Cairo university, Egypt
Keynote: Satisfactorily Responds to Antituberculous Treatment: Surgery Has no Role in the Management of Idiopathic Granulomatous &Tuberculous Mastitis in Egyptian Women Population. A Recent Study
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Cairo university, Egypt
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Mutah university, Jordan
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OMAR ALI NAFI MRCP Pediatric neurologist , Associated professor of pediatrics, Dean faculty of medicine , Mutah university . karak . Jordan. Member NITAG, Member polio eradication committee in Jordan, Member in measles and rubella eradication committee, Interested in childhood developmental disorders, attention deficit hyperactive disorder. Epilepsy. Cerebral palsy. Childhood immunization
Eradication of poliomyelitis has been a major medical achievement made possible by great efforts on the part of the World Health Organization (WHO) and all countries involved. The main tool which made the eradication possible was the oral polio vaccine (OPV), or the Sabin vaccine. The OPV has been administered over 10 billion times to 3 billion children and has prevented over 13 million cases of polio. With a 99% reduction in polio incidence, and the more recent appearance of OPV-related complications, especially the vaccine-derived poliovirus (VDPV) and vaccine-associated polio paralysis (VAPP),it is important to reconsider the role of these vaccines in polio eradication. There are currently more cases due to VDPV than due to the wild polio virus(WPV).Considering that OPV is the only source of VDPV, the WHO has established a phased plan to withdraw OPV from use and to switch to an inactivated polio vaccine (IPV) by 2020. Therefore, the estimated 126 countries that still use this vaccine in their national immunization programmes need to make adequate plans for securing a sufficient supply of affordable IPV. However, there is some concern that vaccinators and caregivers might refuse to give children >2 injectable vaccines in a single visit, resulting in lower immunization coverage. This review discusses the benefits of Sabin vaccine over the years and its medical implications in the future.
Medical Director, Institute of Allergy and Immunology of West Bahia, Brazil
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Fabrício Prado Monteiro has his expertise and passion in evaluating and improving the health and immunology. He is a Medical Director at Institute of Allergy and Immunology of West Bahia, Brazil & Specialist in Allergology & Immunology (since 2006, by ASBAI). He is a Specialist in Pediatrics (since 2004, by SBP), has masters (UCES/ARG) in Administration and Economics (Management) in Health (public and private). He has built work model after years of experience in research, evaluation, teaching and attention in pediatrics and clinical allergy and immunology, both in hospital and education instructions
IgM is the first immunoglobulin to be expressed on the surface of B cells and the first immunoglobulin isotype secreted during an initial immune response to an exogenous antigen. Mature naïve B cells in response to antigens undergo clonal expansion and differentiation into Ig-secreting cells. A subset of activated IgM+ B cells undergo a process of heavy chain isotype switching resulting in the production of antibodies of different isotypes such as IgG, IgA, and IgE, upon engagement of CD40 with CD40L and interaction with cytokines, and somatic hyper mutation in V region results in the selection of high affinity antibody producing B cells (1,2).
In contrast to secreted IgG, IgM comes in two flavors, pre-immune or without exposure to exogenous antigen also known as “natural IgM” that is spontaneously produced, and the second type is exogenous antigen-induced or “immune” IgM antibodies. In addition to providing early defense against microbes, natural IgM plays an important role in immune homeostasis, and provide protection from consequences of infections and inflammation (1,3).
Beyond its well-known effects on calcium homeostasis and bone mineralization, vit.D has become recognized as a pluripotent immunoregulator of biological functions with a particular role in immune tolerance and antimicrobial immunity. The expression of the vit.D receptor (VDR) in many immune cells have led to recognition of the associations between the vit.D metabolism and infections, allergic and cronic auto immune disorders (4,5,6).
Immunostimulating subcutaneous therapy as proposed, according to protocol and subcutaneous and muscular administration bimonthly of glucan and glucoronidase (ITA BG ®) associated with VIT.D 600.000 UI (HERVA’S PINEDA PHARMACIAS ®) , providing an increase of antigenic recognition because of an efficient activation of antigen presenting cells through up-regulation of their receivers. (7,8).
Thus the activation and degranulation of inflammatory products that cause various clinical manifestations are minimized and regulated, with the consequent clinical improvement and no adverse effects.
Nigeria Field Epidemiology and Laboratory Training Programme,Nigeria.
Academic member of Pasteur Institute, Iran
Parvaneh Mehrbod, academic member of Pasteur Institute of Iran, started her postgraduate study in 2006 at University of Tehran in the field of Cellular and Molecular Biology and pursued her PhD study in Molecular Biotechnology at Universiti Putra Malaysia. She was successful to obtain postdoctoral fellowship awards from Universiti Putra Malaysia (2014), Pasteur Institute of Iran (2016) and University of Pretoria (2016-2018). These years’ experiences of research provided her with the opportunity and enthusiasm for successful international collaborations. She has several publications of her research findings in peer reviewed journals and conference proceedings, and has many more in collaborations.
Samples of body fluids can sometimes reveal evidence of the particular microbe that's causing illness. Blood tests, urine tests, throat swabs, stool sample, spinal tap, imaging scans and biopsies are the type of samplings. Antibiotics, antifungals and anti-parasitics are used against bacteria, fungi and parasites, respectively. In regards to antivirals, they can treat some, but not all, viruses. Examples include some important viruses that cause: HIV/AIDS, Herpes, Hepatitis B & C and Influenza. Regarding influenza A virus (IAV), it is a respiratory tract pathogen which causes a great number of deaths and hospitalizations including approximately 49,000 deaths and up to 35,600,000 morbidity cases annually in the USA alone.
For this kind of infection, lifestyle and home remedies are important. Drinking plenty of fluids, taking vitamin C and zinc and also getting lots of rest are the primary steps. However, the clinical manifestations of this infection are related to immune dysregulation, which cause serious risk factor for morbidity and mortality.
Previously, the treatment focus was on direct effect on the virus. Amantdine and oseltamivir are conventional drugs with side effects which have not been successful in controlling this infection in most of the pandemics and epidemics. Recently, scientists have focused on medications which are able to control this infection indirectly by affecting the virus-host interaction pathways and reduction of the outcomes of this infection.
The use of medications with immunomudulatory properties against influenza infection has been increased recently.
In our research we have tested different drugs and compounds with emphasis on virus-host interaction system; like:
Over-the-counter drugs such as statins, Herbal-marine compound named HESA-A, Complementary and alternative medicine such as Edible Bird Nest (EBN) and also different local plants extracts.
Gbenga J Abiodun is a young Scientist whose research interest focuses on biomathematics, epidemiology and mathematical modelling of the impacts of climate (variability and change) on vector-borne and infectious diseases. He has completed his Masters and Doctoral degrees in Mathematics at the University of the Western Cape (UWC) in 2012 and 2016, respectively. He has worked extensively on infectious diseases and published peer-reviewed papers in high-profile international journals
The recent resurgence of malaria incidence across epidemic regions in South Africa has been linked to climatic and environmental factors. An in-depth investigation of the impact of climate variability and mosquito abundance on malaria parasite incidence may therefore offer useful insight towards the control of this life-threatening disease. In this study we investigate the influence of climatic factors on malaria transmission over Nkomazi municipality. The variability and interconnectedness between the variables were analyzed using wavelet coherence analysis. Time-series analyses revealed that malaria cases significantly declined after the outbreak in early 2000, but with a slight increase from 2015. Furthermore, the wavelet coherence and time-lagged correlation analyses identified rainfall and abundance of Anopheles arabiensis as the major variables responsible for malaria transmission over the study region. The analysis further highlights a high malaria intensity with the variables from 1998 – 2002, 2004 – 2006, and 2010 – 2013 and a noticeable periodicity value of 256 - 512 days. Also, malaria transmission shows a time lag of between one month to three months with respect to mosquito abundance and the different climatic variables. The findings from this study offer a better understanding of the importance of climatic factors on the transmission of malaria. The study further highlights the significant roles of An. arabiensis on malaria occurrence over Nkomazi. Implementing the mosquito model to predict mosquito abundance could provide more insight on malaria elimination or control in Africa.
Medical Acupuncture and Pain Management Clinic, Brazil
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Huang Wei Ling, born in Taiwan, raised in Brazil since the age of one, graduated in medicine in Brazil, specializing in infectious and parasitic diseases, a General Practitioner and Parenteral and Enteral Medical Nutrition Therapist. Once in charge of the Hospital Infection Control Service of the City of Franca's General Hospital, she was responsible for the control of all prescribed antimicrobial medication, and received an award for the best paper presented at the Brazilian Hospital infection Control Congress in 1998
She was coordinator of both the Infection Control and the Nutritional Support Committee in Sao Joaquim Hospital in Franca, and also worked at the infectious Sexually Transmitted Disease Reference Center. She is the owner of the Medical Acupuncture and Pain Management Clinic, and since 1997 has been presenting her work worldwide concerning the treatment of various diseases using techniques based on several medical traditions around the world.
Statement of the problem: Very few publications provide sound scientific data used to determine which components are essential for Infection Prevention and Control (IPC) programs in terms of effectiveness in reducing the risk of infection. In recent years, a range of regional best practice or policy principles have been developed that address what could be considered as core components of IPC programs. However there remains a major gap in relation to the availability of international best practice principles for core components of IPC programs.
The purpose of this study was to show why patients still catch hospital infections despite IPC programs. A better understanding of a variety of theories is needed that could explain the physiopathology of diverse diseases described in the medical past history, which are usually disregarded clinically today. A broader view seems to show the necessity of seeing the patient as a whole; not only focusing on the disease in the prevention of these hospital infections.
The methodology used was a review of these theories such as those presented by Hippocrates (“Natural forces within us are the true healers of disease.”), as well as others from oriental medicine, which explain that diseases originate from three factors: external (exposure to cold, heat, humidity, wind and dryness), internal (emotional) and dietary.
Findings: Having a broader view of the patient as a whole (Yin, Yang, Qi, Blood energy and Heat retention), we can understand better the formation of hospital infection which is a systemic energy reaction of our body undergoing normal hospital treatment.
Conclusion: To understand better why a patient is still catching hospital infections, despite these IPC programs, we need to broaden our view observing all emotional, environmental and dietary factors, as well as studying his energy situation at the moment of admittance identifying his risk of hospital infection.
Medical doctor, Nigeria
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Moses Katbi is a UK General Medical Council (GMC) certified medical doctor with immense experience in Public Health in developing countries. Currently, He is leading a USAID funded project on achieving HIV epidemic control in Nigeria. He pioneered a study on novel approach called Strategic Index Case Testing (STRICT) which identifies new infection among sexual partners of PLHIVs published in a peer-reviewed journal. Dr. Katbi has background also in MNCH where he worked towards reducing maternal, newborn and child mortality rates in Nigeria. He initially worked in the UK as emergency medicine physician. His interest is in novel public health program implementation and implementation science research. He has postgraduate degrees in public health and business administration from the UK and USA.
Statement of the problem: A cohort of People Living with HIV (PLHIVs) refused to commence antiretroviral therapy (ART) through conventional linkage methods (self-referral, intra and inter facility referral and community referral). Community Treatment Initiative (CTI) is a community oriented intervention developed to link this group of linkage-resistant PLHIVs to care and treatment in nine program areas across three states in Nigeria. CTI aims to take life-saving treatment to PLHIVs in the community and the confines of their homes.
Methodology and theoretical orientation: A non-controlled Interventional study that evaluates the impact of CTI on ART uptake by examining the proportion of linkage-resistant PLHIVs linked to treatment through CTI in nine high burden program areas. PLHIV data between Octobers – December, 2015 was collected from National HIV registers. A cohort of PLHIVs that rejected linkage to treatment were selected, followed up and offered ART using CTI approach. We analyzed data using excel and SPSS version 20.0. Simple proportion was used to estimate proportion of linkage-resistant PLHIVs, retention and viral suppression rates. Chi square test showed association between categorical variables with level of significance set at P- value less than 0.05.
Findings: A total of 541 (20.4%) PLHIVs seen from October – December, 2015 refused linkage to treatment using conventional linkage methods (P Value <0.0001). 377 (69.7%) of the linkage-resistant PLHIVs were linked to treatment using CTI interventional approach (P Value <0.0001). 332 (88.1%) of PLHIV linked to treatment through CTI were retained in care after a six months observation period (P value <0.0001). 259 (78%) of PLHIVs retained in care attained viral suppression.
CTI is effective in improving linkage of PLHIVs to ART and therefore could be scaled up to increase ART Uptake which may help with control of new infections to achieve epidemic control.
College of Medicine and Health Sciences, University of Gondar, Ethiopia
Background: Visceral Leishmaniasis is an important public health problem in Ethiopia, affecting poor rural communities. The most commonly affected people are mainly migrant daily laborers and settlers to the Visceral Leishmaniasis endemic regions. Although management of Visceral Leishmaniasis in Ethiopia is free of charge, patients are likely to face a lot of direct and indirect expenses during their illness.
Objective: The aim of this study was to assess the cost of illness of Visceral Leishmaniasis patients and associated factors in Northwest Ethiopia.
Methods: Institution based cross-sectional study was conducted amongst Visceral Leishmaniasis treated adult patients. The data were collected between September and December 2015 from the three main Visceral Leishmaniasis treatment centers in Northwest Ethiopia (University of Gondar hospital, Abdurafi Health Center and Metema Hospital) using a structured questionnaire. Data included direct and indirect costs. Data were collected separately for the period before and after Visceral Leishmaniasis diagnosis. Data were entered into Epi-Info version 3.5.4 and transferred to SPSS version 20 for analysis. The population characteristics and cost of illness was presented in a descriptive statistics using frequency, mean, median, range, standard deviation. Factors associated with high cost were identified using logistic regression model. A p-value of <0.05 was considered statistically significant.
Results: The median total cost of care per episode of Visceral Leishmaniasis from patients’ perspective was 3855 ETB. The largest cost category was indirect costs (70.4%) followed by medical (19.8%), and non-medical (9.8%) direct costs. The median days elapsed for consultation at alternative care providers and a public health facility prior to Visceral Leishmaniasis diagnosis was 60 days (40-80 days). The median total cost spent during the period of first presentation to a health care center until Visceral Leishmaniasis diagnosed was 1141 ETB per patient. Low monthly income (AOR=8.19; 95%CI: 4.9-13.5), HIV co-infection (AOR=6.67; 95% CI: 2.1-20.4) and superimposed pneumonia (AOR=1.93; 95%CI: 1.0-3.4) were associated with high direct cost. Similarly, patients with HIV (OR=0.12 CI :( 0.1, 0.8)) low monthly income (AOR=2.321; CI: 2.2, 14.7) and pneumonia co-infection (AOR=1.44; CI: 1.3, 3.4) were factors associated high indirect cost of illness.
Conclusion: Despite the fact that Visceral Leishmaniasis treatment and care is given for free in the health care system of Ethiopia, the cost of illness for the patients was still found to be high.
Ntra Sra De Candelaria in Santa Cruz de Tenerife
Prof Ana Belen Fernández, specialist in Anesthesiology and Resuscitation, has her greatest experience in the critically ill post-surgical patient, and abdominal septic shock. She is a researcher of Multidrug-Resistant Pseudomonas Infections and its more effective antibiotic treatment as well as the expansion of the high-risk clones by disemination of multiresistant bacteria. Currently belongs to the Department of Anesthesiology of the University Hospital Ntra Sra De Candelaria in Santa Cruz de Tenerife since 2005.
The increasing prevalence of nosocomial infections produced by multidrug-resistant (MDR) or extensively drug-resistant (XDR) Pseudomona Aeruginosa strains severely compromises the selection of appropiate treatments. Apart from its notable intrinsic resistance, P. Aeruginosa posses an extraordinary ability to develop resistance to nearly all available antimicrobials, through the selection of mutations in a complex network of genes implicated in resistance and their regulation. This fact has major consequences for the efficacy of treatments for P. Aeruginosa infections, mainly among critical patients at the ICU or those with chronic infections where the problem is magnified due to the high frequency of hypermutator strains, which present a spontaneous mutation rate up to 1000 times higher than normal. Ceftolozane- Tazobactam is a cephalosporin-ß-lactamase inhibitor combination that exhibits potent in vitro activity against Pseudomona Aeruginosa, including strains that are resistant to other ß-lactams, but emergence of resistance has been noted in various reported cases, probably by the previous administration of carbapenems, cephalosporin and / or piperacilin-tazobactam in patients critically illness. There is an urgent need to develop protocols and guidelines for each hospital in order to administer Ceftalozano- tazobactam in selected patients as the first therapeutic option, and thus decrease the growth of MDR/XDR P. aeruginosa strains.
National Institute of Health & Family Welfare, India
Introduction: HIV epidemic in India is concentrated. Surveillance data shows that with high prevalence of HIV is among High Risk Groups. High risk groups include paid sex work by females, homosexuals, injecting drug users and transgender. Moderate prevalence of HIV is among bridge population which includes single male migrants and long distance truckers. Low prevalence of HIV is among general population. The pregnant women are proxy for general population. The drivers of the epidemic includes unprotected paid sex with Female Sex Workers (FSW), unprotected anal sex between Men who have Sex with Men (MSM) and Hijra/transgender (H/TG) people and Injecting Drug Use (IDU). Based on these transmission dynamics, India’s HIV epidemic pattern is monitored among the high-risk groups, bridge populations as well as the general population. Sentinel surveillance is being undertaken in India annually since 1998 to assess trends of HIV infection, estimate the HIV prevalence and disease burden. Based on these transmission dynamics, India’s HIV epidemic pattern is monitored among the high-risk Groups, bridge populations as well as the general population. India is committed to end HIV/AIDS as public threat by 2030.
Objective of the study is to determine plausible factors for declining trends of HIV infection of India among general population, bridge population and high risk groups.
Methodology: The study is based on secondary sources of information from National Family Health Surveys of various rounds and HIV sentinel Surveillance reports, which are available in public Domain
Findings: 15th round of HIV sentinel surveillance shows that the estimate of HIV prevalence of general population is 0.28%, (95%CI: 0.26-0.29), 0.51% (95 CI: 0.34-0.68) among single male migrants (SMM), 0.86%(95% CI: 0.64-1.07) among long distance truckers (LDT), 1.56% (95% CI: 1.46-1.66) among FSW, 2.69% (95% CI: 2.47-2.91) among MSM, 3.14% (95% CI:2.61-3.66) among H/TG and 6.26% (95% CI: 5.92-6.59) among IDUs. Over the years, there has been decline of HIV prevalence of general population and high risk group; however, the trend appeared to be stable at a high level among IDUs. Trends among different population groups at national are derived using moving average method at sites consistent since 2003-07. At the national level, trends continue to be declining among ANC
clinic attendees from 0.8% in 2003 to 0,28% in 2017 , FSW from 10.33% in 2003 to 1,56% in 2017 and MSM from 8.47% to 2.69% during the same period; while the trend appeared to be stable after 2006 at high level I,e,, 6.92% in 2006 to 6.26% in 2017 among IDUs. In India, HIV epidemic continues to be heterogeneous, with varied levels of HIV prevalence by location and population. Each state has a different dynamics of epidemic .In the high prevalence states located in southern and western part of India among FSW, MSM and H/TG indicates an epidemic primarily driven through unprotected sexual intercourse while in many of the north-eastern states, high prevalence among IDU, FSW and MSM, as well as in ANC populations, indicates an epidemic fuelled by multiple, possibly interrelated, risk behaviours. Prevalence of HIV among migrants and truckers is 2- 3 times higher than that of ANC clinic attendees, giving weight to the hypothesis that migration is playing an important role in the high outmigration States.
With robust monitoring system developed in the country to prevent and sustained intervention planning and implementation helped in declining HIV prevalence in the country. Mass media program in the country through electronic and print media, educating the people about HIV infection and methods of prevention. However, one of the major challenges of the HIV prevention program in India is the ignorance and denial of HIV risk. Study shows that to obtain information on HIV testing, all respondents were asked whether they had ever been tested for HIV/AIDS. Study indicates that only 10% of respondents had ever been tested for HIV.
Conclusion: India is committed to the goal of “End of AIDS” as a public health threat by 2030. While the programme has been hugely successful in the past, the current challenge is to understand the diversity of this HIV epidemic, having complex and multiple drivers and therefore require a multi dimensional approach. It requires strengthened prevention programmes among high risk populations and their clients like migrants and truck drivers with high-risk behaviour, as well as among spouses/partners of these populations. Epidemiological findings need to be taken into consideration for tailoring the national programme’s responses and treatment must be complemented.
Professor of Surgery, Cairo University Egypt