Day 1 :
Keynote Forum
Professor James Oleske
Rutgers New Jersey Medical School, USA
Keynote: Combining Touch with Technique: Fusing Technology with the Art of Medicine
Time : 09:30-10:10
Biography:
Dr. James M. Oleske, M.D., MPH, the François-Xavier Bagnoud Professor of Pediatrics at Rutgers New Jersey Medical School, Newark, NJ and Director Division of Pediatric Allergy and Immunology and Infectious Diseases. He graduated from the College of Medicine & Dentistry of NJ and received a MPH from Columbia University. He completed a Pediatric residency and a fellowship in Ambulatory Pediatrics at the Harrison S Martland Hospital in Newark, NJ and a National Cancer Institute fellowship at Emory University and CDC, Atlanta, GA. He is board certified in Pediatrics, Allergy and Immunology, Pediatric Infectious Diseases, Pain Management, Hospice and Palliative Care.
Abstract:
It does not take long walking through a modern hospital to appreciate how much the practice of medicine is influenced by advanced technology that impacts diagnosis and treatment as well as greatly enhancing overall patient outcomes. This technology has allowed us to increase diagnostic efficiency and accuracy as well as managing complex illnesses. However, these advances in diagnosis and medical/surgical management have sometimes led to a sacrifice in the patient-doctor relationship that has impeded patient’s perception of personal interaction and care leading to a climate of distance and distrust. Ultimately, if a patient is diagnosed correctly with minimal care and compassion, have we truly met our responsibilities as physicians? Lacking in the current teaching of medicine is often an explicit discussion of the importance of touch as a therapeutic modality rather than just a consequence of a thorough physical examination. Allopathic medicine would do well to incorporate the basic principles of osteopathic medicine’s emphasis on touch in the everyday practice of medicine. Physicians can provide compassionate care only when empathy is present, which is reinforced by direct contact with patients. Technology should be used to supplement, not replace, the physician-patient relationship. The great challenge in medicine is not in the learning of our professional skills, rather it is in its competent and compassionate administration within the confines of the modern medical world. Within the constant spectre of disease and its complications, our central role as physicians is to blend the technology to diagnose and treat with the compassion and imperative to relieve suffering and by doing so, adding to the joy of life.
Keynote Forum
Professor Raphael David
New York University School of Medicine, USA
Keynote: CONGENITAL ADRENAL HYPERPLASIA: AN UPDATE
Time : 10:30-11:10
Biography:
Dr Raphael David is working as a Full Professor at New York University, USA.
Abstract:
A historical perspective of Congenital Adrenal Hyperplasia (CAH) will encompass the evolution of diagnostics and therapies so as to put current clinical investigation and treatment into context. Recent advances in related genetic mutations for effective management will be discussed. Attendees will understand applicable adjunctive therapies such as Gonadotropin Hormone Agonists and Growth Hormone for effective care. Prenatal diagnosis and therapy including the use of cell free DNA will be reviewed.
Keynote Forum
Professor Lawrence Dean Frenkel
University of Illinois College of Medicine, USA
Keynote: THE PATHOGENESIS OF MICROCEPHALY RESULTING FROM CONGENITAL ZIKA VIRUS INFECTION: WHY IS OUR BABY’S HEAD SMALL?
Time : 11:10-11:50
Biography:
Lawrence D. Frenkel, MD is an academic pediatrician, infectious disease specialist, and immunologist who has devoted himself to clinical care, teaching, research and advocacy for children as well as to service to his colleagues, for over four decades. Dr. Frenkel graduated from the State University of New York at Buffalo in 1965, with a BA degree in Chemistry. He received his MD degree in 1969 from the Georgetown University School of Medicine and did a residency in Pediatrics at The New York Hospital/Cornell medical Center. He served in the US Public Health Service as Associate Medical Officer of the Clinical Center, National Institutes of Health. Thereafter he did a Fellowship in Immunology, Allergy and Pediatric Infectious Diseases at Georgetown. His past academic and clinical appointments include: Director of the Pediatric Infectious Diseases Division at the Medical College of Ohio, Director of the Division of Immunology, Allergy, and infectious Diseases and Director of the Pediatric Aids Program at the UMDNJ-Robert Wood Johnson Medical School, and Professor and Chairman of Pediatrics at the University of Illinois College of Medicine-Rockford. He was invited to visit, present research, teach, and lecture in over 50 countries. He has presented and published over 150 peer-reviewed papers and is himself an editor and reviewer for a score of renowned publications.
Abstract:
The main pathogens associated with congenital infection and affliction, with a focus on Zika virus, which are often manifest with microcephaly are briefly reviewed. Aspects of maternal infection are noted. The epidemiology and manifestations of infections in non-pregnant hosts, the pregnant woman, and in the fetus are described. The pathology of microcephaly is reviewed in detail with a discussion of the neuropathogenesis of congenital Zika virus infection. Further, the innate and adaptive immune mechanisms in the pregnant woman and fetus, including changes at the maternal-fetal interface and induction of fetal tolerance will be described. Finally hypotheses which might explain why: some infants are not infected in the presence of primary maternal infection, while others acquire subclinical infection, but still others are severely afflicted, are discussed. These hypotheses include pathogen strain differences, tropism to developing fetal tissues, the role of various subsets of maternal immunity, and aspects of fetal immune responses.
Keynote Forum
Dr James B. McCarthy
Pace University, USA
Keynote: Pediatric Psychotic Disorders and the Role of Psychotherapy
Time : 11:50:12:30
Biography:
He is working at Department of Psychology, Pace University New York University Child Study Center, New York, USA . His international experience includes various programs, contributions and participation in different countries for diverse fields of study. His research interests reflect in his wide range of publications in various national and international journals.
Abstract:
Psychotic symptoms are moderately widespread in child and adolescent psychiatric disorders and are somewhat frequent in children who have been the victims of maltreatment by adults. The incidence of discreet psychotic symptoms among children and adolescents in the United States is between 8% and 9% of the general population. Aside from psychotic symptoms associated with medical conditions, psychotic manifestations of severe mood disorders, such as Major Depressive Disorder or Bipolar Disorder have the greatest frequency in addition to the intermittent psychotic features associated with Posttraumatic Stress Disorder (PTSD) in highly traumatized children and youth. There have been groundbreaking advances in understanding the genetics, neurobiology, etiology and developmental course of psychotic disorders in children and adolescents as well as the appropriate utilization of antipsychotic medications. However, psychotic disorders often interrupt cognitive, social and emotional development in children and adolescents leading to noticeably compromised functioning. Several studies colleagues and I and other investigators have conducted suggest that children and adolescents with psychotic features associated with mood disorders have greater cognitive deficits than those who have mood disorders without psychotic features; in addition, cognitive and social declines in children and adolescents with schizophrenia have been well documented. Although there are developmental differences in the symptoms of psychotic disorders and there is considerable variability in the outcome of patients with pediatric psychotic disorders, there is a continuity of psychotic disorders from childhood to adolescence to adulthood. There is thus a critical need for research on the role of psychotherapy, supportive services and cognitive interventions that may help to improve the functioning of very high risk children and those with psychotic disorders. Individual psychotherapy approaches with psychotic children aim to improve reality testing, coping skills and anxiety tolerance while examining the stimuli for the exacerbations of their experience of stress and anxiety. Studies on family-based psychotherapeutic interventions consistently point to the need for supporting family members and their efforts to try to restore the psychotic child’s age-appropriate functioning.
Keynote Forum
Dr Usha Kini
Oxford University Hospitals, Oxford, UK
Keynote: GPI- Anchor pathway defects: implications for neurodevelopmental morbidity, congenital disorder of glycosylation, Mabry syndrome and Fryns syndrome
Time : 13:30-14:05
Biography:
Dr Kini is a Consultant Clinical Geneticist working at the Oxford Centre for Genomic Medicine in Oxford, UK. She also holds the position of Honorary Senior Clinical Lecturer in Clinical Genetics at the University of Oxford. Her research interest is in the genetics of birth defects such as congenital brain anomalies and orofacial clefting. She is the Chief investigator of the Genetics of Structural Brain abnormalities and learning disabilities study and is also the Clinical lead of the Oxford Brain Abnormlaties research group. Her group has successfully described several novel genes implicated in causing congenital brain anomalies.
Abstract:
Syndromic intellectual disability (ID) is predominantly genetic in origin. Currently, with the advent of next generation sequencing, an increasing number of novel genes and genetic developmental pathways causing syndromic ID are being identified; the GPI-anchor pathway is one such pathway. In mammalian cells, there are thought to be over 150 different proteins that are attached to the plasma membrane using a glycosylphosphatidylinositol (GPI) anchor. This diverse family comprises receptors, adhesion molecules and enzymes and is critical for normal neuronal and embryonic development. The GPI anchor is synthesised and remodelled in a complex series of biochemical reactions that occur either in the endoplasmic reticulum or golgi apparatus, and at least 30 genes are known that encode components of this pathway. The clinical significance of this pathway was first demonstrated in 1993 when somatic mutations in PIGA were shown to be the underlying cause of paroxysmal nocturnal haemoglobinuria. Recessive mutations in genes in the early part of this pathway are associated with multiple congenital abnormalities, developmental delay and sometimes a reduced life span. Recessive mutations in the later part of the pathway result in global developmental delay, intellectual disability, seizures, microcephaly, facial dysmorphism and brachytelephalangy. This is often accompanied by raised levels of serum alkaline phosphatase and has been termed ‘Hyperphosphatasia Mental Retardation syndrome (HPMRS)’ or Mabry syndrome. Recently, several genes within this pathway including PIGV, PIGO. PGAP2, PGAP3 and PIGY have been shown to cause these phenotypes. Biallelic PIGN mutations have been shown to cause Fryns syndrome – a multiple congenital anomaly syndrome associated with a reduced life span. Genotype-phenotype correlation and the contribution of GPI-anchor biogenesis towards developmental disorders is under further investigation.
- General Pediatrics | Pediatric Neurology | Neonatal/Pediatric Intensive & Critical Care | Pediatric Cardiology | Pediatric Endocrinology | Pediatric Gastroenterology | Pediatric Psychology | Pediatric Pulmonology | Pediatric Rheumatology
Session Introduction
Dr Gerald Katzman
Wayne State University School of Medicine, USA
Title: The bioethics and neuropsychology of children learning to hate or help and pursue violent or non-violent resolution of conflict
Time : 14:05-15:05
Biography:
Dr. Gerald Katzman received his MD degree from the Wayne State University School of Medicine in 1968. He served a Pediatric Residency at the University of Chicago and the Children’s Hospital of Michigan. After serving two years as a physician in the US Navy, he completed a fellowship in Neonatal-Perinatal Medicine at Temple University Hospital. Clinical positions have included Director of Nurseries at The Toledo Hospital, Chairman of Pediatrics at Sinai Hospital of Detroit and Chief of Pediatrics at Detroit Riverview Hospital. Dr. Katzman has been a Clinical Associate Professor of Pediatrics at the Wayne State University School of Medicine since 1986. He received the designation of Certified Physician Executive by the American College of Physician Executives. In recent years, Dr. Katzman has developed an interest in the teaching of hatred to children and the potentially violent actions that result from such indoctrination. Potential solutions to this problem have been suggested in a series of papers dealing with the subject. Explaining the psychodynamics of hatred development through an emphasis on recent understandings in neuropsychology has been a particular focus of these publications.
Abstract:
Learned hatred in childhood leads to violent speech and subsequent violent actions. The process often begins with authoritarian parenting. The fear and anger evoked by such treatment is projected onto socially endorsed targets. These targets are developed through false narratives that are repeatedly espoused in authoritarian societies. The resultant violent actions are further facilitated by the stifling of emotional empathy that results from coercion and intimidation. Authoritative parenting characterized by discipline through reasoning offers a healthy alternative. The trust that develops between parent and child can be used to model caring behaviors inside and outside the family. Sharing stories with a moral and that teach a lesson promote the incorporation of virtues and the avoidance of vices. The emotional empathy that results is the catalyst for acts of compassion. Resistance to adverse influences and promotion of initiatives that support tolerance and appreciation of individual differences are more likely when parents and societies key in on enhancing the moral development of children. Restricting moral development through a planned program of indoctrination to militancy is mental maltreatment. By exposure of children to an atmosphere where reason has been emphasized over might, non-violent resolution of conflict is an attainable result.
Biography:
Dr Alia Chauhan is an Associate director Pediatric hospital Medicine at Southside Hospital, NY and Assistant professor of Pediatrics & Family Medicine Residency Program, North well-Zucker School of medicine at Hofstra University. She is a Preceptor for family medicine residents of Southside & Peconic bay family medicine residency programs, Touro College PA program. She has mentored residents for publications, research & QI projects and poster presentations at national level. In acknowledgement of her work with FMRP she is awarded with honorary title of Assistant professor of FMRP by Zucker School of Medicine in 2014. She is recently awarded an Out Standing Physician Award by Medical Staff at Southside hospital-2017. She has special interest in pediatric hyperlipidemia and have multiple publications on this subject, she published:
- Book chapter on Hyperlipidemia and Xanthomas The Color Atlas of Pediatrics, Usatine, Lippincott Williams & Wilkins, published in November 2014.
- Manuscript, Update on Pediatric Hyperlipidemia, Current Opinion in Pediatrics, published March 2014.
- Disorders of childhood growth and development, Precocious puberty
FP- Essentials AAFP, published 2013 Jul; 410:25-31.
- Clinical Column, Guidelines on Pediatric Hyperlipidemia,
Family Doctor, Healthy living, NY chapter of AFP, published in September 2013. She presented her QI/ Research work about bilirubin at American academy of Pediatrics National conference in Sanfrancisco 2017, and at STFM (Society of Teachers of Family medicine) Annual conference in Orlando, 2015.
Abstract:
Purpose of review: The purpose of this study is to review NHBLI guidelines on screening and management of Hyper lipedema in children, and discuss critics and their concerns regarding universal screening. Recent Findings: Among young adults, ages 12 to 19 years, 20.3 percent have abnormal lipids; boys are more likely than girls to have at least 1 lipid abnormality (24.3% versus 15.9%, respectively). Several studies have shown that atherosclerosis begins in childhood and can lead to coronary heart disease in adults. They have also demonstrated a strong correlation between pediatric hyperlipidemia, carotid intimal thickening, and cardiovascular events in adults. Such as The Young Finns study, The Princeton– Lipid Research Clinics follow up Study etc( detail findings will be discussed). The study by the US Centers for Disease Control and Prevention have shown a favorable trend in serum Lipid among children and adolescents aged 6years to 19 years, between (1988-1994) and (2007-2010) Mean total cholesterol decreased from 165 mg/dl to 160 mg/dl, and the prevalence of elevated total Cholesterol decreased from 11.3% to 8.1%.In the view of prevalence of obesity 1 in 6 adolescents and mean TC decreasing, is universal screening an appropriate step? In the view of multiple studies, discussion will lead towards existing controversies. Management will be discussed including recommendations about universal screening, 2010 Dietary Guidelines for Americans Cardiovascular Health Integrated Lifestyle Diet and medications. Summary: The guidelines provide clinicians with necessary evidence and balanced perspective to make their own informed judgment in implementation of these recommendations. Schematic approach provided by NHBLI commissioned Expert Panel will help Primary care physicians with screening and proper dietary & drug therapy. It will eventually decrease cost on health system by early identification & intervention. Key words: Hyperlipidemia, Cardiovascular, Familial hypercholesteremic, Estimated Energy Requirement, Body Mass Index, Low density lipoprotein, high density lipoprotein.
Dr Gábor Veres
Semmelweis University, Hungary
Title: Adherence to the porto criteria in the diagnostic procedure in hungary based on the data of hungarian pediatric IBD registry (HUPIR)
Time : 15:50-16:15
Biography:
Gabor Veres, MD, PhD, Dsc, Med. Habil. is a Professor of Pediatrics at the Semmelweis University, Budapest, Hungary. He is the President of the Hungarian Paediatric Gastroenterology Society, Deputy director, and Head of the Gastroenterology Unit of Ist Dept. of Paediatric Clinic in Budapest. Currently, he is a member of ESPGHAN Porto Group (2007-) and was a Committee member of Paediatric ECCO from 2013 to 2016. He was a Committee member of ESPGHAN and UEG, and Education secretary of ESPGHAN from 2013 to 2017. He organized the Hungarian Paediatric IBD Registry (HUPIR) in 2007 and published 174 peer-reviewed papers and 13 book chapters mainly in the field of paediatric IBD.
Abstract:
Introduction: Despite the continuous research efforts, the exact ethiology of chronic inflammatory bowel diseases (IBD) are still largely unknown. The incidence of pediatric-onset IBD is constantly growing in Hungary. It is of note however, that the necessary evaluation of the cases according to the Porto criteria are not always conducted completely (to do upper endoscopy, entering to the terminal ileum, and evaluation of small intestine involvement with imaging techniques, preferably with MRI). Aim: The Hungarian Pediatric IBD Registry (HUPIR) is a nationwide database for prospectively registering pediatric IBD cases. The aim of our study was to evaluate the changes in adherence to the Porto criteria in the diagnostic evaluations over time according to the data of HUPIR. Results: The average incidence rate of pediatric IBD was 8.4/100 000 between 2007 and 2016. According to the data collected in HUPIR, the incidence rate elevated by 23% in this period (from 7/100 000 to 9.1/100 000). The incidence rate of Crohn’s disease elevated from 4.2/100 000 to 5.7/100 000 (26%), and the rate for colitis ulcerosa changed form 2.1/100 000 to 2.7/100 000 (22%). The diagnostic procedure adhered completely to the Porto criteria only in 27% of the cases in the first year, but this rate improved to 46% by 2015. The frequency of illeocolonoscopic evaluation improved from 51% to 88%, in addition, the rate of upper endoscopy increased from 51% to 87% in the same period. Diagnostic assessment of the small intestine with imaging techniques was conducted in 46% of the cases registered in HUPIR. Conclusions: Based on the evaluation of data of HUPIR, the diagnostically adherence to Porto criteria grew approximately two fold in the last eight years. This improvement should be multi-factorial, but HUPIR must have a significant role in the process. Our positive experiences could stand as an example for countries where nationwide registry for IBD is not yet established.
Dr Iwona Ben-Skowronek
Medical University of Lublin, Poland
Title: Effect of associated autoimmune diseases on type 1 diabetes mellitus incidence and metabolic control in children and adolescents
Time : 16:15-16:40
Biography:
Iwona Ben-Skowronek has completed her PhD at the age of 25 at the Medical University of Lublin and she conducted postdoctoral studies in this University. She is the Head of the Dept. Pediatric Endocrinology and Diabetology, Medical University in Lublin. She has published more than 55 papers in reputed journals and has been serving as an editorial board member of repute.
Abstract:
Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases developing in childhood. The incidence of the disease in children increases for unknown reasons at a rate from 3 to 5% every year worldwide. The background of T1DM is associated with the autoimmune process of pancreatic beta cell destruction, which leads to absolute insulin deficiency and organ damage. Complex interactions between environmental and genetic factors contribute to the development of T1DM in genetically predisposed patients. The T1DM-inducing autoimmune process can also affect other organs, resulting in development of additional autoimmune diseases in the patient, thereby impeding diabetes control. The most common T1DM comorbidities include autoimmune thyroid diseases, celiac disease, and autoimmune gastritis; additionally, diabetes can be a component of PAS (Polyglandular Autoimmune Syndrome). The incidence of type 1 diabetes in the syndromes is 4-18% in PAS-1, 60% in PAS-2, and 14,5% in PAS-3. Although clinical manifestations of the disease are usually observed in the third decade of life, the first symptoms may appear in childhood. Therefore, every pediatrician should know PAS symptoms, especially in relation to multiple autoimmune comorbidities accompanying type 1 diabetes The aim of this review is to assess the prevalence of T1DM-associated autoimmune diseases in children and adolescents and their impact on the course of T1DM. The author also presents suggestions concerning screening for other autoimmune diseases indispensable in subjects with diagnosed type 1 diabetes
Biography:
Inas mahfouz has completed her PhD at the age of 30 years from cairo University. She is the organizer of pdiatric medical awareness conference in Egypt inside and outside, one of the pulmonology team in national research centre, was resident of pediatric in pediatric hospital cairo university. She has published more than 5 papers in reputed journal.
Abstract:
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation, Acupuncture is one of complementary and alternative medicine modalities and is a key component of traditional Chinese medicine (TCM), Laser acupuncture is one of interesting modalities of low-level laser therapy (LLLT), a noninvasive form of phototherapy. The present study is a randomized clinical trial done on sixty asthmatic children under conventional medical treatment divided randomly in to 3 groups. Group A: Twenty children were subjected to laser Acupuncture session three times per week for four weeks, group B twenty patients using needle acupuncture sessions for 1 month (3times / week) and group C (control group) under conventional medical treatment only. Measuring Pulmonary functions of the patient and assess their use of medications before and after the study and Assessing of the clinical condition of the patient (frequency of attack and severity of asthma). Pulmonary function at follow up were higher in group A than group B and in group B than C the differences were statistically significant in VC cent (A: p<0.001, B: p=0.002 and C: p=0.626) FVC cent (A: p<0.001, B: p<0.001 and C: p=0.516) and PEF cent (A: p=0.016, B: p= 0.044and C: p= 0.432), however in medications used there were a statistically significant different in group A (p=0.004) more than in group B (p=0.017) and C (p=0.490), Frequency of asthmatic attack diminished in group A (p<0.001) more than in group B (p= 0.002) and least in group C (p=0.147) at the end of the study, Clinical severity of group A significantly improved (p<0.001) than group B and C, so we can say that application of laser or needle acupuncture sessions beside conventional medical treatment results in more improvement of the pulmonary functions, Frequency of asthmatic attack and reduces the medications used
Dr Laura Reigada
Brooklyn College , USA
Title: Analysis of anxiety symptoms and disease severity in children and adolescents with crohn’s disease
Time : 17:05-17:30
Biography:
Laura Reigada is an Associate Professor at the City University of New York at Brooklyn College and faculty in the Health Psychology and Clinical Science doctoral program at the Graduate Center. She is a licensed clinical psychologist and an Adjunct Assistant Professor in the Department of Pediatrics at Icahn School of Medicine at Mount Sinai. Her research focuses on early identification and treatment of medical patients who are at increased risk for comorbid psychological problems, with emphasis on the dynamic interplay between psychological and disease processes. Her research aims to increase multidisciplinary collaboration within the medical setting to enhance detection and treatment.
Abstract:
Objectives: Children and adolescents diagnosed with Crohn’s disease (CD), a type of inflammatory bowel disease (IBD), have increased vulnerability for anxiety symptoms that may be related to disease-related processes. The aims of this paper are threefold: 1) to report the proportion of pediatric CD patients whose self-reported anxiety symptoms are indicative of distress; 2) to describe the constellation of anxiety symptoms; and 3) to examine the relationship between anxiety and disease symptoms. Methods: Retrospective medical chart review was performed for 93 youths with CD (ages 9-18) who had completed the Screen for Child Anxiety Related Disorders (SCARED) during their gastroenterology visit. Medical records were reviewed for demographic and disease characteristics. Harvey Bradshaw Index (HBI) was used as a measure of CD activity. Results: Thirty percent of the youths reported experiencing elevated anxiety symptoms (SCARED score >20) and 50% had scored above cutoff in one or more anxiety domains, with school anxiety, general anxiety, and separation anxiety symptoms reported most frequently. Youth rated with moderate/severe disease activity on the HBI (n=4) self-reported more anxiety symptoms compared to youth with inactive disease (n=78; p=.03). Greater school anxiety was significantly associated with decreased well-being (p=.003), more abdominal pain (p<.001), and the number of loose stools (p=.01). Having extraintestinal symptoms was significantly associated with higher somatic/panic anxiety (p=.01). Conclusions: Implementing a brief anxiety screen in tertiary pediatric settings may be one approach to identify young patients with CD in distress. Health providers should consider periodic assessment of school anxiety among youth with CD.
Dr Keyur K. Mehta
Nicklaus Children’s Hospital, USA
Title: Cerebral abscess in a septic toddler with an undiagnosed superior sinus venous defect
Time : 17:30-17:55
Biography:
Dr. Mehta completed his MBBS from Grant Medical College, Mumbai and residency from SUNY Downstate Medical Center, Brooklyn NY where he was also chosen as a Chief Resident and received awards for research and excellence in pediatric education. He is currently a second year cardiology fellow at Nicklaus Children’s Hospital in Miami. He has presented his research work at various national and international conferences.
Abstract:
Cerebral abscess is most commonly seen in the first two decades of life. Approximately 90% of brain abscess result from extra-cardiac infections (sinusitis, mastoiditis and otitis media). Cardiac causes of cerebral abscess are generally related to left sided bacterial endocarditis and congenital cyanotic cardiac lesions. We report an unusual case of a less than 2 years old patient who presented with urinary tract infection, who developed brain abscess, and subsequently was diagnosed with an acyanotic cardiac defect. A 17 months old uncircumcised male with an unremarkable past medical history presented to a community hospital with fever, vomiting, diarrhea and lethargy. A full work up was performed and the patient was diagnosed with Citrobacter Koseri urinary tract infection (UTI). The patient was started on the appropriate antibiotics. However, his fever persisted and he developed a dysconjungate gaze. An immediate MRI demonstrated multiple cerebral abscess. The patient was transferred to Nicklaus Children’s Hospital and underwent an emergent endoscopic exploration of the left cerebral ventricular system with washout and placement of an external drain. A transthoracic echocardiogram was performed and revealed a moderate superior sinus venous defect (SVD) with partial anomalous pulmonary venous return (PAPVR) of the right upper and middle veins to the superior vena cava, there was right atrial and ventricular dilatation. The patient received 6 weeks of antibiotics and showed excellent recovery of his motor and cognitive function. After completing medical therapy, the patient underwent a successful two patch repair of the SVD and PAPVR and was discharged on third post-operative day. This case illustrates an uncommon association between cerebral abscess and acyanotic heart disease. Cardiac imaging either transthoracic or transesophageal echocardiogram are invaluable in the assessment of brain abscess with suspected hematogenous spread.
Dr Araxi Balian
University of Milan, Italy
Title: Class II non-extraction treatment with intermaxillary elastics using aligners versus standard multi-brackets appliances: a comparative study
Time : 18:20-18:45
Biography:
Dr. Balian achieved her Dental Degree (DDS) at the University of Padua, Italy in 2011. She has completed a 3-yr Orthodontics residency program at the Dental Clinic of San Paolo Hospital, University of Milan, Italy and she was awarded the MS degree in Orthodontics in 2015. Dr. Balian is currently Consultant in Pediatric Dentistry and Orthodontics at the Dental Clinic of ASST Santi Paolo e Carlo Hospital, University of Milan and Clinical Instructor at the Master of Interceptive Orthodontics, University of Padua. She is author of several national and international publications and winner of the 2016 International Align Research Award.
Abstract:
Class II malocclusion is a major and common challenge clinicians face in daily practice, as it affects more than one third of adolescents seeking orthodontic treatment. Most of Class II malocclusion presents a normal or at least a slightly altered skeletal pattern with mild-to-moderate anteroposterior occlusal discrepancy, which can be successfully treated with non-extraction orthodontics supported by intermaxillary elastics. It is claimed that Invisalign aligners (Align Technology, Inc., San José, CA, USA) can effectively correct Class II malocclusion when the total amount of anteroposterior discrepancy is within 4-5mm. Even though Invisalign has become a popular treatment choice for clinicians because of the aesthetics and comfort of the removable clear aligners (RCA), there is a general lack of research. Moreover, the majority of research have investigated the feasibility of Invisalign in producing single specific movements rather than evaluate the overall outcome of the treatment of a given malocclusion. The purpose of the present study was to evaluate the Class II non-extraction treatment outcomes of Invisalign supported by intermaxillary elastics and to compare with those observed in a control group treated with standard multi-brackets appliances. Statistical comparison has been carried out to assess post-treatment outcomes of the two groups, as well as to determine differences regarding patients’ complaints and compliance during orthodontic therapy.
Dr Francesca Rusalen
University of Padua, Italy
Title: Perinatal palliative care: a dedicated care pathway
Time : 18:45-19:10
Biography:
Francesca Rusalen has her expertise in paediatric pallitive care and pain management in children. She is involved in the creation of care dedicated pathways for newborns and chiildren with life-limiting and life-threatening diseases She works and researchs fpr the Italian University Hospital in Padua and collaborates in the Paediatric Task Force of the European Association of Palliative Care (EAPC).
Abstract:
In recent years there has been a progressive increase in premature babies, with simultaneous increase of their survival, as well as that of infants with incurable disease. Increased diagnostic-therapeutic potential, even invasive, has strongly contributed to this trend, but at the same time has increased the risk of therapeutics excitement and/or disproportion with a consequent emerging need to define eligible populations for perinatal palliative care (NPC), as well as the need to define a shared pathway for their application. The creation of a shared NPC pathway, within the Maternal-Infant Department should ensure access to NPC to all eligible fetuses/infants/parents; to ensure, as much as possible, the adequacy and quality of care provided, also identifying the most appropriate place of care; to monitor the effectiveness and efficiency of the care pathway, through specific indicators. In a tertiary facility, a multidisciplinary work-group (GdL) was formed, consisting of all the professional staff involved in the process management in order to create a shared care path for NPC. Work Foreword was the literature review, including ethical and regulatory reference documents. 12 GdL meetings were carried out, leading to the creation of a shared document on the NPC pathway and its flow chart. Effectiveness and efficiency indicators were then defined for tracking the application of the care pathway itself. At the end of the work, the document was then presented to the leaders involved for discussing the application criticalities.The NPC is an emerging field within the pediatric palliative care and, as such, calls for the development of dedicated and shared pathways to ensure accessibility and quality of care.
Dr Kun Soo Lee
Kyungpook National University School of Medicine, Republic of KOREA
Title: ITP, IVIG and I
Time : 09:00 to 18:00
Biography:
I graduated from KNU School of Medicine in 1973, completed pediatric residency in 1978 and received Ph.D. in 1988. I started an instructor at same KNU in 1981 and retired in 2014. I studied hematology/oncology subspecialty at Division of Pediatric Hematology/Oncology, UCLA, LA, USA. Almost 200 articles have been published. I performed as a President of the Korean Society of Hematology (2002-3), Pediatric Hematology/Oncology (2003-4), BMT (2007), Medical Genetics (2009-11), Pediatrics (2012), internationally Asia Hematology Association (2013~), East Asia Hemophilia Forum (2013), and Advisor of Advanced Neuroblastoma Research Association (2010~). I received a Korea President Award Certificate in 2009.
Abstract:
The main reason for intravenous immunoglobulin G (IVIG) treatment in acute phase of immune thrombocytopenic purpura (ITP) is prevention of possible life-threatening hemorrhage since 1981. On the 1st trial, I just followed the dose of 400 mg/kg/d of IVIG for 5 days for 8 patients with good result in 1983-1984 (Korean J Pediatr. 28:483-491, 1985). On the 2nd, I stopped medication when platelet was over 100,000 /μL for 73 in 1985-1993. Mean treatment days were 2.8 days. The relapse and chronic ITP was less developed in rapid responders (RR: 1-3 treatment days) than in slow responders (SR: more than 3 days) (P<0.05) (Korean J Hematol 2001;36:241-6). On the 3rd, I also stopped medication when the platelet was over 50,000 /μL for 68 in 1993-2001. Mean treatment days were 2.9 days. Seven of 28 RR and 6 of 8 SR were chronic type (p=0.016) (Korean J Hematol 2001;36:247-52). On the 4th, I reduced daily dose to 200 mg/kg/d when the platelet was over 50,000/μL for 26 in 2005-2006. Average 2 days treatment were needed to increase the platelet count 50,000/μL. Although all 10 non re-treat group who were follow-up over 6 months were acute, all 3 re-treat group who were follow-up over 6 months were chronic (p<0.003) (Clin Pediatr Hematol Oncol 2006;13:143-9). No one died with 4 studies. The IVIG dose was different according to one’s clinical response. In some patient only 1/10 of usual doses (2 g/kg) were sufficient to reach a safe platelet counts in usual life.
Dr Gao Weiwei
Guangdong Province Hospital for Women and Children Health Care, China
Title: Early HHHFNC versus NIPPV for primary respiratory support in preterm infants
Time : 19:10-19:35
Biography:
Prof. Gao Weiwei has completed her MBBS from SUN YAT-SEN University of Medical Science and PHD from JINAN University. She is the consultant of Neonatal Department, Guangdong Province Hospital for Women and Children Health Care, Professor of Pediatrics, Guangzhou Medical University. Tutor of International postgraduate Paediatric Certificate, Westmead Children’s Hospital Sydney University. Her research interests are respiratory support and lung protection in newborn, particularly in premature and critical ill infants. She has been active in researches for invasive and non-invasive mechanical ventilation
Abstract:
Background and Objective
There are limited data to inform the choice between early treatment with heated humidified high-flow nasal cannulae (HHHFNC) and early treatment with nasal intermittent positive pressure ventilation (NIPPV) as the initial support for preterm infants with respiratory distress syndrome(RDS).The objective was to assess the efficacy and safety of HHHFNC compared with NIPPV for preterm infants with RDS in our NICU.
Methods
In this prospective trial, infants, who were born between 28 weeks 0 days to 36 weeks 6 days of gestation, were randomized to HHHFNC or to NIPPV treatment initiated in the neonatal intensive care unit. The primary outcome was the incidence of intubation, defined as the need for intubation within 72 hours or within 7 days.
Results
A total of 208 infants were enrolled in the study. The incidence of intubation did not differ significantly between the two groups. The relative risks (RR) for the primary outcome of incidence of intubation within 72 hours or 7 days were 0.89 (95% CI, 0.37 to 2.11; p=0.79) and 0.00 (95% CI, 0.00 to 0.00), respectively. The rate of bronchopulmonary dysplasia in each of the two groups was similar (RR 1.49; 95% CI, 0.24 to 9.08; p=0.67). The rates of other adverse neonatal outcomes did not differ significantly between the two groups.
Conclusion
HHHFNC is an alternative to NIPPV for the early treatment of respiratory distress in preterm infants.
Dr Mohammed Beshir Yesuf
Jimma University Medical Center, Ethiopia
Title: Typhoid Glomerulonephritis in a child: A rare complication of typhoid fever
Time : 18:45-19:10
Biography:
Dr. Mohammed Beshir Yesuf is a pediatrician with interest in pediatric nephrology & Assistant Professor in Jimma University Medical Center. I graduated from jimma University medical school, Ethiopia
Abstract:
One of the unusual manifestations of typhoid fever is Typhoid glomerulonephritis and accounts for about 1% of its extra intestinal complications of typhoid fever. Although 25% of patients excrete Salmonella typhi in the urine during the acute illness, renal complication may result from diverse pathophysiological mechanisms. The severity of acute glomerulonephritis due to typhoid fever is variable; generally, it resolves completely with treatment of typhoid fever but occasionally it may be fatal.
Here we report a 10 year old male child with typhoid glomerulonephritis who presented with fever, abdominal pain, edema and hypertension. Urine examination showed microscopic hematuria and proteinuria. Salmonella typhi was isolated from a blood culture. Renal biopsy was not performed. The child recovered completely with treatment.