27^th International Conference on Pediatrics, Neonatology and Pediatric Nursing September 24-25, 2018 Tokyo, Japan

Biography:

Dr. Khalaf Hussein Hasan has completed his MBChB at the age of 24 years from University of Mosul and the Arab Board of Pediatrics from university of Baghdad. He was the Head Department of Pediatrics from 2000-2007 at the college of Medicine /university of Duhok. He published more than 10 papers in the international journal and more than 10 papers in the national journals. He supervised 12 students of High Diploma Degree in Pediatrics and more than 20 postgraduate pediatric students for the Arab, Iraqi and Kurdistani Board of Pediatrics.

He work now as Associate Professor of Pediatrics at the College of medicine/University of Duhok and Consultant Pediatrician at Heevi Pediatric Teaching Hospital.

Abstract:

The role of Gut/Gut microbiota in the health and wellbeing is a hot topic for ongoing researches. How does gut health in infancy influence overall health in later life and how do our resident gut microbes affect health, immunity, and mental wellbeing?

Gut health in early life is a central for overall growth, development and wellbeing in later life.

Hippocrates (360-470 BC) said that “all diseases begins in the GUT”.  The gastrointestinal tract is an Organ system responsible for consuming and digesting food, absorbing nutrients, and expelling waste thereafter. It starts with the mouth and end with anus. It contains 70-80% of the body’s immune system, hundred millions of neurons, ninety five percent of the body’s serotonin and about 100 trillion bacteria.

The GUT has three main functions: absorption and digestion, Gut immune function and Gut-brain crosstalk.

The Gut contain  about 100 trillion bacteria¹ (approximately 2 kg body weight), one thousand  different bacterial species, bacteria cells constitute 90% of total number of cells in human body (remaining 10% are human cells) and the human microbiome are 1,000,000 + genes vs only  23,000 human genes and the bacterial composition is unique per individual and influenced by host genotype.

Many factors affect the Gut microbiota composition including: diet, life style, hygiene, stress, environment and the use of antibiotics.

There is a bidirectional signaling between the gastrointestinal tract and the brain ; the brain influences gut microbiota and gut microbiota influences brain, mood and behaviour.

Healthy gut microbiota is essential for normal gut physiology, appropriate signally along gut-brain axis and maintenance of good health.

Biography:

Andy Eyo, is a graduate of Chemistry from the University of Calabar and holds a Postgraduate Diploma in Environmental management and in Education from the University of Uyo- South-South Nigeria. He holds a Master degree in Business Administration (Leadership) from the University of Liverpool and is a community level strategic HIV/AIDS prevention specialist. He is an experienced human resource Manager and grants management specialist with Certificate in Grant Management from North Pole institute, USA and Lagos Business School. He was the Principal Investigator and  Project Director of a 4year long $10million LOCATE project; a CDC/PEPFAR Comprehensive HIV/AIDS care and Treatment project in Enugu, Imo and Ebonyi States which supported over 4000 patients on anti-retroviral therapy. He currently supervises the GFHIV/TB Project in Bayelsa and Cross River States which support over 3500 patients on anti-retroviral therapy. He has certifications on the Epidemiology of HIV/AIDS and Health Planning from John Hopkins University, USA.

Abstract:

Pediatric HIV services in Nigeria lags behind that of adult services despite huge national effort to scale up services for HIV infected children. The link between the PMTCT of HIV program and pediatric services is weak due to poor knowledge in EID among health care workers especially in the rural areas where majority of Nigerians live.

PEPFAR CDC funded LOCATE project implemented by ECEWS, supported HIV services in 209 rural HIV clinics in Ebonyi, Enugu and Imo States, South-Eastern Nigeria since October, 2013. To address low EID services uptake, ECEWS worked with the supported rural HIV clinics to identify 35 Community Health workers (CHWs) who were trained as DBS mentors in January, 2014. This activity was aimed at reviewing the contribution of the DBS mentors on the overall EID services uptake over 12-month period (Jan. – Dec. 2014) following the intervention.

Methods:

The CHWs were mentored on proper method of DBS collection and charged with cascading the training to facility staff involved in the PMTCT/pediatric programs. ECEWS supported the freighting of the collected DBS to the nearest DNA PCR reference lab for analysis. Data obtained from the EID activities was documented using a generic DBS tracking tool. These data were collated and analyzed using Microsoft excel and SPSS data package.

Results:

3 months prior to the intervention, 20 HIV Exposed Infants(HEIs) delivered in the facilities had DBS collected and transferred to the DNA PCR reference lab out of which 2 results were received from the reference lab. Post intervention, 291 HEIs delivered in the facilities had DBS collected and transferred to the reference lab out of which 66 results were received from the reference lab.

Conclusions:

Building the capacity of the CHWs on DBS collection and transfer to the DNA PCR reference lab resulted in the observed increase in EID at ECEWS-supported rural HIV clinics.

Biography:

Dr. Amit Vatkar, MBBS, DCH, DNB (Ped) is working as a Pediatric Neurologist in Mumbai. He has completed my DNB in paediatrics in 2011; I have been working in Pediatrics for last 4 years. He has completed Fellowship in Pediatric Neurology (Mumbai) under the guidance of Vrajesh Udani, in India. He was part of the Hinduja Pediatric Neurology speciality centre from 2011 to 2013. He has also been trained in Epilepsy & neurophysiology at Case Western Reserve University at Cleveland under the guidance of Dr. Hans Luders. He is currently associated with few hospitals as an expert in Pediatric Neurology field and has been treating their patients.    

Abstract:

Statement of the Problem: Neonatal encephalopathy affects 2 to 5 of every 1000 live births and represents a major cause of mortality and long-term morbidity in affected infants. Hypoxic ischemic encephalopathy (HIE) is the major cause of encephalopathy in the neonatal period. Until recently, management of a newborn with encephalopathy has consisted largely of supportive care to restore and maintain cerebral perfusion, provide adequate gas exchange and treat seizure activity.

Preventing the secondary reperfusion injury that occurs following a hypoxic-ischemic event is paramount to ensuring the best possible neurologic outcome for the neonate. Induced hypothermia is currently being studied in various institutions as a means of neuroprotection for neonates at risk of severe brain injury following a hypoxic-ischemic event. 

Methodology: The aim of this study is to evaluate the efficacy of Whole Body Cooling in management of neonatal Hypoxic Ischemic Encephalopahty admitted in NICU. This study was conducted in patients of Neonatal Intensive Care Unit of Satyam Hospital Raebareli. A total of 200 neonates with Whole body cooling, were analyzed their outcome.

Findings: All patients responded to treatment, with a variety range of activity improvement. The number of patients required a second anticonvulsant therapy. Regarding safety of hypothermia was also studied.

Biography:

Associate Professor Dr Nitin Kapur is a Paediatric Respiratory & Sleep Physician at the Lady Cilento Children’s Hospital in Brisbane. His research interest includes bronchiolitis, preschool wheeze and non-CF bronchiectasis, in which he has a PhD. He has also been appointed as Associate Professor at the School of Medicine, University of Queensland.

Abstract:

Acute viral bronchiolitis is associated with lower respiratory tract infections in infants. Although generally self-limiting and managed in the community, acute viral bronchiolitis is the most common cause of hospital admission in infants younger than 12 months of age, and is associated with substantial morbidity and health-care costs. Admissions of infants to hospital for bronchiolitis have increased in the past 20 years for reasons that might be multifactorial, although the use of pulse oximeters and insufficient evidence and clarity about levels of tolerable hypoxaemia are thought to be associated with increased admission rates.

Additionally, duration of hospital stay seems to be determined by the requirement for oxygen supplementation, even when feeding problems have resolved. National guidelines in the USA and UK differ in their recommendations for supplemental oxygen to target acceptable saturations (SpOâ‚‚) of 90% or higher, or 94% or higher, respectively. An observational study in bronchiolitis previously suggested that length of stay could be reduced when lower oxygen cut-offs were chosen, setting the stage for the randomised BIDS trial now reported by Steve Cunningham and colleagues in The Lancet,  which provides welcome evidence about the use of supplemental oxygen and oxygen saturation targets in bronchiolitis. I have championed for this recommendation to be included in the EVOLVE Paediatric Thoracic Guidelines. My presentation would also discuss the latest treatment options in infants with bronchiolitis and the evidence around it, specifically touching on the three controversial aspects of it: Nebulized Hypertonic saline, supplementary oxygen and High Flow nasal cannula oxygen.

Biography:

Dr. Vasile Valeriu Lupu is a senior in Pediatrics and Lecturer at the Pediatric Discipline, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania; he obtained his PhD degree in 2011 and he has Attestates in Complementary Studies of Pediatric Gastroenterology (since 2012), Pediatric Diagnostic Digestive Endoscopy (since 2010). Dr. Lupu is member of the Romanian Society of Medical Genetics, Romanian Society of Gastroenterology and Pediatric Hepatology, European Pediatrics Association (since 2011), being also the general secretary of the Romanian Society of Pediatrics (2009-2017). He is author of 168 scientific papers communicated at scientific congresses and conferences and 116 articles published in extenso (22 in ISI journals); for his scientific activity he was granted with 3 internationals prizes.

Abstract:

One of the greatest achievements of medicine was the discovery and introduction of vaccination for all major contagious diseases. Romania was one of the countries that have contributed to the development of vaccinology.

Currently, one of the most intensely debated issues is related to a person's right to accept or not vaccination. The patient can be put in different situations, which is why the authors discuss these issues. Given that it is easier and cheaper to prevent than to cure, through vaccination this goal can be achieved. The compulsory vaccins should meet the necessary criteria of mandatory and optional ones remain at the discretion of the patient or legal caregivers. The current actualities of vaccinology are analyzed as regards to the progress and drawbacks generated by the disappearance of the autochthonous production of vaccines, as well as the increase in the population’s distrust regarding the value of vaccination, from the perspective of civic and professional ethics and from the perspective of the involvement of the medical system.

Facing the major risks that an epidemic outbreak represents, general interest prevails, because ultimately, the freedom and security of any person ceases where it affects another person's freedom and security.

Biography:

Hamid Abrishami Moghaddam has his expertise in biomedical image analysis. He was the principal investigator of the first neonatal MR head template introduced (in NeuroImage) in 2007 and the principal contributor of the first neonatal head phantom to simulate MR images in 2011. Recently in 2017, he introduced the first bimodal MR-CT neonatal head atlas. He has built these models after years of experience in research, evaluation, teaching and administration as a Professor of Biomedical Engineering at MVMIP lab, K.N. Toosi University of Technology, Tehran, Iran and at GRAMFC Inserm 1105, University of Picardie Jules Verne, Amiens, France as invited researcher in neonatal cerebral image analysis. He is actually working on building multimodal structural and functional atlases of neonatal brain development. He has published more than 150 articles in peer reviewed scientific journals and conferences and served as technical committee member for several international conferences on biomedical image processing.

Abstract:

Statement of the Problem: Construction of a realistic neonatal head model including bone, fontanels, sutures and soft tissues using medical imagery is important for many applications. For example, solving inverse problems for source localization in electro/magnetoencephalo-graphy requires 3D geometry of principal structures of the head. Moreover, most of the longitudinal morphological and functional studies of neonatal cerebral development need standard head models for inter-individual comparison and structural development analysis. Principally, cranial hard tissues are visible in CT scans, while cerebral soft tissues are mostly visible in MR images. Therefore, a multimodal approach is indispensable for creating a complete neonatal head model including hard and soft tissues. The purpose of this retrospective study is to create a bimodal MR-CT head atlas including hard/soft tissues for the neonates of 39-42 weeks gestational age (GA). Methodology & Theoretical Orientation: Neonatal bimodal MR-CT atlas creation is comprised of two crucial steps (Fig. 1): 1) development of an effective two-step intensity-based intermodality intersubject registration method to align neonatal CT data with the MR template, 2) construction of a neonatal CT template using an advanced groupwise registration and template building method. The registration step is performed first on intracranial tissues and then the resulted deformation field is extended to the remaining parts. Findings: The created bimodal neonatal head atlas is the only available for neurological and structural studies on neonates of 39-42 weeks GA (Fig. 2). Visual investigation and mutual information between MR and CT templates demonstrated their fully alignment. Moreover, their performance on normalizing test subjects was superior to already available individual neonatal MR or CT atlases. Finally, skull segmentation using the created skull probabilistic model (Fig. 3) proved its potential application in hard tissue segmentation from MR data. Conclusion & Significance: Bimodal atlases using MR and CT for neonates in narrow interval age ranges provide morphological details of hard and soft tissues in the same stereotaxic space. They help to construct more realistic models of hard/soft head tissues in neonates for neurological studies.

Biography:

Birunu Nivio is a registered general Nurse currently working with the PNG Institute of Medical Research, carrying out research works in various projects in reducing and improving health problems of the population s of PNG. He is now working with the Pneumococcal Conjugate Vaccine study team(PCV team) doing the research work in Pneumonia, Meningitis in children under the age of 5 years.

Abstract:

Introduction: Pneumococcal pneumonia is the most common cause of childhood death worldwide; including Papua New Guinea (PNG). Prior to introduction of 13-valent pneumococcal conjugate vaccine Prevenar13 (PCV13) into PNG’s EPI program in 2014 we began an open randomized controlled trial to determine the safety, immunogenicity and impact on carriage of two PCVs with or without a pneumococcal polysaccharide vaccine (PPV) booster.

Methods: 265 babies at birth were consented into PCV 10 and 13 trial recruited from Goroka General Hospital’s labor ward, villages around Goroka town and Asaro valley. Between November, 2011 and April, 2014 eligible children were randomized to receive Synflorix (PCV10) or Prevnar (PCV13) at ages 1, 2 and 3 months.  At 9 months, they were again randomized to receive PPV (Pneumovax23) or no PPV.  At 23 months, all received 0.1ml PPV challenge dose to assess immunological safety. Bloods and per nasal swabs (PNS) were collected at ages 1, 4, 9, 10, 23 and 24 months.

Results 262 children were randomized to receive PCV10 (131) or PCV13 (131). 176 (67%) completed 24 months of follow up (91 PCV10, 85 PCV13) with 82-96% of vaccination and specimen collection completed according to protocol. There were 25 migrations, 25 lost to follow-up, 20 withdrawals of consent, 8 deaths and 8 protocol violations, half before age 6 months. Successful collection of specimens were taken from >98% of attendees. 781 illness episodes were documented (396 PCV10, 385 PCV13); 79 (PCV10) and 88 (PCV13) were mild pneumonia, 72 and 48 moderate or severe pneumonia respectively. 78 (44 PCV10, 34 PCV13) serious adverse events recorded, none due to study vaccines. 21 participants experienced reactions to vaccines (all fever and/or irritability), none hospitalized. 

Conclusion: Prevenar 13 was included in the EPI program in PNG to be given to infants at 1, 2 and 3 months with other scheduled vaccines. As PCV13 coverage increases over time, reduction in PCV serotype carriage is anticipated in vaccinated and unvaccinated children. An ongoing aetiology study will assist in evaluating the universal PCV13 programme.

Biography:

Manish Mannan is a pediatrician with focus on general and practical pediatrics. He is a national faculty for conducting workshops for handling pediatric emergencies for office practitioners ( under Indian Academy of Pediatrics). His focus is to choose and address common issues faced by pediatricians in day to day practice. He has been associated with clinical research with WHO, ICMR and INCLEN in the past. He is invited as  a speaker in issues related to practical pediatrics in various  pediatric forums. He is presently working as the Head of the Pediatrics Department at Paras Hospitals in Gurgaon, India.

Abstract:

Iron deficiency Anemia (IDA) is a common global problem, particularly in the under-developed countries.  The highest prevalence of IDA (60% to 80%) is seen in India, with about 74% of Indian children between the ages of 6 months to 3 years affected.  Iron is critical for the human immune system and erythropoiesis, and is also integral to the metabolic pathways of pathogens. The complex interactions of anemia, iron deficiency and the immune system may confound the management of these cases. The General paediatrician needs to be aware of the various issues regarding diagnosis of IDA and the dose and duration of iron therapy. It is also important to keep in consideration other issues of iron therapy such as bioavailability, tolerance, drug interactions, dysbiosis, and effect on immunity.  This review focuses on the dilemmas of iron therapy and highlight recent updates, such as optimal time of instituting treatment, newer iron preparations, benefits of intermittent administration , dysbiosis, and risk of infections on iron therapy. There is need for further research to formulate universal practice guidelines for pediatricians on this complex issue.

Biography:

Dr. Huynh Hong Quang, a senior parasitic zoonosis and malaria researcher. The author graduated from National Hue Medical University, vietnam 1998, felowship of Diploma of Tropical Medicine and Hygiene (DTMH) in Mahidol University, Thailand in 2001, received his Science Master degree of Parasitology in National Hanoi university of Vietnam in 2005, and he received his PhD degree from National Institute of Malariology, Parasitology, and Entomology (NIMPE) Vietnam, and Oxford University, United Kingdom from 2010 - now.

Abstract:

Statement of problem: Fascioliasis is a disease of the hepatobiliary system, caused by Fasciola spp that are increasing and threating of public health in the tropic areas (Africa and Asia), including of Central part of Vietnam from 2008-2018. WHO estimates that atleast 2.4 million people are infected in more than 70 countries worldwide, with several million at risk. No continent is free from fascioliasis, and it is likely that where animal cases are reported, human cases also exist. This study carried out to evaluate several particular clinical aspects in the vulnerable groups with fascioliasis. Methodology: With the descriptive cross-sectional study design with sample size in line with hospital based data. Findings: the data post analysis showed that total of 94 pregnant women and 212 child with gigantica fascioliasis were enrolled:

- In the pregnant women group: the major clinical symptoms of epigastric and Chauffard Rivet triangle pain (95.74%), subshoulder muscle pain (97.87%), gastrointestinal disturbances as abdominal pain plus constipation (14.89%), loosed stool (22.34%), nausea and/or vomit (29.78%), mild fever (68%), allergic reaction with pruritis and urticaria (64.89%), mild anemia (4.26%), rare symptoms may be hepatomegaly (6.38%), chest pain, dyspnoea (43.62%), jaundice (2.13%); Laboratory parameters were positive ELISA test with Fasciola gigantica antigen (95.74%), hepatobiliary lesions by ultrasound (97.87%), majority in right liver (90.32%), eosinophilia is the predominant indicator (90.42%);

- In the children group: the clinical manifestations included of epigastric and Chauffard-Rivet area pain (94.34%), flatuence, nausea and intermittent vomiting (76.41%), digestive disoders (40.57%), allergy (30.66%), fatigue plus weight loss (12.74%); laboratory findings included of hepatobiliary lesions by US (100%), positive ELISA with Fasciola gigantica antigen (96.70%), eosinophil of 93.39% and 1.90% positive copro-examination with Fasciolae eggs.

Conclusions and significants: In pregnant women, symptoms are indistinguishable from hepatobiliary, digestive tract diseases or overlap with gestation terrains, and clinical signs of paediatric fascioliasis may mimic a wide spectrum of hepatobiliary disorders laboratory parameters and imaging diagnostics, especially in FasELISA, hypereosinophilia and liver lesions by ultrasound  were very useful in positive diagnosis.

Biography:

Lajos  Lakatos  MD,  PhD,  DSc ,  is  a  Pediatrician-in-Chief at the County Hospital, Debrecen. Chief Supervisor of on Community Child Care in the North-East Part of Hungary and Regional Clinical Audit Lead in Pediatrics and Neonatology.  Consultant at the Department of Pediatrics, Medical University School of Debrecen in a rank of a full Professor. Now he is a retired doctor and the first neonatologist in the world who used D-penicillamine in the neonatal period for the prevention and treatment of neonatal hyperbilirubinaemia and retinopathy of prematurity (ROP).  Wrote 162 papers (46 English) 3 books (Pediatric Emergencies-Hungarian and 1 in English), 6 book chapters (6 English).

Abstract:

Very wide-ranging studies have long been made on the possible biochemical transformations of unconjugated bilirubin (UCB) which is formed during the decomposition of haemoglobin. Particular attention has been paid to its photochemical and redox reactions but the relevant publications comprise only a very small proportion of those dealing with the molecular biochemistry of UCB and metal interactions. Bilirubin has a special affinity for the basal ganglia (BG) because they are also target brain regions for divalent metal (Cu, Fe, Zn et cet.) accumulation. The immature and strikingly vulnerable neurons play important role in the pathogenesis of bilirubin induced neurological dysfunction (BIND). Following the developmental period, neurons mature and restrict the apoptotic pathway to permit long-term survival.

On the basis of abundant research data and hypotheses, according to our concept, the BIND is a neurodegenerative disease of immature brain caused by accumulation of free metals and UCB-Cu complex (as prooxidant) in the BG and other parts of CNS relevant to BIND. During pregnancy the estrogen levels rise, greatly increasing the retention of copper in the body. This metal will pass through the placenta into the unborn child. So many children are being born with toxic levels of copper and other heavy metals which were stored in the mother’s body. The main comorbidity is the hemolysis. During this process a great amount of heavy metals may circulate in free form in the bloodstream, and can pass through the blood brain barrier, finding entrance into the CNS as well.

Biography:

Anjali Kulkarni is an eminent Paediatrician and Neonatologist with over 25 years of experience in India, Australia and New Zealand. She was awarded MD (Paediatrics) with Gold medal in 1984 and subsequently worked as Assistant Professor in Medical Colleges in India. In 1994 she was selected for advanced training in Neonatology at Women’s and Children’s Hospital Adelaide. In 2016 she got associated with Medical Council of New Zealand where she currently resides.

Abstract:

Neonatal Sepsis is a leading cause of mortality and morbidity in developing countries. We tried to analyze the potential of Procalcitonin (PCT) versus that of conventional markers as a reliable prognostic indicator in culture positive neonatal sepsis. It was a prospective study conducted in Neonatal Intensive Care Unit of a tertiary care referral hospital in Northern India.  Hundred consecutive neonates with clinical diagnosis of sepsis were enrolled. Blood culture, TWBC, Platelet and Absolute Neutrophil Counts, Immature to Total neutrophil Ratio, CRP and PCT were done on Day1, 3 and 7. Subjects were grouped into those found culture positive (study group) and those who were culture negative (control group).

The data was then analysed statistically using SPSS software. The markers were also compared amongst various outcome groups as favorable and unfavorable , septic shock and non-septic shock and  survivor and non-survivor groups.

Procalcitonin was a better marker than CRP and hematologic indices in differentiating culture positive and culture negative sepsis in newborns (p-0.048,<0.001 and <0.001 for PCT on days 1,3 and 7; Mann Whitney U Test). We will discuss the role of PCT  in differentiating between different outcomes. Procalcitonin values increase sequentially in those with an unfavorable outcome (p<0.001 for difference in day 7 to 1 values) and decrease similarly (p<0.001 for difference in day 7 to 1 values) in those with a favorable outcome.The values of PCT also correlated well in the subgroup of patients in whom cultures eventually turned negative by the end of the study period   (mean values 11.34, 12.12 and 5.5 on days 1, 3 and 7 respectively)The authors will present the utility of PCT testing for early diagnosis, and management of Neonatal Sepsis.

Biography:

Dr. Gabriel Castillo Casati is the head of Pediatric Cardiovascular Surgery at the Roberto del Rio Children's Hospital in Santiago de Chile, specialized in neonatal cardiovascular pathology and circulatory support. He studied and specialized in Uruguay, Chile, Italy and England. He also works in the American Heart Center as a consulting pediatric cardiac surgeon in Uruguay. He has been an invited lecturer at numerous pediatric cardiovascular surgery meetings both nationally and internationally.

Abstract:

The modified Blalock-Taussig systemic-to-pulmonary shunt (mBTS) is the most commonly used palliative procedure for infants with ductal-dependent pulmonary blood flow in different cyanotic pathologies. Although the mBTS generally provides a reliable and regulated source of pulmonary blood flow, patients remain at risk of early and late shunt occlusion. In addition, the hospital stay increases due to an increase in morbidity and mortality. Locally, it can distort the pulmonary branches and not provide an even flow to the pulmonary tree.

In recent years, percutaneous transcatheter placement of a stent to maintain ductal patency has been used by some centers as an alternative method to provide a source of pulmonary blood flow. Our approach is through the left carotid artery frequently. The potential advantages of ductal stenting include reduced procedure-related risks, avoidance of cardiopulmonary bypass, and improved distribution of pulmonary artery blood flow among others benefits.

We reviewed our initial experience with ductal stenting as an alternative to mBTS in selected patients to determine the safety and effectiveness of this novel approach.

Biography:

Faris Ahmed Mustafa Alkhalil is a PGY4 Pediatrics Resident in Sheikh Khalifa Medical City, managed by Cleveland clinic (USA). He has cleared SEHA Annual exam, with a score of 89, the highest among the residents in SKMC Pediatric residency program. He completed his Bachelor of Medicine, Bachelor of Surgery from University of Sharjah, United Arab Emirates in the year 2013 with very good standard. He have attended many International workshops and conferences. He was awarded the Young investigator award for the ESPGHAN 50th annual meeting.

Abstract:

Introduction:

Paediatric Acute liver failure(ALF) is characterized by severely impaired liver function, with or without encephalopathy in children without previous liver disease. Geographic location affects aetiology, with Non–A-E hepatitis and drugs accounting for the majority of cases in the west.

Aims and Objectives:

We aim to review the aetiology, presentation and outcome of ALF in children in the UAE ( Hepatic Encephalopathy)

Subjects and Methods:

This is a retrospective, single centre study of children presenting with ALF from birth to 16 years over a 7-year period (September 2010-2017).

We used the Paediatric ALF Study Group criteria for defining ALF: 1) absence of a previously known history of chronic liver disease, 2) biochemical evidence of acute liver injury, and 3) hepatic-based coagulopathy defined as PT≥15 s or INR≥1.5 not corrected by vitamin K in the presence of clinical HE or PT≥20 s or INR≥2 regardless of the presence or absence of clinical HE

Results:

81 patients were identified (48 males and 33 females). Median age at presentation was 18 months (range 2 days-16 years). 12% presented in the first 4 weeks of life and 88% between 1-16 years of age.

The aetiology was identified in 86% and included; 49% infection, 16% metabolic (The main cause of metabolic disease was Wolcott Rallison syndrome, seen in 46%), 15% acute circulatory failure, 14% indeterminate, 4% toxic and drugs, 1% infiltrative disease and 1% autoimmune hepatitis. 

Jaundice was seen in 42% at presentation (Median bilirubin 43 (range 2.2-600)) and didn’t favour any aetiology. Encephalopathy was more significantly seen in the metabolic disease (77%, P=0.013). Renal failure was seen more significantly in acute circulatory failure (83%, P=0.008).

INR was highest in toxic group (Median 6.5 (range 2.7-7.2)) and infiltrative disease (INR >10). Highest AST was in Indeterminate (Median 1059 (range 116-1435)) and Metabolic groups (Median 947 (range 38-9515)). Ammonia levels were highest in urea cycle defect (Median 455 (range 264-646)).

Overall survival was 57% with improved survival in patients presenting after 1 month of age (68%). Only three patients were transplanted and they all survived. Metabolic, toxic and autoimmune disease had most favourable outcome with 60%, 100% and 100% survival respectively.

Summary and Conclusion:

ALF in the UAE has unique aetiology; with increased number of infections and reduced incidence of autoimmune hepatitis. The main metabolic disorder contributing to liver failure was Wolcott Rallison syndrome (a syndrome commonly seen in the Arab world and seen in children of consanguineous marriage). The presenting features and biochemical tests alluded to different aetiologies and can help target investigations. The Mortality rate was high in our group, we feel this can be secondary to the different aetiology spectrum in our group in addition to lack of availability of liver transplantation in the UAE, and the need for children with ALF to travel for transplantation.

Biography:

Dr. Azenith L. Tammang is a Pediatric resident at Tertiary Hospital, Philippines.

Abstract:

Background: The Philippines is struggling to avert maternal and neonatal mortality and morbidity due to childbirth complications requiring emergency obstetric and neonatal care. The conduct of BEmONC training for health providers is a strategy towards this end.

Objective: The study assessed the effectiveness of BEmONC trainings at a tertiary hospital from January 2015 to December 2016.

Design: A longitudinal study with pretest-posttest research design that measured knowledge-based mastery at immediate post-course and six months after the training

Subjects: 609 BEmONC participants composed of two groups- Group A: 443 all midwives trainees; Group B: 166 trainees trained as teams (61 physicians, 52 nurses and 53 midwives)

Research Methodology: Convenience sampling method that applied Kirkpatrick’s model and used the standard pre- post-test questionnaires and 6-months post evaluation Form to assess participants’ learning and application of skills/knowledge gained.  Frequencies, percentages, range, mean + SD, median, and mode were used for descriptive analysis, while t-test and chi-square tests were used for statistical significance at p<0.05.     

Results: 91% of Group A and 55% of Group B were satisfied with the course. The pre-and post-test scores of participants showed increased level of knowledge (Group A- 50% to 59%; Group B- 65% to 69%) found to be significant at p<0.05, d.f. =441 for Group A (p=0.000) and p<0.05, d.f.=164 for Group B (p=0.001). But, the increase in knowledge failed to achieve knowledge-based mastery of BEmONC, with 98.2% and 68.1% of Group A and Group B, respectively having post-knowledge scores below 76%. Post-training score and profession were significantly associated (derived X²=36.7; p=0.000), but not with sex, age, and years of service (p=0.446, 0.891, and 0.354, respectively). Partograph, EINC, Unang Yakap, MgSO4 administration and Management of Stages of Labor were learnings most frequently used by the 18 post-evaluated facilities. Only 13 facilities passed post-evaluation, while 5 failed. OB-related referral significantly decreased in 12 facilities (derived t-value=2.355 vs tabular t=2.145; p=0.034) before and after the training.  Poor performance of essential newborn care (mean assessment score = 1.88) was the major barrier for favorable outcome of BEmONC training, including among others, absence of birth plan, shifting schedule, emergency numbers, waste management, emergency lights, and unavailability of basic equipment and sanitized delivery and recovery rooms.

Conclusion: BEmONC participants were predominantly female, midwives, aged between 41 to 50 years old and in service for 1 to 10 years, has never attended previous BEmONC trainings. Majority of its trainees believed that course objectives were achieved and course expectations were met; hence, increased their knowledge level. Majority were generally satisfied with what they have learned and observed. Post-training assessment is incomparable to pre-training due to difference of assessment tools that were used, therefore further statistical analysis were descriptive. 10% of participants achieved knowledge-based mastery of BEmONC.  The study concluded that, there is a significant difference in the OB-related referral of facilities that were post-evaluated 6 months after the BEmONC training. However, readiness of participants’ facilities and favorable training outcomes are hampered by barriers such as poor performance of essential newborn care, and absence of basic necessities, equipment, and sanitized delivery and recovery rooms, among others.  

Biography:

Prof. Jian Liu, an epidemiologist, works in the areas of early life risk factor’s exposures and their impact on later life chronic diseases with special attention to cardiovascular disease.

Abstract:

Objective: to examine the relationship between neonatal thyroid function and the formal education of mothers.

Study design: Participants came from a population-based congenital hypothyroidism (CH) screening program in Tianjin, China.

Methods: Of 66,390 registered births in 2015, 60,568 mothers and newborns had complete data.  Mothers were assigned to one of four categories based on their educational attainment: a) mid-school or less; b) high school or equivalent; c) university; or d) post graduate.  Newborn (thyroid-stimulating hormone) TSH level was measured on day 3-7.  Two neonatal groups were created using cutoffs of TSH >10 μIU/ml and TSH >20 μIU/ml.  Odds ratios (OR) for CH risk by maternal education were estimated from logistic regression models after adjusting for potential confounders.

Results: For TSH >10 μIU/ml, the screen positive incidence rate for CH was 1:201 or 4.98 per 1,000 births; for TSH>20 μIU/ml, the incidence rate was 1:2,222 or 0.45 per 1,000 births.  Screen positive incidence rates decreased with increasing maternal education level.  Compared to mothers with a post-graduate education, the ORs (95% CI) for mid-school or less, high-school or equivalent, and university were 2.09 (1.08, 4.04), 1.45 (0.73, 2.90), and 1.61 (0.85, 3.06) using a cutoff of TSH >10 μIU/ml.  At the higher cutoff of TSH>20 μIU/ml ORs (95% CI) for mid-school or less and high-school or equivalent were 3.05 (1.20, 7.74) and 3.34 (1.24, 8.97), compared to a composite reference of university and post-graduate level education.

Conclusion: Maternal education is inversely related to neonatal thyroid function though by what mechanism remains unexplained.

Biography:

A.P. Dubey is working as Professor of Pediatrics at ESI PGIMSR, New Delhi. His career in Pediatrics spans over 35 years. He has been a thesis supervisor and examiner in Pediatrics for UG, PG and PhD Examinations at various universities. He served as Honorary Lecturer in Pediatrics at University of Sheffield, U.K. for one year. He was awarded “Commonwealth Medical Fellowship” in Pediatric Hemato-oncology at the Children’s Hospital, Sheffield (U.K) and also “Trainee Fellowship of Indian Academy of Pediatrics”. For his outstanding services, Delhi Govt. has awarded him “State Doctors Award” for the year 2010-11. He has been Executive Editor of Indian Pediatrics (official medical journal of IAP), Convener and Chairperson of immunization committee, Secretary and Chairperson of subspecialty chapter of Nutrition. He has over 90 publications in National and International journals and many chapters in text books. He has attended many National and International conferences and presented papers. 

Abstract:

Rapid rehydration, zinc and realimentation remain the cornerstone of management of acute diarrhea. However, researchers have tried other interventions like probiotics for better management as the standard therapy does not significantly reduce the duration of diarrhea. We studied the efficacy of Saccharomyces boulardii as an adjunct to standard therapy in reducing the duration of diarrhea and hospital stay. Efficacy of S boulardii is attributed to a direct inhibitory effect on growth of pathogenic strains, anti-secretory effect by specifically binding toxins to intestinal receptors, and trophic effect on enterocytes with stimulation of enzymatic activity and non-specific anti-infectious mechanisms.

Biography:

He is a practicing physician in the field of healthcare in the state of Kerala in India for the last 29 years and very much interested in basic research. His interest is spread across the fever, inflammation and  back pain. He is a medical writer and have published nine books in these subject. He wrote hundreds of articles in various magazines. He presented 9 research papers in Indian Science Congress 2008 to 2017 and 2 papers selected for the coming 2018 Indian science congress.

Abstract:

When the disease becomes threat to life or organs blood circulation decreases, Temperature of fever will emerges to increase prevailing blood circulation. And it acts as a protective covering of the body to sustain life. When blood flow decrease to brain, the patient becomes fainted-delirious .If we try to decreases temperature of fever, the blood circulation will further reduced. Blood circulation never increases without temperature increase. Delirious can never be cured without increase in blood circulation.

The temperature of fever is not a surplus temperature or it is not to be eliminated from the body. During fever, our body temperature increases like a brooding hen`s increased body temperature. The actual treatment to fever is to increase blood circulation.                                                            

Two ways to increase blood circulation.                                          

1. Never allow body temperature to lose                    

2. Apply heat from outside to the body.

When the temperature produced by body due to fever and heat which we applied on the body combines together, the blood circulation increases. Then body will stop to produce heat to increase blood circulation. And body will get extra heat from outside without any usage of energy.

How can we prove that the temperature of fever is to increase blood circulation!

If we ask any type of question related to fever by assuming that the temperature of fever is to increase blood circulation  we will get a clear answer. If avoid or evade from this definition we will never get proper answer to even a single question. If we do any type of treatment  by assuming  that the temperature of fever is to increase blood circulation , the body will accept, at the same time body will resist whatever treatment to decrease blood circulation. No further evidence is required to prove the temperature of fever  is to increase blood  circulation.

Biography:

Guillermo Magallanes is Pediatric Infectologist, Head of Infectology Service Hospital Issstecali Mexicali, President of the subcommittee for prevention and control of nosocomial infections, Member of Mexican Association of Pediatrics, Member of  directive board of  pediatrician college at Baja California.

Abstract:

In 2016 Baja California went up to the sixth place in incidence of cases from HIV/AIDS. People are getting used to the disease and stopped paying attention to it. To understand this tendency we must determine grade knowledge of the population.

Material and methods: 

Descriptive, transversal and correlative study. 400 people between 17-74 years old were surveyed with an instrument consisting in a polytomous test of 27 items about HIV/AIDS, covering: general knowledge, mechanism of transmission and its prevention. Groups were divided by sex and age: 17-30, 31-45, 46-60, >60 years old. Results were considered sufficient when more than 80% of answers were correct, regular for 60 - 79%, and deficient if < 59 %. Also; age, sex, scholarship and grade of knowledge were determinated. Odds ratios were made to find correlation. 

Results:

Those surveyed were 228 women and 172 men (43%); 58.5% between 17 and 30 years old, 22.5% from 31 to 45; 15.5% from 46 to 60 and 3.5% were >60 years old.  The average age was 31 years.  Scholarship: 41.5% (166) were currently bachelor students. 20.75% obtained a degree. 16.7% graduated from high school.  The average qualification was 66.9%. Prevention knowledge was very low (26% of answered correctly). 30% showed deficient knowledge. Once correlation tests were made, no statistical relation was found between sex, age and level of knowledge (p= >0.005).

Conclusions and recommendations

Most of general population lack knowledge, there is too much misinformation about prevention. We recommend more sex education programs at all levels.

Biography:

Dalal Nasr is a full time pediatrician, working as fulltime specialist, running the outpatient clinic at ZHO Al Ain. Screening and reassessment of the special needs children including all the enrolled students from all the cognitive, academic, vocational and prevocational sections.

Abstract:

Autism is a disorder that typically manifests itself in early childhood and is characterized by "markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests," according to the Diagnostic and Statistical Manual of Mental Disorders. Diagnoses of autism have risen dramatically over the past few decades, from an estimated one in 2500 children thirty years ago to one in 150 today. As a result, autism has become a subject of great concern for parents, medical providers and researchers, and policy makers alike.

Despite the growing interest in autism, its causes are not well understood. It is widely accepted that genetics or biology plays an important role in the development of autism. However, many in the medical community believe that the increasing prevalence of autism points to a role for an environmental "trigger" that is becoming more common over time. Yet there is little consensus as to what the trigger (or triggers) might be.

With the recent explosion in television programming and videos aimed at very young children, exposure to electronic media may be one possible trigger. One study found that on a typical day, four out of five children aged 6 months to 6 years old use screen media (TV, videos and DVDs, computers, and video games), for an average of two hours per day. While similar statistics for earlier periods are hard to come by, it seems likely that young children are spending more time in front of the television today than they did in the past.

  "Does Television Cause Autism?"  , researchers Michael Waldman, Sean Nicholson, and Nodir Adilov explore the hypothesis that "a small segment of the population is vulnerable to developing autism because of their underlying biology and that either too much or certain types of early childhood television watching serves as a trigger for the condition."

Biography:

Becerra-Cardenas Eduardo Daniel is a Pediatric Infectologist in Service Hospital Issstecali Mexicali at Baja California, Mexico.

Abstract:

Objective: determine the frequency of urinary tract infections associated with MDR bacteria, characteristics patients with such infections and the mortality rate associated in Hospital ISSSTECALI during 2015-2016.

Design: Descriptive, observational, analytic, transversal

Methods: We collected data from clinical files of each patient that had been diagnosed with a urinary tract infection and had a uroculture of 10x10⁵ CFU of bacteria with a multidrug-resistant profile. It included, gender, age, comorbidities, predisposing risk factors, obtained isolation, sensibility pattern, days of stay and proper technique of culture. We calculated frequencies and rates.

Results: During January 2015- November 2016 a total of 2401 urocultures were solicited, we isolated bacteria in 123 of them (5.12%). 94 urocultures were included, 71% of the cultures were from women with a median age of 68 years; comorbidities: Hypertension (50%), diabetes (41.5%), chronic renal disease (14.9%), history of stroke and bed-rest. An average of 14.15 days of stay was calculated. They all had a urinary catheter. Of the total of urocultures obtained, 54 urocultures demonstrated bacteria growth with a MDR phenotype (attack rate: 0.43 cases/1000 discharges) Escherichia coli was isolated in 26 (48.14%) cultures; Pseudomonas aeruginosa 7.4%; and Klebsiella pneumonia 5.5%; its mechanism of resistance was calculated according to the reported phenotype on the antimicrobiogram, demonstrating resistance to more than two family of antibiotics. A mortality rate of 21.3% was calculated of which the direct cause was related to the infective process (rate: 0.23 deaths/1000 discharges).

Conclusion: the isolation of bacteria with a multidrug-resistant profile is not very common; however, they generate a high morbimortality index and a great weight in resources to our unit.

Recommendations: reinforcement of programs that encourage rational use of antibiotics as well as the control of nosocomial infections should be employed in the hospital.

Biography:

Maria Clariza A. Coronado, M.D. earned her medical degree from University of the East Memorial Medical Center. She is a graduate of pediatric residency training from St. Luke’s Medical Center, Philippines. She plans to pursue neonatology fellowship training.

Abstract:

Statement of the Problem: The extent to which urinary tract infection (UTI) affects maternal and perinatal health remains indefinite. UTI during pregnancy can lead to preterm birth, low birth weight and even neonatal death. The study aimed to describe the neonatal outcome of women with antepartum urinary tract infection during the 3^rd trimester of pregnancy admitted under social service in a tertiary hospital. The prevalence of maternal UTI and their association to neonatal outcomes were determined. Neonatal outcomes of mothers with UTI and those without UTI were compared. 

Methodology: This was a retrospective cross-sectional analytical study. Medical records of all born neonates and their mothers at St. Luke’s Medical Center Quezon City, Philippines, from January 1 to December 31, 2015 admitted under social service were reviewed. 

Findings: Out of 424 mothers, 148 (34.9%, 95% CI 30.4 to 39.7%) had urinary tract infection on the 3^rd trimester. Mothers with 3^rd trimester UTI and without UTI were similar to outcomes such as Apgar scores of 7 to 9 at 1^st minute (97.3% vs 97.1%) and 5^th minute (99.3% vs 99.6%), intubation (0.7 vs 1.8%), neonatal pneumonia (0 vs 3.3%), neonatal UTI (0.7 vs 0%), clinical sepsis (16.9% vs 16.3%), intrauterine growth restriction (0 vs 0.4%) and neonatal death (0 vs 0.4%). Differences (p-value <0.05) were noted in outcomes such as low birth weight (6.1% vs 19.2%), preterm birth (2% vs 12.7%) and small for gestational age (1.3% vs 5.1%). Mothers who had UTI were significantly less likely to have low birth weight neonates (OR 0.28, 95% CI 0.13 to 0.59) and preterm birth (OR 0.14, 95% CI 0.04 to 0.47).

Conclusion: The prevalence of 3^rd trimester urinary tract infection in pregnancy was 34.9%. Mothers with UTI and those without UTI had almost similar neonatal outcomes.

Biography:

Dr. Meidelin Hoei, MD, earned her Bachelor of Medicine, Bachelor of Surgery degree from Suzhou University, China in 2015. She is currently finishing her residency in Pediatrics.

Abstract:

Multiple births have been associated with increased maternal and fetal morbidity and mortality during delivery. They are associated with higher cases of prematurity and low birth weight. It is important to review trends in multiple pregnancies and their outcomes to be able to identify opportunities for intervention in improving both maternal and neonatal outcomes. The study aims to provide more data on profiles of mothers and infants born with multiple pregnancies, their outcomes providing baseline data for hospital-based protocols and management of future multiple pregnancies. 

Objective: To describe the clinico-demographic profile and outcome of twin pregnancies in a tertiary government hospital

Study Design: Retrospective descriptive cross-sectional study

Setting: Neonatal Intensive Care Unit and Delivery Room of a tertiary government hospital

Study Population: Mother and newborns born at a tertiary government hospital

Results: Among 100 twin births delivered between 2014-2016, 58% were born to the mothers from age group of 20 to <30 years old. Most of the twins were full term and delivered by caesarean section with birthweight of 1000-2000 grams. 45 babies were admitted to NICU mostly due to prematurity with respiratory distress syndrome as number one immediate cause of mortality.

Conclusion: The incidence of twin birth in Philippines is still lower than in other continents. Advanced maternal age and increase gravidity and parity may have a role in increased twinning rates. Prematurity, respiratory distress syndrome still one of the most common complications and cause of death in twin births.

Biography:

Dr. Srijana Dangol Singh is currently working as an Associate Professor at Kathmandu University Hospital, Nepal.

Abstract:

Background

Asthma is one of the most common chronic childhood illnesses with rapidly increasing prevalence in low income countries. For planning effective intervention to reverse this condition we need a better understanding of the risk factors for asthma in early life.

Objectives

This study aimed to identify the risk factors associated with childhood asthma and its morbidity patterns.

Methods

The case control study was conducted in the pediatric department of Dhulikhel hospital, Kathmandu University hospital, Dhulikhel from March 2016 to March 2017. The control group was composed of 175 age matched children attending the outpatient clinic with non pulmonary health problem. Data was collected through Performa and analyzed using SPSS version 23.The association of asthma with genetic and environmental risk factors was evaluated by univariant (chi-square or Fisher’s exact test) and binomial logistic regression.

Results

Childhood asthma was more common in male children between 1-5 years. Majority of children 77(44%) were graded as mild persistent asthma. In multivariate analysis the following factors were associated with asthma: family history of asthma (OR0.06; 95%CI .005-0.94, p=0.04), exclusive breast feeding (OR18.42; 95%CI 2.56-132.3, p=0.004), allergic disorder in children (OR0.003; 95%CI 0.000-0.037, p=0.0001).

Conclusion

Family history of asthma, allergic history in the patient and nonexclusive breast feeding were significantly associated with asthma. Proper treatment and follow up with good drug compliance and avoidance of risk factor can significantly reduce the morbidity pattern of asthma in children.

Biography:

He is a practicing physician in the field of healthcare in the state of Kerala in India for the last 29 years and very much interested in basic research. His interest is spread across the fever, inflammation and  back pain. He is a medical writer and have published nine books in these subject. He wrote hundreds of articles in various magazines. He presented 9 research papers in Indian Science Congress 2008 to 2017 and 2 papers selected for the coming 2018 Indian science congress.

Abstract:

According to the facts of physics, if temperature increases, thermal expansion of an object is positive it will expand and with decrease of temperature it will shrink. Pressure will increase due to increase of temperature. On the contrary, during fever we can see blood vessels and skin are shrunk, pressure decreases, body shivers,   sleep increases, motion decreases, inflammation increases,   body pain increases, blood circulation decreases, dislike cold substances etc. In fever, the firing rate of Warm sensitive neurons decreases, and the firing rate of Cold sensitive neurons increases.

At the same time if we apply hotness from outside by thermal bag or if we drink hot water, our body acts according to the Facts of Physics- increase of temperature  pressure will also increase,  expands blood vessels and skin, body sweats, motion will increase ,  inflammation will decrease , body pain will decrease, blood circulation will increase,  like cold substances etc.

During fever, why our body acts against Facts of Physics? when disease increases, pressure and temperature will decrease. Blood circulation will decrease due to decrease of pressure. If the essential temperature of the  body is going out, essential temperature and  pressure will further decrease. This will further endanger the life or action of organ. When  disease  increase, it is the sensible and discreet action of brain  that tends to act against facts of physics  to sustain life or protect organ .There is no  way other than this for a sensible and discreet  brain to protect the  life or organ. We will get a clear answer if we find out the purpose of fever, sensible and discreet action of brain. No medical books clarify this¹.During fever, if the temperature of fever is not a surplus temperature or if it is not supposed to be eliminated from the body, the shrinking of skin and blood vessels, shivering of body, dislike towards cold substances etc are a protective covering of the body to increase blood circulation to important organs of the body it is against the facts of physics.

Biography:

Dr. Badawy plays an astonishing role in guiding and inspiring general pediatricians, junior residents and medical interns, let alone designing and giving operating teaching sessions directed to seniors. He works for a leading teaching, 500 beds, JCI accredited hospital, located in the southern region of Saudi Arabia. After being granted the Membership of the Royal College of Pediatrics and Child Health from the United Kingdom in 2015, his hospital medical board promoted him to a Neonatal Specialist position in its tertiary care Neonatal Intensive Care Unit (NICU).

Abstract:

Preeclampsia is considered as an obstetric clinical syndrome with an unclear etiology, a genetic component, and a complex pathophysiology, which involves maternal and fetal vascular alterations that could persist and cause diseases in later life.

 Multifactorial polygenic inheritance is presumed, as it shows familial predisposition, geographical and racial variability, as well as, various PE-related genes and polymorphisms that have been identified.

Although its pathophysiology is complex and incompletely understood, it is adopted that placenta (placentopathy) is a triggering organ in the disease development.

Preeclampsia is associated with early and late unfavorable neonatal outcomes, predominantly, due to increasing indications for preterm delivery, which In turn has a major impact on neonatal mortality and morbidity, hence considered as a determinant factor in neonatal prognosis.

Prematurity and IUGR are by far the most common implications of preeclampsia. Even though the relation between Preeclampsia and short & long term neonatal outcomes is controversial in the literature, recent studies mostly are supporting, collectively, the unfavorable outcomes.

Biography:

Segundo Mesa Castillo. As Specialist in Neurology, he worked for 10 years in the Institute of Neurology of Havana, Cuba.  He has worked in Electron Microscopic Studies on Schizophrenia for 32 years. He was awarded with the International Price of the Stanley Foundation Award Program and for the Professional Committee to work as a fellowship position in the Laboratory of the Central Nervous System Studies, National Institute of Neurological Diseases and Stroke under Dr. Joseph Gibbs for a period of 6 months, National Institute of Health, Bethesda, Maryland, Washington D.C. USA, June 5, 1990.

Abstract:

There is increasing evidences that favor the prenatal beginning of schizophrenia. These evidences point toward intra-uterine environmental factors that act specifically during the second pregnancy trimester producing a direct damage of the brain of the fetus. The current available technology doesn't allow observing what is happening at cellular level since the human brain is not exposed  to a direct analysis in that stage of the life in subjects at high risk of developing schizophrenia. Methods. In 1977 we began a direct electron microscopic research of the brain of fetuses at high risk from schizophrenic mothers in order to finding differences at cellular level in relation to controls. Results. In these studies we have observed within the nuclei of neurons the presence of complete and incomplete viral particles that reacted in positive form with antibodies to herpes simplex hominis type I [HSV1] virus, and mitochondria alterations. Conclusion. The importance of these findings can have practical applications in the prevention of the illness keeping in mind its direct relation to the aetiology and physiopathology of schizophrenia. A study of amniotic fluid cells in women at risk of having a schizophrenic offspring is considered. Of being observed the same alterations that those observed previously in the cells of the brain of the studied foetuses, it would intend to these women in risk of having a schizophrenia descendant, previous information of the results, the voluntary medical interruption of the pregnancy or an early anti HSV1 viral treatment as preventive measure of the later development of the illness.

Biography:

Dr. Wael Mohamed Abdelaal Egyptian. Senior consultant pediatric graduated 1995, master pediatric 2001, Ph D pediatrics 2009 working Zagazig university hospital Egypt, Alsabal Hospital Kuwait, Hamad corporation Qatar and currently working at NMC hospital UAE.  Alot of researches in neonatal anemia, neonatal sepsis and childhood asthma together with allergic diseases.

Abstract:

Adverse reaction to cows' milk resulting from an immunologic hypersensitivity to one or more milk protein.  the most common food allergy in infants and can affect the quality of life of the whole family

It affects 1.9% - 4.9% of infants. According to the guidelines from the national institute of allergy and infectious disease it classified into.

IgE- mediated CMPA, Symptoms can occur immediately and up to 2 hours after ingestion of cow’s milk., Can affect skin, respiratory system, GIT or severe systemic reactions---- anaphylaxis

Non IgE-mediated CMPA. Manifestations can be delayed up to 72 H after exposure to cow’s milk. Main effects to GIT. Symptoms are non-specific including colic, reflux, diarrhea or constipation, blood in stool and exacerbation of eczema

Cow’s Milk Antigens. More than 25 proteins in cow’s milk can induce antibody production in humans. β-lactoglobulin (in whey), casein, and bovine serum albumin are the most important antigens. Clinical reactions have occurred to all the major cow’s milk antigens

Human Milk Antigens. Human milk is predominantly whey (80% whey and 20% casein) – total casein content varies during lactation (20% in early lactation, 45% in late lactation) . Human milk lacks αs1 and αs2 caseins and β - lactoglobulin

Predisposing Factors to CMPA in Breast-fed Infants. Genetic predisposition – family history of CMA, Early exposure to cow’s milk – in utero – in newborn nursery, Exposure to cow’s milk allergens – in mother’s milk, Feeding of cow’s milk by relatives and caregivers

Clinical presentation of CMPA. CMPA manifestations involves many organs, mostly skin, GIT and respiratory tracts. The involvement of 2 or more systems increases the probability of CMPA

Studies on infants with CMPA showed that half of them have atopic eczema, and 25-50% are affected by GIT manifestations whereas other clinical manifestations are less common

How to diagnose CMPA?

1-Allergy-focused history ( symptoms, underlying immunological mechanisms and linking this to suspected food, family history of atopy).

2- For IgE mediated---- skin prick tests or specific IgE blood tests.

3-For non IgE mediated---- allergy tests have limited value

4- The oral food challenge test remains the gold standard for both types.

Treatment. Strict avoidance of CMP is the safest strategy. Choosing the substitute formula., hydrolyzed formula AAP defines eHF that it is a formula containing only peptides that have a molecular wt <3000Da.Majority of children are tolerating it. Formula containing free amino acids as the only nitrogen source are the best option in infants reacting to eHF

Prognosis. 50% of children develop tolerance by age 1 yr.75% by age 3 yrs.90% by age 6 yrs. Most infants will outgrow milk allergy by 3 years of age, but may become intolerant to other foods.

Biography:

Mostafa Dehghani Poudeh has B.S degree in Nursing and Masters’ in health education. He started his professional work in the field of medical education since 2001 after some nursing clinical experiences and community health education practices. Most of his experiences and publications are in the area of evaluation which he started in Education Development Office (EDO) of Isfahan Medical School, Isfahan, Iran. He was the member of evaluation committee of Medical School. He is also the member of academic committee of CSLC. He was admitted to an Evaluation, Measurement and Research (EMR) course at Western Michigan University, Michigan, USA on 2012. However he did not started his work at that time because of the US sanctions which denied giving him student Visa. After getting the first ranked position in the national entrance exam for PhD degree, he is now a PhD candidate in Medical Education at Tehran University of Medical Sciences. He has been granted a full scholarship from Isfahan University of Medical Sciences.

Abstract:

With a programmatic approach to assessment, leading through teamwork, our pediatrics residency program evaluates and tracks its graduate learners towards an intended destination, Competent Pediatricians. It is accomplished through a well-structured and organized master plan implemented by a rigorous action plan. It consists of various assessment methods using quantitative rubrics as well as qualitative analyses. The prominent feature of such a system includes directing residents to predetermined milestones and entrustability levels in all levels of Miller’s pyramid. The aims and objectives are fulfilled by using concrete objective and narrative feed backs about the results of formal and informal evaluations within various clinical contexts and through daily encounters. All these venues provide rich data points good enough for reliable decisions which are certainly open to objections by residents. These objections are all considered and answered officially.

The other opportunity which makes our assessment system of good quality is a well-equipped clinical skills learning center (CSLC) which is the national center of excellence in learning clinical skills. This center has the roles of both planning and implementing the assessment plans for clinical and preclinical competencies. It is also the center that leads the national high stakes assessments which are mostly conducted electronically. As an instance I can point to recent Key Features examination which was centrally designed and conducted in our CSLC for all of pediatrics residents from all of medical universities.

However our assessment system has very improvement needs. One of them is mentoring the residents by clinical faculties. It is our next plan for upgrading the assessment system so that it could be more “for learning” than “of learning”. The next one includes the encouragement of our residents to be more “Feedback-Seekers” than “Grade-Hunters”.  Of course the latter depends on the national rules and regulations for decision making about the graduate education system.

Biography:

María Camila Mejía is a General practitioner and surgeon of Juan N. Corpas university, specialist in epidemiology, extensive experience in research on topics of interest in public health and publications in international journals, in addition to great interest in pediatrics.

Abstract:

Introduction. Infections Associated with Health Care (IAHC) are all infections contracted by a patient during treatment in a hospital or other health center, and that said patient was not and was not incubating at the time of admission. In the world, 1 in 20 inpatients are affected, and in Colombia the incidence is 5.9% of all hospitalized patients. Objective. To describe the characteristics of IAAS in pediatrics and to characterize the terms used during the care of pediatric patients with IAAS. Date and place. Juan N. Corpas Clinic, July 2016- July 2017. Methods. Descriptive study divided into three phases; Phase 1: A systematic search was performed on IAAS in pediatrics in EBSCO, PubMed and LILACS; Phase 2: clinical cases of infections were designed, which were delivered to health professionals who had contact with the pediatric population, requesting that they make a brief analysis of the cases to make a theoretical model of predictive or present factors at the time of diagnosis, phase 3: the records of patients diagnosed with IAAS during the period between 2014-2016 were reviewed and the demographic, social and clinical characteristics of these patients were identified. Frequencies were calculated and the qualitative data were analyzed Atlas ti 8.0. Results In the systematic search, predictive terms of common IAAS were identified in the three databases as neonates, male sex, surgery among others, terms used by health professionals were obtained that coincided with those found in the scientific literature and finally were identified and analyzed the IAAS cases of a third level clinic, finding an IAAS rate of 0.46 per 100 hospital discharges. Conclusion. There are terms that can be interpreted as predictive factors contributing to the early diagnosis of an IAAS.

Biography:

Marzieh Heidarzadeh Arani serves as a faculty of Medicine in Pediatric Department at Kashan University of Medical Sciences, Iran.

Abstract:

Asthma is the most common chronic childhood disease, and many of its risk factors have been identified. Although various studies on the link between vitamin D and asthma have been conducted, the role of vitamin D in the onset of asthma as an environmental health problem has not been well identified. This study aims to investigate the link between serum vitamin D level and asthma in children in Kashan, Iran. This case-control study was conducted on the asthmatic (n=99) and non-asthmatic (n=99) children.

Asthma was monitored and examined using spirometry and by an allergy and asthma specialist. The patients were divided into three groups (mild, moderate, or severe) in terms of asthma severity. The age-matched children in the control group were selected from among non-asthmatic children. Serum vitamin D level was measured using radioimmunoassay (RIA) technique.

Results:

The mean serum vitamin D level of asthmatic children and the children in the control group was 14.76±14.19 ng/ml and 30.47±9.7 ng/ml, respectively (p < 0.001). The mean serum vitamin D level of the children with mild, moderate, and severe asthma was 17.6±14.2 ng/ml, 14.6±6.99 ng/ml, and 11.9±4.6 ng/ml, respectively, which was significantly less than the control group (p <0.001). Serum vitamin D levels were not significantly different in terms of asthma severity.

Conclusion: The results of this study showed that serum vitamin D level in asthmatic children is significantly less than in non-asthmatic children.

Keywords: vitamin D, Asthma, environmental health.

Biography:

Medical Doctor and Public Health professional with seven years of extensive experience in Mother Newborn & Child health Care Programs; Nutrition, Immunization, Infectious Disease, and Family Planning. I have strong technical and analytical skills in institutional management, strategic and operational planning, Health System Surveillance, Monitoring, and Evaluation of Health Care Programs.

Abstract:

Low birth weight (<2500grams) is often associated with prematurity (<37 weeks) which is most common cause of neonatal morbidity and mortality in Pakistan. Kangaroo mother Care (KMC) is non-conventional, low cost method intimates skin to skin care between mother and baby, exclusive breastfeeding and early discharge from hospital. PPHI is first organization to initiate KMC intervention in Sindh and established total 150 KMC units out of 300 BHU Plus (24/7 services) Purpose: To determine proportion of low birth weight and prematurity and to evaluate the effectiveness of KMC intervention. Methodology: The retrospective study was conducted in the all health facilities of PPHI Sindh, Pakistan and comprised data from structured registers (DHIS, KMC register and additional summary tools) from July 2017 to March, 2018. Frequencies and proportions were calculated to assess the low birth weight, premature babies versus KMC admission. Results: From July 2017 to March 2018, the total cumulative number of LBW and Premature babies was 6434 respectively among total 110466 live births. Among total low birth and premature babies 3699 were admitted to KMC units. KMC was successful intervention as out of total admission 65% were normally discharged. Conclusion: Though KMC intervention has shown significant results but with proper follow up visits additional results can be achieved. 

Keywords: Kangaroo mother care, low birth weight, premature.

Biography:

Dr. Vasile Valeriu Lupu is a senior in Pediatrics and Lecturer at the Pediatric Discipline, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania; he obtained his PhD degree in 2011 and he has Attestates in Complementary Studies of Pediatric Gastroenterology (since 2012), Pediatric Diagnostic Digestive Endoscopy (since 2010). Dr. Lupu is member of the Romanian Society of Medical Genetics, Romanian Society of Gastroenterology and Pediatric Hepatology, European Pediatrics Association (since 2011), being also the general secretary of the Romanian Society of Pediatrics (2009-2017). He is author of 168 scientific papers communicated at scientific congresses and conferences and 116 articles published in extenso (22 in ISI journals); for his scientific activity he was granted with 3 internationals prizes.

Abstract:

Introduction: Gastritis is associated with multiple etiologies, but in most pediatric cases of gastritis the etiology is unknown. Numerous studies have reported Helicobacter pylori (H. pylori) as etiological factor for mild to severe gastritis. We tried to evaluate the distribution of the infection with H. pylori by gender, age and place of origin.

Materials and Methods: We performed a retrospective study over a period of 3 years, over a  lot of 1757 patients of both sexes, aged between 12 month old and 18 year old, admitted to a regional gastroenterology center in Northeast Romania, with clinical signs of gastritis which underwent upper gastrointestinal endoscopy.

Results: Out of the 1757 children diagnosed with various forms of gastritis, in 30.85% of cases the H. pylori infection was present. Distribution of children with H. pylori infection by gender revealed a frequency of 26.75% in males and 73.25%  in women. In the study group, the average age of children who had H. pylori infection was higher (14.10 + 2.833 DS), compared with children without H. pylori (12.78 + 3.694 SD), an average difference of 1.3 years (95% confidence interval 0.96 to 1.66; p <0.001). Distribution of children with H. pylori infection by place of origin highlighted a frequency of 24.72% in urban and 75.28% in rural areas.

Conclusions: The most important cause of gastritis identified in pediatric age is H. pylori infection. For the identification of H. pylori infection by endoscopy with biopsies, followed by the urease test and / or direct microscopy remains the gold standard.

Biography:

T. Thuileiphy M.Sc. Nursing (pediatric) student at All India Institute of Medical Sciences, New Delhi. Worked as staff nurse for 7 years at AIIMS, New Delhi.

Abstract:

Statement of the problem: A study to assess the effectiveness of an Information, Education and Communication (IEC) package on compliance to Glaucoma medication among the caregivers of children attending glaucoma clinic AIIMS, New Delhi.

Background & Objective: Glaucoma is the leading cause of irreversible blindness worldwide. It is preventable if timely effective and successful treatment is provided. Quality teaching, support and guidance are needed to ensure the compliance to glaucoma medication. The present study was aim to develop IEC package on compliance to glaucoma medication and to assess its effectiveness in increasing knowledge and practice of caregivers of children glaucoma.

Methods: Quantitative research design - pre experimental one group pretest post test was used. Ethical approval was obtained from institute ethical committee. Sixty caregivers of children attending glaucoma clinic in tertiary care hospital were included in the study. Knowledge questionnaire, practice questionnaire observational checklist and medication log sheet are used for pretest and one month after the administration of IEC package (post test) were self-developed, validated and found reliable. One to one teaching, demonstration and return demonstration was provided.

Result: Majority of the caregivers were females, the mean post test knowledge score was increased from 7.3±2.19 to 12.23±1.36 which was significant at p<0.05. There was significant (p<0.05) increase in post test practice score from 11.5±1.91 to 18.08±1.12 The pretest and post test knowledge scores had significant association with educational status and family monthly income (p<0.05) The pretest and post test practice score had significant association with gender and relationship to child (p<0.05). Increase in the knowledge and practice was dependent of caregivers selected variables such as educational status, family monthly income, gender and relationship to child.

Conclusion: The study revealed that an Information, Education and Communication (IEC) package played a crucial role in increasing knowledge and practice regarding compliance to glaucoma medication among caregivers of children with glaucoma one month after the intervention. The most and effective factor identified in the study is the teaching session which takes only 15 minutes in teaching and demonstrating the content in the information pamphlet.

Biography:

Michael Ekholuenetale is currently a researcher and medical statistician in maternal and child health projects. His work focuses on a broad array of multidisciplinary topics in global health. This includes cross-cutting research and publications in disciplines of public-private partnerships and global health intervention. He has a strong interest in large-scale evidence (in particular randomized trials) and analyses of large survey data sets. He has been involved in many research projects in sub-Saharan Africa where he collaborates with international partners to advocate for cost-effective interventions addressing Maternal, Newborn and Child health (MNCH). He has undertaken numerous courses in Epidemiology, Survival Analysis, Advanced Statistics and Ethics in Health Research at the Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria; where he obtained M.Sc. Medical Statistics.

Abstract:

Background: Interpregnancy intervals (IPI) are independently associated with perinatal, infant and child health outcomes. Proper birth spacing is a recommended tool to reduce adverse health outcomes especially among children. The study aimed to determine the prevalence of adverse child health outcomes in Sub-Saharan Africa (SSA) countries and to examine the association between the length of preceding birth interval and child health outcomes.

Methods:  Secondary data  from Demographic  and  Health  Survey  (DHS)  in  34  SSA  countries with  299,065  births,  2008-2017  was  used  in  this  study.  The  outcome  variables  were  infant mortality, low birth weight, stunting, underweight, wasting, overweight and anemia. Percentage was  adopted  for  summary  statistics.  Cox  proportional  hazard  regression  was  used  to  examine association  between  preceding  birth  intervals  and  infant  mortality.  Multinomial  and  binary logistic  regression  models  were  used  to  examine  the  association  between  under-five  children adverse health outcomes and interpregnancy birth interval.

Results: Infant mortality was highest in Sierra Leone (9.3%). Comoros (16.8%) accounted for the highest percentage of low birth weight (<2.5kg). Child stunting was as high as 54.6% in Burundi. IPIs of <24 months, 24-36 months, 37-59 months and ≥60 months were 19.3%, 37.8%, 29.5% and 13.4% respectively. Median IPI was 34 months. The prevalence of infant mortality decreased as IPIs increased as infant mortality was 9.3% in short IPIs (<24 months) and 4.2% in long IPIs (≥60 months). Childhood adverse health outcomes were higher with short birth intervals. Results from Cox proportional hazard regression showed that children with preceding birth interval <24 months had 57% higher risk of infant mortality, compared to children with IPI of 24-36 month (HR= 1.57; 95%CI: 1.45, 1.69). More so, there were higher odds/risk of low birth weight, stunting, underweight, wasting, overweight and anemia among children with short birth interval (<24 months) after adjusting for other covariates.

Conclusion: The findings of this study suggest the need for urgent intervention to promote the WHO recommended IPI to reduce adverse child health outcomes. The findings show the importance of exclusive breastfeeding to prolong lactational amenorrhea and enhanced proper nutritional approach.  Stakeholders would find this study interesting as the basis for policy formulation and implementation.

Biography:

Dr. Kyung Hee Park is a Professor at Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, South Korea. He has more than 10 years of experience in this field and has published many research articles in several reputed National and International journals. He have attended many International conferences and symposia worldwide.

Abstract:

Purpose :

Recently, several studies have reported a correlation of early aEEG parameters with short- and long-term neurological outcome in preterm infants. The aim of this study was to assess characteristics of aEEG in preterm infants with adverse neurologic outcome such as intraventricular hemorrhage, periventricular leukomalacia or death and to evaluate whether aEEG in the early days of life has predictive value of short-term neurologic outcome in preterm infants.

Methods :

This prospective observational study included infants born at less than 32 weeks of gestational age or less than 1500 gm of birth weight who admitted the neonatal intensive care unit of Pusan National University Hospital between December 2016 and November 2017. aEEG were monitored at 12~14 hours (day 1), 46~48 hours (day 2), 70~72 hours (day 3), and 1 week of life (day 7). The aEEG recordings were analyzed using criteria described by Burdjalov et al. Brain ultrasonography was performed before 3 days of life first and then mostly once a week, depending on the clinical course of the patient, until discharged. Based on brain ultrasonography, infants were divided into two groups, which are favorable outcome group and adverse outcome group respectively. We compared characteristics of aEEG between both groups.

Results :

Forty four infants were enrolled. A total of 176 aEEG tracing were analyzed. Twenty seven infants and seventeen infants were identified in favorable outcome group and adverse outcome group respectively. Infants in favorable outcome group showed high scores in almost all components including continuity, cycling amplitude of the lower border, and the bandwidth span and amplitude of lower border. The scores of all components were decreased significantly in day 2 compared to day 1 in adverse group, while the scores was increased as the days went by in favorable group. And total score of day 2 has highest AUC and less than 3 of total score has predictive value of 70.6% of sensitivity and 81.5% of specificity for adverse outcome.

Conclusion :

we evaluated the differences in aEEG during the first week of life in preterm infants between favorable group and adverse group. We demonstrated that preterm infants with lower score of aEEG especially during the second day of life than first day of life or with scores less than 3 duirng the second day of life are more likely to have short term adverse outcome.