Day 1 :
Ph.D., Mohamed Abukahter, FRCS Arjmand Reyaz MS (General Surgery)
Objective: Our primary goal in conducting this prospective study was to investigate and analyze the influence of sleeve gastrectomy on the blood levels of gut peptides; ghrelin, peptide YY (PYY), Glucagon-like Peptide-1 (GLP-1), and leptin in Type-2 diabetic and non-diabetic morbidly obese (MO) patients. And, also, to examine changes in tissue levels of these gastrointestinal hormones in diabetic and non-diabetic individuals at the time of Laparoscopic sleeve gastrectomy (LSG).
Background data: there is ample evidence suggesting that weight loss and the improved glucose metabolism observed following LSG are not only due to caloric restriction, but neurohormonal changes may be involved.
Fasting blood levels of the above peptides and metabolic indices of glucose metabolism were evaluated in 30 consecutive morbidly obese non-diabetic and 29 morbidly obese diabetic subjects before and six months after LSG. The tissue levels of the peptides were determined only before surgery for both groups.
The BMI values decreased noticeably at six months, postoperatively. An improvement in the overall glycemic profile of the morbidly Obese (MO) patients was observed. The fasting blood levels of ghrelin and leptin were decreased, following LSG. On the other hand, however, the blood levels of PYY and GLP-1 were significantly increased, postoperatively.
LSG improves glucose homeostasis, significantly. It, also, produced significant changes in the blood levels of ghrelin, PYY, GLP-1 and leptin in both the MO diabetic or the MO non-diabetic paints. The tissue levels of the peptides, at time of surgery, were also noticeably affected. These hormonal changes may have multiple beneficial effects on the mechanisms underlying weight loss and the control of diabetes.
Sichuan University, China
Time : 10:15-11:00
Luo yunyao has been learning a PhD in Gynecology and has been a member of the Joint Laboratory for Reproductive Medicine of Sichuan University–The Chinese University of Hong Kong since 2016. She mainly studies various female infertility, reproductive endocrine diseases including: menstrual disorders, amenorrhea, polycystic ovary syndrome, menopause and menopausal syndrome, abnormal sexual differentiation, children gynecological diseases. Her current research is focus on the osteoporosis in postmenopausal women and in order to search for the specific protein for therapeutic application of in postmenopausal osteoporosis.
Osteoporosis is a major healthcare burden that affects mainly postmenopausal women and is characterized by compromised bone strength and increased risk of fragility fracture. Exercise has a positive effect on prevention of postmenopausal osteoporosis fractures. Irisin, a novel myokine that was first reported in 2012, has been proposed to mediate the beneficial metabolic effects of exercise on bone tissue. Some studies have shown that irisin can promote osteoblast proliferation and differentiation, inhibit osteoclast differentiation and increase bone mass. This study aims to evaluate the effects of irisin on bones of ovariectomized (OVX) mice, to explore a possible treatment for postmenopausal osteoporosis. Thirty-six mice were randomly assigned to three groups: OVX with r-irisin, OVX with saline and sham with saline. After 5 weeks of injection, they were sacrificed, and the trabecular bone structure of the femur, bone strength of the tibia and serum parameters were assessed. Treatment with r-irisin prevented trabecular bone loss and enhanced bone strength in the bone metaphysis of the OVX mice. The r-irisin-treated OVX mice exhibited a significant increase in bone mineral density, bone volume to tissue volume ratio, connection density, and trabecular number compared to those of the saline-treated OVX mice, which showed increased bone stiffness. Consistently, OVX mice treated with r-irisin showed decreased bone resorption markers such as osteoclasts and increased osteogenic markers such as osteoblasts. Moreover, r-irisin treatment significantly increased serum osteocalcin levels compared to saline-treated OVX mice. Therefore, our study extended the understanding of the role of irisin in bone metabolism and revealed the possibility of therapeutic application of irisin for postmenopausal osteoporosis.
COMSATS University Islamabad, Sahiwal Campus, Pakistan
Keynote: Title:Inhibition of 2C Coxsackie B virus protein to decrease pathogenicity of diabetes mellitus Type1
Time : 11:15-12:00
Dr. Muhammad Asif Rasheed has his expertise in bioinformatics approaches and passion in improving the health and wellbeing. He recently completed PhD studies from Huazhong Agricultural University, Wuhan, China and applied different bioinformatics approaches to predict the virulence factors in Mycoplasma bovis bacteria. Simultaneously he published review articles by applying different bioinformatics tools on proteins related to liver cirrhosis. Recently he is working on virulence factors related to Diabetes mellitus type 1.
Type 1 diabetes mellitus is one of the most common disease in different area of world now a days. Enterovirus infections have been implicated in the development of the disease. The viral protein 2C Coxsackie is thought to be responsible for destruction of beta cells in pancreas. The blocking of 2C Coxsackie can be a milestone to decrease pathogenicity of the disease. By using different bioinformatics tools and databases, there is a need to design an inhibitor against virulence protein of diabetes. We developed an inhibitor based on different In silico approaches. This work will help researchers to get an idea about the understanding of chemicals against Coxsackie B4 viruses and helpful for researchers to test these chemical as a drug to overcome Diabetes Mellitus Type1 due to coxsackie B4 virus.
Assoc Prof Dr USA
A 43-year-old woman presents to discuss continuous glucose monitor (CGM) technologies. She has type 1 diabetes mellitus diagnosed at age 14 and has been on insulin pump since 2001 which was upgraded to MedtronicTM 630G in July 2017. She has adequate glycemic control (A1c 7.3%), but finger-stick blood glucose levels fluctuate widely with occasional hypoglycemia. Past surgical history was noncontributory. She exercises regularly, walking 30 minutes several times per day with a goal of 7000 steps per day. She tried to use a CGM in 2018 (Medtronic) but she discontinued the CGM due to frequent alarms. Patient reports the alarms were not due to highs or lows, but due to difficulty with obtaining accurate readings. Patient consulted an endocrine clinic to improve blood glucose monitor with new CGM technology. Patient subsequently developed bilateral arm pain intermittently for which primary care provider ordered X-ray of both arms which shows the EversenseTM sensor and transmitter on the right arm and the sensor alone on the left arm (Fig 1-2).
CGM devices measure the glucose level of interstitial fluid which correlate well with plasma glucose. Glucose levels are measured every 5-15 minutes, depending on the device. The EversenseTM sensor (Fig 1-2) is placed in the upper arm by a physician. Once inserted, it continuously measures glucose levels for up to 3 months. The EversenseTM smart transmitter sits over the sensor on the upper arm. The transmitter is water-resistant, rechargeable, and can be easily removed. Not only can the transmitter can send data to the EversenseTM Mobile App but it can also provide on-body vibration alerts when glucose level fluctuates high or low. The EversenseTM Mobile App receives and displays the data easy-to-read charts and graphs, making it easy for patients to monitor their blood glucose. The difference between EversenseTM CGM system compared to other CGM devices are that (a) there is no weekly sensor self-insertion since EversenseTM CGM lasts up to 3 months, (b) sensor is placed under the skin; thus, no concern about it falling off, (c) no separate receiver is required; data, trends and alerts can be viewed on mobile device; (d) highs and lows can be detected quickly. Many CGM devices allow patients to share their blood glucose data in real time with friends, relatives, and caregivers using a smartphone app, which may be particularly important when patients have hypoglycemia. The case demonstrates an interesting radiological finding of an implantable CGM sensor, and also the importance of awareness of various CGM systems with different safety advantages to improve diabetic care.
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of the Navy, Department of Defense, or the U.S. Government.
The authors have no multiplicity of interest to disclose.
Division of Endocrinology, Department of Medicine
Objective: Antiphospholipid Syndrome (APS) can involve multiple organ systems but endocrine manifestations are rare. In most cases adrenal insufficiency (AI) is the first endocrine manifestation of APS. The prompt diagnosis of adrenal insufficiency is critical as adrenal insufficiency is a life-threatening disease that may lead to fatal outcomes if left untreated. We present a case of AI associated with antiphospholipid syndrome who was managed successfully.
Methods: A literature search was conducted using the databases PubMed and Google Scholar for diagnosis and management of adrenal insufficiency associated with antiphospholipid syndrome.
Results: We describe a 50-year-old male presenting with deep venous thrombosis and pulmonary embolism treated with heparin. The patient subsequently developed hypotension and worsening bilateral flank pain leading to a final diagnosis of adrenal hemorrhage during the course of his hospitalization. Adrenal insufficiency was diagnosed based on serum cortisol and ACTH levels.
Conclusions: In all cases of adrenal hemorrhage and infarction with unknown etiology, screening with lupus anticoagulant and anticardiolipin antibodies is imperative. Recognition of this high mortality condition will allow for appropriate screening and confirmatory tests leading to prompt diagnosis and timely management.
Department of Internal Medicine, School of Medicine, University of Rwanda, Kigali, Rwanda
Little is known about the prevalence of macrovascular disease in diabetic patients, in Rwanda.No any study done before on macrovascular disease. The aim of our study was to determine the prevalence of macrovascular disease and It associated risk factors, in rwandan diabetic patients.
This study was cross-sectional that was undertaken to evaluate the prevalence of macrovascular disease and associated risk factors among diabetic patients, at Kigali University Teaching Hospital and Butare University Teaching Hospital . We enrolled adult diabetic patients who attended the outpatient departments, from 2018-2019.
For every patient we did twelve lead electrocardiograms and It was done at initial enrollment time and interpreted using Manual Minnesota code (2) .Ankle Brachial Index was calculated using measurements from automated calf sphygmomanometer and every participant was clinically assessed , for the presence of cerebrovascular disease, basing on the WHO Monica criteria (3) .
Results: Features of macrovascular disease were found in 32 (21.7%) of the 147 patients: the most common being cerebrovascular disease with 15.6% ,followed by Peripheral Artery Disease 8.2% ,then coronary heart disease with a prevalence of 2%. The variables associated with cerebrovascular disease were: Gender, being male[p-value 0.02] and presence of coronary heart disease [p-value 0.014 ( 95%CI) ]
Peripheral vascular disease was associated with Duration of diabetes [ p-value 0.017 (95%CI)], tobacco smoking [p-value 0.02 ( 95%CI) ],elevated level of total cholesterol [ p-10 value 0.009( 95%CI)] and elevated level of LDL [ p-value 0.024( 95%CI)] while Coronary Heart Disease was significantly associated with elevated levels of triglyceride [ p-value0.027 ( 95%CI)] and the presence of cerebrovascular disease[ p-value0.014 ( 95%CI)].
CONCLUSION: Macrovascular disease is common in adult diabetic patients, in Rwanda. We need to elaborate a clear protocol on prevention and management of macrovascular disease,in diabetic patients.
West China Second Hospital, Sichuan University, Chengdu 610041, China
Keynote: The efficiency and safety of traditional Chinese herbal medicine Kun Tai in treatment of premature ovarian insufficiency：a meta-analysis
Time : 14:40-15:05
From Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, China, medical student of 8-year program, major in Gynaecology &Obstetrics, focus on the environmental teratogenic factors and their effects on reproduction techniques including preimplantation genetic diagnosis and conservation of female fertility, such as oocyte freezing, ovulation, embryo freezing and in vitro maturation of oocytes.
Published several papers at home and abroad, made poster presentation and oral presentation in several congresses.
To systematically review the efficacy and safety of traditional Chinese herbal medicine Kun Tai in the treatment of premature ovarian insufficiency. Methods PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on Kun Tai used for treating premature ovarian insufficiency from inception to August, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results Twenty-one randomized controlled trials were included. The results of meta-analyses showed that: effective rate (RR=2.78, 95%CI 1.73 to 4.45, P<0.000 01), the change of Kupperman`s score (MD=-3.25, 95%CI -3.75 to -2.76, P<0.000 01), the change of serum FSH (MD=-6.99, 95%CI -8.07 to -5.90, P<0.000 01), E2 (MD=6.38, 95%CI 5.64 to 7.11, P<0.000 01) and LH (MD=-4.66, 95%CI -6.45 to -2.86, P<0.000 01) in Kun Tai combined with hormone replacement therapy (HRT) group were higher than that in the HRT group. Conclusion Kun Tai combined with HRT are better than HRT alone in the effective rate, the change of Kupperman`s score, the change of serum FSH, E2 and LH for patients with premature ovarian insufficiency. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusion.