Parkroyal Hotel, Penang. Programme Book

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1 Parkroyal Hotel, Penang Programme Book

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3 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Contents Welcome Message from President Organising Committee and Welcome Message from Organising Chairman Council Members of Malaysia Endocrine & Metabolic Society (MEMS) Invited Faculty Venue Layout Plan Exhibition Floor Plan Exhibitors Map Conference Information Pre-Congress Workshop Scientific Programme Abstracts Acknowledgement

4 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Message from the President of MEMS Dear Friends and Colleagues, On behalf of the Malaysian Endocrine & Metabolic Society (MEMS), I would like to take this opportunity to welcome everyone to this inaugural Annual Congress of the Society. This year we have combined the Congress with the postgraduate endocrine course with the sole objective of incorporating the basic science strand, oral and poster presentations together with the plenary lectures and clinical case presentations which had been regular features in our previous postgraduate endocrine courses. We hope this effort will expand the scope of the meeting and thus provide a venue for basic and clinical science research in endocrinology to prosper in this country. Vision & Mission of MEMS. In our last council meeting, a blueprint was outlined for the society to pursue in the next five years. Taking into account the reality of endocrinology in this country, we believe that this will serve as the vision and mission of the society in the years to come. Vision of the Society It is our vision that MEMS a. will be the voice of endocrinology & metabolism in this country and serve as the point of reference in issues pertaining to endocrinology and metabolism to help shape policy that encompasses these areas. b. will pave the way for coordination and collaboration of endocrine expertise, training and services in the country c. be the impetus and stimulus for advancement in research and patient-care in endocrinology d. will inculcate in its members the importance of professional independence and integrity Mission Statement 1. It is our objective to turn the society into the voice of endocrinology and metabolism in this country that government, non-governmental organizations and the community will refer to by providing leadership and establishing the Society as an esteemed professional body. 2. The Society will coordinate various endocrine expertise and services in the country. Effort will be expended to consolidate and strengthen those which are established and initiatives will be undertaken to start new services in other centers. 3. The Society will actively involve itself in the training and credentialing of endocrinologists in the country. 4. The Society continues to serve as a body that will generate research and expertise in the various fields of endocrinology. 5. The Society will endeavour at every opportunity to instill professional integrity and independence in its members, cognizant that patronage by pharmaceutical companies may inadvertently subject its members to partiality in his or her dealings. 6. The Society will provide the platform for basic science in endocrinology to flourish by promoting life sciences topics in our major programmes and workshops. 7. The Society will also devote resources into developing certain areas in endocrinology in this country that are fragmented including those that are neglected such the orphan diseases. 2

5 Plan of action 1. The Society will work with relevant governmental and non-governmental institutions and bodies in the fields of endocrinology and metabolism, taking a leadership role where appropriate. 2. The Society will act as a consultative body and interest group in the formulation of policies at various levels pertaining to endocrine and metabolic diseases. 3. The Society through its executive council, will issue media statements periodically pertaining specifically to endocrinology and metabolism matters of public concern. 4. The Society shall be jointly responsible together with the Ministry of Health and Academy of Medicine for the coordination, implementation and assessment of advanced training in endocrinology. 5. Meetings to address availability of resources in endocrinology and how best to develop them will be held, so as to reduce unnecessary duplication especially in time of economic hardship. Main areas of expertise in endocrinology will be identified and nurtured. 6. The Society will make a formal approach to relevant professional bodies and authorities to address certain pertinent issues including addressing the lack of dedicated pituitary surgeons, consolidation of current invasive radiological procedures and the setting up of diagnostic molecular laboratory services in the country. 7. The Society will initiate the formation of databases for selected endocrine diseases. In addition to monitoring the management of these diseases we will aim to implement changes that will improve the outcome. 8. The Society will engage itself in areas of research of national interest, primarily in the topic of iodinisation levels in pregnancy as one of its main research thrusts. The escalation of obesity and diabetes in this country and the possible causal role of the Malaysian dietary composition is another subject of concern. Similarly in this context the Society will initiate a CPG for gestational DM with emphasis on post-natal health of the mothers. 9. Embracing the spirit of accountability and transparency, the society now requires all speakers speaking on its platform to publicly disclose any potential conflict of interest at the beginning of their presentations. This will help our audience to judge the impartiality of any scientific presentations. 10. Public awareness programs will be organized to highlight the plight of diseases such as thyroid, adrenal, pituitary etc. Some of these programmes will be in collaboration with other professional societies. Over the past one year, the Society has successfully acquired a meeting place, organised a postgraduate course in Kota Kinabalu, revised two CPGs (DM2 & Growth Hormone), started an education trust fund, initiated travel grants for adult, paediatric and life sciences members to attend and present their work at international meetings, continued to award small research grants and employ the services of an IT company to launch our webpage. Monthly adult and paediatric clinical meetings continued to be a valuable source of CME for the trainees and trainers alike. Allow me to also take this opportunity to thank Assoc. Prof. Dr. Malik Mumtaz and his Organising Committee for their unrelenting zeal in ensuring the success of this Congress. Of course, this Congress would not be possible without the enthusiastic participation of speakers and delegates alike. Lastly, the contribution of the various pharmaceutical in providing secretariat support, sponsoring the symposia, exhibition booths and bringing in speakers and participants will ensure that these kinds of programmes will continue to benefit the medical and scientific community for many more years to come. We do hope everybody has an enjoyable and beneficial time during the Congress.... Prof. Dr. Nor Azmi Kamaruddin President of Malaysian Endocrine & Metabolic Society 3

6 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Message from Organising Chairman Dear colleagues, On behalf of the Malaysian Endocrine And Metabolic Society (MEMS) and the Penang organizing committee, I would like to warmly welcome you to the 1st MEMS Annual Congress 2009 (MAC 2009) here in beautiful Batu Ferringhi. The Congress will span 3 days and starts with pre-congress workshop on insulin pump therapy, imaging in endocrinology and a workshop for nurses. The main congress will focus on important aspects of endocrinology. Various local experts and oversea guests will deliver these topics. The format is primarily case-based and interactive. It is our great privilege to work closely with our colleagues from the life sciences with their participation, it is hoped that the meeting will cover all aspects of endocrinology, from basics to clinical management. We hope that you will enjoy your time in Penang and make full use of the academic sessions as well as leave time to enjoy the delights of this beautiful location. Finally, I would like to thank the MEMS committee, members of the local organizing committee and all our friends from the pharma industry who have generously lent their support. A special mention to Eli Lilly for graciously agreeing to bear the headache of being the secretariat for this congress. Thank you,... Dr. Malik Mumtaz Organising Chairman, MAC 2009 Organizing Committee: Chairman Members : Dr. Malik Mumtaz : Prof. Dr. Amir Khir Dr. Yeow Toh Peng Dr. Khaw Chong Hui Dr. Shanty Vela Dr. Ang Hock Aun Dr. Nor Azizah Dato' Dr. L R Chandran Dr. Haniffulah Khan 4

7 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Council Members of Malaysia Endocrine & Metabolic Society (MEMS) President Vice President Prof. Dr. Nor Azmi Kamaruddin Dr. Malik Mumtaz Honorary Treasurer Honorary Secretary Asst. Honorary Secretary Council Member Council Member Dr. Wan Nazaimoon Wan Mohamud Dr. Zanariah Hussein Dr. Badrulnizam Long Bidin Dato' Dr. LR Chandran Dr. Letchuman GR Council Member Council Member Council Member Council Member Council Member Dr. Hanifullah Khan Dr. Mohd Arifin Mohd Ali Dr. Hew Fen Lee Dr. Fuziah Md Zain Prof. Dato' Dr. Wan Mohamad Wan Bebakar 5

8 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Invited Faculty Seberang Jaya Hospital Malaysia Malaysia Klinik Kesihatan Simpang Kuala Research Instruments Sdn Bhd Penang Medical College 6

9 SERVICE AREA FIRST FLOOR PASSAGE White Board/ Screen White Board/ Screen White Board/ Screen 7M (23FT) 7.8M (26FT) 7.8M (26FT) PALA LAWANG JINTAN CORRIDOR Collapsible Partitions JINTAN I TIFFINS RESTAURANT Venue Layout Plan GROUND FLOOR Collapsible Partitions 23M (76FT) 12M (39.5FT) Staircase Toilet Toilet Window SERAI White Board/ Screen PRE-COCKTAIL AREA 8M (26.9FT) FOYER White Board/ Screen Lift White Board/ Screen Hospitality Room / Bridal Showroom 5.9M (19FT) Window BALLROOM I Screen ANDAMAN GRAND BALLROOM BALLROOM II 7.8M (26FT) 15.3M (50FT) To Tamarind Brasserie Entrance To Main Lobby 8M (26.9FT) 20M (65FT) Window LADA External Entrance Window 14.4M (47FT) HALIA Balcony Balcony Balcony Balcony Balcony Window Business Centre Screen Pre-Cocktail & Foyer - 21 tables (2.5ft x 6ft) Straircase Window 10M (33FT) Window 16M (53FT) Straircase Lift CORRIDOR PANDAN White Board/Screen 7.8M (26FT) Toilet Screen 20M (66FT) 7

10 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Exhibition Floor Plan (Ground Floor) GROUND FLOOR STAGE Reception Total 21 table (2.5 feet x 6 feet) *The Organiser reserves the right to make last minute adjustment

11 Exhibition Floor Plan (First Floor) Straircase LADA SERAI Booth Company Exhibitors Booth Company 1 Eli Lilly (M) Sdn Bhd 13 Abbott Laboratories (M) Sdn Bhd 2 3 Roche Diagnostic (M) Sdn Bhd Merck Serono Abbott Laboratories (M) Sdn Bhd inova Pharmaceuticals 4 Novo Nordisk Pharma (M) Sdn Bhd 16 Novartis Corp (M) Sdn Bhd 5 Pharmalink-Takeda 17 Novartis Corp (M) Sdn Bhd 6 Genzyme 18 GlaxoSmithKline Pharmaceuticals Sdn Bhd 7 AstraZaneca Sdn Bhd 19 GlaxoSmithKline Pharmaceuticals Sdn Bhd 8 AstraZaneca Sdn Bhd 20 Servier (M) Sdn Bhd 9 Sanofi Aventis (M) Sdn Bhd 21 Eli Lilly (M) Sdn Bhd 10 Sanofi Aventis (M) Sdn Bhd 22 Solvay Pharma 11 Merck Sharp & Dohme Corp. 23 Info Resources Services 12 Merck Sharp & Dohme Corp. 24 St Nicholas Home 9 *The Organiser reserves the right to make adjustments if deemed necessary

12 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Map (Penang) 10

13 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Conference Information Registration Counter Ground Floor, Park Royal Hotel, Penang. Operation Hours 28th May th May th May th May hr hr hr hr Opening Ceremony and Welcome Reception Closing Ceremony Thursday, 28th May 2009, 1700 hr, Grand Ballroom, Ground Floor, Park Royal Hotel, Penang. Sunday, 31th May 2009, 1200 hr, Grand Ballroom, Ground Floor, Park Royal Hotel, Penang. Oral Presentation Please be prepared at your allocated venue at least 10 minutes prior to the start of the session. Please remember that the time allotted to oral session is 8 minutes for presentation and 2 minutes for questions and answers. Posters Presentation Mounting : hr, 29th May 2009 Dismantling : hr, 31th May 2009 The Organiser bears no responsibility for any loss or damage to posters. 11

14 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Pre-Congress Workshop Imaging For The Endocrinologist 28th May 2009 (Thursday) Grand Ballroom, Ground Floor 14:00-14:10 14:10-14:50 14:50-15:30 15:30-16:00 16:00-16:40 16:40-17:00 17:00 : Introduction & Overview : Ultrasonography in Endocrine Diseases Dr. Chong Fook Looi : CT Scan & MRI in Endocrinology Dr. Dennis Tan : Tea Break : PET Scanning in Endocrinology Dato Dr Ali Kadir : Q&A : End of Workshop Practical Aspect of Insulin Pump Therapy Workshop 28th May 2009 (Thursday) Pandan Room, First Floor 13:00-14:00 14:15-15:00 15:00-15:15 15:15-16:15 16:15-17:00 17:00-17:10 : Registration : Overview of Insulin Pump Therapy Prof. Chan Siew Pheng : Coffee Break : Pump Programming Medtronic What You Need to Know About Disposables Medtronic : Hands on Break Out Medtronic : Closing Remark 12 *The Organiser reserves the right to make last minute adjustment

15 Pre-Congress Workshop Diabetes Conversation Map TM 28th May 2009 (Thursday) Jintan Room, First Floor 14:00-14:30 14:30-16:30 16:30 : Welcome Refresshments & Registration : Diabetes Conversation Map TM Implementation Workshop Dr. Arlene Ngan : Tea Break & Closing Opening Reception Cocktail And Welcoming Ceremony 28th May 2009 (Thursday) Grand Ballroom, Ground Floor 17:00-17:45 : Registration and Cocktail 17:45-18:00 : Opening Address Dr. Malik Mumtaz (Organising Chaiman) Prof. Dr. Nor Azmi Kamaruddin (MEMS President) 18:00-19:00 19:00-19:30 : Opening The Last 30 Years In Endocrinology: A Journey Prof. Dato Dr. Khalid Kadir The Last 30 Years In Diabetes: A Journey Prof. Dato Anuar Zaini : 1) Launching of MEMS Website 2) Official Opening of MAC 2009 Prof. Dr. Nor Azmi Kamaruddin 13 *The Organiser reserves the right to make last minute adjustment

16 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Scientific Programme 29th May 2009 (Friday) Time 07:00-09:00 09:00-09:40 09:40-10:20 10:20-10:50 10:50-11:25 Novo Nordisk Breakfast Symposium (Grand Ballroom) Ideal Start & Easy Intensification with NovoMix30 Prof. Dato' Wan Mohamad Wan Bebakar Chairman: Dr. Mohamed Badrulnizam Growth Hormone Use in Adults Dr. Hew Fen Lee Chairman: Dr. Mohamed Badrulnizam Plenary : Highlights of the 2009 Clinical Practice Guidelines in T2DM (Grand Ballroom) Prof. Wan Mohamad Chairman: Dr. Zanariah Hussein Plenary : HsCRP, BNP, PAI etc; What To Make Of All These Emerging Inflammatory Markers? (Grand Ballroom) Dr. Hamat Hamdi Chairman: Prof. Dr. Nor Azmi Kamaruddin Coffee Break Plenary : HbA1c: How Low Should We Go? (Grand Ballroom) Prof. Dato' Dr. Mafauzy Mohamed Chairman: Prof. Amir S Khir 11:25-12:05 12:05-12:45 Adult Track Break Out Session Paediatric Track 12:45-14:00 MSD Lunch Symposium (Grand Ballroom) Achieving Glycemic Control Without Compromise: The Role of DPP-4 Inhibitors Break Out Session 14:00-14:40 14:40-15:30 15:30-16:00 16:00-17:00 A 65 Years Old Man With Progressive Loss Of Height And Back Pain (Grand Ballroom) Dr. Vijay / Dr. Hew Fen Lee A 65 Years Old Man With Progressive Loss Of Height And Back Pain (Jintan Room) Dr. Vijay / Dr. Hew Fen Lee Life Science:Molecular Technology Symposium My Calcium Level Is High. Bone Health And Hormonal Aspects Application Of Microarray: Should I Be Worried? Of Children With Chronic Diseases From Lab To Clinical Practice (Jintan Room) (Halia Room) (Serai Room) Dr. Wong Ming / Dr. Janet Hong Dr. Thomas J Murphy Prof. Dr. Chan Siew Pheng My Calcium Level Is High. Should I Be Worried? What Do Paediatricians Need To Know About Rickets? RNA: From Lab Tool To Therapy (Grand Ballroom) (Halia Room) (Serai Room) Dr. Wong Ming / Prof. Fatimah Harun Dr. Thomas J Murphy Prof. Dr. Chan Siew Pheng Adult Track The Radiologist Found A Mass In My Patient s Adrenal Gland, What Should I Do? (Grand Ballroom) Dr. Florence Tan / Prof. Dato' Dr. Mafauzy Mohamed The Radiologist Found A Mass In My Patient s Adrenal Gland, What Should I Do? (Jintan Room) Dr. Florence Tan / Prof. Dato' Dr. Mafauzy Mohamed Coffee Break Free Paper Presentation (Grand Ballroom) Neuroendocrine Syposium Chairman: Dr. Hew Fen Lee Prof. Chan Siew Pheng My Patient Has Hpertension & Low Potassium (Jintan Room) Prof. Dr. Nor Azmi Kamaruddin / Dr. Ang Hock Aun My Patient Has Hypertension & Low Potassium (Grand Ballroom) Prof. Dr. Nor Azmi Kamaruddin / Dr. Ang Hock Aun 17:00-17:30 17:30-18:00 1. Acromegaly : Somatostatin Analogue Treatment On A Shoe String Budget. (Grand Ballroom) Dr. Zanariah Hussein 2. Radio Surgery For Pituitary Tumors. (Grand Ballroom) AP Biswa Mohan Biswa 19:00-21:00 Lilly Dinner Symposium (Grand Ballroom) The Treatment Continuum of Osteoporosis Prof. Chan Siew Pheng Case Presentation Dr. Malik Mumtaz 14 *The Organiser reserves the right to make last minute adjustment

17 Scientific Programme 30th May 2009 (Saturday) Time 7:00-9:00 9:00-9:40 9:40-10:40 10:10-10:40 10:40-11:20 11:20-12:00 12:00-12:40 12:40-14:00 14:00-14:40 14:40-15:20 15:20-16:00 16:00-16:30 16:30-17:30 19:00-21:00 GSK Breakfast Symposium (Grand Ballroom) Long Term Glycaemic Intervention Studies in Type 2 Diabetes - Implications for Patient Care Prof. Dr. Chan Siew Pheng Chairman: Dr. Letchuman Ramanathan Plenary : Is Screening And Treating Androgen Deficiency In Older Men Justified? (Grand Ballroom) Dr. Peter Ng Chairman: Dr. Malik Mumtaz MEMS ANNUAL GENERAL MEETING (Grand Ballroom) Coffee Break Break Out Session Adult Track Amidarone Induced Thyroid Disease In Pregnancy Treatment Of Thyrotoxicosis - Thyroid Disorder & Post Partum Period Tablets, Surgery or I-131? (Grand Ballroom) (Jintan Room) (Pandan Room) Prof Amir S Khir / Dr. Lim Soo San / Dr. Japaraj Dr. Malik Mumtaz / Dr. Hamat Hamdi Prof. Dato Dr. Mustaffa Embong Amidarone Induced Thyroid Disease In Pregnancy Treatment Of Thyrotoxicosis - Thyroid Disorder & Post Partum Period Tablets, Surgery or I-131? (Jintan Room) Prof Amir S Khir / Dr. Hamat Hamdi Amidarone Induced Thyroid Disorder (Pandan Room) Prof Amir S Khir / Dr. Hamat Hamdi Lilly Lunch Symposium (Grand Ballroom) Byetta : Addressing the fundamental challenges in T2DM : HBA 1C, Weight & Hypoglycemia Dr. Sanjay Kalra Chairman: Dr. Malik Mumtaz Coffee Break Free Paper Presentation (Pandan Room) Dr. Lim Soo San / Dr. Japaraj Thyroid Disease In Pregnancy & Post Partum Period (Grand Ballroom) Dr. Lim Soo San / Dr. Japaraj Break Out Session AZ Dinner Symposium (Grand Ballroom) Recent Updates In The Management Of CV Risks With Statins Prof. Dr. Chan Siew Pheng Chairman: Prof. Dr. Nor Azmi Kamaruddin Treatment Of Thyrotoxicosis - Tablets, Surgery or I-131? (Jintan Room) Dr. Malik Mumtaz / Prof. Dato Dr. Mustaffa Embong Paediatric Track Doctor, My Child Is Not Growing (Halia Room) Dr. Fuziah Md Zain Hyperthyroidism. What Are The Treatment Options? (Halia Room) AP Dr. Rahmah Rasat Update On The Lab Diagnosis Of Phaeochromocytoma (Halia Room) Miss Khalidah Mazlan Adult Track Paediatric Track Pregnant Patient With Diabetes Who Refuses Insulin Initiation For Poorly Controlled Recent Advances In Neonatal Insulin Diabetes Patients Diabetes (Grand Ballroom) (Jintan Room) (Halia Room) Dr. Hanifullah Khan / Dr. Nurain Mohd Noor AP Dr. Norlaila Mustafa / Dr. Letchuman Prof. Wu Loo Ling Pregnant Patient With Diabetes Who Refuses Insulin (Jintan Room) Dr. Hanifullah Khan / Dr. Nurain Mohd Noor (Grand Ballroom) (Grand Ballroom) Dr. Malik Mumtaz / Prof. Dato Dr. Mustaffa Embong Insulin Initiation For Poorly Controlled Diabetes Patients (Grand Ballroom) AP Dr. Norlaila Mustafa / Dr. Letchuman The New Insights Of ADA- EASD Consensus Statement (Grand Ballroom) Dr. Sanjay Kalra Chairman: Prof. Dr. Chan Siew Pheng Insulin Use In Primary Care (Halia Room) Dr. Sri Wahyu / Dr. Gnansegaran Xavier 15 *The Organiser reserves the right to make last minute adjustment

18 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Scientific Programme 31th May 2009 (Sunday) Time 8:00-9:00 Takeda Breakfast (Grand Ballroom) Cardiovascular Risks in TZDs are exaggerated Dr. Letchuman / Dr. Chong Kuck Meng / Dr. Radhakrishnan Sothiratnam / Dr. Wong Kai Fatt Chairman: Dr. Malik Mumtaz Obesity Symposium (Grand Ballroom) Chairman: Prof. Dato Dr. Mustaffa Embong / Prof. Dato' Dr. Mafauzy Mohamed 9:00-9:30 Treatment With Pharmacological Agents (Grand Ballroom) Dr. Masni Mohd 9:30-10:00 10:00-10:30 10:30-11:00 11:00-11:30 11:30-12:00 Bariatric Procedures For Obesity (Grand Ballroom) Dr. Vimal Vasudeavan Diets For Weight Loss. Are Any Of Them Any Good? (Grand Ballroom) AP Winnie Chee Tea Break Break Out Session Adult Track Paediatric Track Doctor, I Have No Periods, What PCOS: Has The Pendulum Swung Abnormal Serum Sodium. Should I Do? Back To The Gynaecologist? A Common Occurrence (Grand Ballroom) (Jintan Room) (Halia Room) Dr. Lim Siang Chin / Dr. Yeow Toh Peng / Dr. Hanifullah Khan Dr. P G Lim Dr. Japaraj / Dr. Nor Azizah Aziz Doctor, I Have No Periods, What PCOS: Has The Pendulum Swung Recurrent Seizures. What Can It Be? Should I Do? Back To The Gynaecologist? (Halia Room) (Jintan Room) (Grand Ballroom) Dr. Ting Tzer Hwu Dr. Lim Siang Chin / Dr. Yeow Toh Peng / Dr. Hanifullah Khan Dr. Japaraj / Dr. Nor Azizah Aziz 12:00-12:30 Closing Ceremony (Grand Ballroom) 16 *The Organiser reserves the right to make last minute adjustment

19 Abstract HsCRP, BNP,PAI, etc; What To Make Of All These Emerging Inflammatory Markers? Dr. Hamat Hamdi Inflammation is the process whereby the body system react to the stimuli such as trauma, genetic defects, physical and chemical agents, tissue necrosis, foreign bodies, immune reactions and infections. It is a protective mechanism for us to survive. This process involved the production of the several markers. This inflammatory markers can be detected in the peripheral blood samples. Atherosclerosis which is a very significant process in the development of Ischemic Heart Disease. It also involved an inflammatory process but in the subclinical manner. However some of the inflammatory markers can be used to detect this process and can be used to predict the risk of developing IHD. These include Hs-CRP, fibrinogen, PAI-1, IL-6, adhesion molecules and etc. These markers has been shown before to carry the risk of developing of IHD especially with Hs-CRP. In case of the myocardium has been injured either from ischemia, strain or stress, Brain Natriuretic Peptide (BNP) will be released to protect the further injury. This BNP is very important marker to be used in conjunction with the clinical conditions to manage Congestive Heart Failure (CHF). It can be used to rule in or rule out of CHF as been recommended by the European Society (ESC) Guidelines For Heart Failure People with diastolic heart failure (DHF) with high BNP also has been shown to have high level of Collagen Markers in the peripheral blood. This reflect that diastolic dysfunction may involved early fibrosis process that can be used to guide an aggressive treatment in this DHF group. As a conclusion, inflammatory markers and cardiac biomarker is important to be used with clinical scenario to guide us to give a better care to the patients. 17

20 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Abstract HbA1c: How Low Should We Go? Prof. Dato Dr. Mafauzy Mohamed The DCCT, Kumamoto and UKPDS Studies had shown that achieving lower glycemic targets resulted in significantly lower rates of diabetic complications. Three studies, which were designed to address the optimal target for HbAlc, were reported in In the ACCORD Study, the intensive glycemia group had target HbAlc < 6% and the standard glycemia group had target of between 7-7.9%. In the ADVANCE Study, the intensive glycemia group had target HbAlc < 6.5% and the ordinary glycemia group had target 7-7.5%. In the VADT, the intensive glycemia group had target HbAlc < 6% and the standard glycemia group had target of about 1.5% higher. The ACCORD Study was prematurely terminated because of a significantly higher mortality rate in the intensive glycemia group. The ADVANCE Study showed a significantly lower primary endpoints in the intensive glycemia group (mainly due to reduction in renal events) and the VADT Study did not show any significant difference in the primary endpoints between the 2 groups. Sub-group analysis of the ACCORD Study showed significant benefit of intensive glycemic control in those patients with no previous history of CVD and those with HbAlc 8.0% at baseline. In all the studies there were significantly increased rates of hypoglycemia in the intensive glycemia group and might have contributed to death. In conclusion, a HbAlc target of 6.5% is recommended for most patients. In selected patients (short duration of diabetes, long life expectancy and no significant CVD) a target as close to normal (6%) as possible without significant hypoglycemia is recommended. 18

21 Abstract Application of Microarray: From Lab To Clinical Practice Dr. Thomas J Murphy Using integrated genomic approaches to understand disease pathology and response to drug intervention." Integrating genomic data has proven to be an effective means of achieving focused discovery and faster validation in genomic studies. Affymetrix integrated solutions provide powerful tools for unlocking the human genome by allowing study of expression at both the gene and exon level and combining that with DNA-based copy number and SNP analysis. The tools and advanced microarray designs which enable researchers to interrogate the genome will be discussed at length and their application in key publications highlighted. Emphasis will be placed on how basic science and technological innovation is being translated into the clinical realm. 19

22 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Abstract RNAi : From Lab Tool To Therapy Dr. Thomas J Murphy RNAi: from discovery to building blocks for a functional map of human genome The interrogation of the whole human genome using genome-wide collections of sirnas is rapidly gaining acceptance as a powerful tool to assign functional annotation in a high-throughput manner. The latest advances in the application of RNA interference (RNAi) technology will be reviewed using recently published screens as case studies. Emphasis will be placed on understanding how the endogenous RNAi pathway operates and can be experimentally manipulated to silence any gene of interest. The outcome of these studies highlight the power of employing sirna technology to uncover complicated genetic and gene-drug interactions. It also suggests sirnas may represent an exciting new therapeutic modality. 20

23 Abstract Role Of Radiosurgery In Pituitary Tumors AP Biswa Mohan Biswal Pituitary gland is strategically situated inside a busy radiosensitive neural structures. Radiation is commonly used in the management of pituitary tumors. However due to non-selectivity of radiation techniques in past, most of pituitary tumors were treated with ordinary radiotherapy and develop late complications. The critical structures for radiotherapy are optic chiasm, optic nerve, brain stem, hypothalamus and II-Vth cranial nerves. They have limited radiation threshold compared to dose required for control of pituitary tumor. Using newer imaging modalities (MRI, PET scan and NMR) and image fusion techniques, it is very easy to delineate normal structures situated nearby and gross tumor volume. Sparsely ionizing radiations (x-ray or g ray) and high RBE radiation (proton beam and charged particle beam) are used for the irradiation of pituitary tumors. Radiosurgery is a very precise image based radiotherapy technique to deliver accurate dose to the tumor volume. The precision is very sophisticated that could discriminate differences in millimeters, which matters for the quality delivery and outcome of radiotherapy. The irregular pituitary tumors could be irradiated using 3D conformal or intensity modulated radiotherapy (IMRT) techniques. The plan can be evaluated using treatment planning system employing forward or inverse planning system. The dose is evaluated using normal tissue complication probability (NTCP) and tumor control probabilities (TCP) algorithms. The above techniques require stringent physical measurement and quality assurance (QA) procedures by experienced medical physicists. Deep seated tumors in strategic locations can be irradiated using proton beam therapy (PRT) wherever available using stereotactic techniques. Proton beam therapy gives edge over conventional x-ray therapy due to its peculiar Bragg peak phenomenon. Radiotherapy is indicated in treatment of macro/microadenomas as planned combined approach, salvage treatment for failure of medical and surgical treatment, primary therapy in poor surgical candidates and those refuse surgery. The aim of radiosurgery is to correct endocrinopathy, remove neoplastic process, and normalize pituitary function. Radiosurgery can be alternatively delivered using either gamma knife, cyberknife or conventional linac based stereotactic multi-arc radiosurgery (x-knife) equipment. The smaller tumors (2-4 centimeters), location away from vital structures are better treated with radiosurgery. The head is either fixed using Laskell s head frame or by frameless image tracking system. The patients are initially scanned for tumor localization using CT/MRI/or PET scan to draw gross tumor volume (GTV) and organ at risk (OAR). The treatment planning system generate multiple rival plans to be verified by the radiation oncologists and an optimal median peripheral dose line is selected. A suitable tumor treated with radiosurgery could achieve a 5 year and 10 year control rate of %. The response to radiation vary according to tumor volume, secretory status, extent of residual disease, distance to OAR, tumor type and prior radiation treatment. The endocrine control rates are excellent in Cushing s disease compared to other secretory adenomas. The endocrine response does not correlate with radiological regression in radisourgery treated cases thus stable volume disease is considered as good response to radiosurgery. The hormonal correction in secretory adenoma could take 2-8 years period to decline. In experienced multidisciplinary team consists of radiation oncologist, neurosurgeon, neuroradiologist and medical physicists, the outcome is excellent with very minimal neurological complications. 21

24 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Abstract Amiodarone-Induced Thyroid Disorder Prof. Amir S Khir / Dr. Hamat Hamdi Amiodarone is very important in the management of many cardiac arrhythmias. It can be used in either supraventricular tachycardia (SVT) and also Ventricular Tachycardia (VT). But since the content of iodine is very high in amiodarone which is 150 times more iodine ingestion than normal requirement (in 200mg daily dose), it carry some risk to developing thyroid disorder. This process can be very complex and it can be in hypo or hyper state. This is called Amiodarone Induced Hypothyrodism (AIH) or Amiodarone Induced Thyrotoxicosis (AIT). This AIT can be further divided into type I, type II and mixed type. In the management of this disorder, there is no specific rule to follow. However it depends on the clinical presentations of this thyroid disorder and the intial indication of starting of Amiodarone therapy. This amiodarone can be stopped and an alternative medication can be used. But, by stopping amiodarone only, sometimes thyroid disorders need to be treated first because of long half life of amiodarone. In AIH, this involved starting with L-thyroxine and titrate accordingly and patient to be in regular follow-up. In case of AIT, if medical therapy failed, partial or total thyroidectomy can be used. As a conclusion, this Amiodarone-Induced Thyroid Disorder is not uncommon. Sometimes it is inevitable to avoid from starting this medication. But,the most important thing is the education of the patient so that this problem can be detect early. 22

25 Abstract The New Insights Of ADA - EASD Consensus Statement Dr. Sanjay Kalra Introduction Newer understanding of the pathophysiology of diabetes, and development of novel classes of glucose lowering drugs have led to the need for an updated, modern algorithm to help healthcare providers manage diabetes appropriately. The ADA and EASD have published a consensus algorithm in December 2008 which use information from clinical trials and clinical judgment (collective knowledge and experience) to suggest an algorithm to guide therapy and result in improved glycemic control Goals of therapy Consensus has been reached regarding glycemic goals: an HbA1c 7% is a call to action to initiate or change therapy with the goal of achieving HbA1c<7%. This may not be appropriate or practical for all patients however, and one should consider potential benefits and risks, including life expectancy, risk of hypoglycemia and presence of cardiovascular disease, while deciding targets for individual patients. The guidelines also emphasize the need to treat hypertension and dyslipidemia as per existing guidelines. Choice of therapy Glycemic therapy should be selected keeping in mind effectiveness, extraglycemic effects, safety, tolerability, ease of use, and expense of various drugs. Choosing a particular medication for an individual patient will depend on the ambient glucose level, duration of diabetes, and nature of previous therapy. Different classes of drugs The ADA- EASD guidelines list the advantages, disadvantages and important points of metformin, sulfonylureas, glinides, _-glucosidase inhibitors, thiozolidinediones, insulin, insulin analogues, GLP-1 agonists, amylin agonists and DPP-4 inhibitors. Lifestyle interventions, weight loss and physical activity have multiple beneficial effects and do not cost much, but are usually insufficient alone. The authors remind us to use sulfonylureas only till half maximal doses, and unanimously advise against using rosiglitazone while advising caution in using either thiazolidinedione Metformin is recommended as it is economical, weight stable, and does not cause hypoglycemia. It can cause gastrointestinal side effects, reduce vitamin B12 absorption, metformin associated lactic acidosis, and is contraindicated in renal dysfunction. Repaglinide is effective in reducing HbA1c, and causes less hypoglycemia. 23

26 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Abstract The _-glucosidase inhibitors are shown to lower postprandial glucose, without hypoglycemia, while reducing cardiovascular risk, but are associated with a high discontinuation rate because of gastrointestinal symptoms. DPP-4 inhibitors are weight neutral, well tolerated and do not cause hypoglycemia. Exenatide has similar advantages, causes weight loss and can be given with sulfonylureas/ metformin &/or thiazolidinediones. Pramlintide is an amylin agonist, with a profile similar to exenatide, which is approved for use with insulin, only in USA. Insulin Insulin is the oldest antidiabetic drug, the most effective medication, can decrease any level of HbA1c, has the most clinical experience attached to it, and has beneficial effects on lipid profile. The guidelines reiterate that 1U/kg/day insulin may be necessary for control. Intermediate or long acting insulin should be used for initial therapy, but prandial therapy may be needed. Premixed insulin is not recommended during dose adjustment, but can be used otherwise, for convenience. Early insulin is also recommended in newly diagnosed patients. Insulin analogues find mention, along with the note that they reduce the risk of hypoglycemia. Initiation and adjustment of insulin therapy is discussed in detail. There is no need to hospitalize a patient, except in specific circumstances. We are reminded that the patient is the key player in diabetes management and should be trained and empowered, under the guidance of healthcare providers, to achieve goals and prevent/ treat hypoglycemia. SMBG and Hypoglycemia The guidelines offer guidance on treating hypoglycemia, but are not clear on the need for, or number of required self-monitored blood glucose (SMBG) measurements, saying that this depends on the type of medication prescribed. Targets for capillary glucose are mentioned as: fasting or preprandial plasma glucose: mmol/l ( mg %); postprandial plasma glucose, done at minutes: <10 mmol/l (180 mg %). The goal of achieving and maintaining an HbA1c 7%, at as rapid a pace as titration of medications allows, is emphasized. 24

27 Abstract Two tier algorithm The algorithm divides all therapies into two tiers: tier 1, which has well-validated, effective and cost effective treatments, and tier 2, which lists less well validated drugs. TIER 1 Tier 1, step 1 is lifestyle intervention and metformin, with detailed advice on titration of metformin (begin from 500mg od or bd/850mg od, and increase every 5-7 days, as required, to a maximum of 2-5 g/day over 1-2 months). If step 1 fails to achieve or sustain glycemic goals, one should add insulin or sulfonylurea (step 2), within 2-3 months of therapy initiation, or at any time when target is not achieved, or if metformin is contraindicated or not tolerated. Insulin is preferred in patients with HbA1c > 8.5%, or in those with symptoms secondary to hyperglycemia. Step 3 is to start, or intensify insulin therapy, as the case may be, using short or rapid- acting insulin, while stopping or tapering off secretagogues. The guidelines clearly discourage triple oral hypoglycemic combinations. TIER 2 The consensus also provides a second tier algorithm, focusing on the advantages of proglitazone and exenatide in avoiding hypoglycemia, and the weight loss associated with exenatide. In tier 2, step 2 is to add metformin and pioglitazone, or metformin and GLP-1 agonist to lifestyle measures. Step 3 will be to give a triple drug oral combinations (metformin+pioglitazone + sulfonylurea) or metformin + basal insulin in addition to lifestyle therapy. Conclusion A thorough understanding of the ADA-EASD guidelines will help health care providers choose the appropriate therapy for their adult patients with type 2 diabetes, and ensure better glycemic control and overall health. 25

28 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Abstract Obesity: Treatment With Pharmacologic Agents Dr. Masni Mohd Obesity is a chronic clinical condition and is recognized as a serious health problem. Obesity is a multi-factorial disease involving an accumulation of excess adipose tissue (fat) sufficient to harm health. Particularly at the abdominal obesity which is a part of a cluster of metabolic abnormalities with strong associations for Cardiovascular disease called Metabolic Syndrome. Overweight and obesity are associated with increased mortality and morbidity. Together, they may account for as many as 15-30% of deaths from coronary heart disease and 65-75% of new cases of Type 2 Diabetes. Obesity is a common public health problem, often unrecognized as a specific disease associated with co-morbidities and complications but rather as an observation of an individual s physical appearance. All health care professionals should regard obesity as a serious chronic disease, thus approaching its management at the earliest opportunity - whether at the time the individual presents to primary care for unrelated health problems or to secondary or tertiary care when the individual is referred for specific evaluation and management of obesity and its related complications - often when the degree of obesity is already severe and the individual is physically and psychologically compromised. Preventing and managing obesity are complex problems. Weight regulation and maintenance are tightly controlled by complex central mechanisms that dictate the energy balance. This has major impact on why in the present day environment of low activity and high food availability, it is difficult to mainatain compliance with a diet and exercise programme. Thus, pharmacotherapy agents played a significant role or step in breaking the cycle of short term weight loss and regain. Pharmacological treatment should only be considered only after dietary, exercise and behavioural approaches have been started and evaluated. Pharmacologic agents are also considered to those who have not reached their target weight loss or have reached a plateau on dietary, activity and behavioural changes alone. Pharmacologic agents such as Sibutramine, Orlistat and Duramine are effective adjuncts to maintain or improve the initial success, boost and provide additional health benefit. Maintained weight loss of 5% is sufficient to improve CV risk profile (including lower blood pressure, improved lipid parameters, reduced abdominal adiposity; better glycemic control and improvements in haemostatic and fibrinolytic parameters); 5-10% weight loss will improve quality of life, prevent progression to Type 2 DM in at-risk individuals and improve osteoarthritic abnormalities; weight loss of >10% is needed for more serious complications eg sleep apnoea. Intentional modest weight loss appears to reduce mortality. 26

29 Abstract Diets For Weight Loss: Are Any Of Them Any Good? AP Winnie Chee Siew Swee Basic treatment of overweight and obese patients requires a comprehensive approach involving diet and nutrition, regular physical activity, and behavioral change, with an emphasis on long-term weight management rather than short-term extreme weight reduction. Given the growing obesity epidemic, many patients and clinicians are interested in using popular diets as individualized eating strategies for disease prevention. Although some popular diets recommend restriction of portion sizes and calories (eg, Weight Watchers), a broad spectrum of alternatives has evolved. Some plans minimize carbohydrate intake without fat restriction (eg, Atkins diet), many modulate macronutrient balance and glycemic load (eg Zone diet), and others restrict fat (eg, Ornish diet). The efficacy and safety of popular diets will be presented. But regardless of which diet is selected, the total energy intake must be reduced in order for weight loss to occur. Moreover, once weight loss has occurred, the lower energy intake must be sustained to prevent weight regain. The pitfall of popular diets is poor sustainability and adherence rates. Conventional low-calorie diets are low in energy and fat content, but promote complex carbohydrate and fiber content through increased intake of whole grains, vegetables, and fruit. This dietary approach promotes a sustainable energy level that does not exceed energy expenditure, which is important for long term adherence and maintenance of weight loss. At the end of the day, the obese individual should always maintain a consistent eating pattern and self-monitor weight on a regular basis. 27

30 Taking the mystery out of endocrinology Malaysian Endocrine & Metabolic Society Annual Congress Acknowledgement The Organising Committee would like to thank the following companies for their support: Abbott Laboratories (M) Sdn Bhd AstraZeneca Sdn Bhd Bayer Schering Pharma Eli Lilly (M) Sdn Bhd Genzyme Malaysia Sdn Bhd GlaxoSmithKline Pharmaceutical Sdn Bhd inova Pharmaceuticals Info Resources Services LifeScan Malaysia, a division of Johnson & Johnson Sdn Bhd Medtronic International Ltd. Merck Sharp & Dohme (I.A.) Corp. Merck Serono Novartis Corp (M) Sdn Bhd Novo Nordisk Pharma (M) Sdn Bhd Pharmalink-Takeda Research Instruments Sdn Bhd Roche Diagnostics (M) Sdn Bhd Sanofi Aventis (M) Sdn Bhd Servier (M) Sdn Bhd Solvay Pharma St Nicholas 28

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