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.