Day 2 :
Keynote Forum
Suad Trebinjac
Al Garhoud Private Hospital, UAE
Keynote: Mesenchymal stem cells in treatment of musculoskeletal disorders
Time : 09:30-10:30
Biography:
Suad Trebinjac graduated from Medical Faculty University of Sarajevo on 3/25/82 with entrance date 9/1/74. The school is in Sarajev. Dr. Suad Trebinjac's specialty is Physical Medicine and Rehabilitation and currently works as a Physician. He is working as Associate professor in Dubai Medical College for Girls. The first Prolotherapy’s in Middle East (training in the University of Wisconsin-USA).
Abstract:
The regenerative medicine by offering to cure rather than to treat disease become very attractive therapeutic scope for clinicians, researchers and patients. The number of research articles related to platelet rich plasma and stem cells grew up exponentially in the last 20 years. Preclinical and clinical studies enriched our knowledge and expertise, but also brought up certain controversies and sometimes disappointments. Regenerative therapy already passed away from animal studies to human applications and it made the footprint in different medical fields. The presentation will focus on clinical application of autologous mesenchymal stem cell, biological properties and mechanism of action as well as selection of patients who might benefit from this type of treatment. Some controversies and commercialization of regenerative medicine will be particularly highlighted.
- Physical Medicine | Spinal Cord Injury | Neurological Rehabilitation | Brain Injury | Physical Health Management | Sports Medicine
Chair
Pedro Orlando Mena Quinones
University Hospital of Torrevieja, Spain
Co-Chair
Khader A. Almhdawi
Jordan University of Science and Technology, Jordan
Session Introduction
Pedro Orlando Mena Quiñones
University Hospital of Torrevieja, Spain
Title: Defining future scope of physical medicine and rehabilitation
Biography:
Pedro Orlando Mena Quiñones has completed his MD from Instituto Superior de Ciencia Medicas de la Habana, Cuba and completed his Residency Training Program on Physical Medicine and Rehabilitation in 1985 at the National Center of Rehabilitation Julio Diaz in Cuba. He is the Former Chairman of Spinal Cord Injury Service and Chairman of Miscellaneous Service at National Center of Rehabilitation Juilio Diaz. He is the Lecturer and Teaching Staff of National Rehabilitation Center Julio Diaz Hospital and Former Member of Physical Medicine and Rehabilitation Examiners Board. He is the Former Senior Specialist at Hamad Medical Corporation. He has participated in 47 congresses, conferences, nationals and international meetings with more 60 papers presented (lectures, oral communications and posters) 11 articles published in different journals.
Abstract:
As a result of the developments during the last decades, there has been a dramatic change in the demographic constituency and the health of general citizenry with an increase of aging population and disabling conditions. This put a permanent progressive stress not only in the present but also in the future on health system having the responsibility to respond to emerging demands. People expect now and will expect then to live longer and better as specialty physical medicine and rehabilitation currently have and will keep in the future a paramount role to ensure a better quality of live by improving functioning, quality of life and proper social integration. To exactly predict how will be medicine in the future and particularly physical medicine and rehabilitation is a difficult task and it is like predicting what is going to happen in the market, we simply don’t know it. There are many factors influencing next generation’s future: economic growth, political stability, natural catastrophes, environment contamination, climatic changes, the presence of wars either localized or globalized, emerging diseases, epidemics etc. Any way there is a permanent discovery and development of new technologies and therapies that will have an impact on the practice of physical medicine and rehabilitation in the future: The next generation of physical medicine and rehabilitation specialists will need to be familiar on robotic medicine, neural implant, nano medicine, artificial intelligence, DNA manipulation etc. But the essence of physical medicine and rehabilitation will remain. The key aspects of future scope of physical medicine and rehabilitation are defined.
Alberto Cliquet Junior
Universidade de Campinas, Brazil
Title: Clinical improvements for spinal cord injured subjects going through innovative rehabilitation techniques and paralympic sports
Biography:
Alberto Cliquet Junior has graduated from Universidade de São Paulo (USP) and PhD (1988) from the University of Strathclyde. He is a full Professor at the Department of Orthopedics, Universidade de Campinas-UNICAMP (from 2003) and full Professor at USP (since 1998). Currently he is the Deputy Coordinator of the Surgery Postgraduate course and the Coordinator for the Orthopedics undergraduate course.
Abstract:
The work presented here displays comprehensive neurologic and orthopedic rehabilitation strategies based upon neuromuscular stimulation, including basic concepts and clinical implications, being twofold: (1) Medical sciences towards functional diagnoses, therapy, cardiovascular health and paralympic sports performance; (2) engineering sciences on innovative technology for rehabilitation of Spinal Cord Injured (SCI) subjects. Artificial and voluntary gait recovery are shown to be feasible, being assessed through motion analysis, electromyography, evoked potential, magnetic resonance imaging, radiography, oxygen consumption, bone densitometry, etc. Comorbidities such as post-traumatic syringomyelia (due to upper limb effort), disuse osteoporosis, cardiovascular disease and autonomic dysreflexia (yielded by pain stimuli and lack of sympathetic nervous system) are addressed. Loss of bone mass is known to be higher in tetraplegia than paraplegia and the same applies to carotid intima-media thickness of SCI subjects which is larger in tetraplegics. SCI physiotherapy focuses mostly on cardiovascular exercises, not on the mechanical loads applied to the lower limbs which are required to preserve bone quality. Shoulder, hip and knee joints are also looked at, in particular for the athletes. Technology innovation is presented for spasticity evaluation, upper limb movement as well as thermal stimulation towards the lesion completeness diagnoses. Rehabilitation techniques, technology and sports can yield a longer life to such patients and minimize their clinical complications.
Mohd Rami Al-Ahmar
Jordanian Spinal Cord Injury Charitable Society, Jordan
Title: Challenges and outcome following spinal cord injury
Biography:
Moh'd Rami Al-Ahmar, MD JB (Physical Medicine & Rehabilitation), Spinal Injury Senior Specialist. Spinal Cord Injury (SCI) Fellowship, Robert Jones & Agnes Hunt Orthopedic Hospital, Oswestry, UK. He is the Vice President of the Jordanian Spinal Cord Injury Charitable Society (JoSCIS). He is Educational Committee Member of International Spinal Cord Injury Society (ISCoS). He is Executive Board member of Jordanian PM&R Society, (ISPRM Society Member). (SCI) Unit, Royal Rehab Centre, King Hussein Medical City.
Abstract:
Spinal Cord Injury (SCI) is one of the most devastating injuries which necessitate considerable changes and life-altering of an individual and their families. Acute SCI is a complicated, multi organ failure; proper and early management may make the difference between recovery and lifelong disability. Although there is contemporary advances in spinal cord medicine, considerable challenges remain, particularly recovery of lost neurologic function following injury. Prevention is the cure in SCI management and motor function is the primary determinant of overall function following SCI. Accurate documentation of the neurological level and completeness of SCI is paramount for diagnostic and prognostic aspects. A detailed neurological examination performed at least 72 hours following traumatic SCI is important prognostic value; significant neurological recovery will be expected over later weeks and months, following an incomplete injury. This talk will present a series of SCI patients evaluated according to the International Standards using the American Spinal Injury Association (ASIA) scoring and were admitted and managed at the spinal unit-King Hussein Medical Center. Accurate neurological assessment and comprehensive surgical vs. conservative management is needed to improve the final functional outcome and prevent lifelong disability.
Suad Trebinjac
Al Garhoud Private Hospital, UAE
Title: Mesenchymal stem cells in treatment of musculoskeletal disorders: Current evidence and future perspective
Biography:
Suad Trebinjac graduated from Medical Faculty University of Sarajevo on 3/25/82 with entrance date 9/1/74. The school is in Sarajev. Dr. Suad Trebinjac's specialty is Physical Medicine and Rehabilitation and currently works as a Physician. He is working as Associate professor in Dubai Medical College for Girls. The first Prolotherapy’s in Middle East (training in the University of Wisconsin-USA).
Abstract:
Musculoskeletal disorders are chronic, painful and followed by significant morbidity. Furthermore, the cost of treatment produces economic burden. Variety of therapeutic options are mainly symptom oriented, often providing only temporary therapeutic effect. Stem cells become an attractive scientific subject due to their potential to differentiate into other types of cells and eventually regenerate or repair damaged tissue. Mesenchymal Stem Cells (MSCs) are commonly used, because of their potential to differentiate into musculoskeletal lineage, eventually generating new cartilage, bones, muscles and fat. Preclinical and some clinical studies show promising results. Better insight into the paracrine effect and favorable joint environment, (which are the most important for successful outcome), opened a new perspective for more efficient outcome in the future. In this oral presentation, I will try to highlight three key points;
(1) What is the current clinical evidence for the application of MSCs in the treatment of chronic knee cartilage damages, ligaments and tendons?
(2) What is the possible mechanism of action of MSCs?
(3) Who are the best candidates for this type of treatment?
Also, the future perspective in this medical field will be specified.
Khader A. Almhdawi
Jordan University of Science and Technology, Jordan
Title: Task-oriented rehabilitation for upper extremity post-stroke: A case study
Biography:
Khader A Almhdawi is the Chairman of Rehabilitation Sciences Department (PT, OT and Speech/Audiology) at Jordan University of Science & Technology (JUST), Irbid, Jordan. He has obtained his OT BSc from JUST in 2003 and his MSc from Colorado State University, USA and PhD in Rehabilitation Sciences (Stroke Rehabilitation) from the University of Minnesota, USA in 2011. He is currently researching in the field of adults' physical dysfunctions particularly of neurological challenges, assistive technology, occupational stress, education and accommodating individuals with disabilities and integrating them in community.
Abstract:
Background: Effective and feasible approaches for Upper Extremity (UE) rehabilitation are needed.
Aims: This case study demonstrated the conduction and efficacy of occupational therapy Task-Oriented approach (TO) for improving UE motor and the functional abilities post-stroke.
Methods: A case study of a 60 years old male (Mr. J) who had ischemic right cerebral vascular accident with resultant left hemiparesis with a chronicity of 12 years. Mr. J got 6 weeks of 3 hours/week TO treatment. TO consisted of client-centered functional activities consistent with Mr. J client-centered treatment goals. Measurements included Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), Wolf Motor Function Test (WMFT), active range of motion and handheld dynamometry strength of the paretic UE.
Results: TO treatment followed large functional and motor improvements. COPM performance and satisfaction were 1.8 and 2.2 units greater respectively, MAL amount of use and quality of use were 2.1 and 1.39 units greater, WMFT time was 4.63 second faster and grip strength increased 14.33 lb. Furthermore, paretic UE range of motion, tone status and grasp abilities were improved.
Conclusion: TO approach appears an effective and feasible UE post-stroke rehabilitation approach inducing clinically meaningful UE functional improvements. More studies are needed to provide more evidence for this approach.
Ali Serhan
Physicians accross Continents, Turkey
Title: Outcome of program designed to evaluate the extent of benefit of the amputee from his prostheses in PAC-prosthetic center in Turkey
Biography:
Ali Serhan has completed his master’s degree from Damascus University. He is the Director of Prosthetic Department in PAC-Turkey.
Abstract:
In order to follow up our patients in PAC-prosthetic center in Turkey, whose most of them were living in Syria and there getting back to the center to evaluate their prosthesis is difficult, so we designed a form to obtain that.
The form in of 1 page, it has some questions, by which we can evaluate the benefit of the patient from the prosthesis.
Also, we designed a computer program to inter this information and analyze the data.
I wanted to share you the results.
Sedigheh Sadat Tavafian
Tarbiat Modares University, Iran
Title: Prediction of stretching exercise behaviour among office employees using Pender Model
Biography:
Sedigheh Sadat Tavafian is a Professor of Health Education, Department of Health Education and Health Promotion. She is the Faculty Member of Medical Sciences, Tarbiat Modares University, Iran. She has published more than 55 published paper indexed in SCOPUS.
Abstract:
Purpose: Office employees of all ages are at risk for developing physical inactivity. In many countries, physical inactivity is one of the main causes of non-communicable diseases such as Musculoskeletal Diseases (MSDs) that are increasing in Iran.
Aim: This study aimed to predict the influencing factors on Stretching Exercise (SE) among office employees using Health Promotion Model (HPM) in Shahid Beheshti University of Medical Sciences (SBUMS) of Iran.
Method: Data were collected by researcher-made and standard questionnaires from eligible office employees working in comprehensive service centers for urban-rural health affiliated to SBUMS from May to Sep 2016.
Results: Totally 420 office workers with mean age of 37.1±8.03 years old took part in the study. This study showed that perceived barriers to action could prevent the studied participants from doing stretching exercise. [OR (%95CI): 0.875(0.815-0.939), P<0.001)], However, perceived self-efficacy [OR (%95CI): 1.126(1.0411-1.2171), P=0.003)], commitment to plan of action [OR (%95CI): 1.118(1.033-1.367), P=0.003)] and interpersonal influences [OR (%95CI): 1.248(1.1371-1.3701), P<0.001)] were significant predictors for stretching exercise behavior.
Conclusion: This study showed that the office workers who were more confident and commitment to plan of action and perceived less barrio were more likely to do stretching exercise.
Sherif Azmy Rizkalla
Nasser Institute for Research and Treatment, Egypt
Title: Nutrition for optimal sports performance
Biography:
Sherif Azmy Rizkalla had the honor to start Nutrition & Pain Management Clinics in more than 5 hospitals – of which NASSER HEALTH INSTITUTE was the greatest. He used to be the Sports Nutrition Consultant of the Egyptian Modern Pentathlon Team (from 2004 -2012 and made New Swimming Olympic records in Bejing 2008 & UK 2012 with C.Amr Elgezairy ). He used to be the Sports Nutrition Consultant of All Egyptian Olympic Teams Qualified for UK 2012 (from 2010 – 2012 Olympic Silver Medal in Fencing with C.Alaa A.Kassem). Now he is a Board member in UAMS (Union Affricane de Medicine du Sport ), also World Society of Sports, Exercise Medicine (WSSEM) Board Member, UKAD – Accredited Advisor, USADA- HealthPro Certified, WADA- Sport Physician’s tool kit Certified and FIFA Diploma in Football Medicine which gives me a great opportunity to serve my country & many other countries giving awareness educational lectures about the importance of healthy nutrition & the hazards of doping for athletes.
Abstract:
Choosing the right foods, fluids and supplements can help athletes perform at their best. To help an athlete reach peak performance, dietitians work with athletes to plan for: 1. Adequate energy from food 2. Enough fluids to keep the body hydrated 3. The right balance of nutrients. Meeting energy needs during activity will help athletes: 1. Replenish glycogen stores 2. Provide protein to build and repair tissue 3. Provide essential fatty acids.
Registered dietitians, particularly those with an expertise in sports nutrition, are uniquely equipped to provide nutrition advice to athletes. Dietitians are the only regulated health care professionals in Canada in the field of nutrition. They can work with athletes to help them achieve peak performance by learning: 1. What to eat and drink before, during, and after exercise 2. How to use nutrition to help with performance and improve recovery time 3. When to use sports drinks instead of water 4. How to prevent dehydration 5. If certain vitamin or mineral supplements are needed 6. That ergogenic [performance enhancing] aids should be used with caution only after careful screening for safety 7. How to reduce their risk of contracting illnesses such as gastroenteritis or upper respiratory tract infections from the foods they eat (and the utensils used to cook them).
- Physical Medicine | Spinal Cord Injury | Neurological Rehabilitation | Brain Injury | Physical Health Management | Sports Medicine | Neuromuscular Medicine
Chair
Sherif Azmy Rizkalla
Nasser Health Institute, Egypt
Session Introduction
Relief International
USA
Title: Post rehabilitation impact on Syrian refugees with lower limb amputation
Biography:
Relief International is a nonprofit organization whose sole mission is to reduce human suffering. It respond to natural disasters, humanitarian emergencies and chronic poverty. It is non-sectarian and non-political. It was founded in 1990 in response to the devastating.Relief international which is a leading nonprofit organization working in roughly 20 countries to relieve poverty, ensure well-being and advance dignity. We specialize in fragile settings, responding to natural disasters, humanitarian crises and chronic poverty. Relief International combines humanitarian and development approaches to provide immediate services while laying the groundwork for long-term impact.
Abstract:
Turkey hosts more Syrian refugees than any other country. As of May 2017, more than three million Syrian refugees were registered with the Government of Turkey. A large number of the refugees have settled in Turkey’s southeastern provinces of Åžanliurfa, Hatay and Gaziantep. The 2017 Humanitarian Needs Overview (HNO) reports that trauma is a leading cause of mortality and morbidity in Syria: 30% of trauma cases result in a permanent disability requiring long-term rehabilitation care. Similarly, among 25,000 injured Syrians assessed, 67% had sustained injuries directly related to the crisis. Of these injuries, 53% were due to explosive weapons. Moreover, 15% of the victims of explosive weapons had undergone amputations. Relief International is supporting the National Syrian Project for Prosthetic Limbs in Reyhanli (Turkey) in terms of organizational capacity building funded by ECHO. Responding to the critical, lifesaving rehabilitation needs among all refugees eligible for services by the Government of Turkey, the center is providing 180 prosthetic devices to refugees with lower limb amputations with capacity of 12 devices. Nearly 90% of the beneficaries are war-related injuries, out of them 10% are females . Post rehabilitation impact on syrian refugess with lower limb amputation is seeking to collect and analysis of information provides a gathered from the beneficiaries through surveys and focus group discussions that includes quantity and quality indicators that aim to moniter the functional improvements by using functional independence measure and amputee mobility predictor during assessment, discharge and follow up session after 45 days of discharge date.
Alqahtani
Mc Master University, Saudi Arabia
Title: Chronic musculoskeletal pain and dysfunction: The regenerative interventions, evidence and practice
Biography:
Alqahtani has obtained his Post-Board training in Chronic Pain and Musculoskeletal Medicine from McMaster University. He has unique contribution to the field of chronic pain both in Canada and Saudi Arabia. His specialty was recognized by Canadian Academy for Pain Management (CAPM) and by McMaster University as the most comprehensive and the first of its kind in Canada. He is a Member of CAPM credentialing faculties. He is leading a significant change in pain/MSK med services in KSA, through Saudi Ministry of Health. He is the Founder and Manager of Surgery Alternatives Chronic Pain Center in Riyadh.
Abstract:
In Six case reports representing common scenarios in this study. Worldwide situational analysis of musculoskeletal pain (MSK pain) and dysfunction incidence parallel the incidence of chronic pain costs exceeds the cost of cardiovascular diseases and cancer. Chronic pain is the most complexed chronic disease. It is associated with physical, mental and social dysfunction, yet the chronic pain associated medical education, clinical services, research and legislations fall short of the right direction. Management of chronic pain/MSK pain/dysfunction is still based on outdated dissociated knowledge. Huge body of evidence have accumulated over the past 25 years, that revealed much cost-effective and saver treatment options, yet, most of it is not yet into practice and medical education leading to high rate of surgical interventions that are not scientifically indicated. Pharmacotherapy and other modalities focus on pain relief rather than treating underlying cause and dysfunction. NSAIDs increase risk of stroke and heart attack by 30%-50% according to recent strong evidence. 90 Americans die every day due to opioid overdose. By evidence corticosteroids work only in the short term and carry some risk. Treatment mostly is not based on adequate understanding of the nature and dimensions of chronic pain syndrome, therefore, patients usually fail to find effective and safe treatment. The solution is putting the dissociated knowledge together and bringing evidence into practice is essential step to improve the situation. Many barriers need to be addressed. The researches of the past 25-30 years on conventional pain medicine, complementary and regenerative medicine have revealed very effective and very safe treatment options that if put together will achieve great results. Prolotherapy is the rehabilitation of an incompetent structure due to disease or injury/failed healing using one of the following dextrose prolotherapy or platelet rich plasma or autologus stem cells or autologus blood or ozone. Meta-analysis, systematic reviews and hundreds of randomized controlled trials have revealed their cost-effectiveness and high safety profile. Other cost-effective treatment options include physiotherapy that is based on good functional assessment, conventional medications, approved herbs, supplements and mind-body medicine/chronic pain psychology.
Bożena Czarkowska-Pączek
Medical University of Warsaw, Poland
Title: Vocational rehabilitation in patient after kidney or liver transplantation
Biography:
Bożena Czarkowska-Pączek is a Vice Dean for Nursing Division in Medical University of Warsaw and the head of Department of Clinical Nursing. He has published more than 30 papers in reputed journals.
Abstract:
Background & Aim: Return to productive employment after transplantation is not well understood process, which is influenced by various bio-psychosocial factors. The aim of present study was cross-sectional analysis of employment status in patients after kidney or liver transplantation.
Material & Methods: Sixty-four (64) patients after kidney or liver transplantation treated at the Infant Jesus Clinical Hospital in Warsaw, Poland, were surveyed, comprising 24 women (37.5%) and 40 men (62.5%). The period after organ transplantation was between 1 to 5 years and the age of patients were between 18 to 45 years old. The study was based on a self-prepared questionnaire developed by specialists in the field of medicine, rehabilitation, psychology and employment. The questionnaire contained 5 parts: Demographic data, professional factors, medical factors, physical factors and psychological factors.
Results: Most of the patients were kidney transplant recipients (79.7%) in relation to liver transplant recipients (20.3%). Sixty-seven percent (67%) of patients had a disability certificate at the time of the completion of the questionnaire. Eighty-four (84) of those patients were after kidney transplantation and forty-two percent (42%) of them were employed during the examination. Forty-eight percent (48%) of patients worked at the time of the completion of the questionnaire and 77 of those worked during 1 year before the transplantation.
Conclusion: The employment rate after kidney or liver transplantation is lower than the general population and it is lower than employment rate from the time before transplantation. Return to employment should be an important milestone in the rehabilitation process after solid organ transplantation.
Amin Hosseini
ACIKMAVI Solution Center, Turkey
Title: Intelligence rehabilitation: The scientific and research-based approach for developing IQ in children and adult
Biography:
Amin Hosseini is a Psychoanalyst, Clinical Psychologist and Medical Acupuncturist. In 2015 he started research in Turkey as a Professor Robert Titzer’s Head Assistant and Research Team Manager. He has several books in psychology field which among them The Key to Dyslexia, Modern CBT, Story Therapy, IQ Therapy, Intensive Short-Term Dynamic Psychotherapy, The Key to ADHD, The Key to Dysgraphia. He is the Director of Psychology at ACIKMAVI Solution Center, Turkey. He has published more than 20 books in psychology field.
Abstract:
There are so many children and adults available who are mentally behind their age and unfortunately, the system considers them as disabled. Although most of the people think intelligence is fixed and cannot be changed but recent studies provide new information which disapproves of the old idea. The new researches highly prove the intelligence quotient can be changed by special programs. According to new information and based on new researches on children with mental disabilities, interfering and increasing the function of the sensory system, neurons, dendrites, axons and other important parts of the brain connected to cognition, understanding and social abilities is possible and by the proper individual rehabilitation program for each person we can change intelligence level. There are two well-known approaches to IQ rehabilitation although each of them has a different point of view in therapy both of them are the same in the foundation. In my speech, I will try to introduce IQ Rehabilitation systems and therapy methods by using recent researched facts and samples.
- Workshop
Session Introduction
Mohd Rami Al-Ahmar
Jordanian Spinal Cord Injury Charitable Society, Jordan
Title: International standards for the neurological classification of spinal cord injury (ISNCSCI) updates & E-learning workshop
Biography:
Dr. Moh'd Rami Al-Ahmar, MD JB (Physical Medicine & Rehabilitation), Spinal Injury Senior Specialist. Spinal Cord Injury (SCI) Fellowship, Robert Jones & Agnes Hunt Orthopedic Hospital, Oswestry, UK. He is the Vice President of the Jordanian Spinal Cord Injury Charitable Society (JoSCIS). He is Educational Committee Member of International Spinal Cord Injury Society (ISCoS). He is Executive Board member of Jordanian PM&R Society, (ISPRM Society Member). (SCI) Unit, Royal Rehab Centre, King Hussein Medical City.
Abstract:
The Spinal cord is the major conduit through which motor and sensory information travels between brain & body, and it extended from foramen magnum to the L1/L2 level.
Spinal cord injury has many causes: Trauma is considered as the most because which result from motor vehicle accident, violent injury such as gun shot and stab wound, fall down, sports accident and diving accident.
Rehabilitation of the individual with Spinal cord injury is lifelong process that requires readjustment to nearly every aspect of life using a Multi-Disciplinary Team (MDT) approach, expected outcomes and rehabilitation program depend on the early and follow up examination.
The most difficult classification tasks in ISNCSCI is to recognize the motor levels (ML) and to classify the ASIA Impairment Scale (AIS). A primary point in the difficulty in ML determination is identified by the fact that motor testing is only performed in 10 key myotomes of the arms and legs while there are 28 dermatomes tested.
In Our workshop we are going to explain the ISNCSCI, discuss the last updates in ISNCSCI and practice some difficult cases.
Hints and clues to use E-learning for MDT will be presented.