Day 1 :
- Pediatric Pelliative Care
Dr. Amrita Sarpal
Sidra Medicine and Weill Cornell Medicine, Qatar
Title: Pediatric Palliative Care: Unraveling Common Myths, Misconceptions and Misunderstandings
Dr. Sarpal completed her MD and general pediatrics residency from University of Calgary in 2004 and 2008 respectively. In 2010 and 2011, she completed fellowships in pediatric critical care medicine and pediatric palliative care medicine. She is also an Erickson Certified Executive Coach, and a member of the International Coaching Federation. She is currently the program director for the pediatric critical care medicine postgraduate medicine fellowship training program at Sidra Medicine and an assistant professor at Weill Cornell Medicine-Qatar, Qatar. Her research/academic interests include medical education, end of life care in the intensive care unit, physician health and wellness and coaching in (and outside) medicine.
Palliative care is a specialized form of medical care intended for individuals with serious and potentially life threatening or life limiting illnesses/conditions and should be made available to patients based on their needs regardless of their expected prognosis. As exposure to palliative care in medical school and throughout postgraduate training remains fairly limited in most settings, palliative care remains to a degree shrouded in mystery for many. While there are commonalities to adult palliative care, there are also stark differences that exist in comparison to pediatric palliative care.
Pediatric palliative care is a very young subspecialty whose focus is to provide relief from “total” pain and burdensome symptoms. The multidisciplinary team’s goal is to improve the quality of life of both the child and their family through a holistic model of care. Care is aimed at anticipating, preventing and treating physical, emotional, psychological, social or spiritual suffering. Children and their families are supported to live as well as they can, for as long as they can, within the limits imposed by the illness/condition.
Due to lack of exposure, and the differences that exist between adult and pediatric palliative care services, it is not surprising that many misconceptions and misunderstandings exist regarding pediatric palliative care. This includes understanding eligibility criteria, role of the subspecialty team and how to manage symptoms at end of life including the ethical dilemmas that exist at end of life for pediatric palliative care providers.
This session will unravel the most common myths, misconceptions and misunderstandings that exist regarding pediatric palliative care. This includes understanding: 1) eligibility criteria 2) the aims of care 3) the differences between palliative and hospice care 4) how symptoms including pain are treated at end of life and 5) the role of narcotics including morphine and other mediations at end of life.
- Pediatric Hematology
Mohamed V University, Morocco
Title: Epistaxis revealing Willebrand disease Type 3(Around a case)
An ambitious final year medical student in Faculty of medicine and pharmacy of Rabat ,very passionate about research. Currently applying for a thesis master in Canada to improve my research skills before joigning a residency program ,in order to become a research physician.
Willebrand's disease (VWD) is a genetic bleeding disorder; a defect in the amount or structure of von Willebrand factor (VWF). VWF: An element of primary hemostasis, its two main roles are the adhesion of platelets to injured vessels, and the transport of factor VIII (FVIII). There are 3 types of variable severities: Type 1 (least severe): Partial quantitative deficit; VWF is made in less quantity, which can lead to factor VIII (FVIII) deficiency. Type 2 (more severe): the VWF is manufactured but does not fulfill its function. Type 3 (the most severe and the rarest): the deficiency in VWF is total and is associated with a constant and profound deficiency in FVII.
The diagnosis of VWD is a clinical and biological diagnosis, most often made in childhood or adolescence, especially in girls in puberty with menorrhagia.The clinical symptomatology is essentially cutaneous and mucosal, the interrogation must seek a history of hemorrhagic accidents as well as a family history of hemorrhagic symptomatology or known pathology of hemostasis. At the end of the interrogation, a haemorrhagic score can be established. This score developed by Tosetto has proven its relevance and has been approved and put online by the ISTH. There are pediatric adaptations.Type 3 VWD is defined by a total quantitative deficit of VWF. This is the most severe form of VWD. It represents less than 5% of the forms of the disease. The genetic abnormalities responsible for this type are nonsense mutations, allele expression defects or complete or partial deletions of the VWF gene. Transmission is recessive and symptomatic patients are homozygous or heterozygous.Routine biological tests are essential, but insufficient to detect VWD. They are carried out during the exploration of a hemorrhagic syndrome, the evaluation of the hemorrhagic risk preoperatively or in the presence of a family history of bleeding. These first-line biological tests include a complete blood count, prothrombin count (PT), thromboplastin time plus activator (PTA) and functional fibrinogen assay. Tests exploring primary hemostasis such as the measurement of platelet occlusion time PFA can be added as first intention. It is a non-specific test, but sensitive to qualitative and quantitative deficits of VWF. The specific biological tests, three in number, are to be carried out on the same sample, plasma VWF activity, called ristocetin cofactor activity, the antigen VWF assay and the coagulant FVIII assay.In VWF type 3 there is a total quantitative deficit. The antigen and the activity of the vWF are collapsed and the level of factor VIII is very low.To make a definitive diagnosis of VWD it is sometimes necessary to repeat the assays at different times.At present it is impossible to cure VWD, apart from accidents and situations at risk of bleeding, in the majority of cases, correction of VWF deficiency is not necessary, especially in the case of minor bleeding that has dried up. spontaneously. However, it is important to follow simple preventive measures.Type 3 patients do not respond to desmopressin, so VWF concentrates alone (Wilfactin*) or VWF concentrates in combination with FVIII (Wilstart*) are used. These treatments are instituted: Either in a curative way in order to treat an unforeseen hemorrhagic accident or, in a preventive way (before a scheduled surgery for example).
Conclusion: Willebrand's disease Type is a pathology of hemostasis, with a significant risk of bleeding, linked to a complete deficiency in vWF, it is the rarest and most severe type of VWD, its diagnosis is based on the clinic with a biological confirmation. The treatment is essentially preventive and is mainly based on the injection of VWF and FVIII concentrates
Shiraz University of Medical Sciences, Iran
Title: Clinical outcome and complications of SARS-coronavirus-2 induced bone marrow aplasia
Sarvin Sajedianfard graduated from Shiraz University of Medical Sciences. She is working at oncology center in Shiraz, Iran as a pediatrician for 2 years.
Background and objectives: Immunization against the coronavirus disease 2019 (COVID-19) began in January 2021 in Iran; nonetheless, due to a lack of vaccination among children under 12, this age group is still at risk of SARS-CoV-2 infection and its complications.
Case presentation: SARS-CoV-2 infection was diagnosed in a 6-year-old girl who had previously been healthy but had developed a fever and pancytopenia. The bone marrow aspiration/biopsy demonstrated just hypocellular marrow without signs of leukemia. She was worked up for primary and secondary causes of pancytopenia. Except for a repeated reactive HIV antibody/Ag P24 assay, all test results were inconclusive. After a thorough diagnostic investigation, the cross-reactivity of the HIV antibody/Ag P24 test with SARS-CoV-2 antibodies was confirmed. The patient did not develop any COVID-19-related signs and symptoms, but she did get a severe invasive fungal infection and neutropenic enterocolitis. She died as a result of disseminated intravascular coagulopathy.
Conclusion: It is critical to recognize children infected with SARS-CoV-2 who exhibit atypical clinical manifestations of COVID-19, such as persistent pancytopenia. SARS-CoV-2 infection can cause severe and deadly consequences in children; thus, pediatricians should be aware of COVID-19's unusual signs and symptoms mimicking other conditions such as aplastic anemia.
- Pediatric Neurology
Dr. Roba Mideksa
Arbaminch University ;SNNPR,Arbaminch,Ethiopia.
Title: PREVALENCE AND ASSOCIATED FACTORS WITH PERINATAL ASPHYXIA IN NEONATES IN ARBAMINCH, IN 2022 G.C, SOUTHERN ETHIOPIA
Dr. Roba Mideksa, MD Arbaminch University School of Medicine, 2022 . Trainer and Medical Doctor at Elbat Solution 2022. Assistant Physician Soyas Clinic 2021. Life time member of Ethiopian Red Cross Society and Proud Volunteer . General Manager at Borif Cleaning and Disinfecting Services ,plc. 2020. Research enthusiast and interests-maximizing efficiency in technology in medical practices .
Birth asphyxia is a leading cause of infant morbidity and mortality in developing nations, such as Ethiopia. Though Ethiopia has made considerable achievement in the reduction of under-five mortality rate, the neonatal mortality burden has not experienced the same reduction, which may be attributed to birth asphyxia. The aim of this research was to identify where the gap is and solve the problem and address good neonatal outcome
The objective of this study was to determine the prevalence and associated factors of perinatal asphyxia among neonates admitted to neonatal intensive care unit in Arbaminch General Hospital, Southwest Ethiopia in the study period.
An institution-based cross-sectional study design was conducted .A simple random sampling method was used to select 372 neonates. A structured checklist was used to collect the data and analysis by SPSS, version 25 (IBM). Binary logistic regression analysis was performed to assess factors associated with PNA among neonates administered to NICU of AGH.
Out of 630 source population 372 neonates were selected using simple random sampling technique data was coded and enter in to computer based statistical package for the social science( SPSS) version 25 for analysis after being collected using structured checklist the prevalence of perinatal asphyxia in the study area was determined to be 21.4% .
After multivariate analysis Complication during labor, Mode of delivery, Presence of ANC visit and Presence of MSA found to be independent variables or predictors for in neonates admitted to NICU (p<0.05). That is AOR shows that those who didnt have complication during labor are 88.7% less likely to develop PNA than those who had complication during labor. Those neonates delivered by C/S are 11.35 times and those delivered by others (vacuum, forceps) are 3.37 times more likely to develop PNA than those delivered by SVD. Those who didnt have MSAF are 84.7% less likely to develop PNA than those who had MASAF.
ALEJ-AN JOYCE MARIE A. GUMPAL-TE
University of Santo Tomas Hospital
Title: Neurodevelopmental Outcome of Infants Born to Mothers with COVID-19 Infection During Pregnancy: A Meta-Analysis
Background and relevance: Intrauterine viral infections induce an increase in the levels of proinflammatory cytokines which inhibit the proliferation of neuronal precursor cells and stimulate oligodendrocyte cell death leading to abnormal neurodevelopment. Epidemiologic studies suggest maternal immune activation during pregnancy maybe associated with neurodevelopmental effects in infants which is of great concern. Given the large number of exposed individuals, even a modest increase in risk for adverse offspring neurodevelopment would still have a massive public health impact. Objective: To determine the neurodevelopmental outcome of infants born to mothers with COVID-19 infection during pregnancy. Methodology: This study utilized a meta-analysis design. Studies published up to September 30, 2022 were included in the analysis. Data Analysis: STATA MP Statistical Software, Version 13, College Station, TX: StataCorp LP was utilized for all statistical analyses. A p-value ≤0.05 was considered statistically significant. Since estimated heterogeneity is non-significant and not substantial, a fixed-effect model was utilized. Pooled risk ratio was utilized as the summary effect measure for the risk of neurodevelopmental delays and was estimated with their corresponding 95% confidence intervals. Heterogeneity was scrutinized using the following statistical tests: Q statistics test, I2 statistics, and tau squared statistics. I2 values greater than 50% imply substantial heterogeneity, while a Q-statistics with a significant p-value denotes a statistically significant heterogeneity. Results: Two studies with a total population of 7,848 patients met the eligibility criteria. Results indicated that all included studies have good quality of evidence in the areas of selection, comparability, and exposure. Appraisal of the included studies in these areas of evaluation also showed that all studies were of good quality. The pooled risk of neurodevelopmental delays among infants born to COVID- 19 positive mother was 2.00% higher than those born from mothers who were negative for COVID-19 infection. However, this was not statistically significant. Graphical analysis of publication bias showed funnel symmetry, suggestive that publication bias was unlikely. This result was confirmed with formal statistical tests using Begg’s adjusted rank correlation test and Egger’s regression asymmetry test. Conclusion: Although not statistically significant, infants born to mothers with COVID-19 infection during pregnancy have increased risk of neurodevelopmental delay. This may be attributed to the limited number of studies and articles available and in part because children born to women infected in the first wave of the pandemic are younger than two years of age. In addition, majority of developmental delay reflected developmental disorders of motor function or speech and language. Recommendations: Given the time-frame since the pandemic has started, little is known about the effect of in- utero exposure to COVID-19 in infants and children. Hence, this research topic remains to be of importance considering the increasing proportion of pregnant women being infected with COVID- 19. The author recommends future studies which assess the neurodevelopmental outcome in children with longer duration of followup should be ex