Conference Schedule

Day 01 Schedule

Mar 19, 2020

Plenary Talks

Title: The Role of Robotic Assisted Radical Prostatectomy in Organ Confined High Risk Prostate Cancer


Abstract


Prostate cancer PCa is the most common non skin malignancy diagnosed in the western hemisphere. One in every seven patient with PCa will eventually die from the disease. PCa is stratified into different risk categories based on the patient's prognosis. High-risk disease was formerly characterized by an increased risk of metastasis and lethality, requiring complex treatments. At least 15-20 % of prostate cancer patient present with high risk organ confined disease. The treatment of organ confined high risk prostate cancer (OCHRPCa) is challenging. The introduction of robotic surgery represent a breakthrough in the surgical treatment of PCa. Robotic technique proved to be of lower morbidity and mortality when compared to the traditional open retropubic surgical approach. In this editorial we are reviewing the role robotic assisted radical prostatectomy (RARP) in the treatment of OCHRPCa. With close to 250 000 new case annually and 35 000 death, prostate cancer (PCa) represent the most commonly diagnosed non cutaneous malignancy and the second leading cancer related death in the United States [1]. Many patients present with organ confined disease, yet 15-20 % of them die due to the progression of the PCa, and that is the representation of real high risk organ confined disease [1,2]. The American Urological Association (AUA) adopted D'Amico criteria to define high risk prostate cancer. This classification uses an endpoint of PSA failure after treatment and leads to the defining “high-risk” as a clinical T stage ≥cT2c, a Gleason score ≥8, or a PSA >20 ng/mL. The extent of tumor in the biopsy specimens (the percentage of core involvement and the ratio of involved cores) was found to be associated with prostate cancer–specific mortality and was additionally adopted as by National Comprehensive Cancer Network (NCCN) for risk classification [3]. The biologic behavior of organ confined high risk prostate cancer (OCHRPCa) varies, and current diagnostic tools lack staging accuracy. Most of the regulation authorities agree to define OCHRPCa as prostate cancer with one or more of the following characteristics, PSA >20 ng/mL, Gleason ≥8, T2c, or > 40% involvement on the biopsy and that should be associated with lack of negative work up. Negative work up is defined as a bone scan that does not show bone metastasis and computerized tomographic study that does not show insolvent of lymph node or surrounding organs [1,2,3,4]. Surgery and radiation with androgen deprivation (ADT) are commonly offered to men OCHRPCa.. The treatment for high-risk localized prostate cancer has evolved, based on evidence from clinical trials that have established important principles of management. According to the AUA guidelines, the treatment of (OCHRPCa can be radiation therapy and androgen deprivation therapy or surgery [2]. European Association of Urology (EAU) guidelines now support a role for RP in selected OCHRPCa patients as a treatment option [4]. The adoption of radical prostatectomy (RP) as a treatment option for OCHRPCa was due to the reported 5-year PSA relapse–free survival rates ranging from 55%–71% and 10-year prostate cancer–specific survival rates from 72%–92% [4, 5]. We should stress of the important of associating radical prostatectomy with extended pelvic node dissection (ePLND). This means that the surgeon should remove all the pelvic lymph node that accompanies the iliac vessels to the bifurcation of the aorta [6]. The justification for extended PLND in OCHRPCa is that nodal spread can occur in up to 40% of patients making such a wide dissection essential for three reasons: the therapeutic benefit, the more accurate staging to estimate prognosis and to inform the need for subsequent therapy [7]. The big question remain whether RP is superior to radiotherapy combined with ADT. Indeed no prospective randomized study addressed this question, however several studies have retrospectively compared radical prostatectomy with radiotherapy. A retrospective studies compared the outcome of RP with radiation and ADT in patient with OCHRPCa found equal 10 years cancer free survival in both groups. However, the risk of all-cause mortality was greater after radiotherapy with ADT when compared to RP [8]. Although a retrospective randomized study from Memorial Sloan Kettering Cancer Center found similar cancer free survival in OCHRPCa patients after radical prostatectomy when compared to radiation and ADT, an absolute benefit of 7.8% in distant metastasis–free survival was suggested favoring RP [9]. RP turns to be superior to radiation combined with ADT in healthy patient with long life expectancy. However, the traditional open retropubic radical prostatectomy is known to be a morbid operation that was difficult to master [10]. Since its introduction by Dr. Menon, the role of robotic assisted radical prostatectomy (RARP) in the treatment of prostate cancer has been investigated thoroughly. Indeed, RARP was associated with lower blood loss and transfusion rate and much greater functional outcomes in contrast to the traditional RP [11]. RARP was advantaged in terms of perioperative and oncologic outcomes [11, 12]. The impact of switching from traditional open RP to RALP in the treatment of OCHRPCa is still under investigation. No large series of RARP in OCHRPCa patients or randomized trials comparing RARP with other treatments have been reported. Recent literature shows better oncologic outcome for RARP when compared to open RP, the positive margin and biochemical recurrence indeed were in favor of RARP [14] reduced blood loss and need for blood transfusion [14] as well as potential benefits to continence and erectile function recovery [14]. Yuh et al. found in their review of the surgical outcome of RARP in OCHRPCa the mean operative time was168 min, and estimated blood loss was 189 ml. Mean length of hospital stay and catheterization time were 3.2 and 7.8 d, respectively. The average rate of organ confined disease was 35% (range: 7–48%), and the positive margin rate was 35% (range: 12–53%). And finally their three-year biochemical recurrence–free survival ranged from 45% to 86% and the overall complication rates ranged from 3% to 30%. Unfortunately many of the studied series did not fulfill the Martin criteria for complication reporting, and thus events may be underreported [15]. The available scientific evidence appears to favor radical prostatectomy as the initial approach of choice to treat patients with OCHRPCa. Since RARP has lower morbidity than traditional open approach, it make sense to utilize as this approach to treat OCHRPCa instead of the open traditional technique. Many factors were studied and found to be surrogate with better oncologic outcome and cure. Zugor et al. in their analysis of their own data, found RARP to be safe and effective in the treatment of OCHRPCa. The group, also, highlighted the fact that a higher PSA (> 20 ng/ml) is more likely to be associated with non-organ confined disease, lymph node positivity, and positive surgical margins in patient underwent RARP [16]. Pelvic node dissection is considered the best method for lymph node staging, with potential curative. The risk of biochemical recurrence and cancer-related death for each positive lymph node resected increases [17]. A median yield ranging from 7 to 24 lymph nodes resected when performing RARP was accompanied with increased PSA free survival [17,18]. In a large multi-institutional study, only (37%) of patient with OCHRPCa needed adjuvant treatment after RARP. The observed 5 years biochemical recurrence free and cancer free survival was as high as 50 % and 87% respectively after RARP for OCHRPCs patients [18]. Age should not be the only exclusion factor when considering RARP in the presence of OCHRPCan due to the risk of urinary incontinence. Nyarangi-Dix et al. found out that it takes longer for incontinence to recover in older patients. It Healthy 70 year old patient may gain continence back up to one year after the surgery. The group concluded that age should not be considered alone as deterring factor to treat OCHRPCa with RARP [19]. It is not uncommon for PCa to recur after radiation even in organ confined disease, and risk of recurrence even multiplies in OCHRPCa [4,5]. PCa is considered high risk if it recurs after radiation. Open salvage RP after radiation failure is considered the standard of care in the absence of nodal and distant metastases [19,20]. Indeed current literature support treating patient with RARP even after radiation failure. Boris et al. demonstrated the feasibility and durability of salvage RARP after failed radiation. The group proved that functional and oncologic outcomes is not inferior to open RP [20]. In summary and whenever feasible, RARP should be considered for patients with OCHRPCa whenever the patient is at acceptable surgical risk. Salvage RARP is good option to treat patient with OCHRPCa after failed radiation.


Biography


Dr. Salkini is the Chief of the Division of Urologic Oncology. He also serves as the Director of Robotics and Urologic Simulation. He is a fellowship trained urologic oncologist who has significant role in treating all types of urologic cancers. His individual surgical case numbers are near the top of the country for robotic urologic procedures.

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Mohamad Salkini

West Virginia University

Title: Gastro-renal communication: role in hypertension


Abstract


In order for normal sodium balance to occur, the amount of sodium that is ingested must equal the amount of sodium that is excreted, mainly in the urine. One mechanism by which sodium balance is regulated involves the sensing of ingested sodium by gastrin secreting cells (G-cells) in the stomach. An increase in intracellular sodium concentration in G-cells, in conjunction with D1-like family of dopamine receptors, increases the transcription and secretion of gastrin. Of all the gut hormones released into the circulation, gastrin is the one that is taken up to the greatest extent by renal tubules. Gastrin transported into renal proximal tubules enhances the renal uptake of circulating L-3,4-dihydroxyphenylalanine which is decarboxylated to form dopamine. Gastrin, via the cholecystokinin B receptor, and dopamine, via its five dopamine receptor subtypes (D1-like [D1R and D5R] and D2-like [D2R, D3R, and D4R]), decrease renal tubular sodium reabsorption, in part, via inhibition of NHE3 and Na+, K+-ATPase activity, resulting in a natriuresis. Excess sodium is excreted and blood pressure remains in the normal range. However, in the presence of variants of G protein-coupled receptor kinase type 4, dopamine receptors (D1R and D3R) are desensitized, impairing their ability to inhibit renal tubular sodium transport. When excess sodium is retained and is not buffered in the interstitial space/lymph, blood pressure increases. Understanding the role of genes and gene-gene and protein-protein interaction in the regulation of renal function and blood pressure may lead to the tailoring of anti-hypertensive treatment based on genetic make-up (pharmacogenomics).


Biography


Pedro A. Jose is Professor of Medicine and Pharmacology and Physiology, The George Washington University School of Medicine & Health Sciences, Visiting Professor, Third Military Medical University, Chongqing, China, Visiting Professor, Anhui Institute of Cardiovascular Disease, Anhui, China, Concurrent Professor, Nanjing University School of Medicine, Nanjing, China, and Distinguished Professor, Henan Provincial People’s Hospital, China. The primary goal of Dr. Jose’s research is to determine the genetic and pharmacogenetic bases of human essential hypertension and the metabolic syndrome. Specifically, the mission of his laboratory is to study the role of dopamine, adrenergic, and angiotensin receptor subtypes and dopamine regulatory genes (e.g., G protein-coupled receptor kinase 4 [GRK4], sorting nexins, gastrin) on sodium transport in specific nephron segments and their roles in the pathogenesis and treatment of genetic hypertension and metabolic syndrome. Dr. Jose’s studies are performed in vitro and in vivo, using molecular and cell biological methods, including gene silencing, gene rescue (e.g., AAV vectors), confocal microscopy and biophysical imaging, and integrative physiology in rats, mice, and humans. A key finding of Dr. Jose’s research is the demonstration of the crucial role of gene variants of GRK4 in the pathogenesis and personalized treatment of hypertension. Dr. Jose and his associates discovered genes that cause high blood pressure when sodium intake is excessive and more importantly, genes that cause high blood pressure when sodium intake is too low. He has published more than 380 scientific articles in book chapters and journals. His articles are currently cited more than 10,000 times, with 66cited 50 or more times, 22 of which are cited more than 100 times. Four of his articles are covers of scientific journals, eight are the subject of editorial commentaries, and two are featured articles. His Hirsch-index is 54 (Web of Science). Dr. Jose has received several academic and research awards, including the 2003 Lewis K. Dahl Memorial Lecture (American Heart Association), 2007 Ernest H. Starling Distinguished Lecture (American Physiological Society), 2007 MERIT award (National Institutes of Health), and 2015 Excellence Award for Hypertension Research (American Heart Association). Dr. Jose has mentored more than 75 undergraduate, graduate, and postgraduate students, and junior faculty members. Many of Dr. Jose’s trainees have become independent researchers with intramural and extramural funding, heading their own laboratories and centers.

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Pedro Jose

The George Washington School of Medicine and Health Sciences, USA

Title: Lysosomal Sphingolipids Metabolism in Podocytopathy and Associated Glomerular Diseases


Abstract


Podocyte dysfunction and depletion may lead to podocytopathy, which constitutes an important pathogenic basis for different glomerular diseases, such as minimal change disease (MCD), diffuse mesangial sclerosis, focal segmental glomerulosclerosis, collapsing glomerulonephropathy and global glomerulosclerosis associated with hyperhomocysteinemia (hHcy), obesity and diabetes mellitus. Despite intensive studies, so far it remains poorly understood how podocytopathy occurs under different pathological conditions. In particular, as a terminally differentiated cell type how podocytes maintain their normal function and respond to different pathological challenges remains unclear. We recently demonstrated that a sphingolipid-mediated signaling pathway is importantly implicated in the development of podocytopathy, nephrotic syndrome (NS) and under some condition it contributes to glomerular sclerosis and end-stage renal disease (ESRD). In podocyte-specific Asah1 (mouse acid ceramidase (AC)) gene knockout mice (Asah1fl/fl/Podocre), severe albuminuria and podocyte foot process effacement were observed, but these mice had no obvious glomerular sclerosis. These pathological changes indicate that Asah1fl/fl/Podocre mice may be a novel animal model for MCD and associated NS. We also demonstrated that lysosomal AC-mediated sphingolipid metabolism critically controls lysosome trafficking or fusion to autophagosomes or multivesicular bodies (MVBs) and subsequent degradation process. AC gene defect or functional deficiency disturbed lysosome degradation of APs and MVBs, which induces AP accumulation and exosome release leading to podocyte phenotypic transition, foot process effacement and ultimate MCD. However, when Smpd1 gene (coding acid sphingomyelinase) was deleted globally or podocyte specifically, inflammasome activation in podocytes, enhanced glomerular inflammatory response and associated injuries under different conditions such as hyperhomocysteinemia, hypertension and obesity were substantially attenuated. We also showed that an exosome secretory mechanism mediated by lysosomal ASM-ceramide signaling pathway is concurrently activated with NLRP3 inflammasomes in podocytes, which work in concert to trigger or promote local inflammatory response, leading to glomerular injury and sclerosis. These recent findings from our laboratory have indicated that lysosomal ceramide-centered sphingolipid metabolism determines the development of MCD, NS and end-stage renal disease due to its actions on NLRP3 inflammasome activation, exosome secretion and exosome-mediated release of inflammasome products. It is believed that these results are particularly relevant to the development of potential novel therapeutic strategies given that the knowledge of chronic inflammation in chronic renal disease available for more than 20 years has not yet resulted in the development of solid therapeutic interventions for glomerular injury or ESRD (Supported by NIH grants DK54927, DK120491).


Biography


Pin-Lan Li, MD. Ph.D., is Professor and Vice Chair in the Department of Pharmacology & Toxicology of the Virginia Commonwealth University. Her laboratory has been working on the molecular mechanisms of chronic degenerative diseases including glomerular sclerosis and atherosclerosis with a focus on sphingolipids-mediated signaling and lysosome pathobiology. She received a M. D. from the Tongji Medical University in China (1982) and Ph.D. from the Heidelberg University in Germany (1992).

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Pin-Lan Li

Virginia Commonwealth University, Germany

Keynote Talks

Title:


Abstract


Lysosomal Sphingolipids Metabolism in Podocytopathy and Associated Glomerular Diseases Pin-Lan Li Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA Podocyte dysfunction and depletion may lead to podocytopathy, which constitutes an important pathogenic basis for different glomerular diseases, such as minimal change disease (MCD), diffuse mesangial sclerosis, focal segmental glomerulosclerosis, collapsing glomerulonephropathy and global glomerulosclerosis associated with hyperhomocysteinemia (hHcy), obesity and diabetes mellitus. Despite intensive studies, so far it remains poorly understood how podocytopathy occurs under different pathological conditions. In particular, as a terminally differentiated cell type how podocytes maintain their normal function and respond to different pathological challenges remains unclear. We recently demonstrated that a sphingolipid-mediated signaling pathway is importantly implicated in the development of podocytopathy, nephrotic syndrome (NS) and under some condition it contributes to glomerular sclerosis and end-stage renal disease (ESRD). In podocyte-specific Asah1 (mouse acid ceramidase (AC)) gene knockout mice (Asah1fl/fl/Podocre), severe albuminuria and podocyte foot process effacement were observed, but these mice had no obvious glomerular sclerosis. These pathological changes indicate that Asah1fl/fl/Podocre mice may be a novel animal model for MCD and associated NS. We also demonstrated that lysosomal AC-mediated sphingolipid metabolism critically controls lysosome trafficking or fusion to autophagosomes or multivesicular bodies (MVBs) and subsequent degradation process. AC gene defect or functional deficiency disturbed lysosome degradation of APs and MVBs, which induces AP accumulation and exosome release leading to podocyte phenotypic transition, foot process effacement and ultimate MCD. However, when Smpd1 gene (coding acid sphingomyelinase) was deleted globally or podocyte specifically, inflammasome activation in podocytes, enhanced glomerular inflammatory response and associated injuries under different conditions such as hyperhomocysteinemia, hypertension and obesity were substantially attenuated. We also showed that an exosome secretory mechanism mediated by lysosomal ASM-ceramide signaling pathway is concurrently activated with NLRP3 inflammasomes in podocytes, which work in concert to trigger or promote local inflammatory response, leading to glomerular injury and sclerosis. These recent findings from our laboratory have indicated that lysosomal ceramide-centered sphingolipid metabolism determines the development of MCD, NS and end-stage renal disease due to its actions on NLRP3 inflammasome activation, exosome secretion and exosome-mediated release of inflammasome products. It is believed that these results are particularly relevant to the development of potential novel therapeutic strategies given that the knowledge of chronic inflammation in chronic renal disease available for more than 20 years has not yet resulted in the development of solid therapeutic interventions for glomerular injury or ESRD (Supported by NIH grants DK54927, DK120491).


Biography


Pin-Lan Li, MD. Ph.D., is Professor and Vice Chair in the Department of Pharmacology & Toxicology of the Virginia Commonwealth University. Her laboratory has been working on the molecular mechanisms of chronic degenerative diseases including glomerular sclerosis and atherosclerosis with a focus on sphingolipids-mediated signaling and lysosome pathobiology. She received a M. D. from the Tongji Medical University in China (1982) and Ph.D. from the Heidelberg University in Germany (1992).

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Pin-Lan Li

Virginia Commonwealth University, Germany

Title:


Abstract


Gastro-renal communication: role in hypertension Pedro A. Jose, MD, PhD Professor of Medicine and Pharmacology and Physiology Division of Renal Disease and Hypertension The George Washington School of Medicine and Health Sciences Washington, DC In order for normal sodium balance to occur, the amount of sodium that is ingested must equal the amount of sodium that is excreted, mainly in the urine. One mechanism by which sodium balance is regulated involves the sensing of ingested sodium by gastrin secreting cells (G-cells) in the stomach. An increase in intracellular sodium concentration in G-cells, in conjunction with D1-like family of dopamine receptors, increases the transcription and secretion of gastrin. Of all the gut hormones released into the circulation, gastrin is the one that is taken up to the greatest extent by renal tubules. Gastrin transported into renal proximal tubules enhances the renal uptake of circulating L-3,4-dihydroxyphenylalanine which is decarboxylated to form dopamine. Gastrin, via the cholecystokinin B receptor, and dopamine, via its five dopamine receptor subtypes (D1-like [D1R and D5R] and D2-like [D2R, D3R, and D4R]), decrease renal tubular sodium reabsorption, in part, via inhibition of NHE3 and Na+, K+-ATPase activity, resulting in a natriuresis. Excess sodium is excreted and blood pressure remains in the normal range. However, in the presence of variants of G protein-coupled receptor kinase type 4, dopamine receptors (D1R and D3R) are desensitized, impairing their ability to inhibit renal tubular sodium transport. When excess sodium is retained and is not buffered in the interstitial space/lymph, blood pressure increases. Understanding the role of genes and gene-gene and protein-protein interaction in the regulation of renal function and blood pressure may lead to the tailoring of anti-hypertensive treatment based on genetic make-up (pharmacogenomics).


Biography


Pedro A. Jose is Professor of Medicine and Pharmacology and Physiology, The George Washington University School of Medicine & Health Sciences, Visiting Professor, Third Military Medical University, Chongqing, China, Visiting Professor, Anhui Institute of Cardiovascular Disease, Anhui, China, Concurrent Professor, Nanjing University School of Medicine, Nanjing, China, and Distinguished Professor, Henan Provincial People’s Hospital, China. The primary goal of Dr. Jose’s research is to determine the genetic and pharmacogenetic bases of human essential hypertension and the metabolic syndrome. Specifically, the mission of his laboratory is to study the role of dopamine, adrenergic, and angiotensin receptor subtypes and dopamine regulatory genes (e.g., G protein-coupled receptor kinase 4 [GRK4], sorting nexins, gastrin) on sodium transport in specific nephron segments and their roles in the pathogenesis and treatment of genetic hypertension and metabolic syndrome. Dr. Jose’s studies are performed in vitro and in vivo, using molecular and cell biological methods, including gene silencing, gene rescue (e.g., AAV vectors), confocal microscopy and biophysical imaging, and integrative physiology in rats, mice, and humans. A key finding of Dr. Jose’s research is the demonstration of the crucial role of gene variants of GRK4 in the pathogenesis and personalized treatment of hypertension. Dr. Jose and his associates discovered genes that cause high blood pressure when sodium intake is excessive and more importantly, genes that cause high blood pressure when sodium intake is too low. He has published more than 380 scientific articles in book chapters and journals. His articles are currently cited more than 10,000 times, with 66cited 50 or more times, 22 of which are cited more than 100 times. Four of his articles are covers of scientific journals, eight are the subject of editorial commentaries, and two are featured articles. His Hirsch-index is 54 (Web of Science). Dr. Jose has received several academic and research awards, including the 2003 Lewis K. Dahl Memorial Lecture (American Heart Association), 2007 Ernest H. Starling Distinguished Lecture (American Physiological Society), 2007 MERIT award (National Institutes of Health), and 2015 Excellence Award for Hypertension Research (American Heart Association). Dr. Jose has mentored more than 75 undergraduate, graduate, and postgraduate students, and junior faculty members. Many of Dr. Jose’s trainees have become independent researchers with intramural and extramural funding, heading their own laboratories and centers.

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Pedro Jose

The George Washington School of Medicine and Health Sciences, USA

Title:


Abstract


Abstract The transurethral prostatectomy syndrome (TURS) is defined as severe vascular hypotension reaction that complicates endoscopic surgery as a result of massive irrigating fluid absorption causing severe acute dilution hyponatraemia (HN) of <120 mmol/l. The vascular shock is usually mistaken for one of the recognized shocks and Volumetric Overload Shock type 1 (VOS1) is overlooked making Volumetric Overload Shock Type 2 (VOS2) unrecognizable. In adults VOS1 is induced by the infusion of 3.5-5 litres of sodium-free fluids and is known as TURS or HN shock. VOS2 is induced by 12-14 litres of sodium-based fluids and is known as the adult respiratory distress syndrome. The most effective treatment for VOS1 and VOS2 is hypertonic sodium Therapy of 5%NaCl or 8.4% Sodium Bicarbonate. The literature on TURS is reviewed and the underlying patho-etiology is discussed. As Starling’s law for the capillary-interstitial fluid transfer, which underlies the principles of fluid therapy, proved wrong an alternative mechanism was found by studying the hydrodynamics of the porous orifice (G) tube akin to capillary. Incorporating the G tube in a chamber (C), representing the interstitial space surrounding a capillary, demonstrated a rapid dynamic magnetic field-like fluid circulation between the C and G tube lumen. The G-C phenomenon is autonomous having both filtration and absorption forces making a true replacement for Starling’s law in every tissue and organ of the body. Suggested References 1. Ghanem AN, Ward JP. Osmotic and metabolic sequelae of volumetric overload in relation to the TURP syndrome. Br J Uro 1990; 66: 71-78 2. Harrison III RH, Boren JS, Robinson JR. Dilutional hyponatraemic shock: another concept of the transurethral prostatic reaction. J Uro. 1956; 75 (1): 95-110. 3. Arieff AI. Hyponatraemia, convulsion, respiratory arrest and permanent brain damage after elective surgery in healthy women. N Engl J Med 1986; 314 (24): 1529-34. 4. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967; ii: 319-23. 5. Danowski TS, Winkler AW, Elkington JR. The treatment of shock due to salt depression; comparison of isotonic, of hypertonic saline and of isotonic glucose solutions. J. Clin. Invest. 1946; 25: 130.


Biography


Ghanem was educated in Egypt and qualified in 1968, Mansoura University, Egypt. He gained postgraduate experience in UK where he was promoted in posts up to the consultant level. He practiced as consultant Urologist in UK, Saudi Arabia and Egypt. During his career he reported over 60 articles. He discovered two new types of vascular shocks, proved that one physiological law is wrong and provided an alternative. He resolved the puzzles of 3 clinical syndromes; TURP syndrome, the LPHS and ARDS. He is now on an editorial board member of many journals while he is happily retired in Egypt.

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Ahmed Nasr Ghanem

Mansoura University, Egypt

Title:


Abstract


ABSTRACT –bladder biopsy series over a period of two and half years from a tertiary referral centre from south India- barbarians at the door-towards point of patient care We are tertiary referral centre of a non profit making establishment of the government of Karnataka. We also host post-doctorate courses, consisting batches of future urologists every year. We get referrals from all over the state and from other parts of the country as well. Bladder tumours are managed in our institute, if extensive spread is present then it goes to regional oncology centre. Most of the patients are investigated for haematuria. Haematuria is also known as the queen of pain and the clinicians are the dragon nights. The relevant interpretation of bladder biopsies is shown to be a single independent indicator for poor prognosis with the identification of necrosis an important surrogate marker. Bladder biopsy data is compiled from the biopsies sent to our laboratory and their various presentations. It’s a histomorphological presentation of the entire range of bladder biopsy cases presented at our institute in the last two and a half a year. The morphology with respect to invasiveness or non invasive (superficial) along with grading and papillary/non papillary nature of neoplasms. We use the ISUP and the WHO 2016 classification at our institute to interpret biopsies. It’s a matter of hot cases and cool solutions.


Biography


Mbbs, MD(pathology), diplomas in human resource, waste management, law and ethics ,pain and palliative care MBA hospital management observer ship in renal and urologic pathology- with 23years experience with several publications and citations Academics research • “A case study of a current waste management practice • Patient with palliative care needs chronic renal failure current objective to have a holistic view of the patient the poor have been provided for in the form of free dialysis, drugs and transplantation under various schemes in the government this study is to emphasis the psychological burden of the patient which can be interpreted in the form of little things which a common man takes for granted for eg passing of urine, sleep patterns • A review of electrophoresis’ patterns in urine • Part of inter observer study on diabetic nephropathy • .Lupus scoring group of proliferative Glomerulonephritis • Artificial intelligence--- urine sediment examination

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Sujatha Siddappa

Institute Of Nephro-Urology, India.

Title:


Abstract


Renal transplantation in sub-Saharan Africa: a case of Tanzania Onesmo A Kisanga1, Francis Fredrick1,2*, Paschal J Ruggajo1,3, Eden E Maro3 1Renal Unit, Muhimbili National Hospital, Dar es Salaam, Tanzania 2Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania 3Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Background: Renal replacement therapy (RRT) is the treatment of choice for patients with end stage renal failure, RRT include dialysis and kidney transplantation. Most sub-Saharan African countries have not developed renal transplantation services and are relying on referring patients to overseas countries. This study was carried out to describe renal transplantation experience in Tanzania. Methods: Forty four renal transplant recipients were recruited in this study. Standardized questionnaire and Swahili version of standard form – 36 (SF-36) were used to collect socio-demographic information, clinical data, laboratory test results and health related quality of life information. Results: Ages of transplant recipient ranged from 21 to 66 years with mean age of 45.9 ± 10.5 years. The leading causes of end stage renal failure among participants was hypertension 58.8% (25/44) followed by glomerulonephritis 15.9% (7/44). Twenty eight (63.6%) of transplantations were paid by the government. Most of the donors (97.7%) were living out of which 26 (59.1%) were siblings and 11 (25%) were second degree relatives (cousins and nephews). Most common complication noted following transplantation was diabetes mellitus 9 (20.5%) and 3 (6.8%) had chronic rejection. Mental health was the domain with highest mean score (75.6 ± 14.3) and role physical had the least mean score (44 ± 45.6). Conclusions: Hypertension was the leading cause of ESRF in this study. Most of the donors were siblings and the costs of transplantation were largely covered by the government. There is a need for concerted effort to establish local kidney transplantation services in Tanzania.


Biography


President, Nephrology Society of Tanzania (NESOT).

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Onesmo Kisanga

Nephrology Society of Tanzania, Tanzania

Title:


Abstract


Heart Failure in Chronic Kidney Disease: Klotho and Heart Aging Kai Chen, Zhongjie Sun Department of Physiology, University of Tennessee Health Science Center, Memphis TN, USA Heart failure is the major cause of mortality for patients with chronic kidney damage (CKD). Changes in the levels of Klotho have been reported to be related to CKD, whereas the relationship between Klotho and CKD-associated heart failure remains unclear. Here, using Klotho mutant homozygous (KL -/-) mice, we found that Klotho deficiency caused hyperphosphatemia and heart failure. Normalization of serum phosphorous by dietary phosphate restriction rescued Klotho deficiency-induced heart failure in male mice. However, low phosphate diet did not rescued hyperphosphatemia and heart failure in KL (-/-) female mice. Therefore, hyperphosphatemia may be the main cause of Klotho deficiency-induced heart failure. Meanwhile, dietary phosphate restriction did not prevented estrogen depletion in KL (-/-) female mice, suggesting that estrogen depletion may involve in Klotho deficiency induced hyperphosphatemia and heart failure. Normalization of serum estrogen level by 17β-estradiol prevented cardiac remodeling and heart dysfunction in KL (-/-) female mice. Moreover, 17β-estradiol treatment maintained phosphate metabolism balance via regulating renal NaPi co-transporter expression. Klotho deficiency induced cardiomyopathy was also accompanied by increased oxidative stress, mitochondrial dysfunction, and cardiac apoptosis, which were prevented by 17β-estradiol. In conclusion, this study demonstrated that Klotho mutant homozygous mice exhibit hyperphosphatemia and heart failure, which can be prevented by dietary phosphate restriction in male mice, but not female mice. Via maintaining phosphate metabolism balance, 17β-estradiol prevented cardiac remodeling and heart dysfunction in KL (-/-) female mice. Keywords: Klotho, chronic kidney damage, hyperphosphatemia, heart failure, estrogen, oxidative stress, apoptosis.


Biography


Dr. Kai Chen is Assistant Professor in the Department of Physiology. He received his MS in Pharmacology from the Beijing Institute of Pharmacology and Toxicology, P.R. China, in 2002, and his PhD in Cardiovascular Pharmacology from the Beijing Institute of Pharmacology and Toxicology, P.R. China, in 2007. Dr. Chen joined the University of Tennessee Health Science Center in 2018 as part of Dr. Sun’s lab.

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Kai Chen

University of Tennessee Health Science Center, USA

Title:


Abstract


ABSTRACT ESWL has become the preferred tool in the urologist’s armamentarium for the treatment of selected renal stones. Compared with open and endoscopic procedures, ESWL is minimally invasive, exposes patients to less anesthesia, and yields equivalent stone-free rates in appropriately selected patients. The outcomes of extracorporeal shock wave lithotripsy (ESWL) depend on several factors and the stone composition has come out as the main factor influencing the effectiveness of ESWL. The density of the stone varies with composition and the stone Density value on non-contrast CT can be used in evaluating fragmentation and clearance of urinary calculi by ESWL. Objective: the purpose of this study was to determine how stone density on NCCT could predict the outcome of extracorporeal shockwave lithotripsy (ESWL) for symptomatic renal stones. Subjects and methods: A prospective study included 50 patients who underwent SWL for symptomatic renal stones to elucidate the stone clearance rate with respect to stone radio-density, after classification of patients in to 3 groups (Group 1, < 500 HU; Group 2, 500-1000 HU; and Group 3, > 1000 HU), from the start of November 2018 to the start of April 2019. Success of the ESWL stone fragmentation has been evaluated after one session of SWL on an outpatient basis. Outcomes were evaluated in a period of time after SWL. Results were analyzed by evaluating the predictive HU value of the stone in all three groups. Results: 50 cases (34 males and 16 females) submitted to the study and all were fit the inclusion criteria. The overall recorded success rate for the input groups were: group1 was 19/21 (90.5%), group 2 was 13/18 (72.22%) and group 3 was 2/11 (18.2%). The cure rate was significantly higher in stone density less than 500 than other patients (P=0.001) Conclusion : Hounsfield units of the renal stones by NCCT scan helps to predict the outcome of stone fragmentation by ESWL. Keywords: ESWL, Stone attenuation value, Non-contrast CT, Hounsfield unit, stone density.


Biography


Tely Dino Jangeer has completed his PhD from Duhok University-College of Medicine in Kurdistan region of Iraq, and now Assistant Urologist at Azadi Teaching Hospital.

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Tely D Jangeer

Azadi Teaching Hospital, Iraq

Title:


Abstract


Objective To evaluate all possible risk factors that can cause impairment of overall renal function in patients with unilateral ureteral calculus and a normal contralateral kidney. Methods This is a prospective study of 90 patients who presented to our institute complaining of renal colic secondary to unilateral ureteral calculus. All patients were evaluated with a thorough history, physical examination, and laboratory and radiological investigations including renal function testing, urine analysis, non-contrast computed topography, and radionucleotide scan. Patients were divided into two groups according to their calculated creatinine clearance using the Modification of Diet in Renal Disease (MDRD) formula. Group I (favorable group) had a creatinine clearance >60 ml/min, while group II (unfavorable group) had a creatinine clearance <60 ml/min. Results The patients’ mean age ± SD was 38.8 ± 11.4 years. Group I included 54 patients (60 %), while group II included 36 patients (40 %). On univariate analysis, factors that were associated with overall renal function impairment were patients’ age, urea-to-creatinine ratio (UCR), use of nonsteroidal anti-inflammatory drugs, stone location, and presence of obstruction. However, using binary logistic regression analysis, only patients’ age, UCR, and presence of obstruction sustained statistical significance in association with renal function impairment. Conclusion The study of factors that help explain the presence of renal impairment in patients with unilateral ureteral calculus is important in the clinical setting. Patients’ age, urea-to-creatinine ratio, and degree of obstruction seem to be significantly associated with overall renal function impairment. Keywords Ureteral calculus • Obstructive uropathy • Renal impairment


Biography


Dr Ammar Al-Ani joined HMC in 2003 and started his residency training program in urology in the same year. He obtained the MRCSI from the Royal College of Surgeons in Ireland in Aug, 2006 and CABU in Mar, 2010. He joined HMC fellowship program in Endourology in Jan, 2010 and finished his fellowship program in Jan, 2012. During his fellowship he did training in endourology with Prof. Olivier Traxer in Tenon Hospital Paris France and Prof. Jens Rassweiler in SLK Kliniken Heilbronn Germany and obtained the Laparoscopy Diploma from the IRCAD Strasbourg France . He played a major role in creation of the various urology fellowship programs in HMC. He worked in collaboration with the medical education department to put the curriculum for the urology fellowship programs according to ACGMEI guidelines. His clinical interests include the minimally invasive management of urinary tract stones including shock wave lithotripsy, percutaneous and ureteroscopic stone removal. He is also interested in clinical teaching and he was awarded HMC Best Teacher Award twice in 2012 and 2013. Currently he is consultant urologist in HMC and instructor in clinical urology in Weill Cornell Medical College in Qatar .He is member of the American Urological Association and the Endourology Society.

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Ammar Abduljabbar Ali Al-Ani,

Department of Urology, Hamad Medical Corporation, Doha, Qatar

Sessions:

Global Congress on Nephrology & Urology

Session Chair:

Ajit Huilgol
a Nephrologist/Renal Specialist in Hebbal, Bangalore

Title: Hydro chemical study and high incidence of human Urolithiasis


Abstract


ABSTRACT Objective: The prevalence and incidence of Urolithiasis have been rising worldwide in recent decades. This research designed to evaluate whether the domestic water is associated with urinary stone formation and whether the quality of this water has any effect on disease prevalence. Methods: To achieve this objective, sixty-five Urolithiasis patients (case) and 22 healthy inhabitants (control) recruited in this study. Domestic water samples collected from water sources that used by clinically identified urinary stone patients and healthy participants during 2018. An analytical framework developed to analyze water quality data using statistical methods to show the significant differences at p < 0.050 in mean and median values of hydro chemical parameters between patient and non-patient samples. Results: This study reveals a kind of association between stone formation and domestic water as evident by the high calcium contents in water used by patients. Conclusions: Examining the water quality on regular basis to avoid its destructive effects on human health and awareness should organize to control the pollution. Keywords: urinary stones, ground water, Hydro geochemistry, patients


Biography


Dr. Rafaat is an associate consultant (Professor) of Toxicology at the Emergency Hospital in the Faculty of Medicine at Mansoura University, Egypt. He obtained a PhD of hydro geochemistry in 2004, at Mansoura University and previously completed an MSc in hydro geochemistry in 2001 at the same institution. He also has a Diploma of toxicology and forensic chemistry (1996) from the Faculty of Medicine and a Diploma of applied chemistry (1993). Dr. Rafaat specializes in medical analysis, toxicology & forensic chemistry as well as water pollution. He has published papers over 10 local paper and 13 in international publications. He has spoken at 55 local conferences and workshops and 15 international meetings. He is currently a member of eight international scientific societies. ?

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Raafat Abdeldayem

Mansoura University, Egypt

Title: The History of Kidney Transplantation - From Myth to Reality, and Beyond


Abstract


Transplantation of human body parts has captured the imagination of mankind from time immemorial. The ancient Hindu texts mention the transplantation of an elephant’s head onto a child’s body by the child’s own father. Both father and son are revered by Hindus as Gods. The Greek mythology, too, is replete with images and descriptions of half-human-half-animal creatures and gods. From those early years, shrouded in the mists of time, was born the idea of organ transplantation. Many discoveries and inventions over the next many centuries, some deliberate, and others accidental, paved the way for better understanding of the human body and its responses to the introduction of a foreign organ. These included the discovery of anesthesia, the recognition of sterile precautions, the discovery of blood groups, better surgical techniques, the understanding of the immune system, the use of immunosuppressives, and many more. Modern kidney transplantation has reached a plateau in terms of technique, medication, outcome predictions, and long-term survival. The next step is to find the ultimate goal, the holy grail of organ transplantation – immunotolerance! Would this take the form of organ cloning, xenotransplantation, 3D printing of organs, stem cell therapy, or something no one has yet thought of?


Biography


Dr Ajit K Huilgol completed his kidney transplant surgical training at the Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India. He performed his first kidney transplant in 1983, and has performed over 2500 transplants so far. He is now the Director and Chief Transplant Surgeon, NEPHTRANS INDIA (www.nephrotransplantindia.com), Columbia Asia Hospitals, Bangalore and Mysore, India. He specializes in multiple artery transplants and double ureter transplants.

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Ajit Huilgol

Nephrologist/Renal Specialist in Hebbal, India

Title: Target “0 by 25”: Our experience of Acute Kidney Injury


Abstract


Acute Kidney Injury( AKI) is one of important causes of morbidity and mortality worldwide. Causes of AKI may vary country to country even within the country. International Society of Nephrology has already set a goal “0 By 25”, targeting 0 death due to AKI by 2025. However limited information is available regarding AKI in developing countries of Asia and Africa. Inspired by this slogan we have conducted a cross sectional observational study over the period July 2015 to February 2018 with an aim to find out the causes of AKI and short term outcome in our center, United Hospital, leading tertiary care center and largest Nephrology and Cardiac referral center in Bangladesh. Total 221 patients with AKI were included in the study during the time frame where we found a changing pattern of AKI. Although volume depletion , infection, glomerulonephritis are the main cause of AKI, in our setting we found Cardio-renal Syndrome and Drug induced AKI were the leading causes next to infection. Malignancy contributed significant portion of AKI.


Biography


Dr. Tania Mahbub, MBBS, MD (Nephrology) is Nephrologist in Bangladesh actively pursuing her career in the field for almost a decade. She did her graduation from Sher e Bangla Medical College, Barishal and MD in Nephrology from Dhaka Medical College, under the auspices of Dhaka University, Bangladesh. She’s a ISN Fellow and obtained her fellowship training from McGill University Health Center, Montreal, Quebec, Canada.Dr. Mahbub is a presenter of numbers of research papers published/ presented in national and international scientific journals/seminars. Presently she is serving in the United Hospital Ltd, Dhaka, Bangladesh as the Associate Consultant Nephrology.

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Tania Mahbub

United Hospital, Bangladesh

Title: Loin Pain and Haematuria Syndrome (LPHS) complicating Symptomatic Nephroptosis (SN), cured with renal sympathetic denervation and nephropexy (RSD&N) surgery: Case report.


Abstract


Abstract Introduction and objective: To report a case demonstrating the link of LPHS with SN that is based on IVU7 sign and retrograde pyelography. Renal Sympathetic denervation and Nephropexy (RSD&N) Surgery has proved curable for the condition. Patient and methods The reported case in which IVU with erect film shows the IVU7 sign is measure of renal pedicle stretch. Retrograde pyelography (RGP) showed the internal renal damage while all ancillary imaging were normal. The surgery of RSD&N was used for treatment of the condition. Results An IVU with erect film and RGP detected the diagnosis and the renal pathology while no other imaging could. Comparing IVU supine and erect revealed the IVU7 sign which is a measure of renal pedicle stretch causing artery stenosis and ischaemia. The findings on RGP show erosion of renal papillae and leakage of contrast medium into renal veins which is the site of hamaturia. The surgery of RSD&N cured the condition. Conclusion An IVU with erect film and RGP clinched the diagnosis and revealed the renal pathology while no other imaging could. It should be essential diagnostic investigation in every LPHS case. The surgery of RSD&N cured the condition.


Biography


Dr Ghanem was qualified in 1968, Mansoura University, Egypt. He gained all postgraduate experience in UK where he was promoted in posts up to the consultant level. He practiced as consultant Urologist in UK, Saudi Arabia and Egypt. During his career life he reported over 60 articles of which he made important discoveries in medicine, physiology, urology, nephrology, cardiovascular and surgery. He discovered two new types of vascular shocks, proved that one physiological law is wrong and provided an alternative. He resolved the puzzles of 3 clinical syndromes; the transurethral of the prostate (TURP) syndrome, the loin pain haematuria syndrome (LPHS) and the adult respiratory distress syndrome (ARDS). He is now on the editorial board of many medical and surgical journals and he is happily retired in Egypt.

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Ahmed Nasr Ghanem

Mansoura University, Egypt

Title: Artificial intelligence and Healthcare: How to embed new skills into clinical practice




Abstract


1.Upon completion, participants will be able to define the terms of AI and machine learning and their general application. 2.Upon completion, participant will demonstrate an understanding of the use of AI to improve patient access and expanding healthcare capacity. 3.Upon completion, participant will learn to engage in the use of digital technology for patient safety and risk reduction and enhance patient experience. 4.Upon completion, participant will be able to describe the potential use of AI and algorithms in the diagnosis and treatment of urological conditions. Course Description This is an introductory course to the changing healthcare environment and the world of artificial intelligence (AI) and machine learning in clinical practice. ∙The course will give an overview in the following areas: ∙The implementation of AI to improve patient access and expanding healthcare capacity, ∙The use of digital technology in patient safety and risk reduction and enhance patient experience. ∙An insight into the digital transformation in the 21st century hospitals and healthcare. ∙Data management: dilemmas and realities and the complexities of cybersecurity. ∙The exciting future of AI and algorithms in the diagnosis and treatment of urological conditions.


Biography


Dr. Zaki is Consultant Urologist who joined Cleveland Clinic Abu Dhabi in March 2017 from the University of Illinois at Chicago, USA. Dr. Zaki was born in Edinburgh, Scotland, UK and attained his doctorship (MD) from the University of Aberdeen, Scotland, UK then moved to Birmingham, England, UK for higher surgical specialist training in Urology. In 2003, Dr Zaki, was appointed Consultant Urologist at the University Hospital of Birmingham, UK. In 2006, he founded the Birmingham Bladder Clinic as one of the first specialised comprehensive clinics to treat a wide range of bladder, prostate and voiding dysfunction. Dr. Zaki, helped patients from all across the UK with his unique holistic and patient-centred approach. Patients travelled from further afield, like Germany and Ireland to seek his advice and expertise. Dr. Zaki Almallah is one of the internationally renowned experts in the treatment of patients with urinary problems following prostate cancer treatment. He has published widely with a long list of scientific studies and book chapters attached to his name. Dr. Zaki has one of the largest experiences in the management of post-prostatectomy urinary incontinence. He has lectured regularly in international conferences including the British Association of Urological Surgeons and the American Urological Annual Scientific conferences. Dr. Zaki Almallah’s passion in helping patients was recognised by his regular appearances on national television including the British Channel 4 prime time popular programme, “Live from the Clinic” where he performed surgery and the US channel CBS and other media outlets. ​​

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Zaki Almallah

Cleveland Clinic Abu Dhabi, UAE

Title: Relationship between Peripheral Blood Parameters and Stage and Grade of Disease in Patients with Urothelial Cancer of the Urinary Bladder


Abstract


Bladder cancer is a common tumor in the urinary tract and is the ninth most prevalent cancer around the world [1]. Approximately 90% of bladder cancers are urothelial carcinomas (UC) and 75-85% of UC are non-muscle invasive while 15-25% are invasive. Treatment of UC depends on pathological behavior of the tumor. Non-muscle-invasive tumors can be removed by transurethral resection but recurrence is common [2]. Two main types of bladder cancer are identified: the transitional cell carcinomas (TCC), related to cigarette smoking and most prevalent in Western and industrialized countries, and the squamous cell carcinomas (SCC), which are more frequently seen in some Middle Eastern and African countries, where urinary schistosomiasis is an endemic disease. Rare types of bladder cancer include small cell carcinoma, carcinosarcoma, primary lymphoma and sarcoma [3]. In the United States, bladder cancer is nearly three times more common among men than woman. In men, it is the fourth most common cancer, after prostate, lung and colorectal cancer, accounting for 5.5% of all cancer cases. In women, it is the eighth most common cancer, accounting for 2.3% of all cancer [4]. In western countries, more than 90% of bladder cancers are transitional cell carcinomas, 80% are papillary and 20% are solid and invasive. Squamous cell carcinoma accounts for only 1% of bladder cancer in England [5] and 3-7% in the United States [6]. The classic presentation of bladder cancer is painless gross hematuria, which is seen in approximately 80-90% of patients. Physical examination results are often unremarkable. Cytology, Cystoscopy and biopsy are the principal diagnostic tests [7]. The host inflammatory response has gained increasing attention in oncology research. Infiltrating cells of the immune system are constituents of virtually all neoplasms [8]. While, initially thought to represent an anti-tumoral response, immune cells, particularly those of the innate immune system, also exhibit effects that promote carcinogenesis and cancer progression [8,9]. Proposed mechanisms include increased supply of growth factors, survival factors, pro-angiogenic factors, extracellular matrix-modifying enzymes (which can facilitate invasion and metastasis) and inductive signals that may lead to epithelial-to- mesenchymal transition [8]. Thus, there is a biological rationale for using NLR, the ratio of circulating neutrophils (immune cells of the innate system) to lymphocytes (immune cells of the adaptive system), as a measure of the systemic host response when evaluating the association between inflammation and cancer outcomes. The prognostic role of NLR has been evaluated in numerous epidemiologic studies of various cancer types. Higher NLR has been found to be consistently associated with more advanced stage and more aggressive tumor behavior


Biography


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Bashar Ali Mohamed Khalaf Al-Abdou

Medicine Cairo University, Egypt

Title: Evaluation the role of the hormone copeptin in patients with renal failure


Abstract


Abstract Background: Previous experimental studies suggest that copeptin plays an important role in the development of renal failure. However, it is not yet known whether the concentration of copeptin increases in autoimmune. Increase in its level is associated with renal failure and low renal insufficiency. Aim: To measure the concentration of copeptin and some of the biochemical variables in patients with renal failure and to clarify if there is a linear relationship between them. Method: Serum levels of copeptin and some biochemical variables were determined in 90 patients with renal failure and compared to 40 subjects as healthy control. Results: There was a significant increase in the level of copeptin in patients with renal failure (95.22 ± 42.3 pmol \ l) as compared to the control group (6.12 ± 2.07 pmol\l). In addition, the tested biochemical variables show significant increase in patients group. The results also showed that there was a significant effect of the body mass on the concentration of copeptin and that there was no significant effect of age, sex and smoking on the concentration of caffeine in the control compared to the group of patients. Conclusion: Copeptin serum level significantly increased in renal failure and of predictive value as variable for monitoring disease prognosis. However, large scale study is warranted to confirm this suggestion. Key words: Copeptin hormone, renal failure, BMI


Biography


Amina Hamed Ahmad Alobaidi serves as Tikrit University College of Medicine, Biochemostry, Iraq Dr. Amina's specializes inChemistry, and has published 7 scientific papers and books indexed in pubmed

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Amina Hamed Alobaidi

University of Kirkuk, Iraq

Title: Computerized monitoring of hemodialysis patient hydration


Abstract


A big problem is an accurate estimate of the fluid volume that must be removed during hemodialysis. The quality of a patient’s life with renal failure depends on the proper balance of fluid in the body. The movement of fluid between different departments in the human body during ultrafiltration is a complex biophysical process based on the physics of the electrolytic fluids exchange through semipermeable membranes. We studied the features of water transport through organic membranes and proved the possibility of non-invasive monitoring (by bioimpedance signals) of the hematocrit level in the blood during hemodialysis. We have developed a hydraulic model of the patient’s body for ultrafiltration, which takes into account all the water departments of the body and their relationship. The simulation results were confirmed experimentally in 30 hemodialysis patients. Using this knowledge, an information technology was developed for statistical monitoring of ultrafiltration based on electrophysiological signals of the human body. The mathematical basis of the computerized procedure for calculating the hematocrit level is the time-frequency components of the bio-impedance coherence signal function. It is proved that such components, taking into account the spectral instability of the signal, make it possible to track not only the hematocrit level, but also the rate of its change. The software of the proposed information technology is based on the use of probabilistic models of local spectral non-stationarity of biophysical signals. This software allows you to minimize decision-making risks during statistical monitoring in hemodialysis devices and ensure the safe achievement of "dry weight".


Biography


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Bogdan Tkachuk

Regional medical clinical center of urology and nephrology, Ukraine

Title:


Abstract


Micturition is more than just an elementary physiological function: apart from maintaining fluid balance and removing metabolic waste, micturition is also important for socially-relevant behaviors, like territorial marking and attracting the opposite sex.However, little is known about the mechanisms controlling urination in the central nervous system of the brain. We injected pseudorabies virus into the bladder of mice, and improved the in vivo bladder pressure measurement in mice. Our team successfully identified a group of neurons on the M1 cortex, associated with urination. We also found that M1 cortical urinary-related neuronal discharge is closely related to PMC urination control related areas. The above research and findings will provide important ideas and clues for revealing central control of urination mechanism. In the future,this approach offers a promising possibility to examine the neural mechanisms underlying neurogenic bladder dysfunction.


Biography


Junan Yan is a professor of urology and a doctoral tutor. He has long been committed to the study of urinary function mechanisms. He has published more than 20 SCI papers and received more than 10 million yuan from the National Natural Science Foundation and other types of funds. He has just won the 2018 Best Research Paper Award of the Chinese Research Hospital Association.

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Junan Yan

Southwest Hospital, Chongqing, China.

Title: GBM Disease: A Rare Case presenting as a rare cause of FUO


Abstract


Acute glomerulonephritis due to anti-GBM antibody disease is rare, estimated to occur in fewer than one case per million population. Patients usually present with acute renal failure with urinalysis showing proteinuria not in nephrotic range and a nephritic sediment characterized by dysmorphic red cells. Systemic signs and signs, such as malaise, weight loss, fever, or arthralgia, are typically absent. In this case study, a 38yo Chinese woman presented to us with a cough and fever for 3 months with a background history of treated latent pulmonary tuberculosis 2 years ago. Positive findings for her on examination were fever with cough and sputum, weightloss of 5 kg and basic blood screening, she had iron deficiency anemia of haemoglobin 7.1, renal impairment(Cr194umol/L) and ESR >140 Sputum for acid fast bacilli, bronchoscopy, bone marrow aspirate and biopsy, ultrasound abdomen, auto immune screening were all negative including ANA, DsDNA, C3,c4,ANCA. Her anti GBM antibody was negative. Renal biopsy showed necrotizing and crescentic glomerulonephritis with inconclusive immunofluorescence studies. Subsequent anti MPO and anti-GBM ELIZA was positive She was subsequently treated with High dose IV methylprednisolone and plasma exchange which showed resolution of her persistent fevers and improvement in her renal function.


Biography


Dr Ronald Chong was born in Trinidad, West Indies and graduated from the University of the West Indies with his MBBS in 2008. He went on to obtain his MRCP(UK) in 2013 and decided to explore The asian medical world. He entered the SingHealth Internal Medicine Residency Program, Singapore from 2016 to 2019 and then joined the National Health Group Advanced Internal Medicine Senior Residency Program, Singapore in July 2019. He enjoys jogging and taking nature walks to relax his mind from the hectic modern world.

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Ronald Chong

Tan Tock Seng Hospital, Singapore

Title: An interesting case of ANCA vasculitis and an approach to glomerulonephritis


Abstract


We present a case of a 60 year old Malay Female who presented in July 2017 with complains of exertional dyspnea, significant weight loss and lower limb swelling. She has a past medical history of 1. Hypertension diagnosed in 2016 2. Asthma diagnosed since 17 years old 3. Anemia Her main presenting reason was that of exertional dyspnea of 6 months associated with 1 week of lower limb swelling. She also presented with weight loss of 8kg over last 7 months. Her physical examination was fairly unremarkable except for bipedal edema and facial swelling . Initial laboratory investigations done revealed microcytic anemia, acute on chronic kidney disease and microscopic hematuria with proteinuria. An autoimmune work up done subsequently showed: P ANCA positive MPO was positive dsDNA 13.3 negative Anti-Ro 5.0 positive C3 /C4 were within normal limits Subsequent renal biopsy done was suggestive of ANCA vasculitis. As the patient remained breathless, we arranged a computed tomography scan which showed peri-bronchial thickening, ground glass opacities in left upper lobe suggestive of possible pulmonary haemorrhage. We then referred to rheumatology. The final diagnosis was that of ANCA associated Vasculitis. There was also a suspicion of microscopic polyangiitis with renal involvement and possible focal pulmonary haemorrhage. The patient was treated with immunosuppressant and she has been doing well since.


Biography


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Shirley Teo

Tan Tock Seng hospital, Singapore

Title: Renal cell carcinoma: Survival and Outcome in Pre-era of targeted therapy The result from the southern tertiary center of Thailand


Abstract


Introduction: Renal cell carcinoma (RCC) accounts for 2-3% of all adult malignancies. In Thailand, the overall incidence and mortality of RCC are 1.6:100,000 and 1.0:100,000 respectively. Surgery is the most effective treatment for localized disease and locally advanced disease. However, approximately 20% to 40% of patients had metastasis or local recurrence after nephrectomy and short of overall survival. Objectives: To retrospectively review RCC patients treated with both radical nephrectomy (RN) and partial nephrectomy (PN), describing demographic data of these patients, identified cancer-specific survival (CSS) and predicting efficacy factors.
 Methods: This study consists of 183 patients including all RCC patients in Songklanagarind Hospital between January 2006 to December 2016. The primary endpoint of this study is to identify CSS after treating with RN and PN by using Kaplan-Meier method. Results: The median age of patients was 58.4 years. All patient was performed RN and PN, 18 % had metastasis RCC at the time of diagnosis. Majority of the patient (74.8%) had clear cell carcinoma. The median CSS was 84.2 months. In multivariate analyses, low T stage and no lymphadenopathy are associated with better CSS. Conclusions: In this study, the median CSS was 84.2 months. The main predictors of efficacy of treatment are low T stage and no lymphadenopathy


Biography


Teeranop Choorit has completetd his MD from Faculty of medicine, Thammasat University, Thailand. Resident training in urology at Prince of Songkhla University, Thailand.

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Teeranop Choorit

Prince of Songkhla University, Thailand

Title: A pattern of increased presentation of patients with kidney stones during Abu Dhabi’s summer months


Abstract


Observation: It has been noticed that there is an increase in the number of patients presented to the emergency department and to urology outpatient clinics with kidney stones, ureteric stones and renal colic during summer months. Furthermore, there is mounting evidence to suggest that the incidence of kidney stones is higher in areas with a hot climate. Aim To study objective observational evidence of increased incidence of kidney stones presented to large tertiary institute in Abu Dhabi during summer months. Methods Initial review of Epic electronic patient record data for the diagnoses of kidney stones, ureteric stones and renal colic (ICD10 N20-N23) in the Emergency and Urology departments for summer months (Jul-Sep) of 2016 and 2017 (2018) and compare them with the preceding and following winter months in the same period. Results In the Emergency Department (ED), there was a trend beginning to emerge, year on year, where Q3 (Jul-Sep) displays a higher incidence rate (diagnoses per 1,000 ED visits) when compared with Q1 (Jan-Mar) in consecutive years from 2016 to Q1 2018. There was a suggestion that the null hypothesis, or no difference between the rates in these periods, can be rejected when comparing Q1’18 (6.4) vs Q3’17 (8.8) (prop.test: x2 =4.4, 95% CI = 0.000 – 0.005, p=0.035) however this level of significance was not repeated in every comparison. Reviewing coded data for the same period for patients attending Urology Clinics suggested a similar trend for the same period although with a potential outlier in Q3’16 (71.5) where the rate was at its lowest for the period. Comparing Q3’17 (116) to Q1’17 (94.2) and Q1’18 (99), as with ED, displays differences in rates similar to ED respectively ([x2=6.7 95% CI = -0.04 - -0.005 p=0.009], [x2=4.4, 95% CI = 0.001 – 0.032 p=0.036]). Conclusion This initial observational study suggests a potential pattern of increased incidence of kidney stones presenting to ED at large tertiary institute in Abu Dhabi during the warmest months of the year (Jul-Sep) compared with winter months (Jan-Mar). Further collection of data over the coming months in the emergency department and urology clinics are needed and collaboration with other centres, to establish further evidence of a trend, if any before work on potentially implementing a prevention programme is to be recommended.


Biography


Recently the phrases of eHealth, AI, machine learning, deep learning etc. have become subjects of excitement in lectures, articles and the media. However these terms can also be the source of a significant confusion, intimidation and anxiety as to what they mean and how they are going to be implemented in medicine and clinical practice. Specifically on how this technology is going to affect future employment and education.

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Zaki Almallah

Consultant Urologist and Staff Physician Cleveland Clinic Abu Dhabi

Title: The use of iPad visualization for prescribed medicine to enhance patient experience in Urology


Abstract


Background: Regular out-patients surveys at our large tertiary institute show that detailed medications and discharge instructions and explanation associated with positive patients’ experience. Further understanding of treatment plan is likely to encourage better medicine compliance by our patients, adherent to treatment and improve overall patients’ care. Aim: To assess the impact of iPad visualization of urology medications to patients on their experience and the overall satisfaction with their hospital visit. Methods: During a period of one month, patients attending urology out-patient appointments with single provider had the standard explanation of their medications with an additional visually enhanced explanation using iPad images for their medications and after care visit summary. Data from the Press-Ganey hospital survey scores were extracted for the intervention period. The data was then compared with similar periods when there was no intervention. A series of questions with scale 1-5 (5 being very good) are asked by an independent agency. Scores were reported as percentage of patients that gave the highest score for each question. Results: Questions on time spent with physician, explanation of problem, information about medications, likelihood of recommending the physician and set of other questions were analysed from 35 patients’ questionnaires. The overall median of the highest score to all questions during the intervention period was 67% (range 60-83). For the previous 3 months to intervention, the overall median of the highest score to all questions was 83% (57-100). On the question of time spent with physician, 67% of patients gave top score in the intervention period compared with a range of 57 -100% in the previous periods. When patients answered the specific question on information on medications given by the physician, 60% gave top score compared with a range of 67-100% in the intervention and the previous periods, respectively. Conclusion: The overall patient experience scores results after using iPad visualization of prescribed urology medications has been mixed. Although improvement on some of the domains were demonstrated, it was surprising to see a slight reduction on the specific question of information on medications given to patiets. Using visual aids and spending more time with patients is a good clinical practice, however, patients perception may be variable. Further work and larger sample size may be required.


Biography


Dr. Zaki is Consultant Urologist who joined Cleveland Clinic Abu Dhabi in March 2017 from the University of Illinois at Chicago, USA. Dr. Zaki was born in Edinburgh, Scotland, UK and attained his doctorship (MD) from the University of Aberdeen, Scotland, UK then moved to Birmingham, England, UK for higher surgical specialist training in Urology. In 2003, Dr Zaki, was appointed Consultant Urologist at the University Hospital of Birmingham, UK. In 2006, he founded the Birmingham Bladder Clinic as one of the first specialised comprehensive clinics to treat a wide range of bladder, prostate and voiding dysfunction. Dr. Zaki, helped patients from all across the UK with his unique holistic and patient-centred approach. Patients travelled from further afield, like Germany and Ireland to seek his advice and expertise. Dr. Zaki Almallah is one of the internationally renowned experts in the treatment of patients with urinary problems following prostate cancer treatment. He has published widely with a long list of scientific studies and book chapters attached to his name. Dr. Zaki has one of the largest experiences in the management of post-prostatectomy urinary incontinence. He has lectured regularly in international conferences including the British Association of Urological Surgeons and the American Urological Annual Scientific conferences. Dr. Zaki Almallah’s passion in helping patients was recognised by his regular appearances on national television including the British Channel 4 prime time popular programme, “Live from the Clinic” where he performed surgery and the US channel CBS and other media outlets.

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Zaki Almallah

Consultant Urologist who joined Cleveland Clinic Abu Dhabi

Day 02 Schedule

Plenary Talks

Title:


Abstract



Biography


A native of Bari, Italy, Dr. Campese graduated medical school summa cum laude before coming to the Keck School of Medicine on a fellowship in 1974. Since his time at USC, Dr. Campese has established himself as one on the most prominent nephrologists in the field and currently heads Keck’s division of Nephrology. In addition to his numerous academic and administrative appointments, Dr. Campese is a former president of the Italian-American Society of Nephrologists and is currently a member of the Program Committee on the Council on High Blood Pressure Research for the American Heart Association.

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Vito Michele Campese

Keck school of Medicine, USA

Title: Clinical Nephrology related to Metabolic and Genetic Diseases.


Abstract



Biography


MBBS. in Internal Medicine - King Saud University, Riyadh - 1980 Full Residency in Internal Medicine - King Faisal University, Dammam - 1986 Fellowship in Nephrology - King Faisal University, Dammam - 1990 Arab Board in Internal Medicine - Damascus - 1987 KFU Fellowship in Internal Medicine - King Faisal University, Dammam - 1988

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Fahad A. Al-Muhanna

Imam Abdulrahman Bin Faisal University, Saudi Arabia

Title:


Abstract



Biography


Sang-Mo Kang, M.D. takes care of both adult and pediatric patients and performs kidney, liver, pancreas and intestinal transplants as well as surgery for numerous hepatobiliary and gastrointestinal diseases. He is Surgical Director of Liver Transplantation at UCSF-Benioff Children's Hospital. Dr. Kang received his B.S. in chemistry from Cornell University and his M.D. from Harvard University Medical School. He completed a general surgery residency, and immunology and clinical transplantation fellowships at University of California, San Francisco. Dr. Kang's current research focus is in the development of novel strategies for the induction of transplant-specific tolerance. Dr. Kang has published numerous articles in medical and scientific journals and been invited to present at national and international seminars and conferences. Dr. Kang is a member of numerous medical societies including American Society of Transplant Surgeons, American College of Surgeons, American Association of Immunologists, National Kidney Foundation, Association for Academic Surgery, and Society of University Surgeons

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Sang-Mo Kang

UCSF-Benioff Children’s Hospital, USA

Title:


Abstract



Biography


President, Korean Society of Endourology and Robotics.Congress Chairman, WCE 2022. Ill Young Seo is Professor (Dept of Urology) at Wonkwang University School of Medicine & Hospital.

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Ill Young Seo

Wonkang University, Korea