Biography:

Amanda J Brisebois is an Internal Medicine and Palliative Care Specialist from Edmonton, Alberta, Canada. She has been practicing for 17 years, and has been focusing on the Integration of Palliative Care Principles in care of patients with chronic illness for the past 5 years. She is the current Facility Chief of Medicine at the Grey Nuns Hospital and also an Associate Clinical Professor at the University of Alberta. She has won numerous teaching awards, as well as grants to undertake her current work.

Abstract:

Introduction & Aim: Patients with chronic illness often have chronic pain. In Edmonton, a non-cancer palliative care clinic has been instituted since 2013 in order to address symptom management in cirrhosis patients in the last years of life. Of the 40 patients seen to date, over 65% of them have had significant pain issues (pain scores of over 4 on a 10 point scale). Many of these patients were initiated on pharmacologic pain management, based on current pain management regimens in the literature. Through evaluation of success of treatment (defined as a decrease of 2 points on the 10 point scale), it was determined that many patients did not respond well to medical therapy, due to a variety of reasons. Within the clinic, mindfulness principles were encouraged through mobile technology, internet based and local mindfulness resources.

Methods: A total of 15 patients, representing ~10% of eligible patients approached and were enrolled with consent. Patient inclusion criteria were: Cirrhosis diagnosis; adults (≥18 years of age); significant symptom burden as per the Edmonton Symptom Assessment Scale (ESAS, score of ≥4 out of 10); and absence of uncontrolled hepatic encephalopathy, psychosis and bipolar disorder or suicidal intent. The online intervention were delivered by eMindful Inc. for over 3 weeks consisting of a live trainer providing video instruction (2 hrs/wk) complemented by daily individual practice (45 min/d).

Results: Data presented as results included: Stage of liver disease, medications and symptom burden. Adherence, completion and success of the MBSR program were discussed.

Biography:

Chi-Tan Hu has completed his MD from Taipei Medical University, Taipei, Taiwan and PhD from Cambridge University, UK. He has done his Postdoctoral studies from National Institute of Health, Bethesda, Maryland, USA. He is the Chief of Department of Gastroenterology, Buddhist Tzu Chi Hospital, Hualien, Taiwan. His research interests are on Transnasal Endoscopy, Helicobacter pylori, Irritable Bowel Syndrome and Hepatocellular Carcinoma. He has published more than 100 papers in the international journals.

Abstract:

An ultrathin endoscope was initially developed in the 1970s for the use in pediatric patients. In recent years, unsedated transnasal esophagogastroduodenoscopy (UT-EGD) has been used for diagnostic and therapeutic purposes such as percutaneous endoscopic gastrostomy, enteral tube placement, nasobiliary tube drainage and polypectomy. The satisfactory safety and tolerance profiles make UT-EGD an alternative to peroral conventional EGD with or without sedation. There is a trend toward performing transnasal laryngoscopy, transnasal esophagoscopy (especially for screening Barrett's esophagus) and UT-EGD in the office. However, many techniques related to UT-EGD are not standardized. Professor Hu proposed reporting the how, where, and grading of nasomucosal injury (grade 0, 1, 2 and 3) after transnasal endoscopy. He demonstrated that an endoscopic-guided method (EGNA) is better than the cotton-tippled applicator method (CTNA) of nasal anesthesia. Further, he revealed a cotton-tipped applicator primed gauze pledgetting (CTGP) method is more effective than EGNA. CTGP, which only needs a 5-min procedure, has achieved a painless nasal insertion and exertion. He has recently introduced anterior meatuscopy coupled with an endoscopic meatus scoring system (EMSS, grade 0, I, II and III), replacing sniff test to select an optimal meatus insertion route before UT-EGD. Documenting a meatus score is important because it may be correlated with the severity of nasomucosal injury and bleeding. In addition to the novel nasal anesthetic methodology, the techniques of endoscopic insertions from the anterior to posterior nasal cavities, nasopharynx to oropharynx, and hypopharynx to the esophagus will be demonstrated. He will also introduce techniques to avoid nasal bleeding and gag reflex.

Biography:

Guo-ming Shen is a Doctoral Supervisor and the Dean of the Graduate School of Anhui University of Chinese Medicine in China. He has published more than 50 papers in reputed journals and has been serving as Editorial Board Member of several medical magazines.          

Abstract:

Acupuncture at gastric Back-Shu and Front-Mu points has a regulating effect on gastric motility. According to the theory of traditional Chinese medicine, Front-Mu points located on the abdomen and Back-Shu points located on the back. The application of acupuncture at a combination of Back-Shu and Front-Mu points, which is based on the theory of Yin and Yang and the pathway of Qi, has synergistic effect and good clinical effectiveness. It has been demonstrated that the combination of gastric Front-Mu and Back-Shu point is effective for the regulation of motility in clinical practice. However, studies on the regulation mechanism underlying those phenomenons have been focused at the level of the spinal cord. Advances in the studies of Back-Shu and Front-Mu point combination focused on whether the superior nerve center involved in the regulation of zang-fu organs by this combinational acupuncture. In order to confirm whether this convergent effect could extend to the superior nerve center, we suggest a targeted convergence hypothesis: Gastric Shu and Mu point acupuncture signals gather not only in the spinal cord but also in a targeted way in the brain stem and hypothalamus in the higher central nervous system, achieving an integrative effect through the neural microcircuitry. Our previous studies found that gastric Shu and Mu may afferent signals primarily convey acupuncture input signals to different levels of the central nervous system, such as the spinal cord, medulla, brain stem, hypothalamus and sub-cortex. For the development of neuroimaging technique and brain science, we intend to investigate the neural mechanism of compatibility of gastric Shu and Mu point by fMRI, neural tracing and multi array electrode technique. It may also provide new ideas for research on compatibility of Back-Shu and Front-Mu points and the mechanism of central integration. 

Biography:

Sonia Shahid is a final year M.B.B.S student of Karachi Medical and Dental College, Karachi Pakistan. She has been a part of several national and international
researches and many are ongoing. She has attended several national and international seminars and conferences. She has good knowledge of clinical practices
and protocols in variety of settings. Sonia is an inquisitive student with a passion for education as a power for change and improvement in the healthcare field of
her country and is very ambitious in pursuing her career.

Abstract:

Objective: To determine the frequency of H.pylori infection causing gastritis and peptic ulcers in children and complications
related to it.
Introduction: Helicobacter pylori is a gramnegative, spiral organism that colonizes the gastric mucosa and causes primary antral gastritis and peptic ulcer disease. Helicobacter pylori infection is a common problem in pediatric practice, and its acquisition is related with poor socioeconomic conditions. The possible routes of transmission are feco–oral, oral–oral and gastro–oral. H. pylori causes chronic inflammation ( gastritis) by invading the lining of the stomach and thus can lead to ulcer formation. When the infection leads to an ulcer, symptoms may include abdominal pain, excessive burping, feeling bloated, nausea or vomiting, lack of appetite and unexplained weight loss. H. pylori infections can lead to peptic ulcers, but the infection or the ulcer itself can lead to more serious complications these include; interna bleeding, which can happen when a
peptic ulcer breaks through your blood vessel; obstruction, which can happen when an ulcer blocks the food from leaving your stomach;perforation, which can happen when an ulcer breaks through your stomach wall and peritonitis, which is an infection of the peritoneum, or the lining of the abdominal cavity
Methodology: This cross‐sectional study was conducted from July 2014 ‐ July 2016. Pediatric patients under 12 years of age were recruited in this study. A history and examination form designed from an application “Forms”,particularly for the study. Children were examined and endoscopic biopsy was done to find out the extent of infection. For data analysis SPSS 16.0
software was used.

Results: Out of 489 subjects, mainly mucosal erosions were revealed at endoscopy in 361 subjects (73.82%). Gastritis was found
in 272 subjects (75.3%), of whom 266 (54.4% of the total) were found to be infected with H. pylori. Gastritis and H. pylori
were noted in both the antrum and corpus in 75% of those infected children. In complications, internal bleeding was found in
35.67% children, obstruction in 21.45%, perforation in 19.7% and peritonitis in 23.18% Stepwise logistic regression analysis
revealed that the relative risk for H. pylori infection associated with gastritis was 5.8 (95% confidence interval), whereas the
relative risk for peptic ulcer was 6.5 (95% confidence interval).
Conclusion: The main predisposing factors identified in these studies were low socioeconomic status and poor hygiene. The
results may explain why the rate of infection is so high in poorer countries and in socioeconomic
groups characterized by
crowded living conditions, poor sanitary conditions, and lack of clean water.Endoscopy also allows determination of the
severity of gastritis with biopsies as well as the presence of ulcers.

Biography:

David Bamshad recieved his MD from St. Georges University School of Medicine. He has also completed a Master’s in Science. He is currently a resident of Internal Medicine at Brookdale University Medical Center in Brooklyn, NY. He has presented his work at major national conferences across the United States. His main academic focus is on health disparities and patient advocacy in medicine.
 

Abstract:

The United States Preventive Services Task Force  (USPSTF) recommends a screening colonoscopy for all average risk patients aged 50-75. Nonetheless, it remains the second leading cause of death related to cancer in the United States, and the third most common type of cancer overall. These statistics are represented disproportionately, as minority populations maintain a greater degree of incidence and mortality. A retrospective review at a major inner city teaching hospital was performed. Average risk first time screening colonoscopies over a 2-month period were analyzed. 122 charts were identified. Ages of males to females and African Americans (AA’s) were compared to Non-AA’s. In addition, the percentage of patients that underwent a screening colonoscopy only once experiencing gastrointestinal related symptoms was analyzed. The average first time screening age for average risk AA’s (n =70) was 59.34. Non-AA’s (n=25) had an average age of 59.76. The average male (n=42) was 59.86 while the average female (n=53)  was aged 59.38.  The percentage of patients that only underwent a colonoscopy once symptomatic was 22.13% (n = 27). Disparities between the USPSTF screening recommendations and the observed age among patients in an inner city hospital were identified . It illustrates the number of patients that only underwent a screening colonoscopy once they had gastrointestinal complaints. It questions the presence of cancer prevention conversations between physicians and patients in an inner city community, and emphasizes the staggering number of patients that are brought into the fold of screening behaviors either late altogether or because of incidental symptoms.

Biography:

Saif Khan has completed his BSc from the University of Bradford and is currently, a 4th year Medical student at the University of Glasgow. He has a keen interest
in Gastroenterology and has completed multiple projects in this subject. He has published many papers in reputed journals in collaboration with others. He also has
an interest in Imaging and is currently undertaking a project on MRCPs.

Abstract:

Aim: ERCP brush cytology is an established technique for diagnosing pancreato-biliary malignancies. However, its accuracy
remains modest with nearly half of malignancies missed. There is a lack of research assessing factors associated with negative
brush cytology results. The aim of our study is to analyze factors associated with negative brush cytology samples and their
ability to differentiate between malignant and benign samples.
Method: Data from all consecutive patients who had ERCP brush cytology in NHS Lanarkshire between January 2006 and
December 2015 was retrospectively collected and analyzed. 217 out of 232 patients were included in the final study; their
cytology, radiology and ERCP reports were analyzed. Age, ALT, ALP, bilirubin, CEA and CA 19-9 levels along with presence of
mass on imaging, mass size, stricture length and location were the factors assessed. Factors highlighted by univariate analysis
were further analyzed by binary logistic regression analysis.
Results: 138 patients had a malignancy of which 77 had a positive brush cytology sample (sensitivity: 55.8% and specificity:
97.5%). 138 patients had a negative sample and the likelihood of a false negative brush cytology increased with an increase in
bilirubin levels {OR 1.005; 95% CI: (1.002-1.008) p=0.001}, ALT levels {OR 1.003; 95% CI: (1.001-1.006) p=0.021} and age {OR
1.045; 95% CI: (1.012-1.079) p=0.01}. Using ROC curves optimal cut-offs for ALT and bilirubin were 84.5 U/L (sensitivity: 70%
and specificity: 70%) and 181.5 umol/L (sensitivity: 73% and specificity: 67%).
Conclusion: Increasing age, bilirubin and ALT levels are independent predictors of malignancy in a negative brush cytology
sample.

Biography:

Wasif Mohammad Ali is currently working as an Assistant Professor at Department of Surgery, J N Medical College, Aligarh Muslim University (AMU), Aligarh, India.

Abstract:

In this presentation, I want to share my 10 years experience of treating giant duodenal perforation (> 2 cm) by the novel technique of triple tube ostomy at our tertiary care centre. The closure of the giant duodenal perforations is still a matter of debate with wide array of options like classical technique of primary closure with and omentopaxy to more complicated ones like gastrojejunostomy with pyloric exclusion. But all these have a high mortality rate particularly in patients presenting with hemodynamic instability and added comorbid condition. We have managed such patients successfully with very low mortality rate using triple tube ostomy technique. This technique is still very unpopular despite good results; therefore the author wants to highlight the utility of this technique by presenting this paper.

Biography:

Chowdhry completed his MBBS from Rajasthan University, India in 2004. He is trained and board certified in Internal Medicine and Gastroenterology. Currently
working as an Assistant Professor at Case Western Reserve University- School of Medicine. He has published multiple papers in reputed Gastroenterogy and
Hepatology journals.

Abstract:

In the last two decades human genome sequence analysis has helped to identify six new members of IL-1 family. IL-36 α,
β, and γ, previously known as IL-1F6, IL-1F8, and IL-1F9 respectively, these ligands bind to a heterodimeric receptor IL-
36 receptor (IL-36R, also known as "IL-1 receptor-related protein 2") and then recruit IL-1R accessory protein (IL-1RAcP)
there by activating NF-kB and mitogen activated protein kinase (MAPK) pathway.(Dinarello et al., 2010, Towne et al., 2004)
Epithelial cells express IL-36 and recent studies suggest important inflammation regulatory role for these novel cytokines
in gut inflammation and psoriasis although there is ambiguity regarding the ability of IL-36 ligands to induce Th1, Th2 or
Th17 immune response (Towne et al., 2004, Ramadas et al., 2012, Johnston et al., 2011). Recent data suggests increased IL-
36α expression in eosinophilic esophagitis and Ulcerative colitis indicating a possible role in Th2 type immune response.
Other reports show IL-36 signaling, induce Th1 polarization of naïve CD4+ T cells (Vigne et al., 2012) and induction of
Th-17 immune response in lung disease and Psoriasis. (Gresnigt et al., 2012, Ramadas et al., 2011) IL-36 Receptor antagonist
(previously IL-1F5) and IL-38 (IL-1F10) also binds to IL-36 R and act as an antagonist for the biological activities of IL-36.
(Towne et al., 2004, van de Veerdonk et al., 2012, Dinarello et al., 2010, Blumberg et al., 2007) IL-37 (IL-1F7) is the newest
member of the IL-1 family with potent anti-inflammatory role in gut and liver. IL-37 is expressed in tonsils, skin, esophagus,
and placenta as well as carcinomas of the breast, prostate, colon, skin and lung. (Kumar et al., 2002) Mice with IL-37 expression
are protected from DSS induced colonic inflammation indicating a potential role in inflammatory bowel disease. (McNamee et
al., 2011). The novel members of IL-1 family are an area of active investigation and we anticipate new data regarding their role
in gut homeostasis and intestinal inflammation in near future, with potential therapeutic implications.

Biography:

Amy  is a  PTSD peer-peer specialist, artist, author, speaker for RAINN, writer for The Huffington Post, award-winning health advocate, actress and playwright.  In 2012, she wrote, directed and starred in a one woman musical about her life, Gutless & Grateful, touring theatres across the country for three years, earning rave reviews and accolades since it’sBroadwayWorld Award-nominated NYC debut.    As an visual artist, her art has won accolades in multiple galleries and in dozens of solo art shows.  Her mixed media creativity workshops emphasize creativity as an essential mindset.

Amy’s “beautiful detour” has inspire her passionate desire to create and help others.  As a health advocate, she's written feature articles for Phoenix Magazine, and has spoken to hundreds of nurses and doctors as the Eastern Regional Recipient of the Great Comebacks Award.  Her Washington Post and On Being with Krista Tippet, and is a regular contributor for numerous publications including Elite Daily, The Mighty, Indie Chicks and Career Girl Daily.  Her story has appeared on the TODAY Show, CBS, Cosmopolitan, Seventeen Magazine, among others.  

Amy's passion for the arts as a means of healing and expression inspired her to devise storytelling workshops for the Transformative Language Arts Network National Conference, the Eating Recovery Center Foundation, and The League for the Advancement of New England Storytelling. 

Determined to bridge the gap of communication between wellness resources on college campuses and students, Amy devised storytelling programs especially for colleges and universities to address the issue and is touring colleges campuses with her program combining mental health advocacy, sexual assault awareness and Broadway Theatre.

For information on keynote presentations, workshops and signature talkbacks, (and specialized versions for corporations, college campuses, survivors, healthcare professionals, and artists) visitamyoes.com. 

Abstract:

In 2005, A mild stomachache led to a total gastrectomy 48 hours later.  In this presentation, I will be serving as my own case study.  How does psychological trauma affect the body and how can it inform both medical and mental health professionals?  At 17 I was sexually abused for eight months, causing severe stress, invoking the “freeze” response in trauma.  Withholding this secret caused severe anxiety and panic attacks.  Two weeks after I finally disclosed my secret, I developed a blood clot on the mesenteric artery leading to gangrene of the intestines.  My stomach literally burst to the ceiling of the OR, both my lungs collapsed, I required 122 units of blood, and I was in a coma for months.  27 surgeries later, and six full years unable to eat or drink, I was reconstructed with the intestines that remained.  How can stress lead to such physical traumas?  How can the mind so dramatically affect the physical body?

Psychological stress has a profound effect on the body and illness.  When stress occurs, the hypothalamus secretes CRH that signals a reaction through a hormone signal pathway.  ACTH is then released, but when this chain of events is turned on repeated in times of high stress like PTSD, the organs can never rest, inducing various physical illnesses and tissues damage.    There is a large effect that this has on the stomach and intestines, causing various digestive problems.  Mental disorders can also be caused when stress quickly activates our system, causing quick alarmed reactions that can lead health damage. As I experienced my abuse and relived it over and over again, the pathway repeated itself relentlessly, and therefore, digestive damage was eventually caused.

Biography:

Dimitrios Tsamis has studied Medicine and thereafter completed his PhD from National and Kapodistrian University of Athens, Greece. He is a General Surgeon in special interest in Colorectal Surgery. He has published more than 33 papers in reputed journals and has been serving as an editorial board member.

Abstract:

Studies dealing with laparoscopic colectomy for cancer have reached to conflicting results in regards to various inflammatory cytokines. The aim of this study was to detect differences of proinflammatory cytokines between conventional and laparoscopic colectomy for cancer.

30 patients who underwent laparoscopic colectomy were with 30 patients treated by “open” surgery. CRP, IL -1, -6, -8 and IFN-γ serum levels were measured preoperatively, at 24 hrs and at the 7th POD.

CRP and IL-6 postop values (24 h and 7th POD) were significantly higher than baseline at both groups (p=0.001), but the respective values at the 7th POD were less than at 24 h (p=0.001). IL-1 and -8 levels did not show any differences. A higher INF-γ measurement was demonstrated at 24 h compared to baseline at the laparoscopic group only (p=0.05). This difference was not maintained at the 7th POD. Relative differences at cytokines concentration showed that INF-γ increment noted at the laparoscopic group was more accentuated than the respective IL-1 value changes (p=0.09 and p=0.024, respectively). INF-γ levels at 24 h and the 7th POD were significantly less at the “open” compared to the laparoscopic group of patients (p=0.001).

This matched case-control study verifies the already reported lack of differences regarding the IL-1. Controversy still exists on likely IL-6 differences. IL-8 does not seem to play an important role on immunologic differences. INF-γ seems to have a more active presence following the laparoscopic colectomies potentially contributing to an immunologic “advantage” by counteracting “harmful” cytokines, such as IL-1.

Biography:

Junqi HE has completed his PhD from Chinese Academy of Medical Sciences and Peking Union Medical College and postdoctoral studies from Emory University. He is professor in the Department of Biochemistry and Molecular Biology in Capital Medical University. He is the director of Beijing International Cooperation Base for Science and Technology on China-UK Cancer Research. He has published more than 40 papers in reputed journals.   

Abstract:

PI3K/AKT pathway, which is frequently altered in gastric carcinoma, can  be negatively regulated via dephosphorylation of PIP3 to PIP2 by PTEN. In the present study, PDZK1 was identified as a novel binding protein of PTEN, in which the interaction was mediated by the PDZ2 and PDZ3 domain of PDZK1 with the last four amino acids (ITKV) in the carboxyl terminus of PTEN (PTEN-CT). Our data from PDZK1 overexpression and siRNA-mediated knockdown experiments further demonstrated that by associating with PTEN, PDZK1 inhibits the phosphorylation of PTEN. In addition, overexpression of PDZK1 down-regulated AKT and ERK signals. Consistent with these results, PDZK1 suppressed gastric cancer cell proliferation, impeded the formation of anchorage independent colonies in soft agar and retarded the growth of xenografts in nude mice. Furthermore, PDZK1 was significantly downregulated in gastric cancer tissues in comparison to that in normal gastric tissues. Collectively, this study shows that downregulation of PDZK1 expression enhances the PTEN inactivation, which may contribute to the carcinogenesis of gastric cancer.

Biography:

Wei Gong has completed his PhD at the age of 30 years from Southern Medical University, China. After 6 years’ strict training at home and abroad, he is good at most endoscopic techniques, such as ESD, STER, POEM, ERCP, et al. Presently, he is the vice director of endoscopic center of Nanfang Hospital, Southern Medical University, a famous center in China. He has published more than 15 papers in reputed journals. In 2015, he was given the International Award by ACG (American College Gastroenterology) because of his excellent research work of novel endoscopic techniques.

Abstract:

Peroral endoscopic myotomy (POEM) has recently been described as a novel treatment for achalasia in humans. We aimed to assess the clinical effectiveness and safety of POEM for treating esophageal achalasia performed by a gastroenterologist in a single endoscopic center within 4 years. Between June 2011 to May 2015, POEM was performed in 115 consecutive patients with achalasia. The Eckardt score and manometry were used to evaluate the outcomes. POEM was successfully performed in all cases. Mean procedure time was 48.7 min (range 35–93) and mean myotomy length was 9.2 cm (range 7–15). Mucosal perforations occurred in 7 (6%) patients during submucosal tunnel creation, major bleeding occurred in 8 (7%) patients, and 6 (5.7%) patients suffered pneumothorax immediate after procedure. All the complications were managed conservatively. During a mean follow-up period of 25 months (range 6–59.4 months), treatment success was achieved in 106/115 patients (93.5%). Mean LES pressure was 54.5 mmHg (28.5–81.4) and 16.4 mmHg (4.8–25.3) before and after the procedure (P < 0.05), respectively. Mean Eckardt score was 6.2 (3–11, median 6) and 0.5 (0–2, median 1) before and after POEM, respectively (P < 0.05). 20 patient (17.3%) developed mild reflux symptoms and required intermittent medication with proton pump inhibitors during the follow-up. Our study demonstrated that POEM is a safe, and effective treatment for achalasia. Further studies are warranted to evaluate the long-term efficacy and to compare POEM with other treatment modalities.

Biography:

Romany Helmy Thabet is Assistant Professor of Pharmacology, Faculty of Medicine, Northern Borders University, Saudi Arabia. His latest publications is titled ''Genetic variants in 6-mercaptopurine pathway as potential factors of hematological toxicity in acute lymphoblastic leukemia'' in Pharmacogenomics  Journal, 2015.

Abstract:

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD). The hallmark of UC lesions is infiltration of the intestine by mononuclear cells, predominantly lymphocytes. There is growing epidemiological evidence that suggest implication of vitamin D deficiency in the development of IBD and also its influence on disease severity. C-reactive protein (CRP) levels are often used in the follow-up of patients with IBD. Adhesion molecules such as intercellular adhesion molecule (ICAM) and E-selectin are cell surface-expressed glycoproteins that play a prominent role in leukocyte recruitment and proliferation in the inflamed colon. The aim of the present descriptive study is to investigate the role of vitamin D, CRP and the adhesion molecules ICAM and E-selectin in prediction of severity of UC.  Samples of blood were taken from 24 diagnosed cases of UC for measurement of serum levels of vitamin D, CRP, ICAM and E-Selectin by enzyme-linked immunosorbent assay (ELISA). Severity index for UC cases and its correlation with the aforementioned measures was determined. Comparing to control groups formed by individuals without clinical and/or laboratory signs of UC, UC patients showed significant increased levels (p<0.001) of sICAM-1, E-selectin and CRP in serum samples. On the contrary, vitamin D levels were significantly decreased in UC patients. Strong correlation was statically determined between vitamin D deficiency, CRP, adhesion molecules and UCEIS.  In conclusion, the present work confirmed the role of vitamin D deficiency, adhesion molecules notably ICAM and E-selectin and the acute phase biomarker CRP in pathogenesis of UC. 

Biography:

Omar Bashandy is gastroenterologiest and Endoscopiest working in Dakhla Oasis general hospital western desert Egypt had Master degree in internal medicin Ain Shams univ And well trained on performing upper and lower GIT endoscopy

Abstract:

Portal hypertension is a major complication of liver cirrhosis and can be a direct cause of variceal hemorrhage and of bleeding related death.

Oesophageal variceal bleeding is one of the most dreaded complications of liver cirrhosis because of its high mortality

Prevalence of varices in patients with cirrhosis is 60-80% with incidence increasing 5% per year. The American Association of the Study of Liver Disease and the Baveno V Consensus Conference on portal hypertension recommended that all cirrhotic patients should be screened for the presence of O.V when liver cirrhosis is diagnosed Identification of non-invasive predictors of O.V and portal gastropathy will able us to carry out UGE in selected group patients thus avoiding unnecessary intervention and at the same time not missing the patients at risk of bleeding.
Serotonin (5-hydroxytryptamine, 5HT) has been the subject of intense biological research since its synthesis in 1951.Erspamer and Asero.originally isolated a potent vasoconstrictor substance from the intestine, which they called enteramine.

About 95% of serotonin in the body is found in the GI tract, of which90%is in enterochromaffin cells (ECs) and 10% in enteric neurons. The remaining of serotonin (5%) is found in the brain.

As serotonin cannot cross the blood-brain barrier, the brain must synthesize its own serotonin.

Virtually all of the serotonin in the blood is derived from the GI tract With respect to the liver, it was found that serotonin has the ability to regulate hepatic blood flow at both the portal and sinusoidal levels

Serotonin is able to induce the contraction of fenestrae which is achieved via a rapid influx of extracellular Ca2+ leading to activation of the myosin light chain In these cells serotonin also inhibits cAMP production, and activates phospholipase A2, causing the release of arachidonic acid The exact significance of these findings has not been fully qualified, it is, however, well established that SEC fenestrae play an important role in the exchange of fluid, solutes and particles between the parenchyma and the blood.

Serotonin may therefore play a role in regulating the exchange of various fluids, solutes and particles across the space of Disse. Serotonin in these cells may also exert complex control over various aspects of inflammation and immunity since arachidonic acid is a precursor of various prostaglandins, prostacyclin, and thromboxane.

Biography:

Will be updated soon

Abstract:

Introduction: Gilbert's syndrome is a functional disorder of the UDP glucuronosyltransferase enzyme defect in the liver causing to decreased secretion of bilirubin to bile. As a result of this disease, serum bilirubin gets above than normal levels. In these patients, there are some studies showing lower cardiovascular risks. In this study, we aimed to investigate the relationship between laboratory results and bilirubin levels in a large number of patients with Gilbert’s syndrome.

Materials & Methods: We collected the data of 1203 Gilbert's syndrome patients and 1155 healthy control groups. The mean age of the patients and the control group were 24.1±6.2 and 23.8±5.1 years respectively (p=0.127). The total and indirect bilirubin values of the patients and control groups were 1.72±0.52 and 0.59±0.21; 0.51±1.53 and 0.44±0.19 mg/dl, respectively.

Results: The mean erythrocyte sedimentation rate (ESR) was significantly lower in patients with Gilbert's syndrome (4.5±4.7 and 5.4±3.3 mm/h, p<0.001). Neutrophil / lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) was high in patients with Gilbert syndrome than in controls (2.68±1.08 and 1.44±0.5; p<0.001 and 10.01±3.8 and 6.8±2.01; p<0.001). Hematocrit levels were similar. Hb levels were higher in patients with Gilbert's syndrome (15.7±1.18 and 15.2±0.98 g/dl, p<0.001). The average MCV values were lower in these patients (83.2±6.1 and 88.5±4.3 fl, p<0.001). Indirect bilirubin levels were associated with RDW (Red Cell Distribution Width) and neutrophil count (Pearson's r=0.141 and 0.087 respectively, p<0.001 and p=0.048). RDW (β=0.164 and p <0.001) and patient age (β=-0.091, p=0.038), were significant parameters associated with indirect bilirubin values in the regression analysis conducted in patients respectively.

Discussion: The mean erythrocyte sedimentation rate was lower in patients with Gilbert's syndrome. This is consistent with data from previous studies which stated the lower cardiovascular risk in these patients. However, verifying this information could not be obtained by the other parameters such as NLR or PLR, which reflects inflammatory conditions. Conversely, the higher NLR and PLR rates in these patients may be due to greater amount of neutrophils or platelets, compared to lymphocytes proportionately. Futhermore, having the lower level of MCV in Gilbert’s syndrome patients, lower erythrocyte volume and also higher bilirubin levels due to increased erythrocyte turnover of some patients, suggests the possibility of thalassemia intermediate forms.