Technology is changing the World and World of Medicine-Prof. Carlos Mestres


Plenary Session-II & III at 4th Int. conference of SMDC
Technology is changing the World and
World of Medicine-Prof. Carlos Mestres
Environment, use of plastics, smoking effect
sperm count and may lead to infertility, various
congenital malformations - Prof. Kazim Chohan
Acute stroke care therapy needs multimodal
approach-Dr. Jason Warren

LAHORE: Prof. Farrukh Zaman chaired the second plenary session during the 4th International Conference of Shalamar Medical & |Dental College held here from February 1-2, 2020. Prof. Carlos Mestres from United States was the first speaker in this session and topic of his presentation was Innovations and New Technology in Medicine Fields. Speaking about transfer of knowledge, education development, he said, there is tolerance to chaos, patients, disease, therapy and the therapist. Interventions is a new idea for improvement and advancement of knowledge. He then referred to the development of first syringe and first hearing aid which were too big but now these are available in tiny shape. We have seen developments like coronary bypass graft surgery, cardiac pace makers. Prof. Ghazi from University of Zurich has written about Medical Bypass 2020. Technology, he said, is changing the world and world of medicine.

Continuing Prof. Carlos said that now calcified aortic valves and other valves can be replaced but this replacement is at times hindered due to scarcity of resourced. We need to understand, educate, innovation, education is innovation. Now structural innovations in aortic valve are possible, he added.

Dr. Edwin Chandraharan was the next speaker who talked about Management strategies to reduce maternal mortality by emerging killer. He discussed in detail the management of placenta, peri partum hysterectomy, and abnormal invasion of placenta, abnormal invasion of uterus, innovative bystanders, and peri operative placental localization. Vast majority of these women, he stated, do not need embolization. If the women is bleeding a lot, look at the anesthetist, if he is looking at the same, it is a bad news. He then talked about modified triple procedure of hysterectomy and also showed a video of this triple procedure. He was of the view that performing hysterectomy at the age of 30-35 years is not good. It also covered the management of adherent placenta and vertical suppression sutures. Ensure blood supply to the vessels in uterus and it is important that we know the anatomy better, he added.

Prof. Kazim R. Chohan from USA was the next speaker who discussed Environmental effects on fertility and Health of future generations. He started his presentation by stating that many people here have asked me about my qualification which are in some other field and how come I am affiliated with Dept. of Obstetrics & Gynaecology in a medical university in United States? They thought that there is no connection between animals, medicine and clinical practice. To this he replied that he was lucky as he was living in a knowledge based society where there is no institution like Pakistan Medical & Dental Council. He then talked about the sex disruptors, toxic chemical exposure as different body organs are affected differently. He also talked about andrology and multigenerational effect of toxic chemicals. It is essential that we chose normal sperm for fertility. He suggested that one should complete one’s family before the age of forty years. After that there is increased chance of genetic abnormalities, autism, and increase in bipolar disorders. Parental age also matters.

Continuing Prof. Kazim Chohan said that reproductive tract infections also lead to many problems. Diet has major impact on future generations. There is increase in mental disorders and more people in United States are now using SSRIs. This leads to DNA fragmentation. Smokiing also leads to low sperm count. Studies have shown that DNA fragmentation is high in smokers. When mothers smoke it is worse. Sperm production is decreased or lost due to over use of plastics. Use of more plastic items will result in loss of sperm production. This results in decrease in sperm count and sperm development. It can also lead to ectopic pregnancy, miscarriage, increase in birth defects, infertility. His advice to women going to the beauty parlors was to avoid the use of fancy products as it results in exposure to carcinogenic products. Mother’s life style, use of cell phones, sperm heat exposure results in semen parameters going down. Studies have also showed that there is 50% reduction in sperm count due to use of cell phones. Now radiation resistant underwear’s are available. His advice was to adopt just simple life style.

Prof. Farrukh Zaman in his concluding remarks said that uterus sparing surgery should be promoted. Now we see more C. Sections being performed. It is important that we must save the uterus and reduce blood loss. We need to look into the causes of miscarriages, infertility and abortions. All these should be avoided. Dr. Asif Bashir remarked that we need to be cautious. Prof. Kazim Chohan has given us a timely warning. We also need to control pollution, he added.

Last Session

Prof. Bilal Bin Younus alongwith Prof. Haroon Yousuf chaired this session. Dr. Jason Warren Freeman from United States was the first speaker. His presentation was on “Acute Stroke Care in Community based setting”. He shared the details of acute stroke care setting in the developing world and discussed acute step therapy, development of stroke care system, large vessel occlusion, brain attacks in which the blood flow to the brain is cut off. Brain cells are deprived of oxygen. If a patient is having acute neurological dysfunctions, he or she could be suffering from stroke. Due to blood clot blood flow stops to the brain tissues. In hemorrhagic stroke, blood vessels rupture and there is bleeding. Transient Ischemic Attach (TIAs) is a focal neurological deficit and there is a different between TIA and stroke.

Continuing Dr. Jason Warren said that in United States, eight hundred thousand people suffer from stroke every year. In 1970, Aspirin was first time used for secondary prevention of stroke. LMWH is used in acute stroke and IV heparin is not used in acute stroke management because of increase in ICH. He then referred to the safety and efficacy of tPA clot buster introduced in 1996 which is very effective in treatment of acute ischemic stroke if used within three hours. It was included in American Heart Association Guidelines for Stroke in 2007. tPA interventions is desirable within three to five hours and it also provides a time window for mechanical thrombectomy. For use of tPA last symptom time should be known. It is important to check blood glucose and do not treat stroke mimic. Ensure that blood pressure is about 185/110 or low when you are going for tPA.

Talking about contraindications to thrombolysis Dr. Jason Warren said we must know how to control blood pressure and measurable neurological deficit. tPA is being used in just about 2% of the patients as the patients do not come to the hospital in time. Public awareness is essential that treatment is available and it should be used. Now in 2014 the use of TPA was increased to 5% of the patients suffering from acute stroke. Acute stroke care therapy needs multimodal approach. Pre hospital contact with the emergency personnel is desirable to manage stroke patients. Nurses looking after these patients need structured training. However, tPA is expensive. In a country like Pakistan, a large number of patients may not afford it. World Stroke Organization says that full use of acute stroke therapy is useful and must be promoted. He also shared with the participants the results of Clot retrieval DAWN Trial results. About 10% of all stroke patients undergo procedures in tertiary care hospitals as stroke is an emergency, he added.

Ms. Annamarie Saarinen was the next speaker who talked about “Accelerated Diagnostics: Innovations in Newborn Screening and Care”. She gave details of Universal Screening for Newborn for Congenital Heart Disease. This, she said, is a forty piece legislation which was approved in April 2009. She then talked about New Born Pulse Oximetry screening and how they started this newborn screening programme. She also discussed in detail the prenatal education, screening, diagnosis, control and follow up. Screening for treatable conditions is very useful and beneficial. However, make sure that the disease being screened is not a very rare condition. These diseases cause disabilities and death if not treated early. This programme is helpful in identifying nine out of thousand life births in USA, particularly critical congenital heart diseases. Screening protocol is twelve to forty eight hours after birth. Now almost 90% of children are being screened in sixteen countries and we have initiated a multi hospital study in forty eight countries, she added.

Dr. Shoaleh Bigdeli from Iran was the last speaker in this session and she talked about “21st Century curriculum for Millennial Medical Universities”. She started her presentation by a quotation from great philosopher and Saint Sheikh Saadi who said that “when ambition meets opportunity anything is possible.” She dealt at length about goals of teaching, learning, evaluation, teachers and students, curriculum and learning opportunities. Curriculum, she opined, was a process of being knowledgeable. She then talked about planned engagement of learners, subject matte taught to the students, tution material, planned course lessons. She also referred to overt, hidden, declared, taught and received curriculum. A successful curriculum, she opined, is one in which they all must overlap.

Speaking about the digital immigrant teachers, she said, now students particularly the new generation is more digital qualified. Now we see a generation divide between digital natives and digital immigrants. Now digital age learners use digital library and they no more require class room. They prefer Flip Class Rooms, small group teaching, team based learning. She then talked about Technology Plan, Simulation, Gamification, faculty development trends in universities. We need to bring a change in attitude. The first generation universities focus on Knowledge, second generation universities focus on Research while third generation universities focus on acting on global level. In order to act at global level, universities need to sign MOUs for Tran’s disciplinary research. John Hopkins, she pointed out was the first research based university in United States established in 1876. Fourth and 5th generation universities focus on marketing. If we set our priorities right, our universities will remain on forefront. Now there is diversity of students. To run large hospitals is a big problem in order to maintain standards. The fourth and 5th Generation universities are involved in cutting edge research and offer excellent teaching capabilities. Research and Education, she concluded, is a strong components of 5th generation universities.

In his concluding remarks Prof. Bilal Bin Younus said that we should aim for prevention of stroke. Aspirin is now also being used for primary prevention in some countries though there are some studies which do not favour it. In stroke patients, one should never try to lower the blood pressure immediately. We are spending on diagnosis of diseases which may be treat able in future. One does not know how much one should spend. Shalamar Hospital, he pointed out has a good database, the use of technology has been put to use for the benefit of improving public health. In Pakistan, he further stated, pregnancies are not planned which is a problem. Medical Education should be evolutionary. We need to develop priorities in our healthcare system. We must train the doctors as per our needs which will improve the healthcare. In the end Prof. Sarah Khalid thanked all those who helped in making the conference a great success.

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