Day 1 :
Mandal Diabetes Research Foundation, USA
Time : 09:35-10:10
Anil K Mandal is a native of India and a naturalized citizen of the United State of America. He is board certified in Internal Medicine and Nephrology (not yet recertified in nephrology). Diabetes Mellitus is the most common cause of kidney failure in the USA and worldwide. This strong association between diabetes and kidney failure has inspired Dr. Mandal to develop the framework of Mandal Diabetes Research Foundation to assist diabetic patients in living a good life with medical treatment, and avoiding dialysis. He is a published author/editor of 12 books and more than 100 articles on research indiabetes and kidney disease. He is a two-time Fulbright Scholar and a visiting professor of 23 countries which permitted lectures on diabetes, high blood pressure and kidney diseases on five continents of the world. His astute knowledge and total dedication help patients get better and to live a good life. His convictions are that in the office patients come first, at home children come first. Roses are his love, hence rose gardening is his hobby
This treatise of chronic kidney disease (CKD) describes association of hypertension, diabetes and congestive heart failure (CHF) with CKD. CKD is defined by estimated glomerular filtration rate (eGFR) of less than 60ml/min for three months or more. CKD is generally irreversible but not necessarily progressive. Thus progression of CKD into end stage renal disease (ESRD) is the concern here and what can be done to reduce the progression of CKD. Exact data of CKD with progression is unavailable but high incidence of ESRD (dialysis) eleven times more in 2011 than in 1980 accordingly to United States (US) Renal Data System is a testimonial to progression of CKD in patients with diabetes, hypertension, CHF and other renal diseases. US Renal Data System reveals that ESRD has soared in parallel with marketing of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) drugs, providing strong indirect evidence that these drugs are someway instrumental in the progression of CKD into ESRD. These drugs produce acute renal failure which is an independent risk factor for CKD. Thus shift in therapy with enthusiastic use of ACEI/ARB drugs has led to dialysis bonanza throughout the world benefiting the professionals and corporations at the expense of vegetative life of the patients associated with family and societal burdens. The ways to turn the pendulum is to treat diabetes with insulin and hypertension with beta blocker, calcium channel blocker and diuretic therapy, and avoid the use of ACEI/ARB drugs. It is important to understand that diuretic orally, by intravenous boluses or by continuous infusion is the cornerstone of therapy for CHF, whereas ACEI/ ARB drugs markedly impair the efficacy of diuretics by lowering the blood pressure to a very low level thereby reducing renal perfusion. An evidence for that is marked elevation of BUN with comparatively slight increase of serum creatinine. Thus with the approaches stated above, CKD is less likely to progress; hence rate of ESRD is likely to decrease.
University of New England College of Osteopathic Medicine, USA
Keynote: Posterior approach to kidney dissection: An old surgical approach for integrated medical curricula
Time : 10:10-10:45
Frank Daly, Ph.D. is an associate professor in the Department of Biomedical Sciences at the University of New England College of Osteopathic Medicine. He received his Doctorate in anatomy & neurobiology in 1997 from Boston University School of Medicine and pursued postdoctoral studies at the Howard Hughes Medical Institute at Massachusetts General Hospital and Harvard University. Dr. Daly teaches gross anatomy & embryology in the osteopathic medical clinical skills course and is course director for gross anatomy, histology and embryology for the dental students. He is the director of the anatomical donor program for the University and the State of Maine.
Integrated medical curricular changes are altering the historical regional anatomy approach to abdominal dissection. The renal system is linked physiologically and biochemically to the cardiovascular and respiratory systems; yet, anatomists often approach the urinary system as part of the abdomen and pelvic regions. As part of an integrated curriculum, the renal system must be covered relatively quickly after the thorax in the cadaver laboratory, often without the opportunity to fully appreciate the rest of the abdominal contents. This article provides dissection instructions that follow one of the historical surgical approaches for nephrectomy, including preservation of the posterior abdominal wall neurovasclature. Dissection procedures were developed for first-year medical students, intending this posterior approach to the kidneys to be their first introduction to the renal system. It has been successfully implemented with the first-year medical students at the University of New England, College of Osteopathic Medicine. Utilizing this posterior approach to the kidney enabled the study of the anatomy of the kidneys, suprarenal glands, and renal vessels, as well as the muscles of the lumbar spine, while maintaining the integrity of the anterior abdominal wall and peritoneal cavity for future gastrointestinal and reproductive system-based dissections