program Book 2014 LR done

NAAMA’s 28th
INTERNATIONAL
MEDICAL CONVENTION
June 16 – 21, 2014
Le Méridien Piccadilly Hotel
London, England
“Medical Innovations: Improving Patient Outcomes in the 21st Century”
Presented by the National Arab American Medical Association (NAAMA)
Convention Committee
Edward (Ted) Yaghmour, MD
Convention Chair
Terry Meriden, MD
FACN, FACE, FACP, FAAMA
NAAMA President
Mohammad Wehbi, MD
Scientific Chair
Samer Elbabaa, MD
Nabil Hilwa, MD
Nidal Isber, MD
Hani Sbitany, MD
Renée Ahee, MSF, APR
NAAMA Executive Director
Samir Khalil, MA
K Tours
Scientific Committee
Mohammad Wehbi, MD
Scientific Chair
Edward (Ted) Yaghmour, MD
Convention Chair
Terry Meriden, MD
FACN, FACE, FACP, FAAMA
NAAMA President
Dana Darwish, DO
Samer Elbabaa, MD
Souzan El-Eid, MD
Shawki Harb, MD
Renée Ahee, MSF, APR
NAAMA Executive Director
TABLE OF CONTENTS
04
Welcome Letter
05
Experiencing London
07
Scientific Program
08
Educational Content and CMEs
09
Convention Faculty
10
Schedule of Events
12
Presenters’ Scientific Abstracts
Dear NAAMA Friends,
On behalf of the board of directors and organizers of NAAMA’s 28th
International Medical Convention, welcome to London… A world
renowned city with a history so intrinsically tied to ours as Americans.
Many of our NAAMA colleagues have worked or
received some of their medical training in London so it’s
a familiar place. It is, however, the first time that
NAAMA has held a medical convention in the city with
many names.
Edward (Ted) Yaghmour, MD
Convention Chairman
Known as “Babylon” for the multitude of languages and
cultures evident in the city, London is welcoming
NAAMA for our third European convention in as many
years. The program is outstanding! Dr. Mohammad
Wehbi and the scientific committee have really worked
hard to bring you topics related to innovation and new
treatments. The theme, “Medical Innovations:
Improving Patient Outcomes in the 21st Century,” is
well covered by noted British physicians and U.S.
physicians, dentists and pharmacists.
We also extend appreciation to the convention
committee for their input.
Terry Meriden, MD
FACN, FACE, FACP, FAAMA
NAAMA President
Delightful experiences await all of you who’ve never
been to London and all who know the city very well.
From the Welcome Reception to the Gala Dinner on a
NAAMA-only cruise along the Thames River, you’ll
enjoy this summer adventure. We are sure that you will
enjoy our convention both scientifically and socially.
Cheerio!
4
EXPERIENCING
LONDON
Program at
a Glance
DAY ONE
June 16, 2014
7:30 p.m. – 9:00 p.m.
Welcome Reception at
Le Méridien Piccadilly Hotel
DAY TWO
June 17, 2014
8:15 a.m. – 12:00 p.m. Scientific Meeting
2:30 p.m. – 5:30 p.m.
Welcome to London. This afternoon, enjoy a tour of many of London’s most famous sights, a
must for first-time visitors and a refresher for those returning. Starting from Piccadilly
Circus, we head to Trafalgar Square, flanked by the National Gallery, the Church of St. Martin
in the Fields and, at its center, the great column dedicated to Admiral Nelson. The square is
frequently the focus of national celebrations. Continue through Admiralty Arch along the
Mall to Buckingham Palace for a close-up of Queen Elizabeth’s main residence with its
famous guards. From the seat of royalty, we drive Thames-side to the Houses of Parliament,
Britain’s seat of government, with a history spanning over 900 years. Take a look at Big Ben,
perhaps the world’s best-known clock, and across the street, the majestic Westminster Abbey,
familiar from television coverage of many royal events. Return to the hotel for some rest.
7:00 p.m. – 9:30 p.m.
Dinner at Circus Restaurant
building in England. From beheadings to
murders, royal prisoners and treasure house,
the Tower is both fascinating and forbidding.
DAY THREE
June 18, 2014
Evening at leisure.
8:30 a.m. – 12:15 p.m. Scientific Meeting
2:30 p.m. – 5:30 p.m.
Windsor Castle Tour
Windsor lies to the west of London and is home to
Windsor Castle, the official residence of the
Queen outside of London. It is the largest and
oldest occupied castle in the world and its
dramatic site encapsulates 900 years of British
history. It covers an area of 26 acres and contains,
as well as a royal palace, a magnificent chapel
and the homes and workplaces of a large number
of people. The magnificent State Apartments are
furnished with some of the finest works of art
from the Royal Collection, including paintings by
Rembrandt, Rubens, Canaletto and Gainsborough. You will also enjoy breathtaking views of
the Castle and Windsor Great Park, the Thames
Valley and the London skyline.
DAY FIVE
June 20, 2014
8:30 a.m. – 12:20 p.m. Scientific Meeting
After the tour, we will enjoy a leisurely dinner in
the Windsor area before returning to our hotel.
Afternoon at Leisure
Optional Excursions are available.
DAY FOUR
7:30 p.m. – 11:00 p.m. Gala Dinner Cruise
Cruising through the heart of the Capital on
the River Thames provides guests with a stunning backdrop for this event! With a partial
glass roof that may be retracted, your boat will
allow guests to dine and dance under the stars
while cruising past the picturesque sights of
London. There will be also a “live band” to
make the night an unforgettable one, exclusively for NAAMA!
June 19, 2014
8:30 a.m. – 12:00 p.m. Scientific Meeting
2:30 p.m. – 5:30 p.m.
“City” Tour
This afternoon’s visit begins in “the City,”
London’s Wall Street, a warren of narrow streets
interspersed with some of the city’s most stunning modern architecture and the historic St.
Paul’s Cathedral at its heart. Today’s highlight is
our visit to the Tower of London, one of the most
famous and well-preserved historic buildings in
the world. Founded by William the Conqueror
between 1066 and 1087, the Great Tower or White
Tower soon became the most talked-about
DAY SIX
June 21, 2014
Departure.
6
SCIENTIFIC
PROGRAM
The Scientific Program will focus on medical innovations in use or on the horizon that will help
physicians improve patient outcomes, an important goal shared by healthcare professionals.
Topics will include original work, analysis or
programs in medical specialties that reveal what is
new in the identification, treatment and cure of
illness and disease.
30 St Mary Axe “the Gherkin”
Educational Content and CMEs
Target Audience
Accreditation and Designation
This scientific program is designed for physicians,
This activity has been planned and implemented in
dentists, pharmacists and other healthcare professionals.
accordance with the Essentials and Standards of the
Accreditation Council for Continuing Medical
Program Objectives
Education (ACCME) through the National Arab
The content of this educational program was determined
American Medical Association (NAAMA). The
by rigorous assessment of educational needs. This activity
National Arab American Association is accredited by
is intended for physicians, physicians in training, medical
the ACCME to provide continuing medical educa-
students and other healthcare professionals to:
tion for physicians.
1. Review new methodologies and state-of-the-art tools
and treatments in a variety of medical specialties
NAAMA designates this educational activity for a
2. Identify effective strategies using medical innovations
maximum of 13.5 AMA PRA Category 1 Credit(s)™
to improve patient outcomes
for the scientific program. Physicians should only
claim credit commensurate with the extent of their
participation in the activity.
Attendees will experience:
Content that…
• Promotes improvements or quality in healthcare
Online CME Instructions
• Has been reviewed for bias and scientific rigor
Physician attendees may submit their scientific
• Addresses the stated objectives or purpose
program evaluations online and receive their CME
• Is driven and based on independent survey and analy-
Certificate online as well. It’s simple and convenient
sis of learner needs, not commercial interests
and it ensures adherence to ACCME standards.
• Is current, valid, reliable, accurate and evidence-based
Beginning on June 22nd, 2014, attendees will be
• Offers balanced presentations that are free of commer-
able to access the online CME evaluation form by
cial bias
typing this link into their browser:
• Is vetted through a process that resolves any conflicts of
http://fluidsurveys.com/s/London-2014-CME-
interest of planners and faculty
Evaluation/. Or you can go to www.naama.com, click
• Is evaluated for its effectiveness in meeting that identi-
on CME Submissions and click on London 2014.
fied educational need
You will be instructed to answer all the questions and
A learning environment that…
certify that you’ve attended the sessions you’ve
• Supports learners’ abilities to meet their individual
checked. You will then be asked to type your name
needs
as you wish it to appear on the CME certificate.
• Respects and attends to any special needs of the learn-
Then be sure to click on Submit. You will receive an
ers
e-mail with your CME certificate, which you can
• Is free of promotional, commercial and/or sales activi-
download and print for your records.
ties
• Is based on adult learning principles that support the
For your convenience and to help you recall high-
use of various modalities
lights of each speaker and each session while
• Respects the diversity of groups of learners
completing your CME evaluation, we have added a
Disclosure of…
Notes section to the bottom of each of the Scientific
• Relevant financial relationships that planners, teachers
Presentations pages.
and authors have with commercial interests related to the
content of the activity commercial support (funding or
in-kind resources) of this activity.
8
CONVENTION FACULTY
Hussam Mihtar, MD
Assistant Clinical Professor, University of
California, San Diego
[email protected]
Roula Baroudi, MD
Attending Physician, Medical Service,
Infectious Disease (ID) Section, and Infectious
Disease Physician Champion for Antimicrobial
Stewardship Program (ASP), Bay Pines VA
Health Care System
[email protected]
Wajeh Qunibi, MD
Professor of Medicine, University of Texas
Health Science Center at San Antonio
[email protected]
Dana Darwish, DO
Anesthesiologist/Intensivist, Department of
Anesthesiology and Critical Care, Loma Linda
University Medical Center
[email protected]
Souheil Saddekni, MD
Professor, Diagnostic Radiology, University of
Alabama at Birmingham
[email protected]
Hassan Fehmi, MD
Senior Staff Physician, Department of
Medicine, Division of Nephrology and
Hypertension, Henry Ford Health System
[email protected]
Hanan Shaban, PharmD
Formulary Manager, Veterans Administration
Eastern Colorado Healthcare Systems, and
Instructor, University of Colorado School of
Pharmacy
[email protected]
Bachar Hachwa, MD
Director of Anesthesia, Springfield Regional
Medical Center
[email protected]
Kamleh Shaban, MD
Resident, University of Louisville Department
of Psychiatry
[email protected]
Shawki Harb, MD
Attending Surgeon, Henry Ford Health
System-Wyandotte, and Clinical Professor,
Michigan State University
[email protected]
Saad Shakir, MD
Adjunct Clinical Associate Emeritus of
Psychiatry and Behavioral Medicine, Stanford
University School of Medicine
[email protected]
Ghabi Kaspo, DDS
Michigan Facial Pain Clinic, PLC (Practice
limited to TMJ, Facial Pain and Oral
Appliances for Obstructive Sleep Apnea)
[email protected]
Tom Treasure, MD
Retired Cardiothoracic Surgeon, Researcher,
University College London
[email protected]
Brent Keeling, MD
Assistant Professor of Surgery, Emory
University
[email protected]
David Verity, MD, MA, FRCOphth
Consultant Ophthalmic Surgeon, Moorfields
Eye Hospital NHS Trust
[email protected]
Terry Meriden, MD
Clinical Assistant Professor of Medicine,
University of Illinois, and Director, Central
Illinois Diabetes & Metabolism Institute
[email protected]
Mohammad Wehbi, MD
Assistant Professor of Medicine, Division of
Digestive Diseases, Emory University School of
Medicine
[email protected]
Zina Meriden, MD
Resident, Department of Psychiatry and
Behavioral Sciences, The Johns Hopkins
University School of Medicine
[email protected]
Saad Yasin, BSD, MSc
Lecturer and Prosthodontist & Implantologist
University of Mosul/College of Dentistry
[email protected]
9
Monday
June 16, 2014
Tuesday
June 17, 2014
Wednesday
June 18, 2014
8:00
Mohammad Wehbi, MD, Scientific Chair;
Introductory and Welcome Remarks
8:30
9:00
Shawki Harb, MD; [email protected]
The History of Arab Medicine &
Its Contribution to Western Medicine
David Verity, MD; [email protected]
St. John Eye Hospital in Jerusalem,
Ancient Order, Modern Hospital
9:30
Terry Meriden, MD; [email protected]
10 Ways to Live to be a 100
Bachar Hachwa, MD; [email protected]
New Anesthesia
Wajeh Quinibi, MD; [email protected]
Obesity and Kidney Disease,
A Preventable Modern Health Problem
Roula Baroudi, MD;
10:00
10:30
11:00
ARRIVE IN
LONDON
Q&A
COFFEE BREAK
Hanan Shaban, PharmD; [email protected]
FDA Warnings... Use of Opioids and Agents
for Insomnia
Mohammad Wehbi, MD; [email protected]
New Innovations in GE Interventions
11:30
12:00
[email protected]
Infectious Disease Emergencies
COFFEE BREAK
Roula Baroudi, MD; [email protected]
Antimicrobial Stewardship Program (ASP)
Q&A
Brent Keeling, MD; [email protected]
Cardiometabolic Syndrome
London
City Tour
Windsor
Castle Tour
12:30
1:00
1:30
2:00
2:30
3:00
3:30
4:00
4:30
5:00
5:30
6:00
6:30
7:00
7:30
8:00
8:30
9:00
9:30
10:00
10:30
11:00
11:30
Reception at
Le Méridien
Dinner at
Circus Restaurant
Ted Yaghmour, MD,
Convention Chair;
[email protected]
Terry Meriden, MD,
NAAMA President;
[email protected]
12:00
10
Dinner on
Your Own
Thursday
June 19, 2014
Friday
June 20, 2014
Saturday
June 21, 2014
8:00
8:30
9:00
9:30
10:00
10:30
11:00
11:30
12:00
Tom Treasure, MD; [email protected]
Personalised Aortic Root Support (PEARS)
for People with Inherited Disorders
Dana Darwish, MD; [email protected]
Oral Anticoagulants: New Challenges in
Perioperative Management
Kamleh Shaban, MD; [email protected]
Professional Interpreters: Getting the Most
Out of Language Access Services
Q&A
COFFEE BREAK
Zena Meriden, MD; [email protected]
Psychiatric Illness in Pregnancy
Hussam Mihtar, MD;
[email protected]
PTSD
Q&A
Souheil Saddekni, MD; [email protected]
1- Modern Imaging and Endovascular
Interventional Techniques
2- Interventional Trans-arterial Chemoembolizationmand Percutaneous Portal Vein Embolization
Q&A
COFFEE BREAK
Ghabi Kaspo, DDS; [email protected]
Role of Imaging in Assessing TMD Symptoms
Saad Yasin, BSD, M.Sc.; [email protected]
Treatment of Lower Edentulous Ridge
Hassan Fehmi, MD; [email protected]
Lean Thinking in Health Care
Q&A
Mohammad Wehbi, MD, Scientific Chair;
[email protected]
12:30
1:00
1:30
2:00
2:30
3:00
3:30
4:00
4:30
5:00
5:30
6:00
6:30
7:00
7:30
8:00
8:30
9:00
9:30
10:00
10:30
Saad Shakir, MD; [email protected]
Neuro-Modulation
At Leisure
“City” Tour
Gala Dinner
11:00
11:30
12:00
11
DEPART
LONDON
SCIENTIFIC
ABSTRACTS
Roula Baroudi, MD
TITLE 1: Antimicrobial Stewardship Program (ASP):
What, Why, and How
DESCRIPTION:
Antimicrobial Stewardship Program (ASP) is not a “new concept” but it is a “hot topic”. The ASP program
is a joint collaborative effort between pharmacy, medicine, infection control, microbiology, and information
technology staff, supported by hospital administration leadership to reduce the development of multi-drug
resistant organisms (MDROs), adverse drug events, length of stay, and healthcare cost. The purpose of the
program is to provide an evidence-based approach to ensure efficacious, safe, and cost-effective use of
antimicrobials within the healthcare system through the development of a formal, interdisciplinary team to
optimize clinical outcomes while minimizing unintended consequences of antimicrobial use including toxicity, and preventing the emergence of resistance.
When developing an ASP program, two “core” strategies including prospective audit and formulary
restrictions along with several supplemental elements such as education, guidelines, antimicrobial cycling,
antimicrobial order form, streamlining or de-escalation of therapy, and dose optimization and adjustment
need to be in place.
We are dealing with a global challenge of MDROs better known as “bugs without borders”. According to
the Centers for Disease Control (CDC), at least 23,000 people a year die in the United States as a result
of antibiotic-resistant infections that affect at least 2 million people a year. Increased MDROs and
decreased anti-infective development require stricter management of antibiotics. ASP is essential in any
hospital/healthcare facility to decrease the incidence of resistance and improve patient care.
NOTES
13
TITLE 2: Infectious Disease Emergencies
DESCRIPTION:
Infectious disease emergencies have the potential for considerable adverse events (including death) to the
patient if not assessed rapidly and treated appropriately. Today’s world has various presentations of
viruses, toxins, and bacteria that create emergencies if not evaluated and treated efficiently and effectively.
Despite advances in medical diagnostics, often healthcare clinicians do not feel confident in managing
infectious disease emergencies. Infectious diseases contribute greatly to the financial burden of health
care as well as contributing to physical and emotional suffering. Early recognition is essential for a positive
outcome for the patient.
The presentation provides five clinical case scenarios with thoughtful discussion on diagnosis,
differentials, and management. Each case will include 10 related practical pearls. The presentation will
engage members’ participation to discuss innovative treatment strategies. Knowledge about important
infectious disease emergencies continues to challenge healthcare clinicians. This presentation will provide
a practical discussion on how to identify some of these infectious emergencies.
Dana Darwish, DO
TITLE: Oral Anticoagulants: New Challenges in Perioperative Management
DESCRIPTION:
Objectives:
Review current and novel oral anticoagulants currently available
Discuss mechanisms of action and indications for use
Examine side effects and complications of these drugs
Outline antidote therapy to reverse the effects of these agents and their limitations.
NOTES
14
Hassan Fehmi, MD
TITLE: Lean Thinking in Health Care
DESCRIPTION:
Lean thinking starts with identifying waste and driving it out, so that all work adds value and serves the
customer’s needs. Separating value-added from non-value-added steps in every process is the beginning
of the lean journey.
In order for lean principles to take hold, leaders must first work to create an organizational culture that is
open to lean thinking. The commitment to lean must start at the very top, and everyone should participate
in helping to redesign processes to improve the work flow and reduce waste.
Although health care differs in many ways from manufacturing, there are also surprising similarities:
Whether building a car or providing health care for patients, workers must rely on multiple, complex
processes to accomplish their tasks and provide value to the customer or patient. The customer (or the
patient), on the other hand, will be willing to pay for value and not waste. Hence the urgent need to identify
waste — of money, time, supplies, or good will.
Numerous examples in recent years of lean adoption in health care demonstrate that, when applied
rigorously and throughout an entire organization, lean principles may have a favorable impact on
productivity, cost, quality, and timeliness in the delivery of services.
NOTES
15
Bachar Hachwa, MD
TITLE: New Anesthesia
DESCRIPTION:
At a general medical meeting, it would be too much to speak about one anesthesia subject.
It is, however, desirable for most medical staff to know about the new developments in anesthesia and how
the future looks from today. This lecture will highlight many subjects and allow most audience members
to participate and learn something related to their specialties.
For example, surgeons will hear about regional anesthesia improvement; orthopedic surgeons will learn
more about continuous nerve block; pediatricians will hear about anesthesia neurotoxicity; cardiologists
will look at our utilization of TEE; specialists who run their own sedation will hear a review of some airway
protocols and devices, etc.
Shawki Harb, MD
TITLE: The History of Arab Medicine & Its Contribution to
Western Medicine
DESCRIPTION:
Introduction: It has been said that history is written by the victorious. Does this apply to the history of medicine? When Ibn al-Haitham refuted the great Roman physician Galen and maintained that, contrary to
what Galen claimed, light is reflected from objects to be perceived by the eyes and the brain, he was
criticized by Western scholars. Arnold of Villanova, two centuries later wrote: “These Moslem physicians
have stupefied European physicians by their misinterpretation of Galen”. Some historians try to assign the
beginning of modern medicine to a certain date or a certain researcher. For example, they postulated that
Viselius in the early 16th century started modern medicine when he started dissection. I, for one, believe
NOTES
16
that reducing the beginning of modern medicine to a certain event or nation is shortsighted because we
know very well that medical development is a continuum, where one phase depends on the previous one
and paves the way for the next phase.
Methodology: In compiling this presentation, I consulted several historic sources in Arabic, English, and
German. Unfortunately, most of the references were not in Arabic, and very often the translation is inaccurate. It is, however, universally accepted that the first medical historian was Ibn Abi Usayba al-Ahmad.
Unfortunately, his original Arabic book ‫ ﻣﻦ ﻋﻴﻮﻥ ﺍﻷﻧﺒﺄ ﻓﻲ ﻃﺒﻘﺎﺕ ﺍﻷﻃﺄ‬was lost and we have only
translations.
Discussion: History of medicine, its progress, and its future are intrinsically related to political,
economical, and social developments. It has, therefore, been agreed upon to divide history of medicine
into the following periods:
1. Ancient period (Babylonian, Egyptian, and Indo-Chinese)
2. Greco-Roman
3. Arabic-Islamic
4. Modern Period
I added another section highlighting the contributions of contemporary Arab physicians.
Conclusion: Progress in medicine depends on the existence of free and stable societies and
governments. The ransacking of Baghdad by Hulago caused immeasurable harm to the progress of
medicine. Likewise, the burning of the Arab libraries of Cordoba on the orders of Queen Isabella of Spain
added to the damage done by Hulago. Unfortunately, in the time of political decline, fanatical movements
appeared in the Arab World which contributed to the loss of our Islamic Arabic heritage, like, for instance,
the burning of Ibn Rushd's books and the poisoning of Abu al-Ala al-Ma'arri.
Arab scholars revolutionized astronomy, invented Algebra, developed the modern decimal number system,
established the basis of optics, and set the ground of modern medicine. It took Europe almost five
centuries to adopt Arabic numerals. The polymath Ibn al-Haitham effectively pioneered the scientific
method, stressing the importance of observation and experimentation. He is the world's greatest physicist
between Archimedes and Newton.
NOTES
17
GHABI KASPO, DDS
TITLE: The Current Role of Imaging in Assessing TMD Symptoms
Using MRI and Cone Beam 3D
DESCRIPTION:
While there are different aspects of the TM clinical examination, imaging of the TM joints including
magnetic resonance imaging (MRI), Cone beam 3D imaging, and other techniques are part of the TM joints
evaluation. The MRI and CBCT continue to provide vital information for the diagnosis of the joint. With
advanced joint disease occurring at younger ages with increased frequency, the use of CBCT will increase
in the future. In order to obtain an accurate diagnosis of TM joint diseases, ordering the proper imaging is
very important. Reading and interpreting the imaging is easier with today’s digital format along with
advanced training.
Brent Keeling, MD
TITLE: Cardiometabolic Syndrome: Far-reaching Solutions for
a Far-reaching Problem
DESCRIPTION:
Cardiometabolic syndrome is a constellation of diseases which continues to greatly impact the healthcare
systems and economies of many western countries. It may affect up to 1/3 of adult patients in the US and
up to 5% of adolescents. Given the ubiquity of the problem at hand, creative solutions are warranted. This
presentation will focus on the depth of the problem at hand and the way in which creative,
technologically-driven solutions can play a role in treatment for patients, physicians, and healthcare
systems alike.
NOTES
18
Terry Meriden, MD, FACN, FACP, FACE, FAAMA
TITLE: 10 Ways to Live to Be 100
DESCRIPTION:
In the book of Genesis, it was reported that Noah and Methuselah lived beyond 900 years. Yet in the past
few hundred years, life expectancy was noted to be much shorter. Coronary Heart Disease is indeed the
number one cause of death in the United States.
Every 16 seconds, an American suffers a heart attack with more than 1.5 million myocardial infarctions
every year in the USA today, 50% of them occurring without a warning leading to sudden death.
Diabesity as well as dyslipidemia, hypertention, and dysmetabolic syndrome in general, as well as
smoking, positive family history and other factors have been incriminated in the genesis of atherosclerosis,
leading to MI as well as CVA, cancer and other devastating health consequences. These factors as well as
others with preventive as well as therapeutic strategies will be discussed in details. “10 ways to live to be
a 100” is not beyond reach. Life expectancy has increased significantly over the past five decades.
Zina Meriden, MD
TITLE: Psychiatric Illness in Pregnancy: What You Need to Know
But Were Afraid to Ask
DESCRIPTION:
Mood disorders (major depressive disorder (MDD) and bipolar affective disorder (BPAD)) and anxiety
disorders occur in up to 20% of pregnant women. Post-partum psychosis may also be observed. These
psychiatric illnesses can be difficult to diagnose in the pregnant population and are easily overlooked, as
their presentation may be mistaken for normal temperamental changes during pregnancy. Management
also poses a particular challenge, as two factors must be weighed against each other: the risk of taking
medication vs. the risk of not taking medication. On one hand, psychotropics carry a risk of teratogenic
NOTES
19
side effects, and providers are often inclined to discontinue or under dose them in pregnancy. However, if
psychiatric illness in a pregnant female is inadequately treated or untreated, premature labor,
pre-eclampsia, and a host of other complications may ensue. The purpose of this lecture is to provide an
overview of psychiatric illness in pregnancy and the post-partum period, psychotropics commonly used
and their safety and side effect profiles, and management strategies in this population.
Hussam Mihtar, MD
TITLE: PTSD
DESCRIPTION:
Often in wars, casualties are counted by the number of people who lost their lives, and in traditional wars,
those lives are generally soldiers who are fighting in the war.
When wars penetrate civilian lives and become part of their daily living and lifestyle, significant and
profound scars develop for years to come in the lives of children, mothers and society in general and the
depth of impact usually is in that order.
Post-Traumatic Stress Disorder or PTSD is a malignant form of anxiety disorders that has a long-lasting
effect on societies in a way that no one can fully predict or even prevent and it usually distorts the society
emotionally, socially and morally.
With the unrest in the Middle East raging and with the unfathomable, unprecedented and most destructive
war in modern history taking place in Syria, I would like to address and present more understanding and
awareness of the PTSD as a disorder and its psychological and social impact on people as individuals,
families and the society at large both in the short and long terms.
NOTES
20
Wajeh Qunibi, MD
TITLE: Obesity and Kidney Disease, A Preventable Modern Health Problem
DESCRIPTION:
Obesity is considered the most serious epidemic of the 21st century. The prevalence of obesity, defined as
a body mass index (BMI) of > 30 kg/m2, has increased substantially over the past two decades in most
societies and is considered a worldwide epidemic. The Middle East, including the Arabian Peninsula,
Eastern Mediterranean, Turkey and Iran, and North Africa, are no exception to the worldwide increase in
obesity. Obesity carries a markedly increased risk for important comorbid complications including Type 2
diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. Obesity also
increases the risk for CKD and its progression to ESRD. In humans and experimental animal models, the
impact of obesity on renal outcome includes structural and functional adaptations, such as increased
glomerular filtration rate, increased renal blood flow and renal hypertrophy. Hemodynamic factors,
hypertension, dyslipidemia, high leptin level and other factors may contribute to obesity-related
glomerulopathy (ORG). Increased fat mass leads to mesangial expansion and increased renal metabolic
demand that may promote glomerular hyperfiltration, glomerular hypertrophy, decreased podocyte density,
increased foot processes, and increased filtration fraction. Moreover, obesity has been recognized as a
strong and consistent risk factor for kidney stones. Treatment relies on weight loss, possibly through
bariatric surgery, and antagonists of the RAS. Weight loss reduces glomerular filtration rate and effective
renal plasma flow along with proteinuria, but these changes are most notable after bariatric surgery in
adults with morbid obesity. Also, a low-sodium intake and angiotensin converting enzyme inhibitors should
be advocated in obese CKD patients.
NOTES
21
Souheil Saddekni, MD
TITLE 1: Modern Imaging and Endovascular Interventional Techniques in
the Management of Lower Gastrointestinal Bleeding
DESCRIPTION:
Gastrointestinal bleeding is one of the most common GI disorders. An accurate diagnosis and management
often require the expertise of several disciplines. While upper GI bleed lends itself readily to endoscopic
diagnosis and treatment, lower GI bleeding (LGIB) can be elusive to diagnose and difficult to manage. The
bowel from the ligament of Treitz to the rectum can harbor multiple disorders which can lead to occult,
chronic or acute GI bleeding. Acute massive LGIB can lead to dire consequences if not emergently treated.
Endoscopic localization of acute LGIB is often difficult to perform or to yield useful information or to treat.
Double balloon endoscopy and capsule endoscopy represent significant advances in GI endoscopy.
Active LGIB can be detected by radionuclide scans which are very sensitive but are not specific.
Remarkable imaging advances occurred recently with Multidetector CT. They are fast, readily available,
sensitive in the arterial phase where active LGIB can be detected, and detailed in the late phase where
sources of sub-acute or chronic causes can be detected. Diagnostic arteriography has been used for many
decades in localization of acute LGIB and less commonly in intermittent or occult bleeds. Embolization of
gastro-duodenal arteries has been known to be safe and effective in stopping active UGIB. However,
modern advances in microcatheter and embolic microcoil technology have allowed superselective
catheterization and safe embolization of distal small bowel and colonic arteries as well.
In conclusion: we present a multidisciplinary algorithmic approach for improved detection, treatment and
outcome for LGIB patients.
NOTES
22
TITLE 2: The Role of Interventional Trans-arterial Chemoembolization and
Percutaneous Portal Vein Embolization in Improving the Outcome of
Oncologic Liver Surgery
DESCRIPTION:
The rate of primary liver cancer is rising while the liver remains a most common target of metastases.
Surgery whenever feasible remains the best option for patients with liver tumors. However, no more that
10-15% of all patients can undergo a potentially curative surgery.
Many patients undergo percutaneous Trans-Arterial Chemo-Embolization (TACE) as the best treatment
when they fall beyond criteria for resectability. However, TACE can allow more patients to have surgery by
“down-staging” certain tumors which are slightly above resectability criteria, so they become resection
candidates. TACE can also control small tumors in liver transplant candidates thus “bridging” them to
transplantation. In both situations a more beneficial outcome is attained as compared to other non-surgical
options.
Another procedure which has a great impact on major hepatic resection outcome is Portal Vein
Embolization (PVE). A major risk factor in post-operative complications and liver failure is the size of future
liver remnant (FLR) which is the remaining segment of the liver post resection. Complications are low if
this segment volume is above 25% of a non-cirrhotic and 40% of cirrhotic liver volume. PVE shifts blood
from the affected lobe to the FLR promoting regeneration and hypertrophy. PVE has been shown in studies
to increase patients’ eligibility for resection and improve post-surgical complications.
We will present our experience and own technique with PVE which proved to reduce
complications and cost while still significantly increasing FLR volume significantly
(up to 60%), resulting in an overall improved surgical feasibility and outcome.
NOTES
23
Hanan Shaban, PharmD
TITLE: FDA Warnings and What You Need to Know About the Use of
Opioids and Agents for Insomnia
DESCRIPTION:
In January 2013, the FDA sent a warning letter regarding prolonged levels of zolpidem impairing alertness
and functional activities such as driving the next day. This effect was more prominent in women. Labeling
changes were made recommending lower doses for women. Other literature has reported potential for
abuse with zolpidem and other insomnia agents and increased emergency room visits. Since 2004 there
has been a 138% increase in ER visits for non-medical use of a prescription drug due to anxiolytics, or
sedative hypnotics, and 14,764 drug-related suicide attempts were attributed to zolpidem. Statistics
indicate that 9 million patients take zolpidem for sleep in the United States.
In September 2013, the FDA sent out a letter to all providers and facilities requiring safety labeling
changes and post-market studies to combat the crisis of misuse, abuse, addiction, overdose, and death
associated with long-acting and extended release opioids. Eighty percent of the global opioid supply and
99% of the hydrocodone supply is consumed in the US. Prescription opioids accounted for 11,499 deaths
in 2007 and this number is on the rise.
Physicians and other healthcare providers need to understand the alarming statistics and utilize these
agents carefully. This presentation will review how and why usage has increased and provide alternatives
to prescribing.
NOTES
24
Kamleh Shaban, MD
TITLE: Professional Interpreters: Getting the Most Out of
Language Access Services
DESCRIPTION:
In the United States, the number of people who speak a language other than English is on the rise. Of those
people, a percentage speaks English either “not at all” or “not well.” This poses a significant problem for
quality of care for these patients presenting for health care. Limited English Proficiency patients have poor
outcomes compared to the English-speaking counterparts. Access to language services is required of all
healthcare providers, either via call-in services or in-house providers. Healthcare providers often express
great dissatisfaction with these services, often using them improperly or not at all. Studies have shown that
proper use of interpreters can actually lead to increased patient and physician satisfaction, better patient
outcomes, and less time spent. The aim of this session is to educate healthcare providers on the need for
interpreter services and how to properly use them, and how they will practice better medicine through their
use.
Saad Shakir, MD
TITLE: Neuro-Modulation: A New Specialty in Medicine,
Focus on Trans-Cranial Magnetic Stimulation (TMS)
DESCRIPTION:
Objectives:
1. To identify new theories for causation of mood and anxiety disorders.
2. To be able to understand amazing advances in treatment of those disorders.
3. To address advances in the recognition of localized interventions including neuromodulation.
NOTES
25
Anxiety and depressive disorders are extremely prevalent in epidemiological surveys in the U.S. The
lifetime prevalence of anxiety disorder is listed at about 25% and lifetime prevalence of depression is
approximately 18%. These disorders are often misdiagnosed, under-diagnosed, and certainly a lot of
time under-treated or mistreated due to the above, and often times the contact might be with a primary
care physician where the presentation might be more complex. Other than presentation with depressed
mood, there might be somatic presentations like a pain disorder, insomnia, irritability, changes in appetite, fatigue, or other more somatic presentations that might camouflage and mask the depressive presentation. Oftentimes, under-diagnosis can contribute to more expensive evaluation with multiple medical procedures and the end result is that, in large epidemiological studies in the U.S., only about
21.6% of patients are receiving adequate healthcare treatment. An investigation done in the United
States on 514 individuals with major depression revealed that about half did not receive any treatment
and the other half did receive healthcare treatment. For those who did receive healthcare treatment,
about 60% received what is considered inadequate treatment and 40% received minimally adequate
treatment. This results in complex, prevalent, under-treated, under-diagnosed, and higher likelihood of
comorbidity. Medical sciences have also investigated that the delay to reach remission in depressive
and anxiety disorders contributes to worsening prognosis in many medical conditions as well as
co-morbid psychiatric and chemical dependency conditions, not to mention the specter of suicide being
very high in those individuals.
Abstract:
This presentation will address the issue and outline solutions that might be effective, including
neuropsychological, neurobehavioral, environmental, and lifestyle solutions, and managing triggering
factors, as well as neuromodulation through the latest advances in treatment with transcranial
magnetic stimulation, either as a stand-alone treatment or as an adjunct to other available
somatic treatments like ACT (shock therapy), and pharmacological treatment.
NOTES
26
Tom Treasure, MD
TITLE: Personalised Aortic Root Support (PEARS) for People with
Inherited Disorders
DESCRIPTION:
Marfan syndrome is one of a number of congenital connective tissue disorders in which dilatation of the
aortic root leads to aortic dissection and rupture. This is the most frequent cause of premature death in
people with Marfan syndrome, most commonly in their twenties and thirties, shortening average life
expectancy by about a third.
Total aortic root and valve replacement with re-implantation of the coronary arteries was first performed in
1968. The operation was progressively refined during the 1980s with improved devices and techniques.
Over the last 40 years, life expectancy in Marfan syndrome has been restored to near normal through
earlier recognition of affected families and individuals and prophylactic aortic replacement.
The new problem was the lifelong consequence of a replacement valve, predominantly thromboembolism
and anticoagulant-related bleeding. Tissue valves provided an alternative but with the inevitability of tissue
failure over time. It was hoped that valve-sparing surgery developed during the 1990s would overcome
these problems but these valves are also prone to fail over time.
In 2000, an engineer with Marfan syndrome proposed that we explore the use of computer-aided design
(commonly known as CAD modeling) to create an external support. He was the first to have this done in
2004. It has now been used in over 40 patients. Results have been published in Heart
(10.1136/heartjnl-2013-304913). The story of this innovation and its potential future will be presented.
NOTES
27
David Verity, MD
TITLE: St. John Eye Hospital in Jerusalem - Ancient Order,
Modern Hospital
DESCRIPTION:
In this presentation, I shall explore the history of the Hospital of St. John in Jerusalem, and discuss the
current work of the Hospital in providing eye-care facilities to the Palestinian population.
The St. John Eye Hospital Group serves the Palestinian people in East Jerusalem and in the occupied
territories, stretching from Tulkarem in the north to Rafa in the southern reaches of Gaza. The Hospital
Group, formed of the main hospital in Jerusalem, a smaller St. John unit in Anabta in the north, the Hebron
clinic in the south, and a clinic in Gaza City, provides comprehensive ophthalmic facilities to all patients.
The total catchment population numbers over 4.3 million, of which about 1.2 million people live in refugee
camps in the West Bank and the Gaza Strip, and the vast majority is dependent on international aid.
The Hospital group provides treatment for all forms of eye disease, including childhood disorders such as
cataract and squint, external eye diseases (allergic disease and acquired corneal pathology being
particularly common), oculoplastic disorders (such as eyelid malpositions and tumors), all retinal
conditions including diabetic eye disease (with a dedicated retinal treatment suite), cataract surgery (with
over 3,200 operations performed in 2012), glaucoma, and a 24-hour emergency service. With its own
orthoptic department and nursing school, diagnostic facilities, on-site pharmacy, theatre suites in
Jerusalem and Anabta, and in-house bioengineering support services - and all provided with local
expertise - the Hospital is equipped to deal with the volume and complexity of ophthalmic work in this
population.
NOTES
28
Mohammad Wehbi, MD
TITLE: New Innovations in Gastroenterological Interventions
DESCRIPTION:
The endoscopic advances in Gastroenterology have reached a new high. Sites, which were once inaccessible like the common bile duct, are readily assessed. The presentation will address advanced endoscopic
procedures including direct cholangioscopy, small probe ultrasound, single and double balloon endoscopy,
colonic and esophageal capsule endoscopy, endoscopic mucosal resection, and the lattest in Barrette’s
esophagus treatment. Clinical cases will be presented pertaining to the different interventions.
NOTES
29
SAAD YASIN, BSD, MSc
TITLE: Treatment of Lower Edentulous Ridge by Implant-supported
PFM Fixed Prosthesis
DESCRIPTION:
Introduction: The mandibular edentulous ridge often represents a challenge for the prosthodontist when he
constructs a removable acrylic prosthesis. In many cases, there are reduction of height and width of the
residual ridge due to long ago teeth extraction and subsequent bone resorption. This, in turn, reduces the
retention and support of the lower complete denture.
Root form dental implants can solve this problem by offering an acceptable degree of retention and support
for the fixed or removable dental prosthesis.
Purpose: To show the steps of fabrication of implant-supported fixed prosthesis for a patient with
edentulous residual lower ridge.
Methods and material : Six root form titanium implants were implanted successfully after making a flap by
incision along the ridge crest and these implants were loaded by 12units of PFM fixed prosthesis after
successful osseointigration after healing period of three months.
Result: The implant-supported fixed prosthesis met aesthetic and mastication demands of the patient
successfully throughout good retention and stability of the prosthesis.
Conclusion: Implants can overcome the retention and stability requirements for success of the prosthesis
in mandibular edentulous ridges by providing good anchorage of the prosthesis to the supporting bone.
NOTES
30
What is NAAMA?
The National Arab American Medical Association (NAAMA) is a nonprofit,
nonpolitical, educational and humanitarian organization. Its members are
medical professionals of Arab descent, or have a close affinity with
individuals of Arabic origin, or demonstrate a
commitment to the mission and organizational objectives of NAAMA.
The objectives of NAAMA encompass a wide range of professional,
educational, charitable, humanitarian and cultural activities.
NAAMA BOARD OF DIRECTORS
EXECUTIVE COMMITTEE
Terry Meriden, MD
FACN, FACE, FACP, FAAMA
NAAMA President
Rezik Saqer, MD
President-Elect
Mahmoud Aqel, MD
Vice President
Haifa Azawi, MD
Executive Secretary
Ghabi Kaspo, DDS
Chief Financial Officer
Elie Azrak, MD
Past President
Edward (Ted) Yaghmour, MD
DIRECTORS
Nadia Abunijmeh, MD
Ahmad Alturjuman, MD
Humam Akbik, MD
Bassam Hadaya, MD
Sherine Hanna, MD
Nadia Kaisi, MD
Marwan Refaat, MD
Mae Sheikh-Ali, MD
George Zureikat, MD
Zaina Mohtaseb, MD (Resident Representative)
Omar Yasin (Student Representative)
Adil Alhumadi, MD, Parliamentarian
NAAMA Foundation Chair
Lena Meriden,
NAAMA Auxiliary Chair
NAAMA EXECUTIVE DIRECTOR
Renée Ahee, MSF, APR
NAAMA’S 36TH NATIONAL MEDICAL CONVENTION
August 29 - September 1, 2014
Manchester Grand Hyatt Hotel
San Diego, California
Registration
Convention: http://www.naama.com/national-naama-conventions-php/
Hotel Rooms: https://aws.passkey.com/event/10809281/owner/414/home
Sponsorship: http://www.naama.com/wp-content/uploads/2012/04/San-Diego-Sponsor-Book-PRINT.pdf