3^rd International Conference on Pediatrics May 18-20, 2015 Texas, San Antonio, USA

Dr. Patricia Stoddard Dare earned her PhD from Washington University in St. Louis and also completed a four-year NIMH fellowship in Mental Health Services Research. She currently is the MSW Program Director at a large urban University in Ohio. She is the author of 18 published papers focused on the vulnerabilities experienced by youth, and has won multiple awards for her research.

Cross-sectional data (N = 1940) from the third wave of a ten-year data collection initiative in seven high poverty US communities sponsored by the Annie E. Casey Foundation were used to assess the odds of experiencing specific material hardships (phone disconnection, inability to pay bills, food insecurity, and inability to fill prescription medication due to cost) between families who have a child member with a limiting health condition, and families with children who do not have a child member with a limiting health condition while controlling for relevant demographic variables. A series of multivariable logistic regressions found having a child in the household with a limiting health condition increases the odds the household will be unable to pay bills (1.41 95% CI, 1.13, 1.77) and have their phone service disconnected (1.33 95% CI 1.04, 1.70). The odds of food insecurity (OR=1.41, 95% C.I., 1.11, 1.79) also increase. Additionally, logistic models indicate families with a child with a limiting health condition are 1.57 times (95% CI 1.21, 2.04) more likely to delay or fail to fill a needed prescription compared to families with children who do not have a child with a limiting health condition. When there are two or more children with limiting conditions in the household, the odds of all these hardships increase. Specific interventions available to assist at risk families who have a child with a limiting health condition are described in detail.

Complete atrioventricular (AV) block is a rare affection. It is the consequence of abnormal conduction tissue within a cardiac malformation or it is due to cardiac injury by maternal antibodies that cross the placental barrier and induce myocardial inflammation. Yet the etiology of late complete atrioventricular block in children child remains mostly unknown. The treatment of children's Complete atrioventricular block is the implantation of a pacemaker with immediate results satisfactory in the absence of associated cardiomyopathy. In this observation we will treat three cases: the first, a 11 year old child with CAVB discovered iafter a syncope, the echocardiography showed absence of cardiac malformation. The mom’s immunological statue was negatif. Treatment was based on the implantation of a dual chamber pacemaker. The second was a 9 year old girl who had a persistent CAVB after heart surgery. The third was boy, 7 years old with a CAVB due to cardiac malformation.

Francesco Costantino achieved his degree in Medicine in 1982 at Sapienza University in Rome. He specialized in pediatrics after few years. He is the director of pediatric diabetology department in Umberto I hospital in Rome. He also teaches in Pediatrics graduate school. He published a lot of papers in reputed journals and has been involved in numerous research projects. At the moment he is one of the most active pediatrician in field of insulin pump therapy and continuous monitering glucose (CGM) in Italy

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked disease responsible for moderate to severe hemolytic anaemia. This is the most common erythrocyte enzyme disorder, often overpassed . A 14-year-old male patient was admitted to emergency department with hyperglycemia. He was treated initially with fluid therapy, after two hours with subcutaneous ultra-rapid insulin. After five days from hospitalization he showed scleral and skin jaundice. Were made diagnosis of hemolytic anemia by G6PD deficiency. There was no significant family or prior medical/ drug history. Interestingly, the hemolytic features were evidenced when blood glucose levels were returning to normal values. The insulin mediated NADPH loss may have resulted in an increased erythrocyte oxidant sensitivity and a loss of sulfhydryl group availability, causing hemolysis to manifest. G6PD deficiency is usually linked to drug which induced oxidative stress. Association with diabetes mellitus is unfrequently reported. This case wants to emphasize that the G6PD deficiency has been unmasked by hyperglycemia until now unknown without signs and symptom.

Guang-Hui Dong has completed his PhD at the age of 34 years from China Medical University and postdoctoral studies from Saint Louis University School of Public Health. He is the chairman of Department of Environmental Health, School of Public Health, Sun Yat-sen University. He has published more than 70 papers in reputed journals and has been serving as an editorial board member of repute. His research areas focus on the effects of environmental risk factors on human health, especially the association between ambient air pollution and children health, including asthma, hypertension sleep disorder, and ADHD.

Perfluoroalkyl acids (PFAAs) are a group of common chemicals that ubiquitously exist in wildlife and humans. Experimental data suggest that they may alter T-lymphocyte functioning in situ by preferentially enhancing the development of T-helper 2 (TH2)- and inhibiting TH1-lymphocyte development and might increase allergic inflammation, but few human studies have been conducted. To evaluate the association between serum concentrations of perfluoroalkyl acids (PFAAs)and T-lymphocyte-related immunological markers of asthma in children, 231 asthmatic children and 225 non-asthmatic control childrenfrom Northern Taiwan were recruited into the Genetic and Biomarker study for Childhood Asthma. Serum concentrations of eleven PFAAs and levels of TH1 [interferon (IFN)-γ, interleukin (IL)-2] and TH2 (IL-4 and IL-5) cytokines were measured. The results showed that asthmatics had significantly higher serum PFAAs concentrations compared with the healthy controls. Adjusted odds ratios for asthma among those with the highest versus lowest quartile of PFAAs exposure ranged from 1.90 (95% CI: 1.08, 3.37) for the perfluorobutanesulfonate (PFBS) to 4.05 (95% CI: 2.21, 7.42) for perfluorooctanoic acid (PFOA). Serum PFAAs were associated positively with TH2 cytokines and inversely with TH1 cytokines among asthmatics. When stratified by gender, a greater number of significant associations were found in males than in females. Among the children without asthma, no significant associations could be detected. In conclusions, increased serum PFAAs levels may promote TH cell dysregulation and alter the availability of key TH1 and TH2 cytokines, ultimately contributing to the development of pulmonary allergic diseases that may differentially impact males to a greater degree than females.

Dr. Eleanor Florencia Montinola Portigo finished her Residency Training in General Pediatrics in December 2006 at Iloilo Doctors’ Hospital and served as chief resident during her 4th year of training. She passed her Diplomate exam last 2009 and she then pursued her fellowship training in Pediatric Cardiology at the Philippine Heart Center in 2012. Presently she is on her 3rd year fellowship training in the said institution. She recently presented in the Philippine Heart Rhythm Society “Search for Best Arrhythmia Case Report” in 2014. She is a member of the Philippine Medical Association since 2006.

Background: Arrhythmia in children may be benign or lifethreatening. Some may produce only mild, nonspecific symptoms. Thus specific documentations such as electrocardiogram, Holter monitor correlated with reported symptoms are very critical in establishing the diagnosis. Long QT syndrome is rare in the pediatric population. It may either be inherited or acquired resulting in abnormalities in the ventricular repolarization leading to ventricular arrhythmia which can be fatal. Case: A case of JB a 10 year old male from Manila who presented for the first time with generalized seizure that was associated with appearance of arrhythmia during active seizure. Thus further diagnostic tests were done. Video EEG showed no definite epileptiform discharges however ventricular tachycardia was seen progressing to ventricular fibrillation with sudden loss of body tone. ECG showed prolonged corrected QT interval of 0.68 with T wave alternans. Lidocaine drip was started. Holter monitor also showed frequent episodes of T wave alternans, fusion beats and nonsustained polymorphic ventricular tachycardia and Torsades de Pointes. With these diagnostic tests pointing out to Long QT syndrome, he was given Propranolol and Phenytoin. There was no recurrence of ventricular tachycardia thus seizure was controlled and he was sent home. Genetic testing was done on follow up. The result was consistent with a genetic form of Long QT syndrome, gene SCN5A (LQTS3). Conclusion: This is the first reportable case of a diagnosed long QT syndrome in the pediatric population at the Philippine Heart Center. Long QT syndrome is a cardiac electrical disorder. It is often difficult for the families of affected individual to understand this rare cardiac disease. Seizure is one of the symptoms of long QT syndrome caused by ventricular arrhythmia that can be fatal. Thus the importance of obtaining an electrocardiogram in patients with seizure is always emphasized. Genetic testing is recommended to determine the specific genotype as a guide to treatment. Once established, genetic counselling is also recommended to discuss to the family the implications of the disorder and the risk of recurrence.

Devashish A. Desai, have completed my schooling from New Era Senior Secondary School, Baroda in the year 2011 at the age of 17 and got admission in Government Medical College, Bhavnagar and last year that is in 2014 completed my second M.B;B.S. at the age of 20 years. Now I am in third M.B.B.S.

Aim: To assess the nutritional status and knowledge in care takers of child in pediatric age group of 0-5 years. Method: Pre-validated questionnaire divided according to age group ( 0-6 months, 6-24 months and 2-5 years), based on IMNCI were given to caretakers of 100 pediatric patient below age of 5 years coming as in-patient in sir Takhtsinhji general hospital, a tertiary care hospital. Result: 24 of 0-6 months, 44 of 6-24 months, and 32 of 2-5 years of age group patients’ caretakers were given questionnaire. Out of them 5, 15 and 11 were PEM patients. Breastfeeding was provided to all the children of 0-6 months, 41.82% of 6-24 months and not provided in 2-5 years age. Only 50% of 0-6 months, 43.18% of 6-24 months and 73.125% of 2-5 years was provided food according to IMNCI. 45.45% of frequently ill children got PEM. 70.83%, 45.45%, and 18.75% of caretakers were provided nutrition counselling for their children, which is very less. Association between illness and bad feeding practices with PEM was proved by chi square test which came 3.85 and 4.481 respectively at p=0.05. Conclusion: In this study there were total of 31% of PEM patients which were either frequently ill or were neglected with nutrition counseling. Malnutrition can be avoided with proper nutrition counseling, feeding practices and proper hygiene.

Dr. Boma A. N. Okoh is a 35 year old female Consultant Paediatrician and Lecturer with the University of Port Harcourt Teaching Hospital and University of Port Harcourt respectively. She is a fellow of the West African College of Physicians and National Postgraduate Medical College, Nigeria. She has published 12 papers in reputable journals and is presently working on many more research papers.

Background: Childhood obesity can cause hypertension, high cholesterol levels, impaired glucose tolerance, respiratory problems, dermatological and orthopaedic problems. Reports suggest increasing prevalence of childhood obesity worldwide. Aims and objective: To determine the prevalence of overweight and obesity among primary school children in Port Harcourt. Materials and methods: A stratified multi-staged sampling technique was used to recruit pupils from primary schools in Port Harcourt. Data was collected using questionnaires completed by parents. The average of two measurements of height and weight were taken and BMI was calculated manually. Using the BMI for age charts developed by the US National Centre for Health Statistics in collaboration with the National Centre for Chronic Diseases Prevention and Health Promotion, overweight was defined as BMI greater than the 85th but less than the 95th percentile and obesity as BMI equal to or greater than the 95th percentile. Results: A total of 1302 pupils (585 (44.9%) males and 717 (55.1%) females) were studied. Seventy five (5.8%) of the pupils were overweight while 77 (5.9%) were obese. The prevalence of overweight and obesity of 127 (15.5%) among younger children was higher than that of 25 (5.2%) among the older children (p<0.001). Female pupils had a higher prevalence of overweight and obesity (12.8%) compared to male pupils (10.3%). A higher prevalence of overweight and obesity was found among the higher (18.1%) than among the lower (2.4%) social class (p<0.001). Conclusion: The prevalence of overweight and obesity in primary school children in Port Harcourt, Nigeria is 5.8% and 5.9% respectively. Children from higher socioeconomic class were significantly more overweight and obese than those from lower socioeconomic classes.

Dr Shaimaa Kandil has completed her MD on 2010 from Mansoura University, Egypt.. She works as a lecturer of the field of Pediatrics, She has published many papers about field of pediatrics and children health.

Background: Childhood immune thrombocytopenia (ITP) is a rare autoimmune disorder of isolated thrombocytopenia in the absence of other causes. There is a great need for reliable predictors for the outcome of childhood ITP at the time of diagnosis which would help to provide information about the expected clinical course, which may help to minimize anxiety, the impact of the disease on daily life and to help guide the decision on therapy. Methods: Our study was retrospective, cross-sectional study to evaluate demographic, clinical presentation, outcome, laboratory findings and treatment modalities of children with acute and chronic ITP. Results: A total of 197 were studied, 148 patients (75.1%) had acute ITP and 49 patients (24.9%) had a chronic course of ITP. Age on presentation was 7.13±4.16 year with male/female ratio (1:0.97). Patients who had chronic ITP were found to have a significantly higher age at presentation (>10-years) and a higher platelets counts >20X109/L (P=0.004). Female sex or mode of presentation were not significantly different between acute and chronic ITP patients. Conclusion: our study demonstrated that ITP is usually have a benign and self-limiting course. The results of this study showed that initial platelet count >20X109/L, and age >10year at presentation were the major predictors, to identify a subset of patients who are more likely to have a chronic course of ITP.

Arash Abbasi has completed his MD at the age of 30 years from Tehran University of Medical Sciences (THMS) and postdoctoral studies from Children’s Medical Center of THMS. He is pediatrics Nephrolohist who is working at the Children’s Medical Center (a pediatrics center of excellence), Tehran, Iran. He has published some papers in reputed journals and has been serving as a reviewer board member of pediatrics journals.

Vesicoureteral reflux (VUR) is the most common urological anomaly in children. Two techniques are available for detection of VUR which include the direct radionuclide cystography (RNC) and the voiding fluoroscopic cystourethrography (VCUG). The RNC provides continuous monitoring with less gonadal radiation than VCUG, therefore, the purpose of this study was to evaluate whether cyclic RNC is superior to the single‐cycle procedure for VUR detection in children. A total of 411 children were selected between January 2006 and January 2013. A narrow catheter was inserted into the urinary bladder. Under aseptic conditions and the urine was allowed to drain. The bladder was filled slowly with saline solution under hydrostatic pressure and then, 18 MBq of 99 m TC-pertectenate was instilled into the bladder. Images were obtained during filling and post voiding phases. After the first micturition, the catheter was left in place and the whole procedure was repeated (cycled) under the same condition. By using a single-head computerized gamma camera equipped with a low-energy all-purpose collimator, visualization of the radiotracer was done. The t-test, the chi-squared and the McNemar’s tests were used for data analysis which were obtained by two separate nuclear medicine specialists. The mean age of the sample was 3.2 years. The overall agreement of both cycles in detecting VUR in the present study was 21.1%, the highest being in detecting moderate VUR (38.7%) and the lowest in detecting severe VUR (14.3 %). If we had used a conventional RNC (first filling only) 58 (44%) mild VUR, 41 (38.7%) moderate VUR and 15 (53.6%) severe VUR, which were detected in the second cycle only, would be missed, making a total of 114 (43%) VURs missed. According to the 246 renal units cyclic RNC detected 26.8% more VURs than the conventional (one cycle only) RNC, (P <0.001). In conclusion, the cyclic RNC is superior to conventional RNC (one cycle only) for detecting VUR and the decision to perform cyclic RNC may be appropriate in children with clinically suspected VUR.