Day 2 :
Keynote Forum
A Martin Gerdes
New York Institute of Technology- College of Osteopathic Medicine, USA
Keynote: Treatment of thyroid dysfunction in heart failure: Are we paralyzed by fear?
Time : 10:00-10:40
Biography:
A Martin Gerdes received his PhD from the University of Texas Medical Branch at Galveston in 1978 and was the 2013 Distinguished Alumnus. He is the Chairman of Biomedical Sciences at New York Institute of Technology- College of Osteopathic Medicine in Old Westbury, NY. Previously, he was the Chairman of the Department of Anatomy at the University of South Dakota (USD) and Founding Scientist of Sanford Research-USD. His work focuses mainly on the role of low thyroid function in heart failure. He has obtained over $30M in funding from the NIH as PI and has authored ~120 research articles.
Abstract:
Many studies have shown benefits from thyroid hormone (TH) treatment of cardiovascular diseases such as heart failure (HF). However, several poorly designed clinical studies using toxic doses of TH analogs convinced the medical community that TH treatment of heart diseases was too risky, primarily due to increased risk of inducing arrhythmias. Due to a steady stream of positive new information, however, this issue has not gone away. Over the years, we have learned many things about low TH function and heart diseases. In many studies, low TH function has been linked to increased mortality in patients with various heart diseases. Many short term clinical studies also showed improvement in cardiac patients treated with THs. A key animal study clearly demonstrated that hypothyroidism alone can eventually cause HF with maladaptive myocyte remodeling and impaired coronary blood flow. Cumulatively, animal studies suggest that all types of heart disease lead to low cardiac tissue T3 levels. One has to ask the question, why is there so much opposition to a drug that improves systolic/diastolic function, improves coronary blood flow, inhibits myocardial fibrosis, reverses fetal gene expression, and new data suggest also reduces arrhythmias? There are good reasons to be apprehensive. But, is fear of overtreatment unreasonable? Is there a safe, therapeutic window for TH treatment of heart diseases, including heart failure? Over the past few years, animal research in our lab has focused on answering the critical questions that have blocked progress to translation in this field. These results will be discussed.
Keynote Forum
Mahir Khalil Ibrahim Jallo
Gulf Medical University, UAE
Keynote: Title: A Triad of Vitamin D Deficiency, Thyroid Disorders and Type 2 Diabetes: Where is the link ?
Time : 10:40-11:20
Biography:
Dr. Jallo, an Associate Professor of Medicine & Senior Consultant Endocrinologist. He granted his MB, ChB from Mosul University College of Medicine in IRAQrn1981, his postgraduate Arab Board Certification in Internal Medicine CABM in1992, Fellowship of The American College of Endocrinology FACE in 2015 andrncertified with Diploma in Dyslipidemia from Boston University School of Medicine, USA in 2014.rnHe is the Coordinator for MBBS Endocrinology Module in GMU, Editorial Board for many international journals and active Principle Investigator in many national &rninternational clinical studies, Member of AACE, EASD, ESE, ISPAD and many professional societies. To his credit many awards of honor & publications in medicalrnperiodicals and conference abstracts.
Abstract:
- Session: Thyroid Disorders: In Children, Teens and Adolescents
Session: Thyroid Surgery & Care
Session: Thyroid Challenges & Improvements
Session Introduction
Artur Bossowski
Medical University of Bialystok, Poland
Title: Analysis of chosen polymorphisms rs2476601 A/G - PTPN22, rs1990760 C/T - IFIH1, rs179247 A/G - TSHR in pathogenesis of autoimmune thyroid diseases in children
Time : 11:40-12:10
Biography:
Artur Tadeusz Bossowski, completed the doctorate in June 2001 and have already presented preliminary findings at various local and international meetings. Also started to performed investigation of lymphocyte subpopulations and co-stimulatory molecules and integrins in peripheral blood and in thyroid tissues of patient with Graves’ disease and non-toxic nodular goiter.
Abstract:
Introduction: Autoimmune thyroid diseases are multi-factorial diseases with a genetic susceptibility and environmental factors. A potential role of the protein tyrosine phosphatase non-receptor type 22(PTPN22) gene, the interferon induced helicase domain 1 (IFIH1) gene, the thyroid-stimulating hormone receptor (TSH-R) gene polymorphisms on autoimmune thyroid diseases(AITDs) in children has not been established equivocally yet. Aim: To estimate the association of polymorphisms of protein tyrosine phosphatase non-receptor type 22 genes, the interferon induced helicase domain 1 gene, thyroid-stimulating hormone receptor gene with the predisposition to Graves’ disease (GD) and Hashimoto’s thyroiditis (HT) in children. Methods: The study was performed in 142 patients with GD, 57 with HT and 160 healthy volunteers. The three single nucleotide polymorphisms (SNPs): rs2476601 - PTPN22 in the protein tyrosine phosphatase non-receptor type 22 gene, rs1990760 - IFIH1 in the interferon induced helicase domain 1 gene, rs179247 - TSHR in the thyroid-stimulating hormone receptor gene were genotyped by Taq-Man SNP genotyping assay using the real-time PCR. Furthermore, the interaction between rs1990760, rs2476601, rs179247 polymorphisms and the status of thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb) and TSH receptor antibody (TRAb) were analyzed. Results: rs2476601: Our study revealed that rs2476601-A alleles were more frequent (18% in men and 20% in women) in GD patients in comparison to healthy subjects (11% in men and 10% in women). P-value=0.009 with OR=2.13 and 95% confidence interval for OR: 1.2–4.0, what means that risk for development of GD is over two times higher for A allele in comparison to G allele. Moreover rs2476601 A alleles were more frequent (25% in men and 21% in women) in HT patients in comparison to healthy subjects (11% in men and 10% in women). P-value=0.008 with OR=2.48 and 95% confidence interval for OR: 1.3–5.0, what means that risk for development of HT is two and a half times higher for A allele in comparison to G allele. rs1990760: Rs1990760 T alleles were more frequent in GD male patients in comparison to healthy males (69% vs. 42%). P-value=0.003 with OR=3.00 and 95% confidence interval for OR: 1.5–6.2, what means that risk for development of GD is three times higher for T allele in comparison to C allele, when considering male group. In case of HT patients rs1990760 T alleles were also more frequent in males compared to healthy subjects (65% vs. 42%). P-value=0.086 with OR=2.47 and 95% confidence interval for OR: 0.9–7.5, what means that risk for development of HT is nearly two and a half times higher for T allele in comparison to C allele. Results for female group were non-significant from the statistical point of view, hence are not discussed here. rs179247: Our study revealed that rs179247 A alleles were more frequent (47% both in men and women) in GD patients in comparison to healthy subjects (37% in men and 38% in women). P-value=0.039 with OR=1.51 and 95% confidence interval for OR: 1.0–2.3, what means that risk for development of GD is over two times higher for A allele in comparison to G allele. Conclusions: Rs2476601: A/G polymorphism in protein tyrosine phosphatase non-receptor type 22 gene could contribute to development of AITDs in children and A allele is the main risk factor. Rs1990760: C/T polymorphism in the interferon induced helicase domain 1 gene could contribute to development of AITDs in children and T allele is the main risk factor. Rs179247: A/G polymorphism in thyroid-stimulating hormone receptor gene could contribute to development of AITDs in children and A allele is the main risk factor.
Roopal N Panchani
The Endocrine Clinic, Vadodara, Gujarat, India
Title: Role of peak systolic velocity of inferior thyroid artery in the differential diagnosis of thyrotoxicosis
Time : 12:10-12:40
Biography:
Roopal N Panchani completed her MD in Internal Medicine from Baroda Medical College, Maharaja Sayajirao University, Gujarat and her super specialization in Endocrinology (DNB Endocrinology) from Sir Ganga Ram Hospital, New Delhi; a premier academic institution of India. She has delivered talks as an invited speaker in 13 conferences, organized about 15 patient education workshops on various topics and served as chairperson and panelist in many conferences. She has 14 publications, 24 poster presentations and 5 oral presentations to her merit. She has a bag full of awards to her merit including the Best Resident Doctor of Sir Ganga Ram Hospital.
Abstract:
Radioactive iodine uptake scan (RAIU) is the investigation of choice in differential diagnosis of thyrotoxicosis. Our study evaluated the diagnostic utility of peak systolic velocity (PSV) of inferior thyroid artery (ITA) on color Doppler ultrasound (CDU) in patients with thyrotoxicosis by comparing with RAIU scan and also determined a specific cut off for PSV of ITA to discriminate accurately between Graves’ disease and (painless and sub-acute) thyroiditis. Over 15 months, 143 patients were selected out of 231 patients with thyrotoxicosis. CDU of thyroid and RAIU scan was performed in 98 patients. RAIU diagnosed thyroiditis in 52 patients and 46 had Graves’ disease. Mean TSH, FT3 and FT4 in Graves’ disease was 0.0214+0.028 µIU/ml, 9.682+6.04 pg/ml and 4.186+1.60 ng/dl respectively. Mean TSH, FT3 and FT4 in thyroiditis was 0.0433+0.040 µIU/ml, 3.602+3.34 pg/ml and 4.027+1.91ng/dl respectively. Mean 2hr and 24hr uptake was 33.07% and 62.38% in Graves’ disease and in thyroiditis it was 6.41% and 11.46% (P<0.01). Patients with Graves’ disease had higher PSV of ITA (63.19+22.85 cm/s) than patients with thyroiditis (16.90+6.54cm/s); P<0.01. PSV>36 cm/s differentiated all patients with Graves’ disease from thyroiditis. Thus CDU of thyroid is a cost effective diagnostic tool and is comparable to RAIU scan for the diagnosis of Graves’ disease or destructive thyroiditis. The unique aspect of study was exclusion of patients with obvious clinical features like neck pain and fever in thyroiditis and infiltrative orbitopathy in Graves’ disease which enabled us to study the role of CDU when it is required the most.
Nargis Khowaja
Nurse Manager, Internal Medicine, Endocrinology & Infectious diseases, Pakistan
Title: Evidence based nursing care guidelines of adult patients with hypothyroidism
Time : 12:40-13:10
Biography:
Nargis Khowaja is currently working as Nurse Manager of Endocrinology, Internal Medicine, Rapid Response Team, and infectious diseases and Working as Co-Chair of CPR Committee in The Aga Khan university hospital Karachi Pakistan, JCIA Certified. Since 17 years she also has worked in various capacities that is; worked as Nurse Administrator Of All Critical Care Areas Moreover, worked as Head Nurse of Coronary Care Unit, Senior Critical Care Nurse in Coronary Care unit(CCU), Intensive Care Unit(ICU) and Cardio thoracic intensive Care Unit(CICU) In the Aga Khan University hospital Pakistan. Also worked as Staff Nurse in Pediatric ICU in Harley Street Hospital and Adult Intensive care unit (ITU) in Gloustershaire Royal Hospital NHS Trust, London. She has completed her BSc in Nursing from New Life collage of Nursing in 2015.
Abstract:
Objective: Hypothyroidism is an endocrine disorder. In hypothyroidism patient has an underactive thyroid ("hypo-" means "under" or "below normal"). In patients with hypothyroidism, the thyroid does not make enough thyroid hormone to keep the body maintain its normal balance. Common causes of hypothyroidism are autoimmune disease, surgical removal of the thyroid, and radiation treatment. The objective of this literature review is to present the evidence based nursing practice for patients with hypothyroidism. Methodology: The literature review was done from the period of January to November 2015 from various online databases such as PUBMED, CINAHL and Allied Health Literature. Key words used: ‘Hypothyroidism’, ‘adults’, and ‘Nursing Care’ using Boolean (AND, OR) words. The final reference list consists of 20 relevant articles ranging from 2010 to 2015, which include qualitative and quantitative researches, literature reviews, peer reviews, and index articles. Results: The evidence based nursing suggests that nurses should monitor vital signs of patients with hypothyroidism because fluctuations in metabolic rate are exhibited by changes in blood pressure, heart rate, and body temperature. Also, nurses should watch for the reduction in symptoms related to hypothyroidism such as fatigue, constipation, cold intolerance, lethargy, depression, and menstrual irregularities, it demonstrate that patient is getting therapeutic effect from drug. Nursing intervention should also include watching for the symptoms of hyperthyroidism such as nervousness, insomnia, tachycardia, dysarrhythmias, heat intolerance, chest pain, and diarrhea as these symptoms may indicate that the drug is at a toxic level. Moreover, evidence based nursing care recommends to monitor T3, T4, and TSH levels as these levels help determine the effectiveness of pharmacotherapy. Monitoring of blood glucose levels, especially in individuals with diabetes mellitus is important as hormone can increases metabolic rate, and glucose utilization may be altered. Most importantly, nurses should provide supportive nursing care to cope with symptoms of hypothyroidism such as constipation, cold intolerance, and fatigue until drug has achieved therapeutic effects as it will decrease the client’s anxiety, which will promote healing and compliance. Nursing intervention also includes monitor weight once a week as weight loss is expected because of increased metabolic rate as these changes help determine the effectiveness of drug therapy. Furthermore, nurses should monitor patients for signs of decreased compliance with therapeutic regimen as it may require early intervention and education about the medical regimen and the disease process. Conclusion: Evaluation of the effectiveness of drug therapy is an important task for nurses in order to confirm that patient goals and expected outcomes have been met. These outcomes include the patient’s thyroid hormone levels are normal, the patient demonstrates decreased symptoms of hypothyroidism, the patient is free from significant adverse effects from drug therapy. And the patient demonstrates an understanding of the drug’s action by accurately describing drug side effects and precautions.
Memon Zahid Ali
Assistant Professor, Civil Hospital, Karachi, Pakistan
Title: Postoperative use of drain in thyroid lobectomy– A randomized clinical trial conducted at Civil Hospital, Karachi, Pakistan
Time : 14:00-14:30
Biography:
Zahid Ali Memon (MBBS, FCPS and MRCS) is a London consultant and a Laparoscopic Surgeon. He is an Assistant Professor at Dow University of Health Science and Civil Hospital Karachi.
Abstract:
Background: Thyroidectomy is a common surgical procedure, after which drains are placed routinely. This study aims to assess the benefits of placing postoperative drains, its complications and affects on postoperative stay, in thyroid lobectomy. Methodology: Randomized Clinical Trial of 60 goitre patients undergoing lobectomy was conducted at Civil Hospital Karachi, during July’11-December’11. Patients were randomly assigned into drain and non drain groups. Patient demographics, labs and complications were noted. Ultrasound of neck was performed on both groups. For drain group, the amount of fluid present in the surgical bed and redivac drain was added to calculate fluid collection while in non drain group it was calculated by ultrasound of neck on first and second post-op days. Data was entered and analyzed on SPSS v16 using Independent T tests. Result: The mean total drain output for 2 days in non-drain group was significantly lower 10.67 (±9.072) ml while in drain group was 30.97 (±42.812) ml (p=0.014). The mean postoperative stay of drain group (79.2±15.63 hours) was significantly higher, as compared to mean postoperative stay of non drain group (50.4±7.32 hours). Mean Visual Analogue Score (VAS) for pain day 1 (6.2±0.997) and day 2 (4.17±0.95) in drain group were significantly higher compared to day 1 (2.6±1.163) and day 2 (1.3±0.877) of non drain group. From drain group, 2 patients complained of stridor, dyspnea on Day 1 which subsided by Day 2 and 1 case of voice change, with no such complains in non drain group. No patients from both groups developed seroma, wound infection or hematoma. Conclusion: In uncomplicated surgeries especially for lobectomy, use of drain can be omitted.
Shenila Anwarali
Aga Khan University, Pakistan
Title: Evidence based nursing in management of hypo and hyper thyroidism during pregnancy
Time : 14:30-15:00
Biography:
Shenila Anwarali is currently working as Clinical Nurse Coordinator of Mind and Brain, Majorly Neurology at The Aga Khan University Hospital Karachi, Pakistan. Since past 5 years she has worked as a registered nurse, special care nurse and a team leader for the same service The Aga Khan University Hospital, Karachi, Pakistan. She has completed her Post RN BScN from Aga Khan University in 2013, diploma in Nursing in 2009 and is currently enrolled in Masters in Hospital Management from College of Business Management, Karachi, Pakistan.
Abstract:
Objective: Thyroid is a ductless gland located in the neck which secretes growth regulating hormones and controls development through metabolism. Alteration in the release of this hormone can result in hypo (decreased) or hyper (increased) secretion resulting in various disorders. Thyroid hormone plays a perilous role throughout pregnancy for both; in the development of a healthy baby and in sustaining the well-being of the mother. During pregnancy the release of 2 hormones HCG and estrogen results an increase in thyroid hormone in blood. Early diagnosis is essential for successful management. The objective of this literature review is to present the evidence based nursing practice for mother with thyroid dysfunction during pregnancy. Methodology: The literature review was done from the period of January to November 2015 from various online databases such as PubMed, CINAHL and Allied Health Literature. Key words used: ‘Hypothyroidism’, ‘Hyperthyroidism’, ‘Pregnancy’ and ‘Nursing care’ using Boolean (AND, OR) words. The final reference list consists of 20 relevant articles ranging from 2010 to 2015, which include qualitative and quantitative researches, literature reviews, peer reviews, and index articles. Results: Literature review depicted that altered regulation of thyroid hormone during pregnancy can be life threatening to both the mother and the baby and can lead to serious complications such as congestive heart failure, preeclampsia- a dangerous rise in blood pressure in late pregnancy, thyroid storm- a sudden and severe worsening of symptoms, miscarriage, premature birth, low birth weight and impaired neurophysiological development of the brain. For mother who has already been diagnosed with thyroid dysfunction need to be vigilantly evaluated at all antenatal visit for signs of complication. Furthermore, nurses and midwives should be aware of the signs and symptoms of hypothyroidism such as appetite change (decrease or increase), difficulty in sleeping (insomnia), fatigue, frequent bowel movement perhaps diarrhea, heart palpitations, heat intolerance, increased sweating, irritability, light menstrual periods perhaps even missed periods, mental disturbances, muscle weakness, nervousness, problems with fertility, shortness of breath, sudden paralysis, tremor/shakiness, vision changes, weight loss-but perhaps, weight gain, dizziness, thinning of hair, itching and hives, possible increase in blood sugar and hyperthyroidism in which fatigue, weakness, weight gain or increased difficulty losing weight, coarse, dry hair, dry, rough pale skin, hair loss, cold intolerance (you can't tolerate cold temperatures like those around you), muscle cramps and frequent muscle aches, constipation, depression, irritability, memory loss, abnormal menstrual cycles, decreased libido in order for timely diagnosis and treatment. Moreover, evidence based nursing care recommends to monitor T3, T4, and TSH levels as these levels help to determine the diagnosis and effectiveness of drugs. Ultrasonography of the fetal thyroid gland by an experienced ultra-sonographer is an excellent diagnostic tool. Health care team members should also provide psychological support to the client and ensure that treatment options are available. Nursing intervention also includes monitoring of vital signs, signs and symptoms and educating clients regarding the disease process. Nurses also need to perform fetal examination and identify emergency signs and opt for help as soon as possible. Conclusion: Hence it is essential to rule out thyroid alteration because it can lead to deleterious outcomes affecting mother and the baby. It can result in irreversible damage to the offspring’s brain causing disrupted neurodevelopment. It is suggested that for those mother who have been diagnosed with the altered thyroid activity need to be frequently re-evaluated of the maternal and fetal complication whereas, for those who show classical signs and symptoms need to be investigated for a proper diagnosis. Awareness sessions need to be held and clients should be accurately educated about the treatment modalities.
Biography:
Surbhi Rana is currently pursuing her PhD from Punjab Technical University, Jalandhar, Punjab India. She has published many papers in reputed journals.
Abstract:
Thyroid gland is located at the front of neck and secretes 2 types of thyroid hormones: T4 (Thyroxine) and T3 (Triiodothyronine). Thyroid hormones regulate many functions in our body, such as the way of energy and oxygen consumption. Thyroid hormones are involved in the regulation of basal metabolic state and in oxidative metabolism. They can cause many changes in the number and activity of mitochondrial respiratory chain components. This may result in the increased generation of reactive oxygen species (ROS). ROS are highly reactive, therefore can lead to oxidative damage. Thyroid disorders occur when thyroid gland releases excess or diminished hormones. An overactive or underactive thyroid can lead to a wide range of health problems. Hyperthyroidism is associated with increase in free radical production and lipid peroxide levels whereas hypothyroidism, a decrease in free radical production because of the metabolic suppression by the decrease in thyroid hormone levels. Mitochondria is also one of the major reactive oxygen species (ROS) producer. Mitochondrial dysfunction is associated with an increase in the generation of reactive oxygen species. Mitochondrial dysfunction and increased ROS contributes to number of diseases including neurodegenerative diseases and cancer. Mitochondria use metabolic intermediates generated during the tricarboxylic acid (TCA) cycle to generate adenosine triphosphate (ATP) during oxidative phosphorylation. It has been reported that mitochondria also serve to regulate cytosolic calcium and iron concentration. Mitochondrial dysfunction is associated with an increase in the generation of reactive oxygen intermediates and release of free radicals derived from oxygen and nitrogen. Both the radical species generated via interaction with free radicals, and referred as reactive oxygen or nitrogen species (RONS). Thyroid hormones are associated with oxidative stress and antioxidant status due to their capacity to change respiratory rate in mitochondria. It has been suggested that changes in thyroid hormone levels may be one of the main modulators of oxidative stress. Thyroid dysfunction is the most frequent endocrine abnormality in population. It has been reported that oxidative stress in both hypothyroidism and hyperthyroidism condition are controversial. In hypothyroidism, a low free radical generation is expected because of the metabolic suppression by decrease in thyroid level. However, in some studies an increased oxidative stress is found in hyperthyroidism as well as in hypothyroidism. However, many aspects that are crucial for the health and well-being of people with this condition remain to be elucidated and require further research.
Zaina Adnan
Zvulon Medical Center at Clalit Medical Services, Israel
Title: Simultaneous occurrence of medullary and papillary thyroid micro-carcinomas
Biography:
Zaina Adnan has completed his MD from Carol Davila faculty of Medicine and Pharmacy, Bucaresti Romania. He is a specialist in Internal Medicine, Endocrinology, Diabetes and Bone Metabolism. He is a Director of the Endocrinology and Bone Metabolism Department at Zvulon Medical Center at Clalit Medical Services – Haifa. He is a Lecturer and instructor of medical students at the faculty of Medicine in the Galilee/Bar-Ilan University. He has published papers in medical journals and has been serving a reviewer for different articles in Endocrinology and Diabetes.
Abstract:
Papillary thyroid micro carcinoma has been demonstrated to present in association with medullary thyroid carcinoma, however, the coexistence of medullary thyroid carcinoma and papillary thyroid carcinoma represent a very rare entity. In recent years, this rarity has been increasingly observed. The pathogenesis is still controversial. Genetic analysis of RET proto-oncogenes in cases of simultaneous papillary thyroid carcinoma and medullary thyroid carcinoma has so far provided conflicting results. Our presentation describes rare cases of simultaneous medullary thyroid carcinoma and papillary thyroid micro carcinoma. These cases were presented in our clinic with unique features and with different ethnicities. Database and literature review will be presented. Our data supports the coexistence of papillary thyroid micro-carcinoma and medullary thyroid carcinoma. Endocrinologists and pathologists should be aware of this entity. Small thyroid nodules should be evaluated preoperatively especially if they are located in the contra lateral thyroid lobe. The pathologist can play a pivotal role in identifying papillary thyroid micro carcinoma in concurrent existence with medullary thyroid carcinoma.
Aslan Ahmadi
Iran University of Medical Science, Iran
Title: Our experience in treatment of recurrent laryngeal nerve paralysis after thyroidectomy
Biography:
Aslan Ahmadi has done with Otorhinolaryngology and head and neck surgery from 2008 to 2012 in Iran University Medical Science and with Board certified with the best degree in Iran at 2012. He has also done Fellowship in Laryngology in 2015. He has an experience as Assistant Professor of otorhinolaryngology at IUMS in Rasule Akram Hospital from 2013 (site of excellent in otorhinolaryngology in Iran), as Chairman of clinic at Rasule Akram Hospital, Director of resident program at department of otorhinolaryngology, Rasule Akram Hospital. Some of the publications are the effect of IMOD in recurrent respiratory papillomatosis of larynx, Iranian Red Crescent Journal 2015
Abstract:
Recurrent laryngeal nerve paralysis is a common complication after thyroidectomy depends on the kind of thyroidectomy, unilateral or bilateral paralysis may occur. Anterior branch of RLN is in the posterior aspect of cricothyroid joint so it can simply injured in blind dissection of this area. After unilateral RLN injury, we have true vocal cord paralysis at the same side. In this category the patients have swallowing problem with voice disorder. Depends on the severity and the type of injury in the operation we can do some procedures with different approach. TVC medicalization with Cortex, cadaveric fascia, fascia late is the procedures of choice in selected patients in our experience. Especially we create a window in lower most border of thyroid cartilage about 6-10 mm posterior to the anterior commissure. Injection of VOX under general anesthesia in paraglotic space with the special injector is the simplest procedure with good outcome. Neuromuscular pedicle transfer, reinnervation with nerve graft is the other procedure that we can do in this situation. Anyway the best result is in the primary surgery at the time of thyroidectomy, that the surgeon should carefully dissect the nerve and prevent to damage the recurrent laryngeal nerve.
Fualal Jane Odubu
Mulago National Referral and Teaching Hospital, Uganda
Title: Challenges impacting giant goiter surgery at a tertiary Sub-Saharan Hospital
Biography:
Senior Consultant Surgeon, Head Breast and Endocrine Surgical Unit at Mulago National Referral Hospital, Past president Association of Surgeons of Uganda, Current Uganda Country Representative College of Surgeons of East Central and Southern Africa [COSECSA]. Hon. Lecturer, Department of Surgery, College of Health Sciences, Makerere University with passion in training and Mentoring of undergraduate and graduate medical students and Fellows/Residents. Pioneer Endocrine Surgeon in Uganda with enormous experience in surgery of the Thyroids, Adrenals and the Breast and Member of the International Association of Endocrine Surgeons [IAES]. Was an International guest speaker at Department of Continuing Education on “Surgery of the Thyroid and Parathyroids”, Harvard Medical School Boston Massachusetts USA. Has 12 publications and several presentations at International scientific meetings and numerous citations. Awarded Model of Excellence by FAWE-U, and Community Service by Rotary Club of Luzira Kampala.
Abstract:
Thyroid disease is prevalent in Africa. Regional governments’ and NGO’s effort to establish tertiary institutions and facilitate surgical outreaches have yielded little. Globally, health funding faces scarcity. Third world countries have been identified with neglected thyroid disease like big goiters causing disfigurements, upper airway and gastrointestinal tract obstruction or neck vasculature engorgement. Longstanding cases may undergo malignant transformation or extend retrosternally. This was a prospective cohort selected from a pool of operated thyroid patients at Breast and Endocrine Unit of Mulago National Referral and Teaching Hospital, Kampala Uganda. Averagely, six (6) thyroidectomies are done every week. Two (2) out of these qualified for the study as having giant goiter. Surgery necessitated the team’s lobbying for ICU space, meticulous peri-operative involvement of anesthesiology residents and undertaking thorough investigations. Age range of patients was 15 – 70 years with majority in the 40-60 year age bracket; a female preponderance of 8:1. Average operative time was 4hours with about half utilized by anesthesia. Challenges encountered included team building, scarce surgical instruments, managing difficult airway, extracting impacted retrosternal goitre, encountering the markedly engorged neck vessels and ICU space. Loss to follow up after discharge was about 30%. Despite innumerable challenges, the result shows that 95% of our patients get successful surgery; 4% develop transient complications like hoarseness and hypocalcaemia. One patient required tracheostomy. Giant thyroid is fairly common at Mulago. Its surgery is challenging. With organized team, competence, overall surgical results are comparable to those in well facilitated centers even amidst scarce resources.
Biography:
Elamin Abdelgadir is a Senior specialist endocrinologist at Dubai Hospital. He is graduated from Sudan in 2004 and obtained his membership at the Royal College of Physicians in 2010. He pursued his endocrinology career in 2010. He got his Post-graduate degree in Endocrinology in 2014. He was appointed as Vice-Head of Medical Education Institute in International University of Africa 2009. He is interested in clinical research and has published 20 papers and abstracts so far.
Abstract:
Data from LEAD trials showed that liraglutide was associated with significant reduction in weight HbA1c and blood pressure values. Unfortunately there are no enough data on Arab population. We aimed to assess the changes in blood pressure, lipids profile, and liver function test upon starting liraglutide and after 6 months of therapy in Arab patients with type2 diabetes as primary objective. 365 agreed to sign an informed consent. 29% of the studied population was males (n=106) compared to 71% females (n=259). There was no significant change in systolic blood pressure, however average diastolic blood pressure improved significantly (74.4±10 to 72±9 mmHg at 6 months P<0.001). Significantly lower average diastolic BP was seen in Insulin users at both start and the end of the study (73+4 vs. 76+4 P=0.05 and (71+ 5 vs. 73+4.6) p=0.02, respectively). Mean AST and ALT was within normal range at baseline and despite that there was a highly significant reduction between baseline and end of study 29+18 to 25.7+13 and 25.1+20 to 22.2+16 for ALT and AST, respectively. Both of them showed highly significant P value (0.0000). There was a significant reduction in weight and HbA1c at 6 months. However the change in weight was more significant in insulin users compared to those who did not use insulin (96+3 to 93+5 vs. 93+5 to 98+3.5, P-value at the end of the study was 0.02). The HbA1c reduction was significant irrespective of weight loss. Liraglutide showed remarkable improvement in weight, HbA1c, liver enzymes and diastolic blood pressure. Patients who used insulin at base line had better results in weight and lipids reduction.
Aslan Ahmadi
Iran University of Medical Science, Iran
Title: Thyroid surgery-Pre and postoperative care address
Biography:
Aslan Ahmadi has done with Otorhinolaryngology and head and neck surgery from 2008 to 2012 in Iran University Medical Science and with Board certified with the best degree in Iran at 2012. He has also done Fellowship in Laryngology in 2015. He has an experience as Assistant Professor of otorhinolaryngology at IUMS in Rasule Akram Hospital from 2013 (site of excellent in otorhinolaryngology in Iran), as Chairman of clinic at Rasule Akram Hospital, Director of resident program at department of otorhinolaryngology, Rasule Akram Hospital. Some of the publications are the effect of IMOD in recurrent respiratory papillomatosis of larynx, Iranian Red Crescent Journal 2015
Abstract:
Iatrogenic injury to recurrent laryngeal nerve in thyroid surgery is an important complication. In thyroid cancer surgery this complication is much more common. When it occurs, at the time of surgery what should we do and at the end of operation what should we in exudation period? When we receive TVC paralysis with the history of thyroid surgery and breathiness after that, we do direct laryngoscopy with evaluation of vocal fold movement. If we found unilateral paralysis with complain of breathiness or aspiration we do medicalization thyroplasty when the patients are sedated or augmentation of vocal cord under general anesthesia directly in the TVC.We have many images or video from this procedure with outcome of such intervention.
Mafalda Gomes
University of Porto, Portugal
Title: Risks to the fetus from diagnostic imaging during pregnancy: Review and proposal of a clinical protocol
Biography:
Mafalda Gomes has completed her Degree in Basic Health Sciences in the Faculty of Medicine of the University of Porto, the best Medical School in Portugal, in 2012. She is engaged in one of the biggest Hospitals in the country and gained clinical experience in Hospital S. João, with internships in Hospital Pedro Hispano and Póvoa de Varzim-Vila do Conde Hospital Center. In 2015, she finished her Master Degree in Medicine in the same Faculty of Medicine. Her thesis was recently published in an international journal with an impact factor of 1.6.
Abstract:
Every day, medical practitioners face the dilemma of exposing pregnant or possibly pregnant patients to radiation from diagnostic examinations. Both doctors and patients often have questions about the risks of radiation. The most vulnerable period is between the 8th and 15th weeks of gestation. Deterministic effects like pregnancy loss, congenital malformations, growth retardation and neurobehavioral abnormalities have threshold doses above 100–200 mGy. The risk is considered negligible at 50 mGy and in reality no diagnostic examination exceeds this limit. The risk of carcinogenesis is slightly higher than in the general population. Intravenous iodinated contrast is discouraged, except in highly selected patients. Considering all the possible noxious effects of radiation exposure, measures to diminish radiation are essential and affect the fetal outcome. Non-ionizing procedures should be considered whenever possible and every radiology center should have its own data analysis on fetal radiation exposure. In this review, we analyze existing literature on fetal risks due to radiation exposure, producing a clinical protocol to guide safe radiation use in a clinical setting.
Biography:
Hussein Abdul Raheem Hussein Alkoofee is Professor in Molecular Pathology, Director of Post-graduate Teaching & Learning and Director of Medical Ethics at the School of Medicine, Trinity College Dublin. He has a PhD in Molecular Pathology from TCD and an MA in Medical Law and Ethics from KCL. The underlying theme of his research is to understand the causes and molecular basis of the development of disease and to apply this knowledge to improving disease prevention, detection, diagnosis and treatment. He has particular interest in developing novel molecular diagnostics. Translational research is the common theme throughout his research, linking identification of disease processes with targets for early disease detection or classification.
Abstract:
Background: Fine needle aspiration cytology (FNAC) with its minimal invasiveness has been a well accepted procedure in the initial diagnosis of various swellings. With time and experience, high sensitivity and specificity of FNAC over conventional open biopsy has lead to the wide acceptance of this procedure. Objective: We decided to compare the accuracy of this method with open biopsy & see if this technique reduces the need for more invasive and costly procedures and to evaluate the utility of aspirate cytology as a first line diagnostic tool in palpable neck masses & even non-palpable masses under U/S or CT guide. Patients & Methods: A hospital based prospective for (100) patients with various swellings at Neck regions in the Department of General surgery, AL-Yarmouk Hospital between Jan. 2014 to Jan. 2015. FNAC were done from the palpable masses of neck regions and were compared with biopsy findings of the same lesions. The sensitivity, specificity and accuracy rates were calculated. Results: A total 100 patients were subjected to both FNAC and histo-pathological examination (HPE). Total (41%) were females and (59%) were males. The age group ranged from 21-30 years. Eighty seven percent of patients were in the age group below 50 years. The highest number of cases included thyroid 52(52%), followed by lymph nodes 29(29%), salivary glands 11 & 8 miscellaneous. The overall sensitivity and specificity of FNAC were (72%) and (87%) respectively in determining the various pathologies. The overall accuracy of FNAC in present study was (79%). Conclusion: FNAC is a minimally invasive first line investigation with a high sensitivity and specificity for the diagnosis of various head and neck masses and it’s highly recommended for diagnosis of cervical swellings.