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									                                           Contents




  Page 2 …………………………………………….. Sponsors

  Page 3 …………………………………………….. Conference's president speech (English)

  Pages 4-5 ………………………………………. Conference Committees (English)

  Pages 6-12…………………………………….. Conference Program

  Pages 13- 20……………………………………Women health conference plenary lectures abstracts

  Pages 21-30…………………………………… Women health conference papers' abstracts

  Pages 31……………………………………………Paediatric orthopaedic symposium abstracts

  Pages 32-33…………………………………… Conference Committees (Arabic)

  Page 34…………………………………………….. Conference's president speech (Arabic)

  Page 35…………………………………………….. Sponsors




Second International Faculty of Medicine Conference 2009                         1
                                         Sponsors


                                            Main sponsors




      ******************************************************************




Second International Faculty of Medicine Conference 2009                   2
                            Conference's president speech


   Dear colleagues and friends:

   It is my pleasure to welcome you at An - Najah National University / Faculty of Medicine to
participate in the second international annual medical conference.

   This important event is becoming a regular tradition that provides professional environment
for colleagues and researchers to interact both locally and internationally. It is the right address
for evaluation and production of medical knowledge in Palestine, while interacting with the
medical world.

   Each year we will be choosing a vital subject of concern to our medical and social
community, this year's was women healthcare in most of its widely diverse aspects.

   This event would not possibly happen except for the tremendous efforts of a group of
dedicated colleagues and faculty members.

   Many thanks goes to the University president, Professor Rami Hamdallah and his assistants
and chancellors for their unconditional support to the faculty of Medicine and its various
activities.

   I must also stress the important role of sponsoring organizations and companies whose
financial support make these events a reality. My special thanks goes to the main sponsors of
this activity:

   o Paltel Group
   o UNFPA

   Finally, I wish you all a very productive and enjoyable conference, and welcome you to An-
Najah University/Faculty of medicine


                                                                               Yours,
                                                                        Prof. Anwar Dudin
                                                                     Dean, Faculty of Medicine
                                                                       An-Najah University
                                                                      Conference Chairman


     Second International Faculty of Medicine Conference 2009                                          3
                               Conference Committee


  Chairman of conference:
                    Prof. Anwar Dudin / Dean, Faculty of Medicine


  Organizing committee:
           Dr. Khalil Issa                                 Chairman
           Dr. Samar ghazal Musmar                         member
           Dr. Rami Zagha                                  member
           Dr. Abdul Muti Al-Azzeh                         member


  Scientific Committee:
           Dr. Samar ghazal Musmar                         Chairman
           Dr. Hisham Na’na                                member
           Prof. Ghassan Abu Hijleh                        member
           Dr. Khalil Issa                                 member
           Dr. Alaa Azmi                                   member


  Social Committee:
           Dr. Rami Zagha                                  Chairman
           Dr. Abdul Muti Al-Azzeh                         member
           Dr. Iyad El Ali                                 member


  Financial Committee:
           Dr. Khalil Issa                                 Chairman
           Dr. Rami Zagha                                  member


  Technological Committee:
           Dr. Tayseer Sadder                              member
           Dr. Hanood Abu Ras                              member




Second International Faculty of Medicine Conference 2009              4
Students Committee

                      Mohammad Al-Haj Qasem
                      Khobaib Badawi
                      Abdulrahman Al-Zitawi
                      Feras Milhm
                      Tareq Hammad
                      Tawfiq Al-Shoubaki
                      Asma Salahat
                      Danya Bani Fadel
                      Jenan Al-Shaer
                      Manal Al-Arda
                      Neda Sammodi
                      Ola Akram
                      Shaza Issa
                      Wajdi Khader
                      Abdullah Hamadneh
                      Ameer Musameh
                      Braa Jehad
                      Hafsa Moalla
                      Lamia Abu Ghazaleh
                      Moath Draghmeh
                      Momen Bani Fadel
                      Mosab Jaber
                      Omar Abu-Zaydeh
                      Yazan Zayed



  Second International Faculty of Medicine Conference 2009   5
                              Conference Program


                       Second International Faculty of Medicine Conference
       "Evidence based advances in women healthcare"
                                                    8-10/10/2009



 Day One 8/10/2009
                                                     Opening
        Place: Prince Turki Bin Abdulaziz theatre New Campus/An-Najah National University
18:00-18:30 Registration
18:30-19:00 Conference Opening Ceremony
Host: Dr. Khalil Ibrahim Issa, An-Najah University, Faculty of Medicine
Speakers:
HE Dr. Fathi Abu Mughli / Minister of Health / Palestinian National Authority
Dr. Jawad Awwad / Medical Association President / Al-Quds Office
Professor Rami Hamdallah / President of An-Najah National University
Professor Anwar Dudin, Dean Faculty of Medicine / An-Najah National University
19:00-20:00 Social program
20:00-21:00 Dinner


 Day Two 9/10/2009
                   Place: Zafer Al-Masri auditorium ,old campus / An-Najah university
                                  Morning Session (main auditorium)
08:00-08:30 Registration
Moderators: Dr. Yousef Al-Sha’bani, OBGYN, Ramallah
            Dr. Akram Sa’adeh, Pediatrician, Ittihad Hospital, Nablus
08:30-09:00 “Recent Advances in Maternal Fetal Medicine”
Dr. Mahmoud Ismail, M.D,Professor Maternal Fetal Medicine /University of Chicago Medical Center,
Department Obstetrics and Gynecology
09:00-09:05 Q&A



     Second International Faculty of Medicine Conference 2009                                      6
 Moderators: Dr. Elias Saba, General Secretary/Pan Arab OSP Society, Beithlahim
             Dr. Odeh Abu Nahle, OBGYN, PRCS, Al-Biereh
09:05-09:45 “Osteoporosis review and current available therapies”
Dr. Rustum Nammari, Makased Hospital/Jerusalem
09:45-10:15 “Vitamin D, the "aspirin" of the 21st Century”
Basel Masri, MD, Consultant Rheumatologist- Jordan Hospital /Jordan
10:15-10:45 “FRAX®”
Basel Masri, MD, Consultant Rheumatologist- Jordan Hospital /Jordan
10:45-11:15 “HRT in Osteoporosis: 2009”
Efteem Azar, MD, Gynecologist, Jordan Hospital /Jordan
11:15-11:25 Discussion
11:30-12:00 Friday Prayer
12:00-12:30 Exhibition
12:30-13:30 Lunch /old campus cafeteria
                                    Afternoon Session (main auditorium)
Moderators: Dr. Walid Barghothi, OBYGN, Al-Mostaqbal Hospital, Al-Biereh-Ramallah
            Dr. Mazen Anabtawi, OBYGN, Nablus
            Dr. Osama Atallah, General Surgery, Ramallah Hospital, Ramallah
13:30-14:00 “The Symptoms of Breast Disease: a practical guide to diagnosis and management”
Jill Donnelly, Consultant / Breast Surgeon/ Hereford County Hospital,UK
14:00-14:05 Q&A
14:05-14:30 “Reproductive health in emergencies”
Dr. Ali Nashat Shaar, MD. MSc, National Program Officer/RH, United Nations Population Fund
14:30-15:00 “Postnatal depression”
Dr Barbara Bavdaž, Psychiatrist, Trieste, Italy
15:00-15:10 Discussion
15:10-15:40 Coffee Break, Exhibition
Moderators: Dr. Shukri Odeh, OBGYN, Augusta Vic. Hospital, Jerusalem
            Dr.Khaled Masri, Human resources dept. director, MOH, Nablus

15:45-16:15 “Maternal Mortality Rate in Palestine”
HishamNana, MD, Consultant, OBGYN/Faculty of Medicine/An-Najah University
16:15-16:45 “Reproductive health services/ Palestinian MOH”
Dr.Souzan Abdou, General Director/Women Health directorate / Palestinian MOH


16:45-17:00 Discussion



      Second International Faculty of Medicine Conference 2009                                7
                                                   Parallel Sessions
                   Hall A
        Pediatric Orthopedic Satellite
                Moderators:                                                         Hall B
   Dr. Khalid Saleh, Orthopredics, Rafidia                                   Breast FNA workshop
              Hospital, Nablus
  Dr. Hasan Fitian, Pediatrician, Al-Watani
              Hospital, Nablus
13:30-13:50 “Pediatric orthopedics in Palestine
facts , future plans”
Ala Azmi,MD, Peds orthopedics/Palestine
                                                             14:00-16:00 Jill Donnelly, Consultant / Breast
13:50-15:50 “Introductory talk on childrens
                                                             Surgeon/ Hereford County Hospital,UK
orthopedic”
 Dr. Michael Benson, Pediatric orthopedic                        Preregistration small group for hands on breast
surgeon – Senior lecturer , Oxford university/                             FNA guided by Ultrasound
Consultant orthopedic surgeon at Nuffield
orthopedic center /UK
15:50-16:00 Discussion
                                   19:00-21:00 Dinner and Social Program
                                   New campus /An-Najah National university

 Day Three 10/10/2009
                                     Morning Session (main auditorium)
                                              Women Health
08:00-08:30 Registration
Moderators: Dr. Hani Al-Nabulsi, OBGYN, Nablus
            Dr. Sameer Mansour, Tulkarm Hospital, OBGYN, Tulkarm
            Dr. Husam Khreem, Dermatology, Nablus
08:30-09:00 “Preeclampsia Etiologies, Prevention and Management”
Dr. Mahmoud Ismail, M.D, Professor Maternal Fetal Medicine /University of Chicago Medical Center,
Department Obstetrics and Gynecology
09:00-09:30 “Family planning in Palestine”
Dr. Ali Nashat Shaar, MD. MSc., National Program Officer/RH, United Nations Population Fund
09:30-10:00 "Prevalence of Sexually Transmitted infections among women in reproductive age"
Dr. Asad Ramlawi, MD. PhD, MOH, Director General, Primary Healthcare and Public Health,
Chairman of National AIDS Committee
10:00-10:10 Discussion
10:10-10:30 Coffee break, Exhibition



      Second International Faculty of Medicine Conference 2009                                                     8
Moderator: Dr. Rami Zagha, Pathologist, An-Najah Univ., Medicare Labs, Nablus
           Dr. Lamah Zakarneh, Pathologist, Makkased Hospital, Al-Quds
           Mr. Khaled Abu Daiah, Deputy Library, An-Najah Univ, Nablus
10:30-11:00 “How can you trust the medical websites on the Internet? How to find the best available
evidence?”
Abdel Hakim Bishawi , M.Sc., Library Manager, Harvard Medical School Dubai Center, Dubai Health
Care City-UAE
11:00-11:30 “Human Papillomavirus and Cervical Cancer in Jordan”
Maher A. Sughayer MD, Chairman, Pathology & Laboratory Medicine Dept., King Hussein Cancer
Center / Jordan
11:30-11:40 Discussion
                                                  Parallel sessions
                                             Main auditorium /Hall B
                 Main auditorium                                                    Hall B
                 Women's Health                                                  Women's Health
                Moderators:                                                     Moderator:
  Dr. Saeed Sarahneh, OBGYN, Prince Alia                          Dr. Husni Maqbool, Pathologist, An-Najah
              Hospital, Hebron                                               University, Nablus
   Dr. Saeed Yameen, OBGYN, Tulkarm                             Dr. Mohamed Barakat Al-Sharabati, Makassed
             Hospital, Tulkarm                                              Hospital, Jerusalem
11:40-12:05 “Makassed experience in                             11:40-12:05 “Early detection of breast cancer in
management of placenta accreta”                                 Bethlehem, A six months evaluation study”
Dr. Sa’adeh S . Jaber, Consultant Gynecology                    Dr Yousef Abu Ghosh, Consultant Pathologist,
&Obstetric, Makased hospital/Jerusalem                          M.O.H.
                                                                12:05-12:20 “Pap smear exam for early detection
12:05-12:20 “Medication Use in Pregnancy, to
                                                                of carcinoma of cervix uteri-10years prospective
Treat or Not to Treat?”
                                                                study”
Mohammed Musmar,Ph.D, R.Ph., Dean, Faculty
                                                                Dr Yousef Abu Ghosh, Consultant Pathologist,
of Pharmacy, An-Najah National University
                                                                M.O.H
12:20-12:25 Discussion                                          12:20-12:25 Discussion
                                               Hall A
                                   Pediatric Orthopedic Satellite
                  Moderaotor: Dr. Khalil Issa, Orthopedics, An-Najah Univ., Nablus
                              Dr. Ayyoub Hamdan, Pediatrician, Nablus
09:00-09:20 “Pediatric spinal surgery in Palestine”
Ala Azmi,MD, Peds orthopedics /Palestine
09:20-11:20 “Developmental dysplasia of the hip”
Dr. Michael Benson, Pediatric orthopedic surgeon – Senior lecturer , Oxford university/ Consultant
orthopedic surgeon at Nuffield orthopedic center /UK



     Second International Faculty of Medicine Conference 2009                                                      9
11:20-11:30 Discussion
12:30-13:30 lunch cafeteria /old campus
                                   Afternoon Session (main auditorium)
Moderator: Dr. Hisham Na’na, OBGYN, Nablus
13:30-14:00 “Intrauterine Growth Restriction: Etiologies, Diagnosis, and Management”
 Dr. Mahmoud Ismail, M.D., Professor Maternal Fetal Medicine /University of Chicago Medical Center,
Department Obstetrics and Gynecology
14:00-14:10 Discussion
                                                  Parallel Sessions
                                             Main auditorium / Hall A
                               Main auditorium
                                                                                   Hall A
                                Women's health
                                                                                Women's health
                             Moderators:
   Time                                                                          Moderators:
                    Dr. Abdulrahman Al-Shunnar,
                                                                      Prof. Anwar Dudin, Pediatrician, An-
                  OBGYN, Nablus S. Hospital, Nablus
                                                                              Najah Univ., Nablus
                  Prof. Dr. Ghassan Abu Hijleh, An-
                                                                       Dr. Dima Amin, OBYGN, Ramallah
                       Najah University, Nablus
                 “Audit on Post partum Hemorrhage
                                                                  “Management of thrombocytopenia
                Management in Al-Makassed hospital”
                                                                 during pregnancy”
14:10-14:25      Dr. Sa’adeh S . Jaber, Consultant
                                                                 Dr. Riad Amer, Assistant professor of
                Gynecology & Obstetric, Makased
                                                                 medicine, Consultant Haematologist
                hospital/ Jerusalem
                                                                  “Rubella immune status of Palestinian
                 “Update on management of diabetes in            women”
                pregnancy”                                       A study for more than 800 ladies tested for
14:25-14:50     Dr. Intisar Alem, Director of Research and       Rubella IgG in the period of 2002 and 2009
                Chronic Disease Surveillance Department          Dr. Bashar Karmi, Clinical Pathologist
                /MOH                                             /Medicare- MediPal Laboratories /
                                                                 Ramallah- Palestine
                                                           “Cutaneous Anaplastic Large Cell
                 “Eye manifestations during pregnancy”     Lymphoma, ALK postive ( ALKOMA)”
14:50-15:05      Mohamed Abusharifa, MD, Ophthalmic        Al-Sharabati Mohamed Barakat, MD,
                Surgeon,Private sector, Tulkarem /Palestin Rasheed Osaid, RN, CNS, Al-Ahli and Al-
                                                           Makassed Hospital, Palestine
15:05-15:15 Discussion
15:15-15:30 Coffee break
                            Moderators:                                           Moderators:
                 Dr. Salem Abu Kheizaran, OBYGN,                        Dr. Husam Al Jawhary, General
15:45-16:00                                                            Internist, Watani Hospital, Nablus
                            SAH, Nablus
                Dr. Thiab Abdelmuhdi, OBGYN Rafidia                   Dr. Adel Al-Sadder, OBGYN, Nablus


     Second International Faculty of Medicine Conference 2009                                                  10
                               Hospital, Nablus                 “Adverse Effects of Cosmetics and
                                                                Proprietary products used by females”
                “Preventive care for Women around
                Menopause”                                      Hisham Arda, MD, PhD, Consultant
                                                                Dermatologist Nablus, Palestine
                Samar Musmar , MD,FAAFP, An-Najah
                National University, Faculty of Medicine
                “Stress Incontinence”                           “Domestic violence”
16:00-16:15      Dr. Eyad Z. AL-Aqqad, M.B.Ch.B.                Dr Barbara Bavdaž, Psychiatrist,
                Urologist , Endoscopic surgery-KHMC             Department of Mental Health, Trieste, Italy
                 “Pharmacological care of women around
                menopause”                              “A case of SVT in a Pregnant woman”
16:15-16:30     Ikhlas Jarrar, MSc. Medical              Mahmoud Abu Slieh, General internist,
                Pharmacology, Lecturer in Pharmacy      Palestinian MOH
                College at An-Najah National University
                 “Genetic Marker Polymorphisms in The           “Association between Factor V Leiden
                VDR and MTHFR Genes Among                       Mutation and Poor Pregnancy Outcomes
                osteoporotic and normal Palestinian             among Palestinian Women in the West-
16:30-16:45     Women”                                          Bank Region of Palestine”
                Riham Smoom and Hisham Darwish,                 Ayman S. Hussein, Faculty of Medicine,
                Department of Biochemistry, Faculty of          An-Najah National University, Nablus,
                Medicine, Al- Quds University                   Palestine.
16:45-17:00 Discussion
                                       17:00-17:30 Closing
         Place: Zafer Al-Masri auditorium ,old campus/An-Najah university (main auditorium)
                                    Moderator: Dr. Rami Zagha




     Second International Faculty of Medicine Conference 2009                                                 11
                            Second International Faculty of Medicine Conference

                        " Orthopedic scientific program "
                                                    8-10/10/2009


   o Day Two 09/10/2009

                                     Morning Session (main auditorium)
08:00-08:30 Registration
09:05-09:45 “Osteoporosis review and current available therapies”
Dr. Rustum Nammari, Makased Hospital/Jerusalem
09:45-10:15 “Vitamin D, the "aspirin" of the 21st Century”
Basel Masri, MD, Consultant Rheumatologist - Jordan Hospital /Jordan
10:15-10:45 “FRAX®”
Basel Masri, MD,Consultant Rheumatologist- Jordan Hospital /Jordan
10:45-11:15 “HRT in Osteoporosis: 2009”
 Efteem Azar, MD, Gynecologist, Jordan Hospital /Jordan
11:15-11:25 Discussion
                                           Afternoon Session (Hall A)
13:30-13:50 “Pediatric orthopedics in Palestine facts , future plans”
Ala Azmi,MD, Peds orthopedics/Palestine
13:50-15:50 “Introductory talk on children’s orthopedic”
 Dr. Michael Benson, Pediatric orthopedic surgeon – Senior lecturer, Oxford university/ Consultant
orthopedic surgeon at Nuffield orthopedic center/UK
15:50-16:00 Discussion

   o Day Three 10/10/2009
                                            Morning Session (Hall A)
09:00-09:20 “Pediatric spinal surgery in Palestine”
Ala Azmi, MD, Peds orthopedics /Palestine
09:20-11:20 “Developmental dysplasia of the hip‖
Dr. Michael Benson, Pediatric orthopedic surgeon – Senior lecturer , Oxford university/ Consultant
orthopedic surgeon at Nuffield orthopedic center /UK
11:20-11:30 Discussion




     Second International Faculty of Medicine Conference 2009                                        12
Scientific Materials

   I. Women health plenary lectures

                 Lecture 1: “Recent Advances in Maternal Fetal Medicine”
   Dr. Mahmoud Ismail, M.D.(invited speaker), Professor Maternal Fetal Medicine University of
Chicago Medical Center, Department Obstetrics and Gynecology

   1. Genetics
      1st trimester screen for fetal aneuploidy screen. This has decreased the need for both chorionic
      villus biopsy and genetic amniocentesis.
   2. Ultrasound:
       o    Doppler studies for management of Rh Isoimmunization other minor antibodies
       o    Doppler for management for IUGR babies
       o    Better diagnosis of fetal congenital anomalies. cardiac, CNS, neural tube defects, abdominal wall
            defects and skeletal anomalies etc
       o    3D and 4 D ultrasound usage
   3. Advances in the management of patients with solid organ transplants Kidney, liver, pancreas,
      lungs etc.
   4. Prevention and management of venous thromboembolism in pregnancy
   5. Management of pregnant diabetics, newer insulins and oral antiglycemic agents, better fetal
      outcomes
   6. Prematurity management, usage of steroids and tocolytic agents, survival at edge of viability
   7. Preeclampsia new etiologic theories Endoglins and sFlt proteins
   8. Obstetric hemorrhage in relation to increased cesarean section rate, and abnormal
      placentations.
   9. Fetal Surgery in utero
       o    Twin twin transfusion syndrome; management by laser vs. clip occlusion
       o    Diaphragmatic hernia
       o    Meningomyelocele
       o    Fetal transfusion
   10. Early pregnancy loss advances in management

           Lecture 2: “Preeclampsia Etiologies, Prevention and Management”
  Dr. Mahmoud Ismail, M.D.(invited speaker), Professor Maternal Fetal Medicine University of
Chicago Medical Center, Department Obstetrics and Gynecology

   Preeclampsia a disorder that complicates approximately 5% of pregnancies. Several risk factors for
this condition are well recognized including nulliparity, extremes of maternal age, obesity, and
preexisting diabetes or hypertension. Etiology of this disease remain unclear. Preeclampsia is a major
cause of maternal and fetal death and the leading cause of mature delivery worldwide. Recently studies
have suggested that circulating angiogenic factors, alterations in the renin-angiotensin system, and
insulin resistance may be involved in pathogenesis. Complications of preeclampsia include stroke,


     Second International Faculty of Medicine Conference 2009                                                   13
renal failure, and placental abruption. There is also increased evidence that the development of
preeclampsia may be a marker for maternal disease risks later in life including hypertension, stroke,
ischemic heart disease and end stage renal disease. Magnesium sulfate is used before and after delivery
in women with mild and severe preeclampsia to prevent eclamptic seizures. Magnesium sulfate has
been shown to be more effective than Phenytoin {Dilantin} in the prevention of recurrent eclamptic
seizures. Recently in the Society of Maternal Fetal Medicine, Magnesium sulfate usage was a
neuroprotective in premature babies. Trials of Vitamin C and E administration for preeclampsia have
shown variable affect. The use of Calcium as well as aspirin has also shown variable results.
Prevention of Eclampsia is a major goal in the treatment of preeclampsia. Although the management
of preeclampsia is delivery of the baby and removal of the placenta. However, patients with mild
preeclampsia remote from term have been managed conservatively and this includes antihypertensive
medications, steroids to mature the baby’s lungs, and hospitalization to closely monitor the maternal
condition.
  References:
   1) Marshall Lindheimer, M.D., Jason Umans, M.D. Explaining and predicting preeclampsia. New
      England Journal of Medicine 355:10, September 2006.
   2) Richard Levine, M.D. et al, Circulating angiogenic factors and the risk of preeclampsia. New
      England Journal of Medicine 350:7, February 12, 2004.
   3) Roberto Romero, M.D. Thomas Garite, M.D.. Unexpected results of an important trial of
      vitamins C and E administration to prevent preeclampsia. AJOG 194: 1213-4, 2006.
   4) Mounira Habli, M.D. et al. Neonatal outcomes in pregnancies with preeclampsia or gestational
      hypertension; and in normotensive pregnancies that delivered at 35, 36, or 37 weeks gestation.
      AJOG October 2007

         Lecture 3: “Intrauterine Growth Restriction: Etiologies, Diagnosis, and
                                     Management”
  Dr. Mahmoud Ismail, M.D.(invited speaker), Professor Maternal Fetal Medicine University of
Chicago Medical Center, Department Obstetrics and Gynecology

        Intrauterine growth restriction (IUGR) is a syndrome that is marked by failure of the fetus to
reach its growth potential with consequences that are related to the underlying disorder as well as the
severity of fetal disease.1 It constitutes one of the major complications of pregnancy associated with an
increased risk of mortality and morbidity and long term adverse consequences extending into adult
life.2 This condition may be caused by maternal disease, fetal disease, or placental insufficiency.
Diagnosis of IUGR is made by multiple modalities. Ultrasound biometry is the main diagnostic
standard used in the identification of fetal growth restriction. Biometry, amniotic fluid assessment, and
Doppler velocimetry are the current tools to monitor fetal growth and well-being. 3 Efforts to prevent
IUGR have not been successful, including aspirin in low risk patients. However poor obstetric history,
unexplained elevation of maternal serum alpha-fetoprotein in the second trimester, flat oral glucose
tolerance test, and abnormal second trimester uterine artery Doppler velocimetry are important risk
factors for IUGR. The management of IUGR consists of ante partum screening and diagnosis, fetal
surveillance for detection of in utero compromise, as well as appropriate and timely intervention. This
includes the fetal non-stress test, biophysical profile, amniotic fluid volume, Doppler velocimetry, and
in rare cases invasive fetal testing by cordocentesis. The timing of delivery depends on gestational age
and surveillance testing. Prematurity and its complications are one of the major outcomes of early
delivery. Beyond 34 weeks gestation amniocentesis for fetal lung maturing can be used to direct
timing of delivery. In spite of excellent management, undefined morbidity predetermined by the
condition will occur.1


     Second International Faculty of Medicine Conference 2009                                               14
  References
   1) Baschat, et al. Intrauterine Growth Restriction in Obstetrics: Normal and Problem Pregnancies
      5th Edition. Philadelphia, PA. Churchill Livingston 2007.
   2) Maulik, D. Management of Fetal Growth Restriction: An Evidence-Based Approach. Clinical
      Obstetrics and Gynecology. 49(2) 320-334.
   3) Turan, et al. Integrated Testing and Management in Fetal Growth Restriction. Seminars in
      Perinatology. 32: 194-200.

                                    Lecture 4: “Postnatal depression”
  Dr Barbara Bavdaž (invited speaker), Psychiatrist, Department of Mental Health, Trieste, Italy

   Postnatal depression affects about 13 per cent of women within the first year of childbirth and is
equally spread world-wide. Childbearing is one of the most complex events in human experience and
can lead to increased vulnerability of women due to psychological and physical changes. Many distinct
disorders are seen and it is important to identify severe disorders of the mother-baby relationship which
usually respond to treatment, but have pernicious effects if untreated.
   It is vital to implement awareness through information and to fight stigma through cultural changes.
Prevention of Postnatal Depression in possible combining antenatal and postnatal screening, enabling
early intervention and offering appropriate support. This can be provided by multidisciplinary teams
and professionals involving fathers, families, voluntary agencies and groups. GPs are at the core of the
intervention and they should have a central role in directing and monitoring the multidisciplinary teams
involved due to complexity of post-partum disorders and due to the challenges of therapy, prevention,
training, research and service development.)
   We can lean about risk factors and how to detect them. Prediction and detection of early signs can
dramatically improve the outcome of treatment which should include psychosocial and biological
modalities. Social support, involvement of fathers, psychological support, access to appropriate and
specific services, cultural changes, reduction of stigma and better awareness can allow mothers to
increase their self-esteem and improve mother-infant interaction and bonding.
  We will describe a range of different services provided by NHS in UK and by SSN in Trieste/Italy.

   Lecture 5: “The Symptoms of Breast Disease: a practical guide to diagnosis and
                                 management”
  Jill Donnelly, (invited speaker), Consultant Breast Surgeon, Hereford County Hospital,UK

   In the UK, women have a 1 in 8 lifetime risk of developing breast cancer. Hereford County Hospital
receives 1500 symptomatic breast referrals a year, 15% of whom will have cancer. I present the highly
accurate and practical approach used at my hospital for confirming or excluding cancer in all women
referred, relying on breast ultrasound and ultrasound-guided core biopsy. The management of benign
symptoms, once cancer has been excluded, is also discussed.

           Lecture 6: “Human Papillomavirus and Cervical Cancer in Jordan”
  Maher A. Sughayer MD (invited speaker), Chairman, Pathology & Laboratory Medicine Dept.,
King Hussein Cancer Center / Amman – Jordan

   Background: High risk HPV genotypes associated with cervical cancer have been repeatedly
identified in most regions of the world. Types 16 and 18 are responsible for 74-77% of cervical cancers
in western societies and for 65-70% in the rest of the world. In the Middle East information on the

     Second International Faculty of Medicine Conference 2009                                               15
responsible genotypes is largely not available with few exceptions. Such information is badly needed
especially now after the availability of vaccines directed towards the 2 most common types.
   Objective: To determine the genotypes of HPV associated with cervical cancers in Jordan.
   Methods: Cases of cervical cancer were identified from the archives of the pathology department.
Those with available paraffin blocks were studied. DNA was extracted from the blocks. Multiplex PCR
using a commercially available kit (Sacace Biotechnologies, Italy) was done. Gel electrophoresis and
band identification was then carried out on the product.
   Results: 48 cases (46 squamous cell carcinoma, 1 adenocarcinoma, 1 adenosquamous) were
available for study but adequate DNA was available for only 41 cases. Type 16 was found in 68%, 18
in 24%, 39 and 56 in 10% each, 45 and 52 in 7% each, 33 in 5%, while 31, 35, 58 and 59 in 2% each of
cervical cancer cases. None of the cases contained types 6, 11 or 66. Type 16 and or 18 were found in
75.6% of the cases.
   Conclusion: Types 16 and 18 are the two most common genotypes found in cervical cancer in
Jordan. The importance of other types is not clear because of the small number of the cases. Further
studies are needed.

              Lecture 7: “Osteoporosis review and current available therapies”
  Dr. Elias Saba .(invited speaker), President of the Palestinian Osteoporosis Prevention Society,
General Secretary of the Pan Arab Osteoporosis Society . Email : palosteo@hotmail.com .

   Osteoporosis is a chronic, progressive bone disease in which bone resorption exceeds bone
formation leading to a reduction in bone mineral density and disruption of bone micro architecture.
Patients with osteoporosis have an increased risk of fracture. The incidence of osteoporosis increases
with age and occurs most frequently in post menopausal women.
   Osteoporosis poses a significant morbidity and cost burden to society with an important negative
impact on the health and quality of life of osteoporotic patients. A number of treatments have been
clearly identified to reduce fracture risk in well designed randomized controlled trials.
  An overview regarding osteoporosis with emphasis on current pharmacological and non
pharmacological therapies will be discussed.

                   Lecture 8: “Vitamin D, the "aspirin" of the 21st Century”
  Basel Masri, MD(invited speaker), Consultant Rheumatologist- Jordan Hospital - Amman/ Jordan,
IOF representative for Middle East & Africa. E-mail: bmasri.clinic@batelco.jo

  Vitamin D is essential for calcium metabolism as well as for fracture prevention,
  Recent review suggested high prevalence of inadequacy among the general population particularly
among women with osteoporosis in different regions of the world.
  This presentation will review the importance of Vitamin D for the skeleton (bones & muscles) as
well as for the prevention of many other diseases.
   Also we will review the Vitamin D results of the FiJoNOR survey showing large inadequacy of
Vitamin D in the Jordanian female population.

                                             Lecture 9: “FRAX®”
   Basel Masri, MD(invited speaker), Consultant Rheumatologist- Jordan Hospital / Amman –
Jordan, IOF representative for Middle East & Africa. E-mail: bmasri.clinic@batelco.jo


     Second International Faculty of Medicine Conference 2009                                            16
    FRAX® is a simple web-tool that integrates clinical information in a quantitative manner to predict
a 10-year probability of major osteoporotic fracture for both women and men in different countries. It
is a practical tool derived from a series of meta-analyses using the primary data from population-based
cohorts that have identified several clinical risk factors for fracture. The performance characteristics of
clinical risk factors have been validated in independent, population-based prospectively studied cohorts
with over a million person-years of observation.
   The ultimate aim of the clinician in the management of osteoporosis should be to reduce the risk of
fractures.
   Treatment decisions must be made through good clinical judgment and through improved
identification of patients at high risk. At a primary health care level, FRAX® will assist in the better
targeting of women and men in need of intervention and in the improved allocation of limited
healthcare resources towards patients most likely to benefit from treatment.

                              Lecture 10: “HRT in Osteoporosis: 2009”
  Efteem Azar, MD.(invited speaker), Gynecologist, President, Jordanian Osteoporosis Prevention
Society, Jordan Hospital / Amman – Jordan

   Up to the beginning of this century, Hormone Replacement Therapy was being used as a primary
treatment for osteoporosis, in addition to its use for the control of post-menopausal vasomotor
symptoms. Several studies at the turn of the century showed that serious side effects can arise from
HRT and its use has since dropped considerably. Further sub analysis of those studies has revealed that
the risks are not as high as initially published and that with careful screening of women, HRT can be
used if high risk factors are ruled out.
  This presentation will define the indications and contraindications of HRT in post-menopausal
women.

                        Lecture 11: “Maternal Mortality Rate in Palestine”
 Hisham Nana, MBBCH, MRCOG, OBGYN Consultant, head, department of OBGYN, An-Najah
national university, Nablus - Palestine

   The maternal mortality ratio (number of deaths per 100,000 lives births) has been declining globally
at a rate of less than 1 per cent. The total number of women dying in pregnancy or childbirth has also
shown a modest decrease in resent years .
  However, maternal mortality is difficult to measure accurately, especially in the developing
countries, which tend to have the highest maternal deaths, and the estimates are bounded by wide
measures of uncertainty. According to a study in 2005 world total maternal mortality rate ranges from
220 to 650 with the developed regions only range between 8-17.
   Maternal mortality rate is still difficult to estimate in Palestine. This is mainly due to either
inadequate or incorrect data for maternal death. Palestinian Ministry of Health has recently founded a
national committee which studies all maternal deaths in the country. MOH has made a questionnaire
which contains information obtained from the family of died mother, and from attending medical &
paramedical personnel.
   Maternal deaths in Palestine are not that high if compared to other developing countries but the
causes are still more or less the same.




     Second International Faculty of Medicine Conference 2009                                                 17
   Political crises, check points, negligence, bad management & lack of facilities are still an important
factors contribute to the rise in maternal deaths among the Palestinian maternity deaths.
  Palestinian Maternity care has recently improved a lot, this care can be better with the effort of other
concerned personnel.

                        Lecture 12: “Reproductive health in emergencies”
  Dr. Ali Nashat Shaar, MD. MSc.(invited speaker), National Program Officer/RH, United Nations
Population Fund

   The recent assault into Gaza resulted in extensive casualties and destruction of homes, livelihoods
and infrastructure. According to MoH 1,326 Palestinians were killed (including 450 children and 110
women), 5,450 were injured and 51,000 people were displaced. Prior to the war 80% of the population
was already dependent on aid of some kind. Healthcare services in Gaza have been affected by eight
years of conflict and two years of strict closure to the outside world pre-ceding the 23 days of military
operations.
   As a consequence of this crisis, the capacity and integrity of the system were severely affected with
remarkable impact on RH witnessed during the crises with women being unable to safely access care
for themselves and their infants.
   Isolated communities in Northern Gaza (Beit Hanun, Beit Lahia, Izbet, Adrabbo), the middle zone
(Johr El Deik, Mughraqa), Khan Younis (Qarara, Khuza'a, Bani Suhaila) and the area surrounding
Rafah could not access services and, in many cases, were subjected to direct military operations and
displacement.
   Access to and quality of care for women in labor and their infants was severely affected with
reported cases of women killed during their movements to access obstetric care, others leaving the
hospital 30 minutes to evacuate space and others denied surgical management of labor as priority is
given to injured.
   The psychological impact on the Gaza population was studied by FAFO and this study revealed that
A considerable proportion of the Gaza population reported symptoms of war-related distress weeks
after the withdrawal of Israel’s troops and the discontinuation of its massive shelling.
   The level of involuntary urination while asleep was elevated in children aged five to 14 as nearly 23
percent of them had a bedwetting problem the week prior to the interview: seven percent reported
bedwetting that had lasted for a long time and 15 percent had acquired the problem with the Israeli
military campaign. One in four children had problems with their concentration in the week before the
interview.
    Symptoms of distress in adults were widespread, and as many as 58 percent reported that they expe-
rienced at least one of the nine symptoms included in the survey often during the two weeks preceding
the interview and 37 percent reported experiencing at least one of the five severe distress symptoms
often during that period.

                             Lecture 13: “Family planning in Palestine”
  Dr. Ali Nashat Shaar, MD. MSc., National Program Officer/RH, United Nations Population Fund
(UNFPA)

   Use of family planning method is a proxy indicator for health and wellbeing of women around the
globe. It was shown that maternal mortality and morbidity is higher among communities with low



     Second International Faculty of Medicine Conference 2009                                                18
prevalence of family planning method use and vice versa. High level of unmet need for family planning
was also associated with higher mortality and morbidity.
   Prevalence of using a family planning modern method in Palestine stands at around 50% of married
women in reproductive age. This figure reflects a stagnation concerning use of family planning,
demonstrates a significant variation in relation to geographic and demographic factors, but most
importantly reflects a high unmet need for family planning in the Palestinian community. Unmet need
for family planning is influenced by many factors related to the community culture and attitude,
availability and access to care and last but not least to the quality of services provided.
   The provision of family planning services falls within the mandate of different healthcare providers
and throughout the years, harmonization of care and reduction of duplication have become a critical
area to address.
   This paper will discuss the current situation concerning availability, access to and quality of family
planning services in Palestine. It will discuss as well the need for harmonized services provision to
achieve higher coverage and lower (unmet need) caused by access and availability issues.

        Lecture 14: “Prevalence of Sexually Transmitted infections among women in
                                    reproductive age”
  Dr. Asad Ramlawi, MD. PhD, MOH, Director General, Primary Healthcare and Public Health,
Chairman of National AIDS Committee

   A previous study conducted in cooperation between the Ministry of Health and UNFPA on
Trichmonas and Candida Albicans have shown that 10.6% of examined women were affected by one
the two agents. Geographical distribution of positive cases was suggestive to a relation between work
in Israel and acquiring an STI. Such findings have informed the epidemiology of STIs within the
Palestinian community and have been instrumental for developing interventions in the area of
prevention, early detection and treatment.
   Based on WHO protocols and recommendations, a national comprehensive study on STI was
conducted during 2008-2009 with support from UNFPA. The study examined urine and blood samples
from 2200 married women in reproductive age attending RH services at MOH, UNRWA and NGO
service delivery point. 7 sexually transmitted infections were screened within this study including
herpes infections, hepatitis, HIV, Chlamydia and others.
    Findings from this study are still preliminary, but have supported previously noted observations.
The presentation on this topic will discuss the preliminary findings of STI study and will shed a light
on the factors associated with observed patterns.

                            Lecture 15: ‫خذِبد اٌقسخ اإلٔدبث١خ/ ٚصاسح اٌقسخ اٌفٍغي١ٕ١خ‬
                                         ‫د. عٛصاْ ػجذٖ/ِذ٠ش ػبَ ئداسح فسخ ٚرّٕ١خ اٌّشأح / ٚصاسح اٌقسخ اٌفٍغي١ٕ١خ‬

‫أٔؾئذ اإلداسح اٌؼبِخ ٌقسخ ٚرّٕ١خ اٌّشأح ػبَ 5991 ٚرُ ٚمغ ئعزشار١د١خ ٚىٕ١خ ٌقسخ اٌّشأح ؽبسن ثٙب وً ِمذِٟ خذِبد‬
 ً‫فسخ اٌّشأح فٟ فٍغي١ٓ ٚاٌٙذف اٌؼبَ ٌإلعزشار١د١خ إٌظش فٟ فسخ اٌّش أح ِٓ ِٕظٛس ؽٌّٟٛ ٚاٌؼٕب٠خ ثٙب فٟ خّ١غ ِشاز‬
                                                                                                          .‫ز١برٙب‬
    .‫ٚرجٕذ رٛف١بد ِإرّش اٌغىبْ ٚاٌزّٕ١خ ػبَ 4991 ٚخيخ ػًّ اٌّإرّش ِغ أخز اٌثمبفخ ٚاٌظشٚف اٌفٍغي١ٕ١خ فٟ االػزجبس‬
‫رؼزجش خذِبد اٌشػب٠خ األٌٚ١خ خبفخ فسخ األَ ٚاٌيفً ٟ٘ اٌؼّٛد اٌفمشٞ ٌٍخذِبد اٌقس١خ اٌسىِٛ١خ ٚخبفخ اٌؼٕب٠خ ثبٌّشأح‬
       ‫خالي اٌسًّ ٚاٌٛالدح ا٢ِٕخ ٚسػب٠خ ِب ثؼذ اٌٛالدح ٚاٌّجبػذح ث١ٓ األزّبي ٚاألِشاك إٌّمٌٛخ ػٓ ىش٠ك اٌدٕظ ٚعشىبٔبد‬
                                                                                  ُ‫اٌدٙبص اإلٔدبثٟ ئمبفخ ئٌٝ ػالج اٌؼم‬


      Second International Faculty of Medicine Conference 2009                                                           19
                                                                                                         َ‫اٌٙذف اٌؼب‬
                                                             .ٓٙ٠‫رسغ١ٓ فسخ إٌغبء ٚرمٍ١ً ٔغجخ اٌٛف١بد ٚاألِشاك ٌذ‬
                                                                                                       :َ‫اٌّإؽش اٌؼب‬
                                                                                            ‫رمٍ١ً ٔغجخ ٚف١بد األِِٛخ‬
                                       :‫رؼًّ ٚصاسح اٌقسخ ػٍٝ اٌٛفٛي ئٌٝ اٌٙذف اٌؼبَ ِٓ خالي اإلعزشار١د١بد اٌزبٌ١خ‬
               .‫ريٛ٠ش ٔظبَ اٌشػب٠خ ٚرّى١ٓ إٌّزفؼ١ٓ ِٓ اٌٛفٛي ثغٌٙٛخ ٚاٌسقٛي ػٍٝ خذِبد اٌقسخ اإلٔدبث١خ اٌؾبٍِخ‬         .1
َ‫رسغ١ٓ خٛدح اٌخذِخ اٌّمذِخ فٟ ِشاوض اٌشػب٠خ اٌقس١خ ٚرٌه ػٓ ىش٠ك رأ٘١ً ٚسفغ وفبءح اٌؼبٍِ١ٓ ِٓ خالي ثشٔبِح ِغزذا‬         .2
                                        ‫اي‬
                  .‫ٌشفغ اٌمذساد اٌغش٠ش٠خ ئمبفخ ئٌٝ رؼض٠ض نفبءرُٙ ِدبي اٌّؾٛسح ٚاالرقبي راد ػاللخ ثبٌقسخ اإلٔدبث١خ‬
                                             .‫ئدِبج لنب٠ب اٌدٕذس "إٌٛع االخزّبػٟ" فٟ ثشاِح اٌزّٕ١خ ٚاٌشػب٠خ اٌقس١خ‬    .3
                                                                       ."‫ثٕبء ٔظُ ِؼٍِٛبد "لبػذح ث١بٔبد ٌقسخ اٌّشأح‬    .4
                   .‫رٛػ١خ ٚاٌزثم١ف اٌقسٟ: رٛػ١خ إٌغبء ٚاٌشخبي ٚرضٚ٠ذُ٘ ثبٌّؼٍِٛبد اٌقس١سخ زٛي اٌقسخ اإلٔدبث١خ‬   ‫اي‬    .5
                                                   .ُ‫رؼض٠ض ثشاِح اٌٛلب٠خ ٚاٌىؾف اٌّجىش ػٓ عشىبْ اٌثذٞ ٚػٕك اٌشز‬        .6
                        .ْ‫ئدخبي ثشاِح اٌٛلب٠خ ٚاٌزؾخ١ـ ٚاٌؼالج ٌألِشاك اٌّضِٕخ ٌذٜ إٌغبء خبفخ فٟ ِشزٍخ عٓ األِب‬       .7

    Lecture 16: “How can you trust the medical websites on the Internet? How to find
                           the best available evidence?”
  Abdel Hakim Yosef Bishawi (invited speaker), Library Manager, Harvard Medical School Dubai
Center, Dubai Health Care City-UAE

   The large volume of health and medical information resources available on the Internet has great
potential to improve health, but it is increasingly difficult to discern which resources are accurate or
appropriate for users. Sometimes the information found is just what was needed. Other searches end in
frustration or retrieval of inaccurate, even dangerous, information.
    How you can tell if a website is reliable? This paper will present rigorous evaluation criteria to
determine the quality of health and medical information published on the Web. It will help the audience
to learn how to read and analyze health and medical related Web sites to determine the authority and/or
credibility of such sites and discover quality information in support of clinical and scientific decision
making by doctors, scientists, and other health practitioners responsible for the nation's health.
   Supporting the practice of Evidence-Based Medicine (EBM) requires ubiquitous access to clinical
information and to knowledge-based resources to answer clinical questions. Many questions go
unanswered, however, due to lack of skills in formulating questions, crafting effective search strategies,
and accessing databases to identify best levels of evidence.
   The first step in applying EBM is to develop a clear idea of what type of information you are
seeking and the asking of well-built clinical questions. This paper will also discuss a stepwise process
named ―PICO‖. ―P‖ stands for ―Patient population‖, ―I‖ stands for ―Intervention‖, ―C‖ stands for
―Comparison‖, ―O‖ stands for ―Outcomes‖. Once you have formed the question using PICO structure,
you can think about what type of question it is you are asking, and therefore what type of research
would provide the best answer.




      Second International Faculty of Medicine Conference 2009                                                              20
   II.      Women health Scientific papers:

     Paper 1: “Adverse Effects of Cosmetics and Proprietary products used by females”
  Dr. Hisham Arda, MD, PhD, Consultant Dermatologist Nablus, Palestine

   In this paper I aim to focus on an important issue to every female in our community, as each one is
using many brands of cosmetics at certain stage of her life; sunscreens, whitening agents, anti-aging
products and hair-care preparations.
   During my practice I, as well as other colleagues, usually meat many types of skin ailments related
to maluse of these products on a daily basis.
  Our market is overcrowded with a countless number of these products and many of them are not
under scientific observation or control.
   In this lecture I will show samples of such accidents such as contact dermatitis, chemical burns, post
inflammatory pigmentation and permanent loss of hair. At the same time I'll try to evaluate the size of
the problem in our community and discuss how to distinguish these complications.

                                        Paper 2: “Domestic violence
  Dr Barbara Bavdaž (invited speaker), Psychiatrist, Department of Mental Health, Trieste, Italy

   Domestic violence can be defined as a pattern of abusive behaviour in any relationship that is used
by one partner to gain or maintain power and control over another intimate partner. It is wide spread in
all countries, cultures, social classes, is not influenced by age, race, ethnic or religious orientation,
sexual identity. We will learn about the state of art in some European and extra-European countries
focussing on Italy. An interesting aspect is to point out differences between myth and reality describing
details of personality traits and behavioural patterns of the abuser. The cycle of domestic violence and
the cycle of separation are two further important characteristics to be known, as well the reactions and
mental processes of the victims and of the groups at risk. The chapter about surviving strategies and
consequences suffered by the victims will complete the first part of the presentation.
   In the second part we will speak about the UN database; in December 2006, the General Assembly
of the United Nations adopted a comprehensive resolution calling for an intensification of efforts to
eliminate all forms of violence against women and requesting the Secretary-General to establish a
coordinated database on the extent, nature and consequences of all forms of violence against women,
and on the impact and effectiveness of policies and programs for, including best practices in,
combating such violence. We will learn about some national realities including Spain, Philippines,
Austria, Malaysia, Denmark and Nepal. A quick final description of the current state in Turkey,
Hungary Morocco and Italy will inform us about possible discrepancies due to cultural, geographical,
political and religious differences.

               Paper 3: “Makassed experience in management of placenta accreta”
   Dr. Sa’adeh S. Jaber, MBBS, MRCOG, MRCPI, Consultant Gynecology & Obstetric, Makased
Islamic Charitable hospital
Abstract
  Study design
  Retrospective analysis of medical records & histopathological finding.
  Population:


     Second International Faculty of Medicine Conference 2009                                               21
   Women delivered at Makassed Hospital 2007/2008 of whom 14 cases of invasive placenta
identified.
   Methods:
   Retrospective analysis complemented with direct communication with patient ,using SPSS to
analyze data .
   Conclusions:
   Incidence of invasive placenta at makassed hospital is one case in 370 deliveries.
   Invasive placenta associated with significantly high morbidity & mortality worldwide, proudly the
outcome in our hospital was excellent, with NO MORTALITY & MINIMUM Morbidity:
   Reasonably good neonatal out come.

     Paper 4: “Audit on Post partum Hemorrhage Management in Al-Makassed hospital”
   Dr. Sa’adeh S . Jaber, MBBS, MRCOG,MRCPI, Consultant Gynecology &Obstetric, Makased
Islamic Charitable hospital
  Abstract
    Retrospective analysis of PPH cases managed at al Makassed hospital during the year 2006 and the
first 2 months of 2007.
  Variables were age, parity, place of residency, mode of delivery, facilities , management & others .
   Conclusion: Mortality due to PPH might be considered a preventable condition provided the
following are available:
       Expertise
       Efficient blood banking services
       ICU facilities

                  Paper 5: “Preventive care for Women around Menopause”
  Samar Musmar, MD,FAAFP, Assistant Dean for Graduate Studies, Head, Department of Medicine
and Society, An-Najah National University, Faculty of Medicine
   Abstract:
   Menopause is a universal and irreversible part of the overall aging process involving a woman's
reproductive system, after which she no longer menstruates. Climacteric is the general term for the time
from the period of this transition to the early postmenopausal phase of a woman's reproductive life
cycle.
   As women age, they may experience menopausal symptoms that interfere with their physical,
emotional, sexual and cognitive functions, which can have a negative impact on their sense of well-
being and quality of life.
   Research has shown that Primary Care Providers lack complete knowledge and confidence in
management of menopause ,more over statistics show that the three main causes of mortality and
disability in developed countries for post-menopausal women are cardiovascular disease (CVD), cancer
and osteoporosis-associated fractures. There are agreed recommendations to include some preventive
measures for these three disorders in clinical practice for health professionals, at least at the minimal
level.
  Health care professionals should bear in mind that many women may be reluctant to raise questions
about some disorders spontaneously. Physicians should therefore search for patients with risk factors



     Second International Faculty of Medicine Conference 2009                                               22
for these diseases. Prevention and treatment to avoid medical accidents will improve the quantity and
quality of life.
   Evidence based guidelines for prevention and the controversies that have been evolving will be
discussed in this presentation

                                      Paper 6: “Stress Incontinence”
   Dr. Eyad Z. AL-Aqqad, M.B.Ch.B. – Iraq, Special Urologist, Endoscopic surgery-KHMC

   Millions of women experience involuntary loss of urine called urinary incontinence (UI). Some
women may lose a few drops of urine while running or coughing. Others may feel a strong, sudden
urge to urinate just before losing a large amount of urine. Many women experience both symptoms. UI
can be slightly bothersome or totally debilitating. For some women, the risk of public embarrassment
keeps them from enjoying many activities with their family and friends. Urine loss can also occur
during sexual activity and cause tremendous emotional distress.
   Women experience UI twice as often as men. Pregnancy and childbirth, menopause, and the
structure of the female urinary tract account for this difference. But both women and men can become
incontinent from neurologic injury, birth defects, stroke, multiple sclerosis, and physical problems
associated with aging.
   Older women experience UI more often than younger women. But incontinence is not inevitable
with age. UI is a medical problem. Your doctor or nurse can help you find a solution. No single
treatment works for everyone, but many women can find improvement without surgery.
   Incontinence occurs because of problems with muscles and nerves that help to hold or release urine.
The body stores urine—water and wastes removed by the kidneys—in the bladder, a balloon-like
organ. The bladder connects to the urethra, the tube through which urine leaves the body.

            Paper 7: “Medication Use in Pregnancy, to Treat or Not to Treat?”
  Mohammed Jawad F. N. Musmar,Ph.D, R.Ph., Dean, Faculty of Pharmacy, An-Najah National
University
   Abstract:
   Pregnancy is a special physiological condition, where drugs treatment presents a special concern
because of misinformation, or more often lack of information.
   Many future "mothers" do not adhere to their prescriptions ,often total avoidance of treatment in
pregnancy is not possible and may be dangerous (e.g asthma, epilepsy, hypertension). Also during
pregnancy new medical problems can develop and old ones can be exacerbated (e.g. migraine
headache) requiring pharmacological treatment.
   It is a fact that certain drugs given during pregnancy may prove harmful to the unborn baby is one of
the classical problems in clinical practice. The FDA classification of various drugs used in pregnancy
(e.g. A,B,C,D,X) provides therapeutic guidelines for the clinicians ,in this presentation I will focus on
various       aspects       related    to     drug    use    during     pregnancy       and      lactation

                 Paper 8: “Update on management of diabetes in pregnancy”
  Intisar Alem, M.B.BCH,MPH, Director of Research and Chronic Disease Surveillance Department
/MOH/West Bank/Palestine
   Abstract:


     Second International Faculty of Medicine Conference 2009                                                23
   Diabetes in pregnancy is associated with risks to the woman and to the developing fetus it’s affected
by pregnancy and affects the course of the pregnancy itself
    Pregnancy outcomes for women with diabetes and their babies are poor compared to those women
who do not have diabetes. Diabetes during pregnancy increases fetal and maternal morbidity and
mortality. Miscarriage, pre-eclampsia and preterm labours are more common in women with pre-
existing diabetes. In addition, diabetic complications (retinopathy & nephropathy) worsen rapidly
during pregnancy.
  Stillbirth, spontaneous abortion, congenital malformations, macrosomia, birth injury, perinatal
mortality and Neonates are at risk of respiratory distress, hypoglycemia, hypocalcemia,
hyperbilirubinemia, polycythemia, and hyperviscosity
   Pregnancy makes diabetes much harder to control, blood sugar and the need for insulin rise
throughout pregnancy. So more effort is needed, home monitoring & intensified insulin regimens
(multiple dose regimens of subcutaneous long-acting and short-acting insulins or continuous
subcutaneous insulin infusion [CSII]) usually achieves the best results.
  Preconception care and good glucose control before and during pregnancy can reduce these risks
   Pre pregnancy counselling and multidisciplinary team management with regular follow-up visits
(before, during, and after pregnancy) is the key for achieving good pregnancy outcomes

                         Paper 9: “Eye manifestations during pregnancy”
  Dr Mohamed Abusharifa, MD, Ophthalmic Surgeon,Private sector, Tulkarem – Palestine. e-mail:
mabusharifa@hotmail.com
   Abstract:
   Changes in metabolism, hormone profile and blood circulation that normally occur during
pregnancy can affect functioning of the mother's eyes. The ocular changes that occur in pregnancy are
commonly transient in nature, but occasionally can be permanent. In addition to the physiological
changes in ocular tissues in pregnancy, pathological eye conditions may occur. While pregnancy can
worsen pre-existing ocular conditions such as diabetic retinopathy, it can have beneficial effects on
others like glaucoma and uveitis. Disorders arising in pregnancy, such as pre-eclampsia and eclampsia,
can also present with visual disorders.
  In this presentation, the following conditions will be discussed:
   o Ocular changes developing during pregnancy
   o The effects of pregnancy on pre-existing eye disorders
   o The disorders of the eye associated with pregnancy-related diseases
   o Neuro-ophthalmological changes in pregnancy
   o P.S.: Resources & references will be mentioned during presentation

                         Paper 10: “A case of SVT in a Pregnant woman”
  Mahmoud Abu Slieh, General internist, Palestininan MOH
  Abstract:
  A 38 year old pregnant woman with history of Thyrotoxicosis presented to the ED with palpitation.
She was diagnosed to have SVT and managed in the ED and followed up and was delivered by CS.
   This article discusses the management of SVT in pregnancy and the safety of Antidysrhythmics on
the fetus. Also we discuss the effects of thyrotoxicosis on the fetus and management of that in
pregnancy.


     Second International Faculty of Medicine Conference 2009                                              24
   Serious cardiac arrhythmias are uncommon in pregnancy but may be associated with congenital or
acquired cardiac lesions. The incidence and severity of tachyarrhythmias, both SVT and VT may
increase during pregnancy.
   The incidence and severity of tachyarrhythmias, both SVT and VT may increase during pregnancy.
   Although the reasons for this observation are unclear, some explanations have been proposed.
   Pregnancy may predispose to and exacerbate symptoms of paroxysmal SVT.
   Clearly, both mother and fetus are at risk when SVT occurs during pregnancy.
   However, emergency Caesarean section is often a consequence, increasing maternal risk and if pre-
term, increasing fetal risk.
  Treatment of SVT in pregnancy may also affect the fetus.
  Emergency and elective DC cardioversion is safe at all stages of pregnancy.
   There is a risk to both mother and fetus in using antiarrhythmic drugs during pregnancy, and these
drugs should be avoided altogether unless the arrhythmias are intolerable.
  Thyroid abnormalities affect 5-15% of pregnant women & 4-8% of post partum women.
Hyperthyroidism Occurs in 0.2% of pregnancies
   The clinical diagnosis of mild to moderate hyperthyroidism in pregnancy can be difficult because
pregnant women often exhibit hyperdynamic signs similar to hyperthyroidism.
   Diagnosis of fetal thyroid dysfunction is challenging. Although transplacental passage of maternal
antibodies (IgG class) to the fetus does occur early in gestation, the fetal concentration is quite low
until the end of the second trimester.
   Gestational thyrotoxicosis refers to the Hcg mediated increased production of thyroid hormone that
occurs in the late first and early second trimesters at the time of peak hCG secretion.
   In managing hyperthyroidism during pregnancy, it should be remembered that two patients are
being treated: the mother and the fetus. A balance must be made in optimizing treatment for one
without impinging on the other.
  Owing to obstetric and fetal risks, surgery is not regarded as first-line therapy, but might be
considered if necessary for the mother’s health.
   Administration of radioactive iodine for diagnostic or therapeutic purposes is contraindicated in
pregnancy and lactation.

             Paper 11: “Management of thrombocytopenia during pregnancy”
  Dr. Riad Amer, MB ChB, MSc, FRCP, FRCPath, Assistant professor of medicine, Consultant
Haematologist, Chairman of Palestinian Oncology society
   Abstract:
   Thrombocytopenia is a fairly common finding during pregnancy. Most cases do not need any
intervention but close follow up is that what is needed. Some of the conditions of thrombocytopenia
can carry a high risk of morbidity or mortality during pregnancy and warrants a special attention. These
include TTP, HELLP syndrome and others. The mother and the baby can be seriously affected due to
maternal antiplatelets antibodies as in ITP.
   The management of thrombocytopenia during pregnancy can range from observe and see to
corticosteroid therapy to plasma exchange depending on the condition and the severity.




     Second International Faculty of Medicine Conference 2009                                              25
 Paper 12: “Rubella immune status of Palestinian women.A study for more than 800 ladies
                 tested for Rubella IgG in the period of 2002 and 2009”
  Dr. Bashar Karmi MD, BSC, Clinical Pathologist Immunologist Microbiologist, Medicare-
MediPal Laboratories / Ramallah- Palestine
   Abstract:
   The rubella vaccine is a live attenuated (weakened) virus which is usually given as part of the
MMR                                                                                         vaccine.
Rubella vaccination is particularly important for non-immune women who may become pregnant
because of the risk for serious birth defects if they acquire the disease during pregnancy.
   The aim of our presentation is to elaborate the immune status of our women who performed the
rubella IgG testing as part of pregnancy follow up. The subject of our cases were the girls and ladies
between the age of 15 till 45 who performed this test in our Medicare- MediPal laboratories during the
period 2002 and 2009. More than 800 samples data in this period tested for rubella IgG were analyzed
and evaluated for immune status.

    Paper 13: “Cutaneous Anaplastic Large Cell Lymphoma, ALK postive ( ALKOMA)”
  Al-Sharabati Mohamed Barakat, MD, Rasheed Osaid, RN, CNS, Al-Ahli and Al-Makassed
Hospital, Palestine

   In general medical practice coetaneous swelling with redness and bad smelly discharge is generally
common. Although we agree that in most cases an inflammatory process is the most likely diagnosis,
and resolution, either spontaneously or with the aid of antibiotic is the rule. This rule must not be
always applied, mainly if the process persists for more than one month or increase in size. And in this
case a biopsy is of great help.
   In this day we present a 22 yrs old pregnant lady with inguinal ulcerated mass since 12 months
managed as cutaneous abscess and treated with drainage and antibiotics. Finally the mass reached
around 10 cm in diameter without any improvement. So an open biopsy was performed and the
pathological diagnosis is cutaneous anaplastic large cell lymphoma ( ALCL ) ALK + ( Alkoma ). It is
important to separate this ALK Pos entity which has an excellent prognosis from cases of ALK Neg
which have a poorer prognosis.

 Paper 14: “Association between Factor V Leiden Mutation and Poor Pregnancy Outcomes
            among Palestinian Women in the West-Bank Region of Palestine”
  Ayman S. Hussein1, Khaled Shelbayeh1, Hisham Darwish2 and U’la Abu Hilal2
  1 Faculty of Medicine, An-Najah National University, Nablus, Palestine.
  2 Faculty of Medicine, Al-Quds University, Abu Dees, Palestine.
   Abstract:
   Pregnancy is a hypercoagulable state, with increased tendency for thrombus formation, a condition
that is increased when pregnancy is combined with thrombophilia.Thrombophilia could be acquired or
inherited. Among the inherited types is Factor V Leiden mutation, an autosomal dominant trait with
reduced penetrance. The mutation is believed to be associated with different poor pregnancy outcomes
including recurrent miscarriages. In the present study we investigated the potential relationship
between the leiden mutation and poor pregnancy outcome among Palestinian women residing in the
West bank region of Palestine. A case-control study was conducted with 191 test subjects with
recurrent miscarriages, intrauterine fetal death (IUFD) and pregnancy induced hypertension (PIH), and
a control group comprised of 205 women with successful pregnancies without any complications. The
leiden mutation was detected in 50 cases out of 191 test group (23.6%), and in 24 out of 205 controls

     Second International Faculty of Medicine Conference 2009                                             26
(11.7%). Interestingly, the homozygous genotype of the mutation was only detected among the test
subjects. A significant relationship is evident between the mutation and recurrent miscarriages with p-
value < 0.001. This relationship also proved significant between mutation and the various stages of
abortion among the two groups. Evidently, with first trimester abortion, the odds ratio was 2.377 and
p-value = 0.005, while the second trimester abortion comparison gave an odd ratio 6.464 and p-value =
0.000 and the IUFD had odd ratio value 3.352 and p-value = 0.015. No significant relationship is
evident among the leiden mutation and pregnancy induced hypertension in our study. The results
indicate a significant relationship between recurrent miscarriages and Factor V mutation in our
population.

   Paper 15: “Early detection of breast cancer in Bethlehem A sex months evaluation study”
   Dr Yousef Abu Ghosh, Consultant Pathologist, M.O.H, Mrs Salam Ratroot

   Introduction: A MOH pilot screening program for breast cancer was launched at Betlehem by the
directorate of health. This program is an integral part of a nationwide project aimed to reduce breast
cancer related mortality among Palestinian women. Bethlehem governerate was assigned as a pilot
area.. The project is sponsored by the Italian Cooperation Office .
   Material and methods: This is an analytical study of 678 women who consulted the screening unit
which was set up in Beit Jala Government Hospital (BJGH).The Palestinian MOH launched a health
educational campaign to raise public awareness about the importance of early screening for and
detection of breast cancer . Women with suspected breast lesions were referred to the unit for
mammography and/or ultrasound imaging. Whereas Moreover, some women attended for opportunistic
screening that is for symptoms or breast lumps . When a lesion was detected by radiology, further
diagnostic procedures and therapeutic measures were offered , namely fine needle aspiration (FNA)
cytology, surgical and oncological treatments. A database that collects all information about patients is
under way and data available to all units concerned through an internal network.
   Results: During six months of screening 768 women were screened , 9 of them were inflicted with
breast cancer. 35(4.6 %) were suspicious or positive on mammography and FNA was suggested for
them.FNA WAS Eight mammographies (1.0%) were unsatisfactory for technical reasons. FNA was
performed for 23 women; six of which were positive (0.8%), 2 were diagnosed as benign but of
uncertain malignant potential (0.3%), 9 were negative and 6 were unsatisfactory. In 15 out of 23 it was
possible to establish a correlation between radiology and cytology results. There was a 93.3%
concordance of cases (14 out of 15).
   Discussion: Turn up for screening was high .Equipment and staff available allow a reliable
diagnosis. Nevertheless, specialized training courses and in-service teaching were organized to enhance
proficiency of the staff in early detection, accurate diagnosis and effective treatment . The discovery
rate was relatively high because some attendees were symptomatic.
   Conclusions: The number of women who turned up for screening denotes
adequacy of the awareness campaign.The remarkable radiological: cytological correlation indicates
adequacy of equipment and proficiency of the screening team ..The high discovery rate proves that
breast cancer is a major health problem in the study area in particular and presumably in Palestine in
general
    Recommendations: A further study is advisable in the future to assess reduction in breast cancer
related death toll.as a result of the screening program . The study will classify woman according to :
age group , symptoms , parity , menstrual history , family history of breast cancer , reproductive history
, breast feeding ( lactation ) , use of contraceptive pills , and hormone replacement therapy BJGH-based



     Second International Faculty of Medicine Conference 2009                                                27
unit is an example to be followed by other units. The MOH Breast Screening Program is nationally
coordinated ;it sets national standards monitored through a national assurance network.

     Paper 16: “Pap smear exam for early detection of carcinoma of cervix uteri-10years
                                   prospective study”
  Dr Yousef Abu Ghosh, Consultant Pathologist, M.O.H

  In recent years Pap. Smears have been proved efficient in reducing mortality from cervical cancer.
.However, changes in sexual behavior have posed a threat to this achievement. In Jordan where the
population is conservative relative to other societies I have undertaken a prospective study of cervical
smears using a non-Arab group of women as control.
    I reviewed 10659 women during the 10- year period 1982-1991, inclusive .Pap smears were sent
either for routine check-up or for cytological diagnosis of cervical disorders. 404 women attended for
routine check-up (38%), 3519 women sought medical advice for specific gynecological complaint(s)
(33%); the remaining 3092 (29%) came for unspecified reason. Of the total number, 7743 were Arab
and 2961 were non-Arab women.
   One hundred –twenty one cases of Cervical Intra-epithelial Neoplasia (C.I.N) were diagnosed , 88
were nationals and 33 non Arab with frequency rates of 0.9% and 1.1%, respectively .Mean age at the
time of diagnosing CIN was 42 years for Jordanian and 34 years for non Arab women , the latter being
appreciably younger. Among Jordanian, mean age for the 3 grades of cervical intraepithelial neoplasia
went upward from 40 to 41 to 46 in contrast with non Arab women who were on the average 31,35,and
37 years, respectively.
   Follow-up was adopted in 27 of the 121 women with CIN. Of these 27 women, 14 attended twice, 5
attended 3 times and 8 appeared 4 times for follow-up after diagnosis. Conization and cautery were the
principal treatment methods used. All the 27women are now doing well and show no evidence of
neoplasia after treatment.
   Three women turned from negative to positive during the period of this study; their Mean age was
36 years while the mean duration of their follow-up from negative to positive smear was 25 months. In
the remaining 29 women, the mean duration of Follow-up was 31 months.
   Uncircumcised male partners of women without CIN numbered 1163(11% of the total) in contrast
with 26 of the 121 of spouses of women with CIN (21%), suggesting              a protective role for
circumcision. Viral studies were not routinely done while there is evidence that sexually transmitted
disease is an infrequent disorder in sexually active Jordanian women.

                 Paper 17: “Pharmacological care of women around menopause”
  MSc. Ikhlas Jarrar, Master degree in Medical Pharmacology, Lecturer in Pharmacy College at
An-Najah National University

  Vasomotor symptoms ,vaginal atrophy ,osteoporosis and depression are the most                common
menopausal symptoms that may seeks for medical care.
   Hormone therapy is currently the only FDA-approved treatment for hot flashes. Current
recommendations are to use the lowest dose of hormone therapy for the shortest period that will allow
treatment goals to be met. Alternative treatments include :serotonin reuptake inhibitors,gabapentin
900mg\d and clonidine 100-150mcg\d still under investigation and need more clinical trials to be
approved from FDA.



     Second International Faculty of Medicine Conference 2009                                              28
   Vaginal atrophy associated with decreased estrogen levels may be treated with an estradiol vaginal
ring that can be left in the place for 3 months and it is suitable for long term use with minimal systemic
absorption. Vaginal cream therapy will relieve the vaginal atrophy but the variable absorption may
limit its use. If estrogen is contraindicated testosterone propionate 1-2% in vanishing cream seems to
be effective.
   Depression across the menopause has a multifactorial etiology and seems to be resistant to treat with
antidepressant alone. The combination of the antidepressant with hormonal therapy seems to offer the
best therapeutic potential in terms of efficacy, rapidity of improvement and consistency of remission in
the follow-up.
   Osteoporosis and osteoporotic bone fractures becomes a serious life threat for women after
menopause. Treatment with selective estrogen receptor modulator (SERM) ,hormone replacement
therapy (HRT),and bisphosphonates improve bone turnover increased in postmenopausal women to
normal range before menopause.
   A limited number of clinical trials have been conducted with nonprescription remedies, including
paced respiration, yoga, acupuncture, exercise, homeopathy and magnet therapy, and some, but not all
of these, have been found to be more effective than placebo. Dietary herbal supplements, such as soy
and black cohosh, have demonstrated some effects in placebo-controlled trials.

    Paper 18: “Genetic Marker Polymorphisms in The VDR and MTHFR Genes Among
                      osteoporotic and normal Palestinian Women”
   Riham Smoom and Hisham Darwish, Department of Biochemistry, Faculty of Medicine, Al- Quds
University, Abu Dies

   Abstract:
   Osteoporosis is a complex skeletal disease, characterized by low bone mineral density (BMD) and
microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility, leading to
higher susceptibility to fractures. Many recent studies indicated that BMD is – at least in part –
genetically determined. However, the most common candidate genes appearing to be closely linked
with variation in BMD and high risk to develop osteoporosis, are vitamin D receptor (VDR) and
methylene tetrahydrofolate reductase (MTHFR) genes. The hypothesis that commonly occurring
polymorphisms in the VDR and MTHFR genes affect BMD has raised great interest. Several studies
have confirmed this relationship– although some are contradictory –, while others showed negative
findings.
   In the present study, we analyzed the Bsm-I , Fok-I , Apa-I, and Taq-I polymorphisms in the VDR
gene, in addition to the (C677T) polymorphism in the MTHFR gene, using RFLP-PCR, and
investigated their correlation with BMD at the hip, the lumbar spine, and the femoral neck regions, in
344 postmenopausal Palestinian women with mean age of 61 years (67 ± 18 years ) from Bethlehem
district. Secondly, we also analyzed whether this correlation is associated by allelic interaction of the
indicated polymorphic sites and other related factors including years after menopause, height, weight ,
multivitamins or calcium daily supplements intake.
    The results clearly indicate the presence of significant associations between the B-allele of the Bsm-
I and the t-allele of the Taq-I VDR polymorphisms with low BMD. Significant correlation between the
CT genotype in the MTHFR gene and lower BMD at the spine was also indicated. However, our results
showed that the Fok-I & Apa-I VDR polymorphism alone are weak predictors of BMD. Interestingly,
the results of the various VDR allelic interactions indicate significant associations. Moreover, the
correlation between the MTHFR and VDR polymorphic genotypes and BMD at the three indicated
sites showed strong interaction. The association between the allelic variation and the other related non-

     Second International Faculty of Medicine Conference 2009                                                29
genetic factors indicate the presence of significant correlation between them in predicting the BMD
level.
    Key words: Osteoporosis - Bone mineral density - Vitamin D receptor gene polymorphisms -
Methylene tetrahydrofolate reductase gene.

 Paper 19: “Personal Digital Assistant (PDA): a new tool for health care professionals and
                              medical students in Palestine”
Abdel Hakim Yosef Bishawi (invited speaker), Library Manager, Harvard Medical School Dubai
Center, Dubai Health Care City-UAE
    Rapid development in information technology has made Personal Digital Assistants (PDA’s), also
called handheld devices or handheld computers, a practical tool for health care professionals. PDAs,
with a wide range of evidence sources installed, may be used as support tools for clinical decision-
making at the point of care, for evidence-based learning and practicing, and for physician performance
improvement.
    PDA’s are perfect companions in medicine because they allow providers to input and review
information directly at the bedside. A physician can open a clinical drug reference, review dosing
guidelines, and then write a prescription, all at the point of care. They are attractive devices because
they offer easy access to reference resources. They also may be used to store protected health
information (PHI).
    This presentation will introduce the PDA as a new tool for health care professionals and medical
students in Palestine. It will also discuss and recommend PDA services, applications, software,
hardware, advantages and disadvantages, using PDA for Medline and PubMed searches, Electronic
Health Records, recommendations to purchase PDAs, use of PDAs in a clinical rotation and more. It
will also suggest ways to secure data stored on PDAs including protecting the PDA from lost and theft.
   The role of the medical librarian in offering PDA services will also be discussed to benefit and
support Faculty of Medicine community at Al Najah National University.




     Second International Faculty of Medicine Conference 2009                                              30
   III. Paediatric Orthopaedics Satellite symposium
A. Dr. Michael Benson (invited speaker), Paediatric orthopaedic surgeon – Senior lecturer ,
   Oxford university since 1990, Consultant orthopaedic surgeon at Nuffield orthopaedic
   centre since 1997.
   He has been the president of number of key orthopaedic associations including the British society of
children's orthopaedic surgery, the European paediatric orthopaedic society, and the British orthopaedic
association.
   He is currently President of the International Girdlestone Orthopaedic Society and Editor of British
Orthopaedic News. He has also been Chairman of the Council of Management for the Journal of Bone
and Joint Surgery, having served on the Council of Management for 15 years.
He has authored and co-authored a number of books and articles including, among others, Orthopaedics
- The Principles and Practice of Musculoskeletal Surgery and Children's Orthopaedics and Fractures,
currently in its 2nd edition with the 3rd in preparation.
  Introductory talk on children's orthopaedics
  An introduction to the range of problems that face any clinician who deals with childhood problems
and how they are addressed by the children's' orthopaedic surgeon.
   Developmental dysplasia of the hip
   The issues of screening, early and late presentation and the problems and complications associated
with management will be discussed.

B. Alaa Azmi Alshaikh MD, Pediatric Orthopedics Surgeon, Arab care hospital, Nablus
   specialty hospital, Mizan hospital, Member of the European Pediatric Orthopedic Society ,
   Pediatric Orthopedic society of North America , scoliosis research society

   Pediatric orthopedic in Palestine facts , future plans
   It will be a talk about health situation in the pediatric. orthopedic field , size of the problem
,concepts in pediatric orthopedic ,role of screening , short and long terms goals for improving pediatric
orthopedic services .
   Pediatric spinal surgery in Palestine
   Talk about the size of the problem here in Palestine , types of deformity we face here , management
done during the last 4 years , short and long term goals for improving pediatric spinal surgery in
Palestine.




     Second International Faculty of Medicine Conference 2009                                               31
                                        ‫ٌدــبْ اٌّإرّــش‬
                                                                                         ‫‪ ‬سئ١ــظ اٌّإرّــش :‬
                                                                                            ‫أْ‬
                                                                 ‫أ.د. ـــٚس دٚد٠ٓ / ػّ١ذ وٍ١خ اٌيت‬

                                                                                                       ‫‪ ‬اٌٍدـــبْ :‬
                                                                                            ‫اٌٍدٕخ اٌزسن١ش٠خ:‬
                                         ‫ْ‬
                              ‫ــــــط اٌٍحــ ـــــــــــح‬‫سئٟ‬                    ‫ـ ػٟ‬
                                                                          ‫د. خٍٟـــي ـــعٝ‬
                                    ‫سئٟط اٌٍدٕخ اٌؼٍّٟ‬
                               ‫ــــــح‬                   ‫ـ‬              ‫د. عّش غضاي ِغّبس‬
                               ‫سئ١ظ اٌٍدٕخ االخزّبػ١خ‬                   ‫د. ساَ ــٞ اٌضاؽــــــح‬
                                              ‫ػنــــــــــٛ‬             ‫د. ػجذ اٌّؼيٟ اٌؼضح‬

                                                                                               ‫اٌٍدٕخ اٌؼٍُ ـــ٠خ:‬
                                            ‫٠ظ اٌٍدٕخ‬  ‫سئ‬               ‫د. عّش غضاي ِغّبس‬
                                            ‫ػنــــــــــٛ‬                                ‫ـ‬
                                                                           ‫د. ٘ؼـــــاَ إٌؼٕغ‬
                                            ‫ػنــــــــــٛ‬                ‫أ.د. غغبْ اثٛ زدٍخ‬
                                            ‫ػنــــــــــٛ‬                      ‫خٍٟ ػٟ‬
                                                                          ‫د. ـــي ـــعٝ‬
                                            ‫ػنــــــــــٛ‬               ‫د. عــــــالء ػضَ ــٞ‬

                                                                                            ‫اٌٍدٕخ االخزّبػ١خ:‬
                                            ‫سئ١ظ اٌٍدٕخ‬                 ‫د. ساَ ــٞ اٌضاؽــــــح‬
                                            ‫عمــــــــــٛ‬               ‫د. ػجذ اٌّؼيٟ اٌؼضح‬
                                            ‫ػنــــــــــٛ‬                ‫د. أ٠ـــــاد اٌؼــــــ ٌٟ‬

                                                                                                   ‫اٌٟ‬
                                                                                              ‫اٌٍدٕخ اٌُ ـ ــــح :‬
                                            ‫سئ١ظ اٌٍدٕخ‬                         ‫ـ ػٟ‬
                                                                           ‫د. خٍٟـــي ــغٝ‬
                                            ‫ػنــــــــــٛ‬                ‫د. ساِٟ اٌضاغـــــــخ‬

                                                                                                    ‫اٌٍدٕخ اٌزمٕٟ‬
                                                                                                ‫ـــح :‬
                                                       ‫ػنــــــــــٛ‬        ‫د. ر١غ١ش اٌقذس‬
                                                       ‫ػنــــــــــٛ‬        ‫د. ٕ٘ٛد أثٛ ساط‬




‫9002 ‪Second International Faculty of Medicine Conference‬‬                                                               ‫23‬
                                                                             ‫‪ٌ ‬دـٓ اٌيٍتح :‬
                                                                                ‫ــ‬    ‫ح‬
                                                 ‫ـ‬
                                            ‫ِرـَ ـــد اٌســــبج قاعُ‬
                                            ‫خجـ١ـــــــــت ثـــــــذٚٞ‬
                                           ‫ــــاٚٞ‬ ‫ػجذ اٌشزّٓ اٌض٠ذ‬
                                            ‫ــــــساط َ ــٌرــــــــــَ‬‫ف‬
                                           ‫ىــــــــبسق ذــِــــــــبد‬
                                            ‫رٛف١ك اٌؾــــــــــــٛثىٟ‬
                                                         ‫ـ‬
                                           ‫ــــــــِبء ؿالذــــاد‬      ‫أط‬
                                                      ‫ف‬
                                            ‫ــــــح ثٕٟ ـــــامً‬     ‫دأٟ‬
                                                           ‫اٌؼ‬
                                            ‫ــــــاْ ــــــــــاػش‬    ‫خٓ‬
                                           ‫ـــــــــاي اٌغـــــــاسمخ‬   ‫ِٓ‬
                                                       ‫ـ‬
                                           ‫ـــــــــــــداء طَ ـــٚدٞ‬    ‫ْ‬
                                           ‫عـــــــــــــــال أنـــــــسَ‬
                                                      ‫ػٟ‬
                                            ‫ػـــــــــرٜ ـــــــعٝ‬     ‫ـ‬
                                           ‫ـــــس‬‫ٚجـــــــــــدٞ خل‬
                                                ‫ادْ‬
                                              ‫ـداهلل زُ ـــــــ ــح‬ ‫ػت‬
                                                           ‫ط‬
                                           ‫أِٟــــــس َ ـــــــــــاِر‬‫ـ‬
                                            ‫ـــــــــــــــساء خٗــــاد‬‫ة‬
                                                                   ‫زفـ‬
                                            ‫ـــــــــــــــح ِغ ــال‬
                                           ‫ـــــــــــاء اثٛ ؽــصاٌخ‬  ‫ٌّٟ‬
                                            ‫ِغــــــــــــار دساغُ ــــح‬
                                                ‫ثٓ فل‬
                                            ‫ِإَ ــــْ ـــٞ ــــي‬
                                                      ‫خت‬
                                           ‫ِقغــــــة ـــــــــــس‬
                                               ‫صاٞ‬           ‫أة‬
                                            ‫ػُ ـــس ــــــــٚ ـــدٖ‬
                                                ‫صاٞ‬
                                            ‫ــــــــــــــــصْ ـــــد‬   ‫ٞ‬




‫9002 ‪Second International Faculty of Medicine Conference‬‬                                       ‫33‬
                                                       ‫ـ‬
                                        ‫وٍّخ سئٟط اٌُ ـؤرُ ـــس‬

                                                                                          ‫اٌضِالء األػضاء، اٌسنٛس اٌىش٠ُ ..‬

                ‫ا‬     ‫ا‬      ‫ال‬       ‫ب‬     ‫ا‬                  ‫اٌثبْ‬
‫ٔشزت ثىُ فٟ وٍ١خ اٌيت اٌزٟ رؼمذ ِإرّش٘ب اٌيجٟ اٌذٌٟٚ ٞ ٚاٌزٞ أفجر رمٍ١ذً عٕٛ٠ً ِزأف ً ِٕٚجشً ػبِشً ثبٌؼٍُ ٚاٌّؼشفخ‬
                                  ‫ٚاٌزٛافً إٌّٟٙ، ٚرٚ دالٌخ أو١ذح ػٍٝ اٌّغزٜٛ اٌّزمذَ اٌزٞ ٚفٍذ ئٌ١ٗ وٍ١خ اٌيت ِسٍ١ب ٚدٌٚ١ب.‬
‫٠ٙذف ٘زا اٌّإرّش ئٌٝ اٌزفبػً ِغ زبخبد اٌّدزّغ اٌّسٍٟ ٚريج١ك ِغزدذاد اٌؼٍُ اٌسذ٠ث ئمبفخ ئٌٝ اٌزٛافً اٌيجٟ األوبد٠ّٟ‬
                                          ‫ِغ اٌضِالء لٟ اٌٛعو إٌّٟٙ ٚفٟ اٌدبِؼبد ٚسفغ ِغزٜٛ اٌّؼشفخ اٌيج١خ فٟ اٌٛىٓ.‬
‫ئٕٔب ٔزٛخٗ الْ ٔغزٙذف وً ػبَ ٚازذا ِٓ اٌّٛام١غ اٌزٟ ٔغزؾؼش أّ٘١زٙب ٚ زبخزٕب اٌيج١خ ٚ اٌّدزّؼ١خ ٌٙب، ٌٙزا اٌؼبَ ٚلغ االخز١بس‬
                           ‫ػٍٝ ِب ٠زؼٍك ثؾإْٚ اٌشػب٠خ اٌقس١خ ٌٍّشأح ِسبٌٚ١ٓ اززٛاء ِب أِىٓ ِٓ اٌدٛأت اٌّزؼذدح ٌٙزا اٌؾأْ اٌٙبَ.‬
‫ٌمذ رنبفشد اٌدٙٛد داخً اٌىٍ١خ ٚخبسخٙب إلػذاد ٚئٔدبذ فؼبٌ١بد ٘زا اٌّإرّش ز١ث ثزي وبفخ اٌضِالء مّٓ ٌدبْ اٌّإرّش‬
          ‫ِٚشافك اٌدبِؼخ ٚىٍجخ وٍ١خ اٌيت اٌىث١ش ِٓ اٌدٙذ ٚاٌٛلذ، ٚػٍّٛا ثشٚذ اٌفش٠ك اٌٛازذ ٌ١خشج ٘زا اٌّإرّش ثأثٙٝ فٛسح.‬
  ‫اٌذػُ اٌّزٛافً ِٓ لجً اٌغ١ذ سئ١ظ اٌدبِؼخ ِٚغبػذ٠ٗ ٚئداسح‬        ‫ئْ سفؼخ ٘زٖ اٌىٍ١خ ٚػٍٛ ؽأٔٙب ٚريٛ٠ش٘ب ٌُ ٠ىٓ ٌجزُ ٌٛال‬
                                                                                        ‫اٌدبِؼخ ٘زٖ اٌىٍ١خ فٍُٙ وً اٌؾىش ٚاٌزمذ٠ش.‬
 ‫وّب ٚاعّسٛا ٌٟ أْ أرٛخٗ ثبٌؾىش ٌىبفخ اٌّإعغبد ٚاألفشاد اٌز٠ٓ دػُ ٚا ٘زا اٌّإرّش ٚأخـ ثبٌزوش اٌشػبح اٌشئ١غ١١ٓ ٌٍّإرّش :‬

                                                                                    ‫‪ِ o‬دّٛػخ االرقبالد اٌفٍغي١ٕ١خ‬
                                                                                      ‫‪ o‬فٕذٚق األُِ اٌّزسذح ٌٍغىبْ‬

                                                                                                ‫ي‬
                   ‫ٚأخ١شاً أرّٕٝ ٌدّ١غ لنبء أ٠بَ ِّزؼخ ِٓ إٌؾبه اٌفىشٞ ٚاالخزّبػٟ فٟ سزبة ٘زٖ اٌّإعغخ اٌؼش٠مخ.‬

                  ‫ـ‬
         ‫أ.د أنور دوديه‬
         ‫عميد كلية الطب‬
         ‫رئيس المؤتمر‬




      ‫9002 ‪Second International Faculty of Medicine Conference‬‬                                                                       ‫43‬
                           ٟ‫سوبد ٚ اٌدٙبد اٌشاػ‬
                  ‫ــح ٌٍّإرّش‬                 ‫اٌؼ‬


                                              ‫اٌشػبح اٌشئ١ظ‬
                                         ْٛ٠‫ـــ‬




    ******************************************************************




Second International Faculty of Medicine Conference 2009                 35
                                                                                                        ‫اٌّسزـــــٛ٠بد‬


                       ‫2‬                      ‫.......‬
                                                    ‫...................................‬
                                                                                      ‫........................‬
                                                                                                             ‫..............................‬   ‫اٌؾشوبد ٚ اٌدٙبد اٌشاػ١ــخ ٌٍّإرّش‬

                       ‫3‬                    ‫..................‬
                                                            ‫...................................................‬
                                                                                                              ‫.............................‬   ‫وٍّخ سئ١ـظ اٌّـإرّـــش "ثبإلٔدٍ١ض٠خ"‬

          ‫4-5‬               ‫.......‬
                                  ‫....... ...........................................‬
                                                                                   ‫...........................................................‬
                                                                                                                                             ‫.............................‬   ‫ٌدبْ اٌّإرّش "ثبالٔدٍ١ض٠خ"‬

 ‫6-‬    ‫.......‬
           ‫.............................................................................‬
                                                                                       ‫....... .............................‬
                                                                                                                          ‫...........................................................‬
                                                                                                                                                                                    ‫.............................‬   ‫ثشٔبِح اٌّإرّش‬
                                                                                                                                                                                                                                      ‫21‬

‫31 –‬            ‫..........................‬
                                         ‫............................‬
                                                                    ‫....... .............................‬
                                                                                                       ‫...........................................................‬
                                                                                                                                                                 ‫.............................‬   ‫اٌّسبمشاد اٌشئ١غ١خ‬
                                                                                                                                                                                                                                      ‫02‬

‫12 –‬    ‫................................................................................‬
                                                                                       ‫....... .............................‬
                                                                                                                          ‫...........................................................‬
                                                                                                                                                                                    ‫.............................‬   ‫األٚساق اٌؼٍّ١خ‬
                                                                                                                                                                                                                                      ‫03‬

                  ‫13‬            ‫..‬
                                 ‫....... .............................‬
                                                                    ‫...........................................................‬
                                                                                                                              ‫.............................‬   ‫األٚساق اٌؼٍّ١خ ألِشاك اٌؼظبَ‬

‫23 -‬                 ‫.....................................‬
                                                         ‫....... .............................‬
                                                                                             ‫..........................‬
                                                                                                                      ‫.................................‬
                                                                                                                                                      ‫.............................‬   ‫ٌدبْ اٌّإرّش "ثبٌؼشث١خ"‬
                                                                                                                                                                                                                                      ‫33‬

                  ‫43‬                   ‫..........................................................‬
                                                                                                ‫.........................‬
                                                                                                                        ‫.............................‬   ‫وٍّخ سئ١ـظ اٌّـإرّـــش "ثبٌؼشث١خ"‬

                  ‫53‬                          ‫... ............................‬
                                                                             ‫..................................‬
                                                                                                              ‫.............................‬   ‫اٌؾشوبد ٚ اٌدٙبد اٌشاػ١ــخ ٌٍّإرّش‬




   ‫9002 ‪Second International Faculty of Medicine Conference‬‬                                                                                                                                                                                ‫63‬

								
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