to look for development of any deep venous thrombosis.

Results

Out of 114 stroke patients only one (0.88%) developed clinically significant deep venous thrombosis.

Conclusion

The incidence of DVT in stroke patients in Asian population is much lower to justify prophylactic heparin which has significant adverse clinical implications in the form of intracranial bleed as well as financial burden on patients in resource limited countries like Pakistan.

Speaker
Biography:

He is working as research assistant in Department of Internal Medicine, Shaanxi Normal University Hospital, China.

Abstract:

Accumulating evidence indicates that telomere length, a reliable biomarker of genomic instability, is associated with increased risk of vascular diseases. However, to date, studies of association between stroke risk and relative telomere length (RTL) have demonstrated with inconsistent results. RTL of leukocytes from 300 stroke cases and 300 healthy controls in a Chinese Han population was measured using a quantitative PCR-based method in a case-control study. An unconditional multivariate regression analysis adjusted for age and sex was performed. The results indicate that stroke patients have notably shorter median RTL than healthy controls (0.4631 vs 0.7663;P<0.001). After adjusting for age and sex, multivariate logistic regression analysis showed that there was a linear association between RTL and stroke patients (P<0001). Compared with individuals in the first tertile of RTL, the odds ratios (ORs) and its 95% confidence intervals (CIs) for participants in the second and third tertiles were16.267(7.716-34.292) and 30.631(14.271-65.746), respectively. Stratified analysis showed that age and sex had no impact on the association between RTL and stroke risk except for a P value(P <0.101) in the female participants. Our study confirms that shorter RTL is associated with an increased risk of stroke in a Chinese Han population.

Speaker
Biography:

Mr Kiyemba ronald DOB, 07-02-1979 in Uganda Kampala. Coach for Uganda cycling national teams, holding a degree in sports science. President, KITANDA CARE for HIV/Aids & UTI infections control Owner of, Bike 2 Bike tours (U) LTD

Abstract:

Substance abuse is popular on the increase in our low income setting today for various reasons and is associated with poverty as a major risk factor.

In Uganda mental illness has become common in sports and is often associated with substance enhancement from alcohol and marijuana intake. Some of the factors that have promoted this rise include physical pain, chronic injuries and pressure to produce results. The overall effect of this problem has led to addiction, low productivity, social dissociation and finally failure to perform in sports.

We reviewed articles and references of related topics finding those relevant to the scope of the subject.

Objectively closed-ended questioners were given to 380 sports participants chosen from 12 sports centers (Pilot) areas under random distribution in 4 different regional urban setting in Uganda.

They were assessed on modified additional and productivity scalesNorthern region n=60 12 normal 48(80%) Addiction low productivity 0.83(83.3%), Eastern region n=100 20 normal subjects, Addiction 40(40%) low productivity 47(47%). Western region n=90 Addiction 23(25.5%) low productivity 52 (57.7%)Central region n=130 Addiction 68(52.3%) low productivity 39(30%)

Conclusion: Urban region e.g. Central have highest rates of Addiction with low productivity due availability of drugs and cheap alcohol/spirits on the market. Restrictions on alcohol is not observed within the local communities in the rural regions Sports men have highest low productivity due to poor social support, unemployment and no formal infrastructure.