Global Wound Care Congress September 12-13 2016
San Antonio, Texas, USA

Biography:

Martina Tierney, an Occupational Therapist since 1983, worked in various settings, including rehabilitation, mental health, nursing and community care. She focused on the provision of specialist seating throughout her career.  As Clinical Director at Seating Matters, Martina oversees the Clinical Team is working on research, education and clinical trials. Through these key areas, she is at the forefront of Seating Matters’ vision; to change the world of healthcare seating. She continually pushes the boundaries of seating innovation whilst improving knowledge available to the healthcare community. Martina has authored ‘The Clinician’s Seating Handbook’, the only handbook in the world dedicated to seating and ‘The Clinician’s Guide to Pressure Injuries’.  Martina delivers Training Days and presents at conferences worldwide, sharing how clinical research improves patient care

Abstract:

While guidance is available on most aspects of pressure injury prevention and management, there has been little information on addressing these issues in seated patients. The issues most often addressed include the use of pressure-redistributing beds and mattresses, risk assessment, repositioning and management of established pressure injury. The role of specialised seating can often be overlooked. This research investigates the effectiveness of a specialised seating programme and its impact on pressure injury incidence in long term care.

Method: A mixed methods, design was ethically approved and employed.  Participants were recruited from three long term care settings before random allocation.  The Control Group continued to use their existing seating while the intervention group was provided with seating tailored to their individual needs following a thorough assessment.  Participants were observed for pressure care, saturated oxygen levels, posture, function and comfort.

Results & Discussion: The significant results proved that no participant in the Intervention Group presented any red skin areas whilst using Seating Matters specialised seating, resulting in an 88.3% reduction in pressure injuries.  In the Control Group, there was a 5% increase in pressure injuries whilst using their existing seating and those with redness noted at the beginning of the trial remained following the 12 week trial period.  Other notable results revealed that oxygen saturation levels increased by 95%, as well as increased functionality and a reduction in sliding or falling from the chair.

Conclusion: This research demonstrates that prescribed seating can contribute to a reduction in pressure injury incidence for patients in long term care. It highlights that the needs of each patient are different, requiring individualised evaluation of seating needs before making recommendations for an appropriate seating system. This research has attempted to address an area which is often overlooked, providing evidence based daytime pressure management through therapeutic seating to compliment therapeutic surfaces at night

Biography:

Michele (Shelly) Burdette-Taylor has completed her PhD at the University of San Diego in California. She is an assistant professor at the University of Alaska Anchorage. She teaches undergraduate and graduate courses in community health, foot care and wound care for the college of health, school of nursing and physician assistant program. She has published numerous skin, wound, pressure ulcer and foot care articles. Her most recent publication was a chapter for the new Wound Ostomy Continence Nurses Core Curriculum for Wound Care for entitled Foot and Nail Care

Abstract:

Evidence suggests that foot and nail care is the most effective intervention for prevention of wounds and lower extremity amputations most often related to lower extremity arterial and neuropathic disease.  Content in this workshop includes hands on lower extremity skill competency for assessment, intervention, evaluation, follow-up and referral.  A review of comprehensive lower extremity assessment will include loss of protective sensation, poor or lack of blood flow, musculoskeletal deformities and dermatologic conditions.  Opportunity will be given to conduct foot and nail care to include skin care, debridement of nails, appropriate compression therapy and off-loading. The participants will work in teams to conduct hygiene, assessment and intervention.  In conclusion of this workshop a brief discussion will be conducted on necessary follow-up based on assessment data, intervention and referrals needed and appropriate education utilizing adult learning principles

Biography:

Jasmina Begic finished postgraduate study at the Sarajevo University Medical School of Medicine. She is the Medical Consultant for BIOPTRON, Zepter International for Bosnia and Herzegovina, Founder of the Association for Wound management in B&H, Founder and author of Euro-Asian Forum, one of founder of Balkan Wound Management Association. She is member of EWMA Cooperating Organisations Board

Abstract:

Chronic Wounds different etiology are important medical problems and major cause of morbidity in the population. Studies have shown that 5%-8% of the world population suffers from venous disease Etiology of ulcers: 72% venous, 14% venous/arterial, 8% arterial, 6% other. Main etiological factors are venous stasis, tissue hypoxia and blockade of fibrin. Normal blood circulation is very important for not only the strong body, but also the vigorous spirit. Disharmony of blood and Qi resulting in various diseases. Six million days of work lost in the United States because of complications of chronic venous insufficiency in European countries, the treatment cost of venous ulcers has been estimated to range from 1% to 2% of annual health care budget. Modern light therapy includes visible light & part of the infra-red  region which contains a range of wavelengths (480-3400nm) therapy and produces  a biological response PHOTOBIOSTIMULATION. Incident on the skin surface exerts a stimulatory effects on metabolism, circulation, cell regeneration and cell function                             

How does it work?

1.Causes dilatation of blood vessels in the area treated

2. Increased delivery of oxygen

3.Improved local blood flow

4.Increased delivery of nutrients

5.Increased microcirculation and biostimulation

6. Promotion of healing

Increased protein synthesis .

7. Patients didn't have pain.

8. .Faster healing of ulcers

  What is coast benefit ?

1. Complete the heal up.

2. Less infection, eradications in some  case of MRSA

3.Reduce infection, time of hospitalization and length antibiotic therapy

4.Improve Quality of life important, like supplementary or monotherapy in cases that      were resistant to the other therapy and natural noninvasive therapy

5.Lead to healing in cases which were supposed to be treated surgically

6. Holistic effect.

Biography:

Ludwik Fedorko has obtained his Doctoral Degree from Oxford University (UK) in 1983. He then has continued his research at the Hospital for Sick Children (Toronto, Canada) and as a Staff Scientist at the Samuel Lunenfeld Research Institute at the Mt Sinai Hospital (Toronto, Canada). He obtained his Royal College Fellowship certificate in Anesthesiology in 1995.  He continues to practice as Anesthesiologist, Intensive Care and Hyperbaric Medicine attending physician at the Toronto General Hospital of the University Health Network in Toronto. He holds the Associate Professor appointment at the Faculty of Medicine of the University of Toronto

Abstract:

Hyperbaric Oxygen (HBO) has been increasing in popularity as an adjuvant treatment for difficult to heal diabetic wounds. Critical review of literature as well as results of our own work challenge the notion that this is the effective and efficatious treatment modality. A brief review of that evidence will be presented. The most recent clinical guidelines supporting HBO use for diabetic wound are often based on expert opinions and poorly controlled studies with significant biases. A recent, very large dataset retrospective review of prospectively collected multicenter data, with propensity matching methodology, failed to find benefits of HBO for any group of diabetic patientsn with difficult to heal wounds. Similarly, our own prospective double blind, placebo controlled study have failed to show benefit of HBO in any of measured wound healing outcomes, when comprehensive wound care was applied equally in sham and HBO group. HBO is a very time consuming and cost intensive modality requiring daily sessions for six to eight weeks. There are other treatment modalities which were  demonstrated to be effective in a properly controlled clinical studies, at lower costs or/and  patient time involvement. HBO by its very nature and cost may possibly prohibit some patients from obtaining access to several more effective and immediate treatments. We will discuss the rational path to successful healing of difficult diabetic wounds based on the most current scientific evidence

Biography:

Hamilton completed his PhD in Cellular Engineering at the University of Glasgow in 2000. He worked as a Research Scientist with Advanced Medical Solutions PLC., in England, followed by postdoctoral studies at the McGowan Institute for Regenerative Medicine, University of Pittsburgh and at the University of British Columbia, Vancouver. He established his independent laboratory at the University of Western Ontario in 2007, which is focused on biomaterials and connective tissue repair. He has published 39 original research articles and serves as an editorial board member for the Journal of Cell Communication & Signaling and The Journal of Cytology & Histology

Abstract:

Non-healing skin wounds are a major clinical complication associated with aging, diabetes and immobility. Current estimates place the cost of treating these wounds at 2% - 3% of the annual healthcare budgets in developed countries. Many treatments have low clinical efficacy are unpredictable,  all too often resulting in limb amputation. Proper wound management from a clinical perspective involves debridement of the damaged tissue,  as well as prevention of infection. However  to induce healing of the wound, mesenchymal cell recruitment (dermal fibroblasts and perivascular cells) and restoration of blood flow to the wound bed must be achieved. While fibrin and fibronectin normally provide structure to the wound bed during healing, matricellular proteins represent another class of ECM proteins normally upregulated in granulation tissue that modulate the adhesion,  migration, proliferation and differentiation of immune cells, perivascular cells, dermal fibroblasts and keratinocytes. As will be demonstrated, based on their described function, the expected pattern of matricellular protein expression within and surrounding chronic skin wounds is highly abnormal which could be  partially attributable to the combined presence of tumour necrosis factor alpha and transforming growth factor beta. The loss of expression of matricellular proteins including periostin and connective tissue growth factor (CCN2) appears to have significant functional implications for wound healing, as will be discussed. Finally, based on our analysis of human tissue the development of a granulation tissue mimetic scaffold containing periostin and CCN2 will be highlighted, which appears to “force” wounds into the proliferative phase of healing

Biography:

Lauren Flynn completed her Ph.D at the University of Toronto and subsequently started as an Assistant Professor at Queen’s University in 2007 before being recruited to a joint Associate Professorship in Engineering and Medicine at Western in 2014. Dr. Flynn’s research expertise focuses on cell-based regenerative therapies with Adipose-derived Stem/stromal Cells (ASCs) and bioscaffolds derived from the ExtraCellular Matrix (ECM) for applications in soft tissue regeneration and wound healing. In 2013, she co-founded a startup company (Adipologix Inc.) that is focused on the development of her decellularized adipose tissue (DAT) technology for use in plastic and reconstructive surgery.

Abstract:

Over the past 7 years, research in the Flynn lab has been focused on the rational design of novel tissue-derived bioscaffolds for applications in tissue regeneration of the integumentary system. More specifically, our group has pioneered the development of Decellularized Adipose Tissue (DAT) derived from human fat discarded as surgical waste as a platform scaffolding technology for soft tissue regeneration. Adipose tissue represents an abundant and accessible source of both bioactive ExtraCellular Matrix (ECM) components and pro-regenerative cell populations for use in advanced wound healing strategies. Our results have been extremely promising, indicating that the DAT is biocompatible, stimulates angiogenesis and is readily remodeled by infiltrating host cells to promote the regeneration of host soft tissues. Building the DAT as a platform technology, we have subsequently developed methods for fabricating an array of DAT bioscaffold formats including DAT microcarriers and 3-D porous foams, with properties tuned for a range of applications in cell delivery and wound healing. Using these engineered 3-D microenvironments, we have made important progress in understanding cell-cell and cell-ECM interactions in the context of soft tissue regeneration. Our most recent findings further support that DAT scaffolds provide a conducive microenvironment for in vivo soft tissue regeneration and demonstrate that seeding the scaffolds with allogeneic ASCs can help to orchestrate this response by promoting the recruitment of beneficial host cell populations that directly contribute to the formation of healthy host-derived soft tissues

Biography:

Anuradha Godavarty received a Ph.D. in chemical engineering from Texas A&M University, Texas and worked as a Post-Doctoral Associate in the Department of Computer Science, University of Vermont, Burlington.  She started as an Assistant Professor in the Department of Biomedical Engineering at Florida International University, Miami, Florida since 2004.   Currently, she is a tenured Associate Professor in the Department of Biomedical Engineering at Florida International University.  Her research interests are in developing near infrared optical imaging technologies and applying them for breast cancer imaging, functional brain mapping and wound care monitoring

Abstract:

Of the nearly 246 million people diagnosed with diabetes worldwide, an estimated 15% of all patients suffering with diabetes will develop Diabetic Foot Ulcers (DFUs).  About half of these DFUs will become infected resulting in 20% of patients left to face some form of a lower extremity amputation.  To date, clinicians employ visual inspection of the wound site during its standard 4-week of healing process via monitoring of surface granulation.  In many cases, surface granulation is not an implication of internal healing.  There is a need to develop on-site, low-cost imaging tools that can objectively classify healing from non-healing wounds.  Herein, a portable, low-cost, non-invasive, and non-contact based Near-Infrared Optical Scanner (NIROS) was implemented to optical differentiate healing from non-healing Diabetic Foot Ulcers (DFUs).  Non-contact, non-radiative real-time imaging was performed on diabetic subjects with foot/leg ulcers. The near-infrared optical images acquired from the foot were processed to obtain optical contrast ratio between the wound and its background under various conditions of imaging location, selection of wound and background regions and analysis by different researchers (to remove operator variability).  Statistical analysis was carried out to determine the accuracy of the imaging approach to classify healing from non-healing wounds.  Preliminary analysis from diabetic foot ulcers showed an accuracy  >90% in differentiating a wound as healing or non-healing.  The optical classification was based on the differences in the optical contrast between the wound and its peripheries.  Currently, work is carried out to classify wounds based on hemodynamic changes

Biography:

Sowmia Thomas is the orthopaedic clinical nurse specialist at Auckland Hospital, New Zealand. She has completed her Post Graduate studies from University of Auckland and Bachelor of Nursing from Manipal University, India. Her primary role is complex wound care for trauma and also sarcoma surveillance

Abstract:

A 53 year old,  severe spina bifida client was unable to complete a below knee amputation at Auckland hospital in 2015.

The patient was admitted to a critical care unit  with septic shock secondary to bilateral lower limb ulcers, infected with Methycillin Resistant Staphylococcus Aureus (MRSA) and Pseudomonas. Lower limb amputation was the obvious choice of treatment and this was discussed very cautiously with patient and family. The prospect of amputation was calmly but adamantly denied by the patient for over a month, despite extensive discussions with the intensive care specialists, orthopaedic surgeons and family. Multiple cardiac and respiratory arrests while in the critical care unit and lack of consent to proceed with further treatment, prompted a palliative care approach and the patient was moved to the wards.  Surprisingly, the palliative patient decided to undergo the amputation. However, the patient had another cardiac arrest on the operating table and so the leg was amputated, but the wound was unable to be closed.

What made the patient change his decision? Many health professionals encounter stages of grief like shock, denial, anger until the patient consents for an amputation. What did the health professionals miss while they were looking at this patient? What did the patient observe of the hospital system while undergoing complex wound care?  The video also looks at a novel way of closing an amputation wound without any suturing and provides a learning point that even a neolithic procedure like amputation can be ever evolving, in terms of its approach towards the wound and the amputee.

Biography:

Michele Burdette-Taylor has completed her PhD at the University of San Diego in California. She is an assistant professor at the University of Alaska Anchorage. She teaches undergraduate and graduate courses in community health, foot care and wound care for the college of health, school of nursing and physician assistant program. She has published numerous skin, wound, pressure ulcer and foot care articles. Her most recent publication was a chapter for the new Wound Ostomy Continence Nurses Core Curriculum for Wound Care for entitled Foot and Nail Care

Abstract:

The aim of this initiative is to prepare and mobilize certified foot and nail care nurses to lead research, education and facilitate intervention in an effort to reduce the number of injuries of the lower extremity that lead to amputation/s, morbidity and mortality.  Approximately 45-60% of foot ulcers are related to Loss Of Protective Sensation (LOPS) with another 45% having combined LOPS and Lower Extremity Arterial Disease (LEAD) of people with diabetes.  Approximately 50-80% of all non-traumatic amputations are diabetes-related complications.  The presence of a foot wound is the number one reason for readmission into the hospital for people with diabetes.

Board certified foot care nurses are specialized in hygiene, assessment, intervention to include skin & nail care, education, and referral.  The newly-enacted Medicare programs focus on preventative care and encourage certified foot and nail care nurses’ opportunity to assume a key role in reducing the cost impact of care for people with diabetes, arthritis and Lower Extremity Arterial Disease (LEAD).  A focus on foot care leads to an increase in referrals for therapeutic shoes, use of over-the-counter compression socks and access to care for the older population having difficulty with mobility, sight, and/or cognitive ability. 

Focusing on the feet allows for a comprehensive foot exam annually to establish risk and a determination of frequency thereafter. On-going education is also preventative.  Foot care nurses provide care on a structured schedule and have opportunities to be proactive in prevention with interventions, observations, education and referrals. The importance of repeated and on-going education of patients with potential complications and to remind them to inspect their feet daily ensures that at the first sign of an injury (no matter how minor) it is reported before the injury becomes serious and expensive

Biography:

Mieczyslawa Franczyk has completed her master’s degree in PT and post graduated study for PhD from the University of Physical Education in Poland. She graduated from the University of Illinois Public School of Health. She is a member of the American Physical Therapy Association. She is author or co-author 8 papers, 7 in the arena of subatmospheric pressure wound therapy

Abstract:

The efficacy of Negative Pressure Wound Therapy (NPWT) leading to reduction in wound volume and promotion of wound healing has been well documented in literature (C. Huang et al Current problems in Surgery 51 (2014) 301-331). Negative Pressure Wound Therapy (NPWT) or Sup-Atmospheric Wound Therapy (SAWT) is a term that refers to any devices that applies differential suction to wounds. A number of commercially available devices exist within this definition. Few of the challenges with commercialized equipment used for NPWT are the overall cost and ideal applications in the wound can be very challenging and painful. From a health care providers' standpoint, our obvious interest is to come up with more cost effective, less painful and easy to apply wound closure dressing. In our hospital burn wound and other complex wound care is provided by a physical therapist for last 40 years. NPWT dressing as a new modality for wound management was introduced in 1999. Throughout my 15 years working with NPWT dressing I was confronted with a lot of critically ill patients (more than 300 patients a year) with complex wounds under NPWT dressing. I’ll share the success and more importantly challenges we have had with the application of NPWT dressing over:

-Sternal wounds:  as a temporary wound closure in OR. For an infected Sternal wound (with or without open sternum).

-Open abdominal wound with exposed intestine (with or without fascia closure by mesh)

-Open wounds with fistulae

-Wounds over vascular graft

-Skin grafts over different body parts

Biography:

Anuradha Godavarty received a Ph.D. in chemical engineering from Texas A&M University, Texas and worked as a Post-Doctoral Associate in the Department of Computer Science, University of Vermont, Burlington.  She started as an Assistant Professor in the Department of Biomedical Engineering at Florida International University, Miami, Florida since 2004.   Currently, she is a tenured Associate Professor in the Department of Biomedical Engineering at Florida International University.  Her research interests are in developing near infrared optical imaging technologies and applying them for breast cancer imaging, functional brain mapping and wound care monitoring

Abstract:

Lower extremity ulcers are one of the most common complications in diabetes patients. Clinical studies have shown that reduction in wound size of < 40% within 4 weeks is an acceptable progress of the healing process. To date, visual inspection is usually adopted to monitor the wound healing process and wound size is measured from the surface of the images. A Near-InfraRed (NIR) optical imaging approach has been developed to internally inspect the wound by non-contact imaging to differentiate the healing of the non-healing wounds. Herein, an automated image segmentation method was used for the first time to quantitatively measure the wound size from NIR and white light images.  NIR wound segmentation was carried out on multiple venous leg ulcers and diabetic foot ulcers (FIU-IRB approved study).  Upon applying graph cuts segmentation algorithm, the wound shape demarcated from NIR images closely matches the white light images (but not completely). This revealed that the NIR images are possibly providing tissue oxygenation information from the internal of the wound and not the surface of the wound. Our ongoing efforts are to co-register the white light and NIR images for comparison of the wound demarcated regions and quantification of the wound area

Biography:

Natesan  graduated from Central Leather Research Institute, Chennai, India, with the specialization in cell and biomaterials core. He began his professional career as post doctoral research associate at the Department of  Extremity Trauma Research and Regenerative Medicine, US Army Institute of Surgical Research, Fort Sam Houston, Texas, US, in the year 2007. He has been actively involved in the stem cell based skin regeneration research. In June 2011 he became a Staff Scientist and presently he is a Research Scientist in the Department of  Combat Trauma and Burn Injury Research, continueing his research in developing technologies for treating combat burn injuries.

Abstract:

Burns are a significant problem in combat casualty care. Since 2003, the USAISR burn center has cared for more than 992 military burn casualties and 4500 civilian burn victims. According to the American Burn Association (ABA), approximately 45,000 have burn injuries requiring medical treatment with about 3,500 cases resulting in death. Despite biomaterialadvancements, the treatment of burn injuries by autologous skin graft remains largely the preferred standard-of-care. The major rate limiting step in treating these burn wounds is the regeneration of functional skin layers to avoid further complications and multiple revision surgeries. Some of the currently available artificial skin substitutes try to address this problem, unfortunately, they are less successful in large  burn wounds. To address these shortcomings we are investigating the therapeutic benefits of adipose derived mesenchymal stem cells, acellular extracellular matrices and hydrogel based regenerative technolgies to address the clinical shortcomings of current skin substitutes. We envision adipose derived stem cell based tissue engineered skin equivalents will provide beneficial effects to treat severe burn wounds and improve patient outcomes

Biography:

Abhishek Tiwari  has been Graduated from SS Medical College of Rewa, India as Medical Doctor, with the specialties Internal Medicine, PSM, Orthopaedics and ENT. Later on he obtained his post-graduation from KMC Mangalore with subject Gen Surgery including Minimal Access/Robotic Surgery and special interest in wound care and then started working at The Indraprastha Apollo Hospital , New Delhi, where he has continued his research. Presently he is working at the at the New Delhi City

Abstract:

Complex perianal injuries are devastating for patients suffering from them either due to Retropharyngeal Abscess (RTA) or Abscess. Long duration of hospital stay huge cost of management long term antibiotics and analgesics, patient and attendant loss of working days. In short high  morbidity and mortality rate in these injuries by conservative management calls for innovation to improve factors discussed above. We managed 6 cases with perianal injuries by diversion stoma and vac dressing along with innovations with advance dressing which otherwise would have taken months to heal or may have scumbed to injuries. Updates and advancement are important aspects of the surgical field and still wound care treated as an orphan son with lesser attention, but it is a morbidity for patient suffering  more than any other surgical condition or emergency. Innovations in wound care are need of time and require advancement for better patient care for example in this case perianal injuries

Biography:

Vijay Langer completed his medical schooling and postdoctoral studies from the prestigious Armed Forces Medical college, Pune, India. He was further a clinical Fellow in Body Contouring following massive weight loss at Iowa City, USA, in 2009. Awarded the Gold Medal in Plastic Surgery by the National Board of Examinations, he is presently Professor and posted to Army Hospital (Research and Referral), New Delhi, which is the largest hospital of the Indian Armed Forces. He has 57 publications including 22 PubMed indexed articles, one chapter in a book, 29 podium presentations in conferences, and is a member of the editorial board of four journals

Abstract:

Limb trauma is a global health concern and indeed is fairly commonly tackled by the military surgeon. While some patients have associated life threatening injuries, a lot of them have isolated but usually complex soft tissue defects. Decision making for managing these patients often requires the aggressive plastic surgeon to step in. From appropriate debridement to arduous but gratifying reconstruction can be planned right at reception of the patient. We in the Indian Armed Forces have taken the initiative to mitigate the suffering of the combatant by this technique and present our 3-year experience of management of such injuries at a large tertiary referral trauma center. 942 consecutive patients with major limb trauma were included in the study. At reception, life saving measures were instituted first followed by limb saving action. Wounds were prepared by debridement during which devitalized tissue was excised.  Immobilisation of possible fractures was then done. If there was no exposure of bone, the wounds were resurfaced with autogenous split thickness skin grafts. If bone was exposed, flaps were raised and inset into the defects. If at debridement, it was thought that a second-look was required, then the definitive coverage of the wound was effected then. Lives and limbs were both saved with such timely intervention.

It is indeed a tough challenge to treat patients with major limb trauma. If the patient presents early, the services of the aggressive plastic surgeon are paramount in markedly reducing mortality and significant morbidity in the wounded soldier and the members of his family

Biography:

Andina Setyawati has completed his Nursing Master at the age of 26 years from Indonesia University School of Nursing. She is the lecture of medical surgical nursing and wound care clinician. She has published 5 papers in reputed journals and has been serving as an editorial board member of repute

Abstract:

Diabetic ulcer is a main health problem, which was found in 15% of 200 million Diabetes Mellitus patients waorldwide and will increase 2.5% annually. Ulcer can become infection’s port of entry, disrupt peripher blood flow progressively and can cause delayed healing.  Hence, it needs innovation on each phase of wound healing, including herbal medicine such as Psidium Guajava Lynn. This study aims to determine the effect of Psidium Guajava Lynn on MMP-9 and TIMP-1 ratio of patients with Diabetic ulcer. This was a quasy experiment study with pre and post-test design with controlled group. Subjects were accidentaly selected in this study. MMP-9 and TIMP-1 was evaluated on first visit and baseline laboratories were taken by Enzyme-Linked Immunosorbent Assay (ELISA). Each subject in the group of intervention took Psydium Guajava Lynn to wash the ulcer each three days. After 10 times, repeat laboratory examinations were taken. No adverse were reported during the trial. The data were analyzed using paired T-test with significance level of  a≤ 0.05. This study found a significant on decreasing ratio on intervention group and increasing ratio on control group (p=0,000). This study found significant different of Psidium Guajava Lynn on changing the ratio of MMP-9 and TIMP-1 (p=0,035). This study concludes that Psidium Guajava Lynn could decrease MMP-9 and TIMP-1 ratio for diabetic ulcer patients

Biography:

Sudha P is an Associate Professor in Anesthesiology at Regional Cancer Centre, Trivandrum, Kerala, India. She has Post-graduate degree (MD) and Diploma in Anesthesiology (DA), Post-graduate Diploma in Health and Hospital Administration (PGDHHA) and degree of Master of Hospital Administration (MHA) from the University of Kerala, India. Her areas of professional interests are pain management, regional anesthesia, nerve blocks and hospital management. She was awarded UICC: ICRETT Fellowship thrice for doing projects in MD Anderson Cancer Centre, Houston, Texas, Memorial Sloan Kettering Cancer Centre, New York and TJ Samson Community Hospital, Glasgow, Kentucky. She has publications in reputed Indian and international journals

Abstract:

Background: Numerous factors affect the risk of recurrence and metastasis after cancer surgery. Studies have observed that anesthetic techniques have effects on tumor recurrence.

Methods: Medical records of newly diagnosed ovarian serous adenocarcinoma patients who underwent radical hysterectomy with bilateral salpingo-opherectomy from 1995-2008 were analyzed for the effect of anesthetic techniques and drugs on tumor recurrence & metastasis free survival rate and mortality rate. Univariate association between overall survival and anesthesia technique was assessed using Kaplan-Meier survival estimates and Cox regression. Multivariate association was tested after adjusting potential confounding factors.

Results: The overall survival rate (RR at 95% CI=3.16 (1.79-5.60)) was significantly better in patients who received regional anesthesia for surgery than those who had general anesthesia. Other factors significantly associated with overall survival rate in univariable analysis were, perioperative blood transfusion, preoperative Ca 125 level, FIGO stage, tumor size and lymphatic metastasis. Kaplan Meier survival curve showed that regional anesthesia group had higher overall survival rate. Recurrence rate did not show significant difference in univariable (Odds 95% CI 1.42 P=0.273) and multivariable (Odds 95% CI=0 P=0.846) analysis. Al1 the 18 patients who had metastasis underwent surgery under GA.

Conclusions: This study showed marked increase in overall survival rate in patients who underwent surgery under regional anesthesia when compared to those who had surgery under general anesthesia. Prospective randomized control trials are needed for better evaluation.

Biography:

Alex Bekker is Professor and Chairman of Anesthesiology at Rutgers New Jersey Medical School. He obtained his Doctoral Degree in Engineering from the New Jersey Institute of Technology and received his Medical Degree from the Rutgers – New Jersey Medical School. He completed his Anesthesia training at Columbia Presbyterian Medical Center in New York. He has joined the Department of Anesthesiology at the NYU Medical Center in 1995 and was appointed a Vice-Chair for Research in 2005. He is internationally recognized expert in neuroanesthesia and is frequently invited to speak at Grand Rounds and Scientific Panels. He has been active in research for many years. He is an author of 65 peer reviewed publications, 6 US patents, 33 educational reviews and more than 100 abstracts. His work has focused on perioperative brain protection, neuroinflammation, postoperative pain control and clinical pharmacology. He was a PI of numerous clinical trials, including studies sponsored by the National Institute of Aging. He serves on the Editorial Board of the Journal of Neurosurgical Anesthesiology and is ad hoc reviewer for 15 peer-reviewed journals, including NEJM, Anesthesiology, Neurosurgery, PLoS One, and Anesthesia and Analgesia

Abstract:

After attending this presentation, the participants will be able to discuss the incidence, etiology, mechanisms and diagnosis of perioperative stroke; understand preventive strategies which may reduce occurrence of perioperative stroke and identify treatment strategies that are available during perioperative period. Perioperative stroke is defined as an episode of focal or global loss of cerebral function with symptoms lasting more than 24 hours. General surgical procedures are associated with a 0.08-0.7% risk of stroke. Potential stroke etiology includes hypoperfusion, thromboembolism and hemorrhage. The preoperative patient related risk factors for perioperative stroke are: Advanced age, previous cerebrovascular diseases, peripheral vascular disease, chronic obstructive pulmonary disease (COPD), atrial fibrillation, hypertension, cardiac valvular disease, diabetes mellitus, HTN, atherosclerosis, and renal disease. General anesthesia, dehydration, bed rest, stasis in the postoperative period, and perioperative withholding of antiplatelet or anticoagulation agents can aggravate surgery-induced hypercoagulability and increase the risk of perioperative thrombogenic events. Elective surgery should be delayed for at least 1 month after a documented ischemic stroke. Another consideration in the preoperative period is patients who require chronic anticoagulation. Bridging oral anticoagulant therapy (warfarin) with heparin or low molecular weight heparin should be considered for the majority of patients who require temporary interruption of warfarin therapy. Postoperative risk factors for a stroke include heart failure, myocardial infarction, arrhythmias (atrial fibrillation), dehydration (blood loss) and hyperglycemia. Preoperative administration of statins, ASA, a continuation of anticoagulation therapy (when indicated), as well as appropriate timing of surgery do appear to reduce the incidence of stroke after CABG and vascular surgery and may show similar results in the general surgery population as well