Day 1 :
Thomas Jefferson University, USA
Time : 09:30-10:05
Samir K Ballas received his MD with distinction from the American University of Beirut-Lebanon in 1967. He completed his training in Hematology at Thomas Jefferson University in Philadelphia, Pennsylvania. He is Board Certified in Internal Medicine, Hematology, Blood Banking, Pain Medicine and Pain Management. He is currently Emeritus Professor of medicine and Pediatrics at Thomas Jefferson University and honorary staff member of HEMORIO, the Hematology Institute in Rio de Janeiro, Brazil. He has authored or co-authored over 800 articles, book chapters and abstracts. He also published two editions of a Book on sickle cell pain in 1998 and 2014 respectively.
Sickle cell disease (SCD) is the most common genetic disease globally and sickle cell anemia (SCA) is its most common and mostrnsevere form. Over 300,000 children are born each year with severe SCD mostly in Africa and about 80% of these have SCA. In the USA there are about 100,000 patients with SCD most of whom have SCA. The phenotypic expression of these disorders and their clinical severity vary greatly among patients and longitudinally in the same patient. They are multi system disorders and influence all aspects of the life of affected individuals. The clinical manifestations of SCD are extremely variable and include four distinct sets of (1) pain syndromes, (2) anemia and its sequelae, (3) organ failure, including infection and (4) co-morbid conditions. Some of these complications can have devastating potentially fatal consequences if they are unrecognized. However, acute episodes of pain commonly referred to as vaso-occlusive crises (VOC) are the hallmark of SCD and dominate its clinical picture throughout the life of patients and they are the most common cause of hospital admissions. The intermittent nature and acuity of these VOCs made the emergency department (ED) the obvious and most important site of care. Most hospital admissions for patients with SCD are for patients that come through the ED. This presentation will briefly review the common complications of SCD and their management that occur sequentially from infancy to adulthood with emphasis on dactylitis, infections, splenic sequestration, stroke, VOCs, acute cheat syndrome and organ damage.
Prof. Dr. Amin El-Gohary completed his MBBCh in 1972 and his Diploma in General Surgery in 1975 at Cairo University, Egypt. He became a fellow of The Royal Collegernof Surgeons in UK: Edinburgh in 1979, London in 1980, and Glasgow in 1997. Prof. Dr. Amin worked initially in Egypt, then moved to Kuwait, then to UK, before coming tornUAE in 1983. In the same year, he became the Chief and Head of the Department of Pediatric Surgery of a large government hospital. Additionally, he held post as a MedicalrnDirector for the same hospital starting 1989. He was appointed as Chief Disaster Offi cer during Gulf War in 1991. He also held post as the Clinical Dean of Gulf MedicalrnCollege, Ajman for 3 years. Prof. Dr. Amin is well known in Abu Dhabi for his extensive interest and involvement in scientifi c activities. He is the President of the PediatricrnSurgical Association of UAE. He was awarded the Shield of the College of Pakistan in 1996 and the Medal of International Recognition in pediatric urology from the RussianrnAssociation of Andrology in 2010. He was given a Silver Medal from the Royal College of Surgeons – Ireland in 1978 and an Honorary Fellowship from the Royal Collegernof Surgeons – Glasgow in 1997. In 2001, he became a Visiting Professor at Munster University, Germany. Prof. Dr. Amin is a member of several associations in pediatricrnsurgery: Executive Member of the International Society of Intersex and Hypospadias Disorder (ISHID), British Association of Pediatric Surgery, Egyptian Association ofrnPediatric Surgeons, Asian Association of Pediatric Surgeons, and Pan African Association of Pediatric Surgery. He is also the founder and member of the Arab Associationrnof Pediatric Surgeons. Prof. Dr. Amin has an intensive academic and teaching experience, has written several publications in distinguished medical journals, and has madernseveral poster and paper presentations in national and international conferences. Currently, he is an external examiner for the Royal College of Surgeons.
Gohary’s disease is a new phenomenon that has not been described before. It depicts a group of children who present to emergencyrndepartment with severe agonizing abdominal pain. Th e pain tends to start and ends abruptly, no predisposing factor andrnrecurs aft er minutes or hours. Ultrasonography revealed mesas at right iliac fossa, which is usually diagnosed as intussusception.rnTh e underlying cause of such phenomenon is the fecal impaction of stool at terminal ileum which acts as intermittent intestinalrnobstruction. We have encountered 19 cases over the last 5 years, their age varied from 9 months to 8 years with the majority underrnthe age of 2 years. Th e cadinal symptoms and signs are severe abdominal pain that warrants urgent attention, empty rectum onrnexamination and ultrasound diagnosis of intussusceptions. All these cases were managed by fl eet enemas with immediate response.rnAwareness of this condition will help to avoid unnecessary investigation and unjustifi ed exploration.
- General Pediatrics
Neonatal Intensive Care
University of Minnesota, USA
Time : 11:00-11:25
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.
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.
Children’s National Medical Center, USA
Time : 11:25-11:50
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.
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.
University of North Texas Health Science Center, USA
Time : 11:50-12:15
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.
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.
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 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.
Latifa Hospital-Dubai Health Authority, UAE
Title: Neonatal assessment in the delivery room: Trial to evaluate a specified type of Apgar (TEST-Apgar)
Time : 13:40-14:05
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.
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.
Chittagong Medical College Hospital, Bangladesh
Title: Sensitivity pattern of micro organisms of septicemia in neonatal intensive care unit of tertiary hospital, Bangladesh
Time : 14:05-14:30
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.
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.
Richmond Chest Hospital, South Africa
Title: Effects of meconium aspiration in new born in developing countries in - Sub Saharan African perspective - How much HIV/AID’s contributes
Time : 14:30-14:55
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.
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.
Fazle-Omar Hospital, Pakistan
Time : 14:55-15:20
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.
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.
University of the East Ramon Magsaysay Memorial Medical Center, Philippines
Title: Dunstan baby language efficacy in decreasing the parenting stress levels of housewives with 0-2 month old infants vs. standard care using a Quasi-Experimental Study Design
Time : 15:20-15:45
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.
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.
Gulf Medical University, UAE
Title: Emergence of multidrug resistance Enterobacter sepsis in a neonatal tertiary care setting: A three year study
Time : 16:05-16:30
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.
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.
Indira Gandhi Institute of Child Health, India
Time : 16:30-16:55
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.
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.
AIMST University, Malaysia
Title: Comparative insights on clinico-epidemiological and bacteriological features of pneumonia among Bangladeshi and Malaysian children: Does socio-economic status matter?
Time : 16:55-17:20
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.
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.
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.
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 [email protected] 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 [email protected] 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.
University of Arkansas for Medical Sciences and Baylor College of Medicine, USA
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.
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.
Case Western Reserve University, USA
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
University of Warmia and Mazury, Poland
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
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.
Children’s National Health System, USA
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.
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.