International Conference on
Obesity & Gynecology

Theme : Current Trends and Concepts in Obesity and Gynecology

Scientific Program Day 1 - Jul 23, 2018

Kindly submit your abstract in detail about the topic that you are going to present in this Conference in about 300 to 400 words. Besides the abstract, add briefly about yourself, your profession, your experience, your skills, your publications, your talks, your presentations, and any other info which you find relevant to this conference. Kindly download the Submission Form. Fill it up and send it to us. After your abstract is accepted at our end the registration process begins.  

Keynote 1

Ran Neiger

Wright State University ,USA

Title: Obesity, Gestational Diabetes and its Long-Term Effects on Maternal Health

Time : 10:10 - 10:50

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Biography:

Ran Neiger received his medical degree at Ben-Gurion University, Israel. He completed an ob/gyn residency at Memorial Medical Center, Savannah, Georgia and his Maternal-Fetal Medicine Fellowship at Brown University. Between 1991-2002 he worked as a Maternal-Fetal Medicine Specialist at the University of Tennessee Medical Center in Knoxville, Tennessee, where he achieved the rank of tenured professor and was head of Obstetric and Perinatal services as well as Director of the Division of Maternal-Fetal Services. He was also the Director of the residency program. Ran Neiger Joined Perinatal Partners in Dayton in 2002. In 2007 he left for Israel where he served as the Director of the Division of Maternal-Fetal Medicine at a large hospital in Tel-Aviv. He returned to Dayton in 2017. He is board certified in both OB/GYN and Maternal-Fetal Medicine.

Abstract:

Most pregnancy-related medical complications appear to resolve at delivery or shortly thereafter. Common examples are preterm labor, placental abruption, preeclampsia, and gestational diabetes. Women who developed such complications are known to be at increased risk of developing similar complications in future pregnancies. It has recently become evident that these women are at an increased risk of long term medical complications. There is a clear association between various obstetrics complications and long-term effects on maternal health: women with a history of adverse pregnancy outcomes are at increased risk of cardiovascular and metabolic diseases later in life. Data increasingly links maternal vascular, metabolic, and inflammatory complications of pregnancy with an increased risk of vascular disease in later life.

There is a clear association between the growing rate of obesity and the increased rate of gestational diabetes (GDM). After delivery, when women with history of GDM undergo the 75 gram GTT at 6–12 weeks postpartum, 2%–16% are diagnosed with type 2 diabetes (DM) and 36% are found to have intolerance to carbohydrates. Women who had prior GDM have a 36-70% risk of developing type 2 DM later in life, depending on risk factors and length of follow-up. It is important for women who had GDM to have appropriate follow-up since, over time, often before patients are diagnosed; DM causes damage to various organs (heart, blood vessels, kidneys, eyes, nerves, etc.) Despite the deceptively benign term, even pre-diabetes, defined as “intolerance to carbohydrates”, is associated with significant morbidity. The authors of a meta-analysis that included 15 prospective studies with 760,925 participants reported that pre-diabetes were associated with an increased risk of stroke. Another meta-analysis of prospective cohort studies to evaluate the associations between pre-diabetes and the risk of cardiovascular disease that included 53 prospective cohort studies with 1,611,339 individuals showed that compared with normo-glycaemia, pre-diabetes was associated with an increased risk of composite cardiovascular disease and stroke. Follow-up of women who had GDM enables preventive measures and early diagnosis; early detection of DM decreases the risk of complications.

Keynote 2
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Biography:

Titilayo Oluyomi-Obi completed her Obstetrics and Gynecology training at the University of Toronto, Canada and completed her Maternal Fetal Medicine training at the University of Manitoba, Canada. She is currently a Maternal Fetal Medicine specialist at the University of Calgary, Calgary with research interest in Prognostication in Congenital Diaphragmatic Hernia, Intrauterine Growth Restriction and other fetal anomalies.

Abstract:

Background: In a day when antenatal and postnatal care for CDH is rapidly advancing, with new options for care available prenatally and postnatally, it is incumbent on prenatal providers to appropriately prognosticate with the resources available to them.

Methods: Search was conducted in MEDLINE, EMBASE, Cochrane Database of Systematic reviews, PubMed, Scopus and Web of Science on the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e LHR), total fetal lung volume (TFLV), o/e TFLV, percentage predicted lung volume (PPLV) and degree of liver herniation to predict neonatal morbidity and mortality in fetuses with CDH. Primary outcome was perinatal survival and secondary was the use of extracorporeal membrane oxygenation (ECMO).

Results: Our review showed that the odds of survival with LHR <1.0 and liver herniation on ultrasound were 0.14 (CI 0.10–0.27) and 0.21 (CI0.13–0.35) respectively. Mean LHR, o/e LHR, absolute TFLV, o/e TFLV, PPLV and liver herniation all predicted survival, however o/e LHR and o/e TFLV performed best in this prediction. When the longest diameter measurement method was used, the o/e TFLV (summary area under curve (AUC) 0.8)was slightly superior to o/e LHR (summary AUC 0.78). This difference disappeared when LHR was measured by the trace method. The most discriminatory threshold for O/E LHR and O/E TFLV was 25%. LHR b1 was predictive of extracorporeal life support (ECLS) use.

Conclusion: O/E LHR, o/e TFLV (thresholds of 25%) and liver herniation are good predictors of mortality in CDH.

Objectives of talk: We will be talking about the various options for antenatal prognostication in left and right CDH by different imaging modalities. We will also discuss how these parameters are useful for determining appropriateness for fetal procedures (like fetal tracheal occlusion).At the end of the talk, we hope the audience will understand the most studied ultrasound and magnetic resonance parameters used to prognosticate in CDH prenatally.

Keynote 3

Jing Song

Albert Einstein College of Medicine ,USA

Title: Obesity and Post Dural Puncture Headache

Time : 11:45 - 12:25

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Biography:

Jing Song is a certified anesthesiologist, associate professor and Director of Research & Clinical Fellow Program in Einstein School of Medicine. She graduated from Shanghai Jiao Tong University School of Medicine in China and received resident training in Montefiore Medical Center/ Albert Einstein College of Medicine.  She was a visiting research scientist of Vanderbilt University and a visiting professor in Wen Zhao Medical Schools in China. She has served in multiple NYSSA committees. She has many publications in reputed journals and has been appointed as editors for multiple anesthesia and medical Journals.

Abstract:

Most authors agree that obesity increases the risk of obstetric complications that lead to a higher maternal and fetal morbidity.  However, previous studies have suggested an inverse relationship between obesity and the development of dural puncture headaches following a spinal anesthetic. However, few have investigated the relationship between obesity and headaches after accidental dural puncture with an epidural needle. This study explored whether obesity has any association with headaches following an accidental dural puncture.
Records of patients who received epidural analgesia for labor and vaginal delivery between January 2011 and June 2015 were reviewed. The body mass index, American Society of Anesthesiologists Physical Status and age were analyzed. Chi-square analysis was performed to determine the relationship between the incidence and severity of dural puncture headaches with body mass index.

17,497 epidurals were placed for vaginal deliveries. 164 patients met our criteria for accidental dural puncture, of whom 51.24% developed dural puncture headaches. 35.71% of patients with dural puncture headaches required epidural blood patch treatment. Data analysis showed no significant difference between body mass index and incidence of dural puncture headaches regardless of the body mass index classification (P>0.05). There was no association between body mass index and the intensity of dural puncture headaches (P= 0.291).
Our conclusion indicates that patients with a high body mass index do not appear to be protected from experiencing a dural puncture headache after having an accidental dural puncture during placement of epidural analgesia in vaginal delivery. Additionally, the intensity of dural puncture headaches does not vary with BMI.

Sessions

Selected Lectures
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Biography:

Paulina Van is a full Professor at Samuel Merritt University, School of Nursing. In prior years, she held full time faculty or administrative positions in the Schools of Nursing at the University of San Francisco (USF), California State University-East Bay, and the University of California, San Francisco (UCSF), teaching at the doctoral, masters, and baccalaureate levels. Dr. Van was awarded a Postdoctoral Fellowship from the University of California, San Francisco, earned her degree as Doctor of Philosophy in Nursing and Master’s Degree in Nursing Administration from UCSF and graduated with a Baccalaureate degree in Nursing from USF. Her interest in obesity and weight management research began in 2015, while serving as committee chair for her former doctoral student, Dr. Riopelle (first author). Dissemination of this award winning research has been successful in publications and international conference presentations in 2017

Abstract:

Objective: The purpose of this study was to examine factors related to of grief intensity after pregnancy loss (i.e., miscarriage, ectopic pregnancy, or fetal death) among a cross-section of African American women. The results are components of a larger study in which the grief and coping experiences of African American women following pregnancy loss were examined using both quantitative and qualitative analysis. 
Methods: Eighty-six adult African American women with a self-reported history of involuntary pregnancy loss were recruited using a variety of culturally sensitive methods. The women completed three instruments: the Perinatal Grief Scale-Short Form (PGS-S), the Women’s Role Integration Protocol (WRIP), and a personal profile tool designed specifically for the study. Pearson correlations were computed using pairwise deletion. Four models were tested using hierarchical multiple regression.
Results: The level of role integration and age of participant factors were recurring predictors of the various dimensions grief as measured by the Perinatal Grief Scale-Short form (PGS-S). 
Conclusion: Being older and experiencing more satisfaction than stress in major roles contributed to less grief intensity after pregnancy loss. This is the first published study exploring factors that impact the grief experiences of a predominately African American sample of women after pregnancy loss. These results will be compared to results from similar studies conducted by the first author with Asian American and European American women. We propose that women with pregnancy loss history be assessed for residual grieving across their life span.  Future explorations should address two main areas:  specific interpersonal relations that facilitate grief management and the partners’ experiences after pregnancy loss

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Biography:

Suellen Serafini has completed her MSc. at the age of 34 years from Universidade de Sao Paulo. She is biologist at the medical research laboratory in pediatric surgery in Universidade de Sao Paulo, since 2010. She has 6 papers in reputed journals.

Abstract:

Background: Hematoxylin-eosin (HE) staining of a full-thickness rectal wall fragment is classically used for the diagnosis of Hirschsprung disease (HD). However, this technique requires large fragments for a better diagnosis. Additionally, the histochemical and immunohistochemical methods of staining small fragments of rectal mucosal and submucosal biopsies are not available in all centers. Therefore, the possibility of diagnosing HD through HE staining in these biopsies could be a valuable alternative for centers that do not have more specific techniques. The objectives of the current investigation were to evaluate the concordance of the results obtained by HE staining and the calretinin method with acetylcholinesterase (AChE) activity in fragments of mucosa and submucosa in the diagnosis of HD.
Methods: For this study, 50 cases from our laboratory were selected. The tissue material was embedded in paraffin. Sixty levels of each fragment were utilized for HE, and the other 3 levels were used for calretinin. These slides were analyzed under the microscope, photographed and classified as either positive for HD when no ganglion cells were found with nerve trunks present or as negative when ganglion cells were found. The results from reading the slides were compared with those of AChE.
Results: Of the 50 cases evaluated by the HE technique, only 5 contradicted the diagnosis based on AChE, with a Kappa value of 0.800 and an accuracy of 90%. In the comparison between calretinin and AChE, 8 cases were discordant, with a Kappa value of 0.676 and an accuracy of 84%.
Conclusions: The concordance of results from AChE and HE methods was satisfactory, allowing for the potential use of the HE method for fragments of mucosa and submucosa as a valid alternative in the diagnosis of HD. The immunohistochemical technique of calretinin did not show good agreement with the AChE activity in our study.

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Biography:

Luminita Cima was born in Constanta on 16th July 1982. She graduated from the Faculty of Medicine, Ovidius University, Constanta in 2007 and performed her residency in Endocrinology at Elias University Hospital in Bucharest. She became a specialist in Endocrinology in 2014 and recently finished her PhD. Her PhD topic was endocrine complications following pediatric hematopoietic stem cell transplantation. Since 2016 she is an Assistant Professor in Endocrinology at Carol Davila University of Medicine and Pharmacy in Bucharest, Romania. Her clinical and research interests are on pediatric endocrinology, endocrine complications in onco-hematological diseases and onco-fertility. She has published several articles in peer-reviewed journals and presented more than 40 papers (posters/oral communications) at national/international conferences. She is a Member of several societies, including Romanian Society of Endocrinology and Neuroendocrinology, European Society of Endocrinology, European Young Endocrine Scientists’ Society, European Society of Human Reproduction and Embriology and Romanian College of Physicians.

Abstract:

The number of hematopoietic stem cell transplantation (HSCT) recipients is steadily increasing as a result of advances in treatment modalities and supportive care. A high prevalence of long-term endocrine complications has been recognized in these patients with a negative effect on quality of life (QoL). Gonadal insufficiency and subsequent infertility are frequent problems that long-term HSCT survivors and their partners face. Different strategies for gonadal protection and fertility preservation have been employed in order to improve QoL in HSCT recipients. Among them, medical therapy with gonadotropin-releasing hormone agonist (GnRHa) before / in parallel with conditioning chemotherapy is one of the simplest method to preserve normal ovarian function and possibly future fertility in pubertal girls / premenopausal women who undergo HSCT. Its role has been well established in cancer patients treated with standard chemotherapy, but the potential preservation of ovarian function and fertility by using GnRHa in HSCT recipients is still a subject of debate. In this lecture we’ll address the current data available and discuss the opportunity of giving GnRHa along with conditioning chemotherapy in adolescents and young women undergoing HSCT.

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Biography:

Takuya Kajisa has completed his PhD from Juntendo University and postdoctoral work at the same facility. Currently, he is Non-Full-time-Assistant Professor at Juntendo University. 

Abstract:

Atopic dermatitis (AD) is a chronic condition that causes red, itchy, dry skin affecting 5%-20% of children worldwide. Several factors including inflammation, oxidative stress, genetic background, as well as environmental factors contribute to disease pathology. Current treatment depends on the severity of the disease and involves rehydrating the skin with moisturizers to application of topical steroids. Recently, hydrogen water (HW) has been reported to alleviate oxidative stress and has shown therapeutic potential for several pathological conditions including AD. We wanted to further elucidate the mechanisms underlying the therapeutic effect of HW on AD severity and to understand how HW affects mast cell infiltration, cytokine abundance and expression of thymus and activation-regulated chemokine (TARC) and of aquaporin (AQP)-3. We therefore studied the effect of ad libitum HW or purified water (PW) on NC/Nga mice that exhibit spontaneous dermatitis on the face and neck. Specific-pathogen-free (SPF) mice were also included as a control. AD severity scores were examined at baseline (0 week) and after 4 weeks. Cytokine, TARC, and AQP-3 gene expressions in skin and transepidermal water loss (TEWL) were estimated in all groups. AD severity scores were higher at 4 weeks after PW treatment while they decreased from 3.4 ± 0.2 to 2.6 ± 0.3 (p<0.05) after HW treatment. Serum TARC level decreased from 73.3 ± 27.9 pg/mL to 53.2 ± 18.3 pg/mL (p<0.05). TEWL decreased significantly with both PW and HW treatment, however, the decrease was significantly enhanced after HW treatment. Further, a significantly higher number of infiltrating mast cells was noted in PW group than the HW group. At the AD lesion site, interleukin (IL)-1β and of IL-33 levels were significantly lower after HW treatment than PW treatment, however, interferon-? levels, AQP-3 and TARC gene expressions were not significantly altered by HW treatment. We can therefore conclude that HW suppresses IL-33 and IL-1β and reduces mast cell infiltration and has therapeutic potential in ameliorating AD severity.

Einat Shalom-Paz

Hillel Yafe Medical Center , Israel

Title: Reproductive Issues in obese patients and after bariatric surgery

Time : 15:15 - 15:45

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Biography:

Einat Shalom-Paz is a clinical Assistant Professor in Obstetrics and Gynecology at the Rappaport School of Medicine, Technion- Israel  Institute of Technology, Haifa, Israel. She is the Medical Director of the IVF Program. After completing her residency in Obstetrics and Gynecology she did a Fellowship in the sub-specialty of Reproductive Endocrinology and Infertility at the prestigious McGill university, Montreal, Canada and graduated with excellence her fellowship, certified by the Royal College.. After completing her requirements to the fellowship she continued as a senior attending physician in the McGill clinic. She is a member of several International Fertility societies such as ASRM, ESHRE, ISMAAR.

Abstract:

Obesity is a worldwide epidemic which increases dramatically around the world. Obesity contributes to the development of chronic diseases such as hypertension and metabolic diseases like type 2 diabetes mellitus, and dyslipidemia. The prevalence of health related disorders among obese patients is about 60%.

The correlation between obesity and infertility is well established, it is associated with anovulation, adverse pregnancy outcome and it is detrimental of IVF outcome. Low pregnancy rates and increased early pregnancy loss are often indicative of abnormalities in the embryo. These very earliest stages of embryo growth are primarily controlled by the quality of the oocyte.

A modest weight reduction of ~10% may reduce the risk of developing co-morbidities and improve infertility.

Lifestyle interventions is the initial approach recommended. If lifestyle changes are not sufficient, then medications are indicated in order to reach the therapeutic goals for each disease. Bariatric surgery is the most effective long-term treatment of severe obesity and overcoming metabolic syndrome.

The use of bariatric surgery for treating severe obesity has increased dramatically over the past 10 years; about 83% of patients who undergo these procedures are women of reproductive age. Pregnancy after bariatric surgery is associated with reduced risk for gestational complication and may improve pregnancy outcome.

Yu Ding

Nanjing Medical University , China

Title: The role of mitochondrial dysfunction in PCOS-IR

Time : 15:45 - 16:15

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Biography:

Yu Ding has completed his master of science at the age of 26 years from Wenzhou Medical University. He is now working at Central laboratory of Hangzhou First People’s Hospital, Nanjing Medical University. He has published more than 10 papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Polycystic ovary syndrome (PCOS) is a very common endocrine disorder affecting women at reproductive age. Insulin resistance (IR), the central component of this disease, occurred more than 30~40% of women with PCOS. To date, the molecular mechanism underlying PCOS-IR remains largely unknown. Most recently, increasing evidence showed that mitochondrial dysfunction caused by mtDNA pathogenic mutations is the important cause for PCOS-IR. For this purpose, we initiated a mutational screening for mt-tRNA genes in 80 patients with PCOS-IR and 50 controls. After PCR amplification and direct sequencing, we identified 9 potential pathogenic mt-tRNA mutations: tRNALeu(UUR) A3302G and C3275A, tRNAGln T4363C and T4395C, tRNASer(UCN) C7492T, tRNAAsp A7543G, tRNALys A8343G, tRNAArg T10454C and tRNAGlu A14693G. We noticed that these mutations were localized at the highly conserved nucleotides of the corresponding tRNAs and may cause the failure in mt-tRNA metabolism. Biochemical analysis showed that a lower level of ATP, mitochondrial membrane potential and mtDNA copy number were observed in PCOS-IR patients carrying these tRNA mutations when compared with the controls, suggesting that these mt-tRNA mutations may cause the mitochondrial dysfunction that was responsible for the clinical phenotype. Taken together, our data indicated that mt-tRNAs were the hot spots for pathogenic mutations associated with PCOS-IR. Thus, our study provided novel insight into the molecular pathogenesis of PCOS-IR that was manifestated by mitochondrial dysfunction.

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Biography:

Loan Minh Do is a Pediatrician at Vietnam National Children’s Hospital and Head of Direction of Healthcare Activities Department. She received her Doctor's degree (Ph.D.) at University of Gothenburg, Sweden.

Abstract:

Childhood overweight and obesity is considered a global epidemic. From being a health problem mainly in high-income countries, it is now an emerging problem in low- and middle-income parts of the world as well. In the past ten years, the Vietnamese economy has grown rather quickly leading to changes in diet pattern and lifestyles among the young generation. These have resulted in rising problems of overweight. A project aimed to estimate prevalences of overweight and obesity for Vietnamese preschool children and to identify risk factors. A cross-sectional study was conducted in urban Dong Da and rural Ba Vi districts, Hanoi, Vietnam. Totally, 2,677 children, 1,364 urban and 1,313 rural were weighed and measured. Caregivers were interviewed. Digital Tanita scales and mobile measurement instruments were used to measure the children in their homes. The WHO standard was used to classify children as overweight or obese.  

Results: The prevalence of overweight and obesity combined were 21.1% (95% CI 18.9-23.3) in the urban area and 7.6% (95% CI 6.2-9.2) in the rural. In both sites, the risk increased with increased child age. The identified urban risk factors were being a boy, consuming large amounts of food, eating fast, and physical activity less than 2 hours per day. The rural risk factors were frequent consumption of fatty food and frequent watching food advertisements on television.

Conclusions: Prevention programs should focus on education about healthy eating habits and need to be tailored separately for urban and rural areas. Non-healthy food advertisement needs to be restricted.

Paola Ciriaco

Scientific Institute and University Vita-Salute H San Raffaele , Italy

Title: Multidisciplinary Approach of Catamenial and Endometriosis-related Pneumothorax

Time : 17:00 - 17:30

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Biography:

Paolo Ciriaco became specialist in Thoracic Surgery in 1993 at the University of Rome “La Sapienza” completing her PhD at the “University of Modena and Reggio Emilia” in 2000. During her education she spent time as “visiting resident” and “visiting instructor” at the Bromptom Hospital in London, the Mayo Clinic in Rochester and the University of North Carolina at Chapel Hill. She authorized more than 60 papers and book-chapters in reputed journals and she is reviewer for different journals. She is contract professor at the University Vita-Salute San Raffaele and RUF at the Department of Thoracic Surgery Ospedale San Raffaele.

Abstract:

Background: Catamenial pneumothorax (CP) is the most clinical presentation of the thoracic endometriosis syndrome (TES). We report our experience in the field, in cooperation with the gynecologists, in terms of diagnosis, treatment and outcome.

Methods: From 2001 to 2017, 25 women were surgically treated for CP at our Department. Surgery consisted of videothoracoscopy and combined laparoscopy in case of diagnosed and/or suspected pelvic endometriosis. Lung bullectomy was performed when required. Endometrial implants were resected when present and diaphragm was repaired in case of fenestrations. Talc pleurodesis was given when diaphragmatic defects were detected. Postoperative hormonal treatment was offered to all patients.

Results: TES was diagnosed in eleven patients (44%). Six of them underwent simultaneous videothoracoscopy and laparoscopy. Diaphragmatic defects were observed in 18 patients with eight of them presenting endometrial implants. One patient presented endometrial tissue in the resected bulla. Postoperative complications consisted in one prolonged air leak (4.3%). After surgery three patients were put on estrogen-progesterone complex treatment and 22 received gonadotropin-releasing hormone agonist. Pneumothorax recurrence occurred in five patients (20%) and was significantly correlated with estrogen-progesterone treatment (p<0.005). The mean follow-up was 94±61 months (range 2-190). Additional surgery for intestinal occlusion due to localization of endometriosis and umbilical endometriosis, was needed in three patients. At the present time all women are well with no sign of pneumothorax recurrence.

Conclusions: All women with CP should be investigated for endometriosis. Thoracic and abdominal surgery along with hormonal treatment helps for resolution of TES.  A close collaboration between thoracic surgeons and gynecologists is therefore advocated.