Day 2 :
Keynote Forum
Sherwin Morgan
University of Chicago Medicine, USA
Keynote: A new horizon for pediatricaerosolized medication delivery to infants via high flow nasal cannula and vibrating mesh nebulization
Time : 09:00-09:40
Biography:
Sherwin Morgan completed his respiratory care training from Malcolm X College of Respiratory Care in Chicago, IL. He is an advanced respiratory care practitioner with the National Board for Respiratory Care in the United States. He is Clinical Practice and Development /Educator/Research Coordinator for the Department of Respiratory Care Services, Section of Pulmonary and Critical Care Medicine at the University of Chicago Medicine. He has published more than 25 peer review papers in multiple medical journals. He has designed, engineered, and collaborated with a number of research studies with the pulmonary medicine department.
Abstract:
Introduction: Th e global gold standard for delivering aerosolized medication to infants in respiratory distress has been via the Small Volume Jet Nebulizer (SVJN) with a face mask. The medication most commonly used is albuterol 0.083%. During the procedure, a parent must hold the mask on the babyface, which can make the child combative. Therefore, the standard oxygen treatment is moving from face mask to High Flow Nasal cannula (HFNC) in conjunction with aerosolized beta-agonist treatments. A recent study of aerosol drug distribution using a face mask with TC99 label albuterol demonstrated that < less than 1% of the aerosol drug reached the lung and deposition was even less when the infant was crying or upset. Medication delivery is decreased even more when the patient has a nasal cannula in their nose and a pacifi er in their mouth. Children are mostly nasal breathers. In vitro pediatric lung model studies with the combination of HFNC&ANB, estimated aerosol deposition at 18 to 26%, although effi cacy is low, it is enough to exert a clinical eff ect when the treatment process was changed to delivery via HFNC and the vibrating mesh nebulizer (Aerogen® Solo Nebulizer), there was improvement with patient and parent comfort levels. Most children were calm and able to sleep throughout the treatment, keep the pacifi ers in and some were able to breastfeed during treatment. The clinical indicator that there was better aerosol medication deposition was that many kids experienced an increased heart rate of 10 to 15% from baseline, although they were not being touched or stimulated.
Bedside clinician could see medication aerosol exhalation around the pacifiers.
Conclusion: This development has revolutionized aerosolized inhaled medication delivery with the ultra-sonic vibrating mesh nebulizer for infants in respiratory distress. More study is needed in this area.
Keynote Forum
Mir Anwar
Richmond Chest Hospital, South Africa
Keynote: Malnutrition in children- South Africa’s present scenario
Time : 09:40-10:20
Biography:
Mir N Anwar graduated in Medicine from Bangladesh in 1975. He did his Post-graduation in Pediatrics from Ireland in 1982. He did his MPH concentration Maternity and Child Health from University of Massachusetts, USA in 2003. Then he joined UN/ WHO and worked as a Pediatric Consultant & Public Health Specialist, around the world including Asia, Japan, Middle East, Africa, Pacifi c Island, Ireland and USA. Since 2007 he has been working in South Africa in different provinces of South Africa with the Department of Health. Presently he is working as a Clinical Medical Manager in Richmond Chest Hospital, KZN. South Africa. Presently his main interest is in Childhood TB and HIV in Sub-Saharan Africa. In his long carrier in Pediatric and Public Health he attended several international congress, conferences, and seminars and presented his original work. Some of them were published in International Journal including American Child Neurology Journal, Japan Pediatric Neurology Journal, Pakistan Pediatric Journal, Bangladesh Child Medical Journal, Nigerian Journal of Obstetrics and Gynaecology etc. For his work he is honoured by American Academy of Pediatrics, Royal College of Health, UK, and International College of Pediatrics. His biography is published in Who’s Who in Medicine Cambridge, UK in 1985.
Abstract:
Malnutrition occurs when an individual’s dietary intake is not balanced with nutritional needs. More than 75% of the children admitted in Public Hospital of sub-saharan Africa for any reason are suffering from malnutrition. Department of Health of South Africa publish that 15% of South African infants are born with a low birth weight. Th ere are 25% of pre-school children and 20% of primary school children in South Africa suff ered from malnutrition. Since 2011 to 2016 over the period of 6 years we followed total paediatric admission in Stanger Hospital, Natal Province, South Africa. Average annual admission is around 1400-1500 (excluding neonates) in paediatric wards, Around 9000 over last six years, female child are predominant, female and male ratio was found 60:40. Lack of breast feeding is also a cause for the malnutrition. The 2010 South Africa department of Health Study found that 30.2% of pregnant women in South Africa have HIV/AIDS and they are reluctant to breast feed their children. Malnutrition is the cause of severe poverty in sub –sharan Africa. According to statistics from the year 2000, 50% of the South African population is under the poverty line. Th e World Health Organization showed that over the span of thirteen years (1995 to 2008), the deviation from the average height of children under age fi ve in South Africa has decreased from 28.7% to 23.9%. Th e approac
Keynote Forum
Kaye Talijancich
Princess Margaret Hospital for Children, Australia
Keynote: The role of laser in tongue tie division: A pilot study
Time : 09:40-10:20
Biography:
Kaye studied Bachelor of Science – Nursing, at Curtin University and graduated as a Registered Nurse in 2008. She currently works as Registered Nurse (parttime) looking after babies under 28 days at Neonatal Department at Princess Margaret Hospital for Children, Subiaco, Perth (WA). Her previous paediatric nursing experience includes working at the Emergency Department, Gastroenterology and Immunology Departments at Princess Margaret Hospital for Children. She has also worked for Edith Cowan University as a Paediatric Clinical Facilitator. Kaye commenced at Perth Paediatrics in 2016. She brings her skills and dedicated passion of working with children, to the fi rst multi-specialty private paediatric clinic in Western Australia.
Abstract:
Background: Laser tongue tie division is an option suitable for neonates, older children, and adults. No general anesthetic is used, but an analgesic gel is applied. Th e procedure is very quick, taking only 2 to 3 minutes to perform.
Aim: To assess the outcome of patients who underwent tongue tie division with Diode Laser at Perth Paediatric.
Methods: We conducted a retrospective review of the 49 children who underwent laser repair of tongue tie at Perth Paediatrics between 30/01/2017 and 10/7/2017. Th e age of the children ranged from 4 days to 6 months. We assessed the outcome aft er 1 to 6 months, with a questionnaire via telephone. Of the 49 children’s mothers telephoned, a total of 41 children were contactable. The outcome was assessed in terms of improvement of breastfeeding comfort to the mother and procedural complications.
Results: The outcome was assessed in terms of improvement in breastfeeding and lack of discomfort. 41 mums had immediate relief, which was rated good to excellent. 3 mums had poor immediate relief but there was an improvement aft er 2 weeks of procedure and was rated good. Only 2 out of 41 mothers reported no relief in improvement in breastfeeding. Furthermore, it was noted that refl ux symptoms in 3 children decreased post laser treatment and a weight gain increase was noted. There were no immediate or delayed procedural complications in terms of post-operative bleeding, infection, scarring or recurrence.
Conclusion: 95.2% (39/41) of children, who underwent tongue tie division with laser, were reported by their mothers, to have improvement in breastfeeding improvement in terms of latch/leakage. This outcome also included an improvement in the mother’s discomfort. Ie. nipple pain, nipple damage, and mastitis.
Keynote Forum
Christina YK Leung
University of Hong Kong, China
Keynote: Drugs use in Biliary atresia and the roles of clinical pharmacist
Time : 11:15-12:55
Biography:
Christina Leung completed two Bachelor degrees in England, BSc Management Sciences followed by the BPharm Pharmacy. Following the registration as a pharmacist in the UK, she worked in different London Teaching Hospitals for 16 years. In UK, she specialised in Paediatrics (especially in PICU and Paediatric Liver), Obstetrics and Gynaecology. She published a number of articles including drugs use in paediatric liver diseases in the UK and management of vomiting in pregnancy and hyperemesis gravidarum. Ms Leung is also a registered pharmacist in Hong Kong. Since 2012, she had worked as the Senior Pharmacist (Clinical Pharmacy in Charge) at the University of Hong Kong-Shenzhen Hospital, a reformed hospital in China. Currently, Ms Leung is the Honorary Tutor at the University of Hong Kong. She delivers lectures to the Master and Undergraduate Pharmacy students relating to drugs use in Paediatrics, Obstetrics and Gynaecology.
Abstract:
Biliary atresia (BA) is a condition in which inflammation develops within the bile ducts around the time of birth. Th is leads to bile duct damage and reduces the flow of the bile which subsequently causes scarring of the liver. Th e initial treatment for biliary atresia is a surgical operation called the “Kasai Porteoenterostomy” (KPE). Th e aim of KPE is to make a drainage channel to allow bile to drain from the liver. Before the surgery, the patient will be prescribed with fat-soluble vitamins for patients with prolonged jaundice. Examples are multivitamin preparations (Abidec® or Dalivit® drops in the UK), vitamin K preparations (phytomenadione injection which can be given by oral, IV or IM routes and menadiol tablet), Vitamin E (tocopheryl acetate), and Vitamin D (Alfacalcidol). 24 to 48 hours before the surgery, the patients will receive bowel preparations and the common ones are Lactulose liquid, Neomycin liquid, and Metronidazole suspension. After the operation, the patient will receive drugs via intravenous or intramuscular route for about 3 to 5 days, standard maintenance IV fluid will be given for about 3 to 4 days. Nurse Controlled Analgesia (NCA) IV pump with morphine is always used for the initial 3 days, and the patient is also prescribed with regular paracetamol (IV or rectal) for breakthrough pain for about 3 days then change to oral. Prophylactic IV antibiotics will be given after the surgery for at least 72 hours. Examples are Gentamicin and Piperacillin/Tazobactam as dual therapies. After 72 hours, if no high temperature is developed and the oral feeds are started, the prophylactic antibiotics can be changed to oral for 28 days (an example is oral Cefalexin). Ranitidine is also used to prevent a stress-induced ulcer. Intramuscular vitamins are used post-surgery. Examples are Vitamin D 30,000 units (60,000 units if radiological rickets is present), Vitamin E 10mg per kg, Vitamin A 10,000 units are given at the discretion of hepatologist (usually for patients with late diagnosis). After day 5 of operations, the patient may start oral therapies. Additional oral vitamins are necessary post-surgery for about 6 months. Examples are Vitamin K, Vitamin E, and multivitamin drops. Oral Phenobarbitone (alcohol-free liquid or tablet) helps to increase bile fl ow and hence to reduce itching symptom. Th e recommended dose is 15mg daily, increasing to 45mg daily in steps of 15mg per week. Colestyramine helps to remove the bile salts which cause jaundice and itchiness. Since Colestyramine can reduce the absorption of some drugs, especially vitamins, it is recommended to leave vitamin preparations at least 2 hours before or 4 hours after giving Colestyramine. Spironolactone suspension helps the patient reduces the amount of fluid accumulated as a result of ascites, but it is not needed in all cases. Th ere have been clinical studies to use high dose oral steroids (oral prednisolone) post KPE to benefit in reduction of postoperative bilirubin and clearance of jaundice. However, the findings show that the effect of steroids may be limited or inhibited by an increasing degree of fibrosis and onset of cirrhosis. If KPE is successful, many of these medicines can be stopped over time. If KPE fails, the liver transplant can be one of the treatment options. Th e care of the biliary atresia patients is best with the multi-disciplinary approach, and clinical pharmacists play a significant role in this care management. Examples of the contributions are dosage recommendations, choice of drugs, stopping or initiation of a therapy, guidelines development, drug history talking and medication reconciliation, therapeutic drug monitoring and other blood results monitoring to optimize drug therapies, patient education such as developing of patient leaflets and delivering of patient education talks, patient counselling of discharged medications such as using of tailored-made discharge medication card, discharge planning to reduce the waiting time, adverse drugs reactions monitoring, medication incidents management, drugs interactions, advice on drug administration (e.g. with or after food, timing of drug administration, method of IV drug administration), review of medications in the out-patient clinics after discharge, and participation in the clinical trials.
- Pediatric Neurology: Disorders and Treatments | Pediatrics and Adolescent Medicine
Location: FREDERICK
Chair
George Giacoia
National Institute of Child Health and Human Development/Food and Drug Administration, USA
Session Introduction
Jamel Hajji
Gafsa University, Tunisia
Title: The effect of experience, coaching and technical post, on the coping strategies solicited by the U15 elites affi liated to the regional centers of the Tunisian Football Federation (TFF)
Time : 14:00-14:30
Biography:
Hajji Jamel is a Researcher at the field of coping and anxiety. He successfully completed his master and Ph.D in the field of Higher Institute of Sport and PhysicalEducation Gafsa, Gafsa University, Tunisia.
Abstract:
Today, the training center represents an unavoidable passage in the career of the high-level footballer. Training centers are among the mechanisms of National Technical Direction, to develop Tunisian football, and to improve performance in youth categories. The objective of our study is to examine the coping strategies of the competition, solicited by the elites affiliated to the regional training centers of the Tunisian Football Federation (TFF) and evaluate the interaction eff ects of coaching, experience, and the technical position. 76 U15 football players regularly evaluated through high-stakes competitions are invited in one hour aft er the competition, to settle against the Arabic version of the inventory of coping strategies of the sporting competition. Data were collected and analyzed by SPSS IBM and AMOS version 21.0.0. Th e results suggest that mental distraction is the coping strategy most solicited by our participants, the MANOVA analysis, only disclosed the effect of the coaching factor on mental imagery, thought control, Eff ort expenditure and Relaxation, but regression analysis revealed no strong explanatory relationship. Overall, this study allowed us to deepen our knowledge about the coping strategies of the competition used in the preformation process in the diff erent training centers of the TFF. In addition, the impact of experience,
coaching and the specifi city of the technical position, on the choice of these strategies in competitive contexts.
Hiba A Awooda
Dar Al-Uloom University, Saudi Arabia
Title: Potential neuroprotective effect of N-Nitro-L-Arginine-Methylester in cerebral injury induced by transient ischemia/reperfusion in rats
Time : 15:00-15:30
Biography:
Hiba A Awooda is an Assistant Professor at the Department of Physiology, faculty of medicine. She successfully completed her master and Ph.D in the feild of neuropphysiology from Alexandria University (2011) and Al Neelain University (2013) respectively. As well as master of medical education from University of Khartoum. She teaches physiology to undergraduate medical, dental, physiotherapy and nurse students. She is also a researcher with interest in developing biomarkers that are used in the treatment of acute ischemic stroke. She has published more than 20 papers in reputed journals.
Abstract:
Role of nitric oxide (NO) inhibition in cerebral ischemia/reperfusion (I/R) remains uncertain; this work aimed to explore the neuroprotective potential of N-Nitro-L-Arginine-Methylester (L-NAME) non-selective NO synthase (NOS) inhibitors. Th e study involved 30 adult male Wistar rats (150-250g), divided into three groups;10 rats in each: sham-operated group (control), I/R group: infused with 0.9% normal saline intraperitoneally prior to 30 minutes of left common carotid artery occlusion followed by 24-hours of reperfusion, third group (test group): infused with L-NAME (15 mg/kg per weight) intraperitoneally 15 minutes prior to the same I/R period. Neurobehavioral assessments were evaluated using six clinical tests. Proper anesthesia was induced. Western blotting was used to estimate Nuclear factor kappa B (NF-κB), Tumor necrosis factor-α (TNF-α) using ELISA and NO metabolites (nitrite and nitrate), were measured colorimetrically in both plasma and
aff ected cerebral hemisphere. Th e result shows that L-NAME group demonstrates a signifi cant improvement in neurological deficit (P <0.001) compared to both I/R and control groups. In I/R rats NF-κB was signifi cantly increased compared to the control group and L-NAME pretreatment resulted in a signifi cant decrease in NF-κB (P <0.001) compared to I/R group. Serum level of TNF-α and NO were signifi cantly increased in I/R group compared to the control group (P <0.001), while L-NAME administration resulted in a signifi cant decrease in serum TNF-α and NO (P <0.001) compared to the I/R group. In conclusions, L-NAME pretreatment for rats undergoing cerebral ischemia/reperfusion signifi cantly improve neurological deficit through it is anti-infl ammatory eff ect in a rat’s model of transient focal cerebral ischemia-reperfusion.
Ashraf Mohammadzadeh
Mashhad University of Medical Sciences, Iran
Title: The therapeutic effect of Zinc sulfate in term Neonatal hyperbilirubinemia
Time : 15:00-15:30
Biography:
Ashraf Mohammadzadeh is an assistant professor Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. He is a vice chancellor of Neonatal Research Center in this university since 2006 and consultant neonatologist of neonatal intensive care unit since 1992 up to now. He has published 66 papers locally and in international journals, 19 books, 71 supervision of thesis in general medicine, pediatric, and neonatology, 120 participation in national and international congress with lecture and poster presentation.
Abstract:
Objective: Zinc is one of the essential elements in neonatal growth, protein synthesis, and regulation of inhibitory and stimulatory synapses of the brain. It has been shown to lower bilirubin levels by inhibition of the normal enterohepatic cycling of unconjugated bilirubin. Th e aim of the study was a therapeutic eff ect of oral zinc sulfate in neonatal jaundice.
Method: In a clinical trial 70 term neonates with a total serum bilirubin (TSB) levels ≥20 mg/dl were enrolled. Th irty-four were treated with phototherapy and zinc (10 mg/day, single dose) as a case while the remaining as control received phototherapy plus placebo. TSB levels were measured at entrance, 12, 24 and 48 hours aft er intervention and compared together.
Result: Th e mean TSB levels were signifi cantly lower in the zinc group aft er 12, 24 and 48 hours (p= 0.038, 0.005, 0.001, respectively). Duration of phototherapy in the case and control groups were 2.03±0.174 and 2.33±0.478 days, respectively, with significantly lesser in the case group (p=0.002).
Conclusion: Th is study showed that oral zinc sulfate in a single dose of 10 mg reduced the TSB levels and duration of phototherapy.
Mohammed Alrowaily
King Abdulaziz Medical City, Saudi Arabia
Title: Gray zone of infant viability from central Saudi Arabia
Time : 15:50-16:20
Biography:
Mohammed Alrowaily is an Paediatrician from King Abdulaziz Medical City. He undertook the present study with indigenous Maori health provider Ngati Awa and Eastern Bay Primary Health Alliance to establish if and how BlisK12 probiotic decreases pharyngeal GAS carriage and sore throats, to increase the effi cacy of school programmes particularly for the one third of children getting ARF, who do not recollect a preceeding GAS sore throat.
Abstract:
Background: Survival of preterm neonates has steadily improved over the past five decades, possibly due to changes in the neonatal intensive care. However, in Saudi Arabia, there are no written guidelines on the definition of the lower limit of viability, and there has been a call for such limit. Thus, the aims of this study were: (1) to determine lower limits of viability and survival outcome in extremely-low birth weight (ELBW) infants, and (2) to determine incidence of neurodevelopmental and cognitive abnormalities within 3-6 years after birth.
Methods: Retrospective review of the charts of all live inborn ELBW infants admitted to the neonatal unit of King Abdulaziz Medical City, Riyadh, Saudi Arabia, within 3 years [between January 1st, 2005 and December 31st, 2007] was conducted (n=117). Data were collected on demographic and birth data, neonatal complications & interventions and death on discharge. Follow up of all survivors was done to assess the outcome within 3-6 years aft er birth, for neurodevelopmental and cognitive abnormalities. Predictors of survival were determined using logistic regression model. Receiver operating characteristic curve (ROC) was applied to determine the lower limits of viability of ELBW. Signifi cance was considered at p-value ≤0.05.
Results: Of all ELBW infants, 59% survived, and 41% died before discharge. Survival rate was directly correlated with GA and birthweight (p<0.05). Th e 50% limits of viability were those at 25 weeks’ gestation or with >600 g. Applying the ROC curve, the optimum limits for viability were 26 weeks’ gestation and 700g birth weight. After adjusting for possible confounders, significant predictors of survival were birthweight (p=0.001) and Apgar score (p<0.001). Th e following impairments during follow up of survivors: developmental delay (39.2), cerebral palsy (36.2%), speech problems (33.3%), wasting (12.5%), mental retardation (10%), visual problems (6.6%) and hyperactivity (5.6%).
Conclusion: Birthweight could be considered as more valid than GA in prediction of viability of ELBW infants. The process of care of ELBW infants needs to be revisited taking these findings into consideration. Routine aggressive resuscitation of newborns at 23 weeks and/or with <600 g. birth weight should be approached with caution A multicenter study is recommended.
John Malcolm
Bay of Plenty District Health Board, New Zealand
Title: Probiotic BlisK12 lowers group A Streptococcal GAS pharyngeal prevalence in a high Acute Rheumatic Fever (ARF) area by lowering school transmission; a stepped wedge cohort study
Time : 16:20-16:50
Biography:
John Malcolm FRACP Consultant Paediatrician, Whakatane, Bay of Plenty District Health Board, New Zealand, Honorary Clinical Senior Lecturer Paediatrics, Universities of Auckland and Otago, Community Paediatrics interests include Acute Rheumatic Fever epidemiology Rheumatic Heart Disease followup and ARF prevention programmes. He undertook the present study with indigenous Maori health provider Ngati Awa and Eastern Bay Primary Health Alliance to establish if and how BlisK12 probiotic decreases pharyngeal GAS carriage and sore throats, to increase the effi cacy of school programmes particularly for the one third of children getting ARF, who do not recollect a preceeding GAS sore throat.
Abstract:
Aim: Th is school study compares the eff ect on the pharyngeal GAS prevalence of 30 days BlisK12 probiotic for all consenting pupils, after 10 days antibiotic treatment of GAS positive pupils, compared with antibiotics alone.
Background: Acute Rheumatic fever (ARF) is prevalent for indigenous Bay of Plenty, New Zealand, Maori and Pacific children and young adults with an incidence similar to that seen for NZ Europeans in the 1930s. Group A streptococcal infection (mainly pharyngeal in New Zealand) precedes ARF. School programmes treating students GAS sore throats with antibiotics halved ARF. We evaluated BlisK12 probiotic containing Streptococcus salivarius, (producing two anti-streptococcal lantobiotics) impact on GAS prevalence.
Method: Consenting pupils with GAS positive throat swabs in two school cohorts 1 and 2 without school ARF programmes were treated with 10 days antibiotics. All pupils in Cohort 1 were then off ered BlisK12 Probiotic for 30 days. Cohort 2 school pupils only had antibiotics for GAS positive throat swabs. Th e outcomes were compared in both cohorts with throat swabs a month later. Th ose initially negative who became positive were noted and those initially positive also followed, separating probiotic effects preventing the carriage from clearance.
Results: BlisK12 is associated with a greater decline in GAS prevalence than antibiotics alone. BlisK12 prevented carriage rather than increased antibiotic effi cacy prolonging GAS clearance; Antibiotics unexpectedly were more effective without BlisK12.
Conclusion: BlisK12 Probiotic is eff ective at preventing GAS pharyngeal carriage; BlisK12 probiotic for GAS negative students might augment school ARF prevention, evaluated with two winter terms’ school sweeps assessing GAS pharyngealprevalen.
Regina Folster-Holst
Past President of European Society for Pediatric Dermatology, Germany
Title: Paraviral exanthems in childhood
Time : 16:50-17:20
Biography:
Regina Fölster-Holst is Professor at the Department for Dermatology, Venereology and Allergology at the Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany. She obtained her medical degree at the Christian-Albrechts-Universität, Kiel and is board certified in dermatology and allergology. She is a member of the German Dermatology Association (DDG), where she leads the Society of Pediatric Dermatology. She is executive board member of the European Society of Pediatric Dermatology (ESPD), a member of the Institute for Medical and Pharmaceutical Examination (IMPP) and engaged in the occupational union of the German Dermatologists e.V. (BVDD). Her scientific focuses are paediatric dermatology, allergic diseases and parasitoses, whereas the main trust of her research is in atopic dermatitis, with special research expertise in immunological and biochemical activity markers, prognostic criteria, epidemiological researches and new therapeutical strategies. Prof. Dr. Regina Fölster-Holst has received numerous awards, such as the Hans-Karrer-Förderpreis (medical brochure for children) in 1997, the “Preis der Hensel Stiftung” (1998), theTeaching Award of the Medical Faculty of Kiel (2003), the German scientific award for communication and the Perle-Award.
Abstract:
Exanthems are common skin diseases in childhood and are usually related to viral infections. Th e infection triggers the exanthema directly (e. g. varicella, herpes simplex, enteroviruses), via an immune response (para viral exanthems as Gianotti-Crosti-syndrome, Pityriasis rosea) or by interactions with drugs (e. g. amoxicillin exanthem in patients with infectious mononucleosis). Para viral exanthems are distinct skin diseases related to infections with diff erent viruses. While infections are caused due to the viral infection, paraviral exanthems reflects the response of the immune system to the viruses, which cannot be identified in the skin. Th e para viral exanthems include Gianotti-Crosti syndrome, Pityriasis rosea, Pityriais lichenoides, Papular-purpuric gloves and socks syndrome, and asymmetrical perifl exural exanthema. nilateral mediothoracic exanthema, eruptive pseudoangiomatosis are not so common and eruptive hypomelanosis have been described recently.
Treeah Majors
University of Pennsylvania School of Nursing, USA
Title: Intranasal Oxytocin as behavioural pharmacotherapy in autism spectrum disorder
Time : 17:20-17:50
Biography:
Treeah Majors has completed her Bachelor of Science in Nursing from Emory University and her Master of Science in Nursing from the University of Pennsylvania. She is currently practicing as a Family Nurse Practitioner.
Abstract:
Background: Autism Spectrum Disorder (ASD) is hypothesized to result from an impairment in social motivation leading to impaired development of social cognition over time. Oxytocin is a mediator of social motivation and has the potential to improve socially responsive behavior in children with ASD. Th e purpose of this review is to provide an appraisal of current literature on the eff ect of intranasal oxytocin on behavior in children with autism spectrum disorder.
Methods: Th e literature search was completed using the PubMed, CINAHL, Scopus, and Web of Science databases. The search terms are as follows: Autism and intranasal oxytocin and children and behavior. Publications of all types from the years 2012 to 2017 were included.
Results: Th e searches yielded a total of 63 articles, 7 of which met inclusion criteria aft er full-text review. One study found a statistically significant improvement in socially responsive behavior. Two studies identified enhanced brain activity on fMRI during social information processing activities. These results point more towards oxytocin’s role in enhancing social motivation and learning in combination with reinforcing social stimuli rather than as a direct mediator of behavior changes.
Interpretation: The evidence supporting the use of intranasal oxytocin to impact behavior in autistic children is of low to moderate quality. Small sample sizes and the indirectness of some of the outcomes measured are primary barriers to drawing conclusions about the clinical applicability of this intervention. Further randomized controlled trials are needed before this intervention can be considered for use in a clinical setting.
Ioanna Konstantopoulou
Athens Medical Center, Greece
Title: Breastfeeding and medication
Time : 17:50-18:20
Biography:
Ioanna Konstantopoulou is graduated from the Medical School in Athens and accomplished her residency in Pediatrics at the second pediatric clinic of the University in Athens. She works in her private medical offi ces in Athens and on the island of Kythira. Also she works at the “Athens Medical Center” private clinic. Since November 2014 she was nominated as an International Boarded Certifi ed Lactation Consultant. Ever since she has been working on the promotion of Breastfeeding.
Abstract:
Despite the belief, over the years, that mothers should stop breastfeeding because they take a particular drug, almost always breastfeeding with a little drug in the milk, is safer than formula feeding. Breastfeeding mother must stop breastfeeding
because of a certain drug should ask the physician to make sure. In the rare case, there is a real concern, the breastfeeding mother should ask the physician to prescribe an alternate medication that is acceptable during breastfeeding. Most drugs appear in the milk but usually in tiny, even minuscule amounts. Th is happens because only the drug that is not attached to protein in the blood can get into the milk.:
a)Th ey are commonly prescribed for infants
b)Th ey are considered safe in pregnancy
c)Th ey are not absorbed from the stomach or intestines
d)Th ey are not excreted into the milk
Also, medications applied to the skin or inhaled or applied to the eyes or nose is almost always safe for breastfeeding. Drugs for local or regional anesthesia are not absorbed by the baby’s stomach and are safe. Also, immunizations given to the breastfeeding mother do not require breastfeeding to be stopped. X-rays and scans do not require a breastfeeding mother to stop breastfeeding for even a second. When the scan with technetium is performed, 30 hours aft er injection, all of the radioactive material will be gone and mother can breastfeed the baby without concern. However radioactive iodine which is used for thyroid scans will be ingested by the baby and it will go to his thyroid where it will stay for long. A mother should express the milk while not breastfeeding but not throw the milk. Th e milk can be used in 6-8 weeks.
- Pediatric Drug delivery and Dosage forms | Pediatric Surgical Pathology | Paediatrics and Child Health | Pediatric Pharmacology | Pediatric Cardio Pharmacology | Pediatric Dermatology
Location: FREDERICK
Chair
Regina Folster Holst
Past President of European Society for Pediatric Dermatology, Germany
Session Introduction
Ahmad Shah Farhat
Mashad University of Medical Science, Iran
Title: Comparison between two & twenty four hour salt powder coverage in infant umbilical granuloma treatment
Time : 14:40-15:05
Biography:
Ahmadshah Farhat assistant professor of neonatology has completed neonatology subspecialty in Mashhad University of Medical Sciences, Iran. He is a vice chancellor of Neonatal Research Center in this university since 2006 and consultant neonatologist of neonatal intensive care unit since 1992 up to now. He had published 66 papers locally and international journal, 19 books, 71 supervision of thesis in general medicine, pediatric, and neonatology, 120 participation in national and international congress with lecture and poster presentation. He was a member of 50 national scientific committee during last 23 years. He had 10 scientific honors in pediatric and neonatology.
Abstract:
Objective: To compare the eff ect of 24 hours and 2 hours salt (NaCl) treatment. for infant umbilical granuloma.
Methods: Th is study took place during two years at NICU and infant follow up clinic of Emam Reza Hospital related to Mashad University Medical Sciences Mashad North East Iran. Th e study consist of two groups, 20 infants in 24 hours treatment with salt or case group and 20 infants in 2 hours treatment with salt or control group.
Results: 40 infants completed the study ,there were 18 boys and 22 girls. In both groups there weren't significant differences between the sex, birth weight, time of umbilical separation and age of enrollment. The treatment days in case and control groups were respectively 1,.25+ 0,55 and 2,10+0,44 days and according to p=0.00 the difference was significant.
Conclusion: 24 hours treatment of umbilical granuloma is more effect.
Jamel Hajji
Gafsa University, Tunisia
Title: Validation of the Arabic version of the Inventory of Coping Strategies of Competitive Sport (ISCCS)
Time : 15:05-15:30
Biography:
Hajji Jamel is a Researcher at the field of coping and anxiety. He successfully completed his master and Ph.D in the field of Higher Institute of Sport and Physical Education Gafsa, Gafsa University, Tunisia.
Abstract:
The aim of our study is to validate the Arabic version of the Inventory of Coping Strategies of Competitive Sport (ISCCS) using factor analysis. After critical analyses of adapted sports versions, Gaudreau and Blondin (2002) proposed the ISCCS questionnaire to measure coping strategies in the fi eld of competitive sports (Andre & Laurencelle, 2010). The ISCCS identify ten coping strategies that are divided into two dimensions: The coping task-oriented and the coping emotion-oriented. 419 athletes (273 men and 146 women; age 16.79±3.82 years, 14 to 34) in different individual and team competitions, volunteered to participate in the study. Data were collected and analyzed for reliability and validity using the test-retest method, reliability,correlation analysis and confirmatory factor analyses. Statistical analysis was performed with SPSS version 22.0.0 the IBM AMOS. The confi rmatory factor analyses showed good adjustments for coping models of task-oriented (chi-square 359.35, CFI: 0.92; TLI: 0.91; GFI: 0.93; RMSEA: 0.040 and p-value < 0.001), and the coping oriented emotion (chi-square 215.45, CFI: 0.93; TLI: 0.91; GFI, 0.94; RMSEA: 0.054 and p < 0.001). In conclusion, ISCCS was translated and validated in various languages, including French, English, Spanish, and Turkish, Arabic version demonstrated good psychometric properties adjustments and can be used in other surveys in the area of sports competition.
Jeng-Sheng Chang
China Medical University, Taiwan
Title: Regression of neonatal cardiac rhabdomyoma in two months through low-dose Everolimus therapy
Time : 15:30-15:50
Biography:
As a director of pediatric cardiology and pediatric intensive care unit, Jeng-Sheng Chang is specialized in diagnosis, management and follow-up of the congenital and acquired heart diseases in children. His team is team also integrated other subspeciality teams, including cardiovascular surgeon, anesthesiology, Pharmacists, respiration therapist, nurse practitioners and nutrionist, etc., for combining care of patients with critical disease his patient-centered projects for the critical heart disease children have won the grands for quality improvement, Taiwan Institute of Health and Welfare, 2015-2016 two successive years. The open heart surgery for congenital heart disease, interventional cardiac catheterization, Extracorporeal Membranous oxygenator(ECMO) therapy, and Kawasaki disease, both in clinical management and researches, are among our best works. His researches in Kawasaki disease, collaborative with the bench team in Central Research Institute, have published important papers in the Journals of Nature Genetics and Circulation Research. A biomarker for early detection of Kawasaki disease has also been put on the markets of Asian countries.
Abstract:
Cardiac Rhabdomyoma (CR) is the most common cardiac tumor in newborns. Approximately 75% of cases are associated with tuberous sclerosis complex. Although these tumors usually spontaneously regress aft er 2 years of age, they can be life-threatening when they obstruct major cardiac infl ow or outfl ow pathways. Everolimus is an inhibitor of mammalian target of rapamycin, reducing its production of the proteins harmartin and tuberin. Everolimus has demonstrated a remarkable suppression eff ect in children with tuberous sclerosis complex at doses of 4.7–5.6 mg/M2/day and serum trough levels of 5–15 ng/mL. Since 2012, fi ve case reports of neonates with CR have also reported the tumor-regressing eff ect of everolimus. However, the optimal dosage for neonates is still unknown. Over the past 2 years, we have deliberately used a low dose everolimus regimen (0.3–0.67 mg/ M2/ day) in three neonates with large CRs, in an eff ort to maintain serum trough levels at 3–7 ng/mL. In all three cases, the tumors regressed smoothly within 2 months. Regarding the drug’s side eff ect of predisposing patients to infection, we observed that adenovirus pneumonia occurred in one case at 3 months of age, and chicken pox occurred in another case at 9 months of age; both recovered smoothly. Our three cases of neonatal CR demonstrate that a low-dose everolimus regimen is an eff ective treatment for tumor regression.
Sura Mohammad Alrawabdeh
Royal Medical Services, Jordan
Title: Xanthogranulomatous appendicitis in a child: Report of a case and review of the literature
Time : 16:10-16:35
Biography:
Sura Al-Rawabdeh a senior specialist in Pediatric pathology is currently working in the royal medical services in Jordan. She got fellowship training in Pediatric
Pathology. In nationwide children’s hospital Columbus Ohio USA
Abstract:
Xanthogranulomatous inflammation is a well-described infl ammatory process, which may involve any organ but is most frequently encountered in the gall bladder and the kidney. There are rare reports of Xanthogranulomatous Appendicitis (XA) in the adult population, but only one brief mention of such a diagnosis in a child. In this report, we describe the case of an 11-year-old boy who presented with clinical signs and symptoms of acute appendicitis necessitating appendectomy. Upon microscopic examination, the appendix showed the typical features of XA. To the best of our knowledge, this is the first welldescribed case XA in a noninterval appendix in a child. We also reviewed the limited medical literature on the subject.
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Case Report: Th e patient is an 11-year-old boy who presented with a 1-day history of abdominal pain and emesis but no fever. His past medical history was unremarkable. In particular, there was no history of hemorrhagic problems or systemic disease. The family history was also unremarkable. On physical examination, he had persistent and well-localized right lower quadrant and right fl ank tenderness at the expected location of his appendix (McBurney’s point). The laboratory findings were unremarkable. WBC was 4.9 K/microliter with the following diff erentials: 49% segmented neutrophils, 41% lymphocytes, 9% monocytes, and 1% eosinophils. Th ere was no evidence of anemia or thrombocytopenia (hemoglobin = 13 g/dL, hematocrit = 36%, and platelet count = 291 K/microliter). A computed tomography scan (CT-Scan) of the abdomen showed an enlargedappendix without inflammation; however, ultrasound images showed a fl uid-fi lled appendix with a diameter within the upper rages of normal. A subsequent physical examination revealed an increase in abdominal pain and tenderness, and, consequently, the patient underwent a laparoscopic appendectomy. Gross evaluation showed a pink-tan appendix, measuring 8.3 cm in length and 1 cm in diameter. Th eserosal surface was unremarkable and cut surface demonstrated no fecalith. Microscopically, hematoxylin-eosin-stained sections of the tip of the appendix revealed numerous lipid-laden xanthoma cells in the mucosa which were surrounded by lymphocytes and plasma cells admixed with multiple mult- inucleatedgiant cells containing cholesterol clefts. The rest of the mucosa showed patchy mild neutrophilic infi ltration. The postoperative clinical course was unremarkable. The patient was discharged home the following day and had an unremarkable physical examination on a follow-up visit three weeks later.
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Discussion: Xanthogranulomatous inflammation is a rare form of chronic infl ammation, manifested by the presence of lipidladen macrophages admixed with lymphocytes, plasma cells, neu-trophils, and often multinucleated giant cells with or without cholesterol cleft s. It was initially described in the kidney by Osterlind in 1944. It has also been reported in other organs, such as gall bladder, prostate, epididymis, ovary, urinary bladder, kidney, appendix, and the exact etiology of xanthogranulomatous inflammation is uncertain.
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Conclusion: Xanthogranulomatous Appendicitis (XA) is a rare clinical entity, particularly in the pediatric population. It may be encountered in specimens resected in the acute phase, but is much more common in interval appendectomy specimens. As observed in the present case and in previous reports, most patients with XA present with a picture of acute or sub- acute abdominal pain, and occasionally with a mass lesion.
Sarah S Nierman
Community Health Network/Butler University, USA
Title: Pediatric antimicrobial stewardship in an adult hospital
Time : 16:35-17:00
Biography:
Sarah Nierman is the Pediatric/PICU/NICU Clinical Pharmacy Specialist at Community Health Network and a Clinical Instructor at Butler University in Indianapolis, Indiana. She is a member of the health system’s antimicrobial stewardship program committee.
Abstract:
Statement of the Problem: Antibiotics are often associated with overuse, antibiotic resistance, medication errors and adverse events. Antimicrobial stewardship is a collaborative effort to improve the appropriate use of antibiotics by focusing on selection of the correct agent, dose, frequency, route and duration.
Discussion: Community Health Network established an antimicrobial stewardship committee in 2014. This committee has thefollowing goals based on expert guidelines:
a) De-escalation of antibiotics based on clinical factors and microbiologic data
b) Optimize antibiotic duration
c) Change from parenteral to oral antibiotic route
d) Dose optimization for effi cacy and safety
e) Avoid duplicate therapy
Th e committee utilizes the following to achieve the goals:
a) Establish evidence based guidelines for disease state diagnosis/ antibiotic use
i. Physician user input and buy in up front
ii. Provide education regarding guideline to physicians/ pharmacy/ nursing
b) Prospective auditing and physician intervention by pharmacy and peer feedback to prescribers.
c) Provider, unit, and Hospital Days of Th erapy (DOT) data for review and comparison to peers and national benchmarks
d) Antibiogram review
e) Formulary review with P&T committee
Conclusion & Significance: Pediatric antimicrobial stewardship is starting on the pediatric, pediatric intensive care and neonatal intensive care units. The goals and initiatives established in the adult population are a solid foundation for identifying pediatric opportunities.
Mersedeh Enshaei
Gilan University School of Medical Sciences, Iran
Title: Iron status profi le in children with hyperkinetic movement disorders: A comparison with normal children
Time : 17:00-17:25
Biography:
Mercede Enshaei has completed her Pediatric Specialty at the age of 32 years from Gilan University of Medical Sciences. She studied Genetic Counseling at Tehran University of Medical Sciences, and she will begin the Pediatric Hematology and Oncology Subspecialty from September 2018. Arya Mahdavi Baramchi has a Master Degree in Clinical Psychology. She is a member of Psychology and Counseling Organization of Iran.
Abstract:
Movement disorders are a growing field of pediatric neurology. Unlike adults, it seems children are more likely to suffer from hyperkinetic movement disorders. Some studies have been done on serum iron in aff ected adults, but there are limited data in pediatrics. Th is survey case-control study was aimed to compare iron profiles in children with hyperkinetic movement disorders with healthy children. 50 children of 2-12 years of age are examined with hyperkinetic movement disorders fifty healthy children as age and sex-matched controls were enrolled too. In children with hyperkinetic movement disorders serum iron, TIBC, and serum ferritin were 51.8 ± 2.77μg/dl, 450± 9.42 μg/dl and 47.92 ± 7.87 ng/ml; while in normal children these amounts were 81.4±3.94 μg/dl, 356 ± 12.34 μg/dl and 140.68 ± 13.61 ng/ml respectively. Th e diff erences in each parameter between two groups were statistically significant. (P-value < 0.05). There was a significant difference between patients with hyperkinetic movement disorders and healthy controls regarding iron profi les. Our findings suggest that decreased blood iron levels may have a predisposing eff ect on hyperkinetic movement disorders, although the knowledge about the mechanism is still limited. Since these disorders affect the quality of life, it seems further studies are needed to understand the mechanism and make some recommendations on prevention or control of the disease.
Reza Saeidi
Mashhad University of Medical Sciences, Iran
Title: Comparison of oral recombinant erythropoietin and subcutaneous recombinant erythropoietin in prevention of anemia of prematurity
Time : 17:25-17:50
Biography:
Saeidi R is assistant professor of neonatology has completed neonatology subspecialty in Mashhad University of Medical Sciences, Iran. He published 66 papers locally and international journal, 19 books, 71 supervision of thesis in general medicine, pediatric, and neonatology, 120 participation in national and international congress with lecture and poster presentation.
Abstract:
Background: Premature neonates are at risk for severe anemia and erythropoietin is the most important hormone in erythropoiesis. The aim of this study was to evaluate the infl uence of oral recombinant Human Erythropoietin (rhEPO) in proving erythropoiesis in neonates.
Methods: This was a randomized clinical trial study. Thirty neonates were enrolled from September 2007 to September 2008. The first group received oral rhEPO and Fe and the second, subcutaneous rhEPO and Fe. Th e patients' Hb, HCT and the need for blood transfusion were recorded. We included all infants with gestational age <34 weeks, birth weight <1500 gr, without respiratory distress (O2 Saturation> 85%, FiO2 of 30%), full feeding tolerance so that oral Fe can be administrated.
Results: In the first group (oral=PO), 65% of neonates were female and 35% were male, mean weight was 1140 g and mean GA was 32.6 weeks. In the second group (subcutaneous=SC), 42% were female and 58% were male. The mean weight was 1245 g and mean GA was 31.2 weeks and this was not statistically significant. In the first group, the mean Hb and HCT were 9.7±1.9 and 29.6±5.9 g/dl. In the second group, the figures were 12.5±1.7 and 38.8±5.1 which were statistically significant. There was no difference in the weight gain between two groups. In the first group, 3 neonates (20%) and in the second one, 1 neonate (15%) needed the blood transfusion.
Conclusions: rhEPO administration either PO or SC could prevent anemia of prematurity but SC route was more effective.
Jamel Hajji
Gafsa University, Tunisia
Title: Validation of the Tunisian version of the French version of the competitive state anxiety inventory-2 revised (CSAI-2R), including frequency and direction scales
Time : 17:50-18:15
Biography:
Hajji Jamel is a researcher at the field of coping and anxiety. He successfully completed his masters and Ph.D in the field of Higher Institute of Sport and Physical Education Gafsa, Gafsa University, Tunisia.
Abstract:
The Competitive State Anxiety Inventory-2 Revised (CSAI-2R), is one of the most frequently used instruments in the evaluation of situational anxiety in sports competition.
Objectives: The objective of this study was to validate the Tunisian version based on the French version of the Competitive State Anxiety Inventory-2 Revised (CSAI-2R), including the direction and the frequency scales.
Method: 418 athletes ranging in age from 14 to 34 years in different individual and team competitions, volunteered to participate in the study. Data were collected and analyzed for reliability and validity using the test-retest method, reliability, correlation analysis and confi rmatory factor analyses. Statistical analysis was performed with SPSS and the IBM AMOS version 21.0.0
Results: The Confi rmatory factor analyzes showed acceptable adjustments for the 3-factor model of CSAI-2R. For the intensity model [X2=343.19; X2/df=3.40; CFI=0.92; TLI=0. 90; GFI =0.91; RMSEA=0.076; p-value<0.001]. for the direction model [X2=360.83; X2/df=3.57; CFI=0.93; TLI=0.92; GFI=0.90; RMSEA=0.079; p value<0.001]. And for the frequency model [X2 =140.31; X2/df=2.58; CFI=0.93; TLI=0.92; GFI =0.92; RMSEA=0.062; pvalue<0.001]. And a good internal coherence of three scales was between 0.76 and 0.90.
Conclusion: Th is study provides support for the reliability and validity of the Tunisian version based on the French version of CSAI-2R, including the direction and the frequency scales. Among others the Tunisian version has demonstrated robust psychometric properties and can be used in other investigation.