Title: A Proposed Approach for the Management of Diastolic Dysfunction: Optimization of the E and A Wave Measurement, Morphology and Timing

Abstract:

The approach to hyponatremia is in a state of flux, especially in differentiating syndrome of inappropriate secretion of antidiuretic hormone (SIADH) from cerebral-renal salt wasting (RSW) because of diametrically opposite therapeutic goals of water-restricting in SIADH and administering saline in RSW. We differentiated SIADH from RSW by utilizing an algorithm based on fractional excretion (FE) of urate and failure of isotonic saline infusions to dilute the urine or correct the hyponatremia  in SIADH as compared to excretion of dilute urines and correction of hyponatremia in RSW . We also identified the natriuretic factor we previously demonstrated in neurosurgical patients with RSW and in Alzheimer’s disease (AD).

Results: Of 62 hyponatremic patients, (A) 17 patients (27%) had SIADH, 11 were nonresponsive to isotonic saline, and 5 normalized a previously high FEurate after correction of hyponatremia; (B) 19 patients (31%) had a reset osmostat based on normal FEurates and spontaneously excreted dilute urines; (C) 24 patients (38%) had RSW, 21 had no clinical evidence of cerebral disease, 19 had saline-induced dilute urines; 2, 10 required D5W to prevent rapid increases in serum sodium to prevent osmotic demyelination, 11 had persistently increased FEurate after correction of hyponatremia. (D) 1 patient had Addison disease with a low FEurate and (E) 1 patient (1.6%) had hyponatremia due to hydrochlorothiazide. We identified haptoglobin related protein without signal peptide (HPRWSP), the first potent inhibitor of proximal tubule sodium transport, as the natriuretic factor in a patient with RSW and in AD.

Conclusions: RSW is much more common than is perceived with 21 of the 24 patients with RSW lacking evidence of cerebral disease, supporting our proposal to change cerebral salt wasting to RSW.   HPRWSP can serve as a biomarker for RSW to simplify diagnosis of RSW on first encounter, direct proper therapy, improve clinical outcomes and identifying a new syndrome of RSW in AD.  We will discuss how HPRWSP will more effectively treat congestive heart failure when combined with a distal diuretic.

Biography:

John K Maesaka was born in Hawaii, received degrees from Harvard College and Boston University School of Medicine, did his medical residencies at BarnesJewish Hospital at Washington University In St. Louis and Mount Sinai Hospital in New York and renal fellowship at Mount Sinai Hospital. His interest-driven decision to spend 5 years exclusively in the renal physiology laboratory at Mount Sinai Hospital as a renal fellow and member of the faculty proved to be the best investment he made to pursue an academic career in medicine. He was involved in developing colorimetric methods for the determination of uric acid and phosphorus in blood and urine that were applied to studying the transport characteristics of both electrolytes by renal micropuncture techniques in rat kidney. He developed several bioassays to demonstrate the presence of a natriuretic factor in the blood of patients with renal salt wasting and Alzheimer’s disease and more recently identified the elusive natriuretic factor after more than a 25-year pursuit.

Title: Pharmaceutical Atrial-Ventricular Optimization in Diastolic Dysfunction: A Clinical Concept Application of Materials Engineering to Myocardial Pathophysiology

Abstract:

Much focus over the past few decades has been on the systolic phase of the cardiac cycle, yet it is becoming evident that more advanced therapies are warranted for the clinical management of heart failure, specifically diastolic dysfunction. A novel optimized approach in evaluating and managing diastolic dysfunction/ heart failure is required to evaluate and treat cardiac dysfunction. The proposed measures include the evaluation of the baseline functionality of the cardiac conduction system, Baseline E and A wave Measurement and Morphology  (BEAMM) and STRess-induced E and A wave Measurement and Morphology (STREAMM) with timing and variability taking into consideration of both macro and micro diastolic myocardial processes. Implementation of a management plan that includes echocardiographic optimization (ECHO-Op) and pharmaceutical optimization (PharmOp) into the current guideline recommendations for the evaluation and management of diastolic dysfunction/ heart failure is an additional goal. Clinical adoption of the proposed approach may lead to earlier identification of patients at risk of diastolic dysfunction/ heart failure as well as other associated cardiac symptoms and downstream pathological processes.

Biography:

Benjamin Cooper is currently a medical resident at Aventura Hospital and Medical Center in Aventura, FL. Prior to starting medical school, He was a full-time Firefighter/Paramedic in Des Moines, Iowa. In addition, he worked at Iowa Heart Center as a Testing Paramedic for CT, Nuclear, and Ultrasound departments. He has been an American Heart Association Basic Life Support Instructor since 2007. Ben received his Doctor Osteopathic Medicine degree and Masters of Medical Science degree from Lake Erie College of Osteopathic Medicine.

Title: Nutraceuticals in the prevention and treatment of atherosclerosis and cardiovascular disease

Abstract:

Atherosclerosis, an inflammatory disorder of medium and large arteries and the underlying cause of myocardial infarction and cerebrovascular accidents, is responsible for more global deaths than any other disease. Although reduction in mortality from atherosclerosis and its complications has been achieved recently by lifestyle changes and pharmaceutical intervention, this is expected to reverse in the future because of global increase in risk factors such as hypercholesterolemia, obesity, and diabetes. Current pharmaceutical therapies against atherosclerosis are associated with substantial residual risk for cardiovascular disease together with other issues such as side effects. In addition, pharmaceutical agents against many promising targets have proved disappointing at the clinical level. It is therefore essential that the molecular basis of atherosclerosis is fully understood, and new therapeutic/preventative agents or targets are identified and validated.

The major focus of recent research in my laboratory is to understand the molecular mechanisms underlying the protective anti-atherogenic actions of natural products using a combination of in vitro and in vivo model systems together with biochemical, molecular biology and immunological approaches. Our research has provided novel insights into the mechanisms underlying the protective actions of several nutraceuticals. This presentation will discuss the molecular basis of atherosclerosis and opportunities for drug discovery, current therapies against the disease and their limitations, emerging therapies targeting lipid metabolism and the inflammatory response, new challenges, and the potential of natural products as preventative and therapeutic agents with focus on probiotic bacteria.

Biography:

Dipak Ramji is Professor of Cardiovascular Science and Deputy Head at the School of Biosciences in Cardiff University. He is also Fellow of the Learned Society of Wales. He received his BSc (Hons) degree (Biochemistry) and his PhD (Molecular Biology) from the University of Leeds. This was followed by post-doctoral research at EMBL (Heidelberg) and IRBM (Rome) with fellowships from the Royal Society and the EU. His current research is focused on understanding how natural products regulate cellular processes in heart disease with the goal of attaining deeper mechanistic insight and identifying preventative/therapeutic agents. He has published over 150 research articles (h index 41 and i10 index 76 with over 8350 citations), including 880-page book in 2022 on Methods in Atherosclerosis. He is an Editorial Board member of 16 international journals; regular organising committee member, speaker, and track/session chair at international conferences on heart disease; involved in grant evaluation for over 20 organisations; and supervised over 25 PhD students

Title: Pasteurella Multocida: A Case Report on the Presentation and Challenges of Cellulitis, Osteomyelitis and Myocarditis

Biography:

Pooja Patel completed her medical school in Mumbai, India and is currently pursuing her Internal Medicine residency at Larkin Community Hospital in South Miami, Florida. She is currently a PGY2 resident, who aspires to specialize in cardiology and critical care. She is from the Midwest, not fearing living in the oh-so-cold winters. Patel enjoys learning and improving her skills, in every aspect available. She believes ‘teaching others is the easy way to learning’. Patel also completed and received her Master’s in Biomedical Sciences. She has volunteered her time at a non-profit organization since 2017, at Waukesha Free Clinic in Waukesha, Wisconsin (former St. Joseph’s Medical Clinic), and still continues to do so whenever  possible. Patel was awarded the Director’s Coin during her rotation at the VA Medical Center in Grand Junction, Colorado for the care provided to our veterans, and for volunteering to help the community in times of the COVID surge in the late 2021. As a physician, she prides herself on serving those who have served our country.

Title: An Investigation of Left Ventricular Valve Disorders and the Mechano-Electric Feedback Using a Synergistic Lumped Parameter Cardiovascular Numerical Model

Abstract:

Cardiac diseases and failure make up one of largest contributions to global mortality and significantly detriment the quality of life for millions of others. Disorders in the valves of the left ventricle are a prominent example of heart disease, with prolapse, regurgitation, and stenoses—the three main valve disorders. It is widely known that mitral valve prolapse increases the susceptibility to cardiac arrhythmia. Here, we investigate stenoses and regurgitation of the mitral and aortic valves in the left ventricle using a synergistic low-order numerical model. The model synergy derives from the incorporation of the mechanical, chemical, and electrical elements. As an alternative framework to the time-varying elastance (TVE) method, it allows feedback mechanisms at work in the heart to be considered. The TVE model imposes the ventricular pressure–volume relationship using a periodic function rather than calculating it consistently. Using our synergistic approach, the effects of valve disorders on the mechano-electric-feedback (MEF) are investigated. The MEF is the influence of cellular mechanics on the electrical activity, and significantly contributes to the generation of arrhythmia. We further investigate stenoses and regurgitation of the mitral and aortic valves and their relationship with the MEF and generation of arrhythmia. Mitral valve stenosis is found to increase the sensitivity to arrhythmia-stimulating systolic stretch, and reduces the sensitivity to diastolic stretch. Aortic valve stenosis does not change the sensitivity to arrhythmia-stimulating stretch, and regurgitation reduces it. A key result is found when valve regurgitation is accompanied by diastolic stretch. In the presence of MEF disorder, ectopic beats become far more frequent when accompanied by valve regurgitation. Therefore, arrhythmia resulting from a disorder in the MEF will be more severe when valve regurgitation is present.

Biography:

Eun-jin Kim is a Professor in Physics and Applied Mathematics at Coventry University, UK. She obtained her PhD in Physics from the University of Chicago, USA. She held postdoctoral positions at the Universities of Leeds/Exeter in UK, High-Altitude Observatory in Boulder, USA and University of California, San Diego, USA, and Assistant and Associate Professor positions at the University of Sheffield, UK. She is interested in self-organisation and complex systems/non-equilibrium processes including cardiac dynamics. She was awarded the Leverhulme Trust Research Fellowship and published over 130 refereed journal papers.

Title: Conduction abnormalities after TAVI

Abstract:

Transcatheter aortic valve implantation is a procedure that allows the aortic valve replacement via minimally invasive technique. We can distinguish several access methods: transfemoral, transapical, subclavian, direct aortic as well as transcaval. Patients who underwent TAVI have a lower mortality rate in comparison with those who have non-operated severe aortic stenosis. Although advantages prevail over disadvantages, the procedure may entail conduction abnormalities. The most common are: left bundle branch block and high-grade atrioventricular block. The proximity of the aortic valve to the conduction pathways (possible injury as a result from interventional equipment interactions) as well as the anatomical variants of AV nodes may predispose patients who underwent TAVI to higher risk of conduction abnormalities. We can distinguish several factors that have the evident impact on previously described complications, such as: pre-existing RBBB, type of the transcatheter valve, annular size, depth of the implantation and the degree of mitral and aortic valve calcifications. The electrocardiographic recordings that are the cause of concern are narrow QRS complexes (especially before TAVI) as well as fluctuating changes in PR interval. Among risk factors for LBBB development we can underline the self-expandable prostheses (in comparison with balloon-expandable ones) and larger implant depth. The behavior of heart blocks has been noticed to change dynamically during and after aortic valve replacement. Patients who presented conduction abnormalities before TAVI, were in the higher risk group. Majority of the heart blocks are reversible. The management of conduction abnormalities after transcatheter aortic valve implantation is based on the clinical status of our patient and ECG monitoring. Temporary pacemakers and PPM are being implanted if needed.

Biography:

Stefania Czapp has graduated from Medical University of Gdańsk in 2021 and now she is doing her postgraduation internship in Szpital Morski im. PCK in Gdynia (Poland). She has the big interest in Cardiosurgery and is planning to do her PhD in this field of science in Poland.

Title: Effects of periodized training regime on vascular and autonomic systems in patients with coronary artery disease: a pilot randomized controlled trial

Abstract:

Background: Periodized exercise training regime in clinical populations have not been well studied until currently days. The purpose of this study was to compare the effects of a periodized training regime to a non-periodized training regime in cardiorespiratory fitness (CRF), heart rate variability (HRV) and pulse wave velocity (PWV) parameters.

Methods: Twenty-four trained patients with stable coronary artery disease (CAD) (64±10 years) were randomized in 2 groups: linear periodized combined exercise training (LPCET) and non-periodized combined exercise training (NPCET) which performed 60 exercise training sessions (3 times per week) for 6 months. Baseline and end-protocol evaluations included: 1) incremental symptom-limited cycling cardiopulmonary exercise test; 2) one-repetition maximum; 3) arterial stiffness; and 4) heart rate variability.

Results: neither of the 2 groups increased VO₂ peak nor overall strength (p>0.05). The LPCET group increased 22% in Central pulse pressure (p=0.04); decreased 16% in upper limb PWV (p=0.009); 7% in Central diastolic blood pressure (p=0.05) and 11% in left ventricular ejection time (LVET) (p=0.05). The NPCET group decreased significantly 10% in upper Limb PWV (p=0.049), 9% in lower limb PWV and 16% in LVET (p=0.015). There were no significant differences between pre-post training in HRV index in both groups. Moderate Pearson´s correlation was found in LPCET: VO₂peak-Aortic PWV and SDNN-Aortic PWV (p<0.05; r=-0.4; r=-0.3 respectively).

Conclusion: Long-term non-periodized training regime in stable CAD patients was more effective to improve peripheral arterial stiffness than the periodized training regime. Both training models were equally effective in maintaining the HRV index. The current study suggests that exercise training may improve arterial stiffness but not autonomic balance independently of exercise type training prescription in trained CAD patients. More studies have to be performed to understand the PWV-HRV and the effects of new training approaches.

Future directions: A gap may exist in exercise protocols when the daily physiological individuality is not considered. As HRV as daily physiological state, both are constant variable. The most appropriate stimulus may be the one that respects the direct and indirect conditions of the organism. Correlating self-perception (i.e. Brums and Borg scale) and physiological variables may be an alternative to enhance the improvement of health and performance.

Biography:

Graduated in Physical Education from the Regional University of Blumenau Foundation (2007); Postgraduate courses related to special groups and biomechanics between 2009-2011 at the Gama Filho University. Postgraduate with emphasis on the improvement in cardiovascular rehabilitation at the Instituto do Coração; Master in Human Movement Sciences from the State University of Santa Catarina (2013). University Teacher (2010-2015) at FURB institutions; UNIDAVI; UNIFEBE; UNIASSELVI; UNIMAX (current job 2022) (Biochemistry of Exercise; Resistance Training; Biomechanics & Kinesiology; Technology in Physical Education). Ph.D scholarship  by CNPQ “Ciências Sem Fronteiras” program (Faculty of Human Motricity, 2015-19); Responsible for the teaching/research/extension process at the Cardiovascular Rehabilitation Center of the University of Lisbon (CRECUL). Dissertation/Thesis theme: Acute Responses and Chronic Effects of Autonomic/Cardiovascular/Cardiopulmonary Systems following exercise training. Research and professional activities in the area of health, training, cardiology, exercise biochemistry, musculoskeletal rehabilitation, cardiovascular rehabilitation, stress, nervous system and vascular system.

Title: Cardiohepatic interactions in the pathogenesis of heart failure

Abstract:

In heart failure, pump function is impaired, blood flow is reduced, and energy metabolism in tissues and organs throughout the body becomes dysfunctional. The liver is the largest organ in the human body and plays a central role in lipid and sugar metabolism, protein synthesis, detoxification, and bile acid production. It has long been known that there is an interaction between the heart and liver via blood circulation and the autonomic nervous system, especially in acute and chronic heart failure, which can cause acute ischemic hepatitis (shock liver) and chronic congestive liver injury. In recent years, basic research has accumulated, indicating the possibility of further interorgan communication between the heart and liver (heart-liver interaction). Hepatokine is a liver-derived hormone synthesized and secreted by hepatocytes. The liver secretes hepatokine to regulate glucose and lipid metabolism throughout the body, and its effects on the heart have recently been reported as a target organ of hepatokine. Selnoprotein P (SeP), a hepatokine, is rich in selenocysteine and has been reported to function as a transport protein for the trace element selenium.

Biography:

Soichiro Usui is an Associate Professor in Cardiovascular medicine in Kanazawa University, Japan. He is also Fellow of the European Society of Cardiology and the Japanese Circulation Society. He obtained his PhD in Medical Science from Kanazawa University, Japan. He held a postdoctoral position at the University of Medicine and Dentistry-New Jersey Medical School, USA. He is interested in molecular mechanisms of cardiac remodeling in heart failure and adipose-derived regenerative cell research. He published over 90 refereed journal papers.

Title: Long follow-up the effectiveness of thoracoscopic ablation of persistent and long-standing atrial fibrillation

Abstract:

Statement of the Problem. Atrial fibrillation (AF) has been identified as one of the most common arrhythmias in clinical setting. The prevalence of AF in adults is estimated to be between 1-2% currently, which is expected to increase by two- to threefold due to extended life expectancy [1, 2]. An important issue in modern arrhythmology is the search for highly effective, minimally invasive treatments for isolated non-paroxysmal AF, which represents up to 70% [3].

The purpose of this study is to evaluate the efficacy of thoracoscopic ablation (TSA) of persistent and long-standing atrial fibrillation in the long-term follow-up period.

Material & methods. From 2019 to 2021 years, 50 patients with persistent (I group) and 50 long-standing AF (II group) underwent TSA and exclusion left atrial appendage (LAA). Patients with paroxysmal AF, any organ heart pathology and decompensated conditions were not included in the study. The effectiveness of the procedure was defined as the absence of any atrial tachycardia (AF, supraventricular tachycardia, atrial flutter) documented on an ECG or on a 24-h HM ECG more than 30 seconds.

Surgical procedure. The procedure was performed according to the "Box lesion set" with additional linear ablations along the posterior wall of the left atrium (LA) and in projections of the ganglion plexus. Isolation of pulmonary vein (PVI) was performed using an ablative bipolar clamp (AtriCure, Inc., West Chester, Ohio, USA). LAA exclusion was performed through one of the left-sided ports using an endostapler, monitored by transesophageal echocardiography (Figure 1). Transmurality and the achievement of bidirectional conduction through the ablation lines performed (exit and entry block) were assessed at all stages of surgery.   

Results. Median age of patients was 58 (51-63) years and 56 (48-62.75) years, with a male domination of 75% (n=33) and 70.83% (n=34) in groups I and II, respectively. There was a statistically significant difference between the groups preoperatively only for the duration of AF of 2.25 (0.77-5) years in group I and 5 (2-8) years in group II (p=0.001*).

The mean follow-up period of the patients was 2.8±0.7 years. The overall efficacy of TSA after 3, 6 and 12 months was 82.7%, 81.6%, 73.5%, respectively. In the long-term follow-up period, freedom from AF was 70.7%.

Efficiency of epicardial ablation of persistent AF was 86.0% and 78.0%, and of long-standing AF 77.1% and 68.8% after 6 and 12 months, respectively (p=0.14).

Discussion. The heterogeneity of patients included in early studies makes it difficult to interpret the efficacy of TSA of persistent and long-standing AF. Whether additional lines of ablation outside the "Box lesion set" improve the efficacy of TSA is not fully understood [4]. The surgical protocol presented in our study was supplemented with ablation lines along the posterior wall of the LA and in the projection of the ganglion plexus, which improved the efficacy of TSA in the long-term follow-up to 70.7% compared with the data where ablations were performed exclusively according to the "Box lesion set" [5].  

Conclusion. Videoassisted thoracoscopic ablation of atrial fibrillation should be considered a promising method of arrhythmia management in patients with persistent and long-standing atrial fibrillation. Additional linear ablations along the posterior wall of the left atrium and in the projection of the ganglion plexus significantly improve the effectiveness of the procedure in the long-term follow-up.

Biography:

Elizaveta Strebkova (28 years). She graduated with honors from the Kursk State Medical University, than She graduated from a residency by cardiovascular surgery from the A.V. Vishnevskiy National Medical Research Center of Surgery in 2021 and wished to continue studying, went on for a Post Graduate by cardiovascular surgery and arrhythmology. The aim of her scientific work is “Effectiveness of thoracoscopic treatment of persistent and long-standing forms of atrial fibrillation”. She assist in all cardiac surgeries and take an active part in the scientific work our department. According to her work, theses and articles have been published. For the first time in our center, simultaneous two-way access is offered when performing thoracoscopic ablation, which significantly reduces the operation time.

Title: Angiotensin converting enzyme gene D-allele, a possible risk factor for procedural complications in the coronary artery disease patients

Abstract:

Purpose: This study aimed to explore the correlations between angiotensin converting enzyme gene’s polymorphism (I/D mutations) and the intra stent restenosis, after successful revascularisation, for patients with coronary artery disease. In addition, we aimed to bring new evidence concerning the interaction between  the most common epigenetical cardiovascular  factors (diabetes, hypertension, smoking habbit and obesity), left ventricle wall motion abnormalities, the D allele and the development of restenosis.Materials and methods: We performed genetical testing on 154 patients with unstable angina and acute myocardial infarction and found that the D-allele was significantly associated with the development of coronary artery disease. We performed percutaneous revascularisation for the patients with this indication.  After excluding the patients with indication for surgical revascularisation, we selected a subgroup of 115 patients, who we followed for one year. Results 43 of the patients developped intrastent restenosis at 6 months follow up coronary angiography. We found a strong association between restenosis and ACE I/D polymorphism. 37.2% of the restenotic patients were DD genotype and 62.8% ID genotype. II genotype patients did not develop intrastent restenosis(p=0,001). Also, patients with restenosis had a greater prevalence of diabetes (88.4% vs 45.8%; p=0.001), stage III blood pressure hypertension (90.7% vs 51.4%; p=0.001), dyslipidemia(100% vs 83.3%; p=0.001), obesity  (74.4% vs 48.6%; p=0.018), smoking habbit  (60.5% vs 41.7%; p=0.039 and as far as wall motion  abnormalities were concerned, only akinesia was relevant (53.2% vs 30.6%; p=0.013).

Conclusions: The presence of the D allele was significantly associated with restenosis, especially when patients were also diabetic, hypertensive, dyslipidemic, obese and smokers. Results in this field are still controversial and more data is needed. However, our study proves useful for our geographical population.

Biography:

Maria Cristina Vladeanu is graduated from University of Medicine and Pharmacy "Grigore T. Popa" in Romania. She is a member of european society of cardiology.

Title: Cardiovascular Complications of COVID-19 among Pregnant Women and Their Fetuses: A Systematic Review

Abstract:

Background: COVID-19 is a viral infectious disease leading to a spectrum of clinical complications, especially cardiovascular. Evidence shows that this infection can potentially accompany a worse outcome in pregnant women. Cardiovascular complications in mothers and their fetuses are reported by previous studies.

Objective:
In this systematic review, we aim to investigate the cardiovascular complications of COVID-19 during pregnancy in the mothers and fetus, according to the published literature. Method: We systematically searched the online databases of PubMed, Scopus, Web of Science, and Google Scholar, using relevant keywords up to April 2022. We included all observational studies reporting cardiovascular complications among COVID-19-affected pregnant women and their fetuses.

Results: We included 74 studies containing 47582 pregnant COVID-19 cases. Pre-eclampsia, hypertensive disorders, cardiomyopathy, heart failure, myocardial infarction, thrombosis formation, alterations in maternal–fetal Doppler patterns, and maternal and fetal arrhythmia were reported as cardiovascular complications. The highest incidences of pre-eclampsia/eclampsia among COVID-19 pregnant cases, reported by studies, were 69% and 62%, and the lowest were 0.5% and 3%. The highest and lowest incidences of fetal bradycardia were 20% and 3%, and regarding fetal tachycardia, 5.4% and 1%, respectively.

Conclusion: SARS-CoV-2 infection during pregnancy canpotentially be associated with cardiovascular complications in the mother, particularly pre-eclampsia and heart failure. Moreover, SARS-CoV-2 infection during pregnancy can potentially cause cardiovascular complications in the fetus, particularly arrhythmia

Biography:

Zohreh Tutunchian is a 5th year medical and MPH student at Shahid Beheshti University of Medical Science (SBMU) and also a member of Medical Student Research Committee (MSRC). She is interested in medical research in the field of cardiology and pharmacology. This research was conducted to gather the cardiovascular results of COVID-19 during the pandemic to help the healthcare system monitor the fetal and maternal health and prevent these complications among them.

Title: Development and characterization of solid dispersion-based orodispersible tablets of Theophylline

Abstract:

The goal of the current study is to improve the solubility of medications that are poorly water soluble by using the lyophilization process. Theophylline is a bronchodilator that belongs to the Xanthene class. It is used to treat lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). The experimental work first studies the saturation solubility of drugs in water, salivary amylase, and 6.8 buffer solutions. Theophylline is lyophilized in the study using solubility-improving polymers such as polyvinyl pyrrolidone (PVP K30) and β-cyclodextrin as well as excipients. The study also focuses on the formulation and development of orodispersible tablet dosage forms of theophylline by the lyophilization method. The saturation solubility study of a pure drug (8.3 mg/mL) is compared with the solubility of a lyophilized product (21 mg/mL) of a drug. It is found that the lyophilized product has greater solubility than the pure drug, which is crystalline in nature. A dissolution analysis of orodispersible dosage forms was also conducted in the study, which showed 90.21 % CDR for orodispersible tablets in 15 min.

Biography:

Prashant J. Shinde is recently working as assistant professor at Department of Pharmaceutics, St. John Institute of Pharmacy and Research, Palghar, Maharashtra, India. He has post graduated from pharmaceutics stream in 2019. He has published several research, review papers and book chapters at national and international level and participated in various national and international conferences and workshops. He has 3 years of experience in academics and research. He has guided 13 students for project and research work in his academic career. During his tenure he served as an academic committee member in his institution and university. He worked with accreditation compliance/self-study projects at the university and college level. He is active member of Indian pharmaceutical association and Maharashtra state pharmacy council. He is a volunteer and member of UNICEF- INDIA and participated in different social progress activities of rural development.

Title: The Potential Role of Antioxidants in the Treatment of Peripheral Arterial Disease: A Systematic Review

Abstract:

Statement of the Problem: Peripheral arterial disease (PAD) has a worldwide prevalence and is a significant cause of cardiovascular morbidity and mortality. Due to its high prevalence and higher rates of ischemic cardiovascular and lower extremity events, its treatment is essential. Oxidative stress plays a vital role in the development of PAD, but not in isolation, as other risk factors including hypertension, diabetes, smoking, hypercholesterolemia, obesity, and physical inactivity also contribute to the development of symptoms of PAD. However, it has been shown that increased levels of oxidative stress can be an important mechanism in the pathophysiology of these risk factors, leading to increased levels of oxidized LDL (ox-LDL), increased thrombus formation, endothelial dysfunction, and the development of atherosclerotic plaques. Therefore, it can be deduced that antioxidants may be effective in PAD treatment. This review aimed to evaluate different studies of antioxidant treatments for PAD patients. Methodology & Theoretical Orientation: A systematic search for relevant studies was performed on the PubMed, SCOPUS, and Science Direct databases, and 18 studies fulfilled the inclusion criteria. Findings: In total, 16.6% of the studies used natural antioxidants, and 83.3% used synthetic antioxidants. The reviewed studies show that natural antioxidants were completely effective in treating PAD, and synthetic antioxidants showed effective results in only 53% of the studies. A less than optimal pro-oxidant–antioxidant balance does not improve the symptoms of PAD. Conclusion & Significance: In conclusion, though there is optimism regarding using antioxidants in treating PAD, the outcomes do not support the optimism. Using antioxidants in the natural forms and vitamins in the form of fruits and vegetables is likely to be more effective for PAD patients. Finally, two essential factors must be considered to be more effective in treating PAD. First, evaluating the optimal pro-oxidant–antioxidant balance can be an effective method for managing treatment with antioxidants. In other words, prescribing antioxidants at the appropriate dose makes antioxidants more effective and strongly suggests that custom therapies need to be devised. Secondly, using the optimal amount of antioxidants for treating the underlying disease in PAD patients, together with other agents such as anticoagulants, antiplatelet agents, antihypertensive, hypoglycemic agents, antidiabetic agents, statins, and other cholesterol balancing drugs, is a strong recommendation.

Biography:

Shayan Keramat chose the field of the medical laboratory from the undergraduate course from 2012 to 2016. After a short time, He became very interested in hematology and pathology. So He decided to pursue a master's degree in hematology. After entering the Master in 2017, I became interested in the fields of coagulation, thrombosis, vascular diseases and especially thromboangiitis obliterans (TAO). Shayan Keramat started my dissertation with research on TAO and finished it with the highest possible score and two articles. In 2019 I took a commitment course in the biochemistry research laboratory of Mashhad Medical University for two years until 2021.  Currently, He is a major member of the Department of Research and Biobanking, Buerger’s Disease Non-Governmental Organization and an active member of Vascular Independent Research and Education, European Foundation, VAS Young committee.

Title: Impact of biological therapy on cardiovascular risk factors in patients with rheumatic disease – a new therapeutic target?

Abstract:

Cardiovascular disease (CVD) remains the leading cause of death worldwide, accounting for about 32% of all deaths.  One positive thing that stands out is that 80% of CVD is preventable, and this is mainly due to modifiable cardiovascular risk factors. Rheumatic diseases have been shown to be independent cardiovascular risk factors and may increase the risk of atherosclerotic disease by 50%, even in the subclinical or early stages of the disease; this is due to the fact that the two pathologies have the same pathophysiological substrate, which is inflammation, and share the same cardiovascular risk factors. In order to reduce cardiovascular risk, optimal management of these patients requires control of both risk factors and inflammation. Biological disease-modifying antirheumatic drugs (bDMARDs) has demonstrated its positive effects by improving clinical status, quality of life and inflammatory syndrome, slowing or stopping the progression of the disease. Due to their greater efficacy and safety profile, the use of bDMARDs has increased significantly over the last decade. Several studies have been conducted lately in order to establish the impact of bDMARDs on cardiovascular risk. Given that atherosclerosis is recognized as an inflammatory disease and that patients with rheumatic pathology have an increased inflammatory status, it has been hypothesized that bDMARDs may reduce cardiovascular risk by improving inflammation and, thus, slowing the progression of atherosclerosis. Therefore, for example, two molecules targeting inflammatory cytokines, Canakinumab (targeting interleukin (IL) 1β) and Tocilizumab (targeting IL-6), have been studied in CANTOS (Canakinumab Anti-Inflammatory Thrombosis Outcome Study) and ASSAIL-IM (Assesing the effect of anti-IL-6 treatment in Myocardial Infarction (MI)) trials, with results demonstrating reduction in acute cardiovascular events. In addition to the effect of bDMARDs on the atherosclerosis process, studies have shown that they can also influence the profile of cardiovascular risk factors (lipid profile, blood pressure (BP), or metabolic syndrome). In conclusion, since patients with rheumatic diseases have an increased cardiovascular risk which cannot be explained by the inflammatory status alone, careful management of cardiovascular risk factors must be done. Given that  biological therapy may exert anti-atherosclerotic and cardioprotective effects, early  initiation of targeted bDMARDs in selected patients needs to be taken into consideration.       

Biography:

Diana Popescu completed her medical studies at the University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Romania - Faculty of Medicine in 2016. In the following five years. She completed the residency program in Medicine, specialty Internal Medicine. In 2019, She started my Ph.D. studies in Internal Medicine. The following year She became an assistant professor at the Department of Internal Medicine of the University of Medicine and Pharmacy "Grigore T. Popa".

In all these years of practice, She have actively participated in numerous national and international medical conferences, She have published more than ten articles in ISI-indexed journals. She was an assistant researcher in a demonstrative experimental project called "Public health risk mitigation of biochemical contaminants of recycled pharmaceutical and food packaging by spectral analysis based method in the TzH domain". She have also participated in a number of volunteer activities, training students and helping patients experiencing socio-economic deprivation.

Title: Challenges in Cardioncology: Aortic Dissection after Cancer Treatment with Angiogenesis Inhibitors

Abstract:

Statement of the Problem:

As the general life expectancy of the population has increased, we have noticed that patients have more and more common risk factors for developing cardiovascular disease and cancer. Furthermore, despite advances in cancer therapies, there are still a variety of cardiotoxic adverse effects of treatment. Vascular endothelial growth factor inhibitors (VEGFI), such as bevazizumab, are widely used in cancer treatments, with a good clinical response. However, although there are still gaps in the available data, bevazizumab has been associated with adverse effects such as hypertension and endothelial dysfunction, including acute aortic disease. Case Report: 76-year-old female patient with  hypertension under control, aortic arch dilation of 4.8cm (stable for 2 years) and right colon adenocarcinoma metastatic to the lymph node and liver. Chemotherapy was started with oxaliplatin, folinic acid and 5-fluorouracil, associated with bevazizumab. After the sixth cycle, the patient developed a sudden episode of intense chest discomfort, sweating and dizziness. In the emergency room, the initial diagnostic hypothesis was acute coronary syndrome secondary to vasospasm caused by 5-fluoracil. On physical examination, a difference in blood pressure was detected in the upper limbs, and aortic dissection was hypothesized. Chest tomography confirmed the diagnosis of type A aortic dissection. She underwent emergency surgery to replace the ascending aorta with suspension of the aortic valve, total aortic arch replacement, brachiocephalic trunk reimplantation and left common carotid artery reimplantation with interposition. The procedure was uneventful. The patient was discharged after 26 days of hospitalization with no neurological or motor sequelae and a ventricular ejection fraction of 39%.

Conclusion & Significance:

Our report aims to draw attention to the need for cardiovascular monitoring and appropriate management of patients taking bevazizumab.

Biography:

Juliana Soares is a cardiologist with a postgraduate degree in cardiology and women's cardiology. Founder of the Cardioncology Service at the Federal University of São Paulo - Brazil. She was head of the medical assistance groups at Hospital Israelita Albert Einstein. Author of several book chapters. Awarded Outstanding Achievement in Cardiology in 2014 by the MD Anderson Cancer Center. Lecturer in postgraduate Cardiology at Hospital Israelita Albert Einstein.

Title: Challenges in Cardioncology: Aortic Dissection after Cancer Treatment with Angiogenesis Inhibitors

Abstract:

Statement of the Problem:

As the general life expectancy of the population has increased, we have noticed that patients have more and more common risk factors for developing cardiovascular disease and cancer. Furthermore, despite advances in cancer therapies, there are still a variety of cardiotoxic adverse effects of treatment. Vascular endothelial growth factor inhibitors (VEGFI), such as bevazizumab, are widely used in cancer treatments, with a good clinical response. However, although there are still gaps in the available data, bevazizumab has been associated with adverse effects such as hypertension and endothelial dysfunction, including acute aortic disease. Case Report: 76-year-old female patient with  hypertension under control, aortic arch dilation of 4.8cm (stable for 2 years) and right colon adenocarcinoma metastatic to the lymph node and liver. Chemotherapy was started with oxaliplatin, folinic acid and 5-fluorouracil, associated with bevazizumab. After the sixth cycle, the patient developed a sudden episode of intense chest discomfort, sweating and dizziness. In the emergency room, the initial diagnostic hypothesis was acute coronary syndrome secondary to vasospasm caused by 5-fluoracil. On physical examination, a difference in blood pressure was detected in the upper limbs, and aortic dissection was hypothesized. Chest tomography confirmed the diagnosis of type A aortic dissection. She underwent emergency surgery to replace the ascending aorta with suspension of the aortic valve, total aortic arch replacement, brachiocephalic trunk reimplantation and left common carotid artery reimplantation with interposition. The procedure was uneventful. The patient was discharged after 26 days of hospitalization with no neurological or motor sequelae and a ventricular ejection fraction of 39%.

Conclusion & Significance:

Our report aims to draw attention to the need for cardiovascular monitoring and appropriate management of patients taking bevazizumab.

Biography:

Juliana Soares is a cardiologist with a postgraduate degree in cardiology and women's cardiology. Founder of the Cardioncology Service at the Federal University of São Paulo - Brazil. She was head of the medical assistance groups at Hospital Israelita Albert Einstein. Author of several book chapters. Awarded Outstanding Achievement in Cardiology in 2014 by the MD Anderson Cancer Center. Lecturer in postgraduate Cardiology at Hospital Israelita Albert Einstein.

Title: Opening pulmonary valve in patients of heart failure

Abstract:

Pulmonary valve is the most dangerous _ the first killer in the world ,and the heart of 3 valves is better than that of 4 valves. Opening it by a stent or by a sond, gives great benefit for 2 types of patients ; TYPE 1;congestive heart failure[DCM]& TYPE II; Systemic arterial hypertension [HTN] Opening it by a stent or by a sond, gives indirect benefit for other types of patients. The new procedure is a new sond like PM sond designed to leave the PV always opened, it is a reversible procedure [if there is deterioration in the RV function , the sond is easily withdraw]. Scientific facts are we have to accept that pulmonary insufficiency[PI] is goodly tolerated for many decades , in pure congenital pulmonary stenosis,the best approach is balloon percutaneous intervention with excellent results,[that means PI is symptomatic],and no need in future for pulmonary val replacement[PVR].the only need for PVR is post Tetralogy of Fallot in only 10% after 20years,knowing that there is hypoplasic in RV outlet and pulmonary arteries and sometimes the need to do blalock[central shunt ],and to put a patch to widen the outlet ,and almost all the operations of PVR are done for pts of patchs, and those with preserved annulus and valvectomy do not need PVR ,that means the cause of right heart failure is iatrogenic and I think the operation PVR is not valid and malevaluated,I think it is avery particular case, and I shell exclude it

Biography:

Samer AKL is medical doctor (MD) by profession and works with one of the private hospitals and lecturer in private institute of medical science in Syria. He holds an MD in medical, He has 2 years of private practices as a general physician (Doctor). He has also been involved in outbreak investigations of EPI in Syria.