2nd Global Congress and Expo on Pediatric Cardiology & Healthcare September 22-24, 2016 Las Vegas, Nevada, USA

Biography:

Guy Fontaine has made 15 original contributions at the inception of cardiac pacemakers in the mid-60s. He has published more than 900 scientific papers including 201 book chapters. He is included in the Profiles in Cardiology (W Hurst 2003) book of the 216 individuals who have made a significant contribution to the study of cardiovascular diseases since the 14^th century. He has been included in the book “500 greatest Geniuses of the 21^st century” of the American Biographical Institute (ABI 2005). He was the reviewer of 17 journals both in clinical and basic Science. He served during 5 years as a Member of the Editorial Board of Circulation. He has been invited to give 11 master lectures of 90 minutes each during three weeks in the top universities of China (2014).

Abstract:

A 20-year-old boy had repeated episodes of precordial chest pain and palpitations. The troponin T increased to 0.8µg/l (normal <0.6µg/l) suggesting an episode of acute myocarditis. ECG and echocardiography remained within normal limits. Two years later, he had another episode of chest pain. His troponin was 2 µg/l. Negative T waves in V1 - V5. LVEF dropped to 55% with signs of anteroseptal and apical hypokinesia. CMR showed late enhancement in the sub-epicardial and mediomural layers. Two years later, he experienced a new episode with a near syncopal episode during soccer game. Negative T waves in leads V1 and in V2. Signal Averaging ECG was positive for both 25 and 40 Hz. His troponin T (HS) was 487ng/l (normal<50ng/l) suggesting a severe episode of myocarditis. Contrast angiography confirmed the diagnosis of ARVD. He was positive for PKP2. Electro Physiological Study induced VT only after isoproterenol administration. An AICD was recommended but was refused despite the finding from an insertable loop recorder that showed three spontaneous asymptomatic short lasting episodes of VT up to 260bpm. The loop recorder showed also before the start and after the end of VT a clear fragmented potential of small amplitude (approximately 30 microvolts) immediately following the ventricular Electro Grams (EGM) complex of 0.4mv. This is the first case in whoman Epsilon wave not visible on surface ECG is reported with an insertable loop recorder located under the skin in close proximity to the RV.It is also the first confirmation of ARVD detected after repeated episodes of myocarditis (Lopez-Ayala HR 2015).

Biography:

Sonia El-Saiedi Graduated from Medical School, Cairo University in 1987. She was trained in Boston Children Hospital in 1998. Currently, she is working as Professor of Pediatric Cardiology in Cairo University Children Hospital, Egypt as well as she is the Director of Pediatric Cardiac ICU and Cardiomyopathy Clinic.

Abstract:

Background: Hypertrophic cardiomyopathy (HCM) is an important cause of disability and death in patients of all ages. Egyptian children may differ from Western and Asian patients in the pattern of hypertrophy distribution, clinical manifestations and risk factors.

Objectives: The present work aimed to register the clinical characteristics and outcomes of our children with HCM over a period of 7 years and to determine whether reported adult risk factors for SCD are predictive of outcome in these affected children.

Study design & Methods: A retrospective study that reviewed the clinical data of 128 HCM pediatric patients. These data included personal and family history, physical examination, baseline laboratory measurements, ECG, Holter and echocardiographic results. Logistic regression analysis was done for detection of risk factor of death.

Results: Fifty-one out of 128 patients died during the period of the study. Extreme LVH (interventricular septal wall (IVS) thickness or posterior wall (PW) thickness Z score>6, presence of sinus tachycardia and supraventricular tachycardia (SVT) were independent risk factors for prediction of death in patients of HCM.

Conclusions: In our Egyptian tertiary care center, HCM has a relatively worse prognosis. Infants have a worse outcome than children presenting after the age of one year. A poorer prognosis in HCM is predicted by extreme LVH, presence of sinus tachycardia and SVT.

Biography:

Sonia Shahid is a final year MBBS student of Karachi Medical and Dental College, Karachi Pakistan. She has been a part of several national and international researches and many are ongoing. She has attended several national and international seminars and conferences. She is an inquisitive student with a passion for education as a power for change and improvement in the healthcare field of her country and is very ambitious in pursuing her career.

Abstract:

Objectives: To determine the frequency of pediatric patients visiting Pediatric out-patient department with ear-related illnesses in a tertiary care hospital of Karachi, Pakistan.

Aims: The aim of the study was to specify the burden of ear infections in the pediatric population.

Introduction: Ear diseases in children can have consequences if not treated promptly, and can result in high morbidity, hearing disabilities and even mortality. Diagnosing such conditions untimely, and treating them effectively, can reduce the undesired outcomes. According to World Health Organization, approximately 278 million people in developing countries, like Pakistan, suffered from moderate to profound hearing impairment. Out of which, 25% had hearing impairment since childhood.

Methodology: This cross-sectional study was conducted from January 2015-December 2015. Pediatric patients under 7 years of age were recruited in this study. A history and examination form designed particularly for the study was filled by concerned doctor.

Inclusion criteria: Pediatric patients of age ≤7 years regardless of gender presenting to pediatric clinic with principal complain of otalgia, discharge from ear, decreased hearing, pulling in the ear, tinnitus, itching, aural blockage, localized symptoms in and/or around ear (swelling, redness) associated with vertigo and perforation.

Exclusion criteria: Patients having systemic illnesses like autoimmune disorders, metabolic syndromes, congenital hearing defect and neoplastic disorders of ear and immunocompromised patients.

Results: Most of the patients presented with complaints of Earache 59%, hearing impairment 57% and aural blockage or heaviness 34%. Other symptoms were itching 27%, discharge 22%, tinnitus 1% and vertigo1%. Many of the patients presented with multiple and bilateral symptoms except for tinnitus, which was unilateral. Majority of patients had impacted wax 34% and otomycosis 26%. Other conditions were furunculosis 4%, foreign body 3%, acute Otitis media 4%, traumatic tympanic membrane perforation 3%, Otitis media with effusion 3% and chronic suppurative Otitis media 1%.

Conclusion: Infections in growing age can cause permanent hearing impairment. Hearing loss may impact the academic performance of the children. Thus addressing the incidence and prevalence of otological infections in pediatric patients is a matter of great concern.

Biography:

Dr Fizza Hassan is a Final Year MBBS Student at Karachi Medical and Dental College, affiliated with Karachi University. She has been a keen researcher since High School and took part in many scientific Projects at city level. She has attended several national and international workshops and conferences. She has taken part in many researches, which have been successfully published in international journals and many are ongoing. She is looking forward to a bright future in medical career.

Abstract:

Objective: To study the awareness about Antibiotic Stewardship Program (ASP) in doctors of pediatric unit of tertiary care hospitals of Karachi, Pakistan

Introduction: Inappropriate antimicrobial prescribing is common and is a key factor in the increase of rates of drug resistance, which causes a significant public health burden in terms of morbidity, mortality, and cost. Antimicrobial stewardship programs (ASP) is designed to optimize antimicrobial prescribing, to lower costs, to prevent medication errors, to improve therapeutic outcomes, and to prevent the development of antimicrobial resistance. Given increasing trends in antimicrobial resistance and the resulting limited treatment options, the treatment of hospital-acquired infections poses a significant challenge to healthcare providers. Optimization and conservation of current antimicrobials are necessary.

Aims: The aim of the study is to measure the knowledge of Antibiotic Stewardship Program (ASP) amongst doctors of tertiary care hospital. By doing this we can know that how many and how frequent awareness programs regarding ASP should be conducted in our tertiary care hospital.

Methodology: This cross-sectional study is based on questionnaire which was filled by doctors of pediatric units of tertiary care hospitals. Awareness amongst doctors was determined by this questionnaire. Inclusion criteria: Doctors registered by Pakistan Medical and Dental College working in Pediatric unit. Exclusion criteria: Doctors who were conducting the study were excluded. Doctors practicing in local clinics or Primary healthcare centers were not made the part of study.

Results: A total of 257 doctors were recruited in this study. Out of these Head of departments were 3.11% (n=8), Consultant, 10.89% (n=28), Senior Registrar 24.9% (n=64), Post-graduate trainees 38.13% (n=98), and Registered medical officers 22.95% (n=59). The percentage of awareness amongst doctors of Pediatric units was 85.21% (n=38), of which only 47.36% (n=18) had complete information regarding Antibiotic Stewardship Program. All the doctors enrolled in the study were willing to gain awareness of this program. 5.83% of the doctors had opinion that awareness program only might not help, a strict check and balance has to be kept on pharmacies and drug suppliers when issuing antibiotics whereas the rest 94.17% strongly agreed that awareness in doctors will be helpful in reduction in overuse and unnecessary prescription of antimicrobial agents.

Conclusion: The successful implementation of antimicrobial stewardship strategies will have a significant impact on reducing targeted and non-targeted antimicrobial use, improving quality of care of hospitalized children and preventing emergence of resistance, thus, reducing morbidity and mortality in young patients.

Biography:

Christine Eloise B Pascua is currently a 3^rd year medical student at the University of the East Ramon Magsaysay Memorial Medical Center, Inc. (UERMMCI). She graduated with a Bachelor of Science in Health Sciences at the Ateneo de Manila University (AdMU) with an award-winning thesis entitled “AsTig (Asensong Tubig): A Quasi-experimental Study of Point Source Chlorination, Cloth Filtration and Adsorption by Activated Carbon to Treat Pump Water”. She will finish her Doctor of Medicine in May 2017.

Abstract:

Cardiovascular disease (CVD) is one of the leading causes of serious illness and death worldwide. Screening for the risk factors of CVD (i.e. hypertension, hyperglycemia, hypercholesteremia and obesity) allows for early prevention and decreased risk of the development of CVD. We looked at the prevalence of these risk factors among adolescents at Jacobo Z. Memorial National High School Laguna, Philippines. An analytical cross-sectional design was done using a convenience sampling of 303 adolescents aged 12-17 in Jacobo Z. Gonzales Memorial National High School. The information on dependent and independent variables were determined through questionnaires, actual measurements and blood chemistry analysis. Data was analyzed using State SE to determine the Odds Ratio for each group. The groups were divided based on diet, physical activity, familial history of disease and smoking status. The prevalence of hypertension, hyperglycemia, hypercholesterolemia, central obesity, and obesity was 36.33%, 48.51%, 38.94%, 35.31%, and 7.61%, respectively. Attributes related to hypertension included a family history of diabetes. Those related to hyperglycemia were passive smoking and a family history of heart disease. Attributes related to hypercholesterolemia were sodium consumption above the daily allowable limit. There are certain variables that increase the odds of developing different risk factors. Family history of heart disease, being a passive-smoker and low physical activity increases the odds of having hyperglycemia. Sodium consumption above allowable daily intake increases the odds of having hypercholesterolemia. Family history of diabetes mellitus is associated with increased odds of developing hypertension.

Biography:

Tanyi Samuel Tanyi has completed his BSc and MSc from Usmanu Danfodio University Sokoto, sokoto state, Nigeria. He is currently an Assistant Lecturer at Federal University Dutsinma, Dutsinma, Katsina state, Nigeria at the Department of Biological Science. He is involved in teaching and research in Microbiology at the University.

Abstract:

Due to high cost, undesirable side effects of conventional antibiotics and emergence of multi-drug resistant bacteria, there is a need to search for novel antibacterial agents from medicinal plants. In this study, clinical isolates of Staphylococcus spp, Salmonella spp, Shigella spp. and Escherichia coli were obtained from Usmanu Danfodio University Teaching Hospital Sokoto, Nigeria. The isolates were tested for susceptibility to crude leave extracts of E. hirta by agar diffusion methods. Minimum inhibitory concentration (MIC) of the extract was determined by broth dilution method. The results showed that the most susceptible bacterium to the extract was Shigella, with a zone of inhibition of 23.33 mm, while the most resistant bacterium was E. coli, with a zone of inhibition of 9.43 mm. MIC and MBC of the extract against Shigella was 21.87 mg/ml respectively. Alkaloids, saponsins, flavonoids, anthraquinones, tannins and polysterols were revealed in the extract by phytochemical analysis. Oral acute toxicity of the extract showed no mortality in Sprague Dawley rats at concentration of 50, 300, 2000 and 5000 mg/kg body weight. Result showed that the LD50 was>5000 mg/kg. The MBC: MIC ration>4, suggesting the crude extract was bactericidal. This study showed that leaves of E. hirta can serve as a potential antibacterial agent.

Biography:

In Uk I got my DCH and MRCP (UK) in 1976. After 8 years in Riyadh, Saudi Arabia I became professor of pediatrics. I was head Department of Pediatrics for two terms, then I established pediatric nephrology at KKUH the first caring for chronic renal failure in children by CAPD. From this center was a record publication of 26 children treated in Riyadh I was requested to be Dean of a new medical college in Sudan by PBL system. After spending 10 years in Medina Now I am teaching and spending most of my time in publications as a professor of Pediatrics in the college of Medicine, University of Science and Technology in Omdurman across the Nile from Khartoum.

Abstract:

Hypocalcemic cardiomyopathy in infants is characterized by heart failure in a previously normal infant with hypocalcemia without organic cardiac lesion. Vitamin D deficiency rickets is increasing in Middle East. In a six month study 136 cases of rickets were diagnosed in the main Children's Hospital in Almadinah but none of them showed evidence of cardiomyopathyexcept a case presnted in this meeting. Concerned of missing this serious complication of rickets we searched pub med and present this review article. 61 cases of hypocalcemic cardiomyopathy were reported as case reports with two series of 16 and 15 cases from London and Delhi, respectively. The major features of these cases: the age ranged from one month to 15 months with a mean age of 5 months. All presented with heart failure and hypocalcemia. There was a minor feature of rickets in a few of the cases. All had high alkaline phosphatase. Echocardiology evidence of cardiomyopathy was found in all. Most of them responded to calcium, vitamin D and cardiotonic and diuretics. We concentrated on pathogenesis of this hypocalcemic cardiomyopathy and reviewed the literature. The evidence available supports that the most likely cause of cardiomyopathy is hypocalcemia. Hypovitamin D also contributes but hyperparathyroidism might have a protective role as we did not detect any evidence of cardiomyopathy with hyperparathyroidism per sey and florid features of rickets. We need to look out for cardiomyopathy among infants with hypocalcemia. For prevention maternal supplementation during pregnancy and lactation with up to 2000 units of vitamin D and 400 units for their infants.

Biography:

Rania Hosny Tomerak is the Professor of Pediatrics and Neonatology in Cairo University. She was graduated in 1994 and obtained her Master degree in Pediatrics in 1998 and Doctorate degree in Pediatrics in 2001. She is an international board certified lactation consultant since 2004 (got the highest score in Egypt). She is a board member of Lactation education accreditation and approval committee in USA, which provides approval and accreditation to all breastfeeding programs all over the world. She has 21 published scientific papers (7 are Pub-Med cited: Tomerak RH, Tomairek RH)

Abstract:

Objectives: To study the frequency of occurrence of the different forms of primary dyslipidemia to display their various clinical presentations and their lipid profile before and six months after therapy.

Methods: Prospective study was conducted in the Cairo University Childrens' Hospital- Twenty primary dyslipidemic cases were included with history taking, clinical examination, electro-cardiography and echocardiography.

Investigations included: Total cholesterol, total triglycerides, LDL-C and HDL-C using enzymatic colorimetric methods, ApoA1, Apo B100 were evaluated using a Behring nephelometer. Different therapeutic modalities were offered and reassessment of laboratory tests was done every three months.

Results: Parents were consanguineous in 75%. Eleven cases had hypercholesterolemia; eight had xanthoma, one had xanthelasma, two had hypo pigmentation, three had corneal arcus, one had lipemia retinalis and six had cardiac manifestations among which one case had myocardial infarction and one case died. Three cases had hyper triglyceridemia; three had milky plasma, two had xanthoma, two had lipaemia retinalis, one case had pancreatitis and none had cardiac manifestations. Six cases had mixed hyperlipidemia; five had xanthoma, three had lipaemia retinalis and two had cardiac manifestations. After six months of multi-drug use, the laboratory lipid profile was unsatisfactory in majority of the cases.

Conclusion: Primary dyslipidemia may present early and pediatricians should have high index of suspicion. These children should be put on early strict lipid reduction protocols to prevent complications.

Biography:

Dr Catherine Taylor completed her undergraduate medical training at The University of Manchester, graduating in 2015 at the age of 23. During her time as a medical student she developed a particular interest in paediatric cardiology whilst conducting research in Dr Dhia Mahmood’s clinic. She is currently a junior doctor completing her foundation training in the East Anglian Deanery. She has an interest in acute medicine, education and medical research and hopes to pursue a career in paediatrics in the future. In her spare she enjoys running and is also a black belt in kickboxing.

Abstract:

AIMS: To analyse the closure rate of isolated ventricular defects in a cohort of 219 children, identifying trends relating to type and size of the defect, gender and age of the patient. Compare rates of endocarditis in these patients after the change in NICE guidance for endocarditis prophylaxis (2008). DESIGN: A retrospective study of all patients with isolated ventricular septal defects attending new or follow up Paediatric Cardiology appointments between January 2006 and May 2014 at Royal Preston Hospital. Those children with more complicated defects, including atrioventricular septal defects, coarctation of the aorta and Fallot’s tetralogy were excluded from the study due to differences in management and outcomes. Data was collected from clinic notes of patients included in the study criteria. RESULTS: 90 patients had perimembranous defects and 125 patients had muscular defects. 35% of the cohort had spontaneously closed defects. By 16 years of age, 48% of VSDs have closed spontaneously, although 93% of spontaneous closures occurred by 8 years of age. All patients requiring medical treatment or surgical closure had perimembranous & larger defects (>2mm). 75% of patients with associated genetic conditions had perimembranous defects. Of the cohort, 1% developed bacterial endocarditis. CONCLUSIONS: Factors reducing the likelihood of spontaneous closure of ventricular septal defects include those patients older than 8 years of age, those with perimembranous defects or defects which are larger than 1mm. Changes in NICE guidance for endocarditis prophylaxis (2008) have not increased the rates of bacterial endocarditis developing in patients with isolated ventricular septal defects.