Day 1 :
Burjeel hospital, Abu Dhabi, UAE
Keynote: Gohary’s phenomenon revisited
Time : 9:00-9:30
I am Amin Gohary. I am working in Burjeel hospital, Abu Dhabi, UAE
Intussusception is a common condition that present with abdominal colic and is usually diagnosed by ultrasonography with appearance of (Target Sign).
Over the last 35 years we have noticed a new phenomenon that mimic intussusception both clinically and radiologically but is not cause by bowel intussusception but by impacted stool at he terminal ileum.
Whereas intussusceptions an emergency that require urgent attention to reduce either by air, saline or Barium and my need urgent exploration , Gohary’s phenomenon if recognized can be treated by simple fleet enema.
We have encountered 56 cases between 1983 and 2018 , their age varied from 9 months and 7 years
They have the common features of
Severe abdominal colic that is not responding to analgesic or antispasmodics
US feature suggestive of ileo-colic intussusception
No red current jelly stool .intussusception
Good response to fleet enemas
More recently we have encountered a subgroup pf patients that have genuine intussusception on radiological examination but not causing complete bowel obstruction and still associated with had srool in the large bowel and still needs simple fleet enema to cure.
We hope by highlighting this new phenomenon to avoid unnecessary radiological investigation and unnecessary abdominal exploration.
NMC Royal Hospital DIP, Dubai, UAE
Keynote: Stem cell-based therapy in neonates
Time : 9:30-10:00
Brankica Vasiljevic is Head of Maternity and Child Health Services in NMC Royal Hospital DIP in Dubai, UAE. After completed her MD she had completed her clinical postgraduate education (Pediatric and after that Neonatology fellowship) and academic postgraduate education (MSc in pediatric and ultrasonography field and PhD in neonatology field) at Belgrade University School of Medicine in Belgrade, Serbia.
She has completed also Yugoslav School of Ultrasound and different courses in ultrasonography and echocardiography in Serbia and UK, Post Graduate Program in Pediatric Nutrition at Boston University School of Medicine and Visiting scholar and Internships in Greece (Alexandar Hospital, Iaso Hospital and Elena Hospital in Athens), USA (Morgan Children’s Hospital in New York) and Austria (General Hospital of Salzburg in Salzburg and Regional Hospital (LKHLandeskrankenhaus) in Graz). She had won the ESPNIC Educational Grant at 5th World Congress on Pediatric Intensive & Critical Care in Geneva Switzerland (2007). She was a local coordinator for International Neonatal Immunotherapy Study-INIS for Serbia and Montenegro and participated in SIOP 93-01 Study, ITP Study and Twin Birth Study. She has published more than 35 international publications in international indexed journals (100 citations), 5 chapters in various fields of neonatal medicine and have more than 30 presentations in international conferences.
Despite recent advances in neonatal intensive therapy, still is present signiﬁcant morbidity associated with extreme prematurty that includes both short-term and long-term pulmonary, neurologic and visual impairments. These complications of prematurity not only affect the quality of life of these children in the rest of their lives, but can also cause numerous medical and economic burdens in the society.
No single therapy has proven to be effective in preventing or treating either developmental lung, brain and retinal injuries in preterm infants or the hypoxic-ischemic brain injury in full-term infants. Stem cell–based therapies are emerging as potential alternative treatment for such complex diseases (BPD, IVH, ROP and HIE) with multifactorial etiologies.
Recently, various preclinical studies have shown that stem cell therapy significantly attenuates injuries in newborn animal models of BPD, HIE, IVH and ROP.
Caution is warranted, however, because stem cell-based therapies for regenerative purposes represent innovation, mechanisms of action are still not completely understood, and standardization, clinical indications, timing and dosage are required to permit safe clinical translation of stem cell therapy in animal models for newborn infants in the near future,
No disclosure of any conflicts of interest.
Spencer ND, Gimble JM, Lopez MJ. Mesenchymal stromal cells: past, present, and future. Vet Surg 2011;40:129-39.
Park WS, Sung SI, Ahn SY, Yoo HS, Sung DK, Im GH, et al. Hypothermia augments neuroprotective activity of mesenchymal stem cells for neonatal hypoxic-ischemic encephalopathy. PLoS One 2015;10:e.
Ahn SY, Chang YS, Sung DK, Sung SI, Yoo HS, Lee JH, et al. Mesenchymal stem cells prevent hydrocephalus after severe intraventricular hemorrhage. Stroke 2013;44:497-504.
Park WS, Sung SI, Ahn SY, Sung DK, Im GH, Yoo HS, et al. Optimal timing of mesenchymal stem cell therapy for neonatal intraventricular tricular hemorrhage. Cell Transplant 2016;25:1131-44.
Waszak P, Alphonse R, Vadivel A, Ionescu L, Eaton F, Thebaud B. Preconditioning enhances the paracrine efect of mesenchymal stem cells in preventing oxygen-induced neonatal lung injury in rats. Stem Cells Dev 2012;21:2789-97.
Chang YS, Ahn SY, Yoo HS, Sung SI, Choi SJ, Oh WI, et al. Mesenchymal stem cells for bronchopulmonary dysplasia: phase 1 dose-escalation clinical trial. J Pediatr 2014;164:966-72.
Stitt AW, O’Neill CL, O’Doherty MT. Archer DB, Gardiner TA. Vascular stem cells and ischaemic retinopathies. Prog Ret Eye Res 2011; 30:149e166e.
Southend University, UK
Keynote: COVID-19 and the challenges of Paediatric Anaesthesia: a survey of practice in a UK District General Hospital
Time : 10:00-10:30
Dr Rachel Ariyanayagam, MBBS, BSc, FRCA, is an Anaesthetic Specialty Registrar at Southend University Hospital, UK, with an interest in clinical paediatric anaesthesia.
Challenges in paediatric anaesthesia during the COVID-19 pandemic include the impact of personal protective equipment (PPE) on communication, the infection risks of carers being present for induction of anaesthesia, the potential infection spread with gaseous anaesthesia induction techniques, and management of the child with mild upper respiratory tract infection (URTI). We surveyed anaesthetists in a UK hospital that undertakes emergency and elective paediatric surgery, regarding these issues.
Concerning children with various COVID statuses, we surveyed what PPE doctors would wear, whether they would allow carers to be present for anaesthesia induction, the use of gaseous induction of anaesthesia, and willingness to proceed with surgery in a child with mild respiratory infection symptoms.
Survey response was 47% (n=48). Even if the child tested COVID negative, 65% of respondents would wear a visor, 40% a FFP3 mask, and 31% a fluid resistant gown. For some, this decision depended on the type, timing and number of tests conducted. For anaesthetic induction, there is reluctance to allow parents/guardians with untested COVID status in the operating theatre or anaesthetic room, and reluctance to use gaseous techniques in a COVID positive child. 12.5% stated they would cancel surgery for a child with mild URTI symptoms (even with a negative COVID test), for whom they would have proceeded with surgery pre-pandemic.
This survey highlights the debate over the reliability of COVID testing in children and what is best anaesthetic practice for a COVID positive child, emphasising the need for further understanding of this disease.
- Clinical Pediatrics| Pediatrics Infectious Diseases | Pediatrics Surgery
Jawaharlal Nehru Medical College, India
Ganga S. Pilli is professor pediatrics, professor of department of pathology, and assistant professor of department of paediatrics. She is working in KAHER University’s Jawaharlal Nehru Medical College, India.
Aims and Objectives: To study the Socio-demographic profile and feeding practices in children with Acute severe malnutrition admitted in Nutrition Rehabilitation Centre (NRC) of a Tertiary Care Hospital in North Karnataka.
Background: India is one amongst the countries with an unacceptably high prevalence of Severe Acute Malnutrition (SAM) among all the developing countries. SAM is a major public health issue, which affects 7.5% of under five children in India. Hence, this study was undertaken to know the contributory factors in clinical profile that can help to plan for proper management strategy.
Material and Methods: This cross-sectional observation study was carried out in NRC attached to Dept of Paediatrics of a tertiary care hospital, Belagavi, Karnataka from September 2017 to March 2018. Children aged between 6-60 months with SAM were evaluated for Socio-demographic profile and feeding practices. Data was analysed by SPSS and results were tabulated.
Results: One hundred children with SAM were included in the study. Male (60%) children suffered more than the female (40%) children. Majority of the children were in the age range of 6 to 24 months. About 65% of the mothers were of younger age (18 to 27 years), followed by 24% mothers in the age range of 28 to 32 years. Most of the mothers belonged to class IV and Class V socio- economic status. Marasmus was commonest type of malnutrition. History of delayed weaning was noted in 38% of the children. Average age at weaning was 7.5months. Majority of the children did not receive appropriate complementary feeds.
Conclusions: Prolonged breastfeeding more than 6 months, insufficient complementary feeds, younger age and low socio-economic status of the mothers contributes to SAM cases.
I am Pediatrician, working at Saint Damien Hospital, Haiti in the emergency department, Assistant Chief of the emergency department. I am Pediatrician, Head of M&E Research Department, Saint-Damien Hospital
In 2017, tuberculosis was still a major public health concern in some countries, as Haiti. In 2016, Haiti counted 20 000 cases of tuberculosis among which 2 600 pediatric cases. In children the diagnosis is very challenging and relies on a careful history of exposure, clinical examination and relevant investigations. Unfortunately, bacteriological confirmation is not always conclusive, then the diagnosis stays presumptive: based on the clinical evaluation and/or exposure’s history, creating a delay of treatment. Now begs the question: What is the influence of the diagnosis methods on the prognosis? This study objective is to analyze the association of presumptive diagnosis and other risk factors with a poor evolution of pediatric inpatients admitted for tuberculosis at Saint Damien hospital.
A case-control study was conducted from January 2015 to December 2017. Cases were any child less than 14-year-old treated for tuberculosis, dead or without any clinic improvement after the intensive phase of the treatment. Control represented any child with a satisfying clinical improvement. ODD ratio with a confidence interval of 95% were calculated and integrated into a multivariate analysis. Confirmed diagnosis was defined as a positive bacteriological exam or a positive Gene-Xpert for tuberculosis. Statistical tests chi2 and Fisher were realized for categorical variables.
The study included 167 children: 85 cases and 31 controls. Mean age was 7-year-old. 38 children had a confirmed diagnosis: 31 (26.72%) with a positive bacteriologic exam and 7(6.03%) with a positive gene-expert. For children with presumptive diagnosis, the exposition source was identified in 48.26% cases, while the tuberculin skin test was conclusive for 62.93%. A presumptive diagnosis with negative bacteriological exam did not show any relationship with the prognosis. Thus, absence of BCG immunization (OR= 4.31, (IC95%= 1.34-13.8) and Clinical severity at admission [OR=3.56, (IC95%= 1.35-9.34) were the risk factors associated with bad outcome.
The study results do not show any relation between the mode of diagnosis and patients improvement. Nonetheless, some measures of presumptive diagnosis such as tuberculin skin test should be used more efficiently in order to optimize not only the diagnosis in itself, but also the evolution by reducing the delay to be treated. The use of the Xpert MTB test should also be increased. BCG vaccination should be optimize in the country as a measure helping to decrease tuberculosis infection and bad outcomes. Clinical status at arrival should also be considered to decrease mortality rate associated with tuberculosis.
Statement of the Problem:
It’s a clinical case presentation of a male Preterm infant Newborn (+31 wks) who was delivered in our hospital & transferred to our NICU because of Prematurity, VLBW & need to respiratory support. Baby shortly undergo Necrotizing Enterocolitis (NEC) on 5th day of life shortly after start of expressed milk feeding …! Which was early detected by use of Near Infrared Abdominal spectroscopy (NIRS).
Baby was deteriorated clinically in a couple of hours & undergo intestinal perforation with peritonitis , So, Abdominal exploration surgery with intestinal resection & end – to end anastomosis was done Urgently
Baby improved gradually & early feedings was started & gradually increased up to full feedings with use of Human Fortified Milk (HMF), probiotics &Prebiotics.
Findings: The Study stated the evidence-based Feeding Strategies guidelines for necrotizing enterocolitis (NEC) among very low birth weight infants & Role of trophic feedings, Probiotics, Prebiotics & micronutrients in Prophylaxis, Prevention & Management of NEC.
Recommendations: 1) -Prematurity is the single greatest risk factor for NEC & avoidance of premature birth is the best way to prevent NEC. 2)-The role of feeding in the pathogenesis of NEC is uncertain, but it seems prudent to use breast milk (when available) and advance feedings slowly and cautiously. 3)-NEC is one of the leading causes of mortality, and the most common reason for emergent GI surgery in newborns. 4)-NEC remains a major unsolved medical challenge, for which no specific therapy exists, and its pathogenesis remains controversial. 5)-A better understanding of the pathophysiology will offer new and innovative therapeutic approaches, and future studies should be focused on the roles of the epithelial barrier, innate immunity, and microbiota in this disorder. 6)-Bioinformatics modeling is a new emerging strategy aimed at understanding the dynamics of various inflammatory markers and their application in early diagnosis and treatment.
Dr. Amr I.M. Hawal has his expertise in evaluation and passion in improving the health and wellbeing. His open and contextual evaluation model based on responsive constructivists creates new pathways for improving health care specially in Neonatology field. He has built this model after years of experience in research, evaluation, teaching and administration both in hospital and education institutions. Our case presentation was done in one of the biggest & modern of art & advanced NICU based on tertiary generation level in the region (Latifa Hospital, DHA, Dubai, UAE).
Egyptian National Institute of Diabetes & Endocrine Disorders, Egypt
Dr. Wafaa Hegab is a consultant of Internal medicine (Diabetes) whose experience in the field spans 24 years, backed by a higher education degree from Tanta University in Egypt. She is known for her astute skills in evaluation and strong passion for improving healthcare and wellbeing. She is pioneering an open and contextual evaluation model based on constructive responses, which has led in the creation of new methods to improve Diabetic healthcare, Endocrinology and Internal Medicine.
Background and Aims:
Diabetes mellitus (DM) is a highly prevalent condition that causes significant morbidity and mortality worldwide. Conventional therapies include lifestyle modification, oral pharmacological agents, and subcutaneous insulin. Emerging data suggest that natural approaches to the treatment of DM may help supplement current therapies for further glycemic control. Herein, we review the evidence of several natural modalities for DM treatment. We describe the pathophysiology of diabetes and its complications, provide an overview of current pharmacologic treatments, and finally, discuss natural approaches to diabetes management. Specifically, we will describe on the utility of diet, physical activity, and common natural products in the treatment of newly diagnosed cases of DM and focus on recent, high-quality studies. Adverse effects and potential interactions of each therapy will be highlighted where applicable.
Maternity & Child Health Care Department (MCH), Saudi Arabia
Dr. Gehan Ismael Mohamed is a Family Physician whose experience in the field spans 20 years, backed by a higher education degree from Netherlands. Se is pioneering as an open and contextual evaluation model based on constructive responses, which has led in the creation of new methods to improve primary Maternity & Child healthcare. Dr. Gehan has established this model following her years of experiences in medical practice, research, evaluation, and teaching in hospitals and medical Facilities in the region, including Egypt and the Saudi Arabia.
Background and Aims:
Acute Diarrhea (AD) is a highly prevalent condition that causes significant morbidity and mortality worldwide. Conventional therapies include oral Rehydration Solutions (ORS), Antibiotics and Zinc Products. Emerging data suggest that Probiotics use in the treatment & control of AD cases in children may help supplement current therapies for further control.
Herein, we review the evidence of several Probiotics modalities for AD treatment. We describe the Clinical Impact & prevalence of Acute Diarrhea in children and its complications, provide an overview of current treatments, and finally, discuss recent emergent Gut approaches to AD management. Specifically, we will describe - in a Comparative study - on the utility of different kinds of Probiotics known & used and common natural products in the treatment of Acute cases of AD and focus on recent, high-quality studies. Adverse effects and potential interactions of each therapy will be highlighted where applicable.
Prime Health Care Group, UAE
Dr. Malak Alia is an Arab Board Certified Pediatrician. She earned her medical degree from Damascus University and later obtained her master's degree in Pediatrics form the same university. Subsequently she obtained Arab Board of Health Specialization in Pediatrics. She is certified in basic life support (BLS), neonatal resuscitation (NRP) and pediatric advanced life support ( PALS). Dr. Malak has 6 years experience in pediatric field and recently working as a specialist in Prime Health Group in UAE.
Our literature review study reflects the light on some chemical substances which are widely used in many & different aspects of our children daily practices & try to get the answers for the following important questions. Do these chemicals that our children are widely exposed to since even their prenatal period & throughout their lives have real high risks & dangers on their health? Is the use of these chemicals essential for our kids or we can avoid and replace them with other non-risky substances & hazardous chemical free products ..!! Recently, a lot of systematic review studies have been done to investigate the possible relations between the most common chemical substances that we use daily and possible risks & health problems that may affect our children. Among the chemicals that have been studied intensively in the last few years are Phthalates which are known as endocrine disruptors due to their anti-androgenic and/ or estrogenic effects! The purpose & Objectives of our study are to provide an overview of some widely and commonly used chemicals that are introduced to many of the products essentially used by our children daily, and the possible relations between their use and some of the common health problems & disorders that affect children in order to raise the awareness among parents & health care providers regarding their potential health impacts on children and to provide a proper guidance that help to minimize the avoidable exposure to these risky chemicals and replace them with hazardous chemicals free products till we get enough studies that prove or disprove their risks & effects. Methods & Results our study tries to search through, emphasis on & spot the light on the use of common chemical substances ( Phthalates ) that are widely used in most of our children life aspects, searches for their possible risks & hazards on our kids' health, tries to get relations & connections between these substances & common pediatric health problems & disorders. In our study we reviewed the data collected from many evidences based systematic reviews and Cohort studies have dealt with these hazardous substances & stated the high incidence of their risks & their bad impacts on our kids' health & prove the relation of these chemicals to certain respiratory problems specially wheezing in childhood, ADHD, some atopic conditions and endocrine disruptions among children. Recommendations Our study concluded & suggested that it is better to eliminate exposure to these chemicals as evidences are rising against their safety. It's very important to increase the awareness among parents & health care providers regarding the possible risks of these chemicals and provide them the most proven practical tips for their avoidance. Further epidemiological studies should be conducted in the future to enhance our knowledge in this area.
Ryan is a Pediatrician. He earned her medical degree from India,
Telomeres play a vital position in cellular destiny and developing antique with the resource of adjusting the cellular reaction to stress and increase stimulation on the idea of previous cell divisions and DNA damage. As a minimum, a few hundred nucleotides of telomere repeats want to "cap" every chromosome cease to avoid activation of DNA restore pathways. Repair of significantly brief or "uncapped" telomeres by telomerase or recombination restricted in maximum somatic cells and apoptosis, or cellular senescence delivered on when too many "uncapped" telomeres collect. The hazard of the latter will increase due to the fact the expected telomere duration decreases. The standard telomere period is ready and maintained in cells of the germline, which naturally explicit excessive levels of telomerase. in the destiny hobby clearly may focus at the genome, and with more appreciation of its importance as a rather sensitive organ of the cell, monitoring genomic sports activities and correcting commonplace mistakes, sensing the uncommon and surprising events, and responding to them, frequently with the aid of the usage of restructuring the genome.