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Hospital Clinica Kennedy , Ecuador
Time : 10:00 - 10:30
Fernando Antonio Aguirre Palacios has completed his Doctoral career at the age of 27 years from Catholic University and postdoctoral studies at Hospital National Marquez de Valdecilla in Spain. He got his Master of Science degree in the University of Guayaquil, and he is the leader of the Primary prevention program to reduce cardiovascular disease in Guayaquil, with the support of the Ecuadorian Society of Cardiology. He has published many papers in reputed journals and has been serving as an editorial board member of the European Society of Cardiol
This is a study in children in Guayaquil-Ecuador, carried out in order to validate the indicator waist/height, with the metabolic syndrome (MS). We hypothesized The w/h index > 0.50, pre-hypertension, and sedentary lifestyle are 3 pre-monitors of MS, provided that the children have reached the Tanner V stage of their sexual maturity. 395 students from 10 to 15 years old, apparently healthy, from a densely populated and middle class area, were included. The physical examination and laboratory tests where done in search of the SM (Triglycerides, HDL Col, Glycaemia, abdominal perimeter, and blood pressure) 3 blood pressure measurements were performed, and the BMI was calculated, the w/h indicator, and plasmatic values of Insulin, HOMA, hs PCR and Interleukin 6 were included. The MS was defined according to NCEP ATP III criteria, modified by De Ferranti. The average age was 12 years. The prevalence of MS was 9.37%; The relationship of the w/h indicator with pre-hypertension and sedentary lifestyle was statistically significant with a P value of 0.001 and 0.003. In children with normal weight, w/h Index < 0.50, there where no risk for MS, but with w/h > 0.50 a risk of 2.2 times. In children with overweight and w/h < 0.50 the risk of MS was 0, while with an I w/h > 0.50 the risk was 9.15 %. The use of the w/h I is 100% sensitive for the MS in children aged 10 to 15 years. The w/h indicator is a simple tool, together with pre-hypertension and sedentary lifestyle, are high-sensitivity pre-monitors to predict Metabolic Syndrome.
Université Protestante au Congo , Democratic Republic of Congo
Time : 10:30 - 11:00
Patrick Ntontolo has completed his Master in Family Mecicine at the age of 41 years from the Université Protestante au Congo, DRC. He is one of the Facilitators of Family Medicine Program in the same University. So far, he has published one paper in the African Journal of Primary Health Care and Family Medicine, and is currently serving as a reviewer in many reputed journals.
Background: Diabetes mellitus is a worldwide increasing health problem of which type 2 diabetes is the most prevalent. Previously considered as a problem of industrialised countries, diabetes is currently a huge concern in developing countries and the Democratic Republic of the Congo (DRC) is one of the sub-Saharan countries with a high prevalence rate of diabetes. Deficit of knowledge has already been shown to be one of the barriers preventing diabetic patients from controlling their disease.
Objectives: This study aimed to assess the knowledge of type 2 diabetic patients seen at the Institut Médical Evangélique (IME) Kimpese Hospital diabetic clinic, DRC, and the factors associated with their knowledge.
Methods: A cross-sectional study involving 184 respondents was conducted at the diabetic clinic of the IME Kimpese Hospital, DRC. We administered a pre-tested questionnaire. Out of a total of 10, scores of < 5, 5 to < 7, and ≥ 7 were classified as ‘poor knowledge’, ‘moderate knowledge’ and ‘good knowledge’, respectively, according to expert consensus. All statistical tests were performed using p < 0.05 as the level of statistical significance.
Results: The mean age of respondents was 57.5 years (s.d. ± 1.4, ranging from 40 to 83 years) with 56% being male. The mean diabetes knowledge score was poor: 3.2 out of a total of 10 (s.d. ± 1.7), with the range between 0.2 and 7.7. The majority of respondents (72.3%) had poor general knowledge about diabetes mellitus. Respondents also scored poorly in areas of the causes (35.6%), risk factors (39.3%), clinical features (34.9%), complications (20.5%) and management (42.4%) of diabetes mellitus. Using the student t-test analysis, it was found that age (p = 0.001), gender (p = 0.002), educational level (p = 0.007) and duration of disease (p = 0.032) were significantly associated with poor knowledge of diabetes mellitus.
Conclusions: Knowledge of diabetes mellitus among type 2 diabetic patients seen at our setting was poor. Areas of deficiency and factors associated with knowledge of diabetes were identified. Our findings suggest the need for a health education intervention programme for our diabetic patients.
Centro De Atención Primaria Malgrat- Palafolls , Spain
Time : 11:00 - 11:30
Introduction: Multiple patients are affected by various health alteration conditions that make it impossible to calculate the body mass index (BMI). For this reason it is our purpose, the development of a mathematical tool that allows the approximate calculation, from the brachial circumference (CB), for diagnosis and follow-up. The proposed formula (FCBC) for both sexes is: (CB in cm x 30) / 32.
Results> = 28 must be added 2 points.
Material and methods: Prospective, descriptive study, with observations made in primary care consultation, including 224 men and 248 women; weight, height, CB, and BMI were calculated by Quetelet's formula and the proposal.
Results: N = 472 patients. In men, BMI (CI = 0.63), while BCF (CI = 0.49), p = 0.95, while in women BMI (CI = 0.73), FCBC (CI = 0.56 ), p = 0.95. The relative risk (RR) calculation, BMI = 0.688; CI = 0.377. FCBC RR = 0.6484; CI = 0.377; X2 = 4.64; p = 0.99. The
numerical ratio showed r = 0.82, R 2 = 0.67, p = <0.005. In percentages, 80.3% of the men, (p = 0.01) obtained results between 90 and 110%, in women it was 85.8%, (p = 0.0001). The median comparison, obtained a Wilcoxon p = 0.83.
According to diagnostic criteria of the World Health Organization (Obesity, overweight, normal and malnutrition) in both sexes, a p = 0.95 was obtained.
Conclusions: The proposed formula has values with no significant difference in its results, with respect to Quetelet, being applicable in patients with special condition due to physical limitations for the measurement of weight and height for the calculation of BMI and therefore not only for the classification of patients, but also for the evolutionary follow-up, elements both of great importance for the control of patients, who with such limitation need a strict control of their state of nutrition.
Royal College of Physicians , UK
Time : 13:45 - 14:15
Graeme Williams is a Physician, Scientist, Molecular Endocrinologist, (Molecular and Cellular Medicine Group, University of Reading, UK) and Harvard Clinical Research Scholar, (Royal College of Physicians (London)/UCL). His Research interest lies in studying the role of aromatase, GPER, cortisol, poor carbohydrate dietary choices and chemical exposures, upon the pathogenesis of obesity, NAFLD, insulin resistance, type two diabetes, breast and prostate cancer, and sexual dysfunction in men and women.
Background: For some years now, reduced testosterone levels have been related to obesity, insulin resistance, type 2 diabetes, heart disease and prostate disease – often considered guilty more by association, than actual cause – with little attention paid to the important role of increased intracellular estradiol biosynthesis, in the pathogenesis of these chronic diseases.
Methods: Bioinformatic and clinical investigations were performed on the effects of poor dietary habits (insulin), stress (cortisol), and exposure to endocrine-active chemicals, in the final stage of the steroidogenic cascade, where testosterone is metabolized to estradiol by P450 aromatase in the cytoplasm of adipocytes, breast cells, endothelial cells and prostate cells, to increase intracellular estradiol concentration at the expense of testosterone.
Results: The up-regulation of aromatase produces increased intracellular estradiol, increases ER-activation and increases GPER activation in combination with insulin receptor dysfunction, to cause aberrant downstream transduction signaling, and induce metabolic syndrome.
This presentation simplifies - how stress, poor dietary choices and chemical exposures increase intracellular estradiol production; how estradiol in combination with leptin and poor dietary choices, increase intrahepatic lipid deposition and induce insulin resistance; and how excess ineffective insulin and EDCs stimulate rapid, non-genomic G protein-coupled phosphorylation cascades, that increase liver and visceral fat deposition and create the vasoconstrictive, dyslipidemic features of metabolic syndrome and induce aberrant growth disorders in estrogen-sensitive tissues.
Conclusion: To understand, that raised intracellular estradiol levels in men, and carbohydrate excess induce obesity, Non-alcoholic fatty liver disease, metabolic syndrome, gynecomastia, erectile dysfunction, type two diabetes, and prostate disease, rather than low testosterone, represents a shift in medical thinking, a new awareness in the understanding of the mechanistic pathogenesis of metabesity.
Medical University of Havana , Cuba
Time : 14:45 - 15:15
Introduction: A lot has been researched about low birth weight, but very few about high birth weight as if it is a predictive factor of the so called arteriosclerotic risk factors or not, some research has been done about obesity by the British, but in adults.
It is stated that this arteriosclerotic accelerators (risk factors), such as obesity, diabetes, arterial hypertension, dyslipidemia, among others, can be found in the adult population, however this is not fully true, as they can be found in early ages, as childhood and we think such problem is not on itself caused by low or high weight among others, but to the invective undergone at fertile ages in women as well as in the pre-natal, per-natal, and post-natal stages, ignoring the prevalence of arteriosclerotic factors.
The process of arteriosclerosis starts at early ages and is tightly with plasmatic lipids, specifically with an increase in the values of low density lipoproteins (LDL), increase in very low density lipoproteins (VLDL) and decrease in the levels of high density lipoproteins (HDL).
Objective: Identify if high birth weight (macrosomia) represents a predictive value of dyslipidemia and other arteriosclerotic accelerators, such as diabetes, obesity, arterial hypertension.
Method: A descriptive study was carried out with a control case type design that included groups of children: one of 140 children with previous history of macrosomia and another of 100 children with standard birth weight, born between 1992 and December 1995, with the purpose of identifying at an early stage the arteriosclerotic risk factors.
Anthropometric variables and lipid profile were studied (cholesterol, HDL cholesterol, LDL cholesterol, VLDL cholesterol and triglycerides), glycaemia, nutritional state, blood pressure among others.
Results: There are highly significant differences between the average weights of both groups. There were no representative statistic differences between the two groups regarding the cholesterol values –in the study group the 93.57% were normal and the 6.43% changed, and in the monitoring group the 90.00% were normal and the 10.00% changed- and in the HDL cholesterol values. The LDL cholesterol resulted changed in a greater amount of children in the monitoring group, being the triglyceride values changed to 14.00% in the study group and 0.00% in the monitoring group, regarding glycaemia and blood pressure there were no statistical differences between the two groups.Conclusions: High weight at birth represents a predictive factor in hypercholesterolemia and esters of HDL, LDL cholesterol, but it does for triglycerides in our study, same as in diabetes and arterial hypertension. It is worrisome the number of children with high blood pressure in both groups.
King Fahad Hospital , Saudi Arabia
Time : 15:15 - 15:45
The early infancy intervention is essential for babies with Critical Congenital Heart Diseases (CCHD). Adding CCHD to newborn screening is an important strategy to assure that all newborns are screened. All hospital in Saudi Arabia now mandate that all newborns be screened by pulse oximetry for CCHD as part of newborn screening.
Objectives: To evaluate the effectiveness of critical congenital heart disease (CCHD) screening program for early diagnosis of cardiac anomalies in newborn infants.
Methods: This is a hospital-based prospective cross-sectional study conducted in the
Pediatric and Neonatology Department, King Fahad Hospital at Albaha, Saudi Arabia,
between February 2016 and February 2017. The data was collected prospectively from February 2016 to February 2017 for all live-birth infants delivered in King Fahad Hospital Albaha. The screening was performed using the CCHD policy and guidelines of the Saudi MOH between 12 and 24 hours of age for all newborn infants. Screening was performed by using a pulse oximeter with an adhesive sensor placed on the baby’s skin. Echocardiography was performed by a pediatric cardiologist to all patients included in the study. The screening was performed in a quiet nursery environment with no active crying.
Results: We screened 2961 (95.4%) of 3103 patients in a nursery unit; 142 (4.6%) patients were not screened. The test was positive in 114 (3.9%) patients and negative in 2847 (96.1%). There were 94 (3.2%) false positives and 20 (0.7%) true positives. Critical cardiac defects were diagnosed in 7 (0.2%) patients of all screened infants, and severe pulmonary hypertension was diagnosed in 13 (0.4%) patients. True negative results were found in 2841(96%) patients, and no cardiac defect was diagnosed, whereas false negative results were seen in 6 (0.2%) patients diagnosed with ventricular septal defect. The sensitivity was 77%, and the specificity was very high at 97%, with a positive predictive value of 18%, and a negative predictive value of 99.8% (95% confidence interval 13.78-19.18, p=0.0001).
Conclusion: Pulse oximetry was found to be easy, safe, sensitive, and highly specific for diagnosis of CCHD.
Charles University , Czech Republic
Time : 11:45 - 12:45
Barbara Stankova is currently a Research analyst at IVth department of Medicine, Charles University, Prague. She has completed her PhD in the year 2016 and since then being working as a researcher at several labs in the same university. She has been an author and co-author in in 69 articles and conference proceedings and actively participated at lectures in various scientific congresses and symposia. Her research interest mainly lies within the field of lipid metabolism, especially that of fatty acids and sterols
Metabolic syndrome (MS) is characterized by the cluster of multiple risk factors – visceral obesity, abnormalities of glucose homeostasis, atherogenic dyslipidemia and arterial hypertension. In the pathogenesis of MS, the most important role is addressed to the volume of visceral adipose tissue; further risk factors are physical inactivity, diet, aging and genetic effects. Hypertrophic adipocytes are not able to manage increased supply of fatty acids (FA) released from lipoproteins and store energy in the form of intracellular triacylglycerols. This situation together with insufficient suppression of lipolysis result in raised flow of nonesterified FA (NEFA) from adipose tissue into circulation and ectopic accumulation of fat in liver, muscles and further organs. Metabolic syndrome is characterized by the decreased concentration of polyunsaturated FA (PUFA) and increased concentrations of saturated and monounsaturated FA. Important regulators of FA concentrations are enzymes - D6-desaturase (D6D, FADS2), D5-desaturase (D5D, FADS1) and D9-desaturase (D9D, SCD1). Genes which control activities of FADS1,-2 and SCD1 are supposed to have pleitropic function. The goal of our study was to find association of the selected polymorphisms of mentioned desaturases and risk factors of MS.
Studied group consisted of 260 middle-aged persons (130M/130F) [49.7 (36.0 – 62.4), years, median (25. – 75. percentile)]. 80 control persons (40M/40F) and 180 persons with metabolic syndrome (90M/0F) were included into the study. All persons were examined clinically as well as anthropometrically. Analyses of lipids, glucose, insulin and CRP were done by enzymatic-colorimetric and immunochemical methods. Genetic analyses [FADS1 (rs174537, rs174545, rs174546), FADS2 (rs174570, rs174575, rs174602, rs174589, rs968567), SCD1 (rs2167444, rs508384, rs7849, rs55710213, rs56334587)] were realized by PCR-RFLP and direct sequenation.Polymorphisms of FADS1 (rs174537, rs174545, rs174546) were associated with concentrations of plasma triacylglycerols (cut-off=2.3 mmol/l). Polymorphism rs174575 (FADS2) was associated with concentration of apoB (cut-off =1.23 g/l), apo AI (cut-off=1.26 g/l) and uricaemia in men (cut-off=420 mmol/l). Polymorphisms rs 2167444 (SCD1) were associated with obesity (BMI³30.0 kg/m2) and increased percent of body fat (adjusted on age and sex), concentrations of LDL-C (cut-off=4.1 mmol/l), conjugated dienes in LDL (cut-off=33.3 mmol/l) and uricaemia in women (cut-off=340 mmol/l). Further we have find association of polymorphisms rs55710213 and rs56334587 (SCD1) with arterial hypertension, insulinaemia (cut-off=24.9 mU/ml), concentrations of hs-CRP (cut-off=3 mg/l), ox-LDL (cut-off=59 U/l), conjugated dienes in LDL, NEFA (cut-off=1.0 mmol/l) and uricaemia in women.
Hamad General Hospital , Qatar
Time : 11:45 - 12:45
Tamer Saafan is currently a general surgery specialist who joined Hamad General Hospital as a resident in September 2012. Hamad General Hospital (HGH) is well known and one of the most advanced tertiary hospitals in the Middle East. During his residency, he showed significant improvement in his academic career and surgical skills that qualified him to be the general surgery academic chief resident between July 2015-July 2016. As an academic chief resident, he helped in restructuring the educational activities of his department which included arranging lectures, conferences and interdepartmental meetings. Tamer Saafan has two published articles in a well reputed journal. He has given multiple national and international presentations about different topics, including laparoscopy, bariatric surgery, endocrine surgery and acute care surgery. Currently Tamer Saafan is working on multiple research projects in bariatric, endocrine and general surgery.
Background: Laparoscopic sleeve gastrectomy (LSG) is a common surgical therapeutic option for obese patients, with debate about the value of routine histopathologic examination of LSG specimens. We assessed the following: prevalence of different histopathologic changes in LSG specimens, risk factors associated with premalignant and with frequent histopathologic changes, and whether routine histopathologic examination is warranted for LSG patients with nonsignificant clinical history.
Methods: Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (February 2011–July 2014, n = 1555), was conducted. Risk factors (age, BMI, gender, and Helicobacter pylori) were assessed in relation to specific abnormal histopathologic changes.
Results: Mean age and BMI of our sample were 35.5 years and 46.8, respectively. Females comprised 69.7% of the sample. Normal histopathologic specimens comprised 52% of the sample. The most common histopathologic changes were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), and lymphoid aggregates (2.2%). We observed rare histopathology in 3.3% of the sample [e.g., intestinal metaplasia and gastrointestinal stromal tumor (GIST)]. Older age was associated with GIST and intestinal metaplasia (P = 0.001 for both). Females were associated with chronic active gastritis (P = 0.003). H. pylori infection was associated with follicular gastritis, lymphoid aggregates, GIST, intestinal metaplasia, and chronic active gastritis (P < 0.001 for each).
Conclusion: Older age, H. pylori, and female gender are risk factors for several abnormal histopathologic changes. Histopathologic examination of LSG specimens might harbor significant findings; however, routine histopathologic examination of all LSG specimens, particularly in the absence of suggestive clinical symptoms, is questionable. The association between female gender and chronic active gastritis; and the association between H. pylori infection and GIST are both novel findings that have not been previously reported in the published literature.
Samuel Merritt University , USA
Time : 11:45 - 12:45
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.
Aim: To evaluate the effects of using an intervention that defines body shape to help counsel and motivate overweight or obese prediabetic or type 2 diabetic men to lose weight.
Background: Anthropometric measurements to assess visceral adiposity, body shape, and fat distribution are more predictive of future disease than body mass index. The “Fat type level”, a novel classification, was proposed to fuse these findings into a compact, user-friendly assessment tool based on waist-to-hip ratio and waist circumference. The tool classifies waist and hip ratios into 6 levels that correlate with truncal fat and subsequent risk for disease.
Methods: A pretest, posttest convenience sample of overweight, prediabetic and diabetic middle-aged men attended a 12-week lifestyle intervention to lose weight (N=30). Variances among two groups, Fat type level versus body mass index, were compared at every two-week primary care office visits. Outcome variables included changes in weight indices, glycemic control parameters, and health behaviors.
Outcome Achieved: The mean change in body mass was greater in the Fat type level group (-10.4 ±.2) than in the body mass index group (-3.88 ±1.06), <.00l. There was a significantly greater decrease in the Fat Type Level group of fasting plasma glucose in mg/dL (p = .026), and in hemoglobin A1C percentage (p = < .001). However, there was no significant interaction between the Fat type level intervention and triglyceride reduction (p = .174).
Conclusion: The risk evaluation and intervention tool, using the Fat type level, helped motivate men to lose weight, exercise, and reduce fasting blood sugar and hemoglobin A1C.
Implications for practice: The use of the Fat type level can aide primary care practitioners in improving communication between provider and patient, as well as between clinicians themselves, as it offers a simple, yet comprehensive method of relating disease risk.
Implications for further research: Further research is needed to evaluate the usefulness of the Fat type level in broader populations across gender, race, age and geographical locations, both among patients and practitioners.