Day 1 :
Warren Alpert Medical School of Brown University, Providence, RI, USA
Time : 10:00 - 10:45 am
Dr. Danni Fu ia an General internal medicine physicians, or internists, are primary-care doctors who perform physical exams and treat a wide spectrum of common illnesses in adult men and women. One of every four physicians in the U.S. is an internist, many of whom are certified in one of 19 subspecialties, including cardiology, infectious disease and medical oncology.
Introduction: Subtherapeutic anticoagulation (AC) of mechanical aortic valves (MAV) can lead to thrombosis causing obstruction. Hyperdynamic left ventricular (LV) systolic function, elevated LV outflow tract velocity, and aortic insufficiency (AI) can be seen on echocardiogram (TTE) due to changes in transvalvular gradient. Thrombolytics (tPA) are used in high-risk candidates while surgery is done in low/moderate risk candidates and those with large clots. Our case shows a high-risk candidate treated with a novel tPA protocol that resulted in the resolution of aortic valve obstruction. Case Description: 54 yo female with MAV underwent abdominal surgery where AC was held now presenting with cardiogenic shock. TTE showed new severe aortic stenosis (AS) due to leaflet restriction from a large thrombus along with new AI, which precluded mechanical circulatory support. She was a poor surgical candidate and was given 50mg of alteplase at a rate of 8.3 mg/dl along with low intensity IV heparin. After 2 hours, TTE showed resolution of AI and significant improvement of AS. Unfortunately she experienced cardiac arrest due to other reasons and failed to respond to multiple rounds of resuscitation. Hemoglobin checked during the code blue was stable, ruling out hemorrhage as the cause of death. Discussion: tPA infusion for AV thrombosis is generally recommended at an ultraslow rate of 25mg over 25 hours followed by IV heparin 6 hours post infusion. Given the instability of our patient, we administered 50mg of tPA over 6 hours, simultaneously with heparin, which led to the resolution of AI and improved transvalvular gradients. Observational studies indicate lower complication rates with the ultraslow protocol, but it can fail in those with severe symptoms or larger thrombus burden. Our case demonstrates a new protocol that can be considered in patients with hemodynamically unstable AV thrombosis.
Assistant professor. Department of Dermatology. Hospital for Tropical Diseases, Goiânia, Brazil
Time : 10:00 - 10:45 am
Dr. Danilo Augusto Teixeira is an Dermatologist, graduated in Medicine and with medical residency in Dermatology from the Federal University of Goiás. Fellow in Dermatological Surgery
Summary: The encapsulation of hyuronic acid is one of the possible complications resulting from fillings performed with this substance. The present report aims to demonstrate that ultrasound-guided hyaluronidase injection is an effective method for resolving such a complication. We describe a case that illustrates the application of the ultrasound-guided technique and with that we intend to help dermatologists to reach an effective and resolute outcome in the treatment of these complications. Case report: The patient underwent 2 filling sessions with hyaluronic acid (HA) in the bilateral infraorbital region, with an interval of 6 months between them, performed by a non-medical professional. After that, the patient evolved with a complaint of edema at the filling site on the left, with consequent indication of reversal with hyaluronidase, by the same professional. However, it did not obtain satisfactory results, being referred to our service. After evaluation, a new reversal session was indicated with 800 IU local hyaluronidase, guided by ultrasound (US) and performed by cannula. However, she returned after 23 days, with the same complaint. The procedure performed with a cannula was not able to completely reverse the accumulation of hyaluronic acid. A procedure with 600 IU of hyaluronidase guided by US was again indicated, now using a 30 g needle, because in this session the presence of a pocket around the HA was evidenced, which prevented the cannula progression and correct product degradation. After the second session, there was complete resolution of the condition. Discussion: In the last decade, there has been a significant increase in the number of aesthetic procedures performed around the world. One of the most commonly performed procedures is filling with hyaluronic acid. Several complications arising from such procedures are described in the literature, such as: tissue necrosis, palpable nodules, granulomas and infections. Recently, an increase in the demand for dermatological services has been observed, the origins of the aforementioned concerns. Therefore, it became necessary to describe an effective technique for resolving hyaluronic acid encapsulation. In the case described, after application of hyaluronidase in the perilesional region, through an ultrasound-guided cannula, there was no satisfactory improvement in the condition. This is due to the presence of the so-called hyaluronic acid encapsulation, preventing penetration of the cannula and the action of hyaluronidase by contiguity. We showed that after the infiltration of intralesional hyaluronidase with a 30g needle guided by ultrasound, there was complete remission of the hyaluronic acid content. The technique described above is a highly effective method for resolving this type of complication and is easy to apply
University of Brazil , Brazil
Keynote: Efficacy and tolerance of probiotic E. lactis SF68® in subjects with sebum production alterations
Time : 11:00 - 11:45 am
Federico Bianchi is a Managing Director & Head of Asset Management at Starwood Capital Europe, based in London and responsible for the management of skin
Relationship between gut microbiota and skin has been supposed since 30’s by 2 dermatologists. Dr. Stokes and Dr. Pillsbury. Now cumulative evidences are confirming the presence of a gutbrain-skin axis, that connects intestinal bacteria, stress and emotions, and diet, to acne severity and other skin conditions. Gut microbiota is demonstrated to influence systemic inflammation, oxidative stress, glycemic control, tissue lipid content: all this has significant implications in some skin diseases (like acne, seborrheic dermatitis, atopic dermatitis, psoriasis). In many acne patients has been demonstrated qualitative and quantitative alteration of microbiota.
MATERIALS AMD METHODS :
25 patients (19 F; 6 M), aged between 20 and 66 Y.O. , presenting sebum production skin alteration as seborrheic dermatitis, impure skin (acne-prone skin), vulgaris acne (mild-moderate grade), not in therapy, were enrolled. The spontaneous single arm study has been performed in one single centre, in Italy. Patients’ signs and symptoms were evaluated clinically (erythema, desquamation, open comedones, closed comedones, papules, pustules, seborrhea) and instrumentally (skin electrical capacitance (hydration), surface lipid level (sebometry), epicutaneous pH, trans epidermal water loss, skin surface microrelief).
Significant reduction of: - Erythema - Skin desquamation - Open comedones - Closed comedones - Papules - Pustules - Seborrhea Instrumental outcomes of treatment are summarized in below graphics: - Skin electrical capacitance (Corneometer):
Jhajjar University, Haryana, India
Time : 12:00 - 12:30 pm
Kunal Joon had completed MSc masters virology from Jhajjar University , Haryana.
DNA ARCHITECTURE THEORY
DNA contains a gene and act as a architecture fro cell
It act as a digital clock for the cell division
1 DNA base pair supplies energy to the cell for division as when the cell divides before cytoplasmic division chromosome divides and during chromosome division a huge amount of energy is released
2 this energy is supplied for division of organelle and accurate amount of energy is released by DNA for cell to divide it is during S phase
3 During meiotic when chromosome pair up then energy is released .
How DNA decides what size cell has to divide ?
DNA decide as it contains different genes activate at different places which decide cell size
Similar genes are also present like
1 skin colour (for outer body)
Due to difference of origin of many tissues and different function cell have different size
Treatment of cancer ( at any stage)
Cancer can be treated at any stage by introduction of gene leading to deactivation of oncogenes through
Antibodies or any other method which leads to destruction of cancer cells and can lead to cure of cancer at any stage.
Cause of formation of T loop
The activation oncogenes due to DNA backward rolling and formation of mRNA and formation of oncoprotiens lead to uncontrollable cell division
Deactivation of onocogenes by inside heat generation through heat gene activation
Through nuclear medicine
Michelle S Min , University of California, USA
Time : 1:00 - 1:30 pm
Michelle S. Min is a board-certified
Introduction: Connective tissue diseases can be challenging to treat, and extensive cases often require systemic and/or procedural intervention. Recalcitrant disease significantly affects quality of life and can cause disability. Herein, we share our experiences and novel approaches to such challenging cases.
Janus kinase (JAK)-inhibitors for Dermatomyositis (DM): We will review our success in treating recalcitrant DM with tofacitinib, a JAK 1/3 inhibitor, in the largest case series available.1 Eleven patients with refractory DM were given tofacitinib, doses ranging from 5 mg po BID to 10 mg po BID. All patients had improvements in their skin appearance (Figure 1), pruritus, and muscle disease if present. The average Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) activity score improved by 17.8, with an average improvement of 19 points in amyopathic DM, 16.75 in classic DM, and 17 in juvenile DM. Therapy was well-tolerated.
Mycophenolate Mofetil for Salt-and-Pepper Dyspigmentation (S&P): Vitiligo-like depigmentation with perifollicular pigment retention, or salt-and-pepper dyspigmentation (S&P), is classically associated with severe systemic sclerosis (SSc). S&P can occur in other autoimmune sclerosing conditions including mixed connective tissue disease (MCTD) with scleroderma features. Unfortunately, such pigmentary changes are disproportionately seen in skin of color, and SSc clinical studies often neglect studying S&P. We report 3 African American patients with either SSc or MCTD with scleroderma features who suffered from S&P that responded to mycophenolate mofetil (MMF).2 All 3 patients experienced >75% improvement of S&P with MMF,
Hyaluronidase Injections for Oral Microstomia: Perioral changes are leading causes of concern to individuals with SSc. Few therapeutic options are available. We completed the first case series investigating local hyaluronidase intradermal injections in four individuals with debilitating oral microstomia (2 patients with limited SSc, 1 with diffuse SSc, and 1 MCTD with sclerodermoid features). Patients received 200 units of intradermal hyaluronidase monthly. All had improvements in mouth opening capacity (MOC) and Mouth Handicap in Systemic Sclerosis (MHISS). Patients’ MOC gained an average of 0.9 cm (range 0.5 to 1.6 cm) or 19.1%, and MHISS decreased 19.3 (17-24) or 61.9%. No serious adverse events were noted.
Conclusion: Patients with recalcitrant connective tissue disease require physicians to consider novel and/or unconventional therapeutic approaches. We share these cases to highlight potential treatments that physicians may want to consider for their sickest patients.