4^th International Conference on Pediatrics and Pediatric Emergency Medicine March 29-30,2016 Atlanta, Georgia, USA

Biography:

Gwenyth Fischer is a Pediatric Critical Care Physician and Assistant Professor at Masonic Children’s Hospital and Medical Device Center Innovation Fellow alumni at the University of Minnesota. She is also the Founder and Director of the Pediatric Device Innovation Consortium based at the University of Minnesota. In addition, she serves as the Clinical Advisor to the University of Minnesota Medical Device Center and Pediatric ECMO and Cardiopulmonary Director at Masonic Children’s Hospital. She has disclosed over 25 inventions to the University, several in the pediatric space. Her research interests are in the area of design, development, testing and regulation of pediatric specific technologies.

Abstract:

Pediatric medical device development is approximately 10 years behind adult device development. The reasons for this are multiple, the primary being that most devices in the pediatric space are smaller markets. Innovation can be successful in pediatrics however, if inventors are willing to think outside the box when it comes to design, funding, regulation and research on devices for kids. This talk will cover the reasons behind the 10 year lag between pediatric and adult device development and methods that innovators across the country are using to overcome these hurdles. Examples of recent success in pediatric medical device and ways to innovate as a pediatrician will also be discussed.

Biography:

Jichuan Wang has completed his PhD from Cornell University and Post-doctoral studies from the Population Studies Center, University of Michigan. He is a senior biostatistician at Children’s Research Institute, CNHS. He has published three statistical books and authored/co-authored more than 100 peer-reviewed journal article with more than 30 first-authored. He has been serving as Editorial Board Members of five academic journals.

Abstract:

While many researches on symptoms in child patients are directed toward studying individual symptoms, interest in symptom clusters in patients has been increasingly expanded in recent years. The terminology of “symptom cluster” in literature has different meanings. First, symptom cluster refers to a group of symptoms that are associated with simultaneous occurrence and second it is defined as a group of individual patients sharing similar symptoms. These are conceptually different types of clusters. The former is about “variable-centered” symptom clusters that have to do with measurement dimensions and the latter is about “person-centered” symptom clusters that represent distinct subpopulations/groups in the target patient population under study. Latent class analysis (LCA) is one of the person-centered analytical approaches that can be applied to identify potential latent classes/groups (sub-populations) that are a priori unknown in the target population under study. Patients are similar within class, but differ cross classes with respect to a set of symptom measures. When symptom measures are continuous (e.g., scale scores of depression), LCA becomes latent profile analysis (LPA). LCA and LPA can be readily extended to latent transition analysis (LTA) to study latent transitions of the symptom cluster/profile status over time using longitudinal data. This study applied LPA to identify distinct latent profiles/groups in children with cancer in regard to the four PROMIS symptoms measures (depression, anxiety, pain, and fatigue). LTA was applied to examine the transitions of latent profile status over time and identify factors that influence such transitions.

Biography:

Xiaowei Dong has completed her PhD in Pharmaceutical Sciences from University of Kentucky and then joined Novartis Pharmaceutical Corporation working as a lead formulator for drug product development for about 4 years. In 2013, she joined UNT Health Science Center as an Assistant Professor in the Department of Pharmaceutical Sciences at the College of Pharmacy. Her research includes drug delivery and formulation development using nanotechnology and has special focus on pediatric formulation development.

Abstract:

Over 65% of current medications do not have commercially available pediatric formulations. Lack of pediatric formulations has led to the need to break tablets or open capsules for administration, risking reduced efficacy and adverse eff ects because of inaccurate dosing. Because of challenges and limitations on liquid dosage forms, flexible oral solid dosage forms are preferred for pediatric formulations. Recently, we discovered a novel platform nanotechnology to manufacture solid granules that produce in situ self-assembly nanoparticles (ISNPs) when introduced to water or other fluids (e.g. gastrointestinal fluid). Th e current ISNPs are lipid-based nanoparticles. We successfully applied the ISNP nanotechnology for ritonavir, lopinavir, a fixed-dose combination of lopinavir/ritonavir and a fixed-dose combination of four drugs. Drug-loaded ISNP granules achieved over 15% of drug loading, acceptable stability at room temperature and over 90% of drug entrapment efficiency. According to the evaluation using an electronic-tongue and dissolution, drug-loaded ISNP granules had similar taste to the placebo granules. Moreover, the pharmacokinetic studies showed that the ISNP granules improved drug bioavailability and biodistribution. Th e overall results demonstrated that the novel ISNP nanotechnology is a very promising platform to manufacture palatable, heat stable and flexible pediatric granules.

Biography:

Syed Zafar Mehdi did his MCPS and FCPS in Pediatric Medicine from college of Physicians and Surgeons Pakistan. He is an Associate Professor of Pediatrics in Baqai Medical University Karachi. During last 18 years in this profession, Dr. Zafar has worked with children suffering from protein calorie malnutrition, infectious diseases and neonatology. He has played an important role in promotion and support of exclusive breast feeding for first six months on which he has published several papers and has given various presentations. Dr. Zafar is also a consultant of Pediatrics at Patel Hospital Karachi. Patel Hospital established Pakistan’s first separate 50 beds burn unit with burn ICU. Dr. Zafar is a member of burn plastic surgery team. His several papers have been published on infantile burn. He has raised the voice for prevention of Pediatric burn both at national and international level.

Abstract:

Abstract Objective: The aim of this study is to determine the causes, incidence, sex distribution, nature of injury and outcome of infants with burn.

Methods: This is retrospective study done at plastic surgery, burn unit of Patel Hospital during period of 7 years from January 2007 to December 2013. Children ageing one year or less at the time of admission were included in the study. SPSS 21 version was used for statistical analysis.

Results: Total 789 paediatric burn patients were admitted in Patel Hospital during January 2007 to December 2013, in which 106 were infants. 83 (78.3%) infants had scald burn and 21 (19.8%) had fire burn. Male female ratio was 1.5:1. Common cause of scald burn was hot water 62.7%.The majority of infants 39.6% and 40.6% had <10% and 10-19% total body surface area burn respectively. Most of them (70.8%) had second degree burn. The mortality rate was 8.5%. 2 infants need reconstructive surgery of face. Out of 95 infants in follow up 7 (7.4%) developed contractures for which surgical intervention was done.

Conclusion: Burn injury is an important public health concern and is associated with high morbidity and mortality. The main cause of burn injury in infants is hot water. Safety measures must be taken while dealing with hot liquids and flame, especially in the presence of infants at home. Infantile burn injuries can be decreased and prevented by educating parents through seminars, posters and print media. In this aspect electronic media can play an important role along with social welfare organizations and housing departments.

Keywords: Infantile, burn, scald.

Biography:

Khaled El-Atawi has completed his Master and PhD degrees in Pediatrics from Ain Shams University. He also had Master degree in Healthcare Management from Royal College of Surgeon of Ireland. He is the Consultant Neonatologist and Clinical Quality Specialist in Latifa Hospital NICU, which is one of the largest tertiary units in the UAE. He is the Lecturer of Pediatric in DMCG and Pediatric Resident Supervisor in LH and a member of local and international societies and associations. He has published many papers and has been serving as an Editorial Board Member of many journals. His fields of interest are Neonatal Ventilation, Nutrition, Brain injury and protection.

Abstract:

Background: Since an objective description is essential to determine infant’s postnatal condition and efficacy of interventions, two scores were suggested in the past but were not tested yet: The specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone.

Methods: Scores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated.

Results: Of 2150 eligible newborns, data on 1855 infants with a mean GA of 28 6/7±2 3/7 weeks were analyzed. At 1 minute, the combined-Apgar was significantly better in predicting poor outcome than the specified- or expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively.

Conclusion: The combined-Apgar allows a more appropriate description of infant’s condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.

Biography:

Chiranjib Barua Chowdhury obtained his MBBS in 1985 from Sylhet Medical College, Bangladesh; Post-graduation Diploma in Child Health in 1997; Fellowship in Pediatrics (FCPS) in January 2001 & Doctor of Medicine (MD) in Neonatology from Bangabandhu Sheik Mujib Medical University Bangladesh, in 2006. He has obtained PhD from Chittagong University in 2011. He has in total 15 publications in different topics of Neonatology & Pediatrics which were published in different national & international Journals. In December 2014, he was honored with Post-graduation in Pediatric Nutrition by Boston University. Currently, he is working as an Associate Professor in Neonatology, Chittagong Medical College, Bangladesh.

Abstract:

Introduction: Neonatal septicemia is a clinical syndrome of systemic illness accompanied by bacteremia occurring in the first 28 days of life. Micro-organism causing neonatal septicemia varies from country to country and also region to region and time to time. In many situations, conventional antibiotics are not sensitive to causative micro-organism. Our aim of the study is to identify causative organism and sensitivity pattern of micro-organism in Neonatal Intensive Care Unit, (NICU).

Methods & Subject: Total 300 patients were enrolled in this study with clinically diagnosed septicaemia with prior antibiotic treatment or not. This study was done in NICU of tertiary Hospital, Chittagong Medical College, Bangladesh during the period of January 2013 to July 2014. Blood culture was done in Bact/ Alerd 3D system and culture incubated in Fractionated Antibiotic Neutralization (FAN).

Result: Out of 300 cases, 204 cases were culture negative and 96 cases were culture positive. Klebsiella is the commonest causative organism 52(54.17%), followed by Pseudomonas 16(16.67%), Acinetobacter 14(14.58%), S. aureus 6(6.25%), E. coli 6(6.25%), E. coli with other Coliform 2(2.08%). In this study, sensitivity of Klebsiella was mostly to Ciprofloxacin, Imipenem, Azithromycin, Co-trimoxazole, Piperaciline and Tazobactam. Sensitivity to Pseudomonas was mostly to Amikacin, Imipenem, Ciprofloxacin, Azithromycin and Cefoperazone+ Sulbactum. Sensitivity to Acinetobactor was mostly to Amikacin, Imipenem, Ciprofloxacin, Netilmicin. Sensitivity to S. aureus was mostly to Vancomycine, Amikacin, Imipenem, Meropenem. Sensitivity of E. coli was mostly to Amikacin, Ciprofloxacin, Ceftazidin. Most of the culture positive organisms resistant to conventional Ampicilin, Gentamycin and a number of organisms were resistant to Meropenem and Imipenem.

Conclusion: Conventional antibiotics Ampicillin and Gentamycin are almost resistant to organism causes neonatal sepsis in our NICU.

Biography:

Mir Anwar graduated Medicine from Bangladesh in 1975 He did his post-graduation in Pediatrics from Ireland in 1982. He did his MPH concentration Maternity and Child Health from University of Massachusetts, USA in 2003. Then he joins in UN/ WHO and worked as a Pediatric Consultant & Public Health Specialist, around the world including Asia, Japan, Middle East, Africa, Pacific Island, Ireland and USA. Since 2007 he has been working in South Africa in different provinces of South Africa with the Department of Health. Presently he is working as a Clinical Medical Manager in Richmond Chest Hospital, KZN. South Africa. His main interest presently is in Childhood TB and HIV in Sub-Saharan Africa. In his long carrier in Pediatric and Public Health he had attended several International Congress, Conferences, and Seminars and presented his original work. Some of them were published in International Journal Including American Child Neurology Journal, Japan Pediatric Neurology Journal, Pakistan Pediatric Journal, Bangladesh Child Medical Journal , Nigerian Journal of Obstratics and Gynecology Etc. For his work he is honored by American Academy of Pediatrics, Royal College of Health, UK, and International College of Pediatrics. Etc. His Biography was published in Who’s Who in Medicine Cambridge, UK in 1985.

Abstract:

Background- Sub-Saharan Africa still has the highest child Mortality rates in the world. Global child mortality has dropped by 53% - from 12.7 million in 1990 to 5.9 million in 2015. South Africa has reduced its child mortality rate from 60 deaths per every 1000 live births in 1990 to 41 in 2015. Though the MDG target is 20.

Objective- To find out the Infant Mortality due to Meconium Aspiration Syndrome how much it contribute in Child Mortality where Home delivery & HIV/AIDS are predominated.

Methods- Our study were overserved & put on consideration of the following criteria – Detection of Prematurity and Fetal gasping secondary to hypoxia, inadequate removal of meconium from the airway prior to the first breath, Use of positive pressure ventilation (PPV) prior to clearing the airway of meconium etc. The inhaled meconium can cause a partial or complete blockage of the airways, causing difficulty breathing and poor gas exchange in the lungs. In addition, the substance is irritating and causes inflammation in the airways and potentially, causes chemical pneumonia. Factors that promote the passage of meconium in utero include the following: Placental insufficiency, maternal hypertension .Preeclampsia, Oligohydramnios, maternal drug abuse, especially of tobacco and cocaine, maternal infection-corioaminitis, etc.

Results- The possibility of inhaling meconium occurs in and around 10% of all births. Out of this 1-3% causes MAS. Its generally happens after 34 to 42weeks of gestation.30% of them needs ventilation In the industrialized world, meconium in the amniotic fluid can be detected in 8-25% of all births after 34 weeks' gestation. Of those newborns with meconium-stained amniotic fluid, approximately 10-15% develop meconium aspiration syndrome.

Conclusion- Our study concludes in HIV/AIDS and TB predominated developing countries with less availability of prenatal care and where home births are common, incidence of meconium aspiration syndrome is thought to be higher than, and is associated with a greater infant mortality rate.

Biography:

Dr. Mirza Sultan Ahmad, did his graduation from Punjab Medical College, Pakistan. He complete his FCPS in 2001. For past 15 years he is working as head of department of Pediatrics in Fazle-Omar Hospital Rabwah, Pakistan. He has presented 10 research papers in national and international conferences, beside authoring 4 articles in peer review articles. Neonatal sepsis, iron deficiency, and electrolyte disorders are his special fields of interest. Beside his profession as Pediatrician, he is a freelance author on history. He has written 3 books on different topics of history.

Abstract:

Objectives: To ascertain the prevalence of hyperthermia and different categories of hypothermia among cases of probable and culture proven neonatal sepsis and to evaluate association of mortality rate with axillary temperature at admission.

Methods: All cases of probable and culture proven neonatal sepsis admitted in NICU, Fazle-Omar Hospital from January to December 2013 were included in this study. Using WHO classification, cases were categorized according to their temperature on admission and outcome was recorded. SPSS 2.0 was used for data analysis and chi-square test was used to compare frequencies.

Results: A total of 374 patients were included in this study and 47 (12.6%) cases died. Two hundred and seventeen (58%) cases had normal temperature, 49 (13.1%) had hyperthermia, 50 (13.4%) had mild hypothermia and 58 (15.5%) had moderate hypothermia. Mortality rate was high among cases with mild and moderate hypothermia i.e., 32.6% and 33% as compared with mortality rate incases with normal temperature i.e., 6.1% and 11.6% patients with hyperthermia died (p<0.0001). Hypothermia was more common in early onset and hyperthermia was more common in late onset neonatal sepsis.

Biography:

Angelica Marie B. Pineda has completed her Bachelor’s Degree in Nursing at the University of Santo Tomas, and currently studies at the University of the East Ramon Magsaysay Medical Center College of Medicine. She has published and presented her college research paper at the 16th East Asian Forum of Nursing Scholars held in Bangkok, Thailand on February 2013.

Abstract:

Literature shows that infant distress and care giving can be sources of stress of primary care givers, especially for first time mothers. The researchers wanted to determine whether Dunstan Baby Language (DBL) is efficacious in decreasing parenting stress among these primiparous women with 0-2 month infants over those utilizing standard newborn care. This research utilized a quasi-experimental approach, where 18 participants were gathered and divided into control (standard care) and experimental (DBL) groups. Descriptive statistics were used in the interpretation of the demographics, while a repeated measures mixed model was used for the Parental Stress Scale (PSS) results. A total of 27 participants were enrolled in the study. The experimental group had 18 participants, with a subsequent loss to follow up of 9, while the control group had 9 participants. These participants had babies with a mean age of 1 month in the experimental group, and 2 months in the control group. An apparent decrease was noted in the Time 1 to Time 2 and the Time 2 to Time 3 PSS scores in the experimental group, as opposed to the control group having minimal changes in their PSS mean scores, but p-values failed to demonstrate any significant difference among them (p-values ranged from 0.053-0.415). Use of DBL among newborn babies led to decreased parenting stress levels among primiparous mothers as reflected in the downward trend of PSS mean scores during the observation period. However, the difference was not statistically significant versus the standard newborn care.

Biography:

Professor Zareen Fasih completed her MBBS holding First class first position- Karachi University pediatrics at the age of 27 years from CPSP. She achieved her MRCP from Royal college of Ireland and was secretary general of Pakistan Pediatric Association 2010_2012. She is the chairperson of Neonatology. She is presently working as professor and consultant Neonatologist at Gulf Medical University, UAE. She has an experience in metabolic and critical congenital cardiac diseases screening at GMC hospital. She is on the editorial board of JppA.

Abstract:

Objective: To study risk factors for Enterobacter sepsis and sensitivity pattern of the organism.

Method: Prospective hospital based study conducted at tertiary neonatal intensive care unit of Ziauddin University Hospital from January 2011 to December 2014. Blood specimens for culture from 2166 babies were sent. Repeat cultures done when the neonate did not show improvement or deteriorated on first line antibiotics. Risk factors were looked for. Antibiotic resistance of the isolate was studied by the disk diffusion technique.

Results: There were 540 (24.93%) cases of culture proven sepsis. Enterobacter was grown in 84 (15.55%) cases. Among the gram negative organism Enterobacter was the commonest organism n=84 (15.5%) followed by pseudomonas n=54 (10%). Among the gram poansitive orgism, Staphylococcus lugdunensis seen in 150 (27.77%) cases followed by Staphylococcus aureus n=54 (10%). Increase incidence of late onset sepsis (4.6/1000 live births) was observed during this period. Univariate analysis of risk factors revealed a significant association between LBW 54 (P value=0.001), prematurity 78 (P value=0.001) and prolong stay 66 (P value=0.001) and Enterobacter sepsis. Resistance to the first line antibiotics (Cefotaxime sodium, Aminoglycoside) was seen in 72% of cases.

Conclusion: Prolonged stay in the nursery due to prematurity/LBW is important risk factors of Enterobacter sepsis. Prolonged use of antibiotics results in emergence of multidrug resistance. Further studies are needed to establish the role of antibiotics in the emergence of multidrug resistant microorganism.

Biography:

Namita Ravikumar has completed her MBBS from Bangalore Medical College and Research Institute Bangalore, India and MD in Pediatrics from Maulana Azad Medical College, New Delhi, India. She has participated in many national and international conferences and presented scientific papers. She is a life member of Indian Academy of Pediatrics and currently working as Senior Resident in Indira Gandhi Institute of Child Health, Bangalore, India.

Abstract:

Children presenting with disproportionate short stature and obvious skeletal deformities were evaluated for skeletal dysplasia in a tertiary care hospital in Northern India. Fift y one children were included from March 2013 to March 2014 in this cross-sectional study. Data collection included detailed history, development, antenatal ultrasonogram, anthropometry and dysmorphic assessment. Skeletal survey/infantogram, thyroid profi le, serum calcium, phosphate, alkaline phosphatase, urinary glycosaminoglycan and enzyme analysis were done in relevant cases. London Dysmorphology Database and European Skeletal dysplasia Registry were utilized. Molecular testing using PCR technique was conducted when feasible. 35 were males and 16 were females and maximum belonged to 6-10 year age group (27%). Twenty six (51%) were short trunk and 25 (49%) were short limb type, further grouped into Rhizomelic (72%), Mesomelic (19%) and Acromelic (9%). Forty five out of 51 skeletal dysplasias could be classified according to Spranger’s atlas, most common being mucopolysaccharidosis (MPS) (23%) followed by Achondroplasia (15%) with a mean age of presentation 70 months and 29 months respectively. Parental consanguinity was present in 23.5%, etiological diagnosis obtained in 88% and molecular confi rmation in 39% of cases. All Achondroplasia & Hypochondroplasia had the common hotspot in FGFR3, two novel mutations were found among the MPS and all cases of Desbuquois dysplasia belonged to the Kim variant. With team approach using clinical and radiological details, fi nal diagnosis can be reached in a large proportion of skeletal dysplasias. Since majority do not have a defi nitive treatment, focus is on the prenatal diagnosis by ultrasonography & molecular methods.

Biography:

Kazi S Anwar, MD (USSR), Mphil (England), Pub Health Training (Japan), is a Bangladeshi Public Health Physician & Microbiologist who devoted most of his research potentiality in child publlic health. He conducted several research projects both at the national (Bangladesh) and international level (Japan, England, Saudi Arabia, Korea, etc.). Currently he is teaching medical students and supervises MSc-thesis at the Faculty of Medicine, AIMST University, Malaysia. He published >50 papers in globally reputed journals, mostly in child public health and presented >26 papers worldwide. He remains a member in editorial/reviewer board of some globally reputed medical journals since long.

Abstract:

Childhood Pneumonia (CPnm) with its 120 million global episodes remains world’s leading cause of child-death and have an estimated 0.22 episodes/child year. While H. infl uenzae type-b causing CPnm has declined dramatically, the non-typeable and Hia, Hif have emerged. Since CPnm reportedly diff ers in population characteristics and socio-economic-status among various countries, this paper highlights cumulative fi ndings from a series of clinico-epidemiological and bacteriological studies on CPnm carried out in Bangladesh & Malaysia relating to socio-economic status, in particular. Posterior-nasopharyngeal samples taken from under-fi ve years-old pneumonnic children using specially designed cotton-tipped fl exible-plastic loops/ wires were streaked on-to supplemented chocolate-agar. Isolated haemophilus colonies were serotyped and antimicrobial susceptibility (disk-diff usion) were performed. In Bangaldesh (Dhaka Medical College Hospital), H.infl uenzae (H. inf) were isolated in 36.2% children, of which ~4.3% were type a-Hia, 1.9% Hid, 1.3% Hic and 0.6% each of Hie & Hif, while vast majority remained either non-typeable (18.2%) or Hib (9.3%). Contrarily, in Malaysia (AlorSetar-SBH Hospital) only 4.8% children (7/148) yielded H. inf all being non-typeable. While multidrug-resistance (MDR)-profi le did not diff er between Bangaldeshi & Malaysian Hin-isolates (p>0.59), child-health care practice diff ered between Malaysia and Bangladesh in terms of clolestrumintroducing (p<0.04), exclusive-breast feeding (p<0.02) and early-hosptalization (p<0.01). similar to parental education, cleanliness/personal hygiene/handwashing and less or smoke-free bedroom (p<0.03, on-average). To conclude, extrapolated data from these studies evidences that child-care practices, socio-economic norms and surronding environment remain plausible factor(s) for pneumonia among young children- a finding which needs more studies focusing causal relationships for further confirmation.

Biography:

Dra Belina Arias Cabello has completed her studies from Autonomous National University of Mexico. She is the Professor from the National Exam for Medical Residencies. She has published some articles related to her field, mostly pediatric ones. She is also the Attending Physician as Pediatric Ophthalmologist and Strabologist at the Association to Prevent Blindness in Mexico.

Abstract:

Introduction: A preventive measure only should be called “screening” when it complies with Frame and Carlson’s criteria. The sought disease must be a common morbid-mortality cause, it should be detectable in a pre-symptomatic stage and therefore the diagnosis tests must have sensibility and specificity. A big percent of children are taken to an ophthalmologist after 24 months after birth, thus the diagnosis of important ocular pathologies is late. Newborn eye diseases are detected in 1:70. There is not a written rule in which, how and with what we should do an ocular screening. From the simple Bruckner’s test, to the most detailed one like the RetCam@ Imaging Digital System, the documentation of the anterior segment and fundus findings for early diagnosis and opportune treatment. Material & Methods: A study was run from August 2013 to April 2015 using the PICTOR@ Digital Ophthalmic Imager/Volk. A complete ophthalmologic checking was performed in newborns in the nursery at the hospital and in the consulting room. Pictures from anterior segment and fundus were took, copied and delivered to the pediatrician. Results: 315 studies were performed before 4 weeks old. 53% were female and 47% male. 85% were made at the nursery hospital and 15% in the consulting room. 13.3% had an abnormal finding like cataract, conjunctival hemorrhage, optic disc pathologies and transitory hemorrhages. Conclusion: Similar findings to those in the literature. The sum of all the anomalies that could be found in the eye are the most frequent of the body. Benefit of newborns in a systemic and ophthalmic level.

Biography:

Shasha Bai graduated from The Ohio State University with PhD. degree in Biostatistics and MS degree in Statistics. Currently she is an Assistant Professor of Biostatistics and Pediatrics at the University of Arkansas for Medical Sciences. Her primary research interest lies in design, analysis and report of agreement and reliability statistics and Biostatistics application in Pediatrics research.

Abstract:

Prolonged neonatal hypoglycemia is associated with poor long-term neurocognitive function. However, it is unclear if early transient newborn hypoglycemia is associated with cognitive impairment. The purpose of the study was to determine if early transient hypoglycemia (a single initial low glucose concentration, followed by a second value above a cutoff) is associated with subsequent poor academic performance. The population consists of a single-center cohort of 1,395 infants born between January 1 and December 31, 1998, at the University of Arkansas for Medical Sciences, who had at least 1 recorded glucose concentration (a universal newborn glucose screening policy was in effect). Medical record data from newborns with normoglycemia or transient hypoglycemia were matched with their student achievement test scores in 2008 from the Arkansas Department of Education and anonymized. Logistic models predicting fourth-grade literacy and math proficiency were developed using initial glucose levels, after controlling for perinatal factors, socioeconomic status and maternal education. We examined the relationship using common hypoglycemia cutoffs (35, 40, and 45 mg/dL). Nomograms, which are graphical representations of logistic regression models, were then developed. Results suggested that, after controlling for gestational age group, race, sex, multifetal gestation, socioeconomic status, maternal educational level and gravidity, transient hypoglycemia was significantly associated with decreased probability of proficiency on literacy and mathematics fourth-grade achievement tests. We will also demonstrate the easiness and usefulness of nomograms in facilitating the clinical prediction of an outcome based on the independent contribution of covariates.

Biography:

Abstract:

Background Pediatric obesity has assumed epidemic proportions with prevalence rates of ≈17% in children between 2-19 years. Childhood overweight and obesity is associated with much co-morbidity that adversely affects a child’s physical, mental, social and emotional wellbeing. It is directly related to obesity in adulthood with risk of progression of various co-morbid diseases, and even early mortality, thus portending a tremendous financial and social burden to the society. Aim To determine the prevalence of obesity in children (6-18 yrs.) in our center’s ambulatory clinics; to define it’s demographic characteristics; risk stratification; and appraise the adequacy and consistency of recommended screening tests as compared to guidelines outlined by the “Expert Committee Recommendation on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity” and endorsed by AAP. Further, to illustrate the establishment of a multidisciplinary, comprehensive Pediatric Weight Management and Wellness Program at our center and a unique partnership with a leading non-profit public sector managed Care Company. Methods This study utilized existing data sets of children aged 6-18 years with at least one visit in the Department of Pediatrics between 2008 and 2012. We categorized the group into four sub-groups. Demographic characteristics- BMI percentile, age, gender, race/ethnicity, and insurance type were evaluated to define each subgroup. We then analyzed each sub-group for prevalence of common obesity-related comorbidities, laboratory screening, and the proportion of patients in each sub-group that were referred to the N.E.W. Clinic or to a registered dietitian. A method was developed to establish a standardized, multidisciplinary, comprehensive weight management program, and a way to sustainably provide the lifestyle services, free of charge to the patients and their families- we negotiated and achieved a unique partnership with a leading non-profit public sector managed care company. Results 28,443 children met the criteria and had all demographic data available for analysis.11,649 children (41%) exceeded the 85th BMI %ile (18% overweight, 17% obese and 7% morbidly obese). Only 13.7% of the children above 85th%ile had fasting lipid profiles completed at least once per recommended guidelines. 5,913 children were overweight with 2 or more risk factors or obese, which requires additional screening for diabetes and fatty liver. Within this high-risk population (n=5,913), only 50% had a screening glucose and 23.8% had screening ALT/AST completed. 21% of children with BMI >85th%ile had a co-morbid condition and there was a statistically significant increase in the number of comorbidities across weight categories, with 1.03 (+ 0.15) of the overweight having a co-morbid diagnosis, 1.26 (+ 0.56) of the overweight + 2 RF population, 1.45 (+0.82) of the obese and 1.82(+1.13) of the morbidly obese (p < 0.0001). It was also found that only 24% of obese and 46% of morbidly obese children were referred to NEW Clinic and of children not referred to NEW Clinic, only 13% of obese and 15% of morbidly obese received a referral for Nutrition consult within the past 5 years. Conclusion The prevalence of overweight and obesity in our center is almost 41%, exceeding the national rates significantly. There were significant gaps in the rates of screening for various co-morbidities as compared to expert committee recommendations, due mainly to a lack of a standardized obesity management protocol and program. A dire need for a standardized, multidisciplinary, comprehensive fatty liver, weight management and wellness program existed for our patients. We illustrate the unique components of our recently developed program. Through a series of processes, our Pediatric Weight Management and Wellness Program accomplished a unique partnership with a leading non-profit managed care company to provide sustainable lifestyle services to our vulnerable obese children and their families

Biography:

Prof., Ph.D., M.D., Head of Department and Clinic of Rehabilitation, Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Poland. Specializations in pediatrics and rehabilitation. Member of scientific bodies: Bioethics Commission and Program Council of the Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Senate Ethics Commission, Experts Team at the Ministry of Health for developing a Posture problems prevention program for children and adolescents in the educational environment, National Examination Committee in the field of Medical Rehabilitation and Medical Experts Team of National Accreditation Commission

Abstract:

Introduction Idiopathic scoliosis (IS) in three-dimension is of various causes. Following atrophic and degenerative changes of muscle and connective tissue, resulting in contractures, usually are secondary in relation to nervous and musculo-nervous damages. Aim Analysis of conservative treatment outcomes of lateral spine deformations and estimation of angle ranges of most effective therapy. Materials and methods Two different models of medical proceedings represented by Scoliosis Research Society (SRS) in the form of corseting and surgical approach and Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) in the form of kinezytherapy, physicotherapy, corseting, and surgical approach. Analysis of Artificial Neural Networks (ANN) was used in evaluation of different treatment methods on 2500 patients in growth age, from 2 to 18 years old. Outcomes The most significant efficacy and effectiveness of analysed conservative treatment methods of IS was accomplished in following angle ranges: Degree of deformation Treatment method 0 - 9 observation + prophylaxis 10 - 19 kinezytherapy + electrostimulation 20 - 29 kinezytherapy + elektrostimulation + orthopaedic brace 30 - 39 kinezytherapy + orthopaedic brace 40 - 49 kinezytherapy + orthopaedic brace +surgical treatment > 50 surgical treatment Discussion Physiotherapy in conservative treatment of IS in children and adolescants is a up to date problem. Under discussion is its effectiveness in deformity correction and the validity of its symmetric or asymmetric use. Conclusions 1. IS require inquisitive analysis in relation to planned type of physiotherapy. 2. Each type of physiotherapy is assigned to specific angle range of IS due to specific effectiveness and efficacy of therapy.

Biography:

Yunfei Wang has completed his Dr of Public Health from the Department of Biostatistics, the University of North Carolina. He is an assistant professor, and a biostatistician in Children’s National Medical Center, the George Washington University. He has published more than 16 papers in peer reviewed journals.

Abstract:

It is a challenge to model hierarchically structured data with a small number of groups (e.g., level 2 units). When the number of groups is small, standard errors of parameter estimates in multilevel modeling tend to be biased downward, thus inflating the test statistics and the type I error. Although both parametric and nonparametric residual bootstrap approaches have been developed to deal with small number of groups in multilevel modeling with continuous response variables, there are limited approaches available with binary response variables. Here, we have developed a SAS macro by implementing nonparametric residual bootstrap multilevel logit model to analyze binary response variables. Using simulated data, our results show explicit advantage of the nonparametric residual bootstrap approach compared to the default estimator -- Residual Pseudo-likelihood (RSPL) – in SAS Proc GLIMIX with respect to modeling binary response variables in multilevel data with a small number of groups.

Biography:

Laura Odom recently completed her DNP from Vanderbilt University after practicing in an Allergy/Immunology clinic as a Family Nurse Practitioner for the last twelve years. She is a clinical assistant professor at the University of Tennessee, Knoxville and is the Presdient and Co-founder of Medic Apps, LLC. She has filed a provisonal patent and trademark for her asthma action plan application BreatheEasy. She is an allied health member of the AAAAI, and is a member of the Adverse Reactions to Foods Committee and the Asthma, Cough, Diagnosis and Treatment Committee.

Abstract:

Background: Asthma burden affects mortality, morbidity, quality of life, and the economy. The British Medical Journal recently reported that two-thirds of asthma deaths are due to failure to follow recommended guidelines and primary care failings in routine care. Written asthma action plans are standard of care according to national guidelines, but these plans are seldom prescribed. Furthermore, these written care plans are often unavailable at the time of an exacerbation. The purpose of this project was to create an asthma action plan application for smartphones. The goal of the project was improved patient access to their asthma action plan and improved utilization rates among providers. Methods: A development studio was consulted for support in developing a smartphone application to code the software for the asthma action plan and assist in the design process. Following development of the application, a survey was completed to evaluate design and functionality. Results: All survey participants agreed that the application was easy to use, could be used without written instruction and was designed for adolescents with asthma of any severity. Patients and providers noted that the app would help provide information about what to do in the event of an asthma exacerbation and that the application would be used frequently. Conclusions: There was consensus from both patients and providers that this application is not only functional but also helpful in the event of an asthma exacerbation. The project met the goal of creating a mobile phone application that improved patient access to asthma action plans.

Biography:

Dr. Benkwitz obtained her Medical Degree and PhD in Cardiology at the University of Wuerzburg, Germany, before spending several years as a Postdoctoral Research Fellow and Research Scientist at the Dept. of Anesthesiology at the University of Wisconsin. She completed her Anesthesiology Residency in the US at Massachusetts General Hospital and Fellowship Training in Pediatric and Pediatric Cardiac Anesthesia at Lucile Packard Children’s Hospital at Stanford University. She served as Faculty member in Stanford, before moving to Monroe Carell Jr. Children’s Hospital at Vanderbilt University, where she currently holds a position as Assistant Professor and is primarily involved in Pediatric Cardiac Anesthesia. She obtained various research awards, has published in high-ranked peer reviewed journals and co-authored several book chapters in major anesthesia textbooks. Her research interests include basic and clinical neurosciences, with the current focus on neuromonitoring and neurocognitive outcome in pediatric cardiac surgical patients. She is presently involved in clinical research, serving as PI or Co-PI on several different studies.

Abstract:

Congenital heart disease (CHD) is the most common birth defect. Today, an increasing number of affected children, who not long ago were considered “inoperable” are now living into adulthood. In fact, there are now more adults than children living with CHD. This turning point has shifted the focus from “primarily survival” to “improving quality of life” for these patients. For this matter, a major area of concern is neurological morbidity, that affects 30-50% of children with CHD and is attributable to multiple causes. While vital organs are routinely monitored in the pediatric cardiac surgical setting, this typically does not hold true for the brain, where monitoring is still indirect. Yet, reliable and accurate neurological monitoring is essential to reduce the incidence of neurological complications and subsequent potential long-term cognitive dysfunction. In this discussion, we review various modalities of neuromonitoring for children undergoing congenital heart surgery with a focus on Near-Infrared Spectroscopy (NIRS). In addition, our own data will be presented, investigating a next generation NIRS device (FORE-SIGHT Elite Tissue oximeter) in combination with simultaneous vital sign recording in pediatric patients undergoing cardiac catheterization. Our data suggest that NIRS monitoring appears superior to standard vital sign monitoring when assessing “brain well-being”, thereby supporting routine use of NIRS as an independent monitor to achieve safer peri-OP management in this vulnerable and extremely heterogeneous patient population. Clearly, future studies refining efficacy and application of this technology are warranted and are on the way.

Biography:

Andreas Petropoulos graduated from Aristotle University’s Medical School, Greece in 1989. Followed 30 year career as a medical officer, senior Flight Surgeon in the Hellenic Air-Force. Specialized in Aviation & Hyperbaric Medicine, Pediatrics, Fetal, Pediatrics and Congenital Cardiology in USA and Europe. Holds M.Sc in Preventive Cardiology. An AEPC Prevention and Heart Failure/Pulmonary Hypertension, working group’s member. Worked and lectured in Athens and Brussels universities. Currently consults in Fetal, Pediatrics and Congenital Cardiology in Merkezi Klinika and is Associate Professor at the State University and Post Graduate and CME Center in Azerbaijan. His research focuses on prevention, CVD imaging techniques, fetal cardiology, and heart failure.

Abstract:

The aim of this paper is to remind to general pediatricians the risk of viral myocarditis as a part of a common viral infection. To explain the clinical futures, the diagnostic algorithm and the available treatments in primary and in hospital care Myocarditis is an inflammatory disease of heart muscle and the pericardium. It is an important cause of dilated cardiomyopathy worldwide. Viral infections are the commonest cause of myocarditis. The spectrum of viruses known to cause myocarditis has changed in the past 2decades. Several new diagnostic methods, such as cardiac MRI, are useful for diagnosing myocarditis. Endomyocardial biopsy may be used for patients with acute dilated cardiomyopathy associated with hemodynamic compromise, those with life-threatening arrhythmia, and those whose condition does not respond to conventional supportive therapy, to differentiate dilated cardiomyopathy from acute myocarditis. Important prognostic variables include the degree of LV and RV dysfunction, heart block, and specific histopathological forms of myocarditis. We review diagnostic and therapeutic strategies of viral myocarditis

Biography:

S E Morgan is a Registered Respiratory Therapist and an Advanced Respiratory Care Practitioner with the National Board for Respiratory Care. He is an active member of The America Association for Respiratory Care. He serves as Clinical Practice and Development /Educator/ Research Coordinator for the Department of Respiratory Care Services, Section of Pulmonary and Critical Care Medicine at the UCM. He has published more than 30 peer review papers regarding subjects such as; nitric oxide, heliox, infl uenza-related respiratory disease and aerosolized epoprostenol) in different medical journals. He has collaborated with departments of neonatology and pediatrics on respiratory related research projects.

Abstract:

Infl uenza-like respiratory infections is a frequent trigger for status asthmaticus. Helium-oxygen (heliox) gas mixtures, has been used for decades to treat pulmonary exacerbations. The lower density and higher viscosity of heliox relative to nitrogen oxygen mixtures can signifi cantly reduce airway resistance, thought little evidence exist regarding effi cacy in viral-related lung disease. Th e morbidity and mortality of these viruses is signifi cant with regard to infants and children. In the summer of 2014 > 600 kids were admitted to Comer Children’s Hospital with rhinovirus-enterovirus. Infections in children may cause bronchitis, viral bronchiolitis and pneumonia in variable combinations and may impede air-fl ow enough to be the etiology of respiratory failure. We present the case review of two pediatric patients treated with heliox who experienced resolution of respiratory failure through the use of heliox. First case; a10-month old Hispanic male diagnosed with a history of seizures, coronavirus – HCoV-43 and rhinovirus-enterovirus treated with high fl ow nasal cannula and heliox to avoid re- intubation. Before heliox the patient was tachypnea 60-70 breaths/min. Aft er heliox, his respiratory rate fell 31-38 breaths/min.Th e second case review is a 4 year old female, diagnosed with rhinovirus-enterovirus that required mechanical ventilation with heliox to treat refractory hypoxichypercarbic (PaCO2-118 mmHg) respiratory failure. Th e benefi t of heliox appeared to serve as a bridge to support these patients’ while time and pharmacologic measures took eff ect and an underlying infection abated. More study is needed to understand and treat viral-related obstruction lung disease of small airways and the role of heliox.

Biography:

Shridevi Pandya Shah received her Medical degree at the College Maharaja Sayajirao University in India. She went on to complete an internal medicine internship at The Coney Island Hospital, Brooklyn, NY. She then began an Anesthesia Residency and completed at The Montefi ore Hospital-Albert Einstein College of Medicine. Following this, she commenced a fellowship in Pediatric Anesthesia at the Children’s Hospital of Pittsburgh. She has had many presentations at both national anesthesia and pediatric anesthesia professional meetings. She is currently an Assistant Professor at the Rutgers, NJMS and has made contributions related to pediatric anesthesia in several professional journals.

Abstract:

A difficult airway management situation was presented by an eight-week-old infant who presented with a bleeding orbital tumor. Th e infant also had a not yet diagnosed inherited trisomy 15 with facial abnormalities and an upper respiratory tract infection that made the face-mask ventilation and tracheal intubation more challenging. The urgent need for the surgery precluded any further work-up and optimization. Anesthetic challenges included difficult mask ventilation, difficult endotracheal intubation, extremely reactive airway and very labile hemo-dynamics during induction. An Air-Q laryngeal mask airway was used as a rescue airway device and as a portal for endo-tracheal tube placement during the anesthetic management with good outcome.

Biography:

A Boufersaoui completed his Doctoral studies in Medicine from University of Medical Sciences of Algiers and its specialty pediatric studies in the same university. It is currently completing a Doctoral thesis on inhalations foreign bodies in children. He presented his experience in different pediatric congresses: International Congress of Pediatrics in El Baha Saudi Arabia, Congress of the Italian Society of Pediatrics, Congress of the Romanian Society of Pediatrics, First Prize at the Congress of Arab societies of pediatrics at Marrakech, North African pediatrics’ Congress, pediatric pulmonology international Congress in Bruges, Congress of the European respiratory society in Munich. He published an article in the International Journal of Pediatric Otorhinolaryngology on the same subject.

Abstract:

Objectives: Th e objective of this study is to analyze the epidemiological, clinical, radiological and endoscopic characteristics of pediatric foreign body aspiration in Algeria. Methods: In this retrospective study, the results of 2624 children younger than 18 years admitted in our department for respiratory foreign body removal between 1989 and 2012, were presented. Most of them had an ambulatory rigid bronchoscopy. Results: Th e children (62.34% males and 37.65% females) were aged 4 months to 18 years with 66% between 1 and 3 years. Choking was related in 65% of cases. Th e delay between aspiration and removal was 2–8 days in 65.8% and within 24 h in 9.2%. In the most cases, the children arrived with cough, laryngeal or bronchial signs and unilateral reduction of pediatric vesicular murmur. Th e examination was normal in 13%. Th e most common radiologic fi nding was pulmonary air trapping (40.7%).

Th e aspirated bodies were organic in 66.7%, dominated by peanuts, while sunflower seeds, beans and ears of wheat were the most dangerous. In the other cases, they were metallic or plastic as pen caps and recently scarf pins. Th e endoscopic removal by rigid bronchoscopy was successful and complete in 97%. Cases with extraction failure (3%) limited to certain FBs, all of them inorganic were assigned to surgery. Th e complications related to the endoscopic procedure were 0.29% with a mortality of 0.26%. Conclusion: Foreign body aspiration is a real public health problem in Algeria. Th e best way to manage it is an early diagnosis and a rigid bronchoscopy removal under general anesthesia used by fully trained staff . Th e prevention of this domestic accident should consider the population lifestyle and cultural habits to be more eff ective.

Biography:

Keva Bethell has completed her Master’s in Public Health from the University of Oklahoma Health Sciences Centre and Bachelor of Science in Biology (Pre-med) from Oral Roberts University. She is the Director of Research for the Family: People Helping People project, a community based project which provides free group therapy in marginalized Bahamian communities. The project’s goal is to encourage re-socialization of participants who attend the weekly group sessions. She has published four papers in reputed journals and is currently working on a manuscript detailing a phenomenon called ‘The Evil Violence Tunnel’.

Abstract:

The Family: People helping people project is a supportive group process modality involving the sharing of personal stories, self-examination, refl ection and transformation using psychotherapeutic principles. Th e group process was developed to confront the prevailing social fragmentation in the Bahamas associated with or caused by the continuing eff ects of the countrywide crack cocaine epidemic of the 1980s and the fall-out due to the recent international fi nancial downturn. Facing community disintegration, high youth unemployment and burgeoning rates of violent crime and murder, many persons have been severely traumatized. Th is paper reviews the major themes presented in 776 group process sessions indicating the pervasive nature of the negativity of the shame process expressed in the high incidence of anger, violence, grief, relationship issues and abuse. Th is innovative project has been proven to enhance the re-socialization of many participants in the program.

Biography:

Roxanne Bautista is a medical student currently fi nishing her basic sciences at Avalon University School of Medicine. She majored in Biochemistry and Nursing during her undergraduate where she found great passion to pursue Medicine. She is committed to making positive difference, staying proactive with her involvement in medicine, while utilizing her potential in health and science fi eld. She is a former president of Phi Chi Medical Fraternity who continues to stay active in not only in community services within her school, but also within Curacao community. She was presented "The Eben J. Carey" award for having the highest grade in anatomy and "The Rudy F. Sievers" award for being the most outstanding senior class member of Phi Chi. She has worked with the research team in Avalon and her recent research activities include a collaborative study with University of Alberta in Canada to identify and compare the modern lifestyle of Antillean and Canadian Post-Secondary students in contributing to obesity rates; and contributed in writing the pitfalls of nanomaterials with the increasing transformative technology of nanomedicine. She is grateful to present in this conference and she looks forward to contributing with many more.

Abstract:

A neonate child ,primigravida with features of Down syndrome, with multiple intestinal atresias was delivered at Ibensena teaching hospital Sirte Libya by a 39 year old mother. Diagnosis was established with plane and contrast X-Rays and was managed by Multiple intestinal anastomosis aft er appropriate resection. Post operative infection of chest and abdominal cavity was managed with broad spectrum antibiotics (Th ird generation Cephalosporins, Vancomycin) covering Gram (+) ve , Gram(-) ve organisms. Post operative state was uneventful without any complications. Parenteral nutrition supplemented with vitamins and minerals. Patient recovered from illness. Intestinal atresia can involve any position of small bowel. It is characterized by an obliteration of the bowl lumen and its replacement by a fi brous cord that connects the proximal and distal segments. Specifi c sub-types include apple-peel atresia, multiple intestinal atresia with mega duodenum. Traditionally intestinal atresia has been regarded as an embryologic defect. Currently the interpretation that the disease is the result of utero mechanical injury to the vascular system of the bowl is favored. Th is may result from interception incarceration. A causal relationship between the use of methylene blue in second -trimester amniocentesis and the occurrence of jejunel atresia has been suggested. Complications include perforation, meconium peritonitis and as a rare late occurrence -Brown - bowel syndrome.

Biography:

Tran Quynh Nhu Nguyen graduated from University of Medicine and Pharmacy, Ho Chi Minh city, Vietnam in 2007. Since 2008, she has worked as cardiologist in Children’s Hospital 2, Ho Chi Minh city, Vietnam. She has completed master course from School of Medicine, The University of Tokyo, Japan in March 2015 and now continues Ph.D course at the same above university.

Abstract:

Ellis-van Creveld syndrome (EvC) is a ciliopathy with cardiac anomalies, disproportionate short stature, polydactyly, dystrophic nails and oral defects. Approximately 60% of EvC patients have severe congenital heart defects (CHD), of which more than half are atrio-ventricular septal defect and common atrium. In this study, we report one EvC Vietnamese family with an atypical CHD phenotype, short chordalis. A 32-month-old boy had a novel heterozygous EVC mutation (c.1717C>G-p.S572X) in exon 12, inherited from his father whose phenotype was milder than his son’s. Of note, the mother without an EvC phenotype showed a lower expression of EVC mRNA compared with controls. SNP array analysis revealed that the patient and mother had a heterozygous 16kb deletion in EVC, ranging from intron 9 to intron 11. As the patient and the father had an atypical CHD, we screened EFCAB7 and IQCE as the candidate for modifiers of EvC phenotype. EFCAB7 and IQCE are ciliary proteins, which positively regulate the Hh pathway and anchor the EVC-EVC2 complex in a signaling microdomain at the base of cilia. A novel missense mutation c.1171T>C-p.Y391H in EFCAB7 was found in the patient and the father. This mutation located in a possible binding site of EFCAB7 and EVC2, and may have modified the EvC phenotype in this family. Our findings suggested the physiological role of EFCAB7 in cardiac development.

Biography:

Salah Thabit Al Awaidy is a Communicable Diseases Adviser in Health Affairs, Ministry of Health, Oman. He is a medical doctor and holds a Master’s in Epidemiology. He is currently the adviser of Communicable Disease Surveillance, Elimination and Eradication of Communicable Diseases of Public Health Importance, EPI, vaccine supply chain system and IHR at the Ministry of Health, Oman. He was the Director of Communicable Disease Surveillance and Control at MoH, HQ, Oman between 1997-2011, IHR national focal point 2002-2013 and was a member in several of the professional committees namely: Strategic Advisory Group on Immunization (SAGE), WHO Geneva (2005-2007); Strategic Advisor Group on Vaccine and Store Management Training Courses (2005-2008), WHO Geneva; Strategic TB Advisory Board (STAG) 2007-2011 2014- till date. He also currently serves as IHR Emergency Committee on Polio and MERS-CoV. He has authored or been the co-author of over 35 publications on a large variety of health topics.

Abstract:

A retrospective study of infl uenza-like illness (ILI) in Oman was completed to describe the epidemiology of pandemic infl uenza-A, subtype H1N1 activity (pH1N1). From June to December 2009, 8,941 specimens were collected nationwide from patients that met the case defi nition for ILI, of which 6,547 (73%) were tested for pH1N1 by real-time polymerase chain reaction (RT-PCR). Out of these, 4,089 (62%) were found positive for pH1N1 and 712 (11%) were positive for seasonal infl uenza A. Th e mean age of patients positive for pH1N1 was 24 years (28 days-74 years). Out of the total patients who met the defi nition of severe acute respiratory illness (SARI) and required hospitalization, 28.3% were positive for pH1N1. Th e overall case fatality rate was 1.1 deaths/100,000 populations. Two governorates, Muscat and Dhofar, witnessed the greatest intensity of infl uenza activity. Mitigation, containment, pharmaceutical and non-pharmaceutical measures were engaged. Based on the experience and lessons learned in Oman, some recommendations were sought in Oman.

Biography:

Shailesh Adhikary currently works in the Department of Surgery, B P Koirala Institute of Health Sciences, Dharan, Nepal. His research interest is Pediatric Surgery.

Abstract:

Introduction: Penetrating or perforating abdominal or chest injuries are very uncommon in the pediatric age group and are associated with a high mortality. Impalement injuries are consequence of penetration by elongated, usually fi xed objects through the body. Case Summary: A 10-year young child suff ered from a penetrating injury to the left iliac fossa when he had fallen down from a coconut tree on to the sharp bamboo fence. Th e bamboo stick penetrated the abdominal wall, perforated the jejunal loops at two sites along with the fundus of stomach, the left diaphragm, upper lobe of the left lung and the bevelled end of the bamboo had exited at the neck aft er tearing apart the neck muscles and skin sweeping along with it few scattered pieces of jejunal tissues which were seen lying alongside. He was brought to the hospital 5 hours aft er the accident. On arrival he was in agony, dehydrated and scored 15/15 on Glasgow scale, remained hemodynamically stable, saturation of 93% with oxygen supplement. On examination a 75x5cm bamboo stick was in situ, which entered 4 cm medial to the left anterior superior iliac spine and exited 3cm above the skin at the posterior triangle of neck. Operation: Imaging modalities were followed by exploration via the left thoraco-abdominal incision. Th e thorax, mediastinum and neck were assessed in the beginning and aft er confi rming that no great vessels were at risk, the foreign body was then carefully removed. Th e perforated stomach, jejunum and diaphragm were repaired. Th e upper lobe of lung had to be resected. An abdominal drain and two inter-costal drains were placed. Th e total operative time was 3.30 hours and the child was managed in intensive care for 4 days and was fi nally discharged aft er two weeks. Conclusion: A rare penetrating injury with damage to the multiple organs could be managed successfully possibly because of teamwork and also due to some sensible move by the villagers as they did not try to fi ddle around with the foreign body.

Biography:

Dr. Khalil Salameh has completed his M.D at the age of 24 years from Zagreb University and postgraduate residency in Jordan. He has a membership of royal college of physicians in Edinburgh. He is the chairman of pediatrics department in Al Wakrah Hospital, Doha, Qatar. He has published more than 10 articles in international journals.

Abstract:

High-risk populations are scarce despite reported increased risk of rickets in breastfed infants. We determined the prevalence and associated risk factors low vD status in breastfeeding mother-infant dyads in a population with high prevalence of infantile rickets. Patients & Methods: We evaluated vD status of 60 consecutive exclusively breastfeeding Arab mother-infant pairs in Doha, Qatar participating in a high dose vD supplementation study to prevent vD defi ciency, prior to study enrollment during August to September 2014 (sunny months). Serum 25(OH)D and PTH were measured within 1 month postpartum. Demographic, sun exposure and vD supplementation data were collected using standardized questionnaires. Vitamin D defi ciency was defi ned as serum 25(OH)D <50nmol/L and severe defi ciency as 25(OH)D < 25noml/L in mothers and infants. Results: Mean maternal age was 29 years and 77% had college or university education. Maternal median 25(OH)D was 32.5 nmol/L. Seventy-eight percent of mothers were defi cient and 20% had serum 25(OH)D <25 nmol/L. Negative correlation between serum 25(OH)D and PTH was not statistically signifi cant(r= -0.22, p=0.09). In the entire group, only 50% of mothers had reportedly taken vD supplements with median dietary vD of 119 IU/day. Median maternal sun index score (sun exposure (hrs/wk) x body surface area exposed while outdoor) was 0. Maternal serum 25(OH)D correlated with age (p<0.02), and percent BSA exposure while outdoor (p<0.004). Infant median 25(OH)D was 20.0 nmol/L and 83% were defi cient while 64% had serum 25(OH)D <25nmol/L. Infant 25(OH)D correlated with maternal levels (r= 0.41, p =0.001). None of infants had received vD supplement at 1 month of age and median sun index score was 0. Infant’s serum PTH showed signifi cant negative correlations with 25(OH)D (r= -0.28,p=0.03). Conclusion: Vitamin D deficiency is common in breastfeeding mothers-infants dyad and severe deficiency is more common in infants than mothers in this sunny environment. Low maternal and infant vitamin D status is associated with lack of sun exposure and low or lack of vD supplement intake. We suggest corrective vD supplement strategy to prevent vD deficiency in breastfeeding mothers and their infants, which should preferably start during pregnancy.

Biography:

Nasir Uddin Mahmud completed his MBBS at the age of 25 years from Chittagong Medical College, and achieved Diploma in child health under Chittagong University and Fellowship (FCPS) in Pediatrics from Bangladesh College of Physician and Surgeon (BCPS). He has published 15 papers in reputed journals and member of the editorial board of the Journal of Chittagong Medical College Teacher Association and The Healer, an Official Organ of Bangladesh Medical Association Chittagong, Bangladesh

Abstract:

Introduction: A retinopathy specific to severe malaria has been reported in African and Malawi children and in Bangladeshi adults. Detection of this retinopathy can be a useful diagnostic tool. This study was designed to detect retinopathy in severe malaria cases in Bangladeshi children. Methods and subject: A prospective observational study was conducted including consecutive 190 severe malaria patients, aged 6 months to 12 years, admitted to Department of Pediatrics, Chittagong Medical College Hospital, Bangladesh, from April 2008 to March 2009. Eighty patients were cerebral malaria and 50 were severe non-cerebral malaria; 31 meningitis and 29 critically anemic patients were included as control. Direct and indirect ophthalmoscopy was performed by two independent observers. Results: Retinopathy was detected in 61.2% with cerebral malaria and in 48% with severe non-cerebral malaria patients. Retinal haemorrhage was detected in 46.2% and 43.4% of cerebral malaria and 32% and 24% of non-cerebral severe malaria and vascular changes were found in 33.8% and 7.2% of cerebral malaria and in 26% and 2% of non-cerebral severe malaria by indirect and direct ophthalmoscopy respectively. Papilloedema in 13.8% and 6% and peripheral whitening in 41.2% and 34% of cerebral and non-cerebral malaria respectively was detected. Macular whitening was found in 46.2% patients. Death was significantly higher in patients with retinopathy (p<0.001). Blantyre coma score (BCS) on admission was lower and hospital stay and coma recovery time was significantly longer in patients with retinopathy. Conclusion: Malarial retinopathy is an important diagnostic tool for diagnosis and is related to prognosis of patients with severe malaria. Key wards: severe malaria, retinopathy, children, Bangladesh

Biography:

Alejandro Berenstein, MD (Dr B.) was born in Mexico City in 1948, graduated from the UNAM, at present is Professor of Neurosurgery, Radiology and Pediatric, Director of the Hyman- Newman Institute for Neurology and Neurosurgery at Mount Sinai Health System in NYC. He is a pioneer in the new field in medicine “Endovascular Surgery”; he established the first Comprehensive center for the multidisciplinary treatment of head, neck and peripheral vascular lesions, His contributions extend from the description of the functional vascular anatomy, understanding and describing the diseases, to the development of multiple medical devises to treat them used throughout the world. He has authored over 150 publications in peer-reviewed journals, more than 25 chapters in the field, and 9 books including the five volumes groundbreaking textbook, “Surgical Neuroangiography”. Among the more than 30 awards, in 1989 he received the Ramon y Cajal Award in Medicine for distinguished Latin American Physicians. In 1998 The First Cerebrovascular Luessenhop Award from the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS); Section of Cerebrovascular Surgery. In 2001 awarded the Paolo Raimondi Award from the AANS/CNS on Pediatric Neurological Surgery, and is the only physician to received both. In 2007 he received the Physician of the Year from Vascular Birthmark Foundation, for his work with children with vascular birth defects. In 2007 the Boston Scientific Neurovascular Lifetime Achievement Award for excellence in research and clinical applications. In 2008 the Heart of New York Stroke Spotlight Award from the American Heart and Stroke Association. Honorary Member of the Japanese Society of Neuroendovascular Therapy, in 2009 he received the first Serbinenko Golden Sign Award in Neurosurgery in Moscow. He has been visiting professor, lecturer and faculty in over 600 occasions. He became the first President of the World Federation of Interventional and Therapeutic Neuroradiology and third President of the American Society of Interventional and Therapeutic Neuroradiology; and has been the President of SILAN the Latin-American Society of Neuroradiology for 2012-2013.

Abstract:

During this presentation I will review the various vascular lesions of the head and neck and the various endovascular treatments. Will review: Venous Malformations, Arteriovenous Malformations, A-V fistulae, Lymphatic Malformations and Hemangiomas. We will present the various endovascular techniques, including transarterial embolization, percutaneous embolization, combination treatments. Will review: the indications and technical aspects of sclerotherapy. The use of STS, Doxycycline, Bleomycin, and sclerotherapy foams

Biography:

Abstract:

OBJECTIVE and BACKGROUND: Three dimensional echocardiography (3DE) enhances the diagnostic capabilities of cardiac ultrasound. This study was performed to determine the utility of 3DE for acquiring superior anatomical detail for Left sided Valvular and non Valvular Cardiac defects. During early 1990s, von Ramm et al developed the first real-time 3D (RT3D) echocardiography scanner, capable of depicting cardiac motion using volumetric data. METHODOLOGY: Fifty eight 3D transthoracic echocardiograms (TTE) and transesophageal echocardiograms (TEE) were performed during January 2012 and April 2013 at Akron Children Hospital, Heart Centre, with specific indication to evaluate left sided cardiac defects. Patient age range was 4 months to 34 years, with varying diagnoses. IE-33 Philips Medical Systems was used. For Transthoracic 3DE using both reconstruction methods and RT3D, following images were obtained; parasternal long, short axis, apical 4 chamber, Sub costal and particular emphasis on area of interest. Supra-sternal notch were obtained if indicated. For TEE 3DE component using both reconstruction methods and RT3D, following images were obtained; apical 4 chambers with 0 degree angle left 2 chambers with 120 degree angle and particular emphasis on area of interest. Live 3D and off-line reconstruction was performed. Image quality (IQ) 5-level score was employed. RESULTS: Out of 56 studies 24 (43%) were TEE and 32 (57%) were TTE. 3DE was technically feasible in 92% with TTE and 100% with TEE in our study. Time for 3D acquisition, reconstruction and measurement was available in 40 patients and was 8-15 minutes. In TTE studies where 3DE was technically feasible, anatomical detail of cardiac valves and chambers was delineated with the IQ score ranging from 4 to 5. CONCLUSION: 3DE demonstrates detailed cardiac anatomy and has the potential to significantly alter clinical decision-making. 3DE provides improved accuracy and reproducibility over 2D methods.

Biography:

Abstract:

Background and Objectives: Leukemic children face many obstacles that interfere with social activities and are at greater risk for neurocognitive dysfunction. This study aimed at highlighting the problems affecting quality of life in leukemic children given chemotherapy without irradiation. Methods: A Cross-sectional comparative study was conducted in 177 leukemic patients, with 281 subjects as a healthy control. All patients and control were subjected to thorough history and examination. Cognitive functions were examined using the Mini-Mental State Examination. Paediatric quality of life was measured using paediatric quality of life inventory version 4. Results: Health and activity, emotion, social relationship and school achievement were significantly impaired among leukemic children. Orientation, registration, attention, recall and language were adversely affected in leukemic children in comparison to healthy children. Conclusion: Neurocognitive function and quality of life in leukemic children treated with chemotherapy were significantly impaired as compared with the healthy group. Keywords: Leukemia; Children; Cognitive function; Quality of life;Egypt

Biography:

Abstract:

A high level of intensive physical training can be associated with structural and functional myocardial adaptation-the so-called athlete's heart. Despite the increasing involvement of child athletes in intensive training regimens, little is known about the influence of swimming training on right ventricular structure and function for child swimmer. Echocardiography is the tool of choice for the assessment of athlete's heart. The aim of this study was to assess right ventricular structure and function by echocardiography pre and after intensive swim training, 16 weeks,6 times per week,120 min per unit in male child swimmers. Methods: 15 elite child swimmer aged 11.46 years(+-.39),height 143.6 cm(+- 4.2), weight 39.4 kg( +-3.73), took part in intensive swim training. All subject underwent two-dimension-mode and Doppler echocardiography before and after swim training to evaluate right and left ventricular performance, ejection fraction, septal and posterior wall thickness. Statistical methods of SPSS, means+-SD, paired t test, percentage of improvement were used. Results: There was significant difference(p<0.01) and percentage improvement for all echocardiography parameter after swim training, the diastolic and systolic diameter and thickness of the right and left ventricular was incresed,interventricular septum and left ventricular mass significantly increased. Conclusions: Swim training is an effective sport activity to enhance"heart athletes' for children. Keywords: Athlete,s heart heart,right ventricular,ecochardiogrphy,Swim training.

Biography:

K L Ravi Kumar Prof. Emeritus-Microbiology is the Chief of Central Research Laboratory at the Kempegowda Institute of Medical Sciences at Bangalore and is also the Principal Investigator of the Pan India Distribution of Pneumococcal Serotypes (PIDOPS) Study. Dr. Kumar is recognized for his contributions to a number of projects and studies. He has supervised and guided more than 16 research projects. Dr. Kumar has done his MBBS from JJM Medical College in 1979, MD in Microbiology in1986 from BMC, Bangalore and has over 30 years of experience in teaching under graduate, post graduate students including mentoring Ph.D candidates.

Abstract:

Identification and continued monitoring of pneumococcal serotypes is needed to access vaccine efficacy, serotype replacement and to identify emerging new types. Presently available serological methods are expensive, labor intensive and prone to misidentification, while current molecular methods have limited serotype coverage, multistep and time consuming. In PCRSeqTyping method two step amplification and sequencing of cpsB and adjoining genes within the pneumococcal capsular locus is implemented. The assay was compared with conventional blood culture, qmPCR and Quellung reaction for its specificity and sensitivity. ply, lytA, pspA and spn9802 primers were used in qmPCR. 1504 blood and serum samples from children clinically suspected of Invasive Pneumococcal Disease with raised CBC, CRP, PCT and abnormal chest X-ray were subjected to testing. Conventional blood culture and qmPCR were positive in 7% and 30% samples respectively. PCRSeqTyping assay identified 456 serum samples positive for S.pneumoniae showing 100% correlation with qmPCR. The assay detected serotype of 456 qmPCR positive serum samples which included 108 culture positives and 348 culture negatives. The results showed 100% correlation with quellung test. Our study reveals the usefulness of PCRSeqTyping for direct detection and subsequent serotyping of S.pneumoniae from culture negative serum samples. An added advantage of this assay was the precise identification of the homologous types and detection of 91 specific serotypes. This simple, efficient PCR sequence based method with total serotype coverage will improve the accuracy of pneumococcal surveillance, identify non typeable and vaccine escape strains.

Biography:

Jichuan Wang has completed his PhD from the Sociology Department, Cornell University and postdoctoral studies from the Population Studies Center, University of Michigan. He is a senior biostatistician at Children’s Research Institute, CNHS. He has published three statistical books and authored/coauthored more than 100 peer-reviewed journal article with more than 30 first-authored. He has been serving as editorial board members of five academic journals.

Abstract:

A challenge in application of Psychotric measures is there are too many variables/items in a scale (e.g., depression, anxiety, …). The often used data reduction approaches are to generate total scale scores or estimated factor scores. The former is simply to sum item scores and the latter is to estimate factor scores from factor analysis model. However, the problems are: the total score does not take into account of measurement errors; and using factor scores or IRT scores as dependent variables in further analysis gives biased slopes (Asparouhov & Muthén, 2010). Such biases can be alleviated by using a recently developed technique - plausible values of latent variables that are a set of generated values of factor scoroes using MCMC Bayesian approach (Mislevy, 1991; Asparouhov & Muthén, 2010). The plausible values can be estimated not only for continuous latent variables (e.g., factors), but also for categorical latent variables (e.g., latent classes). The plausible values of factors or latent class membership can be used as observed variables for further analysis and provide more accurate parameter estimates, compared with the traditional estimates of latent variables (e.g., factor scores or IRT scores). When the plausible values are used in subsequent analysis, multiple imputed plausible value data sets are used and analyzed just like multiple imputations (MI) data sets, i.e., by combining the results across the imputations using Rubin's (1987 ) method. This presentation will demonstrate how to estimate and apply plausible values of depression and anxiety scales using real-world research data.

Biography:

Lin obtained his PhD and MD from Johns Hopkins University and National Taiwan University, respectively. He is trained as a psychiatrist and genetic epidemiologist. He currently holds the position of Assistant Professor at Cincinnati Children’s Hospital Medical Center in Ohio, U.S.A. His publications in the field of neuropsychiatric research have been thus far cited by 1075 studies. His current research interests have been focused on the neurobiological basis of behavioral traits that cur across pediatric psychiatric disorders.

Abstract:

Gene-environment interactions may contribute to the risk of autism spectrum disorder (ASD). Previous evidence has inconclusively suggested that prenatal exposure to some medications may be associated with the risk of ASD. Little is know whether these medications may interact with some ASD-related genes to influence the risk of ASD. I have proposed a novel multi-step approach that combines bioinformatics screening and statistical interaction scans, to identify interactions efficiently supported by convergent lines of evidence. First, we have identified overlapped genes shared by ASD and several class A-C drugs, and quantified the level of attributable risk of each drug in the context of susceptibility to ASD. We found that that ASD-related genes, such as INPP1, KIF5C, and ST7 genes, of which expressions might be perturbed by a terbutaline – a beta 2 adrenergic receptor agonist. Our genome-wide interaction scan on 3,700 cases of ASD provides further discovered several variants in the ST7 (Suppression of Tumorigenicity 7) gene were significantly over-represented in cases with prenatal terbutaline exposure compared to cases without prenatal terbutaline exposure (p < 0.0001). The convergent approach has confirmed that terbutaline may modify the effect of ST7 on the risk of ASD. These findings have also lent some support to the prior findings on the comorbidity link between ASD and cancers. Further research on the impact of terbutaline-induced in-vivo functional changes of the ST7 gene on ASD-like phenotypes is warranted to validate our screening results.

Biography:

Andreas Petropoulos graduated from Aristotle University’s Medical School, Greece in 1989. Followed 30 year career as a medical officer, senior Flight Surgeon in the Hellenic Air-Force. Specialized in Aviation & Hyperbaric Medicine, Pediatrics, Fetal, Pediatrics and Congenital Cardiology in USA and Europe. Holds M.Sc in Preventive Cardiology. An AEPC Prevention and Heart Failure/Pulmonary Hypertension, working group’s member. Worked and lectured in Athens and Brussels universities. Currently consults in Fetal, Pediatrics and Congenital Cardiology in Merkezi Klinika and is Associate Professor at the State University and Post Graduate and CME Center in Azerbaijan. His research focuses on prevention, CVD imaging techniques, fetal cardiology, and heart failure.

Abstract:

The aim of this paper is to present to the primary care pediatricians and family practitioners the preventive, diagnostic and therapeutical measures they can apply to lift the burden of cardiac disease in childhood. Although preventive policies are long time applied both to the adult and the pediatric population the burden of cardiovascular diseases is increasing worldwide. Obesity and essential hypertension are the leading conditions in childhood. Do we know how to prevent or treat them? The use of pulse oximetry after the first 36 to 48 hours post birth increases the early detection of critical and cyanotic congenital heart diseases. When present in an initial assessment of a neonate re we aquatint with this screening method? Frequently the primary care providers are asked to evaluate a child before been involved in sports activities. What seems to be the best algorithm and when we shall reefer a child for a specialist consultation? Finally as populations are rapidly migrating around the world, is it time to remember rheumatic fever and its cardiac involvement? All above questions when answered will underline a new role for the primary care pediatrician and family physician.

Biography:

Jhulan Das Sharma obtained MBBS ,in 1976, FCPS(Fellow of College of Physicians & Surgeons) MD(Doctor of Medicine)& PhD in 1976, 1990, 1998 & 2010 respectively . I worked as Assistant Professor in Pediatrics since 1993 to work in different Medical Colleges of Bangladesh including Institute of Postgraduate Medicine & Research, Dhaka. I worked as Associate Professor since 1999 & presently working as Professor of Pediatrics in Southern Medical College, Chittagong from January 2011. I am involved in teaching & examination of undergraduate & postgraduate examinations for last 15 years. I have 35 publications in different journals.

Abstract:

Abstract: Context: Debate still exists about the necessity of thyroxine replacement in hypothyroxinaemic preterm neonates. The dilemma is that delaying replacement will impair growth and development, especially neurological development while early replacement may have adverse metabolic effect resulting from increased oxygen consumption of preterm newborns suffering from hypoxia. Moreover once replacement is initiated, it may injudiciously be used for prolonged period. Background: Transient hypothyroxinaemia is the most common thyroid dysfunction in preterm postnatals, and is characterized by low sera levels of T4 and FT4. The aetiology is not clear, but may have been due to the withdrawal of maternal placental T4 transfer, expression of temporary HPT axis immaturity, or a nonthyroidal illness. The problem is reported to be present in majority of infants born at less than 30 weeks gestation and is associated with increases in perinatal mortality and morbidity as well as later neurodevelopmental deficits. Objectives: To compare thyroid function in preterm and term neonates and to observe whether preterm neonates with hypothyroxinaemia need thyroxine replacement at the earliest or the treatment may as well be started, with proper follow ups, at about 6 weeks. Methods: An observational study was done during the period of July 2008 to June 2010 in the neonatal and postnatal unit of the Chittagong Medical College Hospital.It focuses on comparison of thyroid function (FT4 and TSH) between preterm and term neonates aged average 7 days with all samples collected after 5 days of life, the time when postnatal TSH surge disappears. One hundred (100) preterm and 50 term infants were selected by convenient sampling. Preterm infants were stratified by postconceptional age. FT4 and TSH estimation were done by the 3rd generation two site chemiluminesent immunometric assay. Serum levels of FT4 and TSH of preterm infants were followed after 6th week (45-50 days) of their age and were compared with their 1st samples (5-11 days). Results: The FT4 level correlated positively with gestational age (p<0.0001, n=150, r=0.61) and differed significantly between adjacent gestational age groups (p=0.0001). No significant differences were found in TSH levels of such age groups of the preterms. TSH level correlated positively with gestational age in the 1st samples but in the 2nd samples significant negative correlation was observed suggesting HPT axis maturity. In preterm neonates subgroup analysis showed highly significant difference in FT4 and TSH levels between 1st and 2nd samples. Conclusion: In preterm infants born at <28 weeks’ gestation, it usually takes more than one month for FT4 levels to reach level equal to those of term infants. In this study, FT4 levels were found to increase in all infants who had initial hypothyroxinaemia and did not receive thyroxine supplementation during the first 6 weeks of postnatal life. This indicates that thyroxine supplementation should be considered if free T4 levels are persistently low after the first 6 weeks of birth. Further studies are needed before clinical application of this finding.

Biography:

Salah Thabit Al Awaidy is a Communicable Diseases Adviser in Health Affairs, Ministry of Health, Oman. He is a medical doctor and holds a Master’s in Epidemiology. He is currently the adviser of Communicable Disease Surveillance, Elimination and Eradication of Communicable Diseases of Public Health Importance, EPI, vaccine supply chain system and IHR at the Ministry of Health, Oman. He was the Director of Communicable Disease Surveillance and Control at MoH, HQ, Oman between 1997-2011, IHR national focal point 2002-2013 and was a member in several of the professional committees namely: Strategic Advisory Group on Immunization (SAGE), WHO Geneva (2005-2007); Strategic Advisor Group on Vaccine and Store Management Training Courses (2005-2008), WHO Geneva; Strategic TB Advisory Board (STAG) 2007-2011 2014- till date. He also currently serves as IHR Emergency Committee on Polio and MERS-CoV. He has authored or been the co-author of over 35 publications on a large variety of health topics.

Abstract:

Oman has committed to the goal of eliminating measles, rubella and congenital rubella syndrome (CRS) by 2015 year. Elimination is defi ned as the absence of endemic measles and rubella transmission in a defi ned geographical area (e.g. region or country) for ≥12 months in the presence of a well-performing surveillance system and for rubella without the occurrence of Congenital Rubella Syndrome (CRS) cases associated with endemic transmission in the presence of high-quality surveillance system. Strategies to reach this goal included: a) vaccination supplemental activities with the goal of achieving high rates of vaccination coverage; and maintenance of coverage in order to increase population-wide and maintaining high vaccination coverage to increase population-wide immunity; b) syndromic surveillance programs to monitor fever and rash illness syndromes for eff ective detection of cases and serological surveillance; c) integrating these strategies into measles surveillance system; and) high-quality surveillance system, and sensitive for CRS. Measles and rubella was a leading cause of infant and child morbidity and mortality in Oman before the introduction of measles vaccine by 1975 and thereaft er until 1994. With the introduction of a second dose of measles and fi rst rubella vaccines (measles- rubella) in 1994, coverage for fi rst and second doses of measles and rubella vaccines increased more than 95% in 1996 and has been sustained at a level greater than >95% since then. A national measles and rubella (MR) immunization catch-up campaign targeting children ages 15 months to 18 years was conducted in 1994 that achieved 94% coverage. As a result, the incidence of measles and rubella have declined markedly in recent years, to ≤1 case per million persons in 2012 and to zero cases for measles and rubella in 2013 and onward. Similarly, no case of CRS has been notifi ed since 2007. Oman has made signifi cant progress toward measles and rubella elimination and has met the regional elimination goals. However, new challenges faced by Oman, for instance with increased globalization, has led to issues such as outbreaks from imported cases. Additional challenges still remain with regard to increasing identification and immunization of unvaccinated non-Omani workers and their families.

Biography:

Globally, pneumonia remains the leading cause of child-death more than combined AIDS, malaria and measles. Of all H. infl uenzae strains causing pneumonia in younger children, non-Hib (Hia, Hic, Hif) and non-typeable strains have started replacing b signifi cantly. Of some exsiting factors, popultion characterisitcs, child-bearing/rearing practices, housing and sanitation status remain plusible in contracting childhood-pneumonia. Th is paper describes some of such factors towards developing pneumonia in Bangladeshi children requiring immediate attention to resolve. Nasopharyngeal-swabs taken from 277 under-fi ve years pneumonic children in Dhaka Medical College Hospital (not receiving >1 antibiotic) were streaked onto supplemented chocolate-agar. Isolated colonies were serotyped and antimicrobial susceptibility were performed. While the mean age was 1.41±1.4 years, no age-specifi c gender diff erence was revealed (p>0.16). Clinically,157 children (69%) had pneumonia (Pnm) and 70 (31%) had Severe Pnm (SPnm) having the predominant signs of chest in drawing (p<0.04) and stop feeding-well than Pnm (p<0.001). While disease severity, was not assoicated with age-groups of <2, 2.1-12 & 12.1-60 months(p=0.26) a gender diff erence was observed: younger boys had SPnm more than girls (p<0.03). H. infl uenzae were isolated from 35.7% children (81/227), vast-majority being non-typeable (87.7%, 71/81) and 13.3% Hib (10/81) but Hin-types was not associated with disease severity (p>0.10). However, disease-severity was signifi cantly associated with colustrumrejection( p<0.02), bottle-feeding (p<0.04), non-vaccination (p<0.03) and some soico-economic/houshehold factors, like: tinned-roof-house (p<0.04), parental smoking (p<0.01) and cooking indoor on charcoal/wood-fi re (p<0.02). It is imparative that the aforementioned socio-cultural bariers and neglected child-caring/rearing practices as we evidenced should immediately be addressed towards preventing children from pneumonia- a potential public health issue. Further studies in this area are strongly recommend for better clarifi cations.

Abstract:

Globally, pneumonia remains the leading cause of child-death more than combined AIDS, malaria and measles. Of all H. infl uenzae strains causing pneumonia in younger children, non-Hib (Hia, Hic, Hif) and non-typeable strains have started replacing b signifi cantly. Of some exsiting factors, popultion characterisitcs, child-bearing/rearing practices, housing and sanitation status remain plusible in contracting childhood-pneumonia. Th is paper describes some of such factors towards developing pneumonia in Bangladeshi children requiring immediate attention to resolve. Nasopharyngeal-swabs taken from 277 under-fi ve years pneumonic children in Dhaka Medical College Hospital (not receiving >1 antibiotic) were streaked onto supplemented chocolate-agar. Isolated colonies were serotyped and antimicrobial susceptibility were performed. While the mean age was 1.41±1.4 years, no age-specifi c gender diff erence was revealed (p>0.16). Clinically,157 children (69%) had pneumonia (Pnm) and 70 (31%) had Severe Pnm (SPnm) having the predominant signs of chest in drawing (p<0.04) and stop feeding-well than Pnm (p<0.001). While disease severity, was not assoicated with age-groups of <2, 2.1-12 & 12.1-60 months(p=0.26) a gender diff erence was observed: younger boys had SPnm more than girls (p<0.03). H. infl uenzae were isolated from 35.7% children (81/227), vast-majority being non-typeable (87.7%, 71/81) and 13.3% Hib (10/81) but Hin-types was not associated with disease severity (p>0.10). However, disease-severity was signifi cantly associated with colustrumrejection( p<0.02), bottle-feeding (p<0.04), non-vaccination (p<0.03) and some soico-economic/houshehold factors, like: tinned-roof-house (p<0.04), parental smoking (p<0.01) and cooking indoor on charcoal/wood-fi re (p<0.02). It is imparative that the aforementioned socio-cultural bariers and neglected child-caring/rearing practices as we evidenced should immediately be addressed towards preventing children from pneumonia- a potential public health issue. Further studies in this area are strongly recommend for better clarifi cations.

Biography:

Abstract:

Aim: Perinatal detection of an abdominal mass in neonates often poses a diagnostic challenge. Neonatal abdominal masses include a broad spectrum of pathologies, with different organs that can originate such masses. The aim of this study was to review the diagnostic pathway, the treatment and outcome of neonates referred with a primary diagnosis of a palpable abdominal mass. Methods: Neonatal admission records were reviewed to identify all patients admitted to the Neonatal Surgical Unit with a primary diagnosis of a palpable abdominal mass over a five-year period (2008-2013). Data collected included demographics, perinatal history, radiological investigations, operative findings and complications. Results: Thirty one patients were identified. There were 16 (53%) girls. The abdominal masses were detected on antenatal imaging in 21(70%) and postnatally in 9. Twenty-two (73%) patients were otherwise asymptomatic, 4 had bilious vomiting, 1 had haematemesis and 3 had respiratory distress. All patients had an ultrasound scan postnatally as the initial investigation of choice with 30% requiring additional cross sectional imaging. In seventeen (57%) patients the mass was renal in origin with the most common underlying urological condition being posterior urethral valves in boys (4/9) and duplex kidney with ureterocele in girls (4/8). Half of these patients required urinary diversion in the neonatal period. For the extra-renal group (13/30); 5 patients (38%) had intestinal duplications and further 5 had tumours and three patients had ovarian cysts. The tumours were sacrococcygeal teratoma (2), hepatic haemangioendothelioma (2) and hepatoblastoma (1). Overall only 4 patients (13%) did not require surgery; this includes two with hepatic haemangioendotheliomas, one with ectopic kidney and one with polycystic kidney disease. Conclusions: Two thirds of the abdominal masses in neonates are diagnosed prenatally. One third of the patients will require further cross sectional imaging. Of the masses of urological origin posterior urethral valves is the commonest cause in males and duplex kidneys with ureterocele in girls. Half of the patients with a urological abdominal mass will require urinary diversion in the neonatal period. Overall, 87% of the neonates with a palpable abdominal mass will eventually require surgical intervention.

Biography:

Larry Olson is a child neurologist at Emory University and Children’s Healthcare of Atlanta with 30 years of experience in epilepsy surgery evaluations using EEG and neuroimaging. For the past 7 years he has had a major focus on using freely available software to improve on the sensitivity of conventional neuroimaging for epilepsy surgery, especially in common cryptogenic cases.

Abstract:

Epilepsy is the most common neurological disease in childhood, and fourth most common in adults. Up to 30% of cases cannot be controlled with medication. The most common cause of these medically refractory seizures is a focal cortical dysplasia (FCD), a localized region in the cortex where neuronal formation, migration or lamination is abnormal. These are often seen with high resolution MRI, and are easily resected with a cure rate of up to 85%. However FCDs are also very often “cryptogenic”- extremely small, subtle or inapparent on MRI. This talk will explore why conventional neuroimaging frequently fails, and the development of new methods of image processing which combine MRI and positron emission tomography (PET) in novel ways to expose otherwise invisible FCDs. This process permits successful surgical cures of an otherwise lifelong disease with a significant morbidity and mortality.

Biography:

Taosheng Huang is a physician-scientist. Currently he is a professor with tenure in Human Genetics, Director, Program of Mitochondrial Medicine, Associate Director of the Molecular Diagnostic laboratory at Cincinnati Children's Hospital Medical Center (CCHMC). Dr. Huang graduated from Fujian Medical University in 1983 and received his Ph.D. study at Mount Sinai Medical School in 1991. Dr. Huang completed his pediatrics residency at Georgetown University Hospital in 1996 and his clinical genetics and clinical molecular genetics fellowship at Harvard Medical School in 1999. Dr. Huang was a faculty member at the Children’s Hospital, Harvard from 1999-2001. In 2001, Dr. Huang moved to the University of California, Irvine as an independent investigator to study the molecular basis of genetic syndromes. Clinically, Dr. Huang is interested in mitochondrial disorders, genetic syndromes with congenital cardiac defects. He has been actively engaged in many programs in China. Dr. Huang is an honorable professor of Peking Union Medical School, a member of the special committee for Yusheng Yuyou of People’s Republic of China, advisory board member to Chinese Ministry of Health for targeted therapy and a principal investigator for birth defect control program of Chinese Ministry of Health.

Abstract:

Advances in next generation sequencing technology have resulted in a rapid increase in the molecular characterization of mitochondrial disease. Recent years, our laboratory has successfully used whole-exome sequencing to identify many novel disease causing genes associated with mitochondrial disease. The mitochondrial asparaginyl-tRNA synthetase (NARS2) mutations cause Leigh syndrome and nonsyndromic hearing loss (DFNB94). We found that some mutation can disrupt dimerization of NARS2 and decrease steady-state levels of mt-tRNAAsn without aminoacylation defects. The cells with NARS2 mutations also display impaired oxygen consumption rate and OXPHOS deficiency that can be rescued by overexpression of wild type NARS2. Recently, we found that recessive SLC25A46 mutations cause optic nerve atrophy and axonal peripheral neuropathy. SLC25A46, putative mitochondrial carrier gene, is human homologs of Ugo1p. Furthermore, we demonstrate the SLC25A46 role in mediating mitochondrial morphology in vitro and in vivo. In zebrafish we found that loss-of-function affects the development and maintenance of neuronal processes and causes abnormal mitochondrial fusion morphology. Our result show many disease causing genes associated with mitochondrial disease are yet to be identified and whole-exome sequencing is very cost-effective for this process.

Biography:

Huili has completed her PhD from Xi’an Jiaotong University in China and postdoctoral studies from Boston Children Hospital in USA. She is the Professor,Doctoral Supervisor,Division of Pediatrics and Neonatology, First Affiliated Hospital, Medical School,Xi'an Jiaotong University . She is the director of Division of Neonatology,Xi'an Children's Hospital,Affiliated Medical school,Xi'an JiaoTong University. She has published more than 60 papers in reputed journals and has been focusing on the behavior disorder of high risk infant by prenatal stress and neonatal health care and neonatal neurology. she has got 6 research projects from China's national natural science foundation.

Abstract:

Newborns show visual preference for their mother's face/voice to strangers. Maternal anxiety and depression during the pregnancy period could result in disorder of Hypothalamic -Pituitary -Gonadal Axis function .To determine correlation between newborns’ visual preference and maternal anxiety and depression and to examine the change of serum cortisol in mothers – newborns pairs.A total of 255 hospitalized pregnant women waiting for delivery have completed the 14-item Hamilton Rating Scale for Anxiety (HAMA) and the 24-item Hamilton Rating Scale for Depression (HRSD), among whom 101 met anxiety criteria(A group),34 met depression criteria(B group) and 120 met control criteria(C group). Within the postnatal 2 weeks, Neonatal Behavioral Assessment Scale (NBAS) was administered to the newborns’ social interactive behavior. The dependent variables were the duration of the infant's looking (measured in seconds) at the mother's face (sum of seconds of looking on the 2 trials) and at the female stranger with happy and warm face and soft voice. Radio immunoassay was used to detect serum cortisol .The score of social interactive behavior in A and B group were lower than that in C group（p<0.01）； the duration of the newborns preference the mother's face/voice was shorter than the female stranger （p<0.01） assoicated with higher serum cortisolin mothers – newborns pairs in A and B group（p<0.01）. Newborns could detect maternal symptoms of anxiety and depression assoicated with increased serum cortisol in mothers – newborns pairs.

Biography:

William Bonadio MD completed his MD at the age of 25 years from The Medical College of Wisconsin, and post doctoral residence at Cincinnati Childrens Medical Center. He has authored over 100 medical publications and frequently reviews articles submitted for publication

Abstract:

Background: There is controversy regarding whether children with perforated appendicitis should receive early appendectomy [EA] vs medical management [MM] with antibiotics and delayed interval appendectomy. Objective: To compare outcomes of children with perforated appendicitis who receive EA vs MM. Methods: Case review of consecutive children aged <18 years with perforated appendicitis who received either EA or MM during an 8-year period. Criteria for hospital discharge included patient being afebrile for at least 24 hours, pain-free, and able to tolerate oral intake. Results: Of 203 patients diagnosed with perforated appendicitis, 122 received EA and 81 MM. All received parenteral antibiotic therapy initiated in the ED and continued during hospitalization. There were no significant differences between groups in mean patient age, mean CBC total WBC count, gender distribution, rates of ED fever, or rates of intra-abdominal infection [abscess or phlegmon] identified on admission. Compared to patients receiving MM, those receiving EA experienced significantly fewer: 1] days of hospitalization, parenteral antibiotic therapy, and in-hospital fever; 2] radiographic studies, percutaneous drainage [PD] procedures, and placement of central venous catheters performed; 3] post-admission intra-abdominal complications; and 4] unscheduled repeat hospitalizations after hospital discharge. Only 1 EA-managed patient developed a post-operative wound infection. Conclusions: Children with perforated appendicitis who receive EA experience significantly less morbidity and complications vs those receiving MM. The theoretical concern for enhanced morbidity associated with EA management of perforated appendicitis is not supported by our analysis.