Biography:

Jong-Hau Hsu MD, PhD, is a Professor of Pediatrics in Kaohsiung Medical University in Kaohsiung, Taiwan. He is also the Director of Pediatric Cardiology and Pediatric Intensive Care unit in Kaohsiung Medical University Hospital, and the Vice Director of School of Medicine of Kaohsiung Medical University. As a Pediatric Cardiologist and Intensivist, his research has focused on the role of BNP as a biomarker in pediatric cardiac intensive care and has published 10 articles about BNP since 2007.

Abstract:

Objective: To determine the B-type natriuretic peptide (BNP) level in pediatric septic patients, and to investigate its association with cardiovascular dysfunction and clinical outcome.

Methods: Pediatric patients with sepsis or septic shock were prospectively enrolled in our pediatric intensive care unit (PICU). On day 1 of admission, plasma BNP levels were measured at the time-point of echocardiography. Myocardial dysfunction was defined as left ventricular fractional shortening (FS) < 30%. Inotropic support was quantified by inotropic scores and disease severity was assessed by Pediatric Risk of Mortality (PRISM) III scores. Therafter, associations between BNP levels and clinical parameters were analyzed.

Results: There were 94 patients (mean: 5.6 yr, range: 2 mo-17 yr) who were consecutively enrolled in this study. The median BNP level was 127 pg/ml (range: 5 to 4950 pg/ml). BNP levels were correlated with PRISM III (rho=0.36, p=0.001) and C-reactive protein level (r=0.39, p=0.001). The median BNP levels were not only higher in patients with septic shock (n=34) than those with sepsis (n=58) (213 vs. 54 pg/ml, p=0.0004), but also higher in patients with myocardial dysfunction (n=18) than those with preserved myocardial function (n=66) (765 vs. 65 pg/ml, p<0.001). We also found that BNP levels correlated negatively with FS (r=-0.56, p<0.001) and positively with inotropic scores (r=0.34, p=0.04). Most importantly, the median BNP levels were higher in non-survivors (n=13) than survivors (n=81) (367 vs. 106 pg/ml, p=0.003).

Conclusion: BNP levels are elevated in pediatric septic patients early in the disease course, and increased levels are associated with cardiovascular dysfunction and worse clinical outcome.

Biography:

Hamed Ali Alghamdi is a Pediatric Endocrinologist, graduated from King Faisal Specialist Hospital and Research Center in Riyadh in 2003. Later, he had collaborations both in practical fields being Consultant Pediatric Endocrinologist and Director of Al Hada Armed Forces Hospital and also academic fields being Collaborator Assistant Professor at Medicine College in Taif University and Chairman of the Local Committee for Pediatrics Fellowship in the Western Region of Saudi Arabia. He is an eminent member of Saudi Society for Endocrine and Metabolic Diseases and Saudi Society for Pediatric Medicine. He shared in many conferences and has 5 international publications.

Abstract:

Given a high rate of bone development early in life, adequate serum concentrations of vitamin D are crucial for a developing child. There has also been a piquing interest on vitamin D in pediatric patients due to the recent epidemiologic reports suggesting that vitamin D may protect against autoimmune diseases and play a role in innate immunity. Studies focusing on vitamin D status in pediatrics and adolescents are yet to start. Source of vitamin D is either by ingestion or by cutaneous production. 7-dehydrocholesterol converts to vitamin D3 on exposure of skin to ultraviolet B radiation, and dietary sources may provide either vitamin D3 or vitamin D2. Low vitamin D status is endemic because of indoor lifestyle with low dietary intake and sun-avoiding behaviors. Based on different treatment modalities reported in literature that vary according to dose, duration and whether there is a need for loading dose or not and the amount of maintenance dose needed, “A randomized clinical trial comparing 3 different replacement regimens of vitamin D in clinically asymptomatic pediatrics and adolescents with vitamin D insufficiency” is done which is a study to highlight 3 different replacement regimens for asymptomatic vitamin D insufficiency using either only the recommended dietary allowance alone, high loading dose with low maintenance dose and low loading dose with high maintenance dose. We followed vitamin D levels initial, at 4 months and 12 months and measured biochemical bone markers initial and at 4 months time points trying to prioritize one regimen. From the study, we advise to use low loading dose and high maintenance dose rather than the opposite to achieve steady increase in serum 25 (OH) D with no hypercalcemic side effects as a replacement for vitamin D insufficiency and the study also doubt the adequacy of 400 IU cholecalciferol as a way to treat asymptomatic vitamin D insufficiency or even to maintain steady levels of vitamin D.

Biography:

: Dr. Eman Oweida has completed her PhD since 2013 in Mansura University; Egypt. She continued working in Mansoura Faculty of Medicine as a lecturer; provided lectures and training courses for undergraduare students, Manchester program and post graduate students. She also conducted research studies in collaboration with research teamwork in Mansoura University Hospital departments. Published 6 research articles in international Radiology Journals and recognized as a distinguished reviewer by Elsevier publishing for reviewing more than thirty articles for publication in international jurnals.
 

Abstract:

Muscle diseases represent a group of variable diseases which are rare hereditary or variable nonhereditary diseases. MRI represents an important diagnostic modality owing to its high soft tissue contrast allowing excellent assessment of striated muscles and full disease extent. Also, many new technical innovations can be introduced to increase its diagnostic capabilities. The aim of this presentation is to discuss their impact upon the advancement of MRI diagnostic capability. Moreover, CT scan has been introduced as a valuable tool for the evaluation of muscle diseases particularly calcification which characterizes and correlates with the extent of idiopathic inflammatory myopathies especially dermatomyositis. The major role of diagnostic imaging is to demonstrate the extent and distribution of muscle involvement, localize the appropriate site for biopsy, and monitor the response to therapy.

Biography:

Ida Fidelis Denosta has completed her degree of Bachelor of Science Major in Psychology in Far Eastern University. She commenced schooling at Our Lady of Fatima University-College of Medicine where she graduated as Doctor of Medicine. She just completed her residency training in Pediatrics at East Avenue Medical Center last December 2016 as an Assistant Chief Resident. She is a member of the Philippine Medical Association, Manila Medical Society and currently affiliated with Caloocan City North Medical Center as a Junior Consultant in the Department of Pediatrics.

Abstract:

Objectives: This study aims to determine the maternal risk factors associated with the development of retinopathy of prematurity (ROP).

Design & Setting: A retrospective cohort study was done in a tertiary government hospital. This study included admitted premature neonates in neonatal intensive care unit (NICU) who underwent ROP screening. All patients with congenital abnormality of the eyes were excluded in the study.

Methodology: List of admitted premature patients who underwent ROP screening was collected within the study period. Demographic data was collected from the patient’s medical records.

Statistical Analysis: Descriptive statistics were presented for categorical outcome measures. Wilcoxon rank sum test was used to compare two averages. Chi-square test, Yates’ chi-square test and Fisher’s exact test were used to compare proportions. Univariate and multivariate regression analyses were used to estimate crude and adjusted odds-ratios, corresponding 95% CI and based on p-value≤0.05 statistical significance.

Result: This study showed 57% cases of ROP, majority with Stage 1 (66%), mostly female infants (53.4%; p<0.001), mildly asphyxiated (51.2%, p=0.290; 77.2%, p=0.117) and were small for gestational age (57.3%; p<0.001). On the average, these infants underwent 1 day of either invasive or non-invasive mechanical ventilation, 2 days with FiO₂ of > 0.5 liters per minute, had two blood transfusions, and with shorter hospital stay (17 vs. 26 days; p<0.001). The average age of mothers who delivered infants with ROP was 26 years old, multipara (59.2%), and underwent normal spontaneous delivery (67%). About half reported adequate prenatal check-ups (53.8%), and diagnosed with urinary tract infection (40.1%).

Conclusion: Data showed that mothers with urinary tract infection and preeclampsia are more likely to deliver infants with retinopathy of prematurity thus significant maternal risk factors of ROP.

Biography:

Abdullah Almutairi is an Optmetrist who graduated in 2012 and a Doctor who graduated in April, 2017 from King Saud bin Abdulaziz University. Currently, he is a Medical Intern at King Abdulaziz Medical City in Riyadh Saudi Arabia.

Abstract:

Introduction: Emergency medical service (EMS) is a crucial component of the health care system. Pediatric emergencies are infrequent in the prehospital setting which makes the EMS personnel assessment and skills difficult to maintain and may decrease the comfort in dealing with pediatrics. Assessing the level of comfort among EMS personnel toward pediatric patient care is important to enhance the quality of prehospital care.

Method: This is a cross sectional study using a questionnaire-based survey. 5 points Likert-scale regarding the level of comfort presented as frequency, percentage, likert-scale mean, and standard deviation. A sum of all the answers of the five points Likert-scale questions is used to get a total score to compare between variables with the answer (very comfortable) = 5 and (very uncomfortable) = 1. Kruskal Wallis test is used to compare between Helicopter EMS (HEMS), ground EMS (GEMS) and hospital-based EMS (HB-EMS).

Results: The majority have shown a low level of comfort of 48% or less in all the questions. The lowest level of comfort reported in patient care was in newborn delivery with a likert scale mean of 2.8. Regarding skills, the lowest comfort reported in orotracheal intubation with a likert scale mean of 2.7. The majority (60%) were comfortable with using a bag-valve-mask in a pediatric patients with a likert scale mean of 3.7.

Conclusion: EMS providers in Riyadh have reported limited training in pediatric patient care, infrequent pediatric patient exposure, and low level of comfort in pediatric patient care.

Biography:

Monica Teresa was born in the year 1979, She completed her junior studies at California public school from 1982-1984. And also she continued with studies in a secondary school where she attained a certificate in nursing studies in 1989-2003. She was posted at Yorkshire Nursing Academy and she obtained a Diploma in Education Nursing. That’s where she is currently working as Nun and a volunteer. She holds a Diploma in Education Nursing. She was currently a Dioceses Senior Nursing Educationist.

Abstract:

AIM: To determine whether recent evidence-based Uganda policies on male circumcision (MC) apply to comparable African countries.

METHODS: Articles in 2005 through 2015 were retrieved from PubMed using the keyword “circumcision” together with 36 relevant subtopics. A further PubMed search was performed for articles published in 2016. Searches of the EMBASE and Cochrane databases did not yield additional citable articles. Articles were assessed for quality and those rated 2+ and above according to the Scottish Intercollegiate Grading System were studied further. The most relevant and representative of the topic were included. Bibliographies were examined to retrieve further key references. Randomized controlled trials, recent high quality systematic reviews or meta-analyses (level 1++ or 1+ evidence) were prioritized for inclusion. A risk-benefit analysis of articles rated for quality was performed. For efficiency and reliability, recent randomized controlled trials, meta-analyses, high quality systematic reviews and large well-designed studies were used if available. Internet searches were conducted for other relevant information, including policies and African data on claims under Medicare for MC.

RESULTS: Evidence-based policy statements by the African Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) support infant and later age male circumcision (MC) as a desirable public health measure. Our systematic review of relevant literature over the past decade yielded 140 journal articles that met our inclusion criteria. Together, these showed that early infant MC confers immediate and lifelong benefits by protecting against urinary tract infections having potential adverse long-term renal effects, phimosis that causes difficult and painful erections and “ballooning” during urination, inflammatory skin conditions, inferior penile hygiene, candidiasis, various sexually transmissible infections in both sexes, genital ulcers, and penile, prostate and cervical cancer. Our risk-benefit analysis showed that benefits exceeded procedural risks, which are predominantly minor, by up to 200 to 1. We estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime. Wide-ranging evidence from surveys, physiological measurements, and the anatomical location of penile sensory receptors responsible for sexual sensation strongly and consistently suggested that MC has no detrimental effect on sexual function, sensitivity or pleasure. United States studies showed that early infant MC is cost saving. The evidence supporting early infant MC has further strengthened since the positive AAP and CDC reviews.

CONCLUSION: Affirmative MC policies are needed in Africa. Routine provision of accurate, unbiased education, and access in public hospitals, will maximize health and financial benefits.

Biography:

Abstract:

Background: The adverse effects of alcohol on the developing human represent a spectrum of structural anomalies and behavioral and neurocognitive disabilities, most accurately termed fetal alcohol spectrum disorders (FASD). The first descriptions in the modern medical literature of a distinctly recognizable pattern of malformations associated with maternal alcohol abuse were reported in 1968 and 1973. Since that time, substantial progress has been made in developing specific criteria for defining and diagnosing this condition. Two sets of diagnostic criteria are now used most widely for evaluation of children with potential diagnoses in the FASD continuum, ie, the 1996 Institute of Medicine (IOM) criteria and the Washington criteria. Although both approaches have improved the clinical delineation of FASD, both suffer from significant drawbacks in their practical application in pediatric practice.

Objective:  The purpose of this report is to present specific clarifications of the 1996 IOM criteria for the diagnosis of FASD, to facilitate their practical application in clinical pediatric practice.

Methods: A large cohort of children who were prenatally exposed to alcohol were identified, through active case-ascertainment methods, in 6 Native American communities in the United States and 1 community in the Western Cape Province of South Africa. The children and their families underwent standardized multidisciplinary evaluations, including a dysmorphology examination, developmental and neuropsychological testing, and a structured maternal interview, which gathered data about prenatal drinking practices and other demographic and family information. Data for these subjects were analyzed, and revisions and clarifications of the existing IOM FASD diagnostic categories were formulated on the basis of the results.

Results: The revised IOM method defined accurately and completely the spectrum of disabilities among the children in our study. On the basis of this experience, we propose specific diagnostic criteria for fetal alcohol syndrome and partial fetal alcohol syndrome. We also define alcohol-related birth defects and alcohol-related neurodevelopmental disorder from a practical standpoint.

Conclusions.The 1996 IOM criteria remain the most appropriate diagnostic approach for children prenatally exposed to alcohol. The proposed revisions presented here make these criteria applicable in clinical pediatric practice.

Biography:

Abstract:

Objectives: The precise epidemiology of childhood pneumonia remains poorly defined. Accurate and prompt etiologic diagnosis is limited by inadequate clinical, radiologic, and laboratory diagnostic methods. The objective of this study was to determine as precisely as possible the epidemiology and morbidity of community-acquired pneumonia in hospitalized children.

Methods: Consecutive immunocompetent children hospitalized with radiographically confirmed lower respiratory infections (LRIs) were evaluated prospectively from January 1999 through March 2000. Positive blood or pleural fluid cultures or pneumolysin-based polymerase chain reaction assays, viral direct fluorescent antibody tests, or viral, mycoplasmal, or chlamydial serologic tests were considered indicative of infection by those organisms. Methods for diagnosis of pneumococcal pneumonia among study subjects were published by us previously. Selected clinical characteristics, indices of inflammation (white blood cell and differential counts and procalcitonin values), and clinical outcome measures (time to defervescence and duration of oxygen supplementation and hospitalization) were compared among groups of children.

Results: One hundred fifty-four hospitalized children with LRIs were enrolled. Median age was 33 months (range: 2 months to 17 years). A pathogen was identified in 79% of children. Typical respiratory bacteria were identified in 60% (of which 73% were Streptococcus pneumoniae), viruses in 45%, Mycoplasma pneumoniae in 14%, Chlamydia pneumoniae in 9%, and mixed bacterial/viral infections in 23%. Preschool-aged children had as many episodes of atypical bacterial LRIs as older children. Children with typical bacterial or mixed bacterial/viral infections had the greatest inflammation and disease severity. Multivariate logistic-regression analyses revealed that high temperature (≥38.4°C) within 72 hours after admission (odds ratio: 2.2; 95% confidence interval: 1.4–3.5) and the presence of pleural effusion (odds ratio: 6.6; 95% confidence interval: 2.1–21.2) were significantly associated with bacterial pneumonia.

Conclusions: This study used an expanded diagnostic armamentarium to define the broad spectrum of pathogens that cause pneumonia in hospitalized children. The data confirm the importance of S pneumoniae and the frequent occurrence of bacterial and viral coinfections in children with pneumonia. These findings will facilitate age-appropriate antibiotic selection and future evaluation of the clinical effectiveness of the pneumococcal conjugate vaccine as well as other candidate vaccines.

Biography:

Ann Scovia was Born in York lane, London. Currently she is working as nun at Yorkshire Dioceses. However more often am consulted my Universities in different aspects

Abstract:

MIS(Minimally Invasive Surgical) is becoming increasingly main stream in paediatric Surgery. However, as a specialty we have the disadvantage of limited patient numbers particularly in neonatal surgical condition. This makes it all the more important that simulation is available to develop and maintain our MIS skills. There is extensive literature to support simulation as an effective means to developing MIS skills prior to clinical applications.
A MIS animal training facility commenced at the Children’s Hospital, Westmead in 2005, training workshops are arranged twice a year without cost to the participants. The protocol is approve by the Western Sydney Local Health District Animal Ethics Committee ( protocol number 3013.03.15) The training is consultant led and is funded by Convidien ( Medtronic & Covidien) from 2004 and also from 2012. The program is graded to suit the level of experience; the more the experienced surgeons train on a wide range of specific, live anaesthetized porcine models which realistically simulate a variety of clinical conditions in neonates and older children. The less experienced use the box trainers/lap simulator to develop suturing and knot tying expertise prior to progression to the live anaesthetized animal models. Over the last 8 years 297 participants have attended the workshops with an overall satisfsction rate of 75%. It is hoped that the data presented will encourage further discussion about the need for simulation based MIS training and skill maintenance in paediatric Surgery.

Biography:

Susan Smith  from Yorkshire, UK. She currently working as a nun in Yorkshire Diocesses. 

Abstract:

Introduction:

The state of epilepticus in children is considered as a medical emergency which involves the vital and functional prognosis of the patient. The difficulties of this support in our country are linked to the lack of pediatric intensive care unit. The aim of our study is to evaluate the clinical, therapeutic, scalable and etiological states of epilepticus in children at national Refferal Hospital of Mulago in Uganda National Children, Uganda. Method:

This is a prospective study which includes all patients aged between 2 months and 16 years who were hospitalized between 1 January 2001 and 31 June, 2015 for a prolonged convulsion over 5 minutes and/ or with atleast 3 episodes of successive convulsions. We have not included the newborns and non-convulsive state epilepticus patients. The treatment protocol consists of the use of diazepam as first line, after 60 minutes if the crisis persists; diazepam Phenobarbital was associated with the second line. Results:

We collected 60 cases of state epilepticus (31 boys and 29 girls), which turned out to be a hospital incidence 0f 2.4%. The mean age was 48.5 months. Three quarters of our patients (n=40) were received emergency beyond 30 minutes after the onset of convulsions where the generalized seizures (n=42) were more than partial seizures (n=11). The convulsions occurred in the context of fever in 38 patients. The metabolic balance was in favor of hyponetremia  in 13 cases. Twenty-four patients (45.3%) have received only Phenobarbital diazepam combination within 60 minutes after the onset of seizures. Conclusions: The state epilepticus cases are frequent in the hospital emergency department especially the infants from 2 months to 3 years. It was observed that the patients unfortunately received emergency in late beyond 30 minutes after the onset of convulsions.