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

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