Peradeniya Medical School Alumni association United Kingdom
The International Academic Conference 2018
Abstracts of Presentations
Carcinoma of Lungs:

Panel presentation & discussion:

Drs PalithaAbyekoon Chairman of the National Authority on Tobacco and Alcohol (NATA), under the Ministry of Health, Sri Lanka

Dr Sethsiri Wijeratne Clinical Lead and Consultant Chemical Pathologist, Coventry and Warwickshire Pathology Service

Dr Jeyakumar Singanayagam Consultant Radiologist, Milton Keynes University Hospital, United Kingdom

Dr Gayathri Wathuge Consultant in Cellular pathology, Buckinghamshire Healthcare NHS Trust

Dr Nirupa Murugaesu Consultant in Medical Oncology at St George’s Hospital

Prof Wickii Thambiah Vigneswara n Director of Thoracic Surgery at Loyola University Health System and System Director of Edwards and Elmhurst Health, in Chicago, USA

The purpose of this session on lung cancer is to review the current management of lung cancer with a particular emphasis on non-small cell lung cancer, which is the frequent form of lung cancer encountered in clinical practice. After attending the session the participants would be able to understand the current indications for lung cancer screening, the methods of establishing the diagnosis, and various treatments that are available for different stages of lung cancer. The format of the session is multiple didactic lectures on epidemiology, screening, diagnosis, staging, indications for surgery, neoadjuvant and adjuvant therapies. In addition there will be lectures on molecular markers, recent advances on targeted therapies and anticipated near future developments in the field. For discussion and audience participation a typical case of non-small cell lung cancer will be presented and the panel will discuss management .

How Life Style Influences Heritable Changes

Dr James Flanagan, Senior Lecturer in the Epigenetics Unit, Dept. of Surgery, Imperial College, London

Epigenetic modifications, such as DNA methylation or histone modifications, are key determinants of chromatin structure, genomic stability and gene expression. These epigenetic modifications are maintained during cell division and when perturbed, play a key role in cancer development. Recent research has explored the possibility that epigenetics may play a role in determining cancer risk. The underlying mechanisms of how epigenetic patterns are altered and how this is related to cancer risk are unclear. The main hypothesis proposes that cancer risk exposures, lifetime and environmental events, can alter the epigenome and stably modify an individual’s cancer risk. The best example of this thus far is the epigenetic signatures of smoking that partly mediate lung cancer risk. Other lifestyle factors that influence the epigenome include aging, body mass index, alcohol consumption and hormonal factors. Whether these lifestyle induced epigenetic changes are heritable across generations remains controversial .

Vitamin D: Is it The Panacea for All Human Ill-Health?

Prof Sunil J. Wimalawansa , Professor of Medicine, Endocrinology & Nutrition

The nutrient vitamin D and its active hormonal form, 1,25(OH)2D are essential for human physiological functions, procreation, and survival. Well-known hormonal functions of 1,25(OH)2D include stimulation of calcium and phosphate homeostasis (intestinal absorption, renal handling, bone resorption, in part, regulation through parathyroid hormone) and bone metabolism. However, effects of vitamin D extend beyond calcium and phosphate homeostasis and prevention of osteomalacia, rickets, falls and fractures.

Mounting evidence supports that suboptimal concentration of serum vitamin D [i.e., serum 25(OH)D less than 75nmol/L (30ng/mL)] is associated with dose-dependent increase risk of morbidities and all-cause mortality, even in the presence of normal 1,25(OH)2D concentration. Disorders associated with hypovitaminosis D include, hypertension, cardiovascular diseases (atherosclerosis, peripheral vascular disease, myocardial infarctions), metabolic disease (obesity, insulin resistance, type 2 diabetes), pregnancy and birth-related outcomes, autoimmune disorders, certain cancers, impairment of DNA repair, and systemic inflammation. The interaction of 1,25(OD)2D with its intracellular receptors modulates vitamin D–dependent gene transcription, triggering several secondary messenger systems leading to protection against disorders like autoimmunity, and viral and bacterial infections.

To-date, many information generated on vitamin D are from observational, epidemiological and ecological studies; only few randomized control trials (RCT) data available. Many published and ongoing RCTs have major study design failures, thus one cannot expect them to generate meaningful data to clarify unknowns. The treatment of vitamin D deficiency costs less than 1% of the cost of investigations and treatment of worsening comorbidities and complications associated with hypovitaminosis D. Despite this cost-benefit, in millions of people, vitamin D deficiency remains uncorrected. Countries with proactive health systems, combined approaches have been introduced to alleviate vitamin D deficiency, including food fortification, advocating safe sun exposure and supplementation; these recommendations are geared for both health professionals and the public.

Countries that have not yet adapted these cost-effective public health interventions should consider embracing such measures. The goal is to maintain the health in populations by maintaining serum 25(OH)D concentrations above 75 nmol/L. The progress of knowledge in biology and physiology made over the last two-decades, in relation to clinical applications to human health will be presented. New understandings of metabolomics, transcriptomics, and epigenetics related to vitamin D promise better clinical outcomes.

Professor Varagunam Memorial Lecture:

Healthcare in 2025 and Beyond

Prof N Sreeharan, Visiting Professor at King’s College, London, University of Jaffna, Sri Lanka and in Malaysia and a Consultant to the Biotechnology Industry.

The delivery of healthcare has seen some extraordinary changes in the past 50 years. Many of these have developed insidiously over the years and have resulted in significant improvements in most health- related outcomes. The pace of change has however increased dramatically in recent years, is expected to accelerate even further in the future and many healthcare systems across the globe will struggle to adapt to these challenges. Predicting the nature of the healthcare environment over the next several decades could be seen more as a role for a clairvoyant rather than as a scientific and evidence-based endeavour. However, evidence from previous developments and current indicators of change could be used to predict the possible healthcare environment of the future.

The main drivers for a paradigm shift in the future delivery of healthcare will be the impact of dramatic technological advances in biology and medicine and the development of artificial intelligence including the processing of “big data” and machine learning. The consequent challenges to the traditional role of doctors and other healthcare providers will need to be managed. The wider society will also need to respond to these changes by modifying its choices and preferences on health and end of life decisions. It is essential that a modern curriculum for the training of tomorrow’s doctors should reflect these dramatic changes to ensure that healthcare practitioners and providers are ready to respond optimally to the challenges.