Day 1 :
Keynote Forum
Abrar Aljunaid
King Faisal Specialist Hospital and Research Center, KSA
Keynote: Outcome of the pediatric medulloblastoma patients: Single center experience from Saudi Arabia
Biography:
Abrar Aljunaid has completed Bachelor of Surgery and Medicine from King Abdulaziz University in 2013 and her Pediatric Residency in 2016 from King Abdulaziz University Hospital. Later she graduated from Pedatric Hematology/Oncology Fellowship program in April 2020. She is interested in neuro/oncology in particular.
Abstract:
Propose: Retrospective study reviewing the outcomes of pediatric patients with medulloblastoma.
Patients & Methods: Relevant clinical data were collected from medical charts of 41 cases of pediatric medulloblastoma patients (≤15 years) diagnosed between January 2001 and December 2017, survival analysis and prognostic factor were done.
Results: The obtained results of OS of 73.7% for the whole cohort. The lower age (Age ≤3), high risk, positive metastasis at presentation, partial resection remained vital and contributed to lower overall survival rate among the patients with P value as follow: (P: <0.001, P: 0.041, P: 0.020, P: 0.006). Moreover, event free survival rate was 54.8% for the whole cohort and analysis of it suggested that the extent of complete surgical resection (P<0.018) and age >3 years (P<0.001) was the major factor for better survival.
Conclusion: In our series, the estimated outcome of total cohort was OS 73.7% and EFS 54.8% which are comparable to the developed countries outcome. The age of >3 years and the complete surgical excision are emerging as the most significant factors affecting OS (80.5%, 88.7%) and EFS (61.2%, 70%). Average risk and negative metastasis had significant OS with p value of <0.04, <0.02 respectively. This study provides an important clue in understanding the importance of the demographic, clinical and treatment modalities in understanding the prognosis of medulloblastoma. This report will serve as an important resource from Kingdom of Saudi Arabia regarding medulloblastoma survival.
Keynote Forum
MS. Suchi
Principal Laughter Coach, Singapore
Keynote: Adopting a laughter therapy to get dosage of happy hormones to remove stress caused by being in slight pain, being depressed, being unhappy anxious or sad. Saying positive affirmations aloud changes body cell energy
Biography:
MS. Suchi is an experienced International Pre School Principal/Manager who picked up laughter exercises from many coaches around the world. She then designed ‘Laughter Therapy' which is being used in many places such as hospitals and senior activity centres. She provides individual and group therapy in educational and home settings. She is a former Manager/Trainer, now engages in building social awareness about holistic approach for recovery. Her aim is to encourage people to seek help early and get on the path to recovery. Her works has been featured in local press, TV and Radio and has been an invited speaker at various community clubs and educational institutions. She has also been awarded by MINDS and various community clubs in recognition of her social work.
Abstract:
Abstract
Statement of the Problem:
There is a lack of awareness about what happy hormones are, how to use positive words to feel energetic and what can be done to get happy hormones. People tend to feel unhappy for multiple reasons and neuropathic pain adds on stress levels of not only the patient but the caregivers as well. Being in pain leads to feeling depressed and anxious in some cases.
Methodology & Theoretical Orientation:
Review of books and research shows that getting a dosage of happy hormones will not only ease slight pain of the patient but feeling happy will also have a positive impact on the recovery of the patient. Adopting laughter therapy and getting hormones which makes one feel good will help many to recover from neuropathic pain/long term sadness caused by having grief, anger or resentment, depression & anxiety.
Findings:
One needs to work on his/her energies using laughter therapy which is a positive approach for not having depression & anxiety caused by neuropathic pain. The therapy can be used as a holistic way to recovery.
Conclusion & Significance:
The laughter therapy which includes ways to get the dosage of happy hormones promotes overcoming depression & anxiety caused by neuropathic pain, is a fun way to manage pain. Repeated sessions to be conducted to remind patients that life while having pain or during the recovery should go beyond just seeking medical and counselling help and also include rebuilding spiritual, physical, emotional, relational and mental health. The model has been put together for testing in many settings including hospitals, elderly homes and senior citizen centres. This is not a research book or paper. It is just an effort to demystify the help available for depression & anxiety caused by pain. It is an attempt to motivate and encourage people to seek help and take a simple approach to remember and work on all aspects of their recovery.
Keynote Forum
Mihaela Pungan
University of Medicine and Pharmacy Victor Babes, Romania
Keynote: The role of the neurologist in management of brain tumors in COVID 19 era
Biography:
Mihaela Pungan is a Consultant Neurologist and Director of a Victor Babes in Targu Jiu, Romania. She is a Graduate of the Faculty of Medicine, University of Medicine and Pharmacy "Victor Babes" from Timisoara, Romania (2000). She has extensive experience in general neurology with specialization in epileptology. She has worked both in the public and private system as Consultant Neurologist. She has had a rich clinical activity, but also a permanent participation in medical events in the country and abroad as passive and active participant. She is a Member of several medical organizations in Romania and in the world.
Abstract:
Abstract
Covid-19 poses a huge challenge, in terms of the medical needs of large number of infected patients all over the world. Patients with brain tumors comprise a heterogeneous group with regard to age, symptom severity and prognosis. Thus, we should make clinical decisions on a case-by-case basis. Brain tumor in COVID 19 with the challenges involved in diagnosing and treating brain tumors during these difficult times. Brain tumor types and through a few case presentations. At the end consideration and recommendations in this regard.
- Neuro Oncology /Brain Tumor
Location: Hall 1
Session Introduction
Ajay Samuel
Barts cancer Institute, UK
Title: Insomnia: a possible cause of Glioblastoma Multiforme (GBM); Traditional Medicine Kava Kava, a potential treatment for GBM.
Biography:
Ajay Samuel is currently pursuing Masters in Cancer Molecular and Cellular Biology at Barts Cancer Institute, Queen Mary University of London, UK. He has strong passion in cancer research, specifically glioblastoma multiforme genetics.
Abstract:
In future and current aspects, more psychologically stressed people emerge from psychological disorder (insomnia) because of technological development and its addiction towards it. Cancer is the most aggressive disease which changes the biochemical reactions in the entire system and leads to mortality. Glioblastoma Multiforme (GBM) is the most lethal among all the brain tumors. Among 23,800 adults diagnosed for primary cancerous tumors of brain and spinal cord in 2017, 85-90% were accounted for brain tumor in USA and in 2500 children every year in India. This cancer is generally caused by multiple genes, multiple mutations and patients who were diagnosed for cancer develop psychological stress that leads to metastasis and cause secondary tumor. It is hypothesized that the chronic psychological stress induced by insomnia, which is caused by MEIS1 gene up-regulation, is responsible for GBM through manipulation of regulatory hormones and multiple onco-gene mutation. The traditional medicine Kava Kava may be used for treatment of GBM by counteracting the effects of stress.
Niharika Prasad
Dr. D.Y. Patil Medical College, Hospital & Research Institute, India
Title: Mr dsc perfusion and multivoxel spectroscopy in intracranial lesions – practical applications.
Biography:
Niharika Prasad is MD Radiodiagnosis, Assistant Professor at Dr. D. Y. Patil Medical College, Hospital & Research Institute, Pune, Maharashtra, India.
Abstract:
Abstract
Aims:
With advancement in surgical treatment and chemotherapy options, imaging modalities also need to incorporate advanced neuroimaging modalities for more accurate diagnosis and grading of intracranial masses. This prospective study aims to distinguish intracranial space occupying lesions using dynamic susceptibility MR perfusion and multi voxel spectroscopy techniques. It also attempts to distinguish between progression, pseudo progression and morphologically similar appearing pathologies.
Materials & Methods:
150 Patients including all age groups, intra and extra axial, supratentorial and posterior fossa lesions were grouped and subjected to perfusion and/or spectroscopy in addition to conventional sequences. Histopathology was considered as gold standard and clinical follow up with reimaging was done in cases where biopsy was not performed. Data was analyzed and cut off values for rCBV, Cho/NAA and Cho/Cr were obtained.
Results:
An intracranial lesion could be said to be high grade if rCBV value was greater than or equal to 2.5(sensitivity- 85%, specificity- 88%) while cut off value for Cho/NAA was 2.5 for high grade gliomas (sensitivity 91%, specificity 87% ) with Cho/Cr cut off 1.7 (sensitivity 75 %, specificity 62 % ).For the follow up cases with known HPE, perfusion was superior compared to spectroscopy (Sensitivity- 84.2%, specificity- 100%, PPV- 100% and NPV- 78.6 % with higher accuracy for perfusion versus Sensitivity- 81.8 %, specificity- 100%, PPV- 94.7 % and NPV- 50 % for spectroscopy).
Conclusion:
MR perfusion and spectroscopy if used wisely, can improve diagnostic performance especially where conventional MRI is doubtful. The lower specificity of Cho/Cr can be attributed to high level of choline in some low-grade gliomas. Lipid lactate is another metabolite which yielded low specificity as it was elevated in necrotic high-grade tumors as well as post treatment changes. Further studies may be required for better standardization of these methods so they can be incorporated in imaging protocol on a larger scale.
Swastika Mishra
Institute of Nuclear Medicine and Allied Sciences, India
Title: Nucleo-liposomes as neurotracer for SPECT and anti-cancer drug delivery agent
Biography:
Swastika Mishra is working under Division of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences, India.
Abstract:
The Blood-Brain Barrier (BBB) is a major obstacle for drug delivery to the brain. Nucleolipid based liposomes are promising drug delivery systems allowing in vivo tracking using molecular imaging techniques and have proved promising theranostics agents especially for tumors. However, efficient liposomal preparations for theranostic of neuro-onco, neuro-infection and neurodegenerative diseases needs further research. Nucleolipidic liposomes (NL-Nps) are of great interest because of the site-recognition (nucleoside), lipophilicity (long alkyl chain) and better membrane translocation by interaction of fatty acid with the lipid bilayer. Thus, we have evaluated uridine derived nucleolipidic liposomes for encapsulation efficiencies of MTX (Methotrexate) anti-cancer and sulfanilamide anti-infection drug and in vivo tracking by radiolabeling with 99mTc.
Materials & Method: (NL-Nps) were prepared using NL-DTPA (synthesized), heated to 50° C when mixed with organic solvent and added to aqueous phase containing the surfactant Tween-80 and the co-surfactant soya lecithin. NL-Nps were encapsulated with MTX and sulfanilamide were similarly prepared by adding drugs (0.1 to 1.5%) to the formulation. NL-Nps were evaluated for release kinetics and brain targeting in BMG-1 (brain glioma) and neuronal cell line in murine model.
Results: Multi-step synthesis leads to the final compound (NL-DTPA) and its liposomal preparation (size 113 to 130 nm, zeta potential -14 to -28 mV) with EEs of 64% was achieved. Liposomes showed sustained drug release for 2-5 days negligible hemolytic activity, no cytotoxicity in HEK cells. Radiolabeling efficiency of 98% was achieved using 99mTc conferring prolonged systemic circulation and renal route excretion. The biodistribution showed 1.8% ID/gm to 2.3% ID/gm for intact versus disrupted BBB in mice models. (NL-Nps) also in BMG tumor mice depicted higher tumor uptake (2.3T/M).
Conclusion: Nucleolipid functionalized liposomes as candidates to be used as biocompatible nanocarrier systems with high systemic retention and anti-tumor effects. Future work will concentrate on targeting of liposomes in brain tumor model using stereotaxis.
Minoo Sharbafshaaer
University of Kurdistan, Iran
Title: Neuroplasticity in context of motor rehabilitation in brain tumor
Biography:
Minoo Sharbafshaaer is an experienced Statistical Analyst with a demonstrated history of working in the mental health care industry. She is skilled in research, psychology, psychotherapy, SPSS, and mental health. She has strong research professional with a Bachelor's degree focused in Psychology from Sistan and Baluchistan University.
Abstract:
Motor deficits can occur at any time throughout a brain tumor illness. More than 70% of patients with malignant glioma report motor dysfunction as a problem at some time during the disease, also malignant brain tumors have a very high likelihood of producing disabling effects on a patient’s quality of life, impaired mobility, the risk for complications of immobility, falls, pain, and loss of functional independence. Then rehabilitation is meaningful and necessary if the survival rate is low and the recurrence rate is high in addition rehabilitation on motor function outcomes and recovery of neurological impairment in patients with brain tumors lead to neuroplasticity in the brain, neuroplasticity is the potential of the nervous system to reshape itself during ontogeny, learning or following brain tumors, both physiological and pathological has flexibility interactions between tumor growth and brain reshaping. In particular, rehabilitation programs could optimize functional recovery following resection of a brain tumor and it will be understood in neuroplastic changes will contribute to an understanding that the expanding of cortical. The neuroplastic changes is one of the most important neurophysiologic characteristics that correspond with the level of motor functional improvement and more effective recovery from neurological damage in brain tumor.
Neera Yadav
University of Hyderabad, India
Title: Downregulation of RAP2B promotes human astrocytoma inhibited by involvement of oncogenic mi-RNA
Biography:
She is from Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, India.
Abstract:
Glioblastoma (GBM) is the most malignant form of primary brain tumor with a poor prognosis among all malignant forms. It remains a major public health challenge, posing a high risk for brain tumor-related morbidity and mortality. RAP2B is a member of the Ras oncogene family and a novel target of p53 that regulates the p53-mediated pro survival functions of cells. RAP2B acts as molecular switches and are able to regulate several cellular processes, including adhesion, proliferation, differentiation and apoptosis by modulating a variety of signaling pathways in addition to cell spreading through its interaction with MAP4K4, TNIK, PARG1 and RPIP9. PLC-€ which is activated interacts with RAP2B facilitates cell growth through activating the Ras-Raf-MAPK/ERK signaling pathway. But clinical importance of RAP2B regulation by oncogenic miRNA in wild type/mtP53 GBM is not known. Here, we are investigating the clinical and functional importance of RAP2B in wt/mutP53 GBM.
Methods:
RAP2B expression was estimated in human astrocytoma tissue (n=64) by RT-qPCR, western blotting, immune-histochemistry and immunofluorescence. RAP2B expression was analyzed with various clinic-pathological parameters and TCGA dataset and correlated with wt/mut P53 and RAP2B downstream targets pFAK and pERK1/2.
Results:
Our findings disclosed down-regulation of RAP2B in malignant astrocytoma associated with pathological grading and patient’s poor survivability corroborating with TCGA dataset. We observed the positive correlation between RAP2B with P53 in GBM tissues which may extort GBM malignancy and poor prognosis.
Conclusion:
Altogether, we found down-regulation of RAP2B in mut type p53 and IDH GBM provokes GBM malignancy and patient’s survivability. The RAP2B overexpression may restrict cell growth and sensitized apoptosis by suppressing EGFR-mediated pFAK-pERK1/2 signaling in wild type p53 GBM cells, suggesting that targeting oncogenic mi-RNA can be a prognostic and therapeutic target for mutp53 GBM.
Muhammad Nouman Mughal
Aga Khan University, Pakistan
Title: Comparative clinical and epidemiological study of central nervous system tumors in Pakistan and global database
Biography:
Abstract:
Abstract
Introduction & Aim:
Brain tumors encompass a broad group showing wide geographic and ethnic variation in incidence. In keeping view the critical dearth of epidemiological data on CNS tumors from Pakistan we undertook this study, with the aim to first describe spectrum of CNS tumors at our center, and then to compare our results with prevalence pattern in global population using TCGA dataset.
Methodology:
Data was retrospectively collected from histopathology archives of Dow Diagnostic Reference and Research Lab (DDRRL), Dow University of Health Sciences (DUHS), Pakistan. Clinical data set for Low Grade Gliomas (LGG) and Glioblastoma (GBM) cohort (TCGA) was downloaded from cBioPortal. All the analyses were performed in IBM SPSS v. 24 and P value less than 0.05 was set as threshold to show significant difference.
Results:
Total 430 cases were enrolled in our study comprising of 224 males and 206 females of which 132 (30.7%) cases were of diffuse gliomas. WHO grade I (53.6%) was the prevalent grade group with nearly half (49.3%) cases diagnosed in adults (>36 years). Significant difference was recorded between our centre and global dataset with respect to age (P<0.0001), common histological subtype (P<0.0001), and histological grade (P<0.0001).
Conclusion:
Present study shows significant variation in CNS tumor prevalence pattern between our population and global data highlighting the need for epidemiological and scientific studies to delineate the environmental and genetic risk factors pertaining to our population.
Rose Daynielle A Cansanay
Philippine Children’s Medical Center, Philippines
Title: Medulloblastoma occurring 7 months after the diagnosis of a primary spinal tumor: A case report
Biography:
Rose Daynielle A Cansanay has graduated cum laude in Doctor of Medicine from Far Eastern Univerisity-Nicanor Reyes Medical Foundation. She is currently a Senior Fellow-in-Training under Child Neurology at the Philippine Children’s Medical Center and a Diplomate of the Philippine Pediatric Society, Inc.
Abstract:
Medulloblastoma is the most common primary malignant solid tumor in children. These are invasive, and rapidly growing intracranial tumors that spread through the cerebrospinal fluid and frequently metastasize to the brain, spinal cord and other extraneural locations. We report an adolescent male who presented as progressive lower extremity weakness and numbness. The initial lesions were seen at the lower cervical and upper thoracic spine. Biopsy of the tumor was not done and the patient underwent radiotherapy. Months after the initial presentation, the patient presented with signs of increased intracranial pressure. Neuroimaging revealed a posterior fossa tumor which was consistent with medulloblastoma WHO Grade IV on biopsy. Several atypical presentations of medulloblastoma have been reported but to our knowledge, this is the first case of medulloblastoma that appeared months after a spinal tumor was detected. The question remains if this is a different tumor from medulloblastoma, or an extensive spinal metastasis from a posterior fossa tumor that was not detected in the initial MRI.