2^nd International Conference and Exhibition on Dual Diagnosis May 18-19, 2017 Munich, Germany

Chan Kam Tim Michael is a Dermatologist in private practice, Hong Kong. He received his fellowship from the Hong Kong Academy of Medicine (FHKAM). He has done his Post-doctoral training from the University of California, Los Angeles (UCLA) in 1997. He is now the Vice President of the Association of Integrative Aesthetic Medicine (AIAM) in Hong Kong. He was the Editor of Hong Kong Journal of Dermatology and Venereology from 2002 to 2007. He was an Assistant Professor in the Faculty of Medicine, University of Hong Kong from July 2007 to June 2009.

Western medicine (WM) treats acute symptoms effectively. TCM has a time-honored record of relieving patients suffering from symptoms unresponsive to WM. Traditional Chinese medicine (TCM) also helps avoiding the use of immunosuppressants and antibiotics. An expert panel as a focus group on eczema comprises Chinese medicine practitioners (CMP) and Western medicine specialists (WMS) working based on an opinion sharing model under the established integrative joint organizational platform (IJOP). It is a program under the Hong Kong Association for Integration of Chinese-Western Medicine (HKAIM), funded by the Innovation and Technology Commission (ITC). The aim is to provide a management framework assisting CMP–WMS collaboration. The diseaseoriented study under IJOP has chosen eczema, asthma, post stroke management, colon and breast cancer, and inflammatory bowel disease (IBD) for the study. These are disease amenable to collaborative practice where lacking either WM or CM is less effective. Toxicologists, University Academics, CMP and WMS could communicate through IJOP for collaboration and to layout examples in eczema collaboration. The study will propose principles, criteria and evaluation for co-consultation borrowing experience from the Chinese University of Hong Kong (CUHK). Sharing on how to develop CM-WM collaboration was fruitful. CM research and development through systematic review of old Chinese literatures, use of Big Data from text mining, and opinions from experienced CMP would be collected through the focus groups for sources of Chinese medicine evidence. Methods should be addressed to build a path for patient effectiveness with reduction of dosing in Chinese and Western medicine in managing diseases. Risk of herb-drug interaction must be documented. Other directives are: to resolve the issues of CMP and WMS using a communicable medical language in describing symptoms; and pairing up of CMP and WMS for patient referral. Position papers were published; furthermore, messaging groups were set up for rapid communication..

Sonila Bitri Tivari has completed her studies from the University of Medicine, Albania 2004 and Specialization in Clinical Toxicology and Addiction in 2010. Currently, she works as a Clinical Toxicologist at the American Hospital, Tirana, Albania. Her field of interest is Drug Addiction (opioid, alcohol, etc.) and has given several trainings in this field. She has taken part in several international conferences in this field like: Global Addiction Congress, UNDP

Background: Alcohol addiction is a chronic and relapsing disease that has affected many patients throughout the world. As alcohol interferes in brain neurotransmitters, it can cause mood and behavior changes. Aim: Through this study we wanted to examine the prevalence of comorbidity between alcohol dependence and psychiatric disorders in patients hospitalized for alcohol detoxification. Method: In our study, we included 92 male patients (mean age 41.4 years old), hospitalized in American Hospital, Tirana, Albania, June 2015-October 2016, with the diagnosis of alcohol use disorders (AUD), DSM-5. The patients with known and treated psychiatric comorbidities were excluded from the study. Any female patient was presented to our service with the diagnosis of AUD was also included. We analyzed the prevalence of psychiatric disorders in these patients. Result: After the psychiatric evaluation, we found comorbidity in 39% of the patients. 51% of patients with comorbidity were unemployed. About 31% of patients with comorbidity referred that they have found alcohol consumption as a “self-treatment” for their anxiety. Discussion: Alcohol addiction and concomitant psychiatric disorders are found very often between our patients. The psychological evaluation and the appropriate treatment is crucial leading to a better health outcome, a lower risk of alcohol relapse and happier patients.

Sonila Bitri Tivari has completed her studies from the University of Medicine, Albania 2004 and Specialization in Clinical Toxicology and Addiction in 2010. Currently, she works as a Clinical Toxicologist at the American Hospital, Tirana, Albania. Her field of interest is Drug Addiction (opioid, alcohol, etc.) and has given several trainings in this field. She has taken part in several international conferences in this field like: Global Addiction Congress, UNDP

Drug abuse and especially opioid abuse, represents a whole of physical and psychosocial issues. But, when it is complicated with cancer diseases, it becomes a challenge for the addiction team and the oncologist. One of the main treatments for cancer pain is opioid therapy. These substances can be prone of abuse and can develop tolerance or physical dependence. But while treating cancer pain in a chronic heroin abuser by methadone maintenance treatment (MMT), the challenge is much more difficult. Hence, through this work we want to share our experience in the treatment of a patient diagnosed with pancreatic cancer with obstructive infiltration of colon, hospitalized at the American Hospital, Tirana, Albania in 2015, for palliative surgery. The patient considered for the study was 35 years old, had a history of heroin abuse via inhalatory route. Age at first abuse was 21 years old, and from that age till present, the patient had several episodes of opioid abstinence and relapses. About 14 months prior to admission in our hospital, he started opioid-substitution treatment with methadone 40 mg/day. The challenge of the treatment team was in finding the best pain treatment, the appropriate dosage for pain relieving, but with lower side effects. In front of such complicated patient, the best treatment is a multidisciplinary approach, a careful follow up, and high comprehension

Orwa Aboud is currently a Resident Physician and Senior Research Investigator at the Departments of Neurology and Geriatrics/Donald W Reynolds Institute on Aging (RIOA), University of Arkansas for Medical Sciences (UAMS). He has made several novel and unique discoveries in the research areas of neurodegeneration and neuroinflammation, particularly on Alzheimer’s disease. He has been playing a key role in the significant research projects including those supported by the National Institutes of Health (NIH) and National Institute on Aging (NIA) on the studies on influences of APOE genotype on cellular and molecular responses in epilepsy and Alzheimer pathology in Olfactory bulb; early events in Alzheimer pathogenesis; and development of a functional screening assay for the leading Alzheimer Disease (AD). His achievements have been extensively shared and recognized throughout the cutting-edge research field of neuroscience.

Objective: The objective is to describe a case presenting with an atypical complication of deep brain stimulator lead infection. Background: Deep Brain Stimulation (DBS) is the most frequent neurosurgical procedure for movement disorders. While this elective procedure carries a low risk profile, it can cause complications such as lead malfunction (5.7%), infection (1.2%), infarct without intracerebral hemorrhage (0.8%), and intracerebral hemorrhage (2.5%) and a permanent deficit (0.2%). Design & Results: A 47-year-old right-handed man with a history of dystonia was treated with DBS placement in July 2015. He presented three months later with a one-week history of headache, mild confusion, and right facial asymmetry. Computerized Tomography (CT) of the head showed a large area of hypoattenuation along the left intracranial lead with midline shift, suggestive of an infectious process. Magnetic Resonance Imaging (MRI) with and without gadolinium contrast showed an area of hypointensity surrounding the left lead without contrast enhancement. Cerebrospinal Fluid (CSF) studies showed three white blood cells with lymphocytic predominance; CSF glucose was 54 mg/dl; protein was 25 mg/dl; and CSF cultures along with blood cultures were negative. Patient’s symptoms improved on intravenous board spectrum antibiotics, and surgical intervention was postponed due to the patient’s clinical improvement. Conclusion: The clinical response of this patient to antibiotic treatment in a case of atypical presentation of deep brain stimulator lead infection without contrast enhancement suggests that early recognition and treatment may obviate the need for more aggressive intervention, i.e., surgical removal of the lead.

Jae-Hyun Cho was Graduated from Department of Korean Medicine, Wonkwang University, South Korea and received degree of K.M.D in 2014. In 2015, he Completed internship in Pusan National University Korean medicine Hospital and in 2017 he Completed his master’s degree in Korean medicine. During 2015- 2017 he received residency training specialization in Korean Internal medicine (cardiology and neurology) in Pusan National University Korean medicine Hospital

Statement of the Problem: Mild cognitive impairment is becoming more common in elderly population. The population aged 85 or older has significant cognitive impairment in 25%. There are many diseases that occur along with cognitive impairment, for example Alzheimer’s disease, dementia and cognitive function, which are affected by various causes. Progressive memory loss indicates mild cognitive impairment and more than half of patients develop dementia within 5 years. But we cannot detect the disease before it produces evident functional defect like memory loss. So we investigate the relation between general laboratory test and Rey-Kim memory test. Commonly, Mini-Mental State Examination (MMES) is used to test cognitive function. But, in this study, we used Rey-Kim memory test, the first adapted and standardized memory test in Korea, because, it is more suitable tool than MMSE to test normal people. Methodology & Theoretical Orientation: Participants were checked for laboratory tests and memory function test. We checked for laboratory tests such as CBC, LRFT, lipid profile, GGT, CK, electrolyte, free fatty acid (FFA), insulin, glucose, HBsAg/Ab, anti-HCV and urinary test. And we used “Rey-Kim Memory Test” to estimate memory function. It consists of two subtests, K-AVLT (K-Auditory Verbal learning Test) and K-CFT (K-Complex Figure Test). There are 5 indices of ‘Learning Curve (LC)’, ‘Memory Retention (MR)’, ‘Retrieval Efficiency (RE)’, Drawing/Memory consistency (DM) and Memory Quotient (MQ). We conducted correlation analysis between these indices and the result of laboratory tests. Findings: We found that memory function was associated with serum lipid level. Accordingly, higher LDL correlated with lower RE, MR and DM, but not with LC and MQ (Table 1). And TC had negative correlation with RE and MR. (Table 2) No significant correlations were found between HDL, TG, FFA and memory function (all p>0.05). Conclusion & Significance: Our findings suggest that high serum LDL and TC could contribute to lowering in memory function partly. So cholesterol control may be the most important for cognitive health.

Hoda Sadrosadat is a Master’s graduate in Medical Physiology. Her thesis was about spinal cord regeneration with biomaterial approach and she is so much interested in Regenerative Medicine. She is currently working at Royan Institute, Iran

Introduction: Transplantation of neural stem/progenitor cells (NSPCs) and their differentiation potency are promising to preserve or regenerate functional pathways after central nervous system injury. However, reconstruct material that can bridge the injury gap, and regenerating axons remain a challenge in spinal cord injury (SCI). Simple and effective biocompatible materials that mimic the natural extracellular matrix (ECM) have been applied in regenerative medicine and there are loads of previously published data that have been established benefit of these materials for cell growth and differentiation. Injectable biocompatible hydrogels would be desirable in regenerative medicine in order to promote not only cell survival and differentiation, but also the regeneration of descending or ascending nerve fibers. The purpose of this study initially is to increase viability of transplanted cells in injured site in order to efficiently support and guide axonal regeneration, secondly to reduce glial scar formation and cavity size as well. Methods: Moderate to severe contusive spinal cord injury was performed at T10-T11 level of spinal cord using NYU-impactor (10 g, 25 mm). Rats (Wistar, male, 250-280 g) received daily extensive post-surgery care and were kept for seven weeks. Three transplantation groups contain GFP labeled human embryonic stem cell-derived neural stem cells (hESC-NSC), hESC-NSC cell encapsulated in hyaluronic acid gelatin hydrogel and hydrogel which inject directly to the cavity sub-acute to the injury and control group just receiving needle stress at one week post SCI. For motor function assessment BBB scores were given to each rat hindlimb function from 0 to 21 once a week during the experiment. One week prior to spinal cord injury surgery, rats underwent stereotaxic screws implantation in somatosensory-motor cortex area that allow stimulation and recording of motor and somatosensory evoked potentials (MEPs, SEPs) and control recording is performed. It is then repeated at days 7 after spinal cord injury and also at the end of the experiment. Conclusions: We use human embryonic stem cell-derived neural stem cells with a hyaluronic acid-gelatin hydrogel in rat model of spinal cord injury and our results demonstrate increasing cell survival and also cell differentiation to all three neural fates and regeneration in corticospinal tract as electrophysiology data confirms and BBB scores shows functional recovery compare to control group.

Aniya M. Mirbulatova and Nazym M. Issagulova are the undergraduate students of Semey State Medical University. They are the members of Young Scientists’ Neurology Society. The field of interest is worldwide spread autoimmune inflammatory diseases particularly in the East Kazakhstan region, Semey city based on clinical and paraclinic manifestations. They have common works during last 2 years about Guillain-Barre’s syndrome with scientific supervisor Tatyana V. Kaimak, associated professor of Neurology department in Medical center of Semey State Medical University. These girls have already published 2 articles in the Republic of Kazakhstan and 1 in the Republic of Azerbaijan. Represented research work is important for their further scientific career in the Internship and Master degree

Semey city is located in the former Semipalatinsk nuclear range region. There is increasing of autoimmune diseases last years [Shabdarbayeva D.M. at all, 2016], including acute demyelinating polyneuropathy of Guillain-Barre. The analysis of occurrence, clinical picture and treatment efficiency of Guillain-Barre’s syndrome during 2015-2016 in Semey was carried out. There are 27 patients with verified diagnosis of Guillian-Barre’s syndrome: 17 women from 24 to 66 y.o, whose mean age is 36.1± 12.28 years and 10 men from 26 to 67 y.o. (46.6± 14.01 years). Nowadays in Semey live 340.000 citizens, it means 7.9 cases per 100.000 people. Frequency among women is higher than men (1.7 : 1), both of these groups have had sensitive disorders and muscular weakness in upper and lower extremities till 1-2,5 balls out of the total 5, with deep bulbar syndrome in 15% and increasing paralysis by type Landry in 22%. 27 % of cases had predominance of weakness in extensor muscles. The sifting of treatment showed that 22% patients took gamma-globulins with plasmapheresis, 48% - only gamma-globulins and 8% - merely plasmapheresis. The other 22% of cases received alterative and symptomatic therapy because they had contraindications for the treatment mentioned above. Conclusion:1) there is a high level of Guillian-Barre’s syndrome in Semey region (7.9:100,000); 2) frequency of morbidity among women is higher than men (1.7 : 1); 3) combined therapy by gamma-globulins and plasmapheresis showed the most visible improvement of clinical effect in normalization of forces decreasing bulbar disturbance and level of invalidity

Mina Mohammadkhani is graduated Biochemistry master student from Tehran University. Her passion for brain function and its mechanism made her doing her master thesis in molecular neuroscience lab in Institute of Biochemistry and Biophysics (IBB) and she was involved in investigation on memory formation . She works on the effect of Tetrahydrocannabinol(THC) (the most important psychotic ingredient of cannabis )on memory formation and brain function in mice through behavioral test , in vitro test on Microtubule and morphological study on astrocyte cell line.She is working as teacher’s assistant in neuroscience lab of IBB and cooperating in projects.(from Feb2016 )

Memory disability is one of the well -known effects of cannabis on human behavior. Cannabis and its constituent cannabinoids are known to impair several aspects of cognitive function, with the most robust effect on short term, episodic and working memory in human. There is growing evidence of role of microtubule dynamic in memory formation and learning .dynamic microtubules are shown to be involved in dendritic spine changes and synaptic plasticity. Numerous studies shows that microtubules play important role in neuronal cells like axonal transportation and cell polarity .In order to investigate the effect of THC on memory formation we treated the mice with Δ⁹-tetrahydrocannabinol (THC) the most important ingredient of cannabis, then we studied the behavior of treated animals via T-maze test. To measure the effect of injection on microtubule of brain in closer condition to biological condition of brain, we used polymerization assay for brain extraction soup. We also found the alternation of microtubule polymerization in present of different concentration of THC and through turbidity spectroscopy and fluorescence spectrometry assay. THC also causes changing morphology of astrocyte cells. According to our results, THC impaired memory formation in treated animals and they had poor preformation which is related to microtubule kinetics.

Ayoub Boudiba is a resident in clinical neurophysiology,: have his passion in improving health and Make electrophysiological explorations more precise and simple in order to be easily realizable ; He has worked and is still working on carpal tunnel syndrome CTS, a very common pathology affecting 2% of the population and whose diagnosis is still controversial. This study drew attention to a parameter that is often neglected and which can help enormously diagnosis at a very early stage of pathology and allow a rapid management in order to reduce the pain and avoid the functional repercussions notably on the motricity.

Statement of the Problem: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by compression of the median nerve at the wrist. the diagnosis of carpal tunnel syndrome (CTS) continues to be challenging due to a large number of electrodiagnostic (EDX) tests available; Median–Ulnar Sensory Latency Difference to the Ring finger (ringdiff) is an efficient method for establishing a relative slowing of the median nerve compared with the ulnar across the wrist; The purpose of this study is to show the value of the sensory nerve action potential SNAP amplitude difference between median and ulnar nerves in the ring finger which is another important parameter that is usually neglected. Methods: We conducted retrospective comparative study about electrophysiology findings in 420 suspected carpal tunnel syndrome patients among them 300 definitive diagnosis of CTS was confirmed by 6 different EDX tests (1) and 120 not and a control group of 50 individuals. Results: in 100% of the confirmed CTS patients and in 98% of the other suspected CTS patients the SNAP amplitude of median nerve was decreased by more than 25% compared to the SNAP amplitude of the ulnar nerve in ring finger; thing witch is not observed in control individuals in which the difference was less than 25% or no difference. Discussion: The median nerve fibers to the ring finger may be more subject to compression and their SNAP amplitude is the most decreased comparing to other fingers. Conclusion: median-ulnar SNAP amplitude difference to the ring finger is an important parameter that can allows a great accuracy for confirming the clinical diagnosis in the mild carpal tunnel syndrome at an early stage and allow a rapid management in order to reduce the pain and avoid the functional repercussions notably on the motricity.