Day 2 :
Keynote Forum
Michael N Liebman
IPQ Analytics, USA
Keynote: Pediatric acute respiratory distress syndrome: NAF’s systems-based approach to risk assessment, diagnosis and treatment
Time : 10:00-10:40
Biography:
Michael N Liebman is an Adjunct Professor of Pharmacology and Physiology at Drexel College of Medicine and Adjunct Professor of Drug Discovery, First Hospital of Wenzhou Medical University. Previously, he was the Director of Computational Biology and Biomedical Informatics, University of Pennsylvania Cancer Center 2000-2003. He has served as Global Head of Computational Genomics, Roche Pharmaceuticals and Director, Bioinformatics and Pharmacogenomics, Wyeth Pharmaceuticals, Director of Genomics for Vysis, Inc. He is a Co-Founder of Prosanos, Inc., (now United BioSource) (2000). He was an Associate Professor of Pharmacology and of Physiology/Biophysics at Mount Sinai School of Medicine. He is on the Board of Directors of the Nathaniel Adamczyk Foundation in Pediatric ARDS, the Chair of the Informatics Program and also Chair of Translational Medicine and Therapeutics for the PhRMA Foundation and a Member of their Scientific Advisory Board.
Abstract:
NAF’s emphasis on prevention has led to its support for the initial development of a web-based, open-access data analysis platform that supports clinician access and analysis of complex clinical data. This platform currently supports integration of data from clinical trials and ICU clinical databases and enables the application of analytic methods to create and evaluate cohorts within the accessible patient population. The Foundation’s intent is to use its role as an honest broker to promote and enable sharing of data, in a de-identified and secure manner, amongst clinical researchers and clinicians to explore patient characteristics, disease presentation and both treatment and response. NAF’s close collaboration with the medical community who treat patients with pARDS has enhanced its understanding of the complexity of dealing with critical syndromes and complex disorders that may only be diagnosed after admittance to the pediatric ICU. Its web-based platform is currently positioned to assist in the stratification of patients to improve patient management and outcome. It is clear, however, that the potential opportunity to identify children at risk and to develop approaches for prevention will be the key to achieving NAFs long-term goals. To accomplish this requires a more comprehensive analysis of the key factors involving exposures to environment and lifestyle factors that may occur during the child’s development of their lungs and respiratory system. In medicine, it is well accepted that prevention can be much more effective than treatment towards obtaining an optimal outcome for the patient and their families, and this aligns directly with NAF”s goals. To better understand what factors might contribute to the development of pARDS, the opportunity exists to enable researchers from clinical, basic science and epidemiological domains, to identify key risk factors pre- and post-natal. The currently is little opportunity to study the critical relationship during the development of a child’s lung, that extends from pre-natal through birth into early childhood. At present, researchers from all domains typically work within silos reflecting overall stages of development as opposed to following a specific target organ, through its developmental stages, to understand the impact of external factors. These factors, including lifestyle and environmental exposure during pregnancy, may be further modulated in their impact by genetic factors as well. Although the complexities and variation in physiological development within specific organ systems is well known, it has rarely, if ever, been followed as the basis for integrating and accessing personal and clinical history data for the child and/or for the mother.
Keynote Forum
Abiodun A Oyebola
Back2Play Pediatrics, Canada
Keynote: Current pharmacotherapautic options for children with attention deficit hyperactivity disorders and co-morbidities: A general pediatrics perspetive
Time : 10:40- 11:20
Biography:
Abiodun A Oyebola has completed his Medical degree in Nigeria. He has obtained his Master’s degree in Public Health (Child and Maternal Health) in USA shortly after leaving medical school. He did his Pediatric Training at the John H Stroger Hosptial of Cook Country in Chicago. He is Board Certified by the American Board of Pediatrics. With over 15 years of experience and wealth of wisdom in the care of children, he is a passionate Advocate for kids and this shows in his expert administration of care to his ever growing patient family. He has become one of the top rated Paediatricians in the Greater Hamilton Area.
Abstract:
Attention Deficit Hyperactivity Disorder is probably the most common neurodevelopmental problem encoutered in children. These kids will present with inattention or difficulty with focus and hyperactivity. As a result, the family doctor and the general pediatrician are the first line of contact for the parent seeking assistance. While monotherapy is effective in treating ADHD, there are common co-morbidites associated with ADHD such as anxiety/depression, learning disorders, tourettes disorder, substance abuse and oppostional defiant disorder. Failure to treat these disorders will lead to poor outcomes in these group of children. This oral presentation will discuss monotherapy vs. combination therapy, treatment options available for the general pediatrician/family doctor in treatment of ADHD and co-morbidities.
Keynote Forum
Virginia Baez Socorro
Case Western Reserve University, USA
Keynote: Eosinophilic Esophagitis: Reflux, protein allergy or both?
Time : 11:40-12:20
Biography:
Virginia Baez Socorro has studied her Medicine at the Luis Razetti School of Medicine in the Universidad Central de Venezuela. She has worked as a General Physician in Venezuela before completing her Pediatric Residency at Albert Einstein Medical Center in Philadelphia, PA, USA. She then completed a Fellowship in Pediatric Gastroenterology at UH Rainbow Babies and Children’s Hospital, Case Western Reserve School of Medicine in Cleveland, OH, USA. She is an Assistant Professor of Pediatrics and the Co-Director of the Eosinophilic Esophagitis program at UH Rainbow Babies and Children’s Hospital. In addition to Eosinophilic Esophagitis, her interests include inflammatory bowel disease and celiac disease.
Abstract:
Eosinophilic Esophagitis (EoE) is a disease characterized by a localized inflammatory condition of the esophagus with symptoms of esophageal dysfunction and eosinophil infiltration of the esophageal mucosa. The incidence and prevalence of EoE has increased during the last decade. The symptoms of EoE are age related. In infants and young children common symptoms are failure to thrive, feeding difficulties, and classic symptoms of gastroesophageal reflux. School age children can present with vomiting, abdominal pain, and regurgitation and adolescents with dysphagia and esophageal food impaction. Patients with EoE have higher atopic comorbidities such as asthma, food allergies, allergic rhinitis, and atopic dermatitis. The diagnosis of EoE is completed with upper endoscopy and the finding of more than 15 eosinophils per high-powered microscopic field within esophageal mucosal biopsies. EoE could be treated with medications or diet modification. Oral steroid (e.g. budesonide and fluticasone) therapy is effective in up to 80% of patients with EoE. These medications are swallowed with the goal of topical application to the esophageal mucosa. An elemental diet using a formula lacking antigenic capacity is effective in up to 90% of patients. A specific six-food (milk, egg, wheat, soy, peanut/tree nuts, and fish) elimination diet has a success of 72%, but is difficult for patients. Recently, specific four-food elimination diets have been shown to be effective with better patient acceptance. Allergy-test driven diets are effective only in 45% of patients. A subclass of EoE responds to proton pump inhibitor therapy.
- Pediatric Pulmonology | Pediatric Endocrinology | Pediatric Cardiology | Pediatric Surgery | Pediatric Nursing
Chair
Michael N Liebman
IPQ Analytics, USA
Co-Chair
Dani Yardeni
Tel-Aviv University, Israel
Session Introduction
Sara Lobo
Hospital Universitário de Santa Maria, Portugal
Title: Regression of large infantile multifocal hepatic hemangioma after Propranolol
Time : 12:20-12:50
Biography:
Sara Lobo has completed her MD at Faculty of Medicine, University of Lisbon and later started the specialization in Pediatric Surgery. Besides congenital malformations, another of her areas of interest are the vascular tumors, their behaviour and their challenging treatment. In the department, where she practices, there is already a large experience in treating this conditions and a great team effort to give their patients the best, according to the standards of care.
Abstract:
Recent literature describes several cases of successful response of infantile liver hemangioma to propranolol treatment. Some multifocal hepatic hemangioma can involve a massive area of the liver in children and carry a high risk of development of cardiovascular compromise, requiring a fast approach and monitoring. This case report describes a 3-months infant with a very large multifocal hepatic hemangioma for whom was proposed to start propranolol. Treatment was completed in a 20 months period with no report to side effects and a surprisingly fast response. The authors present this case to highlight the efficacy and safety of blocker-β propranolol treatment in young children even for very large liver hemangiomas.
Dani Yardeni
Tel-Aviv University, Israel
Title: Single daily dosing of Ceftriaxone and Metronidazole is as safe and effective as Ampicillin, Gentamicin and Metronidazole for non-operative management of complicated appendicitis in children
Time : 13:50-14:20
Biography:
Dani Yardeni has completed his MD in 1989 at the Faculty of health scince Ben Gurion University in Israel and did his residency in Pediatrics Surgery at Afula hospital. In the year 1998 worked at the Red Cross children hospital in Cape Town, S.A. Did fellowship in Ann Arbor Michigan in 2001-2002. In the year 2006 was sent by the Israeli Goverment to work in Ron hospital in Nauru. Since 2016 workes as a Pediatric Surgeon in Haddasa medical center in Jeerusalem.
Abstract:
Introduction: Perforated appendicitis very common abdominal emergency in children and nonoperative management with Ampicillin Gentamicin and Metronidazole (AGM) has shown good results. Recent data show that single daily dosing of Ceftriaxone and Metronidazole (CM) is as safe and effective as ampicillin gentamicin and clindamycin for treatment of perforated appendicitis after surgery in children. Treatment of complicated appendicitis in children with once daily CM can decrease the risk of in drug administration’s mistake, require the patient to be connected to the IV line for short time only once a day, may cause less IV-line infection and may cost less. The aim of this study was to compare the effectiveness, and safety of CM with the traditional triple antibiotic for conservative treatment of complicated appendicitis children.
Methods: A prospective, open, randomized study conducted from July 1st, 2008 to June 30th, 2009. Included were children younger than 14 years with complicated appendicitis who were randomly assigned to therapy with either CM as a single daily dose or AGM. The outcome variables compared were maximum daily temperature, duration of fever, time return to oral diet, length of antibiotic therapy, results of repeat WBC counts, need for abdominal abscess drainage, length of hospitalization and complication.
Results: Overall 22 and 21 children were assigned to CM and AGM regimens respectively. There were no any significant differences in all clinical outcomes parameters between the two groups.
Conclusions: Single daily dosing of CM is as safe and effective as the triple antibiotic regimen and has significant advantages for the conservative therapy of complicated appendicitis in children.
Olumide Olatokunbo Jarrett
University of Ibadan, Nigeria
Title: Country-based reference values and international comparisons of clitoral size in healthy Nigerian newborn infants
Time : 14:20-14:50
Biography:
Olumide Olatokunbo Jarrett had her undergraduate training in Medicine and Surgery: University of Ibadan, 1994. She had Post-graduate training in Paediatrics in 1994 – 2004, obtained the fellowship of the National Postgraduate College, Faculty of Paediatrics in 2007 and sub-specialty training by ESPE in Paediatric Endocrinology 2008 – 2010. She is a Consultant Paediatric Endocrinologist at the University College Hospital, Ibadan since 2009 & a Lecturer in the Department of Paediatrics, College of Medicine, University of Ibadan since 2012. She currently oversees the Paediatric Endocrine unit of the hospital. She has published more than 19 papers in reputed journals and has presented papers at over 15 local and international conferences in the last seven years.
Abstract:
Clitoral size references are useful for diagnosing genital abnormalities. Despite the fact that examining the genitalia is an important aspect of newborn evaluation, few studies have been carried out to determine normal clitoral size in newborn infants. The aim of this study was to establish reference values for clitoral size in Nigerian newborn girls and to compare them with references from other ethnic populations. A total of 244 healthy newborn girls delivered at 28–43 weeks gestation were enrolled in the study, and clitoral lengths and widths were measured at <72 hours. The mean clitoral length was 7.7 mm with a standard deviation of -1.37 mm, while the mean clitoral width was 4.40 - 0.89 mm. The clitoral length was significantly longer than those reported for Caucasian (4.00 - 1.24 mm), Korean (3.82 - 1.47), Turkish (4.93 - 1.61) and Japanese (4.30 - 1.10) babies. The present results make it possible to evaluate clitoral size in Nigerian newborn baby girls in an objective way, to identify genital abnormalities and endocrine disorders. Based on this study, a clitoral length of more than 10 mm would be considered clitoromegaly in a newborn girl in Nigeria.
Mohammed Naeem
King Abdullah Specialized Children’s Hospital, KSA
Title: Continuum of comprehensive care from pediatrician’s office to critical care unit-strategies to conceptualize the hints to critical clinical course
Time : 14:50-15:50
Biography:
Mohammed Naeem MD, FAAP, FCCP has vast interests and experience in care and development of children and adolescents. His passion gears towards constructing and implementing scientific models to improve systems targeting primary, secondary and tertiary care. His ideology takes a positive direction through his in-depth analyses and vision and further to explore multiple ways that would help understand the complex pathological phenomenon and planning to design and implement strategies to overcome these. His particular interest and expertise involves population of children and adolescents requiring intensive care. He had been utilizing his vast experience of research, clinical care, patient safety and strategic planning to ambitiously achieve his goals. Through multiple levels of participation in care and strategic planning relevant to diverse patient population, he had been very successful to make his contributions and judgments being heard and taken in considerations.
Abstract:
The aim of this workshop was to prepare pediatric health care providers to effectively identify the high-risk patients at the point of care who are at high risk to require intensive care settings. Over the last decade, strategic planning in pediatric comprehensive managed care and medico-legal implications has resulted into increasing collaboration between the pediatrician’s office and the critical care units. Guidelines from professional and regulatory societies emphasize upon golden hour and early intensive management. There is a stronger emphasis that the health care providers should be vigilant to identify the pediatric patients with high risk of rapid progression of the disease process. The envisioned workshop provides an overview of simple clinical presentations that may potentially lead to a need for critical care setting. This workshop will target typical respiratory, gastrointestinal, cardiovascular, genitourinary disorders as well as inborn errors of metabolism, infections, high risk behaviors and non-traumatic injuries.
Heather Hudson
Reno School of Medicine, USA
Title: The impact of bedside ultrasound on parent satisfaction in the paediatric emergency department
Time : 16:10-16:40
Biography:
Heather Hudson is a former practicing attorney and completed her JD at the University of Michigan Law School. She is a Chief Research Assistant in the Emergency Department at University Medical Center of Southern Nevada in Las Vegas. She will apply to medical school next year.
Abstract:
Studies suggest the use of bedside ultrasound in the adult emergency department leads to higher patient satisfaction scores, but it is unknown if the same result occurs in the pediatric emergency department (PED). The primary objective of this study was to determine whether the use of bedside ultrasound results in higher parent satisfaction scores in the PED. This was a prospective cohort study, enrolling a convenience PED sample. Trained research assistants identified PED patients presenting with abdominal trauma, motor vehicle accidents, atraumatic abdominal pain, skin/soft tissue infection, or vomiting (n=279). After physician disposition, verbal assent was obtained from the patient’s parent, or legal guardian, to confirm voluntary participation. Prior to leaving, the assented parent was provided a survey characterizing their satisfaction with the care their child received in the PED. The research assistants also determined which patients had a bedside ultrasound performed (n=52). This analysis only includes cases when an emergency medicine resident was involved in the patient’s care. To minimize performance bias, providers who performed the ultrasounds were unaware of the nature of the study. In contrast with bedside ultrasound studies in the adult ED, our study found no difference in satisfaction scores of parents whose children received a bedside ultrasound compared to those whose children did not: mean score 9.48 out of 10 (95% CI 9.16 to 9.80) vs 9.55 out of 10 (95% CI 9.41 to 9.69), respectively. These results may indicate the high quality of care received by patients in this PED.
Byanicha Aurora
Sriwijaya University, Indonesia
Title: Association of BMI and waist to hip ratio with the ratio of LDL to HDL and total cholesterol to HDL in urban adolescents without cardiovascular risk factor in Jambi city, Indonesia
Time : 16:40-17:10
Biography:
Byanicha Aurora has completed his Medical studies in 2012 and graduated from Sriwijaya University, South Sumatera, Indonesia. He has worked as an Internship Doctor in 2013-2014 at one of the regional hospitals and community health centers in Jambi City. After finishing his internship program, he started working as a General Practitioner in rural area of Indonesia that called PTT doctor for almost three years, and currently, he is a government employee working in the same area.
Abstract:
Incidence of cardiovascular disease in adulthood could not be separated from the continuous interaction from infancy through adolescence. Some risk factors for cardiovascular disease occurred since his teens. High level of low-density lipoprotein and cholesterol is often indicative of increased risk for cardiovascular disease. The ratio of LDL to HDL and total cholesterol to HDL can be used to reveal the risk of it. This research is to estimate the influence of 12 potential factors and to find association of BMI and waist to hip ratio with the level of LDL to HDL and total cholesterol to HDL ratio. A correlation ratio (ETA) design study using primary data which are gathered prospectively among random adolescents in Jambi whose BMI is underweight, normal, overweight and obese that could participate on the day of the survey. Data on 12 potential factors including daily intake, physical activity, and family history were collected three days. We administered a questionnaire and measured BMI and waist to hip ratio to assess statistical relation with the level of LDL to HDL and total cholesterol to HDL ratio. Category of LDL to HDL and total cholesterol to HDL ratio was stratified from high risk and low risk. Examinations of lipid profiles were done at the clinical laboratory of Abdul Manap Regional Public Hospital in Jambi. Duration of research was about 3 months. The study included 50 people with age span of 16 to 20 years old with all of them had low level of LDL to HDL and total cholesterol to HDL ratio. Most of samples were underweight (42%) resulting low risk for cardiovascular disease as well as normal (24%), overweight (26%) and obese (8%) people. BMI was likely to influence the low level of LDL to HDL (Æž2=0.705) and total cholesterol to HDL ratio (Æž2=0.765), confirmed statistically significant. 94% samples with low risk category of waist to hip ratio were likely to have low risk for cardiovascular disease. Waist to hip ratio influenced the low level of LDL to HDL (Æž2 =0.003) and total cholesterol to HDL ratio (Æž2 =0.021). Other factors that associated with the level of LDL to HDL and total cholesterol to HDL ratio were frequency of daily intake including fruit, vegetables, and snacking consumption, physical activity, and family history of uncommunicable disease. The strongest association was a relation of the level of LDL to HDL and total cholesterol to HDL ratio with Body Mass Index. By knowing the risk factors, cardiovascular disease can be prevented at earlier age.