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

Karolina Can is a Post-Doctoral Researcher, whose expertise focuses on Rett syndrome and oxidative stress. She performed her PhD at the Georg-August University in Göttingen in Germany, where she now continues running various projects towards mitochondrial dysfunction and potential molecular targets involved in this neurodevelopmental disorder. She strictly extended her proficiency already during her Master’s studies (MSc performed at Jagiellonian University in Krakow in Poland), when she took advantage on annual internship in the Institute of Human Genetics in Göttingen in Germany, and switched her gears from genetics

towards neurophysiology and live-cell imaging.

Statement of the Problem: Rett syndrome (RTT) is a neurodevelopmental disorder, which occurs almost exclusively in girls with a prevalence of 1:10.000-1:15.000 life births. The genetic causes of RTT are de novo mutations in the MECP2 gene. After a short normal development, developmental stagnation occurs with a neuronal and autonomic dysfunction, manifested as mental retardation, erratic breathing, epilepsy, loss of speech and stereotypical hand movements. Growing evidence indicates that RTT associates with mitochondrial dysfunction and oxidative stress. We previously showed that mitochondria of MeCP2-deficient (Mecp2-/y) mouse hippocampus are partly uncoupled and show a higher consumption of O2. To assess molecular events contributing to redox impairment, we intensified our analyses focusing specifically on neurons and their cytosolic and mitochondrial compartments. Methodology & Theoretical Orientation: Quantitative real-time imaging of redox dynamics was performed with the geneticallyencoded redox sensor roGFP1 in cytosol and mitochondrial matrix of dissociated neurons and organotypic hippocampal slices. Optimized expression was achieved by viral transduction. Findings: Detailed excitation ratiometric fluorescence microscopy confirmed that in Mecp2-/y hippocampal neurons, the redox imbalance affects the cytosolic and mitochondrial compartments. These changes were especially obvious for more complex organotypic slices. Redox challenge by H2O2 and severe hypoxia elicited intensified oxidizing and reducing transients in Mecp2-/y neurons, respectively. Inhibition of superoxide dismutase elicited only a dampened oxidation in Mecp2-/y cytosol and mitochondria, suggesting a decreased efficiency of this scavenging enzyme in Rett mice. More importantly, stimulation by neurotransmitters consistently evoked intensified oxidizing shifts in the cytosol of Mecp2-/y neurons. Conclusions & Significance: Redox imbalance associated with RTT clearly affects cytosol and mitochondria of central neurons. Even physiological events such as neurotransmitter stimulation are sufficient to provoke overshooting redox responses in Mecp2-/y neurons. As these changes are already evident in presymptomatic mice, they may promote the progression of RTT.

Xavier F Figueroa has completed his PhD from Pontificial Catholic University of Chile and Postdoctoral Studies from University of Virginia, Cardiovascular  esearch Center. Currently, he is Associate Professor at Pontificial Catholic University of Chile and is the Director of the Laboratory of Vascular Biology at the Department of Physiology. He has published more than 30 papers in reputed peer-reviewed journals, several of which have been highly cited. His lab combines cellular approaches with studies in intact and in vivo preparations to study the mechanisms involved in the control of microvascular function in peripheral tissues and in the brain.

Neuronal activity depends on the fine and timely regulation of cerebral blood flow by a mechanism known as neurovascular coupling. Neurotransmitters released during an increase in synaptic activity (e.g. glutamate) activate receptors in astrocytes located between neurons and parenchymal arterioles, which initiates a Ca2+ signaling that is propagated to the astrocytic-endfeet and

evokes the release of vasodilator factors, leading to an increase in local blood flow. This process is coordinated among neighboring astrocytes, mainly, through gap junctions and ATP release via hemichannels. It has been proposed that release of NO, a potent vasodilator, from neurons, during an increase in synaptic activity, may be involved in neurovascular coupling. However, astrocytes express the Ca2+-dependent NO-synthetizing enzymes eNOS and nNOS and NO may be involved in the control of Ca2+ signals by direct S-nitrosylation of Ca2+ permeable channels such as connexins-based gap junction channels and hemichannels or pannexinformed channels. Then, the participation of NO in the neurovascular coupling initated by metabotropic glutamate receptor (mGluR) stimulation was assessed in primary cultures of astrocytes and rat brain slices. NO production, vasomotor response of brain cortex arterioles, changes in [Ca2+]i and ATP release were evaluated. In addition, the activity of connexin hemichannels, pannexin channels and Ca2+ homeostasis modulator 1 (CALHM1) channels was also analyzed. Interestingly, the results indicate that NO and CALHM1 channels play an essential role in the astrocyte signaling that mediates neurovascular coupling. Stimulation of astrocytes mGluRs leads to NO-mediated activation of CALHM1 channels by S-nitrosylation, which evokes ATP release. The subsequent ATP-dependent purinergic receptor stimulation induces the opening of Cx43 hemichannels and Panx-1 channels, which contributes to the astrocytic Ca2+ signaling. These findings may provide clues to the design of new therapeutic strategies for the treatment of neurodegenerative diseases.

Wang Liao is a first-year PhD candidate majoring in Neurology at Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. He mainly focused on regulation of adult neurogenesis, and development of new therapeutic targets for treatment of Alzheimer’s disease.

Adult neurogenesis, which is the generation of functional neurons from neural precursors, occurs throughout life in restricted anatomical regions among mammals. Numerous studies have demonstrated a correlation between the level of hippocampal neurogenesis and cognition, whereas dysfunction of neurogenesis contributes to some pathological processes including Alzheimer’s disease, Parkinson’s disease, and other degenerative diseases. Magnesium is the fourth most abundant ion in mammals, and its elevation in the brain has been shown to enhance memory and synaptic plasticity in vivo. The substantial synaptoprotective effects of magnesium elevation in the brain have also been demonstrated in a mouse model of Alzheimer’s disease. However, the effects of

magnesium on fate determination of aNPCs, which are vital processes in neurogenesis, remain unknown. NPCs isolated from the dentate gyrus of adult C57/BL6 mice were induced to differentiate in a medium with varying magnesium concentrations (0.6, 0.8 and 1.0 mM) and extracellular signal-regulated kinase (ERK) inhibitor PD0325901. The proportion of cells that differentiated into neurons and glial cells was evaluated using immunofluorescence. Quantitative real-time polymerase chain reaction and Western blot methods were used to determine the expression of β-III tubulin (Tuj1) and glial fibrillary acidic protein (GFAP). The activation of ERK and cAMP response element-binding protein (CREB) was examined by Western blot to reveal the underlying mechanism. Magnesium elevation increased the proportion of Tju1-positive cells and decreased the proportion of GFAP-positive cells. Also, the expression of Tuj1 was upregulated, whereas the expression of GFAP was downregulated. Moreover, magnesium elevation enhanced the activation of both ERK and CREB. Treatment with PD0325901 reversed these effects in a dose-dependent manner. This study showed that magnesium elevation effected fate determination of adult neural progenitor cells (aNPCs) and the possibly via ERKinduced CREB activation.

Christina Accordino has her expertise in operational accountability for the clinical and financial management of the utilization of intra-operative neuromonitoring (IONM) during surgical procedures that may put a surgical patient’s central nervous system at risk. Her passion is in providing superior patient care while meeting or exceeding clinical and quality metrics. Since 2007, she has held her Certification Examination in Neurophysiologic Intraoperative Monitoring (CNIM) through ABRET (American Board of Registration of Electroencephalographic and Evoked Potential Technologists). Her foundational skill-set includes SSEP, TceMEP, S/TEMG, EEG, BAER, and direct cortical mapping. She feels that the use of these combined modalities supports spinal cord continuity during cranial, spine, vascular, ENT, and cardio-thoracic procedures. Her experience both in the operating room as a clinician and out, as Director of Operations for SpecialtyCare, has helped her excel in providing direction in managing complex customer, physician, employee and patient related tasks regarding the use of neurophysiological monitoring in the healthcare field. 

Intraoperative neuromonitoring (IONM) can bring value to the operating suite. This presentation will review the expectations from adding this additional service to your practice. The talk will address the need for quality assurance processes and tell a story of the true purpose of IONM. A review of the benefit of utilizing a multi-modality approach, common signal changes, actions following changes, resolution of neuromonitoring changes, post-operative status, confound avoidance from a technical and anesthetic` standpoint, and the necessity of performing safety checklists will be addressed  uring this demonstration. Learn how to walk through the processes of the use of IONM and look for opportunities of internal and external improvement to ultimately improve patient outcomes.

Craniopagus parasiticus is a rare medical case and it is unique unlike other cases reported from different literature. In this case, the head of parasitic twins is protruding from the temporal area of cranium. Parasitic head has two deformed lower limbs; one is too rudimentary attached to the mass; long bones of bilateral lower limbs and some pelvic bones. After dissection of the mass, the intestine was seen but no chest organs and other abdominal organs are seen. There is also rudimentary labium but no vaginal opening.

Case presentation: A 38-years-old multigravida (Gravida V para IV) women from Amhara ethnicity referred from rural health center to Referral Hospital due to prolonged second state of labor at 42+1 weeks. Upon arrival she had contraction, term sized gravid uterus, and fetal heart beat was 112. On digital pelvic examination the cervix was fully diluted, station of the head was high and

the pulsating umbilical cord coming in front of the presenting part with ruptured membrane but yet in the vaginal canal. The team decided to emergency cesarean section and then a live female infant weighing 4200 g was delivered. The placenta was single and normal. The APGAR scores were 7 and 9 at 1 and 5 min, respectively. The infant appeared to be grossly normal except the parasitic

co-twin attached at the cranium. The neonate was investigated with the available investigations (CBC, X-Ray, Doppler ultrasound) and pediatric side consultation was made. After a week of counseling and investigations, successful separation operation was done. During post-operative time the neonate was comfortably suckling on breasts with no neurological deficit. The details of the surgery, post-operative condition and subsequent follow up will be discussed during the conference.

Conclusion: The possible etiologies craniopagus parasiticus is still unknown due to a rarity of cases. Doctors, Genetic Scientists, Epidemiologists and Researchers continue to investigate this case as the reasons that could give clue to birth defect and to provide answer for better prognosis of cases and to improve the life chances of the twins. This case will have some input in the effort to know the etiology and pathogenesis of this new born 

Statement of the problem: Research results in Cognitive and Psychology sciences in field of relationships between mind and body led a new subject to appeared in modern age medicine calling “Psychosomatic”. Despite of the new concept of Psychosomatic but it has an old background particularly in Islamic Medicine.

The purpose of this study: This study has tried to shed light on Islamic physicians studies about Psychosomatic diseased till end of 10th century and categorized their methods in this field of study.

Methodology & theoretical Orientation: This research used historical method. This study has aimed several famous Islamic medicine books mostly between 6 BC till 10 BC. It consisted of Canon of Medicine from Avicenna, Al-Hawi from Rhazes, and Abu Zayd al-Balkhi notes.

Findings: This study has classified physiology-psychology impacts, diseased, Problems and methods of their treatment based on medieval Islamic Physicians opinions

Robert L Tanguay completed his BSc from the University of Lethbridge, attended Medical School at University of Calgary and did his Residency in Psychiatry. He completed his Fellowship in Addiction Medicine under the guidance of Nady el-Guebaly. He is also a Pain Medicine Fellow in the Department of Anesthesia at University of Calgary. He is actively involved in education, teaching medical students and psychiatry residents at the University of Calgary.

We reviewed the literature that proposes the mechanisms of cannabis induced psychotic disorders and hence, increases the risk of early onset of schizophrenia. There have been recent studies showing psychosis as secondary to the THC levels in marijuana, and several studies were found showing CBD may be protective and actually have antipsychotic properties equal in efficacy to atypical antipsychotics such as amisulpride. The percentage of THC is much higher today than in the past and certain formulations have been able to even further concentrate THC such as shatter, wax, honey oil, etcetera. Complicating this is that CBD is almost nonexistent in illicit and legal marijuana around the world. Due to Mendelian genetics, as THC concentration is increased, CBD concentration seems to be inversely reduced. This eliminates the protective factors of CBD while increasing the risk of psychosis. THC and CBD seem to have opposite physiologic effects on endogenous anandamide levels and cannabinoid receptor binding, the mechanism likely leading to CBD’s antipsychotic effect.

Kaufui Vincent Wong is a Professor of Mechanical and Aerospace Engineering at the University of Miami (UM), Florida, where he has taught and researched since 1979. His primary research areas are in energy and the environment, fluid mechanics, nanotechnology, nutrition and health. He has published over 200 refereed papers in journals and conferences. He authored 2 text-books on Thermodynamics, one on Intermediate Heat Transfer, one on Climate Change and one on Sustainable Engineering. He holds two patents. He has received awards for teaching and mentoring students. He has served on the UM Graduate Council for 3 terms, and elected Faculty Senator for one. He is active in the American Society for Mechanical Engineers (ASME), and have held many leadership positions, including Chair of the Advanced Energy Systems Division, and Deputy Group Leader of the Energy Group. He is the 2015 ASME Dixy Lee Ray Award recipient for the environment. He is a popular invited Keynote Speaker in international conferences and symposiums. He is serving as the Editor-in-Chief of the Journal of Renewable Bioresources, the Journal of Modern Mechanical Engineering and Technology, and the Journal Advanced Sustainable Engineering. He is on the Editorial Board of the Journal of Surface Modeling and Additive Manufacturing, the Journal of Ecology and Environment Sciences, the Journal of Epidemiology and Public Health Reviews

This work is a careful listing of the significant practices which are good for the body, practices which are especially good for the brain, as well as food and nutrition which are especially good for the brain. The objective of this study is to help researchers to promote brain health among the public. It is suspected that several of the practices may not be commonly known. The generation of discussion is healthy in the field of science, and this is a secondary function of this publication. Any omissions of significant actions which can be easily adopted by anyone are regretted. This mini review also produced a listing of commonly available brain- healthy foods. Regular, appropriate exercise that employs all the body’s muscles is advanced as one of the two significant pillars of physical health. In other words, everyone should move daily and try to avoid being too sedentary. The second pillar for one’s health is a balanced and nutritious diet, which would lead to an appropriate weight range and good mental health. Good practices for the brain are highlighted, hich makes use of the fact that the brain generates new cells periodically, but just as often dies, if not employed to form new neural networks when the person learns new activities. In other words, ‘use it or lose it’ applies to neurons as well as muscles

Gholamreza Heydari completed his MD in 1996, and has done MPH and PhD degrees on Epidemiology from Shahid Beheshti University of Medical Sciences. He is currently the Director of Tobacco Prevention and Control Research Center and WHO Collaborating Center on Tobacco Control in Eastern Mediterranean region and also the Chairman and Editor-in- Chief of many tobacco control journals of Iran. He is conducting several studies on tobacco control and smoking cessation in Iran. He has more than 40 papers on this topic internationally. He has attended many training courses such as Classical Method in Data Analysis, Erasmus Medical University, Netherlands, December 2001; Tobacco Free Initiative for Clinicians, St George’s Hospital, London, England, July 2002 and Smoking Cessation, European Respiratory Society School, Bucharest, Romania, December 2004. 

Many of opium abusers are tobacco smokers, though they would like to quit smoking but unfortunately only a small number of them can benefit from assistance in this respect. Thus, authorities in different countries are responsible for providing low-cost and cost-effective interventions and quit programs to help smokers stop smoking. Nicotine addiction is rarely regarded with the same urgency as drug narcotics abuse in the scope of public health. The aim of this study was to evaluate effect of merging smoking cessation with drug abuse treatment nationally. This was a cross sectional study of educating 3 sessions quit smoking intervention with clinical behavioral therapy CBT and medication in 24 drug abuse treatment center in 6 districts of Iran in 2016. More than 2000 clients were involved with mean age of 41 and 89% male. 78% of them were satisfied with this new treatment and after 6 months, 23% had quit smoking, smoking less than half amount at first was seen in 46% and 31% were yet a smoker. In conclusion, smoking cessation intervention with CBT and medication can have a significant impact on the general health of drug abusers.

Esmeralda Thoma is a Clinical Toxicologist and Addictologist. He has completed his Doctoral studies in 2015 and Specialization in 2010 from University of Medicine of Tirana. He is a Professor at the Faculty of Technical Medical Studies/University of Medicine in Tirana since 2005 and has published several articles in journals and has participated in several conferences.

Introduction: Alcohol abuse used to be a common phenomenon mainly among male in Albania. Women usually can be classified as social drinkers.

 

Aim: The aim of this study is to highlight common co-morbidity of alcohol abuse in Albania.

 

Materials & Methods: This is a retrospective study that was conducted at the Clinic of Toxicology and Addictology at Mother Teresa University Hospital during January 2012-june 2013. In this study, 330 patients were included. The diagnosis of alcoholism was based on lab exams and anamnesis.

 

Results: Out of 330 patients 98% were male. 174 of these patients had at least one other diagnosis except alcoholism, from which 107 had dual diagnosis. We have observed statistically significant positive correlation between the time and the amount of alcohol abuse and the number of comorbid diagnosis, respectively (rho=0.2 95% CI 0.05-0.26 p<0.01 and rho=0.2 95% CI 0.079-0.382 p<0.01). In 58.2% of patients with comorbidity, alcohol abuse was considered the main factor responsible for the comorbid diagnosis i.e., alcoholic hepatitis, alcoholic pancreatitis, alcoholic liver cirrhosis, psychiatric diseases, except schizophrenia and post traumatic disorder. Sixty-six patients had a dual diagnosis, alcohol abuse and psychiatric disorder. From these, the most prevalent was anxiety disorder in 45.5% of patients. Forty-five patients had alcoholic hepatitis, 40.4% of patients had Wernicke-Korsakoff syndrome and equally 40.4% had polyneuropathy.

 

Conclusions: As it is known that long term alcohol abuse virtually causes different organ injury, it is important that all alcohol abuse patients must be carefully evaluated for co-morbidity. 

Muhammad Akbar Malik was trained in General Pediatrics in Pakistan and then was trained in Frenchay Hospital Bristal, UK. He established Pediatric Neurology department and worked for five years in Lahore Children Hospital.

Background & Purpose: Evaluating medical coma in systemic cancer patients is inherently complex, neurologic consultation supported with the standard emergent bed-side electroencephalogram (EEG) can be useful. Recommendations for EEG monitoring in the Neurointensive Care Units (NCUs) are lacking. We sought to determine, usefulness of emergent standard bedside EEG features among cancer patients with unexplained coma (GCS≤8).

 

Materials & Methods: We conducted a prospective EEG assessment of 200 systemic cancer patients consecutively diagnosed and admitted in neurointensive care units (NCUs) of the tertiary care cancer hospitals with unexplained acute impaired consciousness (GCS≤08). Bed-side EEG recordings were done according to the clinical scenario and the requirements of the treating neurologist/intensivist. Patients with brain tumor, brain metastasis, seizures or those with known cause of coma were excluded. Data surrounding clinical, electrographic and treatment factors were collected via a prospective systematic review of medical records and electronic EEGs for correlation with diagnosis, change in the diagnosis and management. Results: Over a period of two years (from January 2014 to December 2016), a total of 200 systemic cancer patients with an average age of 36 years with acute deterioration of conscious level (GCS≤08) were identified. Of the total, males were 120 (60%), and overall 40 (20%) of these patients were of ≤16 years. At least one bed-side EEG of ≥30 minutes was monitored on each of these patients, which was abnormal in 100% of the records. The main reasons for EEG requests were: 1) Unexplained impaired consciousness/not gaining consciousness 130 (65%) and, 2) One plus convulsions 70 (35%). The EEG records were abnormal in 100% of these comatose patients. The EEG findings in clinical category 1 were: i) Encephalopathy 90 (69.2%), among these 90 patients 26 (23%) patients had encephalopathy with epileptiform discharges, ii) Continuous spike-wave discharges (NCSE) 14 (10.8%), iii) Burst-suppression pattern 12 (9.3%), iv) Electrocerebral inactivity pattern 8 (6.2%), v) Theta coma 4 (3%) vii) alpha coma 2 (1.5). The EEG findings in clinical category 2 were: i) Encephalopathy 54 (77%), among these 54 patients 17 (24%) patients had encephalopathy with epileptiform discharges, ii) Continuous spike-wave discharges (NCSE) 6 (8.6%), iii) Burst-suppression pattern 6 (8.6%), iv) No electrocerebral inactivity pattern, v) Theta coma 2 (2.9%) and vi) Alpha coma 2 (2.9%).

 

Conclusion: Bed-side EEG record of ≥30 minutes is useful in general cancer patients admitted in NCU with acutely impaired consciousness with or without abnormal body movements. Neurology consultation and EEG studies in these comatose patients provide useful diagnostic and therapeutic information.

Eltoum Etdal has completed her RN, BSN, MSN at the age of 40 years from University of Khartoum Faculty of Medicine School of Nursing and she joined Kingdom

of Saudi Arabia-Riyadh King Faisal Specialist Hospital & Research Center since 1992 up to date as register nurse RN. She is the Psychiatry Nurse Coordinator of

Mental Health Department. She has published continuum of care of clonazepam misuse prescription mental health psychiatry out patient at King Faisal Hospital

& Research Centre.

Background: Mild schizophrenia patient with nicotine addiction may have benefit from alternative therapy such as cognitive behavioral therapy added to nicotine replacement therapy compared to other substance abuse, but patient with severe schizophrenia a token economic therapy is best chose. Smoking cessation in Schizophrenia population, its harmful effects on health, finances, role of mental health care providers and better available options for treatment as are in general population.

 

Objective: To decrease risk of cardiovascular and pulmonary compaction and early death bu using the method of Clinical observation with the schizophrenic patients and nicotine addiction.

 

Result: Patients referred to psychotherapy in addition to nicotine replacement for the better outcome. In agreement with literature mild schizophrenia get benefit from cognitive behavioral therapy than sever schizophrenic patients.

Vahid Farnia is the Head of Substance Abuse Prevention Research Centre at Kermanshah University of Medical Sciences, Kermanshah, Iran. He has studied Medicine from the Isfahan University of Medical Sciences, and obtained his Medical degree in 2000. He studied Psychiatry at the Tehran University of Medical Sciences, and obtained his National Psychiatry Board Certification in 2008. He has undertaken more than 20 projects concerning drug abuse and drug induced psychiatric disorders. He is the author of several published papers in accredited journals, and the author of the chapter entitled: Amphetamine psychosis in "Neuropathology of Drug Addictions and Substance Misuse" published by Elsevier.

Amphetamine and methamphetamine are the principal members of amphetamine-type stimulants. Amphetamine usually prescribed for treatment of several mental disorders including attention deficit hyperactive disorder and narcolepsy. Illegal use of methamphetamine is a global and growing phenomenon and in recent years, there has been a significant increase in the production and use of methamphetamine worldwide. According to the World Drug Report, the amount of methamphetamine seized was increased from 34 tons in 2009 to 88 tons in 2013. In addition to the  rowing market for methamphetamine in Asia, there are also reports which show increasing use in some parts of the North America and Europe. Amphetamine-related psychiatric disorders are a group including several mental disorders which are induced by amphetamine use. Although the relationship between amphetamines use and development of psychiatric disorders are well established from several years ago, the data related to the prevalence, clinical features and treatment of these disorders are very limited. Considering the highly addictive nature, and its ability to produce psychiatric disorders, methamphetamine abuse is a major public health concern in the current century. While the number of the patients with methamphetamine induced mental disorders as well as the patients with abuse and chronic dependence on methamphetamine is growing, more comprehensive understanding of clinical course and treatment of these disorders seems necessary for mental practitioners. In this presentation, the author will talk about their studies regarding several amphetamine-induced psychiatric disorders including methamphetamine induced psychosis, obsessive compulsive disorder, and sexual disorders.