Day 1 :
CHU de Québec-Université Laval, Canada
Time : 09:15 AM
Bolduc has completed his urology residency at Université Laval and completed a fellowship in pediatric urology at The Hospital for Sick Children in Toronto. He is chief of pediatric urology and the director of Regenerative Medicine of CHU de Québec Research Center. He has published more than 70 papers in reputed journals and has been serving as section editor of pediatric urology of CUAJ.
Overactive bladder (OAB) is a highly prevalent disorder in the pediatric population. This condition is especially troublesome for pediatric patients and their families when associated with incontinence since it negatively affects self-esteem and impairs children’s development. A stepwise approach is favored to treat this pathology, starting with behavioral therapy, followed by medical management, and eventually more invasive procedures.
Antimuscarinic agents are the mainstay of medical treatment for OAB. Oxybutynin is the most commonly used antimuscarinic in the pediatric population. However, some patients have a suboptimal response to antimuscarinics and many experience bothersome side effects. Although there have been reports about the use of tolterodine, fesoterodine, trospium, propiverine and solifenacin in children, to date, only oxybutynin has been officially approved for pediatric in most countries.
However, patients with severe OAB symptoms seem not to always respond adequately to oxybutynin. After failure with a first pharmacologic molecule, most practitioners will try a more specific anticholinergic. We have already studied various options to treat children with non-neurogenic refractory OAB, namely trying a different antimuscarinic (tolterodine, fesoterodine, or solifenacin) as well as combining two different anticholinergic. Despite favorable results with these options, they remain unapproved for pediatric use and other therapeutic avenues are therefore worth investigating.
Mirabegron a new molecule with a distinct mechanism of action (β3-adrenoreceptor agonist), has recently been approved as monotherapy for idiopathic OAB in adults, but it has not been studied in the pediatric population. We recently concluded on two open-label studies to explore its efficacy and safety in children. It appears as a safe and effective alternative for children with idiopathic OAB refractory to antimuscarinics, in monotherapy or in association with antimuscarinics (add-on dual therapy).
The different therapeutic alternatives reported could be included in a management algorithm for intractable OAB symptoms in children, but the need for prospective randomized controlled studies prior to official approbation is to be acknowledged.
Pennsylvania State University, USA
Keynote: Rare complications of common injuries in children: Diagnosis and treatment of traumatic bile leaks (TBL) after blunt liver injury and pleural effusions (PlEf) after blunt splenic injury
Time : 10:30-11:10
Selective non-operative management of hemodynamically stable pediatric trauma patients with blunt liver or spleen injury is the standard of care. Traumatic bile leaks (TBL) may complicate liver injury. TBL occurred in 294 patients with blunt hepatic trauma. Symptoms of increasing abdominal pain, distension, nausea and vomiting 3 to 7 days after injury were suggestive. Hepatobiliary scanning was diagnostic. Combinations of peri-hepatic drain placement, ERCP with biliary stenting and/or sphincterotomy were performed with successful resolution of all TBL. Median resolution was two weeks. No child required surgical repair of the leak. Cholangitis developed in one child. There were no long-term complications. A multidisciplinary and minimally invasive approach employing peri-hepatic external drainage catheters and ERCP with sphincterotomy and stenting of the ampulla is a safe and effective management strategy for TBL in children. Pleural effusion (PlEf) as a complication of blunt splenic injury is not well described in children. Of 274 non-operatively managed pediatric blunt splenic injures, 12 patients (4.4%) developed left-sided PlEf. Seven of 12 patients required tube thoracostomy for worsening pleural effusion and respiratory insufficiency. Median time to diagnosis of pleural effusion was 1.5 days. Length of stay was 4 days for those without and 7.5 days for those with pleural effusions (p<0.001) and 6 and 8 days for those pleural effusions managed medically or with tube thoracostomy (p=0.006), respectively. In multivariate analysis, high-grade splenic injury (IV-V) (OR 16.5, p=0.001) was associated with PlEf. Some symptomatic patients may be successfully managed medically, while many require tube thoracostomy for progressive respiratory symptoms.
University of Johannesburg, South Africa
Keynote: The need for early childhood interventions for orphans and vulnerable children: An African perspective
Time : 11:10-11:50
Jace Pillay completed his PhD in 1996 at the Rand Afrikaans University in South Africa. He is the South African Research Chair in Education and Care in Childhood. He has published more than 25 papers in reputed journals and has been serving as an Editorial Board Member of two highly reputable international journals. His research has been presented in numerous international conferences.
In the last decade, there has been a significant escalation in the number of orphans and vulnerable children in various parts of the world, more particularly, in Sub-Saharan Africa. The author strongly asserts that early childhood intereventions, particulary in the fields of health and education, are essential to address the plight of orphans and vulnerable children (OVC) in order for them to develop skills and human capital as future adults in order to break the cycle of poverty. Adopting the bio-ecological systems and social justice theoretical models, the author presents his current research findings on the educational, psychological and social experiences of OVC in South Africa. He argues that African governments should take on the responsibility of addressing the plight of OVC through early childhood interventions if they are serious about economic sustainability and prosperity. However, government cannot do this on its own so the joint collaboration of local communities and stakeholders will be necessary from an African perspective. Based on the findings of the study, the author challenges the rigorous application of the medical model and several western theories to children within the African context. In conclusion, several recommendations are made for the enhancement of the physical and mental health as well as the education and care of OVC during their early childhood years. Although the research discussed in this paper was conducted in South Africa, the author believes that the findings could easily depict what happens worldwide since OVC are prevalent even in the wealthiest of countries.
- Pediatric Surgery
Pediatric Emergency Medicine
Mercer University School of Medicine, USA
Title: A pair-matched case control study of family-environmental factors associated with ADHD in Chinese children
Time : 12:50-13:20
Xianming Carroll has completed her MPH and PhD from Heinrich-Heine University Düsseldorf, Germany. She is Research Assistant Professor at Mercer University School of Medicine in the US. She has published several papers in peer-reviewed journals and has been serving as an Editorial Reviewer of journal Plos One.
Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders, affecting an estimated 5 to 12% of school-aged children worldwide. Approximate 15 to 19 million Chinese children suffer from ADHD. The objective of this study was to investigate the association between family-environmental factors and ADHD in a sample of Chinese children. A pair-matched, case-control study was conducted with 161 ADHD children and 161non-ADHD children of matching age and sex, all from 5-18 years of age. The ADHD subjects and the normal controls were all evaluated via structured diagnostic interviews. We examined the association between family-environmental factors and ADHD using the conditional multiple logistic regression with backward stepwise selection to predict the associated factors of ADHD. Having experienced emotional abuse and being a single child were both significant factors associated with children diagnosed with ADHD. ADHD subjects were more likely to have suffered from emotional abuse (OR=11.09, 95% CI=2.15-57.29, P=0.004) and have been a single child in the family (OR=6.32, 95% CI=2.09-19.14, P=0.001) when compared to normal controls. The results were not modified by other confounding factors. Our findings provide evidence that family-environmental factors are associated with ADHD among children in China. These findings, if confirmed by future research, may help to decrease ADHD by increasing the awareness of the effects of childhood emotional abuse.
Cairo University children’s hospital, Eygpt
Time : 13:20-13:50
I am professor of pediatrics and neonatology in Cairo University. I was graduated in 1994, had my Master degree in pediatrics in 1998 and doctorate degree in pediatrics in 2001. I am an international board certified lactation consultant since 2004 (got the highest score in Egypt). I am a board member of Lactation education accreditation and approval committee in USA, which provides approval and accreditation to all breastfeeding programs allover the world. I have 21 published scientific papers (7 are pubmed cited: Tomerak RH, Tomairek RH)
Breast milk is the white blood containing almost all the factors essential for the physical, physiological and psychological maturity of the preterm infant. Its function represents a continuum of the placental function. Preterm infants are inevitably deprived of the placenta in late pregnancy so the human factor should fight to provide the baby with this white blood; the breast milk. This needs a tight strategy to be mastered by the authorized personnel in the NICU. The policy should include the guidelines of milk expression, storage, transfer and providence to the baby. Promotion of the kangaroo mother care is an important adjuvant. Proper counselling of the mother is also of utmost importance together with the post discharge support of the mothers to continue breastfeeding.
Shanghai Jiaotong University School of Medicine, China
Title: Title: Decreased yes-associated protein 1 (YAP1) expression in pediatric hearts with ventricular septal defects
Time : 13:50-14:20
Jinfen Liu has completed his MD at the age of 25 years from Shanghai Jiaotong University School of Medicine. He is the director of Shanghai Pediatric Congenital Heart Disease Institute, Member of World Pediatric Heart Surgery Management Commitee, Member of American Association for Thoracic Surgery, and Chairman of the standing committee of Chinese pediatric surgery. He has published more than 104 papers in reputed journals and has been serving as Associate Editor of World Journal for Pediatric & Congenital Heart Surgery. (Up to 100 words)
Background: Ventricular septal defects (VSDs) are the most common and simplest type of congenital heart diseases (CHDs). Animal studies have suggested that the downregulation of Yes-associated protein 1(YAP1) during embryonic development causes VSD- associated CHDs. However, how YAP1 contributes to isolated VSD (iVSD) is unclear.
Methods and Results: Twenty right atrial specimens were obtained from iVSD patients during routine congenital cardiac surgery and we assessed YAP1 expression in these specimens. For controls, six right atrial specimens were obtained from normal hearts of children without heart disease, three of whom died from cerebral palsy, and three who underwent heart transplants. YAP1 mRNA and protein levels and nuclear localization were significantly reduced in iVSD specimens compared to normal heart specimens. Concomitantly, mRNA levels of YAP1 downstream targets CTGF and AXL were also significantly decreased in iVSD specimens. Although Ki67-positive cardiomyocytes in iVSD specimens were comparable to normal heart specimens, Ki67-positive non- cardiomyocytes were significantly decreased.
Conclusions: YAP1 expression was markedly decreased in hearts of iVSD children. Given the important role of YAP1 during heart development, downregulation of YAP1 expression may contribute to iVSD and affect the proliferation of non-cardiomyocytes.
University of Pittsburgh Medical Center, USA
Time : 14:20-14:50
Alana Jaye Coleman is a nurse who has completed her degree at the University of Pittsburgh. She has over fifteen years of experience in the Neonatal Intensive Care Unit (NICU) caring for infants born with Congenital Diaphragmatic Hernia. She was honoured by The American Association of Colleges of Nursing (AACN) for her prestigious work done within this cohort. She is currently the Clinician of the NICU at the Children’s Hospital of the University of Pittsburgh Medical Center. She is a published first author in the Journal of Pediatric Surgery and continues to sponsor research studies and speak nationally.
A Research Journey- Enhancing the Management of Congenital Diaphragmatic Hernia (CDH) reflects at how one institution has evolved over time and increased survival in this distinct population. The journey was inspired by a nurse who wanted to make a difference after losing a patient to this terrible birth defect. A quality improvement study (QI) was sponsored to look at the current management of CDH patients to see if a change in practice needed to be made. At the completion of the study, a unanimous decision amongst pediatric surgery and neonatology was made to change current management to entail gentle ventilation, permissive hypercapnea, spontaneous respiration and delayed repair approach. A multidisciplinary team emerged to develop a protocol. After implementation of the protocol, the team continued to monitor, modify and explore its success. Six Institutional Review Board (IRB) studies have been sponsored, multiple poster and podium presentations have been given throughout the United States and Canada, and one article was published in the Journal of Pediatric Surgery. A Research Journey will provide specific details on the interventions, management and outcomes that have not only enhanced care but increased survival rate. The protocol starts prenatally, from the time of diagnosis and ends with discharge from the Neonatal Intensive Care Unit. Specific patients with low Magoon Indexes and inadequate total lung volumes, who are not candidates for ECMO, are discussed. Throughout the years we have learned you cannot save them all, but you can find redemption in the fight to try.
Necmettin Erbakan University Faculty of Medicine, Turkey
Time : 14:50-15:20
Professor Mehmet Emre Atabek has completed his PhD at the age of 37 years from Erciyes University and postdoctoral studies from Selcuk University School of Medicine. He is the director of Pediatric Endocrinology, a premier pediatric endocrinolgy and diabetology service organization. He has published more than 120 papers in reputed journals. He has been interested in searching metabolic problems of obese children in most of his articles. His articles have been cites more than 1100 citations so far.
Obesity is a risk factor for several metabolic complications. Impaired blood glucose regulation and metabolic syndrome are the most frequent of these complications.The aim was to investigate the impact of utilising different criteria on the prevalence of metabolic
A hundred and fourty three obese children and adolescents aged between 8-17 recruited in the study. Metabolic syndrome was defined using International Diabetes Foundation (IDF) and World HealthOrganisation (WHO) definitions.
In obese patient , 68 (47.6%) were male with a mean age of 12,22± 2,34 , 75 (%52.4) were female with a mean age of 12,59± 2,45. 112 (78.3%) of all patients were pubertal. Using WHO criteria, 80 (55.9 %) were newly diagnosed metabolic syndrome. Using IDF criteria, metabolic syndrome was present in 65 (45.5%) patient.
The prevalence of metabolic syndrome, and diabetes in children and adolescent is increasing. In our study we have noted a higher prevalance of metabolic syndrome with WHO criteria.
Guangdong Women and Children Hospital and Health Institute, China
Title: Management for intradiaphragmatic extralobar pulmonary sequestration-Pediatric thoracoscope surgery postnatal and prognosis
Time : 15:40-16:10
Hongchun is Pediatric Surgeon in Guangdong Women and Children Hospital and Health Institute. He completed Master of Medicine from Guangzhou Medical College. He is the Director of Pediatric Thoracic Surgery. His team worked in the field about Fetal Medicine, especially for birth defect and pediatric surgery postnatal (Complete Video-Assisted Thoracoscopic Surgery) especial for respiratory system, like CCAM and BPS. He has published more than 20 papers in reputed journals.
Here we report the largest series of patients with IDEPSs in all bronchopulmonary sequestration cases from March 2011 to Sep 2015 (17cases) and analysis of the surgical treatment.
Purpose: To evaluate the surgical management of intradiaphragmatic extralobar pulmonary sequestration (IDEPS): Complete video-assisted thoracoscopic surgery (cVATS), video-assisted mini-thoracotomy surgery (VAMT) and thoracotomy.
Methods: We retrospectively reviewed cases of bronchopulmonary sequestrations (BPS) diagnosed in our hospital from March 2011 to Sep 2015, in order to identify patients with IDEPS. Diagnosis of IDEPS was confirmed using prenatal doppler ultrasound, postnatal intravascular enhanced computed tomography, and surgery. Experience of surgical treatment was summarized by comparing the cVATS, VAMT and thoracotomy.
Results: The 17 cases diagnosed with IDEPSs were confirmed with histopathology. In our first case, we did not find any mass from abdominal surgery, and then we turned to transthoracic surgery. 6 patients underwent thoracotomy, and 6 cases underwent cVATS; 4 cases underwent VAMT. All surgeries succeeded. MRI prenatal showed a homogeneous mass (2.72 x 2.38 x 4.24 cm) between the diaphragm and the left kidney. It demonstrated high signal intensity on FIESTA and low signal intensity on FIRM. The margin of mass was still clearly defined. Flow empty phenomena were detected. The left adrenal gland was compressed and displaced downward. CT postnatal showed the mass behind the liver, upon the kidney.
Conclusions: IDEPS is a rare type in BPS. It would be better to approach through the chest. Thoracoscopy is safe and effective by experienced surgeon.
Dr.Erik Thaulow is a Professor at the University of Oslo, Department of Pediatrics and has been Head of Section for Congenital Heart Disease for 15 years. He has published several papers on the topic and has two times been part of the committee producing the ESC Guidelines on GUCH. He has been active in congenital heart disease (CHD) for 30 years .He has organized the GUCH-care at the University Hospital and served as Chairman of the Working Group for Adults with CHD in the ESC
There are essentially few restrictions given for exercise in congenital heart disease (CHD). Severe pulmonary hypertension, arrhythmias and risks of sudden drop in cardiac output are the most important factors. In addition some disease (Marfan) collision should be avoided in order to reduce the risk of aortic rupture. A survey on Norwegian children revealed that exercise was very infrequently related to mortality in CHD. It is more important to encourage these patients to be active and also participate in sports than give instructions to avoid sports. Exercise testing is important in individuals both to identify the few in whom exercise should be performed with great care, but most important, to demonstrate to the patient and the family (which should witness the exercise) that exercise activity is safe. Echocardiography done during exercise has been applied in order to study pulmonary hypertension during exercise. This is most often a research tool, but has also in some cases turned out to be of clinical importance. Physical training programs have been applied in CHD. Studies performed conclude that this is safe, there is some increase in oxygen uptake, and activity monitoring has revealed that the effect of such programs is mostly to give the participants greater participation in daily life physical activities. There are several guidelines on exercise in CHD. They should be known by physicians treating CHD patients, but the most important factor is to investigate the individual patients and encourage them to be physically active.
Southern Medical University, Wuhan, China
Title: Treatment of pediatric traumatic intracranial pseudoaneurysm using endovascular covered stent: Three case reports
Time : 16:40-17:10
Peng Liu got his MD & PhD degree of Neurosurgery in 2011 from Southern Medical University. He also has been a Post-doctoral Visiting Professor at Department of Biomedical Engineering of State University of New York at Stony Brook, USA. He is the Associate Professor of Department of Neurosurgery of Wuhan General Hospital of Guangzhou Military Command in Southern Medical University. His clinical skills includes cerebrovascular surgery (endovascular treatment of intracranial aneurysms, ateriovenous malformation and fistula, endovascular treatment of spinal vascular diseases, endovascular treatment of cerebral ischemic diseases, clipping of intracranial aneurysms, total resection of AVMs, craniocerebral injury surgery and neuro-oncology surgery.
Background: Pediatric traumatic intracranial pseudoaneurysm (TIPA) is a relatively rare clinical entity resulting from blunt, penetrating or iatrogenic head trauma. The diagnosis, management and prognosis of patients with pediatric TIPA is not well-understood. Surgical craniotomy for TIPA is a high-risk operation. Advancements in minimally-invasive technology have allowed for endovascular reconstruction of TIPA.
Case reports: We present our experience with use of endovascular covered stents for treatment of three pediatric cases with TIPA. The clinical and radiological characteristics are presented. No procedure-related complications or deaths occurred during follow-up.
Conclusions: In this study, the use of Willis covered stent was associated with favorable prognoses in 3 patients with TIPA. No major complications were encountered during follow-up. The Willis covered stent appears to be a viable therapeutic modality in these patients. A definitive prognosis assessment will necessitate prospective clinical trials with longer duration of follow-up.
Pontificia Universidad Católica de Chile, Chile
Time : 17:10-17:40
Alejandro Gonzalez is Anesthetist who performed a Fellow in Pediatric Anesthesia at Melbourne, Australia, in 1999. Since then, he has been working in Pediatric and Outpatient Anesthesia. He was Director of an Ambulatory Surgery Center for five years (2001-2005), and he also was President of The Chilean Society of Anesthesiologists (2007-2009). He has published several papers about outpatient anesthesia and pediatric anesthesia.
Introduction: Parents feel fear and anxiety before elective surgery is performed on their child, and those feelings could obstruct their preparation for surgery. Pre-operative information could relieve those feelings.
Objective: To determine the preoperative information needs of parents of children undergoing elective surgery.
Patients & Method: A study was conducted on parents of children who underwent elective surgery. Demographic data of parents were recorded. Preoperative information received or would like to have received was assessed in terms of contents, methods, opportunity, place and informant. Descriptive statistics were used.
Results: Thirteen hundred parents were surveyed. More than 80% of them want preoperative information about anesthesia, surgery, preoperative fasting, drugs and anesthetic complications, monitoring, intravenous line management, pain treatment, postoperative feeding, anxiety control, hospitalization room, recovery room and entertainment in recovery room. Most want to be informed verbally, one to two weeks in advance and not on the same day of surgery. The informant should be the surgeon and in his office. In addition, they want information through leaflets, videos and simulation workshops, or guided tours.
Conclusions: Parents need complete preoperative information about anesthesia, surgery and postoperative care, received verbally and in advance.
Bahir Dar University, Ethiopia
Time : 17:40-18:10
Biniam Ayele graduated from University of Gondar as a Medical Doctor in 2012. Currently he is working as a Physician and Lecturer at Felegehiwot Referral Hospital and Bahir Dar University respectively. He is also a 3rd year Surgical Resident at Bahir Dar University.
Volvulus refers to torsion of a segment of the alimentary tract, which often leads to bowel obstruction. The most common sites of volvulus are the sigmoid colon and caecum. Volvulus of other portions of the alimentary tract, such as the stomach, gallbladder, small bowel, splenic flexure and transverse colon are rare. Patients with a caecal volvulus are young, with a mean age varying from 33 years in India to 53 years in Western countries. In contrast, sigmoid volvulus usually occurs in elderly subjects with chronic constipation or distal colon obstruction. The common presentations are colicky abdominal pain, abdominal distention, constipation/obstipation and depending on vascular status, the patient may be febrile and tachycardic. Here I present a case of cecocolic volvulus involving cecum, ascending colon, transverse colon and distal ilium in a 13 years old girl after she presented with colicky abdominal pain, distension, failure to pass feces and flatus for 3 days. She had also previous history of similar complaint but was self-limiting. She was febrile and tachycardic. Diagnosis was made by plain abdominal x-ray which showed air fluid level. She was prepared and operated and intraoperative finding was 360 degree clockwise rotated right colon and transverse colon along its mesentery which was ischemic and the whole large bowel was mobile and redundant with its own long mesentery. We extended right hemicolectomy and iliotransverse anastomosis. The patient was followed for 1 week in the ward and discharge improved. Now she is being followed in the surgical referral clinic. Details of the pathology, diagnosis and management will be discussed.
Hubei Maternal and Child Health Hospital, China
Xiaoyan Wang has completed her PhD at the age of 23 years from Shanxi Medical University .She has been a developmental pediatrician for nearly 20 years in Hubei Maternal and Children Health Hospital . Treatment specialties include: nutritional diseases (anemia, rickets, malnutrition, lead poisoning, loss of appetite, difficulty feeding, etc.), sleep disorders, high-risk children early intervention and potential development of infants and young children, growth retardation (intelligence, language, etc.), short stature, children's psychological clinic (ADHD, learning difficulties, tic disorder, autism, mood disorders, obesity, enuresis, etc.) of counseling, intervention and treatment, published more than 20 papers.
Background: Bone mineral density (BMD) increases progressively during childhood and adolescence and is affected by various genetic and environmental factors. The aim of this study was to establish reference values for lumbar BMD in healthy Chinese infants and young children and investigate its influencing factors.
Methods and Findings: Healthy children aged 0 to 3 years who underwent regular physical examinations at the Child Health Care Clinic of Hubei Maternal and Child Health Hospital (N = 11,898) were recruited for this study. We also chose 379 preterm infants aged 0 to 1 years to preliminarily explore the development of BMD in this special population. BMD (g/cm2) measurements of the lumbar spine (L2–L4) were carried out with dual-energy X-ray absorptiometry and a questionnaire was administered to full-term children’s parents to gather information on various nutritional and lifestyle factors as well as mothers’ nutritional supplement use during pregnancy. Lumbar BMD significantly increased with age among both boys and girls (p,0.05), with fastest growth observed during the first postnatal year. There was no significant difference in lumbar BMD between boys and girls of similar age (p.0.05), either among healthy reference children or preterm infants. However, BMD values in preterm infants were significantly lower than those in term infants 3 to 8 months old (p,0.05) after adjustment for gestational age. Multivariable linear regression analysis indicated significant positive associations between lumbar BMD of healthy children and the child’s age and current weight, mother’s weight gain during pregnancy, birth weight, children’s outdoor activity duration and children’s physical activity duration.
Conclusion: Our study provides reference values of lumbar BMD for healthy Chinese children aged 0 to 3 years and identifies several influencing factors.
Hiroshima University, Japan
Dr. Kunimoto had graduated from Wakayama Medical College at 1987 and completed his Ph.D. study at 1994. He is an Otolaryngologist. He had presented many study about upper respiratory diseases, focal infection on tonsil, cancer related Epstein-Barr virus and immune response analysis using molecular biological technique at that time. Recently, he has had an office in Hiroshima city since 2004, and now former chairperson of Asa Otolaryngology and member of management committee of Hiroshima Otolaryngology. Additionally, he had also belonged to Hiroshima University since 2004.
In 2014, an update to a meta-analysis of heptavalent pneumococcal conjugate vaccine (PCV7) effects on acute otitis media (AOM) was reported in the Cochrane collection and one of major conclusion was that the PCV7 had modest beneficial effects in terms of changes in AOM episodes and total number of visits to medical institutions by children. We have same results in Japanese children using the Japan Medical Data Center Claims Database. The Japanese guidelines for AOM in children recommend classifying AOM by age, manifestations and local findings. Myringotomy is recommended for moderate-grade cases with severe local findings, severe-grade cases, and treatment-resistant cases. We have previously conducted a retrospective multicenter study in the Asa Area of Hiroshima City, Japan to investigate changes in the number of myringotomies performed to treat AOM after public funded inoculation. The myringotomy rate per child-year in <5-year-old children decreased by 29.1% in 2011 and by 25.2% in 2012 compared to the mean rate performed in the 3 years prior to the introduction of public funding in the multicenter study. Our results suggest the public benefit of PCV7 in reducing the AOM morbidity with less financial burden of myringotomy. And we have studied about those subjects with the big data based on the Japan Medical Data Center Claims Database. Our results show that this vaccine may help prevent AOM from aggravation with severe clinical manifestations.
B P Koirala Institute of Health Sciences (BPKIHS), Nepal
Dr Shipra Chaudhary has completed her MD Pediatrics & Adolescent Medicine from B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. She is presently working as Assistant Professor in Department of Paediatrics, BPKIHS, Dharan.
Background: Twins, compared to singletons, have higher perinatal mortality and morbidity. The aim of this study is to describe the twinning rate, epidemiological variables and hospital outcome of twin deliveries at this institution.
Methods: We evaluated retrospectively the outcome of 92 twin pregnancies during one year study period (1st Jan 2014 to 31st Dec 2014). Only inborn twins were included. Cases with <28 weeks gestation and those twins delivered outside institution were excluded. Maternal and neonatal data were retrieved and statistically analysed.
Results: The twinning rate was 9.2/1000 (92/10,031). The mean birth weight was 1636.30 ±339.21 grams and mean gestational age 34.31±2.67 weeks. One hundred eighty-two babies (98.9%) were Low Birth Weight (LBW) while 32.1% were Small for Gestational Age (SGA). There was mild, moderate and severe growth discordance in 68.5%, 23.9% and 7.6% respectively. Three (3.26%) of 92 pairs had twin to twin transfusion syndrome. The mortality rate was 10.87% (20/184). Out of 181 live babies, 69 (37.5%) had complications. The clinical causes of death were hyaline membrane disease (3.3%), severe birth asphyxia (2.7%), sepsis (1.6%) and congenital malformations (1.6%).
Conclusion: Twin deliveries are common in this hospital and need special consideration due to their substantial higher risk of complications and thereby consumption of relatively large proportion of resources before, during and after birth. Preparedness, early management and follow-ups are required for better management of twin infants in our part.
Keywords: Low Birth Weight (LBW), Preterm, Small for Gestational Age (SGA), Twins, Twin to twin transfusion syndrome (TTTS)
Amir Manouchehri has completed his DDS at the age of 25 years from Kerman dental university in Iran. He was he director of university research community. He has done several presentations in multiple domestic and international congresses.
Routine expansion screws produced heavy interrupted forces witch are unfavorable for dental movement and could be harmful to tooth structures. In vitro evaluation of a new expansion screw showed that this new screw could produce light-continuous forces.
The purpose of this study was to compare clinically the new expansion appliance with routine 3.axis expansion appliance in terms of dental arch changes and patient’s problems during treatment.
38 patients (8-14 years old) with bilateral posterior cross bite and skeletal growth potential were selected. They were randomly divided to two groups: 1) new expansion screw group. 2) 3.axis expansion screw group.
The expansion removable appliances were delivered to the patients. The measurements of dental arch dimensions on study models and requiring of patient’s problems by questionnaires were accomplished every month. For comparison the two groups t-test and Mann-Whitney U-test statistical analysis were used.
Results: There were no significant difference between two groups in terms of mean increase in intermolar, inter premolar and intercanine widths (p> 0.05). the mean score of problems during usage of appliances in two groups was not significantly different (p>0.05 ).
Conclusion: Since the changes in dental arches and problems of patients with new expansion appliance were comparable to 3.axis expansion appliance and need less cooperation of patient for activation of screw, this new expansion screw can replace routine expansion screws.
Zaid Rasheed Al-Ani is a professor of pediatrics completed his Bachelor of Medicine from Basrah University, southern Iraq, in 1978, and Arabic Board of Pediatrics specialty (CABP) from Baghdad University in 1992. He is a senior teaching staff in Anbar College of Medicine teaching pediatrics for undergraduates and DCH & CABP postgraduates, and senior consultant pediatrician in Al-Ramadi MCH Teaching Hospital since 1993. He is the project designer and director of the "Western Iraq Center for Congenital Anomalies Registry and Surveillance" (WICCARS) of Al-Ramadi city, and member of different Discussion Committees in DCH, CABP, and PhD theses, published more than 11 papers in reputed journals, and an editor and reviewer of many researches published in different international Journals.
Objectives: To Study the risk of maternal overweight and obesity on congenital anomalies (CAs) using the expected prepregnancy weight and body mass index (EPPBMI) calculated from postpartum weight.
Methods: By deciding a four difference factors, one for low, normal, overweight, and obese pregnant mothers as 60% of the corresponding weight gain during pregnancy, and subtracting every factor from its corresponding postpartum weight, to calculate the corresponding EPPBMI in cases and controls, to study the risk of overweight and obesity on CAs in these types, applied retrospectively on mothers examined in the birth defect center of Al-Ramadi city at 2010. For every case mother, two mothers producing healthy neonates selected randomly as controls. Calculated EPPBMI of cases compared with controls to study the risk of gestational obesity on CAs using Odd's ratio and relevant 95% Confidence interval.
Results: Overweight and obesity was more in postpartum weight and calculated EPPBMI of cases than controls. Both obesity and overweight found a risk factor for development of CAs. Obesity found a risk for development of VSD, ASD, congenital hip dislocation, hydrocephalus, meningomyelocele, cleft lip & palate, and Down's syndrome, while overweight found a risk factor for ASD.
Conclusion: Calculation of the EPPBMI from the postpartum weight is simple, and make studying the risk of maternal obesity on CAs easy in areas with absent or late visiting antenatal care mothers. Overweight and obesity proved a risk factor for CAs. Social education about early antenatal care and alertness for complications of gestational obesity, and the application of the prepregnancy health care system is important to reduce the prevalence of CAs.