The IX t h Makassed Medical Congress - American University of Beirut

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T h e I X t h M a k a s e d M e d i c a l C o n g r e s s POSTERIOR URETHRAL VALVES, CURRENT PERINATAL AND LONG TERM MANAGEMENT Alaa EL GHONEIMI, MD, PhD, FEBPS, FEAPU “Thrombosis, both venous and arterial, is a major cause of morbidity and mortality worldwide. Consequently, there is an ongoing search for new antithrombotic drugs, particularly novel anticoagulants. Recently, this armamentarium undergoes a major change with the introduction of new specific and oral anticoagulants that are likely to fulfil many of the unmet needs of current warfarin and heparin therapies. A direct thrombin inhibitor, dabigatran etexilate, and a direct factor Xa inhibitor, rivaroxaban are actually marketed for an easier and safer venous thromboembolism prevention following orthopaedic surgery. Large ongoing trials try todemonstrate that these drugs would also simplify and optimize stroke prevention in atrial fibrillation, treatment of venous thromboembolism and prevention of ischemic events in acute coronary syndrome. This presentation reviews the latest developments of new anticoagulants and focuses on those which have been approved or are in advanced development”. NEPHROPROTECTION IN PEDIATRICS Georges Deschênes M.D, Ph.D Nephroprotection is an advanced form of the conservative treatment of chronic renal failure that aims at preventing the progression of chronic renal disease to end stage renal failure, whatever the level of the glomerular filtration rate. All patients with a history of congenital or acquired renal disease that is known to decrease the nephron mass are concerned: congenital abnormalities of the kidney and urinary tract, polycystic diseases, chronic glomerular disease (Berger-Hinglais disease, Alport syndrome, membranous and membranoprolipherative glomerulonephritis, lupus nephritis and autoimmune vasculitis), acute and chronic haemolytic and uremic syndromes. In addition, nephroprotection also concerns patients with a systemic disease potentially affecting the kidney: diabetes mellitus, sickle cell disease, metabolic syndrome, essential hypertension, obesity and also history of low birth weight for term. Chronic renal disease is now classified according to the level of glomerular filtration rate: Stage 1: > 90 ml/min/1.73 m²; Stage 2: 60-90 ml/min/1.73 m²; Stage 3: 30-60 ml/min/1.73 m²; Stage 4: 15-30 ml/ min/1.73 m²; Stage 5 < 15 ml/min/1.73 m² representing end stage renal failure. The most determinant factors of progression of renal disease are proteinuria/microalbuminuria and hypertension that have to be both carefully controlled using drugs modifying the renin-angiotensin-aldosterone axis. Inhibitors of angioconvertase (ACEi) and antagonists of the angiotensin-2 receptor (ARA- 2) have definitely proven their efficiency to prevent the progression or chronic renal disease. The targets of these therapies are to maintain the blood pressure at the 50 th percentile and the level of microalbuminuria below 3 mg/mmol of urine creatinine. Other factors able to aggravate the status of chronic renal disease include anemia, carbohydrate intolerance, hyperuricemia and dyslipidemia. Anemia has to be controlled by supplements in iron, vitamine B6 and B12, and erythropoietic stimulating agents, carbohydrate intolerance by a specific diet and insulin id needed, hyperuricemia by administration of allopurinol and dyspipidemia by the administration of statins. Of note, 1/ chronic renal disease and most of the associated factors of progression to renal failure are also factors at risk of cardiovascular disease in the adult age; 2/ Drugs used to control the progression of chronic renal disease are also efficient to prevent the cardiovascular risk at adult age. 72
PREVENTION OF HUMAN PAPILLOMA VIRUS INFECTIONS: CHALLENGES AND PROMISES Ghassan Dbaibo M.D Human papilloma virus (HPV) infections are exceedingly common in women and men. The oncogenic types are responsible for all cervical cancers and a large proportion of other anogenital cancers in women as well as in men. Non-oncogenic types cause skin and genital warts and represent a significant burden on affected individuals. Prevention of four of the most common HPV’s is now possible with vaccination. Studies have shown that vaccination is effective in preventing infection with HPV, preventing persistent infection with HPV, and preventing development of pre-cancerous lesions of the cervix as well as the vulva and the vagina. Although vaccination is highly effective, uptake of the vaccine has been slow due to several barriers. These barriers and possibilities to overcome them will be discussed. ANTI-CD20 MONOCLONAL ANTIBODIES FOR THE TREATMENT OF LYMPHOID MALIGNANCIES AND AUTOIMMUNE CYTOPENIAS Tadeusz Robak, MD Over the last few years several monoclonal antibodies (mAbs) have been investigated in clinical trials in patients with lymphoid malignancies and autoimmune disorders [1]. The most important clinical value have at present rituximab (IDEC C2B8, Rituxan, Mabthera) that targets CD20 antigen and alemtuzumab (Campath-1H), a humanized form of a rat antibody active against CD52. The CD20 antigen is expressed on almost all B-cells but the intensity of expression appears to be lower on chronic lymphocytic leukemia (CLL) cells than in patients with non- Hodgkin lymphoma (NHL). The intensity of antigen expression or the number of receptor sites on the cell surface appears to be correlated with the clinical response. Rituximab is an IgG1 kappa immunoglobulin containing murine light – and heavy chain variable region sequences and human constant region sequences. The Fab domain of rituximab binds specifically to the CD20 antigen expressed on normal and malignant B-cells. The Fc domain recruits immune effect or functions to mediate B-cell lysis in vitro and in vivo. Mechanism by which rituximab may be cytotoxic include complement dependent cytotoxicity (CDC), antibody-dependent cell mediated cytotoxicity (ADCC) and induction of apoptosis. Furthermore, rituximab sensitizes malignant B-cells to the cytotoxic effects of chemotherapy. Rituximab was the first mAb approved in 1997 by the Food and Drug Administration (FDA) for the treatment of cancer. The drug is usually administered as an intravenous infusion with a recommended dosage 375 mg/m 2 given once weekly for 4 weeks. Treatment with this agent is well tolerated. However, infusion-related reactions occur in the majority of patients, although the incidence of these side effects decrease with subsequent rituximab infusion. Rituximab is currently validated as first-line treatment for aggressive and indolent subtypes of B-cell non-Hodgkin lymphoma (NHL). In diffuse large B-cell lymphoma (DLBCL) R-CHOP (Rituximab + CHOP) has became the new standard of care, which led to improve outcomes for this lymphoma [2]. The addition of rituximab to chemotherapeutic combinations (CHOP or CVP (cyclophosphamide, vincristine, prednisone) has also resulted in a significant increase in overall response rate (ORR), complete response rate (CR) and time to progression (TTP) in patients with follicular lymphoma [FL] [3]. In relapsed/resistant FL rituximab maintenance considerably improves progression free survival (PFS) not only after CHOP but also 73
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The IX th Makassed Medical Congress
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CONGRESS PRESIDENT Said Sayegh, MD,
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GENERAL INFORMATION
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• Target Audience: Physicians, Pr
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Durriya Sinno, MD Pediatrics Americ
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Moderators
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PEDIATRICS Bassem Abou Merhi, MD Pe
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Maroun Sokhn, MD Pediatrics Saint G
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Scientific Program
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Session 3: Intensive Care Neonatolo
Page 21 and 22: Session 1: Pediatric Intensive Care
Page 23 and 24: 8:00 - 8:05 08:05 - 08:10 Welcome r
Page 25 and 26: Cardiology Session III: Interventio
Page 27 and 28: Cardiology Session VI: Intervention
Page 29: Cardiology Symposia (NON-CME) Frida
Page 32 and 33: T h e I X t h M a k a s e d M e d i
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The IX t h Makassed Medical Congress - American University of Beirut

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