Dear Colleagues. Meeting chairman Prof. Ehab Ghoneim Vice Dean for Community Services & Environmental Development Affair

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2 Dear Colleagues It gives us a great honor and pleasure to invite you to participate in 2nd Annual Congress of Faculty of Medicine (updates Diabetes 2017), Port Said University. This year the Congress invite eminent speakers in the field of diabetes in different specialties to give their valuable experience. We hope you will enjoy the conference and return home with precious unforgettable memories. Your contribution will share in the success of the Congress. We hope that your attendance of updates Diabetes 2017 will be a truly enjoyable and fruitful educational experience and we wish you a nice stay in Port said. Best Wishes, Meeting chairman Prof. Ehab Ghoneim Vice Dean for Community Services & Environmental Development Affair Meeting Organizer Prof. Mamdouh El-Nahas Professor of Endocrinology and Internal Medicine, Faculty of Medicine, Port said University 2 3

3 Day 1 Thursday 23 rd March :00pm-03:30pm Session (V) Diabetes and Ophthalmology 09:00am-09:30am Opening ceremony 03:30pm-05:00pm Lunch break Program at a Glance 09:30am-10:00am 10:20am-11:20am 11:20am-12:40am 12:40pm-01:00pm Session (I) Faculty of Medicine, Port Said University Session (II) Hyperglycemia and Dyslipidemia in Diabetes Session (III) Multisystem affection in Diabetes Coffee break 05:00pm-06:00pm 06:00pm-07:00pm 07:00pm-07:45pm 07:45pm-08:00pm Session (VI) Diabetes and Intensive care Session (VII) Diabetes and Orthopedic surgery Session (VIII) Diabetes and Neurosurgery Coffee break 01:00pm-02:00pm Session (IV) Management of Hyperglycemia 08:00pm-09:00pm Session (LX) Forensic Medicine & Clinical Toxicology 4 5

4 Day 2 Friday 24th March :00am-10:00am Session (I) Diabetes and academic branches 10:00am-11:20am Session (II) Diabetes and Pediatrics 07:45pm-08:00pm Coffee break 01:00pm-02:00pm Session (III) Diabetes and Dermatology 02:00pm-03:00pm Session (IV) Diabetes and Vascular surgery 03:00pm-03:15pm Conference recommendations 6 7

5 Day 1 Day 1 09:00am-09:30am Opening ceremony 09:30am-10:00am Session (I) Faculty of Medicine, Port Said University Prof. Maivel H. Ghattas Dean of the Faculty of Medicine, Port Said University Faculty of Medicine: The present & The Future Prof. Maivel H. Ghattas Dean of faculty of medicine port said university Prof. Nada El Hosani Vice President for Education and Students Affairs Integrated Medical Curriculum Ass. Prof. Khalid Sabry Vice Dean for Education & student Affairs Prof. Ayman Ibrahim Vice President for Postgraduate Studies and Researches The Role of faculty of Medicine in Community Services Prof. Ehab Ghoneim Vice Dean for Community Service s& Environmental Development Affair Post Graduate Prof. Shams Shaheen President of the university Prof. Magdy Aly Omera Vice Dean for Postgraduate Studies and Researches Maj.Gen. Adel El Ghadban Governor of Port Said 8 9

6 Day 1 Day 1 10:20am-11:20am Session (II) Hyperglycemia and Dyslipidemia in Diabetes 11:20am-12:40am Session (III) Multisystem affection in Diabetes Chairpersons: Prof. Fahmy Emara - Prof. Mamdouh El-Nahas Chairpersons: Prof. Taher El-Serafi - Prof. Farid Fawzy - Prof. Mohammed Mashahet 10:20am-10:40am HbA1c: old dogmas, a new perspective? Prof. Mamdouh El-Nahas Port said University 11:20am-11:40am Diabetic foot diseases Prof. Hanan Gawish MansouraUniversity 10:40am-11:00am Non-fasting lipid profile in diabetic versus non-diabetic Prof. Taher El-Serafi Suez Canal University 11:40pm-12:00pm Diabetic patients in coronary care unit Prof. Azza EL Eraky Port said University 11:00am-11:20am In hospital management of diabetes Dr. Mahmoud Elfowi Port Said General Hospital 12:00pm-12:20pm Management of diabetes in patients with liver diseases Prof. Mohammed Halawa Ain Shams University 12:20pm-12:40pm Updates in type 2 diabetes: clinical approach Prof. Yehia Ghanem Alexandria University 12:40pm-01:00pm Coffee break 10 11

7 Day 1 Day 1 01:00pm-02:00pm Session (IV) Management of Hyperglycemia 02:00pm-03:30pm Session (V) Diabetes and Ophthalmology 01:00pm-01:20pm Chairpersons: Prof. Hanan Gawish - Prof. Mohammed Halawa - Prof. Azza EL Eraky Glucose variability and diabetic complications Prof. Farid Fawzy Zagazig University 02:00pm-02:20pm Chairpersons: Prof. Karem Kolkailah - Prof. Tarek Radwan - Prof. Ehab Ghoneim Cataract and Diabetes Prof. EhabGhoneim Port said University 01:20pm-01:40pm The patient centered approach Prof. Mohammed Mashahet Fayoum University 02:20pm-02:40pm How to avoid and manage complications during phacoemulsification Prof. Yehia Salah El Din Cairo university 01:40pm-02:00pm Cross roads after metformin Prof. Hisham Rafea Consultant Diabetologist, Ain shams University 02:40pm-03:00pm OCT angio in diabetic maculopathy Prof. Tarek Radwan Suez Canal University 03:00pm-03:30pm Management of Diabetic Retinopathy Prof. Hamdy El Komy Tanta university 03:30pm-05:00pm Lunch break 12 13

8 Day 1 Day 1 05:00pm-06:00pm Session (VI) Diabetes and Intensive care 06:00pm-07:00pm Session (VII) Diabetes and Orthopedic surgery Chairpersons: Prof. Mohammed Emadeldin Abdelghaffar - Prof. Gamal Elewa - Prof. Magdy Aly Omera Chairpersons: Prof. Mohamed Wafa - Ass. Prof. khalid Sabry - Gen.Dr. Moustafa El Nakeeb 05:00pm-05:20pm Total Parentral Nutrition: A simple and practical approach Prof. Mohammed Emadeldin Abdelghaffar Suez Canal University 06:00pm-06:20pm Dorsolumbar spine infections Prof. Mohamed Wafa Ain Shams University 05:20pm-05:40pm Diabetes update in relation to anesthesia and intensive care Prof. Gamal Elewa Ain Shams University 06:20pm-06:40pm Diabetes and osteoporosis Ass. Prof. khalid Sabry Portsaid University 05:40pm-06:00pm Diabetes Update: Glycemic Control in Critically Ill Patients Prof. Magdy Aly Omera Port said University 06:40pm-07:00pm Diabetes and bone healing Ass. Prof. khalid Sabry Portsaid University 14 15

9 Day 1 Day 1 07:00pm-08:00pm Session (VIII) Diabetes and Neurosurgery 08:00pm-09:00pm Session (LX) Forensic Medicine & Clinical Toxicology 07:00pm-07:15pm 07:15pm-07:30pm Chairpersons: Prof. Prof. Esam El Khatib - Asst. Prof. Ayman Galhoum Diabetic neuropathy Ass. Prof. Ayman Galhoum Port said University Neuropathy: recent trends in management: Part II Spinal cord stimulation Prof. Esam El Khatib Suez Canal University 08:00pm-08:10pm 08:20pm-08:20pm Chairpersons: Prof. Dina Shokri - Dr. Hesham Abdel Hamid Farag - Prof Mohy Kadri El Masry - Prof. Heba Youssef Mohamed Medicolegal Responsibilities of Physicians That Threat Diabetic Patient Safety Prof. Dina Shokri Cairo University Diabetic Patients and Malpractice from Different Specialties Dr. Hesham Abdel Hamid Farag Authority Ministry of Justice 07:30pm-07:45pm Electromyography of Neuropathy Ass. Prof. Hegazy Megahed Al Azhar University 08:20pm-08:30pm Medical responsibilities and malpractices Dr. Hazem El Masry Advisor to the Egyptian State Lawsuits Authority 07:45pm-08:00pm Coffee break 16 17

10 08:30pm-08:40pm Management of Acute Toxicity of oral Antidiabetic Drugs Prof. Mohy Kadri El Masry Ain Shams University 08:40pm-08:50pm Newer Antidote Approved by FDA For Management of Acute Sulphonylurea toxicity Prof. Heba Youssef Mohamed Port said University 08:50pm-09:00pm Iatrogenic Diabetes: Medical and Medicolegal Dilemma Ass. Prof. Amany Ahmed Port said University 18 19

11 Day 2 Day 2 10:00am-11:20am Session (II) Diabetes and Pediatrics 09:00am-10:00am 09:00am-09:20am 09:20am-09:40am Session (I) Diabetes and academic branches Chairpersons: Prof. Maivel H. Ghattas - Prof. Azza Zidan - Prof. Refaat Sadeq Epigenetics: What is beyond the cancers? Prof. Maivel H. ghattas Port Said University Viral Load Predict Virological Response to Therapy in Chronic Hepatitis C. Prof. Refaat Sadeq Port said University 10:00am-10:20am 10:20am-10:40am 10:40am-11:00am Chairpersons: Prof. Mohamed El Kalioby - Prof. Sonya Gamal Alsharkawy - Prof. Hoda Ahmed Atwa - Ass. Prof. Nesrin Mosad Handoka Curing type1 diabetes: How close are we? Prof. Hoda Ahmed Atwa Suez Canal University Why we are worried about diabetes in children? Prof. Sonya Gamal Alsharkawy Suez Canal University Neonatal Hypoglycaemia Dr. Mohamed Osama Hussein El Nasr hospital 09:40am-10:00am Diabetes Mellitus: pathology and complications Prof. Azza Zidan Port said University 11:00am-11:20am Secondary diabetes in children with thalassemia Dr. Mona Mahmoud Port Said University 11:20pm-01:00pm Coffee break / Pray 20 21

12 Day 2 Day 2 01:00pm-02:00pm Session (III) Diabetes and Dermatology 02:00pm-03:00pm Session (IV) Diabetes and Vascular surgery Chairpersons: Prof. Samir Elhanbly - Prof. Ibrahim Abou Bakr Abdel-Hamid Ass. Prof. Mamdouh M. Abdelgawad Chairpersons: Prof. Mohamed Hosni - Prof. Sherif Ahmed Reffat - Dr Mohamed Ghweeba 01:00pm-01:20pm Testicular biopsy and TESE in cases of azoospermia Prof. Samir Elhanbly Mansoura University 02:00pm-02:10pm Role of endovascular in saving avf for dialysis Dr Mohamed Ghweeba port-said university 01:20pm-01:40pm Current treatment of erectile dysfunction Ibrahim AbouBakr Abdel-Hamid Mansoura University 02:10pm-02:20pm Management of mangeled extremity Prof. Elsayed Abdelfattah Elzayat Suez Canal University 01:40pm-02:00pm The skin in diabetes Ass. Prof. Mamdouh M. Abdelgawad Mansoura University 02:20pm-02:30pm Egyptian experience in EVAR&TEVAR Prof. Mohamed Hosni Cairo university 02:30pm-02:40pm Modern treatment of Varicose veins Prof. Sherif Ahmed Reffat Suez Canal University 22 23

13 Day 2 02:40pm-02:50pm Endovascular Options in the management of lower limb ischemia Ass. Prof. Hatem Hussein Suez Canal University 02:50pm-03:00pm Approche of EVAR Prof. Mohamed Hosni Cairo university 03:00pm-03:15pm Conference recommendations Prof. Maivel H. Ghattas 24 25

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19 Professor Yehia Salah El Din Professor of Ophthalmology, Faculty of Medicine, Cairo University Capsulorhexis related complications, Zonular dialysis, poor pupillary dilation, shallow anterior chamber and rupture posterior capsule and other related complications. 36 Management of Diabetic Retinopathy Prof. Hamdy El Komy Professor of Ophthalmology, Faculty of Medicine, Tanta University Grades of diabetic retinopathy, diabetic maculopathy, investigations include fluorescein angiography, OCT, Laser treatment and intravitreal injections. 37

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21 Assessing daily protein, energy and electrolyte requirements and fulfilling these requirements are of paramount importance for the well being of those patients requiring TPN. Both, protein and energy requirements can be measured fairly accurately in the critically ill. There are many protocols available for TPN. A practical and easy to apply protocol which is implemented in the ICU of Suez Canal University since 2002 is discussed. We conclude that:. TPN is indicated for malnourished patients, severely catabolic patients trauma, burns, and sepsis, cancer patients, and patients with organ failure without a functioning GIT.. Special nutritional support is not indicated for well-nourished surgical patients with uncomplicated surgery who will have a limited period of fasting (2 4 days).. However, if nutritional support is indicated, it should be initiated as soon as possible.. Essential electrolytes for TPN, eg. Na acetate, K acetate, Na phosphate, K phosphate and Mg phosphate, are not available in Egypt.. Making these elements available is pivotal for the success of any TPN protocol 40 41

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24 and risk factor management, treatments based on pathogenetic mechanisms, and symptomatic pain management. This review highlights the recent and emerging trends in treatment of diabetic PDN

25 Neuropathy is a term that refers to general diseases or malfunctions of the nerves. Nerves at any location in the body can be damaged from injury or disease. Neuropathy is often classified according to the types or location of nerves that are affected. Neuropathy can also be classified according to the disease causing it. (For example, neuropathy from the effects of diabetes is called diabetic neuropathy Electrophysiological examinations still play an important role in initial diagnostics of neuropathic disorders and monitoring of the disease progress or recovery process. EMG examination enables determination of location and character of peripheral impairment, establishment of neurogenic or myogenic impairment or neuromuscular transmission disorders and also determination if the process is acute or chronic,localized or generalized. EMG examination is also helpful in detection of subclinical pathology. In neurogenic processes it enables differentiation of spinal and peripheral nerve trunks impairment

26 Dr. Hesham Abdel Hamid Farag Head of Egyptian Forensic Medicine Authority Ministry of Justice In this overview of medical malpractice litigation regarding providing medical care for diabetic patients from various clinical specialties. Practical and philosophic aspects of the so-called malpractice litigation crisis are addressed. After reviewing the historical, legal rationale for compensating victims of negligent conduct by others, attention is focused on the plight of physicians who are charged with medical negligence and malpractice that impose a heavy burden on all health care providers, particularly those in medical and the surgical fields. All surgical procedures have a risk of complications, many of which cannot be avoided completely regardless of the experience and expertise of the surgeon, the surgical team, or the hospital staff. Wrong-site surgery is a relatively uncommon complication that is easily preventable. The Sign Your Site protocol is a simple, straightforward program that requires only a minimal amount of time to eliminate the risk of wrong-site surgery, and it should be standard policy in healthcare institutions. Various procedural changes in the processing of malpractice claims are reviewed and analyzed from the perspective of both fairness and efficacy

27 Prof Mohy Kadri El Masry Professor of Forensic Medicine And Clinical Toxicology Department Faculty Of Medicine Ain Shams University Type 2 diabetes mellitus is an increasing problem reaching alarming percentages. The combined prevalence of diagnosed and undiagnosed diabetes in the Egyptian population > 20 years of age was estimated to be 9.3% compounded by obesity, sedentary life reaching 13.5% in lower socioeconomic status population. Abuse of oral antidiabetic medications for attempted suicide in increasing percentage over the recent years, reflects its widespread distribution. Oral antidiabetic medications can be separated by mechanism of action into two groups: hypoglycemics (sulfonylureas and meglitinides) and antihyperglycemics (biguanides and alpha-glucosidase inhibitors). In Egypt, the major classes include sulfonylureas, biguanides followed by glitazone and meglitinides. The hypoglycemic agents pose a significant risk of morbidity, mortality, and permanent sequelae secondary to prolonged periods of hypoglycemia as persistent vegetative state recorded on several occasions in referred neglected patients. However, outcomes are usually favorable if intervention is initiated early, with the primary goal return of euglycemia using supplemental dextrose infusion and octreotide to reduce further insulin secretion. Metformin-associated lactic acidosis (MALA) can occur with both acute and chronic metformin exposure. While MALA is not common, its associated rates of morbidity and mortality can be high resulting in cardiovascular collapse, renal failure, and death in some cases. Proper management is discussed as is other side effects of oral hypoglycemic agents

28 Prof. Heba Youssef Mohamed Head of Forensic Medicine and Clinical Toxicology Department Faculty of Medicine Port Said University Antidote is a drug or agent that counteracts the harmful effects of poison or overdosage by another drug. Antidotes have an important role in the treatment of poisoned patients. Recently Food and drug administration FDA had approved lifesaving antidote for management of acute sulphonylurea toxicity. Octreotide has been available for many years but has only recently approved by FDA to be used for the treatment of sulfonylurea-induced hypoglycemia. Stabilization of intoxicated patient, supportive therapy and use of specific antidote increase survival rate, decreasing morbidities and shorten length of hospital stay and hence improve patient safety. Knowing indications, dosage forms, adverse effects and cautions before using newly approved antidote will help toxicologists and emergency medicine physician in proper and safe management.recommendations: Essential antidotes should be stocked in every health care facilities that deal with acute intoxicated cases for better clinical outcome. Further experimental and clinical studies are needed for development of newer promising antidotes. Iatrogenic Diabetes : Medical and Medicolegal Dilemma Asisst. Prof. Amany Ahmed Asisstant Professor of Forensic Medicine & Toxicology Many drugs which are prescribed by doctors may predispose, precipitate or provoke diabetes mellitus or at least temporary hyperglycemia or change in the clinical course of diabetes. This may be considered a medical error in many cases which must be known to every physician to avoid harm to his patient 54 55

29 Epigenetics: What is beyond the cancers? Prof. Maivel H. ghattas Professor and Head of Biochemistry Department, Faculty of Medicine, Port said University Dean of Faculty of Medicine Port said University Epigenetics means any process that alters gene activity without changing the DNA sequence. Epigenetic modifications are fundamental for the physiological processes that regulate gene activity. On the other hand, epigenetic is emerging as an important mechanism in the pathogenesis of many diseases. DNA methylation is a major epigenetic modification of the genome that has the potential to silence gene expression. Many studies focused on explaining the role of epigenetics in the development and progression of almost all types of human cancers, but nowadays, most researcher have shifted to emphasizing the role of epigenetic changes in other autoimmune and inflammatory diseases. Our study done on patients with end-stage renal disease unveiled that the methylation at the methylenetetrahydrofolate reductase gene promoter region is a common event in these patients. Epigenetic DNA modifications are potentially reversible and this will raise the possibility that future therapies directed at modifying the epigenome may have favorable effects on preventing disease progression. Therefore we focused to specifically summarize the main epigenetic changes and their role, together with other factors, in diseases rather than cancers

30 Viral Load Predict Virological Response to Therapy in Chronic Hepatitis C. Prof. Refaat Sadek Professor and Head of Medical Microbiology and Immunology Department, Faculty of Medicine, Port said University Hepatitis C is an infectious disease affecting primarily the liver, caused by the hepatitis C virus (HCV). HCV infection is a major problem in Egypt. Egypt has the highest prevalence of the Hepatitis C virus (HCV) in the world, with 14 percent of the population infected and 11.8 million patients, according to the World Health Organisation. Every year there are 170, ,000 new HVC cases in Egypt. It was first discovered in The hepatitis C virus (HCV) is a small, enveloped, single-stranded, positive-sense RNA virus(2). It is a member of the Hepacivirus genus in the family Flaviviridae. There are seven major genotypes of HCV, which are known as genotypes one to seven. It is transmitted by injection which means spread primarily by blood-to-blood contact associated with intravenous drug use, poorly-sterilized medical equipment, and transfusions.. Aim of the study: This study aims to determine the common prevalent HCV genotypes among chronic HCV patients in Egypt and to evaluate the rate of sustained virological response (SVR) with some factors that affecting it. Methods: The study population includes all the 500 patients with chronic HCV infection who were treated in different hospitals during the period February August Epi Info 7 was used to calculate the sample size, it was decided to use a simple random sampling technique in this study and a random sample of 88 patients were selected with confidence level of 99%, the sample size was then increased to 120 to maximize accuracy of the study, later 20 patients dropped out of the study & data of only 100 patients was analyzed. Each specimen was determined for HCV genotyping and HCV RNA viral load was measured before, after 12 weeks, 48 weeks and 6 months after stopping the treatment. Results: In our study, the most predominant genotype was genotype IV with 86 %, 9 % genotype I followed by 5 % genotype II, patients were investigated, after 12 weeks of treatment, 39 of them ( 45.3% ) were HCV- RNA ve, after 48 weeks of the treatment, some remained HCV-RNA ve and others turned into HCV-RNA +ve, but overall 39 patients ( 45.3%) were HCV-RNA ve and after 6 months of stopping the treatment, 23 out of 39 (58.9 %) achieved SVR, i.e % of the total sample (n = 86) achieved SVR. Regarding the effect of SVR according to gender, in this study, it showed that 84.2% of females had a SVR compared to 35% of males only (p.value of 0.003), our study also showed that there is no statistical difference between SVR and various age groups, as it showed that 100% of those >45 years old who had a +ve HCV-RNA after 6 months from stopping treatment while 68.4 % of the age groups years old & 58.8% of the age group < 30 years old had a ve HCVRNA after 6 months from stopping treatment.( p.value of 0.082). We found out that only 2.6 % of those who had +ve HCV RNA after 6 months from stopping the treatment were overweight, and there was no statistical difference in SVR between normal and overweight groups according to Body Mass Index (BMI) measuring, it showed that 60.5 % of those with normal BMI had a SVR.( p.value of 0.41), In our study, there is statistical difference in SVR between those who had low (66.6%) and high viral load (16.6%) (P. value 0.033) and also there was statistical significance between EVR after 12 weeks and SVR after 6 months of stopping treatment ( P value = 0.0), 23 out of 25 patients ( 92%) who had Early virological response (EVR) persist to have SVR. Conclusions: In our study, the most predominant genotype was genotype IV with 86 %. Of our HCV-treated patients, 58.9% had SVR. HCV genotype-4, EVR, and low baseline viral load were predictive of SVR. 59

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