Day 3 :
- Pediatric Emergency Medicine
Lady Hardinge Medical College & Associated Hospitals, India
Time : 09:30-10:00
Dr Gautam Bir Singh completed his post-graduation in Otolaryngology - Head & Neck surgery  from Pt Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. He also underwent short term training at AIIMS, New Delhi. He is currently working as Professor at Lady Hardinge Medical College & Associated Hospitals, New Delhi. Prof Gautam Bir Singh has 48 indexed international publications to his credit and has presented/co-presenter 18 scientific papers and 25 posters at various national/international conferences. He is also an Editorial Board Member: Journal Clinics in Surgery- Otolaryngology Otolaryngology & Heighpubs Otolaryngology and Rhinology
Objective: Aim of this study is to determine the minimum age, influencing factors and prognostic significance of tympanometric volume for paediatric tympanoplasty type I in a select age-group of five to eight years.
Methods: A prospective study was conducted in 30 children with chronic suppurative otitis media-inactive mucosal disease of either sex. The contralateral ear was taken as a measure of eustachian tube function. Pre-operative tympanometric volume was recorded in all the cases and statistically analyzed with the graft uptake results post-operatively. All the patients underwent tympanoplasty type I by underlay technique using temporalis fascia graft. An intact graft at the end of six months, and a postoperative hearing improvement of 10 dB or greater in two consecutive frequencies, was regarded as surgical and audiological success, respectively. The statistical analysis was done using Mantel HaenszelX2 i.e. Chi square test, and Fisher exact p value test for confirmation.
Results: We recorded an impressive surgical success rate of 87% and an audiological improvement of 70% in this study. No significant role for eustachian tube was found in this study. On the basis of mean tympanometric volume of 1.6 cm3, the patients were divided into two groups: Group A (tympanometric volume<1.6 cm3), and group B (tympanometric volume>1.6 cm3). A graft uptake of 95% and 77% was recorded in group A and B respectively. However, the statistical evaluation of the data revealed no significant effect of this factor.
Conclusions: We observed that graft uptake results are comparable to adults in paediatric patients as eustachian tube has no distinct role. In this study, no correlation between the tympanometric volume and the surgical success of paediatric tympanoplasty in selected age group of 5-8 years was observed.
Title: Study of hospital acquired infections in ICUs with special reference to the PICU in a new tertiary care health set up in North Eastern India
Time : 10:20-10:50
Anil Chandra Phukan has completed his MD (Medical Microbiology) from Dibrugarh University, Diploma in Medical Virology (DMV) from National Institute of Virology, Pune University, India and Diploma in STI & AIDS (DSA) from COTTISA, Bangkok, Thailand under WHO Fellowship. He worked as Biomedical Research Senior Scientist in Indian Council of Medical Research for a long time. He is presently working as Medical Superintendant and Head of Department of Microbiology at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong. He has been associated with patient care services, academics and researches with more than 20 national and international publications in reputed journals with involvement in many academic and research institutes of India.
North East India is the northeastern region of the country comprising eight states with 4500 km of international border with China, Myanmar, Bangladesh and Bhutan having population of >40 million with 220 ethnic groups. North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong is the first post graduate institute of Govt. of India in the region and one of apex medical institutes in the country dedicated to the nation in 2010 which is catering tertiary care services to the patients of the entire North Eastern states. The study was planned to know the Hospital Acquired Infections (HAI) trend in the ICUs of this newly started institute hospital considering the global health impact of the emergence and spread of antimicrobial-resistant pathogens in hospitals. The aims were detection of the etiological agents associated with the various types of HAIs in the ICUs and understanding the antimicrobial resistance pattern of isolates from the ICUs in general and PICU in particular. The patients with suspected HAIs admitted in the ICUs of Anesthesiology (AICU), Pediatrics (PICU), Cardiology (ICCU) and Cardio Vascular & Thoracic Surgery (CTVS ICU) Departments of NEIGRIHMS for a period of one year were included. Clinical specimens- urine, tracheal aspirate, sputum, wound swabs; pus, discharges, exudates, blood, cerebrospinal fluid, pleural fluid, peritoneal fluid and pericardial fluid were collected and processed with due ethical clearance. Relevant microbiology laboratory analysis was made for identification of the pathogens including study of the antimicrobial susceptibility pattern employing standard protocols. A total of 276 patients [126 (AICU), 47 (ICCU), 101 (PICU), 2 (CTVS ICU)] were included in the study of which 167 (8%) developed HAIs with the occurrence of 14% in AICU, 8% in PICU and 4% in ICCU respectively. Respiratory tract infections (RTI) (43%) were highest followed by urinary tract infections (34%), blood stream infections & septicemia (11%) and wound infections (10%) found in general. Urinary tract infections (54%) and RTI (24%) were the major HAIs in the PICU. Escherichia coli was the commonest pathogen (26%) followed by Enterococcus species (16%), Pseudomonas aeruginosa (14%) and S. aureus (12%). The Escherichia coli isolated showed resistance to beta lactam (73%) and cephalosporins (68%); Enterococcus species to quinolones (62%), aminoglycosides (46%) and cephalosporins (38%) and Pseudomonas aeruginosa to cephalosporins (67%), beta lactam (50%) where S. aureus was resistant to penicillin (50%) and quinolones (40%) respectively. The study demonstrated that HAIs are found to be a major threat in practice of patient safety in hospitals. Holistic approach for awareness, effective surveillance, antimicrobial policy and strict infection control practices is the present day need to address this global health issue.
B P Koirala Institute of Health Sciences, Nepal
Time : 10:50-11:20
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 January 2014 to 31st December 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. 182 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.
Shipra Chaudhary has completed her MD in Pediatrics & Adolescent Medicine from B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. She is an Assistant Professor in Department of Pediatrics, BPKIHS, Dharan.
Dr. Mildred Mudany completed her Masters Degree in Paediatrics from the University of Nairobi and her PhD in Tropical Medicine in 2004 from Tokyo Women’s Medical University She is the Country Director of Jhpiego, an affiliate of Johns Hopkins University, Kenya. Prior to this she worked for Centers for Disease Control and Prevention (CDC) as a Senior Technical advisor in PMTCT and Chair for USG Inter-agency Technical Team on Maternal, Newborn and Child Health. She has published more than 15 papers in reputed journals and made significant contributions to Guidelines in PMTCT, Infant Nutrition and Early Infant Diagnosis of HIV. (Up to 100 words)
According to Kenya AIDS Indicator Survey (KAIS) 2012, 1.2 million (5.6%) people live with HIV/AIDS. Globally Kenya ranks among 22 priority countries targeted to reduce new HIV infections in children. Approximately101, 000 (0.9%) children between 18mo-14 years are HIV-infected, majority due to mother to child transmission. In 2013 WHO recommended use of HAART for all HIV positive pregnant and lactating women; guideline adopted by Kenya in October 2013.
Dissemination of national guidelines done. Nationwide rollout of option B plus starting with large volume facilities offering ART and facilities with integrated HAART within MCH. APHIAPLUS Kamili scaled up Option B plus to 134 high volume facilities in Eastern and Central Kenya. Service providers trained on new guidelines. Regular supervision, mentorship, chart reviews and HIV-exposed infant cohort analysis established. HIV positive mentor mothers placed in high volume facilities, to support adherence and retention in care of HIV positive pregnant mothers. HAART integrated into MCH for easy access. Exclusive breastfeeding for 6 months encouraged. National EID website monitored for PCR results.
Between October 2013 to September 2014, 1,320,664 pregnant women were tested for HIV of whom 66,258 (5%) HIV positive. Of positives, 56,137 (85%) put on ARV prophylaxis. Of these, 64.2% were on HAART for life (Option B plus). For KAMILI supported zone, EID positivity reduced between APR 2013 and 2014 as follows: @2mo from 5.9% to 4.8%; @9mo from 7.5% to 6.2%; @12mo from 7.8% to 6.7%; @ 18mo from 8.7% to 7.5%.
Nationally 6 weeks PCR positivity has dropped as follows: 12% (2010); 10% (2011) ; 6% (2012) ; 5% (2013); 4% (2014)..
Shiraz Dental University,Fars,Iran
Title: The new expansion appliance with routine 3 axis expansion appliance in terms of dental arch changes and patient’s problems during treatment
Time : 12:50-13:20
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 team. He has done several presentations in multiple domestic and international congresses.
The aim of this study is to evaluate the correlation between lateral cephalometry and Hand-wrist in short stature in Shiraz and also to evaluate craniofacial morphology in short stature patients.
Method and materials:
178 patients divided into two groups containing 76 patients (38 female and 38 male) as familial short stature and 102 patients (52 female and 50 male) patients as other short stature except as familial origin. Lateral cephalometry and Hand-wrist radiogragh in determining skeletal age were measured using K-statistic. In addition 50 patients were selected for comparing craniofacial morphology in short stature patients with patients with 147 (47 female and 73 male) class II malocclusion without short stature status.
Result: In familial short stature patients the Kappa static between lateral cephalometry and Hand-wrist radiographs for determining skeletal age was measured as 0.6361, which can be considered as good relationship. In short stature patients with other etiologic factors the Kappa statistic between lateral cephalometry and Hand-wrist radiographs for determining skeletal age was measured as 0.615 which is also a good relationship. In evaluation of craniofacial morphology of patients with short stature male patients had shorter anterior cranial(P=0.01) base and more convex profile than normal patients with class I malocclusion (P=0.005). Female patients had shorter (P=000.1) , more convex profile and more vertical anterior cranial base (P=0.0001). Class II growth tendency than normal class I patients malocclusion patients had more convex profile, larger anterior cranial length and more vertical growth pattern comparing to short stature patients both female and male (p<0.05).
Conclusion: Lateral cephalometry radiographs can be used instead of Hand-wrist radiographs for determining skeletal age without the need for further exposure in short stature patients. Short stature patients have more vertical growth pattern and more convex profile than normal class I malocclusion patients.
Al-Anbar University, Iraq
Title: Postpartum weight: A guide to calculate the expected pre-pregnancy weight to study the risk of maternal overweight and obesity on congenital anomalies
Time : 13:20-13:50
Zaid Rasheed Al-Ani is a Professor of Pediatrics. He has completed his Bachelor of Medicine from Basrah University, Southern Iraq, in 1978. He is a Senior Teaching Staff in Anbar College of Medicine teaching pediatrics for undergraduates and DCH & CABP post-graduates, 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. He has published more than 11 papers in reputed journals.
To study the risk of maternal overweight and obesity on congenital anomalies (CAs) using the expected pre-pregnancy 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, mothers were examined retrospectively at 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 makes studying the risk of maternal obesity on CAs easy in areas with absent or late visiting antenatal care mothers. Overweight and obesity is proved to be a risk factor for CAs. Social education about early antenatal care and alertness for complications of gestational obesity, and the application of the pre-pregnancy health care system is important to reduce the prevalence of CAs.
University of Naples Federico II, Italy
Time : 13:50-14:20
MD and European Specialist in Clinical Chemistry and Laboratory Medicine. Full Professor of Laboratory Medicine, School of Medicine, University of Naples Federico II. Recent studies: Cystic Fibrosis: gene analysis, search of new mutations, genotype-phenotype correlation, studies on genes modifier of phenotype; functional studies of novel mutations and drug effect on ex-vivo epithelial nasal cells; epigenetics of CF (methylation and microRNA). Analysis of specific mRNAs in blood from cancer patients. Molecular genetics of congenital diarrhea. Epigenetics of suicide.
Mannose binding lectin (MBL) is a protein of innate immunity that activates the complement and promotes opsonophagocytosis. The deficiency of MBL due to several common gene polymorphisms significantly enhances the risk of severe infections, particularly in the neonatal age and in childhood and a recombinant protein is now available. We demonstrated that in patients affected by cystic fibrosis (CF) the deficiency of MBL acts as a negative modifier gene enhancing significantly the risk for pulmonary bacterial colonisation and for severe liver disease infections. On the contrary, the role of the protein in carcinogenesis and atherogenesis is still debated: MBL has a relevant role against neoplastic cells, in fact our group demonstrated that an MBL deficient haplotype is a risk factor for gastric cancer in subjects with H. pylori infection. Other studies described a protective effect of low levels of MBL toward breast cancer and a longer survival of lung cancer patients with a reduced MBL activity. Similarly, some studies concluded on the protective role of low levels of MBL toward cardiovascular diseases while other focused on a higher risk of myocardial infarction in subjects with a deficient activity of the protein. Finally, a role of MBL in the clearance of senescent cells emerged, and a study by our group in two large cohorts of centenarians demonstrated that a high biological activity of the protein enhances the risk of autoimmune diseases. This body of data strongly suggests that the optimal levels of MBL activity depend on the age and on the environmental context of each subject.