Day 2 :
José R. Reyes Memorial Medical Center, Philippines
Keynote: The efficacy of bile acids in the treatment of non-alcoholic steatohepatitis: A 10-year systematic review
Time : 09:30-10:15
Higinio T Mappala is a full-time Medical Specialist III and Administrator at the Jose R. Reyes Memorial Medical Center, Manila, Philippines and has served as a University Professor and Dean of two medical schools. He has attended the 3-level training courses on Leadership and Management by the World Gastroenterology Organization held in Florida, USA, Dubrovnic, Croatia and Porto, Portugal. He is a focused Lecturer on NAFLD in local and international conventions.
Non-Alcoholic Fatty Liver Disease (NAFLD) is one of the most common forms of chronic liver disease which may progress to Non-Alcoholic Steatohepatitis (NASH). Currently there are no therapeutic strategies for such disease. Only lifestyle modification through diet and exercise were proven to afford some benefit in patients with NAFLD. No pharmacologic agents have so far been approved for the treatment of NAFLD or NASH. Therefore, most clinical efforts have been directed at treating the components of metabolic syndrome, namely obesity, diabetes, hypertension and dyslipidemias. Other interventions are directed at specific pathways potentially involved in the pathogenesis of NAFLD, such as insulin resistance, oxidative stress, pro-inflammatory cytokines, apoptosis, bacterial overgrowth and angiotensin pathway. This lecture aims to show the potential of bile acids as a promising therapeutic option for NAFLD. This is a 10-year systematic review of the effects of bile acids on non-alcoholic fatty liver disease. Bile acids may yet prove to be an effective targeted treatment for non-alcoholic fatty liver disease.
KIST Medical College and Teaching Hospital, Nepal
Keynote: Prevalence of obesity in correlation with physical activity among the school students of Pokhara, Nepal
Time : 10:15- 11:00
Archana Bhaila has completed her BSc in Human Biology from Kathmandu University and her MSc in Physiology from Manipal College of Medical Sciences, Pokhara. She is currently working as a Lecturer in Department of Physiology in KIST Medical College and Teaching Hospital.
Obesity is an emerging major public health problem throughout the world and its prevalence has largely increased over the last decade in both developed and developing countries. Only few studies addressing obesity is available in Nepal. While this global epidemic is well described in the adult population, not much data is available regarding the prevalence of overweight/obesity in children or adolescents amongst developing countries. Therefore the present study was to obtain prevalence of obesity in school children and to analyze the relationship of obesity with physical activity of the students. Anthropometric data was collected from 100 students. Physical activities of the students were assessed with the help of a set of questionnaires. The results of this study showed that the obese/overweight subjects had a greater BMI. Of the total population 3% was obese while 19% was overweight. The prevalence rates of overweight and obesity in girls were higher than in boys. Of our sample, 31% were found to be underweight. Most of the obese/overweight children belonged to the private schools, while majority of the underweight belonged in government school. The association of different types of physical activities (sports, domestic help and motor transportation) with BMI was found to be significant. Thus, we can say that obesity and under nutrition co-exist in Nepalese school-children. This study showed the higher rates of underweight children, even though Nepalese population is starting to have worrisome rates of overweight. There is a great need for information on nutritional status and physical activity in school-age children.
- Liver Diseases diagnosis | Liver Cancer | Viral Hepatitis C
Medical Officer, Seychelles
Naomi Ferguson is an experienced Medical Officer with a demonstrated history of working in primary health and HIV clinics. She is passionate about strengthening risk communication capacities in African countries with language proficiency in English, French and Seychelles Creole. She is an experienced presenter, which includes the presentation of Seychelles’ Risk Communication capacity during the Joint External Evaluation (JEE) of implementation of International Health Regulations (IHR 2005) in Seychelles in March 2018 and forming part of the external team of Rwanda’s JEE of implementation of IHR in May 2018. She actively participated in the review of the draft of 3rd Edition of the Technical Guideline for the Integrated Disease Surveillance and Response (IDSR) in Brazzaville Congo in March 2018. She is proactive and hardworking with experience of taking multiple duties during the Seychelles’ response to plague epidemic in Madagascar in 2017.
Background & Aim: Approximately 80 million people around the world are living with hepatitis C, and 700,000 people die every year from hepatitis C related complications. Since 2014, oral medications called Directly-Acting Antivirals (DAAs) have been available for curative treatment. In Seychelles, a total of 777 cases of hepatitis C were reported from 2002 to 2016, but up to mid of 2016, the cases were not being treated. Treatment with DAA Harvoni, a combination of Sofosbuvir and Ledipasvir (SOF/LDV), is now being offered conditionally to those at low risk of re-infection. The aim of this study is to establish cost effectiveness of treating all cases of hepatitis C in Seychelles with Harvoni, as compared to no treatment.
Methods: A systematic review was carried out, using MEDLINE, Embase and NHS-EED. Data was extracted from the identified studies, including author, year, title, country, population, intervention and comparators, method (time horizon, perspective, model, clinical data source, cost data source, outcome measures and discount rate), results and discussion. Evidence from the systematic review was used to populate an economic model to calculate cost-effectiveness from Seychelles’ Government perspective. The population characteristics were based on the HCV cohort data from Seychelles. The model structure was also informed by the systematic review and an accompanying grading of economic models using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist. The economic model used was a Markov model, using a lifetime horizon and taking a payer’s perspective. Costs were discounted at 3% per annum. Outcome measures included Quality Adjusted Life Years (QALYs). Costs and QALYs were used to calculate Incremental Cost Effectiveness Ratios (ICERs).
Results: Harvoni, was found to be cost-saving in Seychelles HCV cohort, as compared to no treatment, with an ICER of €-753.65/QALY. The treatment was also cost-saving when stratified by gender, with the ICER of male and female being €-783.74/QALY and €-635.20/QALY, respectively. These findings were robust to probabilistic sensitivity analysis.
Conclusion: Treating hepatitis C cases in Seychelles is cost-saving. These results will help inform the policies on strategies to eliminate hepatitis C in Seychelles.
St. Luke’s Medical Center, Philippines
Ma Marylaine Dujunco is an working at St. Luke’s Medical Center, Philippines
Background & Aim: Acoustic Radiation Force Impulse (ARFI) imaging is a method to evaluate tissue stiffness. This study aims to evaluate the use of ARFI to non-invasively determine if a liver mass is benign or malignant.
Methodology: This is a two-year cross-sectional study of patients’ diagnosed liver tumors those underwent liver elastography using ARFI at St. Luke’s Medical Center. Liver masses were grouped to either benign or malignant according to their etiology and the mean ARFI value per group was computed. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic accuracy of the ARFI measurement. The optimal cut-off value was chosen to maximize the sensitivity and specificity. A p value <0.05 was considered statistically significant.
Results: Among 90 included patients in the study, 23.3% of the patients had history of other malignancy and 35.5% had cirrhosis. 81.1% of the patients had malignant liver masses. Average ARFI value of malignant masses was 2.24 m/s while that of benign is 1.88 m/s (p=0.113). Based on the ROC curve, a cut off ARFI value of 1.965 m/s has the highest sensitivity and specificity to distinguish malignant from benign liver masses at 65.8% and 58.8%, respectively. Using a cut off ARFI value of 1.02 m/s, the sensitivity and specificity of diagnosing a liver mass to be malignant are 90.4% and 23.5%, respectively. Calculated positive likelihood ratio is 1.18 and negative likelihood ratio of 0.41.
Conclusion: ARFI imaging is a promising method to characterize a liver mass as benign or malignant. It can accurately and objectively assess the stiffness of the liver mass in a non-invasive way. Any liver mass with an ARFI value of ≤1.02 m/s is benign (sensitivity 90.4%, specificity 23.5%). Liver masses with ARFI value of >1.02 m/s is likely malignant hence further investigation is warranted.
- Obesity and Public Health | Childhood obesity | Obesity Medicine
Immanuel Kant Baltic Federal University, Russia
Daria Skuratovskaia conducts his research in the field of genetic studies of the metabolic syndrome and its complications. She studies the polymorphic variants of adipokine and cytokine genes responsible for the formation of insulin resistance in obesity. In addition, she investigates the relationship between the components of NF-ĸB and Wnt signaling pathways with mitochondrial biogenesis.
Mitochondrial DNA (mtDNA) encodes core subunits of oxidative phosphorylation complex and as a result of a complex regulatory crosstalk between nuclear and mitochondrial genomes the total number of mtDNA copies fits the requirements of each cell type. Deviations from the optimal number of mtDNA copies are expected to be deleterious and thus can cause some diseases and agin. The reasons of potential deviations in mtDNA copies might be genetic or environmental such as hormonal imbalance in non-hereditary diseases. We studied 193 individuals (69 men; 124 women) who were divided into two cohorts, with and without obesity. The types of tissues were analyzed from each individual- peripheral venous blood, liver, Subcutaneous Adipose Tissues (SAT) and Visceral Adipose Tissue (VAT) from both greater omentum and mesenterium. The absolute mtDNA copies per cell were measured by droplet digital PCR and were significantly lower in peripheral blood than in the other tissues examined, 228±31 in peripheral blood, 1158±151 in liver, 1312±142 in greater omentum, 1161±86 in mesenterium and 1418±219 in SAT. The Body Mass Index (BMI) correlates positively with the mtDNA copies in SAT and negatively with peripheral blood mtDNA copies. There are positive correlations between greater omentum and mesenterium mtDNA copies (cor=0.44, p<0.05) and between SAT and greater omentum (cor=0.48, p<0.05). Multiple regression model revealed that blood and SAT mtDNA copy number affect the change in BMI (multiple R2: 0.4491, adjusted R2: 0.3471, p-value: 0.004633). Thus, we have revealed positive relationships between BMI and mtDNA copies in SAT and fat depots, but negative relationship between BMI and mtDNA copies in peripheral venous blood.
Technion Israel Institute of Technology, Israel
Ehud Goldhammer has his expertise in exercise physiology and cardiac rehabilitation, obesity, metabolic syndrome and heart failure patient's rehabilitation in particular. His passion in improving the health and wellbeing of coronary artery patients led him to establish (1982) the first cardiac rehabilitation center in the northern part of Israel, encouraging women, elderly, old people and minorities to join cardiac rehabilitation programs. Since the establishment of this center he tried to promote exercise programs for obese, diabetic, hypertensive and heart failure patients. Most of his research projects were done in exercise physiology, in the various subsets of coronary artery disease patients (diabetics, obese, hypertensive and heart failure patients).
Background: Klotho protein is a membrane-based circulating protein that regulates cell metabolism, as well as the lifespan modulating activity of Fibroblast Growth Factors (FGFs). Higher plasma circulating Klotho levels reduce cardiovascular risk, suggesting Klotho has a protective role in cardiovascular diseases. Recent studies have identified Klotho as a target gene for Peroxisome Proliferator-Activated Receptor-γ (PPAR-γ), a master regulator of adipocyte differentiation and an adipogenesis-promoting factor. Aerobic exercise reduces the risk of cardiovascular events and mortality in patients with proven Coronary Artery Disease (CAD), thus, S-Klotho serum levels were assessed in lean and obese patients in order to find out whether exercise can modulate its activity.
Purpose: To assess the impact of 12 weeks exercise training program on S-Klotho in obese vs. lean CAD patients and to assess possible correlation between S-Klotho and diabetes.
Methodology: S-Klotho was assessed pre and post 12 weeks supervised aerobic exercise program (45 min/4-5 sessions/week) in 2 groups, Group-A=27 CAD patients with BMI≤29, age 59.7 years±2.2 SD and Gropup-B=13 CAD patients with BMI≥30, age 63 years±2.4 SD. All patients had a recent (<45 days) Aortocoronary By-Pass Surgery (CABG) years, Myocardial Infarction (MI) or Percutaneous Intervention (PCI). Assessment was done twice, prior to exercise program and at the end of 12 weeks intervention. Serum S-Klotho levels were analyzed using α-Klotho enzyme linked immuno-sorbent assay (ELISA) kit (IBL, Immuno-Biological Laboratories Co., Japan), Germany.
Results: No difference (p=0.21) was found at baseline for S-Klotho levels between the two groups, 730.49 pg/ml±201.20 SD and 715.33 pg/ml±209.11 SD respectively, while a difference was found following exercise intervention, 843.27 pg/ml±210.56 SD in the obese patients group compared to 767.51pg/ml±167.46 SD in lean patients group, p=0.037. S-Klotho had an inverse correlation with diabetes at baseline and following exercise program, r=-0.59 and -0.61 respectively (p<0.05).
Conclusion: Aerobic exercise may modulate S-Klotho activity, among obese patients in particular, thus conferring a possible mechanism for the enhanced survival of coronary artery patients engaged in aerobic exercise program. If it contributes to the obesity paradox it should be further investigated.