20th International Conference on Pediatrics & Primary Care September 03-04, 2018 Hilton Zurich Airport | Zurich, Switzerland

Biography:

Edmund Kessler is an attending Pediatric Surgeon at a number of New York City hospitals and is an Associate Clinical Professor of Surgery at Weill Cornell Medical Center. His practice is limited to the surgery of infants, children and adolescents. He has completed his MBBCh in General and Pediatric Surgery training at the University of the Witwatersrand in Johannesburg, South Africa. He was a Visiting Fellow at the Hospital for Sick Children in London. He was a Lecturer in Anatomy and was a Consulting Surgeon and Senior Lecturer in Surgery at the University of the Witwatersrand. He is a Fellow of American College of Surgeons, Royal College of Surgeons (Edinburgh), South African College of Surgeons, International College of Surgeons. He is a Member of British Association of Pediatric Surgeons, South African Pediatric Surgical Association, American Pediatric Surgical Association, and a Surgical Affiliate Member of American Academy of Pediatrics.

Abstract:

Acquired diaphragmatic hernias are a rare occurrence. They can result from blunt, penetrating or inadvertent iatrogenic injury. When overlooked they can potentially be catastrophic. We report a case of iatrogenic diaphragmatic hernia in a six-month old infant presenting with acute respiratory distress as a result of strangulated bowel herniating into the left hemithorax caused from a traumatic chest tube insertion in the neonatal period. To avoid potentially life-threatening complications associated with misplaced chest tubes such as viscus perforation in the future, one might consider using soft pleural catheters using the Seldinger technique, especially in pre-term neonates as well as a general awareness of complications associated with misplaced chest tubes.

Biography:

Amelie Stritzke is an Assistant Professor, Clinical Neonatologist and Lecturer in the Cumming School of Medicine at the University of Calgary, Alberta, in Canada. She has completed her Graduation at Johann-Wolfgang-Goethe University in Frankfurt, Germany, and Pediatric Residency in Switzerland (Aarau and Berne). After fellowship and additional pediatric cardiology training in neonatal echocardiography, her primary educational and research interest is in cardiovascular neonatology and perfusion. She is currently involved with investigating perfusion patterns of intestinal blood flow after red blood cell transfusion and impact of maternal biologics on neonatal outcomes, as well as with teaching point of care ultrasound skills to neonatal practitioners.

Abstract:

Statement of the Problem: Extremely preterm infants are at higher risk than their term born peers to be affected by arterial hypertension beyond their stay in the Neonatal Intensive Care Unit (NICU). Modifiable and unmodifiable risk factors together create a phenotype that may contribute to cardiovascular and renal disease much later in life. For the primary care physician providing care after discharge from the NICU, guidance for diagnosis of arterial hypertension, treatment indications, and strategies aimed at improving outcomes are often not clear.

Methods: This is an evidence-based review of the risk factors, prevalence, and definition of arterial hypertension in neonates, particularly those born preterm. It includes state-of-the art renal conservation strategies inside and outside the NICU which may amend further, especially renal insult, in an attempt to improve long-term outcomes.

Findings: Determinants of blood pressure values and their measurement in neonates will be discussed. Implications of developmental origins of adult-cardio-vascular disease in preterm populations and management suggestions will be discussed.

Conclusion & Significance: This evidence-based review aims at giving health care providers a guideline in understanding the often renal impact on the development of neonatal arterial hypertension in this high-risk population. Furthermore, potential foundation of neonatal arterial hypertension in maturational disturbances are laid out, as well as the long-term implications and screening strategies, and especially, the treatment indications in an attempt to mitigate potential damage and improve long-term cardiovascular health.

Biography:

Stefan Holland-Cunz is Head of the Department of Pediatric Surgery at University Hospital of Basel. He is an expert in Visceral and Neonatal Surgery as well as in Pediatric Trauma Care. New wound therapy concepts are often evaluated and new approaches are developed in the unit and emergency unit at University Hospital of Basel.

Abstract:

Necrotizing fasciitis is a soft tissue infection that can rapidly progress and end lethally if not treated early and radically. With an extremely low prevalence (0.02% of all pediatric in hospital cases), most physicians will probably only see very few cases during their career. Unlike adult patients, the majority of children affected by this disease are healthy individuals. There is no chronic disease and necrotizing fasciitis often arises from minor lesions. We present two cases treated in our clinic within the past year. Our first case of necrotizing fasciitis was a 5 years old Caucasian male patient with a varicella lesion on the back. The second case, a 4 year old Caucasian male patient, presented after an insect bite at the lower limb. Both cases were triggered by a super infection after scratching. Rapid surgical treatment is necessary to reduce morbidity and mortality in cases of necrotizing fasciitis. Due to the rarity of the disease it is often misdiagnosed by physicians. We emphasize the importance of staying alert and to keep necrotizing fasciitis in mind.

Figure: Preoperative findings of necrotizing fasciitis following varicella infection on the back (left) and intraoperative result after the entire necrotic fascia was debrided (right)]

Biography:

Marco Carotenuto completed his Degree in Medicine and Surgery in 2000 and Specialist degree in Child Adolescent Neuropsychiatry in 2005. In 2008, he completed his Doctorate in Behavioural and Learning Disorders Sciences. From 2008 to 2011, he was a Junior Researcher and from 2011 to 2017, he was a Senior Researcher in Child and Adolescent Neuropsychiatry at Università della Campania Luigi Vanvitelli. In December 2017, he became Associate Professor at Università della Campania Luigi Vanvitelli.  His main field of interest and research includes: “Child neurology, pediatric sleep disorders, polysomnography, pediatric primary headaches, and pediatric rehabilitation”.

Abstract:

Background & Aim: Traumatic Brain Injury (TBI) may be considered as one of the main causes for childhood morbidity and mortality. TBI increases the risk of psycho-social problems, intellectual disability and cognitive impairment, but the most common consequence of TBI is sleep troubles. Aim of study is to assess polysomnographic findings in pediatric patients with TBI.

Materials & Methods: 37 children with TBI (mean age 9.69+/-1.81, 20 males and 17 females) were included in the study. The control group was composed by 37 children (mean age 9.34+/-1.78, 19 M and 18 F).  Exclusion criteria were: psychiatric and neurological disorders, intellectual disability (IQ≤70) and psychoactive drug administration. All children in both group filled out a full overnight polysomnography (PSG). Statistical analysis t-student’s analysis was used to verify the mean differences between groups for PSG parameters. Statistical software package (STATISTICA 8.0, StatSoft Inc.) was used. P value <0.05 were considered as statistically significant.

Results: Children with TIB showed a statistically significant (p<0,001) reduction for TIB (Time in Bed) min, SPT (Sleep Period Time) min, TST (Total Sleep Time)-min, SE (Sleep Efficiency) % , N2 min, N3 min, REM min, N3 spt, REM spt , N2 tst, N3 tst, REM spt  and a statistically significant increase in parameters  such as SOL (Sleep Latency) min, SS-h (Stage Shifts/h), AWN (awakenings)-h, and WASO (Wakefulness After Sleep Onset) min, N1 min, N1 spt, N1 tst.

Conclusions: Our study shows that pediatric TBI may alter sleep architecture consistently, although further studies are needed. The audience will take away from presentation are: importance of polysomnographic evaluation for pediatric traumatic brain injury (TBI); TBI may affect the sleep macrostructure consistently and; sleep disorders in pediatric TBI may be considered as a mandatory sign to consider and evaluate in TBI management.

Biography:

Geertje Lewin has completed her medical degree in Biology at US and Germany with an ongoing passion for physiology and toxicology. After working as an Eco-toxicologist, she went back into academia to complete her PhD in the Toxicology department of University Hospital Munster in 2005. In 2007, at the Fraunhofer Institute for Toxicology and Experimental Medicine, she entered the world of reproductive toxicology as a Study Director and Risk Assessor. Starting in 2014, she runs her own consulting company and recently joined Preclinical Science as a senior partner, providing advice in the fields of Teratology, Pre-Clinical Toxicology and Risk management.

Abstract:

The lung is so much more than simply our organ for gas exchange. Its development starts early in embryogenesis as a derivative of the foregut and a multitude of functional aspects matures over time, including immunological and metabolic properties. At every step of development, exogenous noxae and factors derived from maternal-fetal interaction can interfere and have long-lasting consequences. An excursus in developmental pulmonary morphology along with functional maturational aspects is given.  The adaptations during child birth and growth and expansion well into childhood are discussed. An emphasis is laid upon malformations, congenital diseases, drug influences and toxic impact during pre- and postnatal development. Since pediatric drug development is an ongoing hot topic but also a battle due to missing data in science and industry, testing strategies and data on comparative organ maturation in human babies and juvenile experimental animals are presented

Biography:

Marta Carballal Mariño has her expertise in Primary Care Pediatrics in A Coruña, Spain. Psychiatric workshop of the Primary Care Pediatrics Galician Association (AGAPap) in Spain has the aim to improve knowledge about these disorders and to give primary care pediatricians skills in diagnosis and treatment of these conditions, and in this group is formed by two psychiatrics and nine primary care pediatricians. This study was presented as an oral communication at the 67th Congress of the Sociedad Galega de Pediatría, November 12, 2016, Santiago de Compostela, Spain. It was also presented as an oral communication at the 65th Congress of the Asociación Española de Pediatría, June 1-3, 2017, Santiago de Compostela, Spain, and awarded the prize to the best oral communication of the AEPap. Another relationated publication this year has been: Ageitos AG, Maseda MJD, Villaverde AB, González BP and Mariño MC. Attention Deficit Disorder with Developmental Coordination Disorder: A Subgroup of Clinical and Therapeutic Importance. SM J Schizophr Res. 2018; 1(1): 1004.

Abstract:

Objectives: To determine the prevalence of psychiatric disorders in primary care pediatrics in Atlantic Galicia.

Methods: An observational, descriptive, cross-sectional prevalence study was carried out in 9 outpatient clinics in A Coruña and Pontevedra; Spain, with a population of 8293 children between September and November 2015. A total of 1286 randomly selected patients from 0 to 14 years of age were included. From the medical history was registered: age, sex, psychiatric diagnosis established by DSM-IV-TR criteria in its five axes, professionals who participated in the diagnosis and treatment of the process and what type of treatment was received. Authorization was obtained from the Research Ethics Committee of Galicia number 2015/427.

Results: 148 of 1286 patients presented psychiatric pathology (11.5% IC 95% 9.73-13.29), 68% male. Between 0 and 5 years, the prevalence was 4.5%; between 6 y and 10 y, 18.5% and between 11 y and 14 y 22%. Symptoms lasted a median of 25 months. The most frequent pathologies in 1286 patients were ADHD (5.36%), language disorders (3.42%), learning disorders (3.26%), anxiety-depressive disorders (2.4%) and behavior disorders (1.87%). Of the 148 cases, 47% had comorbidity with another mental disorder. Most of them required attention by multiple social, health and educational professionals; 33% received psychopharmacological treatment.

Conclusions: The prevalence of psychiatric disorders in pediatric primary care is frequent, chronic and complex, increases with age and requires many health, educational and social resources.

Biography:

Rise Consolação Iuata Costa Rank holds a Bachelor degree in Dentistry from University of Uberaba in 1988; Master's degree in Pediatric Dentistry from the São Leopoldo Mandic Dentistry Center in 2004; Specialization in Ortodontia from UNINGÁ (TO); Doctorate in Pediatric Dentistry from Universidade Cruzeiro do Sul. She is currently a titular Teacher II of Pediatric Dentistry at UNIRG University Center and Regent Teacher of Pediatric Dentistry at CEULP/ULBRA. She is Coordinator of the Research Ethics Committee (CEP) at UNIRG University Center, and Coordinator of the postgraduate course in Pediatric Dentistry of CEULP/ULBRA Palmas TO. She has experience in Dentistry, with emphasis on Pediatric Dentistry, acting mainly in the following subjects: promotion in oral health, interceptive orthopedics, dentistry for baby, behaviour and child anxiety.

Abstract:

In order to evaluate children’s oral health related to their frequency in a public early preventive dental care, this research was a retrospective cohort study with the purpose to evaluate 252 children, between 36 and 60 months of age, both sexes, in Gurupi city, in the Legal Amazon region, Brazil. Three groups were created for classification of the participants: G1 - effective participants since their birth; G2-children who have stopped participating for more than 24 months and G3 (group control)-children who have never attended a prevention program. The development of the evaluation occurred within two stages: interviewing mothers and children that have received a caries, gingivitis and occlusion clinical examination. The WHO index of decayed for primary dentition (deft) presented different data in the groups, G1 was 0.05, G2 was 1.96 and G3 was 3.30. Moreover, oral diseases were statistically more common in children that have never participated of an oral health program (p=0.025). As said by 54% of the mothers who left the program, the main reason was the forgetfulness of the appointment. In addition, the ruled children who always appear for the appointment have better results comparing to those who dropped out or never attended, regarding caries, gingivitis and malocclusion.

Biography:

Omaima El Tahir has completed her Graduation in Biomedical Sciences and a Master’s degree in Medicine. She has her expertise in the role of host genetic variants in susceptibility, severity and outcome of childhood bacterial meningitis, aiming to create prediction tools for complications of bacterial meningitis integrating both clinical and genetic biomarkers because it is still a life-threatening infectious disease. She also aims to provide more insight into the possible very long-term sequelae which could have a significant impact on subsequent health state of childhood BM survivors during young adult life.

Abstract:

Statement of the Problem: Sensorineural hearing loss is the most common severe sequela in survivors of childhood bacterial meningitis. In the past, we developed a validated prediction model to identify children at risk for post-meningitis hearing loss based on clinical factors. As genetic variation in host immune response genes is also associated with susceptibility to and severity of bacterial meningitis, the purpose of this study is to determine host genetic risk factors to improve the performance of the prediction model.

Methodology & Theoretical Orientation: The generated data of 471 Dutch Caucasian survivors of childhood bacterial meningitis genotyped for four single nucleotide polymorphisms (SNPs) in three different genes involved in pathogen recognition and inflammation were used to improve the prediction model. Genetic data were included during model construction and performance of the model was compared to the original model by likelihood ratio tests and the area under the curve (AUC) of the receiver operating characteristic curves.

Findings: Addition of genetic predictors significantly improved the performance of the new model compared to the original clinical prediction rule (increase of AUC from 0.85(95% CI 0.78-0.91) to 0.91 (95% CI 0.84-0.97). Independent predictors for hearing loss were S. pneumoniae, presence of ataxia during illness, CSF glucose level≤0.6 mmol/L, duration of symptoms before admission >2 days, TLR4+896 A>G and TLR9-1237 T>C.

Conclusion & Significance: Including host genetic factors during model construction results in a significantly improved prediction model for post-meningitis hearing loss in children. Prediction of outcome using host genetic risk factors and clinical variables may contribute to better understanding, timely intervention and thereby appropriate follow-up of children after bacterial meningitis. Future studies should focus on additional value of other SNPS and investigate SNP combinations (SNP traits) in larger cohorts but also assess applicability of the model.

Biography:

Benslimane Hammou has completed his MD from Oran School of Medicine. Currently, he works as a Pediatric Surgeon at Children Hospital of Oran, Algeria, in Pediatric Urology department. He published many of the research articles which are related to urethral problems in children.

Abstract:

Introduction: Disorders of Sex Development (DSD) is affecting 1 in 10,000 births. Current management is very heterogeneous because of the low volume of patients for Persistent Mullerian duct syndrome. The persistence syndrome of Mullerian derivatives (PMDS) is a rare form of abnormalities of sex development. The persistence of Mullerian derivatives can be seen as Persistent Mullerian duct syndrome (PMDS): intraoperative diagnosis in case of cure of a hernia in a boy normally virilized with the discovery of a fallopian duct or a uterus when opening the hernia sac during a laparoscopy, the treatment of a nonpalpable testicle. The treatment is surgical and some author recommends dissection to separate the vas mullerian duct, orchidopexy and mullerian duct excision. This treatment is done by laparoscopy and is consist of a longitudinal section of the uterus and the cervix to allow lowering each testicle by an internal pathway within the umbilical artery and preserving the testicular vasculature.

Patients & Methods: Four patients admitted in our department of pediatric urology for Persistent Mullerian duct syndrome from 2015-2017.

Results: One case diagnosis of PMDS either inguinal hernia repair, one case either urethrocystoscopy for utero hydronephrosis bilateral, one non palpable testis in two cases.

Conclusion: Laparoscopy is best way for PMDS diagnosis. Division of Mullerian duct is a safe way to do orchidopexy without damage of the vas.

Biography:

Lucia Celesti has completed her Degree in Medicine and Surgery at La Sapienza University in 1983 and is a Specialist in Pediatrics and Hygiene. She is the Director of Family Services at Bambino Gesù Children’s Hospital in Rome, Italy. She has published more than 25 papers in reputed journals and three books on children’s rights and relational and social issues in pediatrics.

Abstract:

In 2015 the Bambino Gesù Pediatric Hospital (OPBG), within the European project "Common approach for refugees and other migrant’s health-CARE", studied and drafted a protocol for determining age in unaccompanied minors using a multidisciplinary and holistic approach. Due to the increasing numbers of migrants arriving in Italy by sea, a useful tool to manage the phenomenon in the difficult context of hotspots was required. In fact, being or not identified as a minor constitutes a watershed for the fate of the foreigner. At international level experts affirm that age assessment must consider a number of physical, psychological, environmental and cultural factors and that, for this reason, the involvement of doctors-with auxological skills, child neuro-psychiatrists, developmental psychologists, social workers, intercultural mediators-specialized and trained is needed. Based on demonstrated feasibility of the project, OPBG is going to be implemented in collaboration with Rome Municipality– the holistic protocol on local context of city of Rome. The age assessment foresee three main steps: a social evaluation, aimed at collecting information regarding the child’s life, his/her previous sexual activities, reason for the migration and useful details about the present situation; a neuropsychiatric/psychological evaluation through mental state evaluation (a qualitative analysis aimed to verify the existence of a potential psychiatric risk) and modified mini-mental state examination (a test used to assess and monitor cognitive functions in child’s principal neuropsychiatric domain); a medical-auxological examination, collection of all useful parameters to determinate age, including the child’s pubertal development. At the end of multidisciplinary evaluations, the case manager report the conclusion indicating the presumed age with a minimum value and a maximum value (range) deriving from the biological variability and the methods used by the team. If doubts remain, the migrant is considered as minor.

Biography:

Paweł Nachulewicz is a Pediatric Surgeon, Transplant Surgeon and a General Surgeon. Since 2010, he is the Chief of Pediatric Surgical Clinic at Medical University of Lublin, Poland. From 1998, he focused in laparoscopic and thoracoscopic surgery in children. He is the author and co-author of more than 190 publications, congress reports and books chapters.

Abstract:

Symptomatic cholelithiasis surgery in children has increased in tendency over the last 10 years. The frequency of cholelithiasis in children is assessed to range from 0.13 to 1.9% and when compared with the adult population, where risk of cholelithiasis is assessed as 10-15%. Cholecystectomy in children was performed extremely rarely before the era of minimally invasive procedures. They present their experience of treatment of cholelithiasis in children. Laparoscopic cholecystectomy was performed using the three ports technique. Laparoscopic cholecystectomy is routine surgical procedure in non-complicated cases when concernments are located in gallbladder, but in the cases of cholodocholithiasis or complications of cholelithiasis as: cholecystitis, hydrops of the gallbladder and biliary pancreatitis algorithms of treatment are different. The pediatric surgical units which treat those conditions should be prepared to manage all that complications. The experience of pediatric gastroenterologist’s in endoscopic retrograde cholangiopancreatography (ERCP) is limited and in many times cooperation with adult gastroenterologist or experienced pediatric units are crucial. Between 2011 and 2017, 149 laparoscopic cholecystectomies were performed in their center. In 98 patients, elective LC was performed. In 32 patients with biliary colic LC was performed after resolution of symptoms during the same admission. In nine patient’s cholecystitis and in three hydrops of gallbladder were recognized. In five patients choledocholithias required ERCP procedure before cholecystectomy and in two patient’s biliary pancreatitis was connected with cholelithiasis. All patients had performed LC using three port techniques. There were no intraoperative complications demanding reoperation such as injury to the choledochus or other viscera, bile leakage or bleeding. The time of hospitalization ranged from 2 days to 21 days (average 4.5 days). The treatment of cholelithiasis should be performed in pediatric surgical units which have experience in laparoscopic procedures and are able to treat complicated cases especially when choledocholithiasis is suspected. In experienced hands the laparoscopic three ports technique is safe procedure connected with minimal rate of complications.

Biography:

Paweł Nachulewicz is a Pediatric Surgeon, Transplant Surgeon and a General Surgeon. Since 2010, he is the Chief of Pediatric Surgical Clinic at Medical University of Lublin, Poland. From 1998, he focused in laparoscopic and thoracoscopic surgery in children. He is the author and co-author of more than 190 publications, congress reports and books chapters.

Abstract:

Symptomatic cholelithiasis surgery in children has increased in tendency over the last 10 years. The frequency of cholelithiasis in children is assessed to range from 0.13 to 1.9% and when compared with the adult population, where risk of cholelithiasis is assessed as 10-15%. Cholecystectomy in children was performed extremely rarely before the era of minimally invasive procedures. They present their experience of treatment of cholelithiasis in children. Laparoscopic cholecystectomy was performed using the three ports technique. Laparoscopic cholecystectomy is routine surgical procedure in non-complicated cases when concernments are located in gallbladder, but in the cases of cholodocholithiasis or complications of cholelithiasis as: cholecystitis, hydrops of the gallbladder and biliary pancreatitis algorithms of treatment are different. The pediatric surgical units which treat those conditions should be prepared to manage all that complications. The experience of pediatric gastroenterologist’s in endoscopic retrograde cholangiopancreatography (ERCP) is limited and in many times cooperation with adult gastroenterologist or experienced pediatric units are crucial. Between 2011 and 2017, 149 laparoscopic cholecystectomies were performed in their center. In 98 patients, elective LC was performed. In 32 patients with biliary colic LC was performed after resolution of symptoms during the same admission. In nine patient’s cholecystitis and in three hydrops of gallbladder were recognized. In five patients choledocholithias required ERCP procedure before cholecystectomy and in two patient’s biliary pancreatitis was connected with cholelithiasis. All patients had performed LC using three port techniques. There were no intraoperative complications demanding reoperation such as injury to the choledochus or other viscera, bile leakage or bleeding. The time of hospitalization ranged from 2 days to 21 days (average 4.5 days). The treatment of cholelithiasis should be performed in pediatric surgical units which have experience in laparoscopic procedures and are able to treat complicated cases especially when choledocholithiasis is suspected. In experienced hands the laparoscopic three ports technique is safe procedure connected with minimal rate of complications.

Biography:

Jessica Arditi is a Pediatric Endocrinologist, currently works in her private practice in Athens, Greece. She has completed her MD, medical thesis, Pediatric Subspecialty and Diploma in Pediatric Endocrinology. In Athens, she has worked for more than 10 years in the Division of Endocrinology, Metabolism and Diabetes, 1^st Department of Pediatrics, University of Athens, Agia Sophia Children’s Hospital. She continues to work as a Scientific Associate of the Division.

Abstract:

A decrease in sleep duration has been reported in children and adolescents. It seems associated to later bedtime, attributed to aspects of modern life, like screen time and use of internet and smart phones. The results from the literature suggest that sleep restriction may be associated with long-term risk of significant morbidity. Both cross-sectional and longitudinal studies support an association between short sleep and the risk to develop overweight/obesity. Moreover some preliminary results show a link between too little sleep and worsening cardio metabolic risk (insulin resistance and increased waist circumference). Laboratory studies have given us some plausible mechanisms linking weight gain and short sleep. The appetite regulating hormones are dysregulated by sleep restriction with lower leptin and higher ghrelin levels. The endocannabinoid system is also influenced by sleep restriction promoting excessive food intake. Sleep restriction has been shown to influence the stress system (hypothalamic pituitary adrenal-sympathetic axis) and the cytokines. The sympathetic nervous system and the HPA axis activity are increased and the inflammatory markers are elevated. These have been linked to insulin resistance. Too little sleep during the night in children has been associated with an adverse effect on growth. Twenty-four hour GH studies in children suggest that a child can lose up to 1/3 to 1/4 of the nighttime GH peak secretion when he delays his bedtime. This may have a negative impact on his final height. Knowing that today many children and adolescents are chronically sleep deprived, these results are a major source of concern. They should inspire us to better address the issue of sleep in the daily routine of our practice. Prevention and screening of our patients for sleeping problems will not only ensure their daily well-being, but will promote a better long-term health.

Biography:

Hernan Villalon-Urrutia is a Physician, qualified Surgeon at Pontifical Catholic University of Chile in 1987. He is a Specialist in Paediatrics and Neonatology. He is Professor of Paediatrics at University of Chile. His research interest is in the field of Neonatology and early Parenting. He has presented more than 100 research papers in national and international conferences and publications.

Abstract:

Regenerative therapies using stem cells (SC) are theoretical options in perinatal diseases. These are promising in inflammatory cascade or regenerative capacity in CNS and lung. However, ethical controversies emerge of its use when it comes to the methods used in its obtaining, being embryonic origin the most questioned. Actual research is based on the use of somatic mesenchymal stem cells (MSC) since they have less ethical conflicts. Development of embryonic cell in vitro aims to overcome this dilemma. Benefits today are potential. MSC ability to self-regeneration and pluripotency could provide replacement in brain and lung, but still oncogenic risk must be considered. In addition, its immunomodulatory role can decrease inflammation and increase tissue repair through a paracrine effect. Non-beneficial results using MSC’s have been seen in cases of pulmonary embolism with endothelial damage when administered intravenously in myocardial infarction. From a psychological perspective, a reflection is needed mainly when SC is offered in the context of delivery, in which obtaining umbilical cord cells and/or placental tissue is easy. An informed consent considering high costs and uncertain benefits is needed to avoid encouraging expectations. Parents should have no limit to any attempt to improve the quality and life expectancy of their children. Regenerative therapy with SC in neonatology lacks of solid evidence to support its use in terms of efficacy and safety. However, ongoing research is promising. Further research is required. Therefore, conservative advising to parents is recommended to avoid creating false expectations based on MSC’s.

Biography:

Dawn Lee has completed her PhD from National University of Singapore, School of Medicine. She has spent her Post-graduate years rotating through various specialities in tertiary hospitals in Singapore and has obtained pediatric specialist accreditation in year 2015. She is a General Pediatrician at KK Women’s and Children’s Hospital in Singapore, and participates actively in research publications as well as teaching activities of medical staff and students.

Abstract:

A 2-month-old girl presented with fever and irritability. She was born full term with no other medical problems. Her vital signs were stable. Other than a generalized maculopapular exanthema, physical examination was normal. On day three of fever, she developed non-tender palmoplantar erythema (Figure 1 and 2). Parents declined administration of intravenous antibiotics. The white cell count was 4.33×10^9/L (5-15×10^9/L; 42% neutrophils, 36% lymphocytes, 21% monocytes). Hemoglobin level and platelet count were normal. C-reactive protein and procalcitonin levels were unremarkable. Full septic workup did not yield growth of any organism. Cerebrospinal fluid (CSF) showed no pleocytosis, with normal protein and glucose levels. Real-time PCR analysis of CSF detected parechovirus RNA (the serotype was not analyzed in this case). Fever subsided subsequently and she was discharged after three days. Differential diagnoses of an acral rash include Kawasaki disease (KD), contact dermatitis, and hot hand-foot syndrome caused by Pseudomonas aeruginosa and parvovirus infection. In addition, infants with enterovirus infections (hand-foot-mouth disease) can also present with similar rashes on the palms or soles. She had no other clinical stigmata of KD and the blood inflammatory markers were not significantly raised. Contact dermatitis presents with vesicular, weepy, crusted eczematous plaques instead and is less commonly seen in her age group. Moreover, she had no history of contact allergen or topical agents applied to her palms preceding the rash. Hot hand-foot syndrome presents with red and tender palmoplantar nodules after exposure to Pseudomonas aeruginosa in warm pools with low pH and low chlorine levels. Papular-purpuric gloves and socks syndrome, usually seen in parvovirus B19 infection, presents with erythematous and purpuric papules on dorsal, palmar and plantar surfaces of distal extremities. This infant had parechovirus meningitis with palmoplantar erythema and a non-specific maculopapular rash, both of which were previously described. Palmoplantar erythema in a febrile infant is uncommon and can be a diagnostic sign for parechovirus infection. In suspected meningoencephalitis cases, CSF should be sent for parechovirus testing despite normal CSF microscopy as the majority of infants with parechovirus meningitis had no CSF pleocytosis. If real-time PCR analysis of CSF detected parechovirus RNA, it would also be useful to analyze the serotype of parechovirus involved. As parechovirus can present with a sepsis-like syndrome and encephalitis in neonates and infants, recognizing its dermatologic manifestations can be helpful to streamline investigations and avoid unnecessary skin biopsies. Paraviral palmoplantar erythema was self-limiting in this case and did not require specific treatment. This observation can potentially be added to the list of lesser known parainfectious exanthems.

Biography:

Emiko Katsurada is a Professor in Department of Integrated Psychological Sciences at Kwansei Gakuin University, Japan and Vice President at Kwansei Gakuin University School of Humanities during 2015-2017. She completed her Medical degree in Philosophy at Oregon State University in the year 1995. Her research expertise is Educational Psychology.

Abstract:

Introduction: Despite a decrease in the total number of children in Japan, the number of children living in residential foster care facilities is increasing. One of the reasons for this increase is the rise of child abuse and negligence in Japanese society. In fact, more than half of the children (53.4%) living in residential foster care facilities have experiences of maltreatment before being institutionalized. Previous studies have indicated that maltreatment influences children’s attachment formation (attachment patterns), which can create children’s behavior problems. In Japan, however, there has been no study to investigate the relationship between child maltreatment and attachment patterns, although there are a few studies that show no association among child maltreatment, child’s degree of attachment security, and child’s behavior problems. The present study examined the association among those variables with Japanese institutionalized children.

Method: Twenty-nine children (12 boys and 17 girls) from 3 different institutions participated in the study. Their average age was 6.4 years old. The attachment doll play assessment and the child behavior checklist/4-18 were used to assess their attachment patterns and behavior problems respectively. Children’s maltreatment history was obtained from each institution.

Results: None of the children with secure pattern had history of maltreatment, whereas five out of six children with disorganized pattern had history of maltreatment. Children with maltreatment history had significantly higher externalizing problem score than those without it. Children with disorganized pattern and maltreatment history had extremely high externalizing problem score compared to those with other attachment patterns.

Conclusion: Consistent with previous studies in western society, associations among child maltreatment, attachment pattern, and behavior problems are confirmed in Japanese children.

Biography:

B Dwibedi is working as a Medical Scientist at ICMR-RMRC, Bhubaneswar. He has 15 years of research experience in the area of Clinical, Molecular Virology and Clinical trials in tropical diseases. He is also the Nodal Officer of Model Rural Health Research Unit and Viral Research and Diagnostic Laboratory, Department of Health Research, Ministry of Health and Family Welfare, India. He received National Award from ICMR and nominated as a Member of National Academy of Medical Science for Excellency in tropical disease research. He demonstrated alternate regimen for elimination of lymphatic filariasis and has given the first evidence of sub-clinical lymphatic pathology in children with W. bancrofti infection and its reversal with MDA drugs. His evidences on epidemiology of viral diseases and bacterial infections especially in children could move the programme towards introduction of vaccine against Rota and JE virus as well as Haemophilus influenzae b in the regional immunization programme

Abstract:

Acute respiratory infection is of public health importance in terms of its severe manifestation requiring hospitalization and ICU management. Influenza pandemic (H1N1) 2009 strain put many countries including India into emergency alertness because of sudden rise in cases and lack of preparedness of the hospital facilities to take up the challenge. After this an inclination towards flu vaccination is being observed in different parts of the country, but still it is driven by media havoc on news of H1N1 outbreaks or resurgence, not as a conscious preparedness towards regular flu vaccination. In the state of Odisha, India during flu epidemic seasons, we studied 2863 reported cases of severe ARI suspected with H1N1 in 2009, 2010, 2012, 2015, 2016 and 2017 whereas no cases were reported during 2011, 2013 and 2014. Our laboratory investigations revealed association of influenza pandemic (H1N1) 2009 virus infection in 606 (21.2%) of above cases those required ICU admission or emergency management in hospitals. Hence, 78.8% of severe ARI cases in flu seasons remained influenza pandemic (H1N1) 2009 negative. But of these 349 (12.2%) were shown to be infected with Influenza A virus which are not grouped as influenza pandemic (H1N1) 2009. From the above observation it may be assumed that non-H1N1 Influenza A also contributes towards 12.2% of ICU admissions with severe ARI. Besides above our study during non-flu seasons (n=1044, January to July) shown Influenza A as the second most (23%) common cause after RSV (23.5%). This gives an impression that routine flu A vaccination can prevent severe respiratory illness throughput the year in the country like India but a proper sensitization of the health systems and community would be essential to promote flu vaccination emphasizing its usefulness in regular health care rather than an emergency post-epidemic response.

Biography:

Natchanan Chivanon is an Assistant Professor in the Faculty of Nursing at Burapha University and completed her PhD in Nursing in 2011. She is a Lecturer in Division of Pediatric who teaches both bachelor degree and master degree nursing students. She has published eight papers in nursing.

Abstract:

This qualitative research was aimed to explore suffering among mothers with low birth weight infants. The participants consisted of 24 mothers with low birth weight infants at sick newborn care unit. In-depth interview was used to collect data at the regional public hospital in Eastern Thailand. Content analysis was performed for data analysis. The findings revealed five themes of mothers’ suffering such as mothers’ suffering characteristics: anxiety/stress, sadness, sleepless, and no appetite; causes of mothers’s suffering: fear from complication and death of infants; factors affecting mothers’ suffering: illness condition of infants, and family support; the means to soften suffering: creating hope, making merit, pray, and accepting infant’s condition and; outcomes of softening suffering: living with suffering, suffering softened, and having hope. The findings enhance a basic knowledge about mother’s suffering. Therefore, nurses involving with low birth weight infants and their mothers could develop the nursing intervention for soften suffering based on this findings