4
th
International Diabetic Foot Conference 14 -15 November, 2013 JW Marriott Marquis Dubai, United Arab Emirates
www.idfc.ae
Conference Brochure Supported By
Main Sponsor
Conference Secretariat: Tel: +971 4 311 6300, Fax: +971 4 311 6301 Email: idfc@mci-group.com1
His Highness Sheikh Khalifa Bin Zayed Al Nahyan President of the U.A.E
2
His Highness Sheikh Mohammed Bin Rashid Al Maktoum Vice President, Prime Minister and Ruler of Dubai
3
His Highness Sheikh Hamdan Bin Rashid Al Maktoum Deputy Ruler of Dubai, Minister of Finance, UAE President of Dubai Health Authority
4
Table of Contents Welcome Message ……………………………………..............…07 Committee ............……………………………………..............…09
Organizing Committee…………………………………… 09
Scientific Committee……………………………………… 10
Conference Faculty ………….....................……….......…11 - 14 General Information ………………………………….......…15 - 16 Venue Layout ……………......…………………………….………..18 Scientific Program & Workshops ....………………….........… 19 Faculty Profiles ....………………...........................…..….23 - 33
International Faculty……………………………………… 23
Regional Faculty……………………………………….…… 26
Local Faculty……………………………………….………… 33
Oral Presentions.…………......................……….…………36 - 39 Poster Presentions.…………......................……….………40 - 51 Sponsors Profiles…………......................……….……………… 52 Acknowledgements ……………………………………….....…….53
5
TheraHoney™
Sterile Wound Dressings
The sweet solution for wound care 100% medical grade honey helps promote debridement, moist healing environment, reduced wound odor TheraHoney products contain 100% medical-grade Manuka honey, which is derived from the pollen and nectar of the Leptospermum scoparium plant in New Zealand. The honey comb is used only one time, and once harvested, the honey is carefully filtered, irradiated and tested in a laboratory for maximum efficacy. The high sugar levels (87%) in TheraHoney result in osmotic pressure that helps promote autolytic debridement of necrotic tissue, lowers the pH of the wound, provides a moist wound healing environment and rapidly reduces wound odor.
TheraHoney™ Gel
For more details on the uses for TheraHoney or to arrange a trial, call your Medline representative or 1-800-MEDLINE.
© 2012 Medline Industries, Inc. TheraHoney is a trademark and Medline is a registered trademark of Medline Industries, Inc.
6
TheraHoney™ Gauze
Welcome Message
Dear Colleagues & Friends, Following a successful 3rd International Diabetic Foot Conference held in November 2012; we will once again host the International Conference of global experts in the field of diabetic foot care during the 4th International Diabetic Foot Conference (IDFC) taking place from 14-15 November, 2013 in JW Marriott Marquis Hotel Dubai, UAE. This year’s conference is a continuation from the previous editions where it will highlight international, regional and local speakers who come with a wealth of knowledge to share through plenary sessions, evidence-based and hands-on workshops with breakout sessions to meet the needs of all attendees. The IDFC has been identified already in the region as a platform for the medical fraternity to get together and update in the field of Diabetic Foot Prevention and Management. Attendees will have the chance to network with experts from around the world. There have been many recent advances in wound healing specifically at the level of the individual cells. New technologies and therapeutic modalities are promising and will soon be available in routine clinical practice. We look forward to share it all with you!
Dr. Marwan Al Zarouni Conference Chair
7
Welcome Message
Dear Colleagues & Friends, On behalf of the IDFC Committee, it is my great pleasure and honor to invite you to the 4 th International Diabetic Foot Conference to be held from 14-15 November, 2013 in Dubai, United Arab Emirates. Diabetic foot care is a global issue, with its risk factors increasing around the world. Physicians in every country must share their state-of-the-art knowledge of diagnostic, therapeutic, and preventive methods to empower everyone worldwide to fight against the disease. I sincerely hope that this conference will successfully spread the awareness. I am looking forward to your participation in the conference and your great contribution is very much appreciated. Looking forward to meeting and participating with you at the Congress!
Ms. Mounia Sabasse Conference Co-Chair
8
Organizing Committee
Dr. Marwan Al Zarouni
Conference Chair Head of Plastic Surgery and Wound Care Rashid Hospital, President of Emirates Plastic Surgery Society Scientific President of Emirates Medical Association Founded the Gulf Diabetic Foot Working Group (GWFWG), Chairperson of GWFWG United Arab Emirates
Ms. Mounia Sabasse
UAE Representative in International Working Group on Diabetic Foot IWGDF Founded the Gulf Diabetic Foot Working Group (GWFWG), Co-Chair of GWFWG Wound, Ostomy, Diabetic Foot Specialist Rashid Hospital United Arab Emirates
9
Scientific Committee
Ms. Aisha Saif Amour Al Mahrazi
Aisha Saif Amour Al Mahrazi Senior Staff Nurse Directorate General of Health Services Oman
Dr. Salma Ebrahim Ali Khuraibet Vice president Kuwait Wound care society Diabetic foot & Wound care specialists Kuwait
10
Dr. Badriya Abdulla Al-Lenjawi
Assistant Executive Director of Nursing Hamad Medical Corporation Qatar
Dr. Sadiq Abdulla
Chairman of Vascular and Transplant Unit Consultant Thoraco-Vascular and Transplant, Surgeon SMC Assistant professor Arabian Gulf University Bahrain
International Faculty
Dr. David G. Armstrong
Professor of Surgery and Director Southern Arizona Limb Salvage Alliance (SALSA) University of Arizona College of Medicine USA
Ms. Madeleine Flanagan
Principal Lecturer Faculty of Health & Human Sciences University of Hertfordshire United Kingdom
Dr. Karel Bakker
Chairman of the International Working Group on the Diabetic Foot The Netherlands
Dr. Omar Schembri
Senior Specialist Podiatrist Tissue Viability Unit Mater Dei Hospital Malta
Dr. William Ennis
Professor of Clinical Surgery Division of Vascular Surgery Chief, Section of Wound Healing and Tissue Repair University of Illinois USA
11
Regional Faculty
Dr. Adel Abdul Aal Hyperbaric & Diving Medicine Consultant Head Of Hyperbaric & Diving, Medicine Unit King Hamad University Hospital Bahrain
Ms. Eisiah Maqboul Abbas Wound & Ostomy care specialist King Abdul-Aziz medical city Saudi Arabia
Dr.Huda Al Dhubaib
General surgeon and diabetic foot specialist Kuwait
12
Ms. Aisha Saif Amour Al Mahrazi Senior Staff Nurse Directorate General of Health Services Oman
Prof.Hanan Gawish
Dr. Badriya Abdulla Al-Lenjawi
Assistant Executive Director of Nursing Hamad Medical Corporation Qatar
Dr. Hashim Mohamed
Prof Diabetes & Endocrinology Unit, Mansoura University. Scientific Secretary of Egyptian Society of Diabetic Foot (ESDF) Secretary of the IDF DF Consultative section Egypt
A/professor Weill Cornell Medical College Senior Consultant Family Medicine Hamad Medical Corporation Qatar
Prof.Mamdouh El-Nahas
Muhammad Yakoob Ahmedani
Professor of Endocrinology The head of Endocrinology and Diabetes unit Mansoura University Chairman of Egyptian Society of Diabetic Foot Egypt
Consultant Physician & Diabetologist Baqai Institute of Diabetology & Endocrinology (BIDE) Professor of Medicine Baqai Medical University Hospital Pakistan
Regional Faculty
Dr. Nashat Ali Ghandoura Surgical & DF Consultant Head of Surgical Departments King Fahd Hospital Ministry of Health Saudi Arabia
Dr. Sadiq Abdulla
Chairman of Vascular and Transplant Unit Consultant Thoraco-Vascular and Transplant Surgeon SMC Assistant professor Arabian Gulf University Bahrain
Dr. Salma Ebrahim Ali Khuraibet Vice president Kuwait Wound care society Diabetic foot & Wound care specialists Kuwait
Dr. Saud M. Al Harthi Endocrinologist Department of Medicine Al Nahdha Hospital Oman
13
Local Speakers
Dr. Marwan Al Zarouni
Conference Chair Head of Plastic Surgery and Wound Care Rashid Hospital, President of Emirates Plastic Surgery Society Scientific President of Emirates Medical Association Founded the Gulf Diabetic Foot Working Group (GWFWG), Chairperson of GWFWG United Arab Emirates
Ligi Thomas Palathingal Wound Care Nurse Rashid Hospital United Arab Emirates
Ms. Gulnaz Mir
Senior Charge Nurse/Unit Manager, Wound Care Services Sheikh Khalifa Medical City United Arab Emirates
14
Ms. Mounia Sabasse
UAE Representative in International Working Group on Diabetic Foot IWGDF Founded the Gulf Diabetic Foot Working Group (GWFWG), Co-Chair of GWFWG Wound, Ostomy, Diabetic Foot Specialist Rashid Hospital United Arab Emirates
Dr. Mohammed Seddiq
Dr. Samir Mohammed Alassar
Ms. Waafa Helmi Rida
Ms. Shyarlin Ruba
Vascular Surgeon Rashid Hospital United Arab Emirates
Director of Clinical Nutrition Department Clinical Support Services Sector United Arab Emirates
General Surgeon Specialist Registrar and Wound Care Physician Rashid Hospital United Arab Emirates
Wound Care Nurse Rashid Hospital United Arab Emirates
General Information Registration Desk: Registration desks for name badge collection and onsite registration will be operational as below: 14 November, 2012 07.30 – 17.30 15 November, 2012 08.00 – 12.00 Badges: u Name badges must be visible and used at all times at the Conference Venue. Badge Colors: Red: Faculty (all access) Gold: Committee (all access) Black: Organizer (all access) Blue: Delegate (all access except speaker preview room) Green: Exhibitor (access to exhibition only) Orange: Guest (all access except speaker preview room) Violet: Media (all access except speaker preview room) Conference Bags: u Conference bags may be collected from the bag collection desk in the registration desk. Your badge contains a voucher needed to collect your conference bag. CME Certification: u This scientific program is awarded (12 CPD Credit points by Dubai Health Authority) u This scientific workshops are awarded (0.75 CPD Credit points by Dubai Health Authority) u Certificates of attendance for Scientific Program & Scientific Workshop will be issued online after the conference. Delegates are required to keep note of the codes for each session & Workshop which will need to be entered online to receive the certificate of attendance after completing the online evaluation form Speaker Registration & Preview Room: u Speakers are requested to register at the registration desk in the Speaker Preview Room (Salon 8c) NOTE: All speakers are requested to report at least 2 hours before their lecture for a final check on their presentation material in Salon 8c. Conference & Workshops: u The Conference will be held in the Emirates Ballroom on the 6th floor. u Scientific Workshops, Industry Workshops and free paper presentations will be held in Majlis Rooms 1, 2, 3 on the 6th floor concurently to the main program 15
General Information Food & Beverage: u Coffee Breaks and lunch will be open to all registered delegates ONLY. The hotel also offers a variety of all day dining restaurants to choose from. u Lunch will be served at the Emirates Ballroom 1 & 2, Business Bay Restaurant. Exhibition: u The exhibition of the 4th International Diabetic Foot Conference 2013 will be located in the foyer area of the Emirates Ballroom. Rules: u u Parking: u
Smoking Policy: The JW Marriott Marquis Dubai hotel is a non smoking venue. Participants are requested to exit the building to the designated smoking areas. Mobile Phones: All conference attendees are kindly requested to keep their mobile phones in the off mode in meeting rooms when scientific sessions are in progress.
24 hours courtesy valet parking is available at the conference venue.
Prayer Room: u A shuttle bus will be available to the mosque for Friday Prayer. Bus will leave the hotel at 12:15. u Prayer rooms availabe for ladies and gentlemen at the venue. Emergency Contact: While in Dubai during the conference, for any emergency, please contact the following people from the conference secretariat: Michael Latti Fabby Almirol +971 50 784 0993 +971 56 1763277 Conference Secretariat:
16
MCI Dubai Office
P.O. Box: 124752 Dubai, United Arab Emirates Tel: +971 (4) 311 6300, Fax: +971 (4) 311 6301 Email: idfc@mci-group.com
More Healing Less Pain
PolyMem Silver Rope
PolyMem Polytube (Tube Dressing)
PolyMem Pink & Silver Pads
The Four in One Intelligent Dressing
PolyMem Cavity Filler
Enhances the healing process Reduces pain & discomfort Effective & easy to use FDA approved
Tel.: +971 4 3405991 marketing@lunatus-me.com
Cutimed Off-Loader
Total Contact Cast System Cost effective Complete treatment kit for diabetic foot ulcers 1st choice for wounds not showing significant healing at 4 weeks Reduces shear and friction 17
18
Poster Presentation Area
Speaker Room
Convatec Medway
2 7x4
Medline
Main Entrance (from hotel)
13 2x2 14 2x2 3 4
1
Lunatus 7x3
4x2
Julphar
Coffee Station
4x2
Al Maz/ Molnlycke
Sessions
Ballroom
Main Entrance (outside delegates)
Registration Desk
Lohmann 4x2 5
Bridgeway 9 4x2
4x2
Abbott
Diaped
Schein
12 2x2 11 2x2
3x2
8
3x2
Smith & Nephew
7
3M
Workshops
13 2x2 10 2x2
Pfizer
KCI
Coffee Station
6
Lunch
Ballroom
Venue Layout
19
14 -15 November, 2013
Majlis 1
Panel Discussion
Session 2: 12:30 – 12:50 Differential of Leg Pain in Diabetics Prof. Hanan Gawish, Egypt
Session 2: 12:10 – 12:30 The Role of Endocrinologist in Treating the Diabetic Foot Dr. Saud Alharthi, Oman
Session 2: 11:50 – 12:10 DF is a Terminal Disease? Dr. Salma Khuraibet, Kuwait
Session 2: 11:30 – 11:50 Endovascular Treatment of Peripheral Vascular Disease in Diabetic Patient Dr. Sadiq Abdulla Ahmed Salman, Bahrain
Ms. Mounia Sabasse, UAE Ms. Shyarlin Ruba, UAE
Diabetic Foot Assessment and Advance Wound Dressing
12:05 – 12:45 Scientific Workshop 1 (0.75 CPD Points)
Ms. Mounia Sabasse, UAE Ms. Shyarlin Ruba, UAE
Diabetic Foot Assessment and Advance Wound Dressing
11:15 – 12:00 Scientific Workshop 1 (0.75 CPD Points)
11:30 - 13:40 Session 2 - Moderator: Dr. David G. Armstrong, USA
11:00 – 11:30 Coffee Break & Exhibition Viewing
10:15 – 11:00 Opening and Welcome, Dr. Marwan Al Zarouni, UAE Patron of Conference International Diabetic Foot Conference 4 Years Journey, Ms. Mounia Sabasse, UAE
Session 1: 09:55 – 10:10
Session 1: 09:25 – 09:55 The Future of the Diabetic Foot Prevention in the Gulf (Foundation of Gulf Diabetic Foot Group) Ms. Mounia Sabasse, UAE
Session 1: 08:55 – 09:25 Diabetic Foot Surgery: Rational or Reckless? “It’s not what you put on, but what you take off” Dr. David G. Armstrong, USA
Session 1: 08:30 – 08:55 The Impact of Diabetic Interdisciplinary Foot Care Teams Ms. Madeleine Flanagan, UK
Session 1: 08:00 – 08:30 Epidemiology of Diabetic Foot in the Region Dr. Karel Bakker, The Netherlands
08:00 - 10:10 Session 1 - Moderator: Dr. Sadiq Abdulla Ahmed Salman, Bahrain
07:30 - 08:00 Registration
Emirates Ballroom
JW Marriott Marquis Dubai, UAE |
4th International Diabetic Foot Conference
Ms. Margaret Falconio-West, USA
Diabetic Foot Assessment and Classification
11:30 – 12:15 Medline Workshop (Non CME)
Majlis 2
Dr. Charalambos Agathangelou, Cyprus
PolyMem, An Innovation in Diabetic Foot Wound Management
11:30 – 12:45 Lunatus Workshop (Non CME)
Majlis 3
Preliminary Scientific Program Thursday, 14 November, 2013
20
Panel Discussion
Art and Science of Wound Dressings: DIMES Applied to Wound Bed Dr. Debashish Chakravarthy, USA
Diabetic Foot Assessment and Advance Wound Dressing Ms. Mounia Sabasse, UAE Ms. Shyarlin Ruba, UAE
Panel Discussion
17:35 Closing & Prize Draw
Session 4: 17:20 – 17:30
Panel Discussion
Session 4: 17:00 – 17:20 Educate Before Your Treat Ms. Eisiah Maqboul Abbas, Saudi Arabia
Session 4: 16:40 – 17:00 Neurological Assessment for Diabetic Foot Dr. Omar Schembri, Malta
Session 4: 16:20 – 16:40 Is Natural Honey a Credible Alternative to Advanced Wound Products? Dr. Hashim Mohamed, Qatar
Session 4: 16:00 – 16:20 The Importance of Tissue Viability Nurse in Diabetic Foot Management Dr. Badriya Abdull Allengawi, Qatar
Dr. Mohammed Seddiq, UAE Ms. Ligi Thomas, UAE
Diabetic Foot Vascular Assessment
16:45 – 17:30 Scientific Workshop 2 (0.75 CPD Points)
Dr. Elia El Hachache, UAE
Mr. Mohammad Al Derwish, Saudi Arabia Mr. Samir Ouizi, Saudi Arabia
Diabetic Foot Offloading Management
12:50 – 13:35 Lunatus Workshop (Non CME)
Majlis 3
Free Paper: 14:55 – 15:15 Quality of Life of Patients with Diabetic Peripheral Neuropathy Dr. Amal Samir Ahmed, Egypt Free Paper: 15:20 – 15:40 A Comprehensive Physiotherapy Approach for Management of the Diabetic Foot Dr. Veena Raigangar, UAE
Free Paper: 14:30 – 14:50 Matrix Therapy in Regenerative Medicine from Basic Science to Clinics Evidenced in DFU Prof. Denis Barritault, France
14:30 - 15:40 Free Paper Session - Moderators: Dr. Samir Al Assar (UAE) and Dr. Sadiq Salman (Bahrain)
Botannical Science Applied to Diabetic Foot Care: The Phytoplex Technology
16:45 – 17:30 Medline Workshop (Non CME)
Dr. Elia El Hachache, UAE
Promoting the Edge Effect in Refractory Diabetic Foot Ulcers
Diabetic Foot Vascular Assessment Dr. Mohammed Seddiq, UAE Ms. Ligi Thomas, UAE
16:00 – 16:45 Medline Workshop (Non CME)
Ms. Margaret Falconio-West, USA
Rules of Compression Therapy Applied to Lower Limbs: Do's & Dont's
Diabetic Foot Vascular Assessment Dr. Mohammed Seddiq, UAE Ms. Ligi Thomas, UAE
14:30 – 15:15 Medline Workshop (Non CME)
14:30 – 15:15 Scientific Workshop 2 (0.75 CPD Points)
16:00 – 16:45 Scientific Workshop 2 (0.75 CPD Points)
16:00 – 17:30 Session 4 - Moderator: Ms. Waafa Helmi Rida, UAE
15:40 – 16:00 Coffee Break & Exhibition Viewing
Session 3: 15:30 – 15:40
Session 3: 15:10 – 15:30 Medical Nutrition Therapy for Wound Healing Ms. Waafa Helmi Rida, UAE
Session 3: 14:30 – 15:10 Diabetic Foot Ulcers: Findings at the Micro-Environmental Level Dr. William Ennis, USA
14:30 – 15:40 Session 3 - Moderator: Ms. Aisha Saif Al Mahrazi, Oman
13:40 – 14:30 Lunch
Session 2: 13:30 – 13:40
Session 2: 13:10 – 13:30 The Impact of the Diabetic Foot Nurse In Preventing and Treating the Foot Ulcer Ms. Aisha Saif Al Mahrazi, Oman
Majlis 2 12:50 – 13:35 Medline Workshop (Non CME)
Majlis 1
Preliminary Scientific Program Thursday, 14 November, 2013
12:50 – 13:40 Scientific Workshop 1 (0.75 CPD Points)
14 -15 November, 2013
Session 2: 12:50 – 13:10 Management of Painful Peripheral Diabetic Neuropathy Prof. Mamdouh El-Nahas, Egypt
Emirates Ballroom
JW Marriott Marquis Dubai, UAE |
4th International Diabetic Foot Conference
21
10:45 – 11:30 Medline Workshop (Non CME) Art and Science of Wound Dressings: DIMES Applied to Wound Bed Dr. Debashish Chakravarthy, USA
Diabetic Foot Offloading from Basic to Advance Dr. Omar Schembri, Malta
Panel Discussion
12:10 – 14:00 Friday Prayer & Lunch
Session 6: 12:05 – 12:10
Session 6: 11:45 – 12:05 A Diabetic Foot Prevention, A 5 year Journey UAE Ms. Gulnaz Mir, UAE
Session 6: 11:30 – 11:45 Open Access System of Diabetic Foot Care Salmanya Hospital Experience Dr. Sadiq Abdulla Ahmed Salman, Bahrain
Ms. Margaret Falconio-West, USA
Diabetic Foot Assessment and Classification
09:40 – 10:25 Medline Workshop (Non CME)
Majlis 2
11:30 – 12:10 Medline Workshop (Non CME) Rules of Compression Therapy Applied to Lower Limbs: Do's & Dont's Ms. Margaret Falconio-West, USA
11:30 – 12:10 Scientific Workshop 3 (0.75 CPD Points) Diabetic Foot Offloading from Basic to Advance Dr. Omar Schembri, Malta
Dr. Christoph Reuter Mr. Chahine El-Hindy, UAE
Integration of Collagen Dressings and NPWT - Indications, Choices and Limits of a Novel Approach
10:50 – 11:30 Lohmann & Rauscher Workshop (Non CME)
09:40 – 10:25 Molnlycke Health Care and Al Mazroui Medical Workshop (Non CME) Patient Centered Concerns in the Ulcerated Diabetic Foot Mrs. Hiske Smart, Canada
Majlis 3
Preliminary Scientific Program Friday, 15 November, 2013
10:45 – 11:30 Scientific Workshop 3 (0.75 CPD Points)
Dr. Omar Schembri, Malta
Diabetic Foot Offloading from Basic to Advance
Session 5: 11:25 – 11:30 Panel Discussion 11:30 – 12:00 Session 6 - Moderator: Dr. Nashat Ghandoura, Saudi Arabia
Session 5: 11:05 – 11:25 Diabetic Foot Experience in Kuwait Dr. Salma Khuraibet, Kuwait
Session 5: 10:45 – 11:05 Diabetic Foot Past, Present Future in Pakistan Prof. Muhammad Yakoob Ahmedani, Pakistan
10:30 – 10:45 Coffee Break & Exhibition Viewing
Session 5: 10:05 – 10:30 Offloading the Diabetic Foot: 30 years of Research in 30 minutes Dr. David G. Armstrong
Session 5: 09:40 – 10:05 Update of Diabetic Foot Guidelines Dr. Karel Bakker, The Netherlands
Session 5: 09:15 – 09:40 The Role of Education in Prevention and Management of Diabetic Foot Complications Ms. Madeleine Flanagan, UK
Session 5: 08:45 – 09:15 Diabetic Foot Prevention Dr. Karel Bakker, The Netherlands
Majlis 1
09:40 – 10:25 Scientific Workshop 3 (0.75 CPD Points)
14 -15 November, 2013
08:45 – 11:30 Session 5 - Moderator: Dr. Hashim Mohamed, Qatar
07:30 – 08:30 Registration
Emirates Ballroom
JW Marriott Marquis Dubai, UAE |
4th International Diabetic Foot Conference
22
14 -15 November, 2013
Panel Discussion
Panel Discussion
17:10 – 17:30 Closing & Prize Draw
Session 8: 17:00 – 17:10
Session 8: 16:40 – 17:00 Surgical Management of Diabetic Foot Dr. Marwan Al Zarouni, UAE
Session 8: 16:20 – 16:40 Negative Pressure Wound Therapy: Clinical Practice in Management of Diabetic Foot Ulcer? When the Patient Refuses the Amputation. Dr. Samir Al Assar, UAE
Session 8: 16:00 – 16:20 Honey and Wound Healing: An Overview of a Three Year Local Clinical Experience Dr. Hashim Mohamed, Qatar
Majlis 1
Ms. Madeleine Flanagan, UK
60 Second Diabetic Foot Screening Workshop
14:55 – 15:40 Scientific Workshop 4 (0.75 CPD Points)
Ms. Madeleine Flanagan, UK
60 Second Diabetic Foot Screening Workshop
14:00 – 14:45 Scientific Workshop 4 (0.75 CPD Points)
Ms. Madeleine Flanagan, UK
60 Second Diabetic Foot Screening Workshop
16:00 – 16:45 Scientific Workshop 4 (0.75 CPD Points)
16:00 - 17:10 Session 8 - Moderator: Dr. Badriya Abdull Allengawi, Qatar
15:40 – 16:00 Coffee Break & Exhibition Viewing
Session 7: 15:30 – 15:40
Session 7: 15:05 – 15:25 Diagnosis & Management of Red, Swollen & Painful Diabetic Foot Dr. Huda Al Dhubaib, Kuwait
Session 7: 14:45 – 15:05 The Role of Human Amniotic Membrane in DF Ulcer Dr. Nashat Ghandoura, Saudi Arabia
Session 7: 14:20 – 14:40 Management of Diabetic Foot Complications by Utilizing Hyperbaric Oxygen Therapy and a Structured Inter-Professional Wound Care Approach Dr. Adel Abdul Aal, Bahrain
Session 7: 14:00 – 14:20 Clinical Case Study: Challenges in Diabetic Foot Ulcer Management Ms. Aisha Saif Al Mahrazi, Oman
14:00 - 15:40 Session 7 - Moderator: Dr. Salma Khuraibet, Kuwait
Emirates Ballroom
JW Marriott Marquis Dubai, UAE |
4th International Diabetic Foot Conference
Dr. Elia El Hachache, UAE
Botannical Science Applied to Diabetic Foot Care: The Phytoplex Technology
16:00 – 16:45 Medline Workshop (Non CME)
Dr. David G. Armstrong, USA & Dr. Chris Liscio
The Importance Of Effective Off-loading and an Easy Way To Use the Gold Standard
16:00 – 16:45 Bridgeway Workshop (Non CME)
Topic TBA Speaker TBA
15:00 – 15:45 Julphar Workshop (Non CME)
Mr. Radi Khasawneh, UAE & Mr. Khaled El Kerdany, UAE
NPWTi – The New Standard in Treating Wounds.
Promoting the Edge Effect in Refractory Diabetic Foot Ulcers Dr. Elia El Hachache, UAE
14:00 – 14:45 KCI Workshop (Non CME)
Majlis 3
14:00 – 14:45 Medline Workshop (Non CME)
Majlis 2
Preliminary Scientific Program Friday, 15 November, 2013
International Faculty Dr. David G. Armstrong Professor of Surgery and Director Southern Arizona Limb Salvage Alliance (SALSA) University of Arizona College of Medicine USA
Dr. Armstrong is Professor of Surgery (with Tenure) at The University of Arizona. Dr. Armstrong also holds a Masters of Science in Tissue Repair and Wound Healing from the University of Wales College of Medicine and a PhD from the University of Manchester College of Medicine, where he was appointed Visiting Professor of Medicine. He also co-founded the Southern Arizona Limb Salvage Alliance (SALSA). Dr. Armstrong has produced more than 350 peer-reviewed research papers in more than three-dozen scholarly medical journals as well as over four dozen book chapters. He is co-Editor of the American Diabetes Association’s (ADA) Clinical Care of the Diabetic Foot, now in its second edition. Dr. Armstrong was selected as one of the first six International Wound Care Ambassadors and is the recipient of numerous awards and degrees by universities and international medical organizations including the inaugural Georgetown Distinguished Award for Diabetic Limb Salvage. In 2008, he was the 25th and youngest-ever member elected into the Podiatric Medicine Hall of Fame. He is the 2010 and youngest ever recipient of the ADA’s Roger Pecoraro Award, the highest award given in the field. Dr. Armstrong is past Chair of Scientific Sessions for the ADA’s Foot Care Council, and a past member of the National Board of Directors of the American Diabetes Association as well as a former commissioner with the Illinois State Diabetes Commission. He sits on the Infectious Disease Society of America’s (IDSA) Diabetic Foot Infection Advisory Committee. In 2011, he was appointed Chair of the World Diabetic Foot Commission of the FIP, representing clinicians from more than 30 nations. Dr. Armstrong is the founder and co-chair of the International Diabetic Foot Conference (DF-Con), the largest annual international symposium on the diabetic foot in the world.
Dr. Karel Bakker Chairman of the International Working Group on the Diabetic Foot The Netherlands
Dr Karel Bakker was a specialist in internal medicine, diabetology and endocrinology at the Spaarne Hospital, Heemstede (The Netherlands), from which he retired in 2002. Dr Bakker was trained in the USA (Madison, Wisconsin), the Dutch Antilles and the State University Groningen in The Netherlands, where he received his PhD in Endocrinology. Dr Bakker has been very committed and involved in diabetes and foot care. In 1987 he founded the first specialized Diabetic Foot Clinic in the Netherlands. He is chairman of the IDF Consultative Section and International Working Group on the Diabetic Foot (IWGDF), which published the International Consensus and Practical Guidelines on the management and prevention of the diabetic foot in 1999. Dr Bakker has chaired a number of International Symposia on the Diabetic Foot at Noordwijkerhout, The Netherlands (1991, 1995, 1999, and 2003). Previous appointments include chairman of the Dutch Consensus Group on the Diabetic Foot and chairman of the Dutch Diabetes Education Study Group for more than 10 years. Dr Bakker has been invested with the title of Knight of the Order of the Lion of the Netherlands in 2001 in recognition of his lifelong commitment to diabetes and to diabetes foot care in particular. He was the first recipient of the Edward James Olmos Award for “Advocacy in Diabetic Foot Amputation Prevention” at the Second Southern Californian Symposium “The High-Risk Diabetic Foot in the New Millenium” in November 2003. Chair IDF Diabetic Foot Programme / International Working Group on the Diabetic Foot (IWGDF).
23
International Faculty
Dr. William Ennis Professor of Clinical Surgery, Division of Vascular Surgery Chief, Section of Wound Healing and Tissue Repair University of Illinois USA
Dr. William J. Ennis D.O. M.B.A., F.A. C.O.S. serves as the Chief Medical Officer of Accelecare Wound Centers, Inc. Dr. Ennis serves as the Chief, Section of Wound Healing and Tissue Repair, Division of Vascular Surgery at the University of Illinois Chicago. He serves as Medical Director of the Comprehensive Wound and Disease Management Center at St. James Hospital, Olympia Fields campus, and the Sub-Acute wound unit at Crestwood Care Center. Dr. Ennis serves as Medical advisor for National Medical Solutions. He is an accomplished Physician and Health Care Executive and his professional experience includes over 20 years in the health care services field. Dr. Ennis has been a Member of Clinical Advisory Board of Derma Sciences Inc. since March 2007. He is President of Association and Founding Board Member for the Advancement of Wound Care (AAWC). He is a Clinical Professor of Surgery at Midwestern University in Downers Grove, IL, as well as an Adjunct Faculty Member at Northwestern University. He is Professor of Clinical Surgery at the University of Illinois Chicago. He has published and lectured extensively and recently created the nation’s first academic, physician based fellowship in wound care at the University of Illinois Chicago. Dr. Ennis has been practicing advanced wound care for over 18 years. He is board certified in General Surgery, Vascular Surgery and Family Medicine. After graduating Phi Beta Kappa from the State University of New York at Stony Brook, Dr. Ennis earned his Medical degree from the New York College of Osteopathic Medicine. He received an MBA from the Keller Graduate School of management in Chicago
Ms. Madeleine Flanagan Principal Lecturer Faculty of Health & Human Sciences University of Hertfordshire United Kingdom
Madeleine Flanagan has been a Wound Specialist for over 25 years in a variety of hospital and community settings and was responsible for the development of the first undergraduate wound management programmes in the UK. She is currently the Programme Director for an MSc Skin Integrity Skills and the MSc Dermatology Skills & Treatment at the University of Hertfordshire, Postgraduate Medical School and has expertise of developing inter-professional curricula to support specialist clinical practice. The postgraduate programmes that she manages have been integral in supporting the development of wound management skills for a wide range of health professionals both in the UK and overseas. Madeleine has considerable experience in providing a variety of consultancy, research and educational activities related to wound management and dermatology. She regularly participates in international conferences and has lectured extensively in Europe, Australia, New Zealand, India, Japan, Middle East and South Africa on a variety of wound management related topics. Madeleine’s new text book Wound Healing and Skin Integrity: principles and practice has just been published in April 2013 and is the first of its kind to combine wound management and dermatology to provide a practical resource for managing patients with a variety of skin integrity problems.
24
International Faculty
Dr. Omar Schembri Senior Specialist Podiatrist Tissue Viability Unit Mater Dei Hospital Malta Omar Schembri has been a Podiatrist for the past 20 years. He completed his podiatry degree at the University of Brighton, UK and has recently graduated with a Master degree in Skin Integrity from the University of Hertfordshire, UK. Over his career, Omar has worked in a variety of hospitals in Malta and overseas. He developed a tissue viability podiatric service in Malta 2008 and is now the Director of this busy service. Omar is a Visiting Lecturer at the university of Malta and lectures on a variety of undergraduate and postgraduate in the professional programmes. He is the Maltese representative for the International Diabetic Foot Federation, as well as the Maltese Volunteer Podiatrist for the Special Olympics. Omar has considerable experience in providing a variety of consultancy, research and educational activities related to diabetic foot care and has a special interest in offloading.
25
Regional Faculty
Dr. Adel Abdul Aal Hyperbaric & Diving Medicine Consultant Head Of Hyperbaric & Diving Medicine Unit King Hamad University Hospital Bahrain
Dr Adel Abdul Aal is the current medical consultant of the Hyperbaric and Wound Care unit at King Hamad University hospital in The Kingdom of Bahrain. He was born in 1970, finished his schooling in the Kingdom of Bahrain and obtained his first degree to become a medical doctor in 1993 from the University of Ovidius Constanta in Romania. He is an active member of the Bahrain Defense Force with distinguished career that have led him to become the Assistant Commander of the 1st Medical Platoon in 2008. He advanced his studies at the University of Stellenbosch in South Africa in the field of Diving and Hyperbaric Medicine acquiring first the BSc and then MSc in Baro-medicine with specialization in hyperbaric oxygen Therapy in 2010 and 2011 respectively. On completion of specialization and fellowship at Stellenbosch University, he was transferred to King Hamad University Hospital to take the lead in developing a hyperbaric specialty unit at this hospital. This was achieved successfully and the unit opened its door to patients in need of Hyperbaric Oxygen therapy in February 2011 and received international accreditation as Hospital based Hyperbaric Oxygen therapy unit from Divers Alert Network International and the South African Undersea and Hyperbaric Medical Association. In advancing the Hyperbaric Oxygen Therapy service to patients, this unit had evolved into an advanced wound care unit with assessment modalities that include, diabetic neuropathy screening, transcutaneous oximetry and Doppler investigations, together with advanced dressing and treatment modalities that include the use Topical Negative Pressure therapy. Adel is well known as speaker and researcher in Bahrain and the Middle East region and is actively involved in advancing the field of Hyperbaric Oxygen Therapy regarding fitting physiological action of the therapy to specific patient pathology. His patient case load involves Diabetic foot severity, severe trauma, severe infection, autistic children and babies with Hypoxic Encephalopathy at birth. He is also a member of the research and ethics committee at King Hamad University Hospital.
Ms. Aisha Saif Amour Al Mahrazi Senior Staff Nurse Directorate General of Health Services Oman
Ms. Aisha Al Mahrazi finished her general nursing school on 1997 and International Inter Professional wound care course from University of Toronto IIWCC on 2009. Since 2003 she is working as Nursing in-charge of diabetic foot clinic in Bousher poly clinic .Since 2007 she has been post as National trainer of diabetic foot and wound management in Oman also she has been invited as trainer in many Regional conferences and workshops . She is an active Member in Oman Diabetic foot committee. Member in National Diabetic foot ulcer and management guideline and Member in Medical Surgical Specialty Group in MOH. She was award as Best Staff in health care Organization on 2012, Best understanding & performance 2011 and Diabetic foot care best and new service award 2010.
26
Regional Faculty
Dr. Badriya Abdulla Al-Lenjawi Assistant Executive Director of Nursing Hamad Medical Corporation Qatar Dr. Badriya Al-Lenjawi is an Assistant Executive Director of Nursing at Hamad Medical Corporation in Doha, Qatar. She received her Diploma in Nursing from Qatar School of Nursing in Doha, Qatar. She then completed her Baccalaureate in Nursing at the College of Health Science in the Kingdom of Bahrain. Dr. Al-Lenjawi later received a Master of Nursing from Whitworth College Spokane, WA, U.S.A and became Clinical Nurse Specialist. She then pursued a Post graduate research Diploma at Middlesex University in Enfield, UK. Lastly, she completed a Doctorate of philosophy (Ph-D) at The University of Greenwich in Kent, UK. She is a member of Nursing and nursing specializations for cooperation council states (CNNS), member in the international nutrition society, member in UK diabetes association and a member in the International Council on Women Health issues in the Eastern Mediterranean Region. Journal articles and abstracts by Dr. Al-Lenjawi have been published in several journals including the Middle East Journal of Family Medicine.
27
Regional Faculty
Ms. Eisiah Maqboul Abbas Wound & Ostomy care specialist King Abdul-Aziz medical city Saudi Arabia Eisiah is a wound& Ostomy care specialist at king Abdul-Aziz medical city (king Khalid national guard Hospital)Jeddah kingdom of Saudi Arabia. She considered to be the 1st Saudi nurse earned diploma of wound care from Toronto University through international interprofessional wound care course (IIWCC) 2007.also was one of the IIWCC course mentors in Saudi Arabia course 2008 /2009 She is also having Patients education diploma and especial training in the management of wound &Ostomy and incontents. She did many local and international Training in –Wound and Diabetic foot& Ostomy care &management. She is also having many local and international presentations about wounds and Ostomy care. She participated in the 3rd world union of wound healing society in Toronto Canada 2008 by poster presentation also in the 4th world union of wound healing society in Yokohama Japan 2012by Oral presentation. Also presented poster in the (ECET) European council of Enterostomal therapy conference in Bologna Italy 2011. Her poster about patients Education was awarded the best poster presentation in (WCET) World council of Enterostomal therapy conference Adelaide Australia 2012. Also developed many patients’ education materials (booklets & Hand outs) about wounds&ostomy care. She is a member of Hospital wound care committee. Also a member of ostomy care committee and WCET member. Also an executive member of GCCDFWG (Gulf Diabetic foot Working group).
Dr. Sadiq Abdulla Chairman of Vascular and Transplant Unit Consultant Thoraco-Vascular and Transplant Surgeon SMC, Assistant professor Arabian Gulf University Bahrain
Dr Sadiq graduated from Al Mustansiriya University, Baghdad, Iraq in 1987. He later completed his training in General Surgery at Salmaniya Medical Complex in Bahrain and received his Arab Board Certification in General Surgery. Later, moved to the UK for further training in three surgical subspecialities; Vascular , Thoracic and Transplant surgery. He trained and worked at distinguished hospitals including St.Thomas’ Hospital, The Royal Brompton Hospital, The Heartlands Hospital, St.Peters’ Hospital , London Chest Hospital and the Royal London Hospital. Up on my appointment in Salmaniya Medical Complex as a consultant vascular , thoracic and transplant in August 2000, I work very hard to reestablish the three subspecialties as the only surgeon in the Bahrain subspecialized in vascular , thoracic and transplant surgery. First successful living related transplant performed in Feb 2001 and the first cadaveric transplant in Bahrain in July 2001. Since then, I performed more than 45 cadaveric transplant operations and more than 145 live- related transplant cases. I worked to help establish the first Integrated Vascular Surgery Unit in Bahrain. The unit is one of a kind in the country where patients with diabetes and vascular disease receive highly specialized care it included under one roof outpatient clinics, diabetic foot clinic, vascular laboratories. angiogram, vascular ward. And surgical HDU. Thoracic surgery I performed a large number of lung surgeries for lung cancer and introduce thoracoscopic procedure for the first time in the country. I trained considerable number of surgical resident in my unit and educate medical student at the Arabian Gulf University.
28
Regional Faculty Prof. Muhammad Yakoob Ahmedani Consultant Physician & Diabetologist Baqai Institute of Diabetology & Endocrinology (BIDE) IDF Centre of Education Professor of Medicine Baqai Medical University Pakistan Run Diabetic Foot Clinic, besides diabetic clinic and managing Emergency and In-patients. Represented BIDE at national and international forum, participated in seminars and gave lectures to Diploma students. Working as is the project Director of ‘Insulin-my life�. This project is running in collaboration with World Diabetes Foundation to improve the care of Type 1 Diabetics all over Sindh province. The deserving patients are provided Insulin free of charge through this project.
PO Box 997, Ras Al Khaimah, United Arab Emirates T +971 7 246 1461, F +971 7 246 2462 E info@julphar.net, www.julphar.net
29
Regional Faculty
Dr. Saud M. Al Harthi Endocrinologist Department of Medicine Al Nahdha Hospital Oman Dr. Al Harthi graduated from College of Medicine (Sultan Qaboos University) in 1998. He underwent training in internal medicine and was awarded membership of the royal college of physician (MRCP) in 2003. He joined the department of endocrine and metabolism at royal hospital in 2004. Following that, he underwent higher specialty training in adult endocrinology and metabolism at King Faisal Specialty Hospital and Research Center Riyadh, KSA from 1/1/2007 to 31/12/2008 and he was awarded the Advanced Training Certificate in Adult Endocrinology and Metabolism. After his return to Oman in 2009, he joined department of medicine at al Nahdha hospital, taking care of patients with general medical and endocrine problems, and diabetes. Recently he also joined the new National Diabetes and Endocrine center conducting 2 clinics per week. Dr Al Harthi actively participate in many ministry of health activities regarding diabetes and it s complications. He is currently the chairperson of national diabetic foot management subcommittee. He is coauthor of several papers in endocrinology. l
Executives Member of Gulf Working Group of Diabetic Foot.
Dr.Huda Al Dhubaib General surgeon and diabetic foot specialist Kuwait
l Graduated from Bangalore University in 2002 undergone training in Bangalore in Ramahia Hospital. l Then in 2003 appointed in Kuwait in Al Sabah Hospital for internship. l Undergone training in many surgical department Vascular, Orthopedic, General surgery, Anesthesia, Urology, Accident Emergency l Worked in general surgery for 7 years l Appointed in Diabetic foot department for the last 3 years. l Member of Kuwait wound society l Member of Kuwait Red Crescent l Executives Member of Gulf Working Group of Diabetic Foot.
Prof.Mamdouh El-Nahas Professor of Endocrinology The head of Endocrinology and Diabetes unit Mansoura University Chairman of Egyptian Society of Diabetic Foot Egypt
Professor El-Nahas is the head of the Endocrinology and Diabetes unit at Mansoura University, Egypt. He cofounded the diabetic foot as a new subspecialty in the Endocrinology units in Egypt through setting up a centre of excellence foot clinic, publishing original papers and review articles and organizing several conferences and training courses. He is also a cofounder and the chairman of the Egyptian Society of Diabetic Foot that aims to disseminate foot care knowledge into patients and health care providers.
30
Regional Faculty Prof. Hanan Gawish Prof Diabetes & Endocrinology Unit Mansoura University Scientific Secretary of Egyptian Society of Diabetic Foot (ESDF) Secretary of the IDF/DF Consultative section Egypt
Dr. Gawish is a Professor of Diabetes and Endocrinology at Mansoura University, Egypt. She has co-founded the Mansoura Diabetic Foot Clinic. Dr. Gawish has peer-reviewed research papers in the field of DF as well as 2 book chapters. Dr. Gawish is a cofounder and now the scientific secretary of the Egyptian Society of Diabetic Foot, member of the Diabetic Foot Study Group (DFSG of EASD and Secretary of Diabetic Foot Program committee, International Diabetes Federation (IDF). In 2008, she started to manage the ‘step by step project - improving foot care in Egypt’ funded by the World Diabetes Foundation (WDF).
Dr. Nashat Ali Ghandoura Surgical&DF Consultant Head of Surgical Departments King Fahd Hospital Ministry of Health KSA
l l l l l l l
General Surgery Consultant & Diabetic Foot specialist. Head of Surgical Departments at King Fahad Hospital, Jeddah, KSA. Member of Saudi Society of surgery. Member of Scientific & Technical Committees of Diabetic Centers in Ministry of Health in Saudi Arabia. Establish 1t Diabetic Foot Unit in Saudi Arabia. Speaker & Attendance in National & International Diabetic Foot Conferences. Executives Member of Gulf Working Group of Diabetic Foot.
Dr. Salma Ebrahim Ali Khuraibet Vice president of “Kuwait Wound care society Diabetic foot & Wound care specialists Kuwait
l Diabetic foot & Wound care specialists. l Participating with faculty of medicine in Kuwait in student education in diabetic foot l Vice president of “Kuwait Wound care society”. l General surgeon. l Participated as a speaker and organizer in the “first international diabetic conference” in Kuwait at Dasman center in April, 2008 topic was Amiri hospital experience in management diabetic foot ulcers. l Organizer and speaker in a workshop held in Kuwait “ Recent advances in chronic wound management”,2011 l The first Kuwaiti doctor to be a member of the European wound management association (EWAM) since 2008 l The first Kuwaiti doctor to be a member of the Canadian wound care association (CWCA) 2008,2009&2010. l Executives Member of Gulf Working Group of Diabetic Foot.
31 31
Regional Faculty
Dr. Hashim Mohamed Professor Weill Cornell Medical College Senior Consultant Family Medicine Hamad Medical Corporation Qatar Dr. Hashim Mohammad is an Assistant Professor at Weill Cornell Medical College, Qatar and Senior Consultant of Family Medicine working at Um Ghwailina Health Center – Hamad Medical Corporation in Doha, Qatar. He is certified by the Arab Board of Family Medicine. Dr. Al-Sayed received his medical degree from the Royal College of Surgeons, Ireland and served his internship year at St. Columbcills Hospital in Dublin, Ireland. He completed his residency and fellowship in Family Medicine at Hamad Medical Corporation in Doha, Qatar. He is affiliated with several other institutions including the Arabian Gulf university, College of medicine– Kingdom of Bahrain, Greenwich university – United Kingdom Arab Board of medical specialties – Damascus Syria and Weil Cornel Medical College – Qatar. He is a member of the American Diabetes Association, Qatar Diabetes Association and American Association of clinical endocrinologists. Journal articles and abstracts by Dr. Al-Sayed have been published in numerous journals including Qatar Medical Journal, Current Urology, Middle East Journal of Family Medicine, Saudi Medical Journal, and Singapore Medical Journal.
32
©2013 KCI Licensing, Inc. All rights reserved. All trademarks designated herein are proprietary to KCI Licensing, Inc., its affiliates and/or licensors. These materials are intended for healthcare professionals only. DSL#13-0274.EBJIS.N (8/13)
NOTE: Specific indications, contraindications, warnings, precautions and safety information exist for KCI products and therapies. Please consult a physician and product instructions for use prior to application. These materials are intended for healthcare professionals only.
www.kci-medical.com
V.A.C.UltaTM NEGATIVE PRESSURE WOUND THERAPY SYSTEM: TWO THERAPIES, ONE SYSTEM.
Executives Member of Gulf Working Group of Diabetic Foot.
NO ONE IMAGINED WOUND THERAPY COULD GET ANY BETTER… WE DID
l
Local Faculty Dr. Marwan Al Zarouni Conference Chair, Head of Plastic Surgery and Wound Care Rashid Hospital, President of Emirates Plastic Surgery Society Scientific President of Emirates Medical Association Founded the Gulf Diabetic Foot Working Group (GWFWG) Chairperson of GWFWG United Arab Emirates
Consultant Plastic Surgeon. Swedish Board in Plastic Surgery. Head of Plastic Surgery and Wound Care Unit in Rashid Hospital in Dubai. l l l l l l
President of Emirates Plastic Surgery Society Scientific President of Emirates Medical Association National secretary representing United Arab Emirates in International Society of Aesthetic Plastic Surgery (ISAPS). Board member as Scientific Secretary in European Society for Laser Aesthetic Surgery (ESLAS). Member in International Plastic Reconstructive & Aesthetic Surgery (IPRAS). Founded the Gulf Diabetic Foot Working Group (GWFWG), Chairperson of GWFWG
Ms. Mounia Sabasse
UAE Representative in International Working Group on Diabetic Foot IWGDF Founded the Gulf Diabetic Foot Working Group (GWFWG) Co-Chair of GWFWG Wound, Ostomy, Diabetic Foot Specialist Rashid Hospital United Arab Emirates
Mounia Mustafa Sabasse is a wound ,Ostomy and diabetic foot care specialist with extend training and 8 years’ experience in wound, stoma and diabetic foot . Currently she is a UAE representative in International Diabetic Foot Working Group. IDFWG. Founded the Gulf Diabetic Foot Working Group (GWFWG), Co-Chair of GWFWG She has completed International Interprofessioal Wound Care Course, IIWCC from Toronto University Canada and she has completed many international accredited courses on wound care and diabetic foot. Currently She is studying her MSc in Skin Integrity from University of Hertfordshire (UK). She has great passion for wound care which leads her to be the first proposed the wound care and diabetic foot clinic In DHA, Dubai. She introduced and conducted the pressure ulcer prevalence and incidence study in RH and DHA. She co-coordinating a multidisplinary wound care team in multispecialty in tertiary hospital. She has been project leader in diabetic foot prevention programme in Rashid hospital and conduct many quality improvement projects in the DHA . She presented in many international and local conferences, and she published in international wound care journal. She has Organizer of the International Diabetic Foot Conference for last 4years from 1st to 4th International Diabetic Foot Conference. She had Organized many wound, stoma and diabetic foot courses in UAE. and is developed and implement clinical practice guidelines, protocols and implementing evidence based practice related to wound care and diabetic foot in Rashid Hospital.
Dr. Samir Mohammed Said Al Assar General Surgeon, Specialist Registrar and Wound Care Management Rashid Hospital United Arab Emirates
Bachelor of General Medicine (Pavol Jozef Safarik University) 1998 European board in General Surgery ( Slovak Postgraduate Academy of Medicine)2001 General Surgery Department and Wound Care unit in Rashid Hospital (Dubai Health Authority) 2002 till today.
33
Local Faculty
Ms. Gulnaz Mir Senior Charge Nurse/Unit Manager, Wound Care Services Sheikh Khalifa Medical City United Arab Emirates
Gulnaz Tariq is a Unit Manager for wound care in Sheikh Khalifa Medical City (SKMC) and resides in Abu Dhabi. She is a Registered Nurse with a Post Graduate Diploma and BSc. She trained as a nurse in the armed forces and graduated with a gold medal and post-graduation with HONOURs. She has pursued further international wound care training by joining the International Inter-professional Wound Care Course (IIWCC) at the University of Tehran with Collaboration from University of Toronto (Canada) under auspice of Prof. Gary Sibbald in 2007. Gulnaz introduced a diabetic foot prevention program and pressure ulcer prevention program in SKMC. She has organized the Abu Dhabi Wound Care Conference for the past 5 years and was appointed as the current course coordinator for the IIWCC for UAE and Asia from University of Toronto. She is currently studying her MSc in Skin Integrity from University of Hertfordshire (UK). She has been invited to present posters and conference presentations in Toronto (World Union for Wound Healing Societies meeting) 2008, Arizona (WCET and WOCN joint conference) 2010, South Africa ( Wounds International Conference) 2011 and presented many other topics related to wound care both internationally and locally. Gulnaz says “I truly love what I do. I have a busy schedule with a lot of latitude. I plan my days to allow for interruptions and emergencies. One of the things I like about my position is that I can see wounds making progress and where my contribution makes a difference. I also enjoy the fact that I can support my great team of staff and share my knowledge and enthusiasm for wound care’’
Ms. Waafa Helmi Rida Director of Clinical Nutrition Department Clinical Support Services Sector United Arab Emirates
She has completed her B.Sc in Public Health/Nutrition from medical Allied Sciences Yarmouk University, Jordan in 1985 and thereafter done her Masters in Food Science and Nutrition from Clayton University –USA in 2003 She has The European ESPEN Diploma from European Society for Clinical Nutrition and Metabolism - France on 8th September 2010. Ms. Wafaa is a part time lecturer in the Faculty of Allied Health Sciences, Sharjah University-UAE from 2006 till date. She is a member of the following Associations: • Member for Diploma in Nutrition from March 2012 till date • Member in National Committee for Iodine Deficiency from February 2012 till date. • Member for National Task Force (National project for control of Diabetes) since November 2010 till date. • Member in Health & Nutrition Magazine & Consultant in UAE since 2002 till date • Member for Friend for Diabetes in UAE 2009 till date • ASPEN (American Society of Parenteral and Enteral Nutrition) from 2005 till date • A member in the Scientific Committee in the Arab Children Health Congress from 2006 till 2009 • Member in ADA (American Dietetics Association) 2006 till date • Member in international Diabetic Dietetics Association 2006 till date • Member in International Dietitians Leadership Management Association 2006 till date • Member in International Obesity Dietetics Association 2006 till date • Member in Obesity Task Force 2003 • Member & founder for Sweet Kidz Group in UAE 2003 till date
34
Local Faculty
Ms. Shyarlin Ruba Wound Care Nurse Rashid Hospital United Arab Emirates
Shyarlin Ruba is a registered nurse and midwife for 12 years with a Masters degree in hospital management. She is working as a wound care Nurse for the past 3 years in Rashid hospital,which is a multispecialty tertiary care center in Dubai. She is a clinician as well as wound care educator. She had lectured in various wound care conferences and seminars in Middle East.She has great passion for wound care and is involved in formulating clinical practice guidelines, protocols and implementing evidence based practice related to wound care in Rashid Hospital. She has co authored and presented some of the quality improvement projects in international conferences like Wounds international & EWMA.
Dr. Mohammed Seddiq Vascular Surgeon Rashid Hospital United Arab Emirates
l European Board of Surgery in 1996, and peripheral vascular surgery subspeciality and PhD in 2000. l Competency in reconstructive microsurgery. l Appointed in Rashid Hospital in 2002. l At the moment: senior specialist surgeon in vascular and endovascular unit of Rashid Hospital and senior lecturer in Dubai Medical College. l Member in wound care team. l Published more than 40 articles as first author and as coauthor. l Participated in several national and international conferences. l More than 10 conferrences as lecturer.
Ligi Thomas Palathingal. RN Wound Care Rashid Hospital United Arab Emirates
Ligi Thomas Palathingal is a registered nurse and midwife for 14 years. She is working as a wound care Nurse for the past 1 year in Rashid hospital,which is a multispecialty tertiary care center in Dubai..She has great passion for wound care and is involved in formulating clinical practice guidelines, protocols and implementing evidence based practice related to wound care in Rashid Hospital.
35
Oral Presentation Denis Barritault Emeritus Professor and Head of Regenerative Medicine Research Institute Paris 12 University France Matrix therapy in regenerative medicine from basic science to clinics evidenced in DFU Heparan sulfate (HS) are glycosaminoglycanes playing a key role in the extracellular matrix (ECM) architecture and in tissue homeostasis. Indeed all matrix proteins contain specific HS binding sites to which HS binds and bridges proteins to organize a scaffold surrounding the cells. HS are also known as the storage and protecting sites of vast majority of communication peptides identified in cell-cell and cell-matrix such as growth factors, cytokines, chemokines etc.. Hence HS will indirectly participate in the control of the cell migration and differentiation required for wound healing processes. Tissue injury will lead to destruction of cells and surrounding ECM including CCP. CCPs synthesized by inflammatory and circulating cells can then be locally delivered to promote an emergency signal of tissue repair, but with a loss of tissue quality, leaving traces, scars or fibroses. We have engineered biodegradable nano-polymers mimicking the HS in order to bind to the structure proteins of the damaged ECM, as well as to the CCP produced by healthy neighboring cells. These HS mimicking polymers restore the ECM microenvironment and tissue homeostasis as documented in various animal models and these HS mimetics where named RGTA as for ReGeneraTing Agents. Indeed skin lesions such as necrotic ulcers, incisions, burns, ischemia, punch in healthy and diabetic animals showed remarkable and highly significant improvement of healing both on speed and quality reminding that of a regeneration process. This was documented by analysis and quantification of biochemical, histological, inflammation, vascular and mechanical parameters all showing strongly significant benefits of RGTA on all parameters studies in healthy and diabetic models (see Diabetes. 2012 Oct;61(10):2633-4) As of today efficacy of healing agent have been poorly evidenced human and there is a lack of robust animal studies to support clinical observations providing unquestionable evidence based medicine in the field of wound. Based on these data we can now bring more evidence in clinics and develop new strategies to treat and prevent DFU. Hence the potential of RGTAs as a new therapeutic class, safe, simple to use and cost effective is now supported in clinics and constitutes a new avenue in the field of regenerative medicine.
Amal Samir Ahmed Medical Surgical Nursing Department Faculty of Nursing-Alexandria University Egypt Quality of Life of Patients with Diabetic Peripheral Neuropathy Diabetic Peripheral Neuropathy (DPN) is one of the chronic complications of high prevalence, affecting 60% of people with Diabetes Mellitus, and is considered the most important precursor of plantar ulcers and amputations of feet in this group of people. Diabetes mellitus permanently changes a patient’s life. Patient’s self care, consisting of daily insulin injections or oral anti-diabetic agents, self monitoring of blood glucose and diabetic diet has an impact on quality of life (QOL). The evaluation of QOL directed toward health problems, such as DPN among people with DM, is essential to identify the needs and specific interventions and, therefore, to promote effective solutions to minimize injuries and to prevent future ones. Thus, the aim of this study was to assess the quality of life of patients with diabetic peripheral neuropathy. A descriptive design was used in this study. A convenience sample of 120 adult diabetic patients (type I or type II D.M) admitted to outpatient diabetic clinic department at Main University Hospital in Alexandria and diagnosed with diabetic peripheral neuropathy were surveyed using Modified Neuropathy Disability Score (NDS) and Neuropathy -Specific Quality of Life Instrument. The results show that the diabetic peripheral neuropathy have a significant effect on patient’s physical, emotional, and social functioning. The findings of this study highlight the need for using Neuropathy -specific Quality of Life Instrument in practice to direct the medical and nursing staff towards the specific problem area for each patient and in order to establish interventions for the nursing care of people with DM. Keywords: Diabetic Peripheral Neuropathy, Quality Of Life.
36
Oral Presentation Veena Raigangar University of Sharjah United Arab Emirates A comprehensive physiotherapy approach for management of the Diabetic foot Abstract: Diabetic foot disease is one of the most common, serious, feared and costly complications of diabetes. It results in loss of protective sensation and in structural changes that make the feet more susceptible to injury. Eighty percent of lower limb amputations in diabetes are preceded by the development of a foot ulcer. In addition to peripheral neuropathy, increased plantar pressure is an important factor in the development and maintenance of diabetic foot ulceration. This talk will explore the physiotherapy care options for diabetic clients. More emphasis will be placed on recent evidence based literature pertaining to the use of electrical modalities like High voltage pulsed galvanic current, low level laser therapy and other forms of stimulation for the diabetic foot which are frequently overlooked. These modalities have been shown to have an positive impact in vascular perfusion and wound healing. Preventive strategies including using appropriate footwear and orthotics will also be briefly highlighted. A comprehensive physiotherapy protocol for the assessment and management of the diabetic foot will be described, together for guidelines for implementation in UAE settings to conclude the talk. Authors: Veena Raigangar
Mohd Albaqali Slamanyia Medical Complex Bahrain Charcot foot surgical management in Kingdom of Bahrain Introduction: The diabetic Charcot foot is a potentially limb-threatening disorder that is being recognized with increasing frequency in persons with longstanding diabetes and concomitant peripheral sensory neuropathy. It is believed to be the result of repetitive trauma to the limb with a defect in pain and proprioception sensation. Although there are not enough studies evaluating the incidence of such complication in patients in diabetes, it has been noticed with increasing frequency in the Arabian Gulf countries from practice and observation of visits to the outpatient clinics. The incidence of diabetes in Bahrain is around 25 % of the population. With this incidence, the complications of diabetes are increasing and we as orthopedic surgeons are seeing more Charcot foot cases in the outpatient diabetic foot clinic. Our unit consists of one orthopedic surgeon specialized in foot & ankle diseases, one senior resident and one junior resident with cooperation with vascular and plastic surgeon working in Salmaniya Medical Complex, Bahrain’s biggest hospital. Objective: To determine, the effectiveness of external (circular) fixation “Ilizarov” and retrograde nailing in treating advanced cases of Charcot foot in plantigrade position of the foot & prevention of any deterioration in the condition, healing of diabetic foot fractures in “Ilizarov” fixation and arthrodesis in ankle Charcot. Research design and methods: Retrospective case study of 12 Charcot foot cases seen treated with “Ilizarov” fixation and 8 cases of Charcot ankle treated with retrograde nailing. Period of cases were from 2007-2012. Sampling of patients included those with moderate to advanced Charcot foot/ankle, aged from (32-90) years of age. Results: 12 cases of Charcot foot were treated with “Ilizarov” fixation, most cases had good results in preventing the advance of the disease and helped in the healing of the diabetic fractures involved in plantigrade position. 8 retrograde nailing was done for the Charcot joint foot with ankle instability, most cases had good results with one case of infection noted and one case of non-union. Conclusions: The use of “Ilizarov” fixation and retrograde nailing helps in having stable joints in diabetic patients with advanced Charcot foot with rigid fixation and the prevention of worsening of the condition and preventing the option of amputation. Retrograde nailing of the ankle gives more stable fixation for Charcot foot with ankle instability. Authors : AlBagali M, Hashim F, AlSaif M
37
Oral Presentation Abdul Samad Arja Sen Consultant Vascular&Micro Surgeon King Abdul Aziz Hospital Saudi Arabia Limb salvage in diabetic patients using below knee short distal bypass Abstract: In diabetic patients with critical limb ischemia and palpable popliteal pulse who are not candidate for endovascular treatment ,these patients can get benefit of a short bypass starting from popliteal artery below the knee till distal tibial or pedal arteries . I am presenting my experience and the results a long term in a retrospective study in 5 years. A 41 short distal bypass were done in 40 type II diabetic patients with mean age was 65 years(extremes 60-85years) The indication for bypass surgery was: Acute ischemia in 9 pts 22% Critical ischemia 31 pts 78% The LSV was used in 32 pts 78% and PTFE graft was used in 9 pts 22% The proximal anastomosis was done on a patent artery below the knee. Distal anastomosis was done on distal tibial or pedal arteries, 2 bypass were done with double anastomosis in y. All patients were followed during the study period The follow up was from 1 to 48 months (main is 23.5 months) These are my results: One pt died in the first month post op 2.5%. The mortality during the follow up was 16 pats 40% The graft patency for the LSV was 91% for one month,78% for one and for 4 years. Limb salvage was achieved 94% in one month ,90% in one year and 87% in 4 years. PTFE bypass :4 grafts were still patent till the end of our follow up ,4 PTFE grafts were thrombosed in first 3 months and patients get major amputations. One bypass was thrombosed in the first year but the limb survived In conclusion: Short distal bypass below the knee have good results in short and long terms ,they may have better results than distal endovascular treatment in diabetic calcified arteries and they are also a substitute for long bypass starting from the SFA or CFA and these results justify also the trial to do these type of bypass before doing any major amputations. The synthetic grafts are reserved to patients in whom we dont find usable autogenous veins. Authors : Dr Abdul Samad Arja
Patricia Connolly University of Strathclyde United Kingdom Moisture in diabetic wounds can be measured without disturbing the dressing and tracks wound healing Aim: The aim of this work was to show how a disposable moisture sensor placed inside a wound dressing allows diabetic wounds to be monitored for moisture. This in turn allows appropriate scheduling of dressing changes and avoids disturbing the wound bed unnecessarily during healing. The work also illustrates that the moisture profile in a healing wound follows an expected trend predicted by the literature on wound healing but not demonstrable in real time in patient dressings before this moisture sensor became available. . Method: A CE-marked wound moisture sensor has become available for monitoring of moisture within a wound dressing without disturbing the dressing1. In the work reported here the sensor has been tested in diabetic foot wounds, leg ulcers healing under compression bandaging and has also been placed in a diabetic foot cast during construction to test for the presence of moisture in the cast. For moisture monitoring the sterile sensor is placed on a cleaned, prepared wound bed before the application of the dressing. The sensor is interrogated for moisture whenever a reading is required by a clinician or carer using a hand held meter. The sensor works on ultra low current impedance but the reading is reported on the moisture meter as a simple 5 drop moisture scale that is easy to interpret , 1 drop means the wound is dry and 5 drops means the wound is wet. A reading of 3 drops means that the wound is moist, the ideal condition for most wound healing2,3. If the clinician judges that the drop reading is appropriate for the stage of wound healing e.g. 3 drops, then there is no need to change the dressing and disturb the healing process. Figure 1 shows the meter and a disposable sensor. Results: The results show that the sensor reads the moisture profile inside the dressing accurately on the 5 drop scale. In addition when a wound is healing well and needs little intervention then the wound stays in the Ëœmoist™ range for much of the process. Figure 2 shows and example of the moisture profile obtained from a patient with a leg ulcer healing under compression bandaging. The compression bandages required only weekly changes and the wound remained moist as the
38
Oral Presentation wound healed. The length of the wound was easured at dressing changes and this confirmed the progression to healing. Studies of the sensor in the diabetic foot cast show that the use of moisture in the casting process did not cause the dressing to become too wet during application. References: 1. McColl, D, Watret, L., MacDougall, M., Connolly, P.. Monitoring Moisture without Disturbing the Wound Dressing.. Wounds UK, Vol 5, No 3, 2009, 2. Winter G . Formation of the scab and the rate of epithelisation of superficial wounds in the skin of the young domestic pig. Nature 193: 293“4, 1962, 3. Schultz G, Mozingo D, Romanelli M, Claxton K. Wound bed healing and TIME.. Wound Repair Regen 13(4): (suppl): S1“S11, 2005 Authors : Professor Patricia Connolly, Professor Andy Collier, Mr Willie Munro
Nedal Katib Prince of Wales Hospital NSW Australia Australia A Single-Center Comparison of Primary Endovascular versus Open Surgical Revascularization Strategies for Diabetic Patients with Critical Limb Ischemia Aim: To compare outcomes in diabetic patients presenting with critical limb ischemia (CLI) who were treated with an endovascular or open surgical revascularization strategy. Method: We conducted a single-center, retrospective analysis of all recorded diabetic CLI admissions between 2004 and 2012. In 2008 the center™s primary strategy changed from open surgical revascularization to endovascular, leading to two equal 4 year time periods for comparison of length of stay (LOS) and limb salvage rates (LSR). A treatment-based comparison of endovascular versus open surgical revascularization was also undertaken. Results: Over the entire period there were 79 diabetic patients who presented with 95 CLI. They were treated with 43 endovascular procedures, 21 open surgeries and 13 primary amputations (18 underwent no intervention). Comparing endovascular versus open surgery LSR was 90.4 vs 95.3 %, the average LOS was 13 vs 17 days and ICU was 2 vs 21 days respectively. Comparing the two time frames, the œearlier and œlatter groups saw 25 vs 70 CLI presentations respectively, of which 36 vs 5.7% had primary amputation, 28 vs 17.1% had no intervention. Comparatively 12 vs 25% had open surgery, over those respective time periods, and 24 vs 52.8% had endovascular surgery. Overall LSR in the two groups was 92 vs 97%. Conclusion: A primary endovascular strategy for diabetics with CLI has resulted in our center performing more revascularization procedures, fewer primary amputations and higher LSR. Authors: Dr Nedal Katib, Dr Shannon Thomas, Dr Ramon Varcoe
39
Poster Presentation Charalambos Agathangelou ARITI Center of Assisted Living, Rehabilitation and Wound Care Cyprus Experience Of Using Polymeric Membrane Silver Cavity Dressings On A Misdiagnosed Charcot Foot Abstract: A 38 year old woman with type 1 diabetes and neuropathy contracted a red swollen lower leg. Her family physician diagnosed it as DVT. Improper footwear, constant walking and nonexistent off-loading lead to an ulcer formation on the sole of her foot; first then was the patient referred to the orthopedic clinic where she was diagnosed with a Charcot foot. The orthopaedic clinic treated her with systemic antibiotics, daily foot baths and dressed the wound with cadoxomer Iodine. Five months on the wound was still deteriorating with exposed bone, malodour and maceration. Amputation was discussed. Aim: Our main concern was to protect the exposed bone, manage the exudates in order to minimize maceration and control infection in order to save the foot. Method: Strict immobilization of the foot and ankle with a total cast was not possible due to the exudate level so a specialized off-loading shoe was custom made instead. We used a silver cavity version of polymeric membrane dressings (PMDs) with changes twice daily the first week, after that changes according to exudate level. PMDs contain ingredients that facilitate autolytic debridement and help reduce swelling. PMD cavity fillers reduce risk of maceration by wicking the exudate away from the wound surface and locking it into the dressing in a gel form. The silver dressings have additional antimicrobial properties Result: After 5 days we could see that the bone was covered by a thin layer of granulation tissue. The antibiotic treatment was discontinued after three weeks and by then the exudate and odour was under control. Six weeks into the treatment a swab verified that the Pseudomonas infection was still resolved so we switched to standard PMDs without silver. After using PMDs for a total of 3,5 months the deep wound had completely closed. Discussion: Prior experience on other complicated wounds had us convinced that PMD™s could heal the wound but this was the first time we had used silver cavity dressings for as long as 6 weeks. We are now convinced that PMD™s are an excellent choice for all types of infected diabetic cavity wounds. Authors: Charalambos Agathangelou
Charalambos Agathangelou ARITI Center of Assisted Living, Rehabilitation and Wound Care Cyprus Three Years Experience Of Treating 46 Painful Diabetic Foot Ulcers With Polymeric Membrane Dressings Purpose: Diabetic foot ulcers (DFUs) may lead to serious infection, gangrene and lower extremity amputation. An often neglected problem faced by these patients is pain. We looked for dressings that preserve the integrity of the ageing skin, are atraumatic, pain-free, controls exudate, prevents infection and promotes healing. We decided to use polymeric membrane dressings (PMDs) which have all these characteristics and work in a unique way to promoting healing Method: We have treated 46 patients since 2009 with painful DFUs. 15 were infected prior to treatment and were initially treated with i.v. antibiotic, 6 referrals after partial or below knee amputation. The rest were treated in their homes or at our nursing home. We used PMDs with dressing changes according to exudate levels. Results: Within weeks pain levels dropped from an average of 8 to pain-free within a month. The below- knee amputations suffered from phantom pain but were helped by medication. Two patients died due to complications and 13 patients were treated at the rehabilitation centre till full recovery, the rest were treated in their homes. Average healing time between 4-6 months, no infections during this period. Discussion: At our Clinic we focus on continuous debridement, exudate control, preventing wound trauma and infection and pain control. We also take into account changes in the skin such as appearance, structure, mechanical properties and barrier function due to ageing. PMDs help us achieve our goals, as a single treatment modality it™s effective for all phases of wound healing and doesn™t require additional treatments or additives.
40
Authors: Charalambos Agathangelou
Poster Presentation Charalambos Agathangelou ARITI Center of Assisted Living, Rehabilitation and Wound Care Cyprus Problematic Stage IV Pressure Ulcers On Heels Closed With Polymeric Membrane Dressings Abstract: Heel pressure ulcers on disabled patients tend to have marginal circulation and often become infected. Even with good compliance many heel pressure ulcers never close. This study highlights three patients who would/could not appropriately offload their heels leading to large pressure ulcers Aim: It was important for us to use a dressing that could easily be changed by the relatives at home. We chose to evaluate polymeric membrane dressings (PMDs) in regards to ease of use, cleansing and healing. Method: One patient™s wound was sharply debrided, PMDs moistened with a small amount of saline softened the necrotic tissue/slough on the others. PMDs were placed directly on each wound and replaced daily, without rinsing or any other intervention. Results: Patient 1 could not tolerate any pressure relieving devices. His previous dressings stuck painfully to his wound, but PMDs were non-adherent and promoted steady wound healing. Patient 2 had Alzheimers, was extremely aggressive and agitated, dressing changes with PMDs changes were quick and easy to perform, so his wife was able to do them, allowing community nursing visits to decrease from daily to weekly. Patient 3, improved after 2 days, her large cavity closed after 3,5 months. Both the other ulcers closed within 9 months. Conclusion: PMDs protected wounds by providing cushioning and promoting a moist environment while continuously cleansing the wounds which lead to wound closure. Because these dressings are safe and non-adherent and manual wound bed cleansing was unnecessary, all families performed the dressing changes, greatly saving nursing costs. Authors: Charalambos Agathangelou
Metab Algeffari Qassim University Saudi Arabia Comparison of different screening tests for diagnosis of diabetic peripheral neuropathy in Primary Health Care setting. Background: DPN is an important complication and contributes to the morbidity of diabetes mellitus. Evidence indicates early detection of DPN results in fewer foot ulcers and amputations. Objective: The purpose of this study was to compare different screening tests in the detection of DPN in primary care setting. Methodology: It is a cross-sectional study in a random sample (N = 242) of type 2 diabetes mellitus participants at primary care setting. Different screening tests for detecting DPN such as Michigan Neuropathy Screening Instrument (MNSI), Semmes-Weinstein Monofilament (SWM), vibration sensation and ankle reflex were performed for each patient and compare between them. Results: 45% of the participant had DPN based on MNSI, The detection rate using the 128-Hz tuning fork and 10-g SWM was nearly same (32.6 & 31.4%) respectively and significantly higher than ankle reflexes (23.1%). Although, the prevalence of DPN determined by the combined two tests (38.79%) was higher than that through the single test. Conclusion: this study showed different results of DPN screening tests, even in the same group of patients. However there was a significant correlation between them. 128-Hz tuning fork and 10-g SWM monofilament would appear to be an appropriate, cheap and easy to use tool for identifying patients at risk of having neuropathy in primary care setting. Authors: Metab Algeffari
41
Poster Presentation Khalifa Al Jabri Buraimi Hospital Oman
Diabetic Neuropathic Pain Abstract: Diabetes is associated with numerous complications. It is a leading causes of peripheralneuropathy, a heterogeneous group of disorders that can affect neuronal function throughout the body.One of the most debilitating microvascular sequelae is painful diabetic peripheral neuropathy (PDPN). Pain is the most distressing symptom of DPN and affected patients often have a progressive build-up of unpleasant sensory symptomsPDPN results from a multi-faceted pathogenesis involving direct axonal degeneration; free radical mediated cellular apoptosis, and microvascular perfusion abnormalities. While tight glycemic control has been shown to modulate the history of this diabetic complication, practicing clinicians have access to numerous published practice recommendations for treatment. Of the frequently utilized medication classes, anticonvulsants, antidepressants, anesthetics, and the neuromodulators are perhaps the most widely understood.In this systematic review of the literatures, epidemology, pathophysiology , and types of managmnet will be discussed in the presentation Authors: Dr Khalifa Al Jabri
Habib Eslami Doolabi researcher and lecturer Hormozgan University of Medical Sciences Iran Effect of Dieckol on Promoting Diabetic Wound Healing in an in Vitro Model Aim: To evaluate the effect of dieckol, a phlorotannin derivative, on human umbilical vein endothelial cells (HUVECs), human skin fibroblast cells and murine macrophage cell (RAW 264.7) as an in vitro model of wound healing in diabetic foot ulcer. Methods: To study the anti-inflammatory, granulation formation and angiogenesis-enhancing effects of dieckol, we used lipopolysaccharide (LPS)-induced inflammation assay in RAW 264.7 cells, human fibroblast proliferation and HUVEC migration assays, respectively. Results: Dieckol stimulated the proliferation of fibroblast cells, which is an important step in wound healing for granulation formation. In addition, LPS-induced nitric oxide production from RAW 264.7 cells was suppressed and cell migration of HUVEC cells was significantly promoted by dieckol treatment. Conclusions: These in vitro results suggest that dieckol may have potential for therapeutic use for wound healing in human diabetic foot ulcers. Authors: Habib Eslami, Ali M. Sharifi
42
Poster Presentation Achamma Joseph Queensland Health Australia Measuring Diabetic Foot Ulcers An Update Background: The global prevalence of Diabetic Foot Ulcers (DFU) is increasing with newer treatments constantly being explored to improve healing rates. Recently predictive calculations have been used to evaluate the effectiveness of these treatment options. Aim: To present recent methods of measuring wound size reduction, time-to-healing of wounds and associated predictive equations. Methods: Relevant articles, from routine databases, were reviewed for methods of wound measurements and associated prediction equations. Results: Differing prediction equations are used to measure reduction in wound size based on length, width, radius, perimeter, total surface area and depth. Frequently used methods are: Surface Area Methods: determine absolute area reduction and healing time; usually expressed as area reduction/day or week and/or as percentage area change by time/day or week. Planimetric measurements (two diameters and no depth) are used to calculate the reduction in wound radius; there appears to be a linear relationship. Linear Healing Rate: measures the wound perimeter/edge advancement; it does not depend on initial wound geometry or surface area; is expressed as perimeter advancement/day and/or mean adjusted healing time. Both methods predict healing at pre-determined time points. Advances in digital planimetry and photography, with analytical software have greatly improved wound measurement accuracy. Conclusion: Robust, valid and reliable predictive healing rate calculation for wound size reduction and time-to-healing of DFU will help to determine efficacy of newer treatment modalities. This will be an important addition to the toolkit of health practitioners in the management of diabetic wounds. Authors: Achamma Joseph
D
d Stan ard of
Ca
re
GO L
Quicker application Greater comfort
TCC wound healing rate1, 2
Advancing the Gold Standard of Care to the Next Generation. Total Contact Casting is recognized as the GOLD Standard of Care for off-loading diabetic foot ulcers.1-17 • Fast and Effective Healing1 • Enforced Patient Compliance TCC-EZ® offers a one-piece, roll-on, woven design that simplifies the application process while reducing the potential for causing additional tissue damage. The result is now an application process that can be completed in under 10 minutes while providing greater patient comfort.18
For more information call 800.445.7627 or visit www.TCCEZ.com 1. Armstrong DG, et al. Off-loading the diabetic foot wound. Diabetes Care 24:1019-1022, 2001 2. Bloomgarden ZT: American Diabetes Association 60th Scientific Sessions, 2000. Diabetes Care 24:946-951, 2001. 3. American Diabetes Association: Consensus Development Conference on Diabetic Foot Wound Care. Diabetes Care 22:1354–1360, 1999 4. Coleman W, Brand PW, Birke JA: The total contact cast, a therapy for plantar ulceration on insensitive feet. J Am Podiatr Med Assoc 74:548 –552, 1984 5. Helm PA, Walker SC, Pulliam G: Total contact casting in diabetic patients with neuropathic foot ulcerations. Arch Phys Med Rehabil 65:691– 693, 1984 6. Baker RE: Total contact casting. J Am Podiatr Med Assoc 85:172–176, 1995 7. Sinacore DR, Mueller MJ, Diamond JE: Diabetic plantar ulcers treated by total contact casting. Phys Ther 67:1543–1547,1987 8. Myerson M, Papa J, Eaton K, Wilson K: The total contact cast for management of neuropathic plantar ulceration of the foot. J Bone Joint Surg 74A:261–269, 1992 9. Walker SC, Helm PA, Pulliam G: Chronic diabetic neuropathic foot ulcerations and total contact casting: healing effectiveness and outcome probability (Abstract). Arch Phys Med Rehabil 66:574, 1985 10. Mueller MJ, Diamond JE, Sinacore DR, Delitto A, Blair VPD, Drury DA, Rose SJ: Total contact casting in treatment of diabetic plantar ulcers: controlled clinical trial. Diabetes Care 12:384 –388, 1989 11. Liang PW, Cogley DI, Klenerman L: Neuropathic ulcers treated by total contact casts. J Bone Joint Surg 74B:133–136, 1991 12. Walker SC, Helm PA, Pulliam G: Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location. Arch Phys Med Rehabil 68:217–221, 1987 13. Armstrong DG, Lavery LA, Bushman TR: Peak foot pressures influence the healing time of diabetic foot ulcers treated with total contact casts. J Rehabil Res Dev 35: 1–5, 1998 14. Lavery LA, Vela SA, Lavery DC, Quebedeaux TL: Reducing dynamic foot pressures in high-risk diabetic subjects with foot ulcerations: a comparison of treatments. Diabetes Care 19:818–821, 1996 15. Lavery LA, Armstrong DG, Walker SC: Healing rates of diabetic foot ulcers associated with midfoot fracture due to Charcot’s arthropathy. Diabet Med 14:46–49, 1997 16. Lavery LA, Vela SA, Lavery DC, Quebedeaux TL: Total contact casts: pressure reduction at ulcer sites and the effect on the contralateral foot. Arch Phys Med Rehabil 78:1268–1271, 1997 17. Fife CE; Carter MJ, Walker D: Why is it so hard to do the right thing in wound care? Wound Rep Reg 18: 154–158, 2010. 18. Jensen J, Jaakola E, Gillin B, et al: TCC-EZ –Total Contact Casting System Overcoming the Barriers to Utilizing a Proven Gold Standard Treatment. DF Con. 2008. © 2013 Derma Sciences, Inc. All rights reserved.
43
Poster Presentation Amit Kumar C Jain St Johns Medical College India Distribution And Analysis Of Diabetic Foot According To The New Classification For Diabetic Foot Complications Background & Aim: For more than 4 decades, Wagner™s classification has been used to grade the lesions of the diabetic foot. This study aims to evaluate and analyze the diabetic foot lesions according to this new classification for diabetic foot complications. Methods and Materials: This is a single unit retrospective study conducted from January 2012 to December 2012 in the department of surgery at our institute, which is a premiere tertiary care referral hospital. Results: Diabetic foot accounted for 6.95% of total surgeries done in our unit. 38 were males and 7 were females. 39 (86.66%) patients had type I diabetic foot complications whereas 5 (11.11%) had type 3 diabetic foot complications. 42.2% of patient had abscess and debridement (44.4%) was the most common procedure performed with majority done in type 1 diabetic foot complication. 8.8% patient underwent major amputation and all of them where in type 1 complications Conclusion: Majority of the diabetic foot treated in hospital are type 1 diabetic foot complications. This classification has been easy and useful in analyzing diabetic foot lesion and can be used for research purpose. Authors: Dr Amit Kumar C Jain
Amit Kumar C Jain St Johns Medical College India A New Scoring System For Predicting The Risk Of Major Amputations In Patients With Diabetic Foot Complications Poster Presentation: Various classifications and scoring system exist for diabetic foot problems. Each has its own merits and demerits, but the basic aim of all of them is to improvise the practice of diabetic foot. Some of the scoring systems are DEPA scoring system, Toronto clinical scoring system, DUSS, etc. These scoring systems basically concentrate on either healing of ulcers or on neuropathy. The author for the first time presents a new scoring system that addresses the diabetic foot complications. The primary advantage of this new scoring system is that it is simple, practical and includes all the common complications of diabetic foot. According to this system, a patient whose score is in between 21 25 has a high risk of major amputation. If the score is above 26, then amputation becomes inevitable. This scoring system for the first time gives weight age to the operating surgeon, an important point that is not present in all the other scoring system in diabetic foot. Authors: Dr Amit Kumar C Jain
Amit Kumar C Jain St Johns Medical College India Analysing Diabetic Foot Over 3 Decades In A Surgical Unit Of A Tertiary Centre. Abstract: As the prevalence of diabetes is increasing globally, so is the incidence of diabetic foot. We reviewed the data from our OT register and compared the status of diabetic foot in 1991, 2001 and 2011, each representing the beginning of the decade. Data obtained included the age, sex, incidence of diabetic foot in operative surgical patient and the type of surgery done. The poster shows the comparative analysis of diabetic foot over these years. In 1991, around 72% of patient with diabetic foot were males and in 2011, it was 76%. In 1991, the major amputations in diabetic foot were around 33.4% whereas it fell to 12.12% in 2001 and further to 8% in 2011. The poster will clearly depict that the incidence of diabetic foot increased over the decade but with improving health care in developing countries, the incidence of major amputations grossly decreased. Authors: Dr Amit Kumar C Jain
44
Poster Presentation Amit Kumar C Jain St Johns Medical College India Contribution Of Indian Doctors In The Field Of Diabetic Foot In The 21St Century Background: Diabetic foot is a devastating complication of diabetes mellitus. This condition is often neglected in developing countries where this speciality is neglected. Infact india, was once considered to be a diabetic capital of the world, with no podiatrist in the country. AIM: To evaluate the significant contribution by the Indian doctors to the field of diabetic foot Methods & Materials:A web survey was done and all the important contribution by the Indian doctors was studied. Words like India, diabetic foot, new concept, technique, etc were used and were surveyed in Pub med, Medline, Google scholar, Index scholar, etc. A total of 67 articles were studied. Results: The study showed that there were many new concept and technique from the Indian subcontinent that influence the practice of diabetic foot. The data obtained were categorized into Technical, epidemiological, educational/institutional contribution. Amrita sling technique, Mandakini technique, Samadhan system, Amit Jain™s classifications, etc were all newer concept that originated from India in last few years, in order to improve the diabetic foot practice. Till now, the country was adopting the concepts from the west. Conclusion: With improving health care system, there is an improvement in the dealing with diabetic foot management in developing countries like India, where this entity was known to be neglected. There is a significant growth in newer concept and ideas in the diabetic foot over last few years in India. Authors: Dr Amit Kumar C Jain
Payam Rafat A Step Ahead Foot Care, P.C. United States Viable Indication for the Use of Human Amniotic Membrane Allograft: A Case Series Abstract: Wound healing can best be accomplished through the use of conventional wound care protocols which include debridement, infection control, offloading, optimization of circulation and nutrition, and achievement of moisture balance. In recent years, the use of various new advanced synthetic dressings and biologic grafts have proven to be beneficial in the management of different types of wounds. Human amniotic membrane allograft exhibits unique properties, making it ideal for use in tissue regeneration and wound care. This graft provides a biologically active matrix for cellular migration and proliferation and contains essential growth factors. Human amniotic allograft has been used for a variety of clinical applications ranging from the treatment of burns and vascular, pressure and diabetic ulcers to wounds resulting from trauma or surgery. The goal of this case series is to evaluate the efficacy of human amniotic membrane allograft in treating chronic foot wounds of different etiologies, which had not shown significant improvement over a period of four weeks despite the treatment of the underlying causes of these wounds paired with conventional wound care. Wound etiologies presented in this case series include those due to: peripheral vascular disease, sustained pressure, thermal injury, deep puncture trauma and diabetic foot infection. Results: demonstrate effective achievement of wound closure with limited residual scar tissue formation. However, due to the limited number of cases, no definitive conclusions can be made. The authors recommend that further investigation is warranted for the use of human amniotic membrane allograft for the treatment of wounds of various etiologies. Authors: Payam Rafat, DPM, AACFAS, C.Ped., Justin Cohen, DPM, Bohdan Batorfalvy, DPM, Margaret Fisher, MBA, ADN
45
Poster Presentation Abdulhakim Altamimi Assistant Prof. of Surgery, University of Aden Faculty of Medicine Yemen Major amputation in diabetic patients Background: Diabetes mellitus is common cause of non traumatic amputation, account for more than 85% which usually precede by foot ulcer. Peripheral neuropathy and vascular impairment or occlusion in addition to infection and trauma are the main risk factors for such ulcers. Patients and Methods: This is a retrospective descriptive study done after review the medical files of 75 patient admitted to the surgical words in Al Gamhouria modern ground hospital Aden “Yemen. 75 medical files were reviewed by the researcher and only 60 files where included in the study due to missed important information related to the study according to designed queshonnaire .The file included all patient admitted between January 2012- to December 2012 complaining of diabetic foot ulcer and infection The study included 44 male and 16 female. Results: 60 patient files of diabetic patient admitted to hospital for first time with diabetic foot ulcer with complication (44 M.16F)73.4%, 26.6 % respectively ,male to female ratio 3:1. Youngest patient aged27years while the oldest 80 years three patients. Majority of patient age group between51-65 which are 34 (56.7%) . The majority of the patient had diabetic since more than 5 years (43) “ 71.6 % and type two diabetic mellitus is the commonest seen in 56 patient where most of them used oral hypo glycemic drug seen in 80 % .The pathological lesions by which the patient are present to the hospital are infected ulcer n=13 (21.7%) ,gangrene n=12(205),cellulites n=9 (15%),abscess n=26 (43.3%)Surgery done for the entire patient and its ranges from surgical toilet to minor or major amputation, The indication of such surgery was local infection n=21(35%) ,sepsis n=16(26.7%),wet gangrene n=17(28.3%), dry gangrene n=5 (8.3%) ,usless limb one Twenty five patient (42.7%) underwent various types of amputation ranged from distal toe to above knee amputation in which major amputation seen in n=11(18.3%) Conclusion: ¢ Diabetic foot ulcer is a common problems in diabetic patient, ¢ Male patient are more affected than female and usually more prone for major amputation. ¢ Certain hard work jobs may incriminated in trivial or major trauma that eventually lead to major infection and followed by major amputation. Cardiac problems are more frequent associated co morbidity. Amputation in general affected nearly half of our patients among which fifty percent was a major amputation Authors: Abdulhakim Omer Al-Tamimi
Abdulhakim Altamimi Assistant Prof. of Surgery, University of Aden Faculty of Medicine Yemen Ischemic foot ulcer in diabetics at Alwaly typical hospital Aden - Yemen 2006-2012 Background: diabetes is metabolic systemic disease affected mostly all organs with special consideration toward the affection of the lower limbs where neuropathy and ischemia play a major role in the development of diabetic foot and its complications Objectives: to evaluate the arterial insufficiency among diabetic patients Patients and Method: prospective study involve all diabetic patient admitted to Alwaly hospital , more than 14076 patients were treated for diabetes and its complication and only 2610 patient are investigated for peripheral ischemia Results: 1934 are males and 676 females, ischemia is more severe in males may be due to risk factors as smoking Amputation are common in both sex Conclusion: ischemia is a serious association in diabetic patients it associated with high rate of amputation and mortality Authors: Dr Abdulhakim Omer Al-Tamimi MD, Dr Mahmood Taha Makki, MD Dr Yasser Ahmed Ba-Ashen ,MD
46
Poster Presentation Abdulhakim Altamimi Assistant Prof. of Surgery, University of Aden Faculty of Medicine Yemen Amputation among diabetic patients on regular hemodialysis Background: diabetes mellitus is a systemic metabolic disorder affected all body organs being the cardiovascular and renal systems are more vulnerable, diabetic foot ulcers and infection consider to be an alarm especially in those people with uncontrolled long standing diabetes with renal and cardiovascular dysfunction. These groups of patient are at high risk for amputation and its sequence important complication as sepsis, strokes and even death in the early post operative period. Objectives: this study aims to evaluate the outcome of diabetic foot ulcer and infection in those diabetic patients with mild or moderate renal impairment and those on regular hemodilysis Patients and Method: this is retrospective cohort study done at Alwaly typical hospital and AlGamhoria modern hospital Aden from March 2008-Februray 2011, involving all diabetic patient with foot problems that need any form of amputation. Results: The total number of patient candidate for amputation was 620 (384 males, 236 females) 61.9%, 38.1% respectively. 210 (33.8%) patients have no any renal problems according to the renal function tests available. The other 410 (66.2%) patients present with different degrees of renal problems, mild renal impairment 231(56.3% ) ,moderate renal impairment 105(25.6% ) , and those dialysis dependent are 74 patients ( 18.1%). Most common indications of amputation were sepsis and ischemia. Among those on dialysis major amputation (above knee 28, below knee 11) trans-metatarsal 16, and Ray™s amputation was 19. Majority of the patients are males (55 patients) with predominant of major amputation giving significant P value. Post operative complications encountered in dialysis patient within 30days of surgery, death cases 14 patients, acute myocardial infarction 9, acute stroke 6 and 26 patients developed wound infection. Conclusion: diabetic foot infection may result in fatal complication on those patients with chronic renal failure undergo regular hemodialysis , major amputation is the end result for the majority of the cases especially for males ,, ischemic changes may be exaggerated and the mortality and morbidity increased after even minor surgery . Authors: Dr Abdulhakim Omer Al-Tamimi MD Dr Mahmood Taha Makki , MD Dr Yasser Ahmed Ba-Ashen, MD
Abdulhakim Altamimi Assistant Prof. of Surgery, University of Aden Faculty of Medicine Yemen Fifty gloomy pictures in diabetic foot: disaster complication of diabetes mellitus Abstract: Diabetes mellitus can be presented with many complications from which the diabetic foot complication can affected 15% of all diabetic patients world wide. All theses patients developed foot complications as consequence of delayed diagnosis, neglect ion or both can participate in such disaster out come. The majority of these patients present with severe sepsis, wet gangrene or severe necrotizing fascitis with some organ failure mainly the kidneys. We present these cases to highlight this problem which can be prevented in the majority if they were managed properly, and to arise the final out come of the survived patients with many functional and structural abnormalities. Authors: Abdulhakim Omer Al-Tamimi
47
Poster Presentation Abdulhakim Altamimi Assistant Prof. of Surgery, University of Aden Faculty of Medicine Yemen Ten years Local experience in the management of diabetic foot The aim of this talk is top share our experience in dealing with diabetic foot. Especially in condition was very sad for the patient and the doctors , nurses and the other members of the group. In our talk we are going to speaks frankly about the hinders in providing a proper treatment. Our deficiency in the instrument we used. Our implementation of the minimal resources and our participation to follow the new technique and conferences. Will share our difficult area in the vascular surgery and proper foot care Authors: Dr Abdulhakim Omer Al-Tamimi MD Dr Mokhtar Algamali , MD Dr Yasser Ahmed Ba-Ashen ,MD Dr Tariq Alshaabi MD
Abdulhakim Altamimi Assistant Prof. of Surgery, University of Aden Faculty of Medicine Yemen Heel ulcer in diabetic patients Objective: The aim of the study is to determine the effect of heel ulcer in diabetic patients & its consequence due to the dependence of the leg on the heel in walking & standing which lead to the heel ulcer mainly in diabetic person.. Method: From June 2007 to April 2011 a retrospective study was applied for 57 patients of Diabetic Heel Ulcer in one hospital & single work team. The patients were classified according the following: Sex , age , social habits , discover of DM , its duration & type of treatment , causes of seeking help & its sources. Presence of similar attack or amputation, presence of other medical disease or complication , peripheral vascular disease , peripheral neuropathy , radiological & Duplex changes. Direct cause of the heel ulcer , site of ulcer in the heel , its duration , extension of the ulcer , need for skin graft or amputation .. Result: A total number of 720 patients with diabetic foot were admitted, treated and followed by a single surgical team in al-gamhouria teaching hospital in the period between June 2007- April 2011 and only 57 patients ( 7.9 % ) were enrolled in this retrospective study who had complaing of diabetic heel ulcer. - Majority of the patients were male (63.2%) and female( 36.8%) with male: female ratio Of 1.7 : 1. - Out of these 57 patients, most ( 50 %) of them were above age 60 years old while the least (3.4%) age group affected were between age 30-40 years old. - Majority of the patients were from Aden Governorate ( 65.5 % ) followed by Abyan Governorate. ( 13.8 % ). - About ( 33 ) patients came with complain in the right foot (55.2 %) and ( 24 ) in the left foot ( 41.4 % ) , while ( 1 ) patient with bilateral foot involvement ( 1.7 % ) , and the most common site of involvement in the posterior. aspect of the heel with ( 41.4 % ) in ( 24 ) patients , followed by bottom of heel in ( 22 ) with ( 37.9 % ) . - About ( 42 ) patients ( 72.4 % ) had discover that they have Diabetes Mellitus by medical investigation incidentally , while about ( 15 ) patients with ( 25.9 % ) discovered it by infection or unhealed foot ulcer . - Majority of the patients ( 44 ) with ( 75.9 % ) were with more than (10) yrs duration of diabetes mellitus, and about ( 26 ) patients ( 44.8 % ) under oral hypoglycemic drugs , while ( 25 ) patients ( 43.1 % ) with injectable insulin . - About ( 46 ) patients came with other medical co morbidities (58.50 % ) while about (11 ) patients ( 19.0 % ) free of it. - About ( 46 ) patients came complaining from different degree of pain ( 79.3 % ) while ( 11 ) was painless ( 19.0 % ) , and about (43) patients ( 74.1 % ) complaining from unhealed ulcer.
48
Poster Presentation - Majority of the patients ( 53 ) about ( 91.4 % ) came with impaired sensory monofilament test , while ( 4 ) with negative test ( 6.9 % ) , and about ( 40 ) patients ( 69.0 % ) presented with variable degrees of lower limb arterial stenosis and about ( 7 ) patients came with complete occlusion ( 12.1 % ) . - Most of the patients came with distal extension of the infection to the mid foot ( 42 ) and ( 72.4 % ) , and about ( 14 ) with proximal extension to Achilles tendon ( 24.1 % ) , while one patient infection extend in both direction ( 1.7 % ). - About ( 29 ) patients with ( 50.0 % ) came after more than one month of the problem.
About ( 23 ) patients need more than ( 16 ) weeks for complete healing ( 39.7 % ) , while ( 2 ) patients not continuo treatment one of them due to mental disturbance and the other due to death for other cause with ( 1.7 % ) for each of them. Of all of them ( 5 ) patients undergone skin graft ( 8.6 % ) and ( 3 ) patients required major amputation ( 5.2 % ) .
- The most common cause was trauma in ( 37 ) patients with ( 63.8 % ) . Conclusion: Diabetic heel ulcer consider as one of the most common presentation of diabetic foot & it has a great influence on limitation of the movement which lead to loss of working person with socioeconomic defect. This problem mostly can be due to either peripheral neuropathy or peripheral vascular disease or both of them . Authors: Dr Abdulhakim Omer Al-Tamimi MD Dr Talat Ali Albaiti, MD Dr Tariq Alshaabi MD Dr Mokhtar Algamali MD
Awol Mekonnen Ethiopia In vivo wound healing activity and phytochemical screening of the crude extract and various fractions of Kalanchoe petitiana A. Rich (Crassulaceae) leaves in mice Abstract: Ethnopharmacological relevance: The leaves of Kalanchoe petitiana A. Rich (Crassulaceae) are used in Ethiopian folk medicine for treatment of evil eye, fractured surface for bone setting and several skin disorders including for the treatment of sores, boils, and malignant wounds. Aim of the Study: In order to scientifically prove the claimed utilization of the plant, the effects of the extracts and the fractions were investigated using in vivo excision, incision and dead space wound models. Materials and Method: Mice were used for wound healing study, while rats and rabbit were used for skin irritation test. For studying healing activity 80% methanolic extract and the fractions were formulated in strength of 5% and 10%, either as ointment (hydroalcoholic extract, aqueous and methanol fractions) or gel (chloroform fraction). Oral administration of the crude extract was used for dead space model. Negative controls were treated either with simple ointment or sodium carboxyl methyl cellulose xerogel, while positive controls with nitrofurazone (0.2 w/v) skin ointment. Negative controls for dead space model were treated with 1% carboxy methyl cellulose. Parameters, including rate of wound contraction, period of complete epithelializtion, hydroxyproline contents and skin breaking strength were evaluated. Results: Significant wound healing activity was observed with ointment formulated from the crude extract at both 5% and 10% concentration (p<0.01). Conclusions: The present study provided evidence that the leaves of Kalanchoe petitiana A. Rich possess remarkable wound healing activities supporting the folkloric assertion of the plant. Fractionation revealed that polar or semi polar compound may play vital role, as both aqueous and methanolic fractions were endowed with wound healing activity. Key Word: Wound healing, Kalanchoae petitiana, Excision wound, Incision wound, Dead space model Authors: Awol Mekonnen
49
Poster Presentation M Mazen Hachem Sen. Consultant Vascular Surgeon Saudi Arabia Principles of Management of Diabetic Foot Ulcer and its Prevention Abstract: Foot ulcers are a significant complication of diabetes mellitus and often precede lower extremity amputation. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischemia, and abnormal foot structure. Early recognition of the etiology of these foot lesions is essential for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, aggressive and frequent debridement, moist wound care, negative pressure wound therapy treatment of infection, and revascularization of ischemic limbs are the mainstays of therapy. Prompt and aggressive treatment of diabetic foot ulcers can often prevent exacerbation of the problem and eliminate the potential for amputation. The aim of therapy should be early intervention to allow prompt healing of the lesion and prevent recurrence once it is healed. Multidisciplinary management programs that focus on prevention, education, regular foot examinations, aggressive intervention, and optimal use of therapeutic footwear have demonstrated significant reductions in the incidence of lower-extremity amputations. Authors: M Mazen Hachem, MD, PhD, FACS. Fekria A Mustafa, MD.
M Mazen Hachem Sen. Consultant Vascular Surgeon Saudi Arabia Diabetic Foot Ulcer Management is Single Man Show? Multidisciplinary team Approach Abstract: Diabetic foot (ulceration, infection, gangrene) is one of the most disabling complications of diabetes mellitus, if left untreated, can result in the amputation of the limb and serious lifestyle challenges for the patient. It frequently leads to depression, social exclusion and physical impairment. It contributes to the increased morbidity and mortality. The incidence of foot ulcers amongst diabetic patients is very high, affecting about 50 per cent of all diabetic patients. Risk factors of diabetic foot are as follows: age, race, sex, duration of diabetes, biomechanical factors, level of glycemia, smoking habits. According to international standards, around 85 per cent of all major amputations due to diabetic foot ulcer are unnecessary and could be avoided successfully if treated only by a multidisciplinary team which can provide more comprehensive and integrated care as compared to single specialist. Multidisciplinary team consists of: diabetologist, shoemaker, orthopedist, psychologist, surgeons both vascular and general, podologists, radiologists, wound care nurses, educator nurses and rehabilitation team. Multifactorial treatment of the complex foot lesions by a multidisciplinary team can dramatically improve the prognosis of this disease. The challenge is mainly to reduce the number of major amputations that are responsible for high morbidity and mortality. Authors: M Mazen Hachem, MD, PhD, FACS./ Fekria Mustafa, MD.
Francesco Serino Director Endovascular Program Italy The Angiosome Concept Should be the Standard of Care for Critical Foot Revascularizations Abstract: From the last 50 years and up to now, those interventions are based â&#x20AC;&#x153; through different and constantly developing technology- on reestablishing a direct flow from above the obstructed vessel to one of the three leg arteries, the choice falling on the least diseased one or by Ĺ&#x201C;chance. With this current practice, yet 20% of vascularized patient, will experience a non-healing ulcer or gangrene, which will thigh them to long standing medical care or, more likely, to permanent handicap due to foot or leg amputation.
50
Poster Presentation Recently, a new concept has been developed and based on the anatomical studies of J. Taylor and C Attinger, who pioneered preferential strategies for surgical access, tissue reconstruction and amputation following specific 3-dimensional tissue sectors of the body called œthe angiosomes and fed by distinct arterio-venous bundles. Adjacent angiosomes are interconnected by numerous œchoke vessels that create a blended compensatory system between different territories. A schematic illustration of the angiosomes described in the foot and lower ankle, is depicted in Figure 2. This concept implies choosing, as target of revascularization, the exact leg /foot vessel which feeds the foot zone (angiosome) where the ulcer/ lesion lie, thus directing the revascularization toward the rationally chosen vessel - although the more difficult to operate on- instead of the œrandom one. In all research centers in which this concept has been tested against the œstandard practice, it has been regained that 20% chance for healing. That observations have been based on some retrospective analysis in centers scattered throughout the world, thus not enough to base evidence for restructuring clinical guidelines and drive all clinical centers to convert their practice. Kabra A, et al. (J Vasc Surg. 2013; 55:44-49) limb salvage 84% with and 75% without AM /1 year Iida O, et al. (J Vasc Surg. 2012; 57: 363-370) 57% with and 35% without AM /1 year Iida O, et al. (Catheter Cardiovasc Interv. 2010; 75: 830-836) 86% with and 69% without AM /1 year Neville R, et al. (Ann Vasc Surg. 2009; 23: 367-373) 91% with and 62% without AM /1 year Varela C, et al. (Vasc Endovasc Surg. 2010; 44: 654-660) 93% with and 72% without AM /2 years Alexandrescu V, et al. (J Endovasc Ther. 2008;15: 580-593) 91% with and 84% without AM /1 year Alexandrescu V, et al. (J Endovasc Ther. 2011; 18: 376-387) 89% with and 79% without AM /1 year A retrospective analysis on our experience on revascularization of 84 diabetic patients with foot salvage also shows an advantage of the Angiosome directed revacularization and data will be presented and commented since a major problem in all retrospective data analysis is the lack of specific study on collateralization between the angiosomes, which, of course may affect outcomes and bias retrospective analysis. A prospective, controlled clinical “non per profit- trial has been planned in order to prove that we can link the wellness, integrity and better quality of life of millions of people to certainty instead to randomness . Authors: Francesco Serino
51
We would like to give a special thanks to all our sponsors for their support Main Sponsor
Platinum Sponsor
Gold Sponsors
Silver Sponsors
Bronze Sponsors
52
Sponsors Profile
Main Sponsor Medline was founded in 1966, but its roots date back 100 years when A.L Mills started Northwestern Garment factory. Since then, the company has grown into Americaâ&#x20AC;&#x2122;s largest privately held national manufacturer and distributor of health care supplies and services. Our mission is to provide quality medical products with superior value to healthcare providers and end users improving patient care and the quality of peoplesâ&#x20AC;&#x2122; lives. Business Overview: Medline has 20 product divisions, and manufactures and/or distributes more than 125,000 products to hospital, extended care facilities, surgery centers, home health agencies and retail and other healthcare markets. Over the past 5 years, Medline has been growing distributor of Medical and surgical supplies in the US, serving as primary distributor to over 250 major hospitals and healthcare system. Medline maintains 34 distribution center to deliver products to its health care customers where and when they need them.
Platinum Sponsor Lunatus Marketing & Consulting is a Dubai based subsidiary of Lunatus Holdings in USA & Canada. Lunatus acts as a key link between international Health Care companies and healthcare professionals, including general practitioners, primary health centers, hospitals and pharmacies in the Arabian Gulf and Middle East markets. Since its inception in 2003, Lunatus has established a successful track record in introducing building and developing profitable brands in the fields of pharmaceuticals, aesthetics & skin care, OTC, consumer health, medical equipment and wound care which displays a successful range or advanced and smart wound care dressing ranges from Polymeric membrane dressings known as Polymem, a total wound care system, and antimicrobial wound dressing range known asCutimedSorbact, boasting unparalleled healing capabilities. For more information please contact +971 4 3405991. Email: marketing@lunatus-me.com Website: www.lunatus-me.com
53
Sponsors Profile
Gold Sponsor Lohmann & Rauscher (L&R) is a leading international supplier of high quality, forward-looking medical devices and hygiene products - ranging from conventional bandages to modern treatment and nursing systems. Included focus areas are moist wound care, controlled negative-pressure therapy and OR set systems. For the Diabetic Foot Syndrome L&R provides a complete solution consisting of Suprasorb Wound Management products and Cellacast Total Contact Cast system. Created in 1998 from the merger of two long-established family-owned companies, Lohmann (founded in 1851) and Rauscher (founded in 1899), L&R has over 150 years expertise as a dependable partner and solution provider for its customers. Currently, L&R has over 4,000 employees worldwide. The corporate group is represented by 39 subsidiaries and shareholdings in 20 countries, and by more than 30 selected partners in 80 countries. The companyâ&#x20AC;&#x2122;s headquarters are located at the Rengsdorf (Germany) and Vienna (Austria) sites.
Gold Sponsor Julphar is a true reflection of Ras Al Khaimahâ&#x20AC;&#x2122;s significant development. Established in 1980 under the guidance of H.H Sheikh Saqr Bin Mohammed Al Qasimi, we have established ourselves as a leader in production and distribution of pharmaceutical products. Our goal is to create high-quality medicines whilst maintaining a competitive cost. We achieve this through a network of twelve world-class manufacturing plants (with further expansion planned) and a reliable logistics network which covers five continents. We maintain a diverse product portfolio which target major therapeutic segments including endocrinology, anti-infective, cardiovascular and gastroenterology, over-the-counter, nephrology, dermatology, respiratory, metabolic and burn and wound management. Highlighting our commitment to diabetes management in the region, we have also become the only company in the Middle East to produce the raw material needed to make insulin through our division dedicated to Diabetes. With over 800 products in various dosage forms and more in the pipeline, Julphar is an example of one of the UAEâ&#x20AC;&#x2122;s local businesses making an impact on the global stage.
54
Sponsors Profile
Gold Sponsor At KCI, we are devoted to advancing the science of healing and positively impacting patient care by developing customer driven innovation to meet the evolving needs of healthcare professionals. For over 35 years, we have led the way in the development of new technologies, medicines and therapies designed to make wound healing more manageable for caregivers and more comfortable for patients around the world. We believe all patients deserve the most advanced treatments available. Our employees are focused on innovation and examining how to make science, and patient care, better for tomorrow. In over 20 countries around the world, KCI is improving patient outcomes, lowering costs and delivering the advanced treatments necessary to heal wounds and better the lives of patients. Our proprietary KCI negative pressure technologies have revolutionized the way in which caregivers treat a wider variety of wound types. The KCI Vacuum Assisted Closure® or V.A.C. ® therapy has been used on more than 7 million wounds worldwide. The capabilities we have built in transforming wound care provide us with a road map to transform the practice of medicine in other areas and to continue successfully growing the company. For more details please visit our website: www.kci-medical.com
Gold Sponsor Al Mazroui Medical & Chemical Supplies, Serving the Medical Sector for more than 3 decades Founded in 1978, Al Mazroui became an established leader in medical industry by consistently providing exceptional, comprehensive and world-class Medical products and services in UAE and the GCC country. Empowered by highly trained professional from managers, sales & marketing, engineers, doctors and pharmacist, we provide all kinds of medical, dental, laboratory equipments, consumables, instruments, pharmaceutical and chemical products to all government and private hospitals, clinics and medical centers. Al Mazroui also caters turnkey projects from feasibility study, commissioning, installation, training and maintenance of mobile clinics to hospitals. For the 4th Diabetic Foot Conference, Al Mazroui will be showcasing different kinds of Molnlycke WOUND CARE products.
Gold Sponsor Derma Sciences, Inc. is a specialty medical device company focused on wound care. The product line includes our market leading MEDIHONEY® line of Active Leptospermum Honey dressings, XTRASORB® Super Absorbent Polymer Dressings for highly exuding wounds, BIOGUARD® Barrier Dressings for prophylactic infection prevention and ALGICELL® Ag for wounds with high bioburden.In IDFC 2013 we launch the TCC-EZ® - a gold standard total contact casting system for the management of diabetic foot ulcers. Bridgeway Medical Systems is a leading distributor of Medical Devices and Wound care products in the Middle East. Having offices in Dubai, Abu Dhabi, Doha and Ernakulam (India) we offer the complete range of advanced wound care products including MEDIHONEY and TCC-EZ system to our customers. For additional information please contact info@ bridgewayhealthcare.com or call us on +9714-282 2890
55
Sponsors Profile
Silver Sponsor 3M is fundamentally a science-based company. We produce thousands of imaginative products, and we’re a leader in scores of markets - from health care and highway safety to office products and abrasives and adhesives. Our success begins with our ability to apply our technologies - often in combination - to an endless array of real-world customer needs. For more than a century, people have looked to 3M for new products and solutions to solve their problems. Our health care business is using 3M’s diverse technologies and global strength to safeguard people’s health and wellbeing - today and tomorrow. Our extensive line of trusted critical & chronic care products helps improve skin health and the treatment of acute and chronic wounds. These products provide cost-effective solutions and are supported by educational services, professional and technical support. Our Critical & Chronic Care solutions division comprises of wound dressings, wound closure, tape & bandages, skin integrity, & intravenous therapy.
Silver Sponsor Smith & Nephew is a global medical technology business dedicated to helping improve people’s lives. We have leadership positions in Orthopaedic Reconstruction, Advanced Wound Management, Sports Medicine and Trauma l l l l
Orthopaedics Reconstruction - joint replacement systems for knees, hips and shoulders Advanced Wound Management - wound care treatment and prevention products used to treat hard-to-heal wounds Sports Medicine – minimally invasive surgery of the joint Trauma – products that help repair broken bones
We have almost 11,000 employees and a presence in more than 90 countries. Annual sales in 2011 were nearly $4.3 billion. We are a constituent of the UK’s FTSE100 and our shares are traded on London Stock Exchange and through American Depository Receipts on the New York Stock Exchange (LSE: SN, NYSE: SNN) http://www.smithandnephew.com/ http://www.globalwoundacademy.com/
56
Sponsors Profile
Bronze Sponsor MEDWAYGroup is one of the reputable local distributors working in the Medical , Dental & cosmetic field in MENA Region. We are working as a distributor and business manager for multinational companies. We have a powerful staff who could fulfill our mission and always have precise view to our vision
Bronze Sponsor ConvaTec is a leading developer of innovative medical technologies that have helped improve the lives of millions of people worldwide. With four key focus areas - Ostomy Care, Wound Therapeutics, Continence and Critical Care, and Infusion Devices - ConvaTec products support healthcare professionals from the hospital to the community health setting. As world leader in skin and wound care products for over 30 years. We work on the principal of creating NEW medical technology and evidence-based products “to use for and impact the safe recovery of the patient.” One of our major focuses is to help manage wounds due to diabetic foot ulcers, burns, leg ulcers, pressure or bed sores over a bony prominence, surgical wounds, as well as skin tears for elderly thin skinned patients.
Bronze Sponsor Diaped – Solutions for Multidisciplinary Diabetic Foot Clinic Diaped was founded in 2007, as a member of the ALG group of companies, when a clear opportunity arose for a range of prevention, diagnostic, education and offloading products within the global diabetic foot market. The aim of the brand is to offer the clinician, within the multidisplinary diabetic foot care team, and the patient, a range of products that would be trusted for quality and evidence based research. The Diaped range offers tools and equipment for Diagnostics (Neuropathy and Ischaemia), Prevention, Management and Patient and Clinician Education. Since 2007 the brand and product range has grown recognition within UK, Europe, South & East Asia and Middle East sponsoring many diabetic foot conferences and academic research. 2011 saw the opening of the first franchise Diaped clinic in Mumbai and 4 more clinics opened since then. We also opened our first clinic in the Philippines this year, 2013. Diaped is now seeking clinic franchise partners across the Middle East and North Africa. Website: www.diaped.co.uk
57
Sponsors Profile
Bronze Sponsor Abbott Abbott is a global, broad-based healthcare company devoted to the discovery, development, manufacture and marketing of pharmaceutical and medical products, including nutritionals and devices, operating from its headquarters in Chicago. The company has area head quarters in US, Europe, Africa, The Far East and Latin America. Abbott employs over 65,000 people and markets products in more than 130 countries. The promise of our Company is in the promise that our work holds for health and life. Abbott Nutrition International (ANI) Abbott is behind some of the most trusted names in pediatric, adult and healthy living nutritional products including wellknown consumer brands. Abbott also offers medical foods and feeding devices for patients with special dietary needs due to injury, food allergies, or diseases that affect the body’s metabolism such as cancer, respiratory conditions and gastrointestinal impairment such as Glucerna, Ensure, Abound, Jevity, Osmolite, Oxepa, Nepro, Suplena, Pediasure and FreeGo pump. Pediatric brands such as Similac, Similac Gain, GainPlus, Pediasure and Similac Total Comfort are having a role in helping babies grow and develop for more than 80 years. Health care professionals and their patients trust us to provide cuttingedge nutrition products that meet changing nutrition needs. And we deliver on their expectations—providing a vast array of nutritional and therapeutic products that help babies and children grow, work to keep bodies strong, and support the unique needs of patients with chronic illnesses.
Bronze Sponsor The commencements of the company reach back to the year 1879, when Heinrich Schein (senior) made orthopaedic treatments besides his profession as a shoemaker. In 1926 the actual production started and the trade with medical foot supports, which he had patented for himself, began. After the Second World War, Heinrich Schein junior and his wife Anneliese took the business over. From this time on, business success combined with a continuous expansion distinguished the development of the enterprise. This also necessitated the erection of a new building for manufacture and administration which could be moved into in 1993 in RemscheidLennep in the Trecknase industrial area. Son Klaus Peter followed in his parents’ footprints and took over the management of the company after finishing his vocational training as a rehabilitation technologist in 1967. At that time, roughly 50 people were employed with the company. With his feeling for successful company policy and the courage to launch into new things he built up a future-oriented group of companies over the years. After taking over Ruckgaber Orthopädie Service in Rottenburg in 1997 and the company of AteC-Shoes in Erfurt in 1999, Klaus Peter Schein extended his range of products by the fields of orthopaedic tailormade shafts and orthopaedic materials. The son of Klaus Peter and Ulrike Schein, Arnd Schein, joined the company after completion of his vocational training in 1994. Since 2001 the Remscheid-based company of F.W. Kraemer belongs to the Schein group. This company, too, can look back on a long orthopaedic tradition.
58
Sponsors Profile This merger also required local changes, which could be allowed for by the purchase of a large terrain in the industrial area of Jägerwald near the Autobahn slip road of Remscheid. The new company building with more than 23,000 square meters of administration and production area could be moved into early in 2004. Arnd Schein, the son of Klaus Peter and Ulrike Schein, who had been working in the house of Schein since 1994, took over the company management in 2004 after his father’s death.
Bronze Sponsor Good health is vital to all of us, and finding sustainable solutions to the most pressing health care challenges of our world cannot wait. That’s why we at Pfizer are committed to applying science and our global resources to improve health and well-being at every stage of life. We strive to provide access to safe, effective and affordable medicines and related health care services to the people who need them. We have a leading portfolio of products and medicines that support wellness and prevention, as well as treatment and cures for diseases across a broad range of therapeutic areas; and we have an industry-leading pipeline of promising new products that have the potential to challenge some of the most feared diseases of our time, like Alzheimer’s disease and cancer. To ensure we can continue to deliver on our commitments to the patients, customers and shareholders who rely on us, we are focused on improving the way we do business; on operating with transparency in everything we do; and on listening to the views of all of the people involved in health care decisions. Through working in partnership with everyone from patients to health care providers and managed care organizations to world governments and non-governmental organizations, our goal is to ensure that people everywhere have access to innovative treatments and quality health care.
59
Puracol Plus Ag+ ordering information
Puracol Plus ordering information
Item # MSC8622EP MSC8622EPZ MSC8622EPH MSC8644EP MSC8644EPZ
Description
5
Packaging
th
Item #
Description
Packaging
International Diabetic Foot Conference 10/bx, 5 bx/cs
MSC8722EP
2" x 2.25", 2 mm
10/bx, 5 bx/cs
1 bx, 10 ea
MSC8722EPZ
2" x 2.25", 2 mm
1 bx, 10 ea
2" x 2.25", 2 mm
1 each
MSC8722EPH
2" x 2.25", 2 mm
1 each
4.25" x 4.5", 2mm
10/bx, 5 bx/cs
MSC8744EP
4.25" x 4.5", 2 mm
10/bx, 5 bx/cs
4.25" x 4.5", 2mm
1 bx, 10 ea
MSC8744EPZ
4.25" x 4.5", 2 mm
1 bx, 10 ea
1 each
MSC8744EPH
4.25" x 4.5", 2 mm
1 each
2" x 2.25", 2 mm 2" x 2.25", 2 mm
MSC8644EPH
4.25" x 4.5", 2mm
MSC861X8EP
1" x 8", 2mm
MSC861X8EPZ
1" x 8", 2mm
MSC861X8EPH
1" x 8", 2mm
610/bx, - 85 November, 2014 1" x 8", 2mm MSC871X8EP bx/cs Dubai, United Arab Emirates MSC871X8EPZ 1" x 8", 2mm 1 bx, 10 ea 1 each
MSC871X8EPH
1" x 8", 2mm
10/bx, 5 bx/cs 1 bx, 10 ea 1 each
References 1. Driver Vickie et al. The use of the Native Collagen Dressing on Chronic Lower Extremity Wounds, Case Studies: Presented at the Symposium on Advanced Wound Care. Tampa, Florida, 2007. 2. Shah S, Chakravarthy D: A Clinicial Safety and Efficacy Evaluation on Seriously Chronic Wounds with a Native Collagen Dressing. Puracol Plus Clinical Report. Internal Report, Dec. 2007. 3. Simon SR, Chakravarthy D. Picrosirius Assay on Nativity Assessment on Two Collagen Dressings. Internal Report Puracol -012 4. Simon S, Chakravarthy D. Picrosirius Assay on Nativity Assessment on Two Collagen Dressings. Internal Report Puracol Plus Ag+-012.2 5. Physical Property Comparison of Two Collagen Dressings, Highly Native Collagen Compared to Denatured Collagen/ORC. Internal Report Puracol- 013. 6. Fleck C, Chakravarthy D. Understanding the Mechanisms of Collagen Dressings. Advances in Skin and Wound Care. 20 (5), 256-259. 7. Fliegel S et al. Collagen Degradation in Aged/Photodamaged Skin in vivo and After Exposure to Matrix Metalloproteinase-1 in vitro. J Invest Dermatology 12: 842-848, 2003.
8. Electron and Optical Microscopy of Puracol Plus Microstructure. Internal Report Puracol-011. 9. Sibbald RG et al. The Edge Effect: Current Therapeutic Options to Advance the Wound Edge. Advances in Skin and Wound Care, 20 (2) 99-117. 10. Kingsley A. The Wound Infection Continuum and its Application to Clinical Practice. Ostomy/Wound Management. 49 (7A) 1-7, 2003. 11. Ovington L. Bacterial toxins and wound healing. Ostomy/Wound Management 52 (11) 50-56, 2006. 12. White RJ et al. Critical Colonization-the concept under scrutiny. Ostomy/Wound Management 52 (11) 50-56, 2006. 13. Sibbald RG, Woo K, Ayello EA. Increased Bacterial Burden and infection, the story of NERDS and STONES. Advances in Skin and Wound Care. 2006;19:447-461. 14. Gibbons B. The antimicrobial benefits of silver and the relevance of Microlattice® technology. Ostomy/Wound Management. 2003;49(2A):4-7. 15. Percival SL, Bowler PG, Russell AD. Bacterial resistance to silver in wound care. J Hosp Infect. 2005;60(1):1-7.
Medline Industries, Inc. One Medline Place Mundelein, IL 60060
Save The Dates!
Medline United States 1-800-MEDLINE (633-5463)
Medline Canada 1-800-396-6996
Medline México 01-800-831-0898
www.medline.com | info@medline.com
www.medline.ca | canada@medline.com
www.medlinemexico.com | mexico@medline.com
Some products may not be available for sale in Mexico or Canada. We reserve the right to correct any errors that may occur within this brochure. ©2013 Medline Industries, Inc. Medline and Puracol are registered trademarks and MicroScaffold are trademarks of Medline Industries, Inc. Microlattice is a registered trademark of Kimberly-Clark Worldwide, Inc. MKT1325612 / LIT385R / DP / 17
Conference Secretariat: Tel: +971 4 311 6300, Fax: +971 4 311 6301, Email: idfc@mci-group.com 60
PURACOL PLUS + PURACOL PLUS Ag ®
®
MOIst WOunD DressIngs WIth MIcrOscaffOlD™
Native 100% Collagen Promotes Natural Healing 61