Day 2 :
Keynote Forum
M Bonucci
University of Chieti, Italy
Keynote: Artoi nutritional approach in the hematological patient: Is there a rationale
Biography:
Massimo Bonucci MD is Chief of Clinical Pathology and Surgical Pathology and Outpatient Oncology in San Feliciano Hospital, Rome, Italy; he is a member of IAP (International Academy of Pathology-Italian Division). For ten years he had collaborative experience with Dr. Nieper (late President German Society of Oncology); after he introduced the use and development of integrative medicine on cancer patients in Italy. He is Professor of the G. Marconi University “Centro Studi Scienza Della vita” in Rome, for Master in Integrative Oncology of the postgraduate program. He is Professor on the University of Chieti for Master in Integrative Oncology of the postgraduate program for the year 2017-2019. He wrote a book “ Quello che mangi fa la differenza” who speaks about the integrative medicine and the nutrition. He organized from 2009 to 2018 the International meeting of Integrative Oncology in Rome. He is Visiting Professor at Zhejiang Chinese Medical University in Hongzhou, China.
Abstract:
Introduction: In the last years, it is emerging more and more convincingly the evidence that nutritional manipulation in oncological patients may have a therapeutic benefit. The principles which it is based on are as follows:
- Reducing sugar intake and growth factors (ex IGF1) to tumor cells
- Reducing the inflammatory pattern and the favorable ground to the development of the tumor cells
- Using foods with a proved antitumor protection because of their content of specific phytochemicals
Discussion: 1) The validity of the PET also in lymphomas and myelomas as well as the evidence of the glucose captation in bone marrow cells gives us that the reduction of sugar intake has a strong reason. Also, the role of IGF1 confirms that a reduced level of growth factors is important in this setting in the development of multiple myeloma cells. High levels of IGF1 are connected to an excessive intake of meat, cow cheese, and sugars, the last one through the action of insulin, which is a real growth factor for myeloma cells. In chronic lymphocytic leukemia, IGF1 is seen as a negative prognostic factor. (2) Reducing inflammation: in fact, many drugs used in hematology act on inflammatory pathways (ex Bortezomib). Therefore, it is of great relevance to eliminate foods well known as biomarkers of inflammation (C reactive protein and others) such as red meat and at the same time increasing those with proved anti-inflammatory power. Interference with NFkB, Bortezomib main function, is also documented for many substances such as turmeric that should be taken into account as useful therapeutic tools. (3) Activating a direct anticancer action: many substances studied for their cytostatic effects on hematological neoplastic cells, come from vegetable foods such as curcumin, epigallocatechin-3-gallate, and resveratrol.
Conclusions: It seems reasonable to use these substances in the patient’s diet to get at least an anti-inflammation response; for a real and effective anticancer action, we should make use of concentrated extracts following a specific therapeutic protocol.
Keynote Forum
Diana Anderson
University of Bradford, UK
Keynote: Sensitivity and specificity of the empirical lymphocyte genome sensitivity (LGS) assay: Implications for improving cancer diagnostics
Time : 09:55-10:35
Biography:
Diana Anderson holds the Established Chair in Biomedical Sciences at the University of Bradford. She obtained her first degree in the University of Wales and second degrees in the Faculty of Medicine, University of Manchester. She has 460+ peer-reviewed papers, 9 books, has successfully supervised 32 PhDs, is an Editorial Board Member of 10 international journals. She is Editor-in-Chief of a book series on Toxicology for the Royal Society of Chemistry. She gives keynote addresses at various international meetings. She is a consultant for many international organizations, including WHO, EU, NATO, TWAS, UNIDO, OECD.
Abstract:
Statement of the Problem: This study examined differences in the sensitivity to genomic damage of lymphocytes derived from cancer patients, pre/suspect cancer patients, and normal healthy volunteers. We investigated responses from 208 individuals: 20 melanoma, 34 colon cancer, 4 lung cancer patients (58); 18 suspect melanoma, 28 polyposes, 10 COPD patients (56) and 94 healthy volunteers. The natural logarithm of the Olive tail moment was plotted for exposure to UVA through 5 different agar depths (100 cell measurements/depth) and analyzed using a repeated measures regression model. Genomic damage in lymphocytes from cancer patient samples plateaued and did not decrease as UVA intensity decreased. In comparison, lymphocyte response patterns for healthy individuals returned towards control values as UVA intensity decreased. The responses for samples from pre/suspected cancers patients were intermediate. All cancers tested exhibited comparable responses. Results indicated that lymphocyte sensitivity was cancer status dependant, thus an analysis of Receiver Operating Characteristic curves was undertaken on 208 individuals. The mean log Olive tail moments, for all cancers plus pre/suspected-cancer versus controls gave a value for the area under the curve of 0.87 (95% CI: 0.82, 0.92); for cancer versus pre/suspected-cancer plus controls the value was 0.89 (95% CI: 0.83, 0.95); and for cancer alone versus controls alone (excluding pre/suspected-cancer), the value was 0093 (95%CI: 0.88, 0.98). For all 3 values p<0.001. Results indicated that the characterization of differences in lymphocyte sensitivity to UVA enabled discrimination between cancer patients, pre/suspect cancer patients, and healthy volunteers. This relationship could be used in an assay that functions as a stand-alone test or as a possible adjunct to other tests as part of a detection programme for cancer.
Keynote Forum
Andrew Jolivette
San Francisco State University, USA
Keynote: Examining Internal Traumatic Gay Men’s Syndrome (ITGMS) and syndemics among American Indian and indigenous gay men
Biography:
Andrew J Jolivette is Professor and former Chair of the Department of American Indian Studies at San Francisco State University, where he has been since 2001. He also currently serves as the Interim Executive Director of the San Francisco American Indian Community Cultural Center for the Arts. He is the author of five books: Among which Indian Blood: HIV and Colonial Trauma in San Francisco’s Two-Spirit Community was a finalist in the LGBTQ Studies Category for a Lambda Literary Award in June 2017. He recently served as scholar in residence in Native Sexualities and Public Health at the University of California, Santa Cruz in fall 2013. He is the former Vice-Chair of the Data Center: Research for Justice Board of Directors as well as a former board member with the African American Art and Culture Complex, the Vice-President for Finance for Black Community Matters and as a Board Member of the Center for Restorative Solutions in California. He is the Book Series Editor of Critical Indigenous and American Indian Studies at Peter Lang Publishing in New York.
Abstract:
Recent biomedical advances in HIV prevention strategies such as pre-exposure prophylaxis (PrEP) and achieving an undetectable viral load (UVL) support evidence-based scientific studies indicating HIV transmission rates can continue to be reduced through campaigns such as “Getting to Zero.” Despite the new evidence there continue to be disparities in risk and in access to prevention strategies based on a number of social, cultural, and economic factors collectively noted here as Syndemic impact (the co-constitutive epidemiological factors in large urban areas where the social and biological intersect). Syndemic impact when coupled with Internal Traumatic Gay Men’s Syndrome (the inter-generational, socially-isolating and traumatic [life changing] experiences that shape risk for HIV and overall long-term health outcomes for gay HIV positive men) can help to explain the on-going social and cultural impact of trauma on health outcomes for both negative and positive self-identified gay men. Previous studies (Diaz, 1997; Cohen, 1999; Vernon, 2001; Jolivette, 2016) have shown the socio-cultural and socio-psychological impact of identity factors such as race, religion, economic status etc. on the mental health of gay men of color. Among American Indians, First Nations, and Alaskan Native gay men we must also incorporate an analysis of (ITGMS) to explore how social and cultural interactions influence HIV prevention, treatment, and long-term care.
Keynote Forum
EE Enwereji
Abia State University, Nigeria
Keynote: Students’ sexual exposure in tertiary institutions: A case study of some universities in the Abia state of Nigeria
Biography:
EE Enwereji is an professor at College of Medicine, Abia State University Uturu, Nigeria. She teach medical, nursing and public health students and have attended several HIV and AIDS conferences both in the US and other places.
Abstract:
Introduction: Studies have shown that new entrants in institutions of higher learning are at risk of sexual exploits by the older students. The drama has been found to be an intervention strategy capable of internalizing both the emotional and cognitive dimensions of problems to produce positive changes. This study used drama to create awareness on likely common sexual exploits in institutions of higher learning. The study examined the extent to which students in tertiary institutions are at risk of multiple and same-sex sexual relationships.
Materials and method: The study used first-year students in three universities, Federal, State and Private. It was assumed that first year students in institutions of higher learning are likely to be exposed to sexual overtures by older students. As such, intervention to highlight this problem is needed. It was considered that using drama as an intervention will create awareness among the students on the types of sexual overtures they would possibly experience in tertiary institutions. A random sample of ninety ((90) students was used for the study. Thirty ((30) randomly selected students were used in each of the universities studied. Pre- and post-self-administered questionnaire were given to the selected students to complete. On completion, the copies of the questionnaire (pre- and post) were analyzed qualitatively and quantitatively.
Results: The study showed that students in these three universities studied were approached for sex by fellow students, but this was more at Rhema University 8 (28.8%) than in other universities. The students were, however, approached by both male and female sexes. The finding showed that some of the students in the three universities practiced anal, oral, and multiple sexes, but this was more in MOUA 10(33.3%) than in ABSU and Rhema with 9(30%) respectively. For knowledge on how HIV is transmitted, a good proportion of the students had the knowledge that HIV transmission occurs by sharing harp objects. This knowledge was more among students in MOUA 29 (97%) than among those in ABSU 28 (93%) and Rhema 27 (90%). On the method of HIV prevention, students in the three institutions studied claimed not aware of any method of HIV prevention, this claim was more among students in ABSU and Rhema with 19 (63%) respectively than in MOUA with 14 (47%).
Conclusion: Based on the result of the study, drama helped sexual risk behaviors that could predispose individuals to sexually transmitted infections including HIV. Drama, therefore, is a valuable and timely intervention strategy
- Hematology| Blood Disorders| Hemato-Oncology |Awareness and Knowledge on HIV/AIDS, STDs and STIs|Paediatric Hematology| Blood Banking |Hematology Nursing| Viral Immunology and Vaccines Development
Location: Plaza II
Session Introduction
Jongkol Akahat
Khon Kaen University, Thailand
Title: Move forward to blood safety in Blood Transfusion Centre
Biography:
Jongkol Akahat has completed her MSc (Clinical Pathology) , BSc (Med. Tech) from Mahidol and Khon Kaen University, respectively. She is a medical technician specialist in All blood transfusion science; HLA, genotyping, serology, etc. At present, her position is the head of blood components preparation in Blood Transfusion Centre, Faculty of Medicine, Khon Kaen University, Thailand.
Abstract:
Introduction: Safety of blood components considers the relative freedom from harmful effect to patients, directly or indirectly, of a prudently administered product taking into account the character of the product and the condition of the recipient at the time of the transfusion. To assure blood component safety, several measures are taken into consideration during product manufacturing and storage. Additionally, testing for infectious agents, including viruses, bacteria, and parasites, is routinely or seasonally performed by different blood operator. Transfusion of blood products carries certain inherent risks and hence it should be undertaken only if it improves patient outcome. Our blood transfusion center tries to produce high-quality blood components to increase every year for an added safety to the patients. This study aimed to compare the trends of using blood components in patients and blood components production of our agency.
Study Design and Methods: The studies were conducted from 2015-2017, on the use of blood components in patients and blood components production trends of our agency. The data collection by excel. The mean and standard distribution results were compared by Chi-Square test with red blood cell concentrates (leukocyte-poor red blood cells: LPRC, packed red blood cells: PRC) and plasma (fresh frozen plasma: FFP, frozen plasma: FP, cryo-removed plasma: CRP) in each year.
Results: Production units of blood components, LPRC equal 12980, 15368, 13683 (46.85%, 49.82%, 52.22%) and PRC equal 14725, 15480, 12523 (53.15%, 50.18%, 47.79%), respectively. Plasma production units were, FFP equal 27921, 28597, 24924(84.45%, 81.17%, 73.74%), FP (include CRP) equal 5143, 6636, 8875 (15.56%, 18.83%, 26.26%), respectively. The subscription requests for blood components in patients since 2015-2017 were 34625, 34810 and 32177, respectively. The use of blood components were, LPRC equal 14193, 15428, 14549(50.74%, 53.26%, 56.37%), PRC equal 13778, 13542, 11259 (46.26%, 46.74%, 43.63%), FFP equal 16390, 15712, 13893 (86.74%, 89.09%, 88.69%), FP (include CRP) equal 2506, 1924, 1771 (13.26%, 10.91%, 11.31%), respectively.
Conclusion: Trend of using the LPRC in patients has increased, while the PRC has decreased all over three years with significant statistically (p<0.05), consistent with the production of blood components. FFP production rates decline every year with statistical significance (p<0.05), but the rate of using in patients increased, while the rate of FP and CRP reduction, which does not correspond to production rates.
Thipaporn Jaroonsirimaneekul
Khon Kaen University, Thailand
Title: T-ACE II+: Semi-automated in blood components preparation
Biography:
Thipaporn Jaroonsirimaneekul has completed her Master Degree in the year 2001 at the age of 24 years from Faculty of Public Health, Khon Kaen University, Thailand. She is the supervisor of Blood Transfusion Sciences.
Abstract:
Introduction: Previously, blood components preparation in Blood Transfusion Centre, Faculty of Medicine, Khon Kaen University, all procedure handled by the manual. Qualitative were depended on the expertise of staffs. Packed red blood cells (PRC) are produced from a unit of whole blood by centrifugation and removal of most of the plasma, leaving a unit with a hematocrit of about 60 to 70%. Retrospective data for PRC preparation from April to December 2016 was 11,663 units, in 2017 was 12,477 units and January to June 2018 was 6,588 units, respectively. Plasma was separated from packed red cells by plasma extractors, clamp transfer line and seal to separate. All procedures are done by manual. Since 2001, T-ACE II+ was installed with the protocol of quadruple bags for leukocyte-poor red blood cells (LPRC) preparation, the instrument can apply and set parameter for double and triple blood bag. Then T-ACE II+ are available for all blood bags first time at Blood Transfusion Centre, Faculty of Medicine, Khon Kaen University, Thailand in 2017. Therefore, this study aimed to monitor and compare PRC separation between T-ACE II+ and manual.
Study Design and Methods: Survey was conducted in 2017 to 2018 at 1% of PRC, which were separated by T-ACE II+ (A protocol) and hematocrit (Hct.) measured by complete blood count (Matrix 3000). Data collection was excel. The mean and standard distribution results were compared by Z-test with PRC from manual in 2015 (B protocol).
RESULTS: 83 and 263 samples of PRC from protocol A and B preparation were hematocrit and volume measurement. The results found 68.62+5.03 and 73.11+2.91 % hematocrit and 200+19.37 and 221+26 mL. (mean+SD). The average of the A's population is considered to be not equal to the average of the B's population. The difference between the average of the A and B populations is big enough to be statistically significant (p=1.45).
Conclusion: A and B protocol for PRC preparation are statistically significant. Hematocrit percentage and volume of both procedures were accepted by international standard. Therefore, T-ACE II+ completely success instead of manual procedure and benefit to support routine PRC preparation.
Ezeama Martina
Imo State University, Nigeria
Title: The effectiveness of classroom-based HIV and AIDS education among in-school adolescents in Orlu Senatorial zone, Imo state, Nigeria
Biography:
Ezeama Martina currently works at Imo State University, Nigeria
Abstract:
Introduction: Adolescents in secondary schools are engaging in risk behaviors that put them at risk of HIV infection and AIDs. Although HIV and AIDS educational interventions have been widely implemented in secondary schools in Nigeria, the effectiveness of these programme studies in this area are limited in Nigeria. This study investigated the effects of using Classroom Instruction (CI) and Drama (DR) for HIV and AIDS prevention among in-school adolescents in Orlu Senatorial Zone, Nigeria.
Materials and Method: A quasi-experimental design using 165 students from three randomly selected co-educational secondary schools was adopted. The knowledge and attitude of 55 students who received classroom-based HIV and AIDS education intervention (CBI) were compared with those that received drama intervention (DRI) and the control group (CG) without intervention. Baseline and follow up data were collected using a semi-structured questionnaire with 29-point knowledge and 9-point attitudinal scales. Knowledge, scores of <15 and ≥15 were classified as poor and good respectively; while attitude scores of <5 and ≥5 were categorized as negative and positive. The results for baseline studies were used to design interventions that were implemented for 8 weeks followed by the conduct of mid-term and follow-up evaluations. Data were analyzed using descriptive statistics, t-test, and ANOVA at p=0.05.
Results: There was no statistically significant difference (P<0.05) in mean ages of respondents in CBI, DRI and CG groups (13.4±1.2, 13.9±1.5, and 13.8±1.2 years respectively). Knowledge scores on HIV/AIDS at baseline were 20.5±2.7, 20.4±2.6 and 21.1±2.7 for CBI, DRI and CG groups respectively. These scores increased to 22.7±2.7, 22.6±1.8 and 21.2±0.3 at mid-term for CBI, DRI, and CG respectively. At follow-up, knowledge scores for CBI and DRI increased to 23.9±1.8 and 24.5±1.4 respectively while the score for the control dropped to 20.0±2.8. Scores for attitude among CBI, DRI and control groups during the baseline study were 5.3±1.4, 4.9±1.5 and 5.3±1.0 respectively. For mid-term, attitude scores were 5.1±1.2, 5.0±0.9 and 4.7±1.5 for CBI, DRI, and CG respectively while scores at follow-up were 5.3±1.2, 5.6±0.7 and 4.5±1.2, indicating greater increase among the intervention groups than of control.
Conclusion: The use of drama intervention yielded the most positive outcomes for knowledge increase and attitudinal change among the students. This strategy is recommended for adolescents’’ HIV and AIDS prevention education in rural secondary schools in Imo State, Nigeria.
Heba Gouda
Cairo University, School of Medicine, Egypt
Title: Breast cancer resistance protein in acute myeloid leukemia: Clinical relevance and prognostic significance
Biography:
Heba Gouda has completed her MD degree since 2005 she has more than 26 international publication in the field of hematology and stem cell research, she is a full professor of clinical and chemical pathology since 2010 at the school of medicine Cairo University (ranked among the first 250 medical schools all over the world). She has a professional health care and hospital management diploma from the American University in Cairo since 2017.
Abstract:
Acute myeloid leukemia (AML) is a genetically heterogeneous clonal disorder characterized by the accumulation of acquired genetic alterations in hematopoietic progenitor cells. The multidrug transporter Breast Cancer Resistance Protein (BCRP) gene expression is an important prognostic marker in adult AML. In this study, we measured BCRP mRNA expression by quantitative real-time RT-PCR in 100 de novo cytogenetically normal adult AML patients and 50 healthy normal controls. The expression was evaluated in relation to other clinical and prognostic factors as well as response to treatment and disease-free survival. There was a positive correlation between BCRP gene over-expression and the percent of CD34 expression. This coexpression was associated with a lower complete response (CR) rate and with worse event-free survival and overall survival. We conclude that co-expression of CD34 and BCRP reflects a clinically resistant subgroup of adult AML.
Ogbonna Collins Nwabuko
Federal Medical Center, Nigeria
Title: Challenges of managing multiple myeloma in a developing country: The case of Nigeria
Biography:
Ogbonna Collins Nwabuko was born on the 12th of November, 1972. He hails from Umuode Nsulu in Isiala-Ngwa North Local Government Area of Abia State, Nigeria. He obtained his post-doctoral (FMCPath) fellowship in Hematology from the National Post-graduate Medical College of Nigeria in 2010. In 2012, he obtained a post-graduate certificate training in Palliative Medicine (PGCert.Pallia.Care) from the Institute for Hospice and Palliative Care in Africa, Kampala, Uganda. He is an international active member of American Society of Hematology, USA (ASH), a combined Master’s and PhD student of Public Health (Epidemiology) of University of South Wales (United Kingdom) and Walden University, Baltimore, USA respectively; a lecturer with Abia State University, and a consultant Hematologist with Federal Medical Center, Umuahia, Abia State, Nigeria. He is currently an editorial advisory board member of “The Open Orthopedics Journal”, Bentham Open; Cancer Management Research, Dove press, Journal of Blood & Lymph just to mention but a few.
Abstract:
Background: Multiple myelomas (MM) is one of the commonest hematological malignancies of public health importance in low-income countries of sub-Saharan Africa. It accounts for 1% of all cancer diagnosis and second commonest hematologic malignancy after malignant lymphoma. MM accounts for about 8.2% of hematological malignancies in Nigeria. The diagnosis of multiple myeloma is based on a constellation of haematologic, immunologic, histologic, and radiographic features. The two major challenges in the management of MM in Nigeria are in the diagnosis and treatment. Though primarily a disease of the bone marrow, it often poses a diagnostic dilemma for the orthopedic surgeons because of the frequent skeletal manifestations”. It is usually misdiagnosed as an orthopedic disease when in the real sense it is a hematologic disease with orthopedic complications. Lack of modern equipment for diagnosis is key players in the late diagnosis of MM in Nigeria. The mean duration from onset of symptoms to diagnosis in a study was 13.12 months (95% CI, 6.65-19.58). The diagnosis of MM is made late between Durie-Salmon Stages II-A and III-B. This late staging contributes to the poor survival outcome of people living with MM in Nigeria. The last step in the management of multiple myeloma is the therapeutic intervention. The current standard holistic treatment for MM is palliative care. Palliative care offers supportive, definitive and psychosocial care for people living with MM. There is a gross inadequacy in the palliative care of MM in Nigeria. There are less than three functional radiotherapy machines serving a population of about 180 million people in Nigeria. The definitive treatment in Nigeria still remains Melphalan-Prednisolone (MP) combination regimen (>84% of MM patients) as against the standard Bortezomib-lenalidomide-dexamethasone (RVD) triplet regimen (0%). About 28% of MM patients could afford a “partial-standard” triplet regimen made up of either one proteasome inhibitor (VMP/7.7%) or one immunomodulatory agent (Thalidomide-MP/19.7%). “Partial” in this context connotes combination of a novel therapy with the old conventional regimen (i.e. MP). Stem cell transplantation (i.e. ASCT) is still a far cry in the treatment of MM in Nigeria. Only 3.8% benefited from SCT intervention carried out outside Nigeria. About 7.6% of MM patients survive up to 5 years post-diagnosis. This was below estimated 5 years post-diagnosis period survival of 44.9% recorded by SEER cancer statistics review of 1975-2007 in the USA. This study highlights some of the challenges encountered in the management of people living with multiple myeloma in developing countries using Nigeria as a case scenario. It also tends to proffer possible solutions on how to mitigate these challenges in order to improve their quality of life.
Conclusion and Recommendations: Late diagnosis and inadequate palliative care are the hallmarks of poor prognostic and survival outcome of MM in Nigeria. The government, stakeholders in health institutions and donor agencies passionate for MM have a role to play towards improving the quality of life of people living with MM in Nigeria and developing countries.
Jacobus Hendricks
University of KwaZulu-Natal, South Africa
Title: B cell exhaustion in HIV: A role for programmed death receptor 1 (PD-1) immune checkpoint
Biography:
Jacobus Hendricks is a qualified Molecular Biologist. He is a lecturer in the Discipline of Human Physiology at the School of Laboratory Medicine and Medical Sciences at UKZN. He is responsible for the supervision of research students within the School of Health Sciences. He completed his Doctoral Degree in the field of Immunogenetics at the University Medical Center Groningen, Netherlands (2015). The tile of his Doctoral study is: “Heterogeneity of memory marginal zone B lymphocytes”, where he has studied the nature and origin of these memory B-cells in the Marginal Zone.
Abstract:
Programmed cell death protein 1 (PD-1) and PD-L1 function as major immune checkpoint regulators, which are the inhibitory pathways in the immune system that maintain self–tolerance and modulate the immune response. The most studied of these checkpoints is PD-1 pathways in T cells. Generally, PD-1 a surface protein expressed on B cells and T cells transmits inhibitory signals when bound to its ligands, programmed cell death ligands 1 and 2 (PD-L1/PD-L2) expressed on other antigen presenting cells. Various studies suggest that during the HIV infection the up-regulation of PD-1 could possibly cause the diminishing of B cell responses thereby interfering with antibody production. Suggesting that using anti-PD-1 antibodies could enhance antibody responses in infections like HIV that comprises B cell responses. Failure of immune protection is caused in patients with HIV partly due to B cell dysfunction and the reduction of viral-specific T cells during the chronic infection. It is possible that the exhaustion of these cells is characterized by lowering the competence of the cells to proliferate due to the up-regulation of the inhibitory receptors, therefore making them poorly responsive to stimulation. Whether the upregulation of inhibitory receptors in exhausted B cells includes the canonical immune checkpoint inhibitor programmed cell death protein 1 (PD-1) is unknown. Therefore we have investigated the HIV-driven expression of inhibitory surface molecules, specifically PD-1, to explain any impairment of SHM in the HIV infected patients.
Amitabha Bhattacharya
Calcutta School of Tropical Medicine, India
Title: Garbage to gold: Experience of placental umbilical cord whole blood transfusion in Eastern India
Biography:
Amitabha Bhattacharya MPhil student of Regenerative Medicine and Translational Sciences School Of Tropical Medicine, Kolkata. He passed MBBS in the year 1979 from Kolkata Medical College and also passed Diploma in Public Health from All India Institute Of Hygiene in 1988. He wrote several editorials as Editor of “YOUR HEALTH”-An Indian Medical Association Publication for the people to propagate Health Awareness amongst Community. He is at present Henry Associate Editor of “Journal Of the Indian Medical Association”- Indexed in Index Medicus. He retired as Deputy Chief Medical Health Officer Kolkata Municipal Corporation. Throughout his career, he worked as Tuberculosis control officer of RNTCP Kolkata. He also worked for of Malaria and Dengue control programme.
Abstract:
After birth or placenta is generally regarded as a discarded product. However umbilical cord blood is an admixture of fetal and adult hemoglobin, high platelet and WBC counts, several cytokine and growth factors and as well as its hypo-antigenic nature and altered metabolic profile, is a potentially safe alternative to adult blood transfusion. In under developed and developing countries there is a huge dearth of safe transfusion facilities and infrastructures like leukoreduction, selective apheresis, irradiation of the blood, viral inactivation of blood by solvent and/or detergent treatment and cytomegalovirus safe blood. We transfused 413 U (range 50ml to 146ml; mean 86±7.6ml; median 80ml; mean packed cell volume 48±4.1%; mean hemoglobin concentration 16.2g/dl±1.8g/dl) of placental umbilical cord whole blood, after lower uterine cesarean section from consenting mothers, to 129 informed consenting patients, after screening by the institutional ethics committee between 1999 to 2005. The list of consenting patients included 54 men and 75 women. Patient age varied from 2 years to 86 years. Seventy-three patients (56.58%) suffered from advanced cancer and 56 (43.42%) patients had diseases like ankylosing spondylitis, systemic lupus erythematosus, rheumatoid arthritis, tuberculosis, aplastic anemia, and thalassemia major. In non-malignant diseases like tuberculosis and rheumatoid arthritis, the peripheral blood hematopoietic stem cell (CD34) estimation revealed a rise from the pretransfusion base level (0.09%), varying from 2.99% to 33%, which returned to the base level in most patients at the end of three months. None of the transfusions were associated with the immunologic or nonimmunologic reaction so far. Umbilical cord blood is a gift of nature, free from infection, hypoantigenic with an altered metabolic profile, the high oxygen carrying capacity and hence can be used as an emergency source of blood for the management of disaster or crises anywhere in the world.
Meravt Khorshied
Kasr Al Ainy School of Medicine, Cairo, Egypt
Title: Genetic variations in tumor necrosis factor related apoptosis-inducing ligand-1 and the susceptibility to B cell Non-Hodgkin lymphoma in Egypt
Biography:
Meravt Khorshied has completed her MD at the age of 34 years from Kasr Al Ainy School of Medicine, Cairo University and postdoctoral studies from CairoUniversity School of Medicine. She is the director of Teaching module of the master of Clinical and Chemical pathology, Faculty of Medicine, Cairo University. A former member of the committee responsible for directing and improving blood banks as well as conduction of point of care system, Kasr Al Ainy Teaching Hospitals, Cairo University. She has published more than 25 papers in reputed journals and has been serving as an editorial board member of repute.
Abstract:
B-cell non-Hodgkin lymphomas (B-NHL) represent a heterogeneous group of disorders characterized in most cases by genetic alterations and chromosomal translocations. As lymphoma is a multi-hit phenomenon, other genetic abnormalities including concurrent deregulation of other dominant oncogenes and/or inactivation of tumor suppressor genes (TSGs) are necessary for lymphomagenesis. Tumor necrosis factor-related apoptosis inducing ligand-1 (TRAIL1) and its receptor (TRAIL-R) engage the suicide machinery of cells and activates the apoptotic proteases to mediate apoptosis. Dysregulation of their function due to genetic alterations has been reported to play a crucial role in the pathogenesis of different cancers. To explore the possible association between TRAIL1-C626G, -A683C and -A1322G single nucleotide polymorphisms (SNPs) and the susceptibility to B-NHL in a cohort of Egyptians, we conducted a case-control study. The study included 100 B-NHL patients and 150 healthy controls. Genotyping of TRAIL1 (rs20575, rs20576, and rs2230229) SNPs was done by polymerase chain reaction technique.
Results: The frequency of polymorphic alleles of TRAIL1-C626G and A1322G SNPs was higher in B-NHL cases compared to controls and conferred twofold increased risk of B-NHL in Egyptians (OR=1.76, 95%CI=1.01-3.07 and OR=2.04, 95%CI=1.02-4.07 respectively). There was no statistical difference in the distribution of TRAIL1-A683C genotypes between B-NHL patients and controls (OR=1, 95%CI=0.5-2). Combined genotypes analysis revealed that coinheritance of TRAIL1-C626G and A1322G conferred fivefold increased the risk of B-NHL (OR=5.02, 95%CI=2.35-10.73), while coinheritance of A683C and A1322G was associated with almost threefold increased risk of B-NHL (OR=2.6, 95%CI=1/05-6.73). Co-existence of the variant genotypes of the three SNPs conferred fourfold increased risk of BNHL (OR=4.1, 95%CI=1.01-17.63). In conclusion, genetic variations in TRAIL1 gene could be considered as molecular risk factor for B-NHL among Egyptians. Deeper insight into the contribution of TRAIL1 genetic polymorphism in lymphomagenesis is recommended. Furthermore, TRAIL is a novel promising treatment target for hematological malignancies. Ultimately, functional studies concerning the role of these polymorphisms may allow the identification of potential therapeutic targets.
Biography:
Rubiya Nadaf currently doing her fellowship in the branch of Pediatric Hematology Oncology with a special interest in Bone marrow transplant, in India. She worked very hard in order to secure MD with Gold Medal at one the most reputed institutes in India and she was also selected as a young scholar from the entire western part of India and represented west India at a young scholar meet. She works with dedication and honestly which enables her to acquire essential knowledge and skills for safe and expected practice in pediatrics and in the field of Oncology.
Abstract:
The outcome of pediatric Acute promyelocytic leukemia (APL) has improved after the introduction of All-trans retinoic acid (ATRA) given with anthracycline-based regimen. Differentiation syndrome (DS) is a severe sometimes life-threatening complication of ATRA occurring during induction therapy. Cardiac manifestations in the form of myopericarditis associated with LV dysfunction have rarely been documented. Here we report a rare case of myopericarditis with LV dysfunction as a result of DS-related to ATRA administration during induction treatment of APL. A 5-year-old male child presented with bleeding diathesis characterized by bruises and bleeding gums. He was evaluated and diagnosed to have an Acute promyelocytic leukemia-high risk, FLT3-ITD mutation positive. As per the AIDA-2000 trial of the GIMEMA group he was initiated on induction with ATRA plus idarubicin. On the fourth day of induction, he developed fever, peripheral edema, hepatomegaly, tachycardia with gallop and dyspnea with a drop in saturation requiring oxygen. A chest X-ray revealed bilateral pulmonary infiltrates and an enlarged cardiac shadow. Electrocardiography showed non-specific ST elevations. Cardiac enzymes were elevated. 2D Echocardiography with Doppler showed global hypokinesia of the left ventricle with an ejection fraction of 40% and features were consistent with myocarditis. ATRA was temporarily withheld. Considering cardiac involvement due to differentiation syndrome, dexamethasone was started. A dramatic relief of symptoms and resolution of radiological signs were observed during the following days. Repeat 2D-ECHO was done which was normal. Pericardial effusion is a common cardiac manifestation of DS but myocarditis had been rarely documented. The differential diagnosis between DS and acute cardiac toxicity induced by anthracyclines might be challenging. In this case disappearance of myocardial dysfunction after treatment with a corticosteroid, confirmed the diagnosis of DS resulting in myopericarditis. In conclusion, a better knowledge of the spectrum of DS can be a useful tool for early decision-making in patients who develop this syndrome.
- Hematology | Blood Disorders | Hemato-Oncology | Paediatric Hematology | Blood Banking | Hematology Nursing
Location: Plaza II
Session Introduction
Ogbonna Collins Nwabuko
Federal Medical Center, Nigeria
Title: Beyond the legislation for sickle cell prevention getting the right outcomes: A Nigerian experience
Biography:
Ogbonna Collins Nwabuko was born on the 12th of November, 1972. He hails from Umuode Nsulu in Isiala-Ngwa North Local Government Area of Abia State, Nigeria. He obtained his post-doctoral (FMCPath) fellowship in Hematology from the National Post-graduate Medical College of Nigeria in 2010. In 2012, he obtained a post-graduate certificate training in Palliative Medicine (PGCert.Pallia.Care) from the Institute for Hospice and Palliative Care in Africa, Kampala, Uganda. He is an international active member of American Society of Hematology, USA (ASH), a combined Master’s and PhD student of Public Health (Epidemiology) of University of South Wales (United Kingdom) and Walden University, Baltimore, USA respectively; a lecturer with Abia State University, and a consultant Hematologist with Federal Medical Center, Umuahia, Abia State, Nigeria. He is currently an editorial advisory board member of “The Open Orthopedics Journal”, Bentham Open; Cancer Management Research, Dove press, Journal of Blood & Lymph just to mention but a few.
Abstract:
Background: Sickle cell disease (SCD) is one of the non-communicable diseases (NCDs) of public health importance globally. It ranks among the top ten NCDs in Nigeria. The World Health Organization (WHO) considers it the most prevalent genetic disease in Africa. It is estimated that more than 300,000 births are affected annually worldwide and greater than 75% of the world’s SCD patients are said to be living in sub-Saharan Africa (CDC 2012). Nigeria ranks first in the sickle cell disease burden worldwide with 40 million people carrying the gene. It is reported to have one-third of the world’s annual incidence (i.e., 90-150 x 103 births annually (Piel et al., 2013). The estimated prevalence rate in Abia State, a south-eastern Nigerian state is 1.8% (Nwabuko et al., 2015). This is in keeping with the estimated national prevalence of 1-3%. A good health policy is the major determinant of the health of the population in any nation. Building healthy public policy is one of the major key factor areas of health promotion. It influences the health outcome of any nation with respect to average life expectancy and infant mortality rate (IMR). The United Nations and the WHO use the health outcomes of the population of a nation to rank the nation (CIA, n.d.). Nigeria ranks 214th (with average life expectancy from birth of 53.8 yrs) out of 224 member nations of the United Nations. The implication is that 213 countries in the world are healthier than Nigeria. Nigeria is the 8th worse country to be born on earth based on the IMR of 69.8 per 1000 live births per year (World Fact book, 2017). These poor health indices are attributable to lack of health-promoting policies from the government. Nigeria falls within the countries with the worst health policies and guidelines worldwide. The Abia State government, a state in south-eastern Nigeria, has just passed a bill for compulsory identification of blood groups and genotypes of all her citizens irrespective of their ages. This bill is a healthy public law which will authorize all health institutions in the state to craft policies that will curb the burden of SCD in the state by prevention, treatment, and curative interventions. For the first time, a state in Nigeria is holding the bull by the horn by promulgating a health-promoting policy which is geared towards preventing a disease of public health importance. A bill termed with the slogan “breaking the chains of SCD”. This study takes a look at this policy and how it can bring about the desired positive changes in the targeted audience and the entire population of the state. It also takes a look at the reproducibility and the challenges of implementing this health policy globally.
Niladri Shankar Ganguli
Calcutta School of Tropical Medicine, India
Title: Placental umbilical cord blood transfusion: A new method of treatment of patients with diabetes and microalbuminuria in the background of anemia
Biography:
Niladri Sankar Ganguli is a student of Regenerative Medicine and Translational Science (Part II), School of Tropical Medicine Kolkata. He is presently working under Prof Niranjan Bhattacharya, HOD of Regenerative Medicine and Translational Science, School of Tropical Medicine, Kolkata. His special interest is in Cord Blood Banking, its transfusion affect in various diseases including Malignancy. He passed MBBS in the year 1980 from North Bengal Medical College and was a senior resident in the Dept of Orthopedic Surgery SSKM hospital Kolkata and a junior resident in the Dept of Obstetrics and Gynecology in the same hospital. He is a practicing physician since last 35 years.
Abstract:
Diabetes mellitus is the commonest endocrine disease in all populations and all age groups. It is a syndrome of disturbed intermediary metabolism caused by inadequate insulin secretion or impaired insulin action, or both. Anemia is a common accompaniment of diabetes, particularly in those with albuminuria justifying tubulointerstitial injury or reduced renal function. There are other additional factors present in diabetes, which may contribute to the development of an increased risk of anemia. Cord blood, because of its rich mix of fetal and adult hemoglobin, high platelet and WBC counts, hypo-antigenic nature, altered metabolic profile and high affinity for oxygen, may be an ideal choice for cases of diabetes with severe anemia necessitating blood transfusion. This article presents my team's experience with 78 units of placental umbilical cord whole blood (from 1 April 1999 to April 2005), collected after lower uterine cesarean section (LUCS) from consenting mothers (56 ml-138 ml mean 82ml+/-5.6ml SD, median 84ml, mean packed cell volume 49.7+/-4.2 SD, mean percent hemoglobin concentration 16.6g/dl+/-1.5g/dl SD) and transfused to diabetes patients with microalbuminuria and severe anemia necessitating transfusion. After collection, the blood was transfused, in most cases immediately after completion of the essential norms of transfusion. In rare cases, it was kept in the refrigerator and transfused within 72 hours of collection to a suitable recipient. For inclusion in this study, the patient's percent plasma hemoglobin had to be 8g/dl or less (the pretransfusion hemoglobin in this series varied from 5.2g/dl to 7.8g/dl) in the background of type two diabetes (fasting sugar 200mg or more), along with features of microalbuminuria (albumin excretion 30-299mg/g creatinine). This study included 39 informed consenting patients (22 males+17 females, aged 48-74 yrs, mean 59.6 yrs). The patients were randomized into two groups: Group A (control cases N=15, males=8 and females=7) and Group B (study group N=24, males=14 and females=10). In Group A the rise of hemoglobin (Hgb) after two units of adult blood transfusion was 1.5 to 1.8g/dl, as seen after a 72-hour blood sample assessment. The rise of Hgb as noted after 72 hours of two units of freshly collected cord blood transfusion was 0.6g/dl to 1.5g/dl. Each patient received two of four units of freshly collected cord blood transfusion (two units at a time), depending on availability and compatibility. Microalbuminuria was assessed in both groups after one month of treatment with transfusion and other identical support. The mean result was 152+/-18m SD of albumin per gram of creatinine excreted through 24-hour urine (pre-transfusion mean excretion was 189+/-16mg) in Group A and 103+/-16mg SD of albumin excretion per gram of creatinine in 24-hour excretion of urine in Group B (pretransfusion mean excretion was 193+/-21mg). Univariate analysis using Fisher's exact test was performed for the results of Groups A and B. The difference between Group A and B values and its comparison with the pre-transfusion microalbuminuria appeared to be statistically significant (p< less than .003). We have not encountered any clinical, immunological or non-immunological reaction so far in either group. Fetomaternal cell traffic has been implicated as the cause of scleroderma in mothers delivering male babies. In the present series, we did not see any such rare and unusual complication due to neonatal blood transfusion in the adult system in Group B patients in the six years from the initiation of the study.