PES CME at Mirpur Khas, Sindh

 PES CME at Mirpur Khas, Sindh

A seminar was organized at Mirpur Khas by Pakistan Endocrine Society, Sindh Chapter, in collaboration with Mohammad Medical College, Mirpur Khas on the 10th. September 2015.

It was attended by more than 300 medical officers, family physicians, post-graduates and final year medical students, along with senior faculty of the College. Three credit hours were awarded for this CME program by Liaquat University of Medical and Health Sciences, Jamshoro.  Dr. Saeed A Mahar, Professor Tasneem Ahsan, Professor M. Zaman Shaikh, and Dr. Ali Asghar were the speakers on this event.

Dean of the College, DR, Razi Mohammad, the chief guest of this seminar highlighted the role of CME programs and appreciated the role of PES in promoting awareness and education about diabetes and other endocrine disorders amongst the medical profession and masses. He emphasized that there is evidence of differences in the disease pattern in the different regions of Sindh. He invited PES office bearers to begin mutual research projects in collaboration with each other to make local guidelines for various common endocrine diseases in different villages of Sindh.

On this occasion, Dr. Saeed A. Mahar, President of PES and Consultant Endocrinologist at NICVD, Karachi, highlighted the objectives and goals of the Society. He mentioned about research grant awarded to the trainees in Endocrinology for the attachment in overseas Endocrine institutes. He added that first-ever, very successful and well-attended “Endocrine Review Course” was held recently at Agha Khan University, Karachi. He highlighted the preparation of first ever in Pakistan “Type 2 Diabetes Mellitus Guidelines” by PES and the also “Regional Guidelines about the Usage of Sulfonylureas” in collaboration with SAFES.

Talking on the topic of “Hyperthyroidism / Thyrotoxicosis”, he mentioned that the need for surgery is minimum nowadays because of early diagnosis and more awareness of this disease. He discussed interesting and interactive cases of toxic multi-nodular goiter, Grave’s disease, thyroiditis factitive, post-partum, gestational, HCG-induced, and sub-acute varieties of thyroiditis.  He elaborated on various eye signs in Grave’s disease. He showed an algorithm, for a rational approach to a suspected case of thyrotoxicosis. He highlighted the special problems occurring in children with hyperthyroidism.

Coordinator of the program and Vice President of PES, Sindh Chapter, Prof. M. Zaman Shaikh, Professor of Medicine and Director of Sir Syed Institute of Diabetes and Endocrinology, Karachi, said that this CME program is the second one in the series of seminars and Insha Allah many such programs both for doctors, diabetic and endocrine patients and for the general public would be organized. Talking on his topic “New Developments in the Management of Diabetes “, he said that new once-weekly GLP-1 RAs are Inj. Bydureon, Lixisenatide, Albiglutide, and Semaglutide (soon to come). Once-monthly GLP-1 RAs are also in pipeline. Tab Semaglutide, first oral GLP1-RA is a new development, in phase 3 trial now. New DPP-4 inhibitor is Saxagliptin (now available in Pakistan), Alogliptin, and Linagliptin (excretion: 90% through the gut; 10% through kidneys, therefore safe in mild to moderate renal failure). Tab Omarigliptin (Once a week DPP-4 inhibitor) is in phase 3 trial (From Japan). There are possible novel roles and pleiotropic effects of GLP-1 RA, for example, use in obesity, pre-diabetes, T1DM, fatty liver, and even in Parkinsonism. New SGLT-2 inhibitors (handling renal glucose) are Dapagliflozin, Canagliflozin, Empagliflozin, all yet to come in Pakistan. Bromocriptine (Cycloset), as the quick-release formulation is already FDA-approved for T2DM. True basal insulin Degludec is FDA and EMA approved. Smart insulins (with glucose sensors) once daily, even once weekly, are not far away. New routes of administration of insulin will be as S/L spray, oral capsule, nasal insulin and as skin patches. New inhaler insulin, Afrezza is recently approved by FDA and this inhaler is now marketed in the USA. Semi-automatic insulin pumps with CBGM are now available in Pakistan. However, the dream of a fully-automatic closed-loop pump (artificial pancreas) and smart bionic pump (with insulin+ glucagon) will soon be a reality. Inj. Xultophy (I Deg Lira) is a combination of inj. Degludec (basal insulin) and inj. Liraglutide (a GLP-1 receptor agonist) is now available and EMA approved as a single solution in one syringe.

Professor Tasneem Ahsan, ex-Director of JPMC Karachi, talking on “Poly Cystic Ovary Syndrome- A Systemic Metabolic Disorder”, said that ultra-sonographic picture PCOS doesn’t always fit into clinical scenario. Polycystic ovaries on ultrasonography are found only in 80% of overall PCOS patients. PCOS is found in 20% of cases with normal menses. 20% of women with PCOS have no symptoms. She emphasized the role of insulin resistance in the etiology of PCOS. She stressed on the possible role of deficiency of vitamin D, calcium, magnesium, copper, zinc, chromium, selenium. Folic acid and some other micro-nutrients in the pathogenesis of PCOS.

Title of the speech of Dr. Ali Asghar, Consultant Endocrinologist of Liaquat National Hospital, Karachi was “Thyroid Nodule”. He elaborated on the differences in the clinical and laboratory parameters between benign and malignant nodules. He emphasized on the significance of taking a proper history and performing an appropriate physical examination of a nodule and generally to assess thyroid status.  He said that before doing further imaging techniques; we should see TSH levels to assess the status of the thyroid.

The chief guest along with Principal of the College, Professor Ghulam Ali Memon presented traditional Sindhi Ajrak and shields to all the delegates of PES.

In the end, the question-answer session was held in which post-graduates, family physicians and medical students of the College took an active part. Dr. Shams-ul-Arfeen, Vice Principal of the College presented the vote of thanks. This was followed by lunch. This grand event was generously sponsored by PES Corporate Member PharmEvo Pharma.

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