Scientific program

Aug 29-30, 2024    Toronto, Canada
6th International Conference on

Respiratory Disease and Care

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Keynote Forum

Scott A. Rivkees

Title: Health Care Providers are Now the Frontline for COVID-19 Response: Are We Ready?

Abstract:

The COVID-19 pandemic continues to evolve as the virus mutates to more contagious forms. With the new waves of new variants and continuing federal effort to address COVID-19, the pandemic response is shifting to state and local levels. We all need to recognize that health care providers are and will be playing an increasingly important role in COVID-19 control and treatment.  Measures to fight COVID-19 are widely available to healthcare providers, including tests, vaccines, monoclonal antibodies, and antiviral medications.  Our challenge is to help practitioners take advantage of the ample tools and guidance available to fight COVID-19.  Health care providers can prescribe anit-viral agents. Health care providers can offer protective monoclonal antibodies to immunocompromised patients. Health care providers can register as COVID-19 vaccine providers. It is recognized that the medical community has endured much during this pandemic. It is also recognized that we can continue to step up.

Biography:

Rivkees is a Professor of the Practice of Health Services, Policy, and Practice in the School of Public Health. He served as Florida's State Surgeon General and Secretary of Health from 2019 to 2021. Before moving to Florida, he served as a professor of pediatrics with tenure at Yale University. Dr. Rivkees has had more than 35 years of continuous research funding from the National Institutes of Health. He was responsible for the safety alert on liver toxicity caused by the antithyroid drug propylthiouracil. This led to major international treatment practice changes.

Jack Caravanos

Title: Challenges in the Epidemiological Evaluation of COVID Interventions

Abstract:

Why is it that we are having so much trouble answering the very basic question: What COVID interventions have proven to be most effective?  To answer this question, we need to study population and their behaviors; meaning we need epidemiology. As the COVID epidemic progressed we implemented what seemed be reasonable actions; i.e. social distancing, hand hygiene, wearing gloves, and later resorted to more complicated interventions such as closing businesses, closing schools, masking, double masking, and finally vaccination (followed by booster 1,2,3). But these rapid adoptions, changes and pivots, have produced a study population which is so confounded that deductions are challenging to say the least. While numerous COVID evaluations and investigations have been conducted, they tended to be singular actions within very small and specialized at risk populations; i.e. health care workers, bus drivers etc.. This session will present the historical progression of COVID interventions and review epidemiological study designs and applicable confounding variables. Suggestions for future public health surveillance programs will be presented and evaluated.

 

Biography:

Jack Caravanos, life in the field ranges from jumping onto a motorcycle and navigating the jungles of Madre de Dios in the Peruvian Amazon studying toxic substances to traveling to remotes areas in Zambia, Indonesia, and Bolivia studying lead and other toxic wastes. By cooperating with local governments, his work provides safe, healthy, and evidence-based solutions for pollution problems in low- and middle-income countries. In partnership with Pure Earth, an international non-profit organization, Caravanos is studying the impact of gold extraction with mercury in Peru and Indonesia. Since miners are in danger of mercury poisoning, his research team is planning interventions that teach safer techniques for gold extraction. In Kabwe, Zambia - a mining town with exposure to lead - his research will provide methods to institute safer mining practices and policy recommendations to improve environmental remediation laws. Caravanos teaches Environmental Health for graduate students and Environmental Health in a Global World for undergraduate students. He also provides opportunities for student researchers in his ongoing projects, including in Indonesia and Ghana.

Gediminas Mainelis

Title: SARS-CoV-2 Aerosols in Homes of COVID-19 Infected Adults: Presence and Control

Abstract:

Introduction. One key challenge is to reduce secondary attack rates among household contacts, which are estimated by the CDC to be as high as 50%. In addition to close interpersonal contact, emerging evidence suggests that airborne transmission is important for spreading SARS-CoV-2 infections in enclosed and/or poorly ventilated spaces, such as homes. Since one of the virus transmission routes is airborne, we hypothesized that its spread could be controlled using portable air cleaners (PACs). However, the existing data are sparse and based on scripted scenarios. Here, we report the first naturalistic intervention study to reduce SARS-CoV-2 airborne transmission using PACs with HEPA filters in the homes of COVID-19-infected individuals.

Methods. Subjects were recruited in the fall/winter of 2020-2021 through an email flyer delivered at the time of notification of test positivity. Saliva screening at the time of the first visit verified continued positivity for all reported subjects. 24-hr air samples of total aerosols were collected in the isolation room (the primary room used by the subject) and the common room (a secondary room) on PTFE filters using open-face filter holders (CH Technologies, Westwood, NJ, USA and SKC, Inc. Eighty-Four, PA, USA) or modified IMPACT filter samplers (SKC Inc.) and Leland Legacy pumps (SKC Inc.) operated at 10 L/min. The PAC was placed only in the primary room, away from any walls. In one 24-hr period, the PAC was operated with a HEPA filter and, during the other, without a filter ("sham" period). The filtration and treatment order was randomized. Samples were analyzed by RT-PCR for expression of three distinct SARS-CoV-2 genes: N, ORF1ab, and S. Samples were considered positive if any one gene and internal control (MS2 phage) were detected at Ct ≤ 40.

Results and Conclusions. Samples were collected in the homes of 17 individuals with newly diagnosed COVID-19 infection. Seven out of sixteen (44%) air samples in primary rooms were positive for at least one gene during the sham period. Seven out of fifteen (47%) air samples in secondary rooms were also positive during the sham period. The data also suggested a strong association between the amount of viral RNA in an infected person's saliva and the likelihood of airborne virus being detected in the primary room. During the filtration period, the proportion of positive aerosol samples decreased to four out of sixteen residences (25%) (p=0.223).

Conclusions

Thus, our results show that SARS-CoV-2 RNA is common in the home air of COVID-19 patients. Therefore, using air cleaners to reduce SARS-CoV-2 exposure should be considered part of guidance for caring for COVID-19 patients in residential and community-based indoor environments, especially in situations of limited space and resources.

Acknowledgments

Supplement to NIEHS P30 Center ES05022, NIH/CATS (UL1TR003017), NIEHS Training Grant in Exposure Science (1T32ES019854; Dr. Nirmala T. Myers), and NIOSH ERC (T42OH008422; Dr. Frederic T. Lu).

Recent Publications

  1. Laumbach, R., Mainelis, G., Black, K., Myers, N.T., Ohman-Strickland, P., Alimokhtari, S., Hastings, S., Resende, A.D., Legard, A., Calderón, L., Lu, F., and Kipen, H. (2021) Presence of SARS-CoV-2 in residences of adults with COVID-19, Annals of the American Thoracic Society, 19(2): 338. Link.
  2. Myers, N.T., Laumbach, R., Black, K., Ohman-Strickland, P., Alimokhtari, S., Legard, A., Resende, A.D., Calderón, L., Lu, F., Mainelis, G.*, and Kipen, H. (2022) Portable Air Cleaners and Residential Exposure to SARS-CoV-2 Aerosols: A Real-World Study, Indoor Air32(4). Link.
  3. Grogan, S. and Mainelis, G. (2022) Effect of Sampling Duration on Culturable and Viable Bioaerosol Determination when using Rutgers Electrostatic Passive Sampler (REPS), Journal of Aerosol Science, 106066. Link.
  4. Myers, N. T., Han, T.T., Li, M.-L., Brewer, G.; Harper, M., Mainelis, G. (2021) Impact of Sampling and Storage Stress on the Recovery of Airborne SARS-CoV-2 Virus Surrogate Captured by Filtration, Journal of Occupational & Environmental Hygiene18 (9), 461-475. Link.
  5. Metaxatos, A., Manibusan, S., and Mainelis, G. (2022) Investigation of sources, diversity, and variability of bacterial aerosols in Athens, Greece: a pilot study, Atmosphere, 13(1), 45. Link.

Biography:

Gediminas “Gedi” Mainelis is a Professor in the Department of Environmental Sciences at Rutgers, the State University of New Jersey, USA. He has a Bachelor’s degree in physics from Vilnius University, Lithuania, and a Ph.D. in Environmental Health from the University of Cincinnati, Ohio, USA. His research focuses on various aspects of bioaerosol science, including sampling and analysis methods, exposure assessment, and airborne microbiomes. Over the past years, his research expanded to investigate exposures to manufactured nanoparticles and explore indoor air issues. Several of his current projects focus on COVID-19 issues. His research efforts have resulted in more than 110 peer-reviewed publications, book chapters, and several patents. In addition, multiple papers from his group have been included in the most downloaded article lists of various peer-reviewed journals. Dr. Mainelis has served as Chair of the Bioaerosols and Health-Related Aerosol working groups of the American Association for Aerosol Research (AAAR). He is currently an editor (associate) of the Aerosol and Air Quality Research journal. Prof. Mainelis is a recipient of the Research Excellence Award from Rutgers University and the Lyman A. Ripperton Environmental Educator Award presented by the A&WMA.

M. Lavae-Mokhtari

Title: Effective secretolytic and bronchodilatativ Strategies by Prolonged Weaning by COPD GOLD D Patients on Respiratory Intensive Care Unit after quantitative based Lung Computertomographie and Lung Volume Reduction Surgery bei massive Emphysema

Abstract:

A meta-analysis of studies published in the 1990s calculated the incidence of VAP (ventilator-associated pneumonia), which is equivalent to 16.5 cases per 1,000 patient days. Attributable mortality due to VAP was estimated to be 20-40%, although the range in different studies was very broad. Healthcare costs related to VAP seem to be remarkable in particular with regard to multidrug-resistant pathogens. VAP is an infection frequently caused by Pseudomonas aeruginosa, Haemophilus spp., and Klebsiella spp. or by Staphylococcus aureus. Anaerobes are a rare cause of VAP. Patients with COPD GOLD D and massive Emphysema, who undergo a Lung Volume Reduction Surgery by prolonged Weaning and long-term treatment on intensive care units, after a quantitative-based Lung Computertomographie to prevent VIDD need an intensive and efficient secrtlytic additionally to bronchoscopy by presenting bronchospasms at the same time. On our Respiratory Intensive Care Unit, we use a Dymedso Frequenzer with sound wave (45 Hz) from the company inspiration medical four times daily in combination with six times deeply bronchodilatativ Aeronep Inhalation from the company Aerogen to reach a 17% lung disposition in compared to 3% by conventional nebulizer. We optimize this by an LALMA/LABA fix combination (Glycopyrroniumbromid/Formoterol) via tracheal cannula from the company AstraZeneca with AEROSPHERE Delivery Technology. Active ingredient particles are connected on aerodynamic Phospholipid particles, which are a natural carrier substance and a component of lung surfactant. Previous studies with health persons could show lung disposition of 38%. The safety and efficiency were demonstrated in phase 3 study PINNACLE 1 and 2 and long-term data of safety and effectiveness in PINNACLE 3.

Biography:

M Lavae-Mokhtari is a consultant in the Respiratory Intensive Care Unit in General Hospital Ibbenburen in Germany since 2013. He has seven publications, 17 national and international poster publications, one book publication, and three scientific international and one national oral presentation. He has 152 citations and a 17.48 RG Score by research gate. He is a member of the German Respiratory Society, Section Intensive-Care and Ventilation Medicine, European Respiratory Society, Section Intensive-Care and Ventilation Medicine, and Section Thorax oncology and German Interdisciplinary Society of Outpatient Ventilation.

Mitch Simpler

Title: How Does Antiviral Technology Stack Up Against Enhanced Ventilation and Filtration Measures?

Abstract:

How does the Grignard Pure antiviral technology stack up against enhanced ventilation and filtration measures for airborne virus mitigation? Grignard Pure is not intended to replace the enhanced ventilation and filtration strategies recommended by the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) and the U.S. Centers for Disease Control and Prevention (CDC). Grignard Pure has been deployed as an additional layer of protection for public health in the fight against the COVID-19 pandemic. The product’s label directs users to follow public health officials’ advice, including enhanced ventilation and filtration guidance.
Grignard Pure can be introduced into an indoor space either through application equipment installed in an HVAC system or by a free-standing dispersion unit. Engineering studies show that aerosol quickly and evenly disperses throughout an indoor space and does so in both small and large spaces. (New Amsterdam Theatre Grignard Pure Proof of Concept Part 1: Enhanced Ventilation Studies and JBB: Grignard Pure Deployment Case Study.) commercially available sensors can measure the level of aerosol in space. In order to ensure a consistent, safe, and efficacious concentration of Grignard Pure in the air, proprietary software can use commercially available sensor measurements to automatically direct the dispersion equipment to maintain Grignard Pure at the concentration level within the EPA-approved concentration range once the target level is reached.
Three criteria are critical to examine when comparing an antimicrobial air treatment with enhanced ventilation and filtration measures. First, the amount of reduction: What percentage of the circulating virus is eliminated? Second, the speed with which the measure works: How quickly does the measure remove virus particles? Third, the mechanism of action—removal versus inactivation of the virus particles: How does the measure achieve its effect? A case Study will be presented to demonstrate the engineering principles developed and executed in the delivery technology and effectiveness of the Grignard Pure deployment.

Biography:

Mitch Simpler joined JB&B, a global consulting engineering firm, in 1977 and currently serves as a partner after having served as Managing Partner from 2012- 2018. He has acted as project manager and partner-in-charge on life/health science institutions, health care facilities, high-rise office buildings, museums, residential and mixed-use buildings, as well as hotels. Simpler’s list of notable projects in the life science sector spans the past 45 years, including premier laboratory facilities and research centers in New York City, such as the Jerome L. Greene Science Center at the Columbia University Manhattanville campus, The East River Science Park in New York, the New York Genome Center, Mount Sinai’s Hess Center for Science and Medicine, Weill Cornell Medical College’s Belfer Research Building, MSK’s David H. Koch Center for Cancer Care and Rockefeller Research Laboratories, Cornell University’s Biotechnology Building, and NYU Langone Health’s Smilow Research Building and Skirball Institute of Biomolecular Medicine. His experience extends around the world to China, with the Innovation Center at Duke Kunshan University in Kunshan and the Rohm & Haas Research Center in Shanghai. Mr. Simpler is a fellow of the American Council of Engineering Companies (ACEC) and recently served as the National Chairman of ACEC. He is also a founding member and Co-Founder of NYC Builds Bio+.

Alexander D. Verin

Alexander D. Verin

Augusta University USA

Title: Mechanisms of lung endothelial barrier protection in acute lung injury: role of extracellular purines

Biography:

Verin completed his Ph.D. at the age of 29 years from Moscow State University, Moscow, USSR, and postdoctoral studies at the University of Indiana. During his scientific carrier, he was a faculty member at Johns Hopkins and the University of Chicago. Currently, he is a Professor at the Vascular Biology Center and Pulmonary Division, School of Medicine, Medical College of Georgia, at Augusta University, Augusta, GA.   He has published more than 170 papers in reputed journals primarily in the field of pulmonary vascular endothelial barrier regulation.  He served as an Editorial board member of the American Journal of Physiology (Lung) from 2006-2011 and Editor-in-chief of the academic journal, Vessel Plus, in 2016-2022. He is currently serving as an academic editor of the British Journal of Medicine and Medical Research and Cardiology and Angiology, and an editorial board member in several other journals in the field of pulmonary/cardiovascular research such as Biomolecules, Cardiovascular Pharmacology, Journal of Multidisciplinary Pathology, Tissue Barriers, World Journal of Respirology.

Tim Higenbottam

Tim Higenbottam

United Kingdom

Title: London Hospital Almost Runs out of Oxygen for Covid-19 Patients

Abstract:

Standard delivery of oxygen (O2) to patients with respiratory failure is inadequate, both in pneumonia and in COPD patients.
In COVID-19 mortality rates from pneumonia in UK hospitals rose from 30% to 45%1. This was linked to early use of mechanical ventilation. Similar accounts were reported in USA.2
Currently home O2 is recommended for hypoxic patients at flow rates limited to 3-5L/min for COPD.3 In the USA O2 therapy costs $2.8 billion annually.4 COPD patients appear not to comply with its prescribed use.3 The National Institute Clinical and Care Excellence (NICE) recommends a maximum flow rate of O2 of 15 L/min for patients in acute respiratory failure when arterial O2 saturation (SpO2) falls below 94%.5
These recommended flow rates are below the inspiratory flow rates seen during mild exercise. The Minute Ventilation (MV) rises to 30L/min but requires the peak inspiratory flow rate to rise to 100L/min.6 The same MV occur in pulmonary disease at rest where there is reduction of gas exchange.7 Suggesting that these recommended O2 flow rates for pneumonia or hypoxic COPD patients are too low to match their peak inspiratory flow.
As standard O2 delivery uses open mask to the face/nose, that requires entrainment into the lungs by the inspiratory flow. If the inspiratory flow rate exceeds the flow of O2 then air is entrained so diluting the O2 reaching the lungs.8 The high COVID pneumonia mortality rates and the under use of home O2 can be explained by the use of recommended O2 at flow rates as low as 5L/min to 15L/min could explain.
We recommend instead, automatic matching the flow rate of O2 to the patients inspiratory flow and pulsing automatically selected volumes of O2 to ensure SpO2 remains between 94% - 100%, by using a robotic delivery device.

Biography:

Scientist and Clinician, NHS physician at the Royal Papworth Hospital Cambridge, discoverer of first effective therapies for Pulmonary Arterial Hypertension [PAH] (iv. Prostacyclin and Inhaled NO). Established the UK National Network of PAH centres. Professor, Medicine Sheffield University Medical School and Senior Principal Scientist AstraZeneca plc, Corporate Clinical Director Chiesi Farmaceutici (Italy), Architect of the first triple inhaler for asthma/COPD Trimbow®, Senior Partner TranScrip LLP, R&D Director Allergy Therapeutics plc, Vice President, and President Faculty of Pharmaceutical Medicine Royal Colleges of Medicine UK. CEO and founder of Camcon Robotics Ltd.

Speakers

Ashwani Verma

Title: Smartphone enabled home based self-management informatics platform for COPD in India

Abstract:

Background: COPD is one of the prominent causes of mortality, morbidity and disability among chronic respiratory diseases. Digital health interventions exist to provide various healthcare services to individual diagnosed with COPD. Training and support to the COPD patients on selfmanagement of their COPD status, improves health related QoL and can reduce unplanned hospital visits and admissions. Method: A prospective non-randomized study will be conducted to implement the selfmanagement informatics platform among 164 COPD patients (82 each in intervention and control group) in the selected hospital of India. A mixed methods will be conducted among identified COPD patients to assess the impact of COPD self-management informatics tool. Intervention: Identified COPD patients (GOLD-2 and 3) will be provided a smartphone application which includes the educational videos in local language on breathing techniques, airway clearance techniques, exercise training, fatigue management, counselling on physical activities, nutrition, smoking cessation, and spirometry. Control group: COPD patients assigned to control group will be treated with standard treatment regime for their COPD. Data Analysis: Data will be analyzed using statistical software like SPSS 21 version. Continuous variable will be summarized using mean and standard deviation and frequencies will be reported for categorical data. Independent or student t-test will be used to analyze the mean difference between intervention and control groups. Chi square test will be used for comparison between groups. Logistic regression will be done where outcome variable is dichotomous. Conclusion: Smartphone enabled informatics platform may assist the COPD patients in the management of the exacerbations, reduced health care facility admissions, hospitalization days and health related quality of life.

Iveta Rumenova Madzharova

Title: Co-pathogens causing respiratory infections in patients with SARS-CoV-2 in Bulgaria

Abstract:

Statement of the Problem: Coinfections with SARS Co-2 and bacterial, fungal, or viral pathogens can worsen the clinical condition and pose challenges to the disease's diagnosis, treatment, and prognosis. This study aims to determine the prevalence and clinical significance of co-infection with SARS-Co-2 and another respiratory pathogen in Bulgaria.Methodology & Theoretical Orientation: Nasopharyngeal swabs from patients with confirmed SARS-CoV-2 infection were prospectively collected from both inpatients and outpatients, with female patients being 55% and male patients being 45%, respectively, and patient ages varied from 45 days to 98 years. RT-PCR was used to detect SARS-Co-2, 8 common respiratory viruses - respiratory syncytial virus(RSV), human metapneumovirus(HMPV), parainfluenza viruses(PIV)1/2/3, rhinoviruses(RV), adenoviruses(AdV), bocaviruses(BoV) and 4 seasonal coronaviruses: OC43, NL63, 229E, and HKU-1. Capillary electrophoresis was used for the detection of three bacterial co-pathogens: Mycoplasma pneumonia(MP), Chlamydophila pneumonia(ChP), and Haemophilus influenza(HI).
Results: From August 2021 to early May 2022, clinical samples from 337 SARS-CoV-2 positive patients were tested for the presence of respiratory co-pathogens, with 42 co-infections detected. Those involving bacterial pathogens were n=23(54.8%) and those involving viral pathogens were n=14(33.3%). The order of evidence of co-pathogens was: HI(n=20; 47.6%), RSV(n=4, 9.5%), ChP(n=3,7.1%), AdV(n=3;7.1%), HI+RSV(n=3;7.1%), BoV(n=2,4;8%), HMPV(n=1;2.4%),PIV-3(n=1;2.4%), RV(n=1;2.4%), HKU-1(n=1;2.4%), NL63(n=1;2.4%), HI+AdV(n=1;2.4%) and HI+PIV2 (n=1;2.4%). Children aged 6-16 years and patients over 65 years had the highest rate of co-infections (37.5%/18.2%). Of the co-infected patients, 32(76%) were hospitalized and three(7.1%) had a fatal outcome. The deaths were in patients co-infected with a bacterial pathogen and SARS-CoV-2.Conclusion & Significance: In patients positive for SARS-Co-2, the frequency of co-infections with a bacterial pathogen prevailed over that with a viral one. Due to the large proportion of antibiotic-treated patients(83%) with complications due to COVID-19 and the risk of the emergence of resistant strains, timely diagnostics aimed at identifying co-pathogens is of particular importance, which would help in the correct and timely treatment of patients.

Biography:

Iveta Madzharova is a biologist at the National Center for Infectious and Parasitic Diseases, National Laboratory "Influenza and SARS", Sofia, Bulgaria since the beginning of 2022. She has а bachelor’s degree in Biotechnology - Sofia University "St. Kliment Ohridski", Biological Faculty and started a master's degree in 2021 in the field of Microbiology and microbiological control - Sofia University "St. Kliment Ohridski", Biological Faculty. She is developing a master's thesis on the research topic. She participated in two projects related to the research topic. She published one article with impact factor in a reputable journal on the topic "Clinical significance and role of co-infections with respiratory pathogens among individuals with confirmed coronavirus-2 infection with severe acute respiratory syndrome". She participated in an international congress.

Grishma Desai

Title: Efficacy of Grignard Pure Against a Variety of Bioaerosols

Abstract:

The awareness of airborne transmission of infectious diseases has greatly increased during the recent COVID-19 pandemic. Laboratory studies have shown that the SARS-CoV-2 virus can remain viable for up to 16 hours in respiratory droplets with a diameter of 0.09µm. Grignard Pure® (GP) is a unique and proprietary blend of Triethylene Glycol (TEG) and inert ingredients designed for continuous antimicrobial treatment of air. GP received approval from the US EPA under its Section 18 Public Health Emergency Exemption program for use in seven states . Grignard Pure® has been tested by third party accredited labs for efficacy in the air and on hard surfaces against multiple microorganisms (gram positive bacteria, gram negative bacteria, enveloped viruses, non-enveloped virus, mycobacteria and mold endospores). Experiments measured the decrease in the airborne viable bioaerosol concentration in the presence of specified concentrations of GP from 60 to 90 minutes, accounting for both natural die-off and settling of the bioaerosols.  Experiments were conducted with GP in its undiluted form where it was aerosolized in a control time release method utilizing a nebulization dispersion device. Settling slides were used to assess reduction of viable microorganism deposition onto surfaces. GP is consistently able to rapidly reduce viable bioaerosol concentration by 2-3 logs at GP concentrations of 0.02 mg/m3 to 0.5 mg/m3 (corresponding to TEG concentrations of 0.012 mg/m3 to 0.287 mg/m3) for a variety of microorganisms. In addition to being efficacious, GP is also safe to use. The safety of TEG, the active ingredient of GP has been evaluated by third party independent labs as well as the US EPA and FDA. The likelihood of adverse effects from continuous inhalation exposure to TEG resulting from the use of aerosolized GP is considered low. The assessment also indicated that acute, subacute/sub-chronic and chronic toxicity, genotoxicity and carcinogenicity are not expected. This TEG-based antimicrobial air treatment product tested shows high efficacy against a variety of bioaerosols and has a favorable safety profile. As a result, it can be used to reduce transmission of airborne infectious diseases in indoor public spaces.

Biography:

Grishma Desai is multifaceted Scientist and Quality Manager at Grignard Company LLC with experience in Biological Nutrient Removal (BNR), wastewater mineral removal and US EPA Pesticide Testing and Regulations. She has a Bachelor’s of Science in Biotechnology from Rutgers University, New Jersey, USA. During her eight years at Grignard Company, she has led multiple R&D efforts in new product development as well as regulatory compliance for products.  In the past two years, Ms. Desai’s work has focused on developing, testing and obtaining regulatory approvals for Grignard Pure® – an airborne antimicrobial effective against MS2 Bacteriophage, a surrogate for the SARS-CoV-2 as well as other bioaerosols. Ms. Desai worked closely with Dr Katherine Ratliff and her team at the US EPA Office of Research and Development to evaluate the efficacy of Grignard Pure® in reducing airborne virus concentrations using a large-scale test chamber and a standardized testing approach. Ms. Desai recently submitted a paper titled “The efficiency of Grignard Pure to inactivate airborne SARS-CoV-2 surrogate” to a peer reviewed journal detailing the testing conducted on Grignard Pure at independent testing labs.

Sadia Saber

Sadia Saber

Bangladesh

Title: Socio-Demographic Determinants of Adult Pulmonary Tuberculosis Patients: A Hospital Based Study at Dhanmondi, Dhaka, Bangladesh

Abstract:

Tuberculosis (TB) is a multi-system infectious disease with a major cause of morbidity and mortality all  ver the world but particularly in developing countries like Bangladesh. A normal healthy individual does not face the symptoms causing by tuberculosis due to their immune system that’s why infection among healthy individuals always remain silent. As it is highly infectious air borne disease that’s why treatment completion for TB is the cornerstone of its control and prevention. So to understand these factors efficiently this study was carried out about socio-demographic determinants of adult TB patients attending the tertiary care teaching hospital, Dhanmondi, Dhaka.

Methodology: This was hospital based cross sectional observational study done at Bangladesh Medical College Hospital, Dhanmondi, Dhaka with the study period from January 2020 to December 2021.Total 410 patients of age group 18 years and above with persistent cough with sputum production for more than 2 weeks were enrolled for this study purpose.

Results: Total prevalence of sputum positive adult pulmonary TB among the studied group was 69.02%. Majority 54% were male patients in the age group of 41-50 years (31.45%). Pulmonary TB was predominantly diagnosed among employed group 41.34%, those who have completed their high school level (34.28%) in mainly the rural (66.08%) locality. Joint family (61%) with 8-10 family members (43.46%) have been found mostly affected in our study. The cardinal features were cough with sputum production (80.21%) followed by fatigue (71.73%), fever (42.05%), sweating (46.99%), loss of appetite (32.86%) and weight loss (27.56%). Pulmonary TB was found mostly among smokers (57.23%) with normal BMI (44.88%).

Conclusion: To decrease the rate of infection with Tuberculosis, a multifactorial approach can play the pivotal role by improving the living conditions, education level, economic status and adequate sanitation. Awareness can bring a new dimension in this regard.

Biography:

Sadia Saber, currently working as an Assistant Professor in the department of Medicine, Bangladesh Medical College, Dhanmondi, Dhaka, Bangladesh for the last 4 years. She has completed her MBBS under the university of Dhaka in the year July 2010 with honours marks in Anatomy, Physiology, Biochemistry and Pathology. She also secured 4th position in the merit list during her 2nd Professional MBBS Examination.Then she completed her 5 years Post-graduation Clinical Training at Bangladesh Medical College Hospital From January 2012 – December 2016. She has acquired her Fellowship (FCPS) in Internal Medicine from Bangladesh College of Physicians and Surgeons (BCPS) in the session of January 2017. She has obtained her MRCP (UK) & MRCP (Ireland) in the year of November 2017 & October 2019 respectively. She has passed MRCP SCE in Respiratory Medicine (UK) in the year of October 2021. She has also completed her Postgraduate Diploma in Respiratory Medicine, under the University of South Wales, Cardiff (UK) in the session of 2021-2022.She has acquired European Diploma on Respiratory Medicine (Switzerland) on 2022. Currently she is doing her Master’s Degree in Sleep Medicine under the European University of Madrid, Madrid, Spain. She is working as an active member of the Royal College of Physicians and Surgeons of Glasgow (UK), the Royal College of Physicians of Edinburgh (UK), American College of Physicians (USA) & American College of Chest Physician (USA). She has got more than 35 publications in both national and international level, among those she is the 1st author for than 25 publications.

Keynote Forum

Brian Regan

Title: A Story About Chemicals, Science and Public Health

Abstract:

The treatment and distribution of drinking water for safe use is a landmark achievement of the 20th century. Up through the end of the 19th century, typhoid fever, dysentery, and cholera killed thousands of Americans every year. Beginning in 1908, cities began treating drinking water with chlorine. Drinking water chlorination and filtration have helped to virtually eliminate these diseases in the United States. The U.S. Centers for Disease Control and Prevention (CDC) regards the disinfection of drinking water as one of the 10 most significant public health advances of the 20th century. Almost all drinking water systems in the United States that disinfect their water use some type of chlorine-based process, either alone or in combination with other disinfectants. What public health achievements will define the 21st century? With the arrival of COVID-19 in 2020, a group of scientists and engineers came up with an exciting idea. In researching the safety of triethylene glycol(TEG), one of the primary ingredients in lighting effects products, they discovered that TEG was effective at killing harmful microorganisms. These scientists and engineers came to think that it would be possible to make a product that could be released into the air at levels that would kill the virus that causes COVID-19. Further testing confirmed its effectiveness against a wide array of viruses, bacteria and mold. 1.1 million US deaths later, COVID has delivered a stark reminder of how unhealthy our indoor air really is, with the presence of airborne pathogens so prevalent in our schools, homes, workspaces, and public places. Could a solution powered by TEG prove to be a milestone 21st-century public health achievement in the effort to make our indoor air healthier and safer against future pandemics, hospital-acquired infections, sick building syndrome, and the common cold?

 

Biography:

Brian T. Regan serves as Chief Strategy Officer for Grignard Pure, LLC, an innovative science and technology company developing next-generation solutions for eliminating airborne pathogens in all indoor environments from healthcare, to food processing, to workplaces, schools, and homes. He is responsible for shaping and executing Grignard Pure’s go-to-market strategy, integrating science, IP, regulatory, product development and partner engagement into successful implementation. Prior to joining Grignard Pure in January 2021, he spent twenty-five years working with organizations from start-ups to Fortune 500 companies, helping position them for optimal competitiveness in the markets they serve. Among those companies he counseled include Virgin, EMC, CA Technologies, Intuit, MongoDB, Docusign, and Philips.

 

Attapon

Attapon

Thailand

Title: Long COVID-19 and Cardiopulmonary Metabolic Syndrome

Abstract:

Several  previous  studies  hypothetically  reported  that  the  prevalence  of  diabetes  mellitus, hypertension, and  dyslipidemia, and  obesity  in  persons  older  than  60  years  were  significantly  rising.  The  effects  of  changes  on  the  immune  status  and  insulin  secretion  in  patients  with  diabetes  are  still  questionable, whereas  several  previous  studies  demonstrated  trigger  higher  stress  conditions  of  the  effects  of  SARS-CoV-2 (COVID-19)  contributing  to  hyperglycemia  in  patients  with  diabetes.

  Despite  the  increased  risk  of  adult  respiratory  distress  syndrome (ARDS)  and  multi-organ  dysfunction  in  early  COVID-19  phase  or  in  long  COVID-19  phase  after  diabetes, diabetes  alone  is  not  related  to  an  increased  risk  of  respiratory  infection, including  COVID-19.  Diabetes, diabetic  traits, and  diabetic  blood  proteins  may  have  the  most  causal  effect  on  the  angiotensin-converting  enzyme 2 (ACE 2)  expression, particularly, in  the  lung, thus, diabetes  can  trigger  the  risk  of  COVID-19  infection  and  increase  chance  of  worst  outcome  in  the  long  COVID-19  phase, and  finally, COVID-19  patients  with  diabetes  mellitus  will  have  poor  prognosis  during  long  COVID-19  phase.    

In  conclusion, dyslipidemia, high  serum  levels  of  cholesterol, low  serum  levels  of  HDL, hypertension, and  obesity  with  high  expression  of  ACE 2  in  adipose  tissue, an  epidemic  of  the  last  century  in  conjunction  with  COVID-19  pandemic, particularly, in  the  over-60-year-old  population  are  the  cardiopulmonary  metabolic  or  cardiometabolic  events  that  could  contribute  to  the  COVID-19  disease  worsening  both  in  the  early  and  long  COVID-19  phases.  Treatment  type  of  cardiopulmonary  metabolic  or  cardiometabolic  diseases  or  disorders  did  not  impact  the  COVID-19  status, but  non-treatment  of  these  diseases  or  disorders  could  importantly  increase  COVID-19  incidence.  Monitoring  of  the  cardiopulmonary  metabolic  or  cardiometabolic  risk  factors  is  urgently  needed. 

Biography:

Cheepsattayakorn  graduated  Doctor  of  Medicine  from  Chiang  Mai  Medical  School, Chiang  Mai  University, Chiang  Mai, Thailand  in  1986.  He  then  further  had  trained  in  Internal  Medicine,   Pulmonology, and  Radiology  at  Chiang  Mai  University  Medical School.  Recently, on  October  26, 2019, he  was  bestowed  the  Gold  Medal  Award (First-Class  Award)  from  the  Chiang  Mai  University  Medical  School  Alumni  Association  in  Chiang  Mai, Thailand  for  his  academic  and  medical  practice  excellence  for  cerebrating  the  60th  Anniversary  of  the  Chiang  Mai  University  Medical  School, Chiang  Mai, Thailand  that  was  established  on  October  28, 1959.  He    graduated  numerous  Fellowships  from  the  Royal  Colleges  of  Physicians  of  Edinburgh, London  and  Thailand, Royal  College  of  Physicians  and  Surgeons  of  Glasgow, American  College  of  Physicians, and  American  College  of  Chest  Physicians.  Presently, he  serves  both  Editor  and  Editorial  Board  Member  and  also  referee  of  several  international  journals. 

  He  has  very  high  experience  in  the  fields  of  Pulmonary  Diseases  and  Tuberculosis  including  Infectious  Diseases  and  Immunology.  He  has  numerous  scientific  publications, more  than  300  publications  both  in  national  and  international  journals  and  books, including  authored  textbook  of  COVID-19, “ Thailand’s  and  Global  Perspectives  of  COVID-19 ”, both  the  United  Kingdom  version (361  pages, first  edition  published  by  the  Medical  and  Research  Publications  in  2021)  and  the  United  States  of  America  version (367  pages, second  edition  published  by  the  Science  and  Education  Publishing  in  2022).  He  had  been  served  as  Pulmonologist  and  Senior  Expert  Level  11 (Highest  Level-equivalent  to  Professor  of  Medicine  Level  11), Department  of  Disease  Control, Ministry  of  Public  Health, Thailand.  He  serves  as  Faculty  Member  of  the  Faculty  of  Medicine, Western  University, Thailand. 

Currently, he  also  serves  the  International  Regional  Adviser (Advisory  Board)  for  Thailand  of  the  Royal  College  of  Physicians  of  Edinburgh, United  Kingdom  and  the  Reviewer  for  the  journals  of  the  Royal  College  of  Physicians  of  London, United  Kingdom.   He  was  appointed  the  Japan  International  Cooperation  Agency (JICA)’s  Advisor  in  2021-2022.  He  was  directly  invited  &  proposed  to  the  World  Federation  of  United  Nations  Associations (WFUNA)  Membership  by  the  United  Nations  Former  Secretary-General  “ H.E.  Ban  Ki-Moon ”. Recently, he  has  been  approved  for  the  Membership  of  the  WFUNA  since  4  January  2022 (Ref. : UN-467-NYUN)  and  has  been  appointed  the  WFUNA  Membership  signed  by  the UN authorities (the  UN Secretary-General, the  UN President of the General  Assembly, and  the  UN  President  of  the  Security  Council)  since  January  15, 2022.

Speakers

Martha Chadyiwa

Martha Chadyiwa

South Africa

Title: Workers exposure to respirable crystalline silica dust at selected coal fired power stations in Bethal, Mpumalanga province, South Africa

Abstract:

Workers in coal-fired power stations engage in a range of work tasks or processes which may involve handling or exposure to respirable dust, including coal dust or coal fly ash. Recent studies have shown that crystalline silica exposure remains one of the detrimental concerns in mining, construction and general industry. A quantitative study was conducted to determine employee’s level of exposure to respirable crystalline silica at a coal fired power station in Mpumalanga Province, South Africa. A total of 34 employees participated in the study. The study revealed that the male employees were most predominant in the coal handling plant as compared to the females. 81.2% (n=27) of the respondents were found to be males while 18.8% (n=7) were found to be females. The study determined the mean exposure value of 0.969 mg/m3 for respirable coal dust which was found to be below the recommended occupational exposure limit (OEL) of 2 mg/m3 as set by the Department of Labour (DoL). While the study determined the mean exposure value for crystalline silica as 0.184 mg/m3 which was found to exceed the recommended OEL of 0.1 mg/m3 as indicated by the DoL. Results from this study confirms occupational exposure to crystalline silica, which is a well-established hazard in mining, therefore, use of personal protective equipment should be recommended.

Biography:

Martha is a registered EHP with the Health Professions Council of South Africa. She is a holder of a Bachelor of Science Degree in Environmental Health. She also have an MBA in Environmental and Energy Management from Twente University. She completed an Honors in Leadership at the University of Johannesburg. She is currently registered for a PhD in Public Health at Witwatersrand University focusing on Occupational Health injuries. She was involved in the creation and content development on the online Master of Public Health at the University of Johannesburg. Currently she is an Online Facilitator on the Sample Abstract Template Master of Public Health at the University of Johannesburg. She has been an Adjunct lecturer at the Witwatersrand University and MANCOSA for more than three years. She has published papers on occupational and environmental health in internationally accredited journals. She has supervised more than 16 Masters Students to completion in her career. Her niche area of research is occupational and environmental health. She also involved with research that is focusing on how artificial intelligence is impacting occupational and environmental health. She was recently recognized as one of the top fifty influential women in Science, Technology, Engineering, and Mathematics (STEM) in South Africa for her contribution in the subject matter.

Nightingale Syabbalo

Title: The role of interleukin-17 in the pathogenesis and treatment of severe neutrophilic asthma

Abstract:

Asthma is a common chronic airway disease affecting approximately 334 million people worldwide, and about 7 million children globally. Approximately 10% of patients with asthma have severe refractory disease, which is difficult to control on high dose inhaled corticosteroids and long-acting β2-agonists (LABA). Half of these patients have neutrophilic asthma. Neutrophilic asthma is a phenotype of asthma characterized by severe and persistent airflow obstruction, frequent exacerbations and hospitalization, and is associated with status asthmaticus, and fatal asthma. Immunopathologically, it is characterized by the presence of high levels of neutrophils in the lungs and airways. Interleukin-17 secreted by Th17 cells, plays a key role in the pathogenesis of neutrophilic asthma by expressing the secretion of chemoattractant cytokines and chemokines, such as IL-8 for the recruitment and activation of neutrophils. Activated neutrophils produce an oxidative burst, releasing multiple proteinases, reactive oxygen species, and cytokines which cause airway epithelial cell injury, inflammation, airway hyperresponsiveness, and remodeling. Most patients with neutrophilic asthma are unresponsive to high dose inhaled corticosteroids, and to eosinophilic asthma targeted biologics, such as omalizumab (anti-IgE), mepolizumab, reslizumab (anti-IL-5), benralizumab (anti-IL-5R), dupilumab (anti-IL-4Rα), tezepelumab (anti-TSLP). Blockage of IL-17 with monoclonal antibodies has not been successful in the precision treatment of neutrophilic asthma. Brodalumab, a monoclonal antibody against the IL-17 receptor did not meet end point in clinical trials. Similarly, blockade of IL-8 receptor CXCR2 produced minimum asthma control. Treatment of neutrophilic asthma is challenging. The most appropriate approach is to use single inhaler tripple therapy incorporating a long-acting muscarinic antagonist; and macrolide antibiotics, such as azithromycin. Accompanying airway remodeling and airway muscle hyperplasia and hypertrophy may require bronchial thermoplasty (BT). This bronchoscopic therapy is effective in patients with severe, uncontrolled asthma irrespective of the phenotype. BT has been shown to reduce the severity of asthma symptoms, exacerbations, and to improve lung function, and health-related quality of life. BT has also a corticosteroid-sparing effect and can allow patients to wean from glucocorticoids.

Biography:

Nightingale Syabbalo is a Pulmonologist, and Clinical Respiratory Physiologist by training, and obtained his postgraduate training at St. George’s Hospital Medical School, University of London, UK. He was trained by one of the international distinguished Respirologists of our times. Nightingale has worked as an academician, Consultant Physician, and Clinical Researcher in several counties, including Canada, Kuwait, Oman, South Africa, and Zambia. He has published extensively in high-impact medical journals, and is an Editorial Board member of twenty-two journals in Pulmonology and Respiratory Medicine; and a reviewer of four journals in Thoracic Medicine, Respiratory Research, and Internal Medicine. Prof. Syabbalo’s current area of research focuses on the role of interleukins in the pathophysiology and treatment of severe asthma. He has also interested in the mechanisms of interleukins-1β in the pathogenesis and treatment of pericardial syndromes.

MudassarRasool

MudassarRasool

Pakistan

Title: CONCOMITANT PRESENCE OF ALLERGIC RHINITIS (AR) IN CHRONIC/FIBROTIC HYPERSENSITIVITY PNEUMONITIS (C/F-HP) PATIENTS: COINCIDENCE OR CORRELATION?

Abstract:

Background:
Owing to cumbersome diagnostic process of chronic/fibrotic hypersensitivity pneumonitis (C/F-HP) - necessitating lung biopsy which is usually fraught with complications in very sick patients, C/F-HP remains under-diagnosed inspite of its high prevalence. There is a need to find out clinical indicators to ease up the process of diagnosing C/F-HP. The concomitant presence of Allergic Rhinitis (AR) in C/F-HP patients may fulfill the need.
Objective:
To elucidate the concomitant finding of Allergic Rhinitis(AR) in C/F-HP , and its utility as one of the clinical indicator for the non-invasive diagnosis of C/F-HP. Thereby obviating the need for lung biopsy.
Method:
This cross sectional descriptive study was conducted in the pulmonology departments of BakhtawarAmin Medical College &Trust Hospital from July 1, 2021 to December 31, 2022. It comprised 107 patients of C/F-HP. Sample size was calculated assuming 50% prevalence of AR, 95% CI, and 9% margin of error. The patients aged 18 to 60, were enrolled by consecutive sampling technique. Prior approval from Ethical Board of the hospital was taken. The patients with C/F-HP without any comorbidities were included and ILD patients with known causes like connective tissue disorders; severe pulmonary hypertension, respiratory failure, BMI <18 or >30, and comorbidities like diabetes mellitus, hypertension, CKD, CLD, CCF, were excluded. Allergic Rhinitis was diagnosed by the history (most relevant)and serum IgE levels as per AAFP criteria. Once
registered, frequency of AR in C/F-HP patients was calculated.
Results:
107 patients of C/F-HP patients were divided into two age groups viz, group A 18-40 years old, group B 40-70. Mean age +/- SD 46.73 +/- 9.363. Group A comprised 29/107 (27.10%) patients, and group B 78/107 ( 72.90%).
Male 64/107 (59.8%), female 43/107 (40.2%). Paint factory workers were 21/107 (19.6&), pigeon/parrot breeders 55/107 (51.4%), and power loom workers 31/107 (29.0%).
Allergic Rhinitis was diagnosed in 99/107 (92.5%) patients with C/F-HP patients. Mean +/- SD of total serumIgE in these AR patients was 542.65 +/- 182.930. Of these 99/107 AR patients, 4 had normal serum IgElevel (may be due to prior use of high dose corticosteroids)but with clinical features of AR. In group A 28/29 patients, and in group B 71/78 patients fulfilled AAFP criteria for the diagnosis of AR. In the patients with positive diagnosis of AR male patients were 62/64, and female patients 37/43. Whereas C/F-HP patients displayed male:female ratio of 64:43, and in these patients AR was elicited in 99 patients with male:female ratio of 62:37. Of the 8/107 C/F-HP patients who were negative for AR, 1/20 patients was paint factory worker, 4/51 pigeon/parrot breeders, 3/28 power loom workers.
Conclusion:
This study illuminates the so far unearthed coincidence/correlation of AR in C/F-HP patients and lays premium upon AR to be employed as one of the clinical indicators for the diagnosis of C/F-HP, as very high frequency of the AR was noted in C/F-HP patients. It seems our hypothesis that "in an uncertain ILD patient, if AR is concomitantly present, C/F-HP should be sought out", stands validated. This study holds the potential to obviate the need of lung biopsy for the diagnosis of C/F-HP. To firmly establish it, more rigorous studies are warranted in this regard

Biography:

Mudassar Rasool is one of the best Medical Specialist in Lahore with a high patient satisfaction rate. He has the following qualifications: MBBS, FCPS. He continued serving in different general medicine departments for years treating all kinds of health conditions. Mudassar Rasool aims to provide the best healthcare services to people of all age groups. 

Video Presentation

George Pule

George Pule

Zambia

Title: A SIMULATION STUDY ON QUAD/DUO PATIENT SPLIT MECHANICAL VENTILATOR

Abstract:

Respiratory diseases and injury-induced respiratory failure are among major public health problems in both developed and developing countries. Asthma, chronic obstructive pulmonary diseases and other chronic respiratory conditions are widespread. Patients with underlying lung diseases may develop respiratory failure due to a variety of challenges and they can be supported by mechanical ventilation. A mechanical ventilator is a machine that helps a patient breathe (ventilate) when they cannot breathe on their own due to a critical illness. The COVID-19 outbreak has become a global issue as this new pandemic socially and economically affected the entire world. This virus has caused a substantial global health problem with very significant economic and social impacts. According to the World Health Organization (WHO), as of 23 January 2022, over 346 million confirmed cases of COVID-19 were reported worldwide, and many of those critically ill have required days of supportive invasive mechanical ventilation (IMV) as part of their treatment. Most developing nations, especially those in the sub-Sahara Africa have been facing ventilator shortages for a long time. The high cost of ventilators has also contributed to limited access to the life-saving machines in countries like Zambia. The need for ventilators in many hospitals in most developing nations has surpassed the supply. The novel coronavirus disease (COVID-19) has exposed critical shortages of ventilators in both developing and developed countries. One possibility to address this problem is the utilization of a single ventilator on two to four patients. The need to carry out mathematical modelling and simulation of the machine-patient configurations to ascertain the feasibility as well as understand the limitations of this approach is nontrivial. This paper presents a simulation study on the implementation of a single ventilator on two or more patients with different lung compliances. Results show that in theory it is technically possible to ventilate two or more patients provided a control strategy is implemented to regulate the inhalation tube resistances. It has also been demonstrated that ventilating two or more patients with unequal lung compliances from a single ventilator without a controlling resistance will lead to clinically significant reductions in tidal volume in the patient with the lowest respiratory compliance. The study demonstrate that it may be possible to achieve the same tidal volumes in two and four patients with mismatched lung compliances, and the results show that the tidal volume of one patient can be manipulated independent of the others.

Biography:

George Pule is a 3rd year Biomedical Engineering Technology Student at Evelyn Hone College of applied Arts and Commerce; and he is a student Member of the Engineering Institution of Zambia and IEEE, Engineering in medicine and biology society (EMBS). He is the inventor and Lead innovator of the Vent Splitting Device (VSD) under development at Evelyn Hone College with sponsorship from the National Science and Technology Council. The invention received a grant from National Science and Technology Innovation Youth Fund. He has presented an abstract on ventilator sharing method at the 2022 IEEE EMBS Middle East Africa international conference in Uganda.