Biography:

Ahmed Zaky, is currently an Associate Professor at the Department of Anesthesiology and Perioperative Medicine at the University of Alabama At Birmingham since January 2014. Dr. Zaky is highly trained; in addition to completing 2 residencies in Anesthesiology both at his home country, Egypt, and at the University of Miami, he has completed 3 fellowships in Multi-organ Transplant, Critical Care, and Cardiac Anesthesiology from the University of Miami, Johns Hopkins University and the Cleveland Clinic, respectively. Driven by a passion towards clinical research, Dr. Zaky has completed a Masters in Public Health from the University of Washington, Seattle. Dr. Zaky has since been engaged in projects that focus on studying cardiac function in critical illness using innovative imaging techniques.  Dr. Zaky, has published over 30 peer reviewed publications and numerour book chapters on the appraisial of cardiac dysfunction in critically ill patients. Dr. Zaky, is a funded investigator and co-investigaor on several grants that target interventions to early detect and treat cardiac dysfunction in animals and in humans exposed to toxic inhalants. He also has received the UAB Award for Faculty Academic Achievement in 2015 to study acute kidney injury post cardiopulmonary bypass. The strong clinical training, coupled with research experience and accomplishment make Dr. Zaky a suitable candidate for this talk. 

Abstract:

End stage liver disease (ESLD) is a multi-system disease that complexly and mutually interacts with other body organs. The heart is one of the organs most adversely affected by liver disease both directly and indirectly. Cardiac dysfunction in the setting of cirrhosis may contribute to mortality as high as 50% post liver transplantation. The spectrum of heart diseases associated with liver cirrhosis includes 3 major groups:

1.            Underlying heart disease aggravated by cirrhosis

2.            Heart disease that is caused by a pathologic process that concomitantly affects the heart and the liver

3.            Cirrhosis-associated cardiac disease, which may be vascular, myocardial or pericardial.

Liver transplantation while considered the definitive treatment of patients with ESLD, can independently contribute to further deterioration of pre-existing cirrhosis-associated cardiac dysfunction. These adverse effects occur as a result of acute changes in loading conditions, and the liberation of inflammatory cytokines and other mediators during graft reperfusion. Furthermore, following liver transplantation there is an increased risk of adverse cardiac events associated with chronic immunosuppressive therapy. Thus, such patients require a thorough cardiac evaluation prior to being deemed acceptable liver transplant candidates.

A thorough cardiac evaluation of liver transplant candidates is a challenging task, however. Altered cardiac response to stress, the heterogeneity of cardiac disease in liver transplant candidates, and the paucity of well-designed studies investigating preoperative cardiac testing; all explain the current lack of agreement on a single best screening strategy to optimize perioperative and postoperative outcomes.

This talk will discuss the following: profiles of cardiac dysfunction in ESLD, short and long term cardiac dysfunction associated with liver transplantation, and the preoperative evaluation of liver transplant candidates in light of the current evidence, appraising its limitations. Also, this talk will propose avenues for future investigation of cardiac function in liver transplant candidates.

Biography:

Dr. Ashktorab has completed his Ph.D at the age of 28 years from Utah University and postdoctoral studies from Indina University and University of Florida, School of Medicine. He is the director of Microarray lab, a member of Gastrointestical Research group.  He has published more than 100 papers in reputed journals and has been serving as an editorial board member of many Journal including DDS, GUT, PlosOne and others. 
 

Abstract:

Colorectal cacner is the second cause of death in the world and genomic alteration palys an importan role in this desase. Much of the underlying genetic ‘cancer driver’ mutations in sporadic colorectal cancer (CRC) have not been characterized by race.

Here, we report the identification of distinct novel variants from CRC patients in mismatch repair (MMR) genes MHS3 and MSH6, and APC. We developed a panel of 20 frequently altered colon cancer genes for targeted sequencing in 138 colon tissues using next generation sequencing to examine 98.8% of the targeted exons and splice junctions at a depth of sequencing that allowed for high confidence variant calling. After alignment and variant calling, we annotated the variants with information from the 1000 Genomes Project, COSMIC, Polyphen2, and PFAM domain and transcription factor motifs. Excluding synonymous SNVs, 212 deleterious variants in adenoma, 760 in advanced adenoma, and 2624 variants in tumors were detected. Novel variants (1591 and 1363) were found in MMR genes (MSH6 and MSH3) and APC gene, respectively. These findings further highlight the relevance of APC gene in CRC onset but also the potential underestimation of the MSI-H in sporadic CRC as many of the novel mutations in MMR genes detected here were of a deleterious nature with an therapeutic interest.

Biography:

Alex has completed his MD (I) at the age of 31 years from Udine University after have obtained a CCT in General and Colorectal Surgery. He is now working as senior specialist registrar at the prestigious St Mark’s Hospital in the UK and he is aiming a new MD in Physiology and Neurostimulation at the Imperial College of London. He has published more than 20 papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

The new Anopress© device has been promoted as a portable, quick and reliable new device which can reproduce easily pressures measurements of the anal canal. The aim of these studies was to formulate normative data for this newer device by recording the anorectal function in asymptomatic subjects. We also intended to assess its practicality and acceptability in daily clinic in symptomatic patients.

Anorectal function was assessed in 150 asymptomatic volunteers using the Anopress©. All volunteers were tested in a standardised way in accordance with the study protocol and normative values were obtained. Sixty patients with faecal incontinence were retrospectively evaluated. A cohort of other 60 patients had both Anopress and high resolution manometry.

Further statistical analysis allowed calculation of normal values for this newer device. All the patients tolerated the procedure. When comparing the two manometric evaluations, there were significant differences in terms of pressures likely due to the different technology of the two machines.  

Anopress© appears to be an easy, quick and a straightforward way of measuring anal canal pressure. One of the main advantages is the solid state probe which is able to represent the pressures of the whole anal canal. This newer device is also portable and we could use it easily in clinic at the bedside.