19^th Annual Conference on
Nephrology

Health is the wealth of the nation. To create a thriving economy every nation needs healthy people to work with skills and jobs. It is the duty of each and every nation to create an excellent healthcare which is safest and the best and is affordable. NHS is a great Institution and each year 360 million patients are seen by 1.3 Million staff. Most staff work hard and most patients receive safest and the best care. However, sadly culture of bullying is common in NHS. Staff survey shows that 20 to 30% of staff report being bullied or seen someone being bullied in the NHS. Bullying culture is common not only in NHS but throughout the World in healthcare sector. There are complex reasons for the culture of bullying. When I was the Medical Director of Wrightington, Wigan and Leigh FT (2010-2016) I had to deal with culture of bullying and we transformed the culture of bullying to kind caring compassionate learning and supportive culture, we reduced harm to patients by 90% over 8 years. We empowered staff to speak up and 70 staff raised concerns with me and other Directors and this helped us to transform the culture. The Trust appointed kind caring compassionate leaders to each and every department, created good team working, implemented good governance and duty of candour. Trust received 45 awards and 450 more patients survive each year and for staff happiness Trust improved from bottom 20% in 2011 to third best by 2016. In my presentation I will be presenting as to how we transformed the culture and I will be focusing on some of the nephrology cases like Diabetes, renal surgery and acute kidney injury and how we reduced harm and how we learnt lessons. Leadership is honesty, sincerity, integrity and courage to protect patients and to support staff. Happy staff – Happy patients is the culture we created to transform the Trust.

Atherosclerosis, a chronic inflammatory disorder of medium and large arteries and the underlying cause of heart attacks and stroke, is responsible for more global deaths than any other disease. A slight reduction in morbidity and mortality from atherosclerosis and its complications has been seen recently, at least in the western world, due to lifestyle changes and pharmaceutical interventions (e.g. statins). However, the global burden from this disease is expected to worsen in the near future because of recent increases in risk factors such as diabetes and obesity. Current pharmaceutical treatments for atherosclerosis are associated with considerable residual risk for cardiovascular disease together with various side effects. With the exception of few successes (e.g. ezetimibe, PCSK9 inhibitors), many pharmaceutical leads against established targets have proved disappointing at the clinical level. It is therefore important that further research is carried out on the molecular basis of atherosclerosis together with alternative therapies for its prevention and treatment. Natural products have received substantial recent interest in the prevention and treatment of atherosclerosis. However, more research is required that addresses the molecular mechanisms underlying the beneficial effects of natural products together with large clinical trials that evaluate their efficacy. We have recently initiated studies on the effects of many natural products, including certain polyunsaturated fatty acids, polyphenols and probiotics, on several key monocyte/macrophage processes associated with atherosclerosis in vitro and various risk factors in vivo together with the underlying mechanisms. These will be presented in the context of molecular mechanisms underlying atherogenesis together with current therapies and those that are being developed.

The autoimmune chronic thyroiditis or Hashimoto' thyroiditis is an inflammatory autoimmune disease of the thyroid, characterized by a lymphocytic chronic infiltration. This pathology is frequently silent, often hands to a gradual but progressive and irreversible hypo-function of the thyroid. It is the most frequent cause of hypothyroidism in the guilty ones of the world to enough contribution of iodine, while it is relatively being rare in the zones to lack iodine. The greatest incidence is the women it is calculated around 3,5 cases for 1000 inhabitants a year. At the base of the pathology there is an inflammatory autoimmune process that brings to the destruction of the thyroid follicles, caused both from a cells-mediate mechanism and from organ specific antibodies. Once activated the lymphocytic T helper it produces different cytokines that perpetuates and the inflammatory process they make autoimmune chronic. Therefore, both the inflammatory process and the lymphocytic infiltration leads to a reduction of the synthesis of the thyroid hormones. The bio-humoral mechanism seems to have a secondary role. Sometimes in some occasions we can also be found some antibodies anti TSH receptor blocking (TSHRblokingAb) responsible of the atrophy variant (idiopathic myxedema) or even more rarely anti Receptor of the TSH antibodies (TRAB) responsible of the condition of transient hyperthyroidism or at times permanent that rarely can be found in patients with Hashimoto' thyroiditis (Hashitoxicosis) due to the release of the thyroid hormones from the destroyed thyroid cells. Often the chronic thyroiditis can be are associated with other autoimmune diseases (polyglandular autoimmune syndrome). The diagnosis founds him on the data of laboratory that underline elevated values of specific antibodies (overall AbTPO). Nevertheless in a low percentage of cases 5- 10%, we can find a condition of chronic thyroiditis in absence of specific antibodies. In such case the diagnosis is sustained by the aid of the sonography. The typical picture in fact it is peculiar with a markedly hypoechoic thyroid with poor intra-thyroidal vascularization. In many cases is not in demand some treatment because the gullet is small the patient it is often asymptomatic with levels of TSH in the range of the norm and in absence of antibodies. In that case it is not required any therapy a part the use of selenium as anti-oxidant agent and Vitamin D. In patients with hypothyroidism (both subclinical than clinical) the pharmacological treatment was mandatory as the administration of the substitutive therapy with levo-thyroxine especially in children and in the women that are in pregnancy or to the search of pregnancy. The purpose of the hormone-therapy is that to normalize the TSH values with a first control to 45-60 days and once reached the therapeutic remuneration they are enough hormonal controls TSH and FT4 every 6-12 months. Lasting the therapy in the 50- 90% of the cases is assisted to a reduction of the thyroid volume and consistence both for the normalization of the values of TSH and for the reduction of the lymphocytic infiltrate. Besides it is also assisted to a reduction of the antibodies title, to which has been shown the association it contributes using selenium and vitamin D.