Day 1 :
Keynote Forum
Michael Sammaan
Royal Manchester Children Hospital, UK
Keynote: Accurate assessment of the ventricular function in Neonates
Time : 10:00-10:45
Biography:
Dr Michael has completed his residency training at the age of 25 years from Ain Shames University in Egypt, and postgraduate studies from Royal Collage of Paediatric and Child Health. He is currently one of speciality trainee in paediatrics in the United Kingdom. He has a passion toward paediatric cardiology and haemodynamic assessment.
Abstract:
Ventricular function may be the depressed in neonatal disease processes such as hypoxia, sepsis, haemolytic disease of new-born, surfactant deficiency lung disease, PPHN and transient tachypnoea of new-born. In contrast to adult patients, little is known about the best way to assess ventricular function. Invasive monitoring of central venous pressure, capillary wedge pressure and cardiac output are seldom done in the neonate especially the preterm.
Usually heart rate and blood pressure are the only measured indices of cardiac function and they may be misleading. A dysfunctional heart maybe tachycardic, bradycardic, or have a normal rate. In hypotensive neonatal cardiac function may be depressed, normal, or even hyperdynamic.
Therapeutic interventions may modify cardiac function or cardiac output intentionally or incidentally, so an index of ventricular performance is needed to make sure that such interventions are appropriate this is now possible by echocardiography serial measurements allow rapid assessment of the effectiveness of therapeutic interventions.
In this presentation, or poster, I will discuss how to assess:
Systolic function of both Left ventricle and right ventricle including new principles in assessing right ventricular function.
Diastolic functions; especially that in recent years have seen an enormous increase in interest in other cardiology and the role of the diastole in ventricular performance particularly in ischemic heart disease, ventricular hypertrophy cardiomyopathy, and pericardial disease. Now that diabetic cardiomyopathy and dexamethasone induce cardiac hypertrophy are recognised in neonates, the assessment of the diastolic function should be an important subject of research.
Keynote Forum
Hissa Mohammed
Hamad Medical Corporation, Qatar
Keynote: Radiological proedures for pediatric patients with Down Syndrome
Time : 10:45-11:20
Biography:
Hissa has completed her Master degree in medical imaging at the age of 33 years from Aberdeen University. She is the Radiology supervisor in Communicable disease Centre, member of HMC. She has published 1 paper in online OMICS Journal of Radiology and member of Quality team in CDC.
Abstract:
Introduction
Down syndrome is a condition of the chromosomes that is caused when an error occurs during cell division creating an extra chromosome 21 (Gardiner et al., 2010). People with Down syndrome especially pediatric patients may develop several health conditions that may require to be diagnosed through imaging (Bull, 2011).
Purpose
This research was used to identify environmentally friendly methods for pediatric patients with Down syndrome. These methods are aimed at reducing the radiation dose for a patient during a radiological procedure. Additionally, the methods should be able to provide the best quality images to improve diagnosis and hasten recovery.
Method
We used the PRISMA guidelines to perform a systematic review of the current literature obtained from various databases. We searched for several articles and found a total of 51 articles related to environmentally friendly radiological procedures. Out of the 51 articles, 17 were analyzed in detail.
Result
Caring for pediatric patients with Down syndrome requires environmentally friendly methods to improve the quality of care. Patients may not respond well to high dosages of radiation because they sometimes cause irritations. Both patients and clinicians need improved image quality of the radiological procedures to make the diagnosis of the condition easier and hasten the process of recovery.
Conclusion
Methods that create a friendly environment for pediatric patients with Down Syndrome during radiological procedures such as CT scans and X-rays are important in the diagnosis of disease. High radiation dosages may not suit patients sometimes thus affecting the quality of care. Improving image quality is also important in the diagnosis and management of the condition.
- Pediatrics | Clinical Pediatrics | General Pediatrics | Pediatric Cardiology | Pediatric Cardiac Tumors | Pediatric Congenital Heart Disease
Location: Paris, France
Session Introduction
Suryakanthi
Rainbow Children’s hospital and Birth right, India
Title: Infants with acute pulmonary hypertensive crisis: a case series
Biography:
Dr Suryakanthi completed her postgraduate training in Pediatrics under Diplomate National Board, New Delhi, and is currently doing fellowship in Pediatric Critical Care in Rainbow Children’s Hospital and Birth right, Telangana, India.
Abstract:
Introduction
Pulmonary hypertension (PH) refers to an abnormal elevation of blood pressure in the pulmonary vascular circulation, and has multiple etiologies. The condition is potentially life threatening and can have varied presentations. We present our experience with 3 infants who were admitted in our tertiary level PICU over a span of 3 months.
Case description
Three infants presented to us in early infancy with severe PH. All 3 were exclusively breast-fed young infants with normal birth and family histories, and came in respiratory and circulatory failure with severe metabolic acidosis. An observation made retrospectively after the management of the first case led to the prompt diagnosis of the succeeding 2 cases. In view of severe metabolic acidosis in the first infant, as part of workup and management of inborn errors of metabolism, Thiamine was added to the treatment along with mitochondrial cocktail therapy. Reversal of metabolic acidosis and pulmonary hypertension happened over the next 48 hours. All other etiological workup came normal. And retrospectively the possibility of Thiamine deficiency as the cause of PH was thought of. In the other 2 patients, thiamine levels were sent before adding vitamin supplementation, and early intervention reduced the morbidity and hospital stay.
Discussion and Implications
Before labelling any PH as idiopathic, it is important and life-saving to rule out Thiamine deficiency as a possible etiology. Thiamine is an integral component of cellular metabolism. And it has been found that it can cause severe pulmonary hypertension in exclusively breast-fed infants. It can be easily reversible with the simple intervention of adding Thiamine supplementation. Awareness of this condition is important for early recognition and prevention of mortality.
Irfan Oguz Sahin
Ondokuz Mayıs University Faculty of Medicine, Turkey
Title: A rare reason of sudden cardiac arrest in children: Cardiac rhabdomyoma
Biography:
Irfan Oguz Sahin has completed his MD at the age of 24 years from Atatürk University. He had completed pediatrics education and pediatric cardiology education. He is the director of “Division of Pediatric Cardiology, Ondokuz Mayıs University”. He has published more than 15 papers in reputed journals.
Abstract:
Sudden cardiac arrest (SCA) is a rare but devastating condition. The most common cause of out-hospital SCA is ventricular tachycardia (VT). Major causes of VT in children are congenital heart diseases, cardiomyopathies, myocarditis, channelopathies, electrolyte imbalances. We present a case of benign cardiac tumor of which the first symptom was SCA.
Sixteen year-old previously healthy male had a SCA after he worked at farm. He was resuscitated for 10 minutes and admitted to pediatric intensive care. After initial stabilization, patient was evaluated for possible cardiac diseases. Electrocardiography and echocardiography was found normal. 24 hour Holter monitoring showed lots of ventricular ectopic beats and two nonsustained left-sided VTs (Figure 1). Magnetic resonance (MR) imaging showed a mass on left ventricle apex (Figure 2). Mass (2.5x1.5x1 cm) was resected surgically from the left ventricle (Figure 3). Holter tests after surgery were completely normal and resection of mass was seemed to be effective for elimination of VT. Histopathologic diagnosis was rhabdomyoma.
Primary cardiac tumors are rare with an incidence of 0.2%. They are mostly asymptomatic but may result to cyanosis, respiratory distress, heart failure. Although the mechanism has not been well characterized, cardiac tumors can lead to distinct electrocardiographic changes, VT and SCA. Data regarding arrhytmias associated with cardiac tumors are limited with small series. Management strategies include antiarrhytmics, cardioverter defibrillator and surgery but which is optimal remains unclear. We conclude that clinicians should keep benign cardiac tumor in mind as a cause of SCA and VT in children.
Biography:
Ahmad Pandu Pratama is a Cardiology trainee in National Cardiovascular Center Harapan Kita, teaching hospital of Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia.
Abstract:
Introduction. Anomalous left coronary artery arising from pulmonary artery (ALCAPA) is a very rare congenital anomaly. The incidence is about 1:300.000 live births and accounts for 0.25%–0.5% of all congenital heart defects. ALCAPA is one of the most common causes of myocardial ischemia and infarction in children. If left untreated, up to 90% of patients with ALCAPA syndrome will die within the first year of life. In patients who live to adulthood, ALCAPA syndrome may cause myocardial infarction, left ventricular dysfunction and mitral regurgitation, or silent myocardial ischemia, which can lead to sudden cardiac death. Early diagnosis and prompt surgical intervention with an aim to restore two-coronary-arteries circulatory system have shown an excellent results and lead to gradual myocardial recovery.
Case Report. Here we have 3 babies with ALCAPA came with signs and symptoms of heart failure. First and third case patients developed symptoms during 2-3 month of age, while second case patient at the 6 month of age. Diagnosis of ALCAPA confirmed by echocardiography in the first case patients. The second case beside echocardiography examination, also underwent multi-slice computed tomography (MSCT) scan examination. The third case patient have to underwent coronary angiography because coronary sinus was not well visualized by echocardiography. First and third case patient underwent ALCAPA repair with LCA implantation into Aortic root technic, showing favorable result, while second case patient scheduled to receive ALCAPA repair.
Conclusion. Diagnosing ALCAPA is challenging, but features like episodes of irritability during feeding that associated with sweating or pallor should alert us to suspect ALCAPA. Echocardiography is the most important non-invasive diagnostic tool and has replaced coronary angiography as the standard method of diagnosis. However, if it fails to visualized coronary sinus, other modalities such as MSCT Scan and magnetic resonance imaging (MRI) could be useful in order to make an early and accurate diagnosis. ALCAPA repair with left coronary artery (LCA) implantation was chosen due to favorable results found following re-establishment of the dual coronary system.
- Pediatric Cardiology
Location: Paris, France
Session Introduction
Roya Kelishadi
University of Medical Sciences,Isfahan,Iran
Title: Association of Beverage Consumption with Cardio-metabolic Risk Factors and Liver Enzyme in Children
Biography:
Roya Kelishadi is a Professor of Pediatrics in Isfahan University of Medical Sciences, Iran. She has more than 500 publications in English peer-reviewed journals. She is the chair of the Research Institute for Primordial Prevention of Non-Communicable Disease. She had presented her scientific works in several international conferences.
Abstract:
This nationwide study aims to evaluate the association of beverage consumption with cardiometabolic risk factors and alanine transaminase (ALT) levels in children and adolescents. Students, aged 7-18 years, were selected from 30 provinces by multi-stage cluster sampling. The weekly use of six different beverage types including milk, juice, tea, coffee, soda and non-alcoholic beer, was documented. Data of 3733 students were complete for this study. The mean (SD) age of participants was 12.58 (3.15) years; 52.6% were boys, and 72.7% lived in urban areas. Beverages types were clustered into healthy, containing high amounts of sugar and containing high caffeine levels categories. Mean ALT level was 7.70(3.42) IU/L. Tea was the beverage with highest frequency of consumption (73% had daily or weekly consumption). Beverages containing high levels of sugar such as soda and non-alcoholic beer were significantly associated with higher levels of ALT. Model coefficient of regression (SD) was 0.66 (0.31) (P-value:0.034). Healthy beverages such as milk and fresh juice and also beverages containing high levels of caffeine did not have significantly association with ALT levels (p-value=0.32, p-value=0.60). Healthy beverages had a significant and inverse relationship with triglycerides (P-value=0.029), total cholesterol (P-value=0.008) and low density lipoprotein (P-value=0.008) levels. This study showed that consuming sugar sweetened beverages are significantly associated with higher levels of ALT, whereas healthy beverages are associated with a better cardiometabolic profile meaning that consuming healthy beverages leads to lowers TG, TC and LDL levels. The effects of beverages on children health should be emphasized in health recommendations.
Zhimin Geng
Zhejiang University School of Medicine, China
Title: Monocyte heterogeneity and monocyte subsets specific to kawasaki disease revealed by single-cell RNA-seq
Biography:
Zhimin Geng is a medical doctor reading in Zhejiang University School of Medicine and her research expertise is Kawasaki disease. Her tutors is Prof. Fangqi Gong, who has published more than 20 papers in reputed journals and has been serving as a leader of Chinese medical association.
Abstract:
Kawasaki disease (KD) is characterized by a disorder of immune response, but its etiology remains unknown. Monocyte is an important member of body's innate immune system, however its role in KD is still elusive due to its ambiguities heterogeneity and complex functions. Here, single-cell RNA-seq was performed to map monocyte subsets and identify the KD specific monocyte subsets. Single-cell RNA-seq was used to transcriptionally profile the circulating monocytes that were separated from peripheral blood mononuclear cells and Seurat R package was used to identify the monocyte subsets. Four monocyte subsets were identified in healthy children, in which three clusters were mainly CD14+CD16- monocytes and one cluster was mainly CD14-CD16+ monocytes. Transcriptional markers of each subset were identified and the four monocyte subsets represent a linear differentiation. Two monocyte subsets specific to KD were identified, including one subset expressing FOLR3, S100A12 and IL1R2 and the other expressing MT-TN specifically. Moreover, KD specific monocyte subsets were mainly classical monocytes that poorly differentiated, and their function mainly involved in neutrophil activation. In conclusions, a relatively comprehensive map of circulating monocyte subsets was plotted for the first time in healthy children. KD specific monocyte subsets and their transcriptional markers were revealed respectively, which will contribute to the confirmation of diagnostic markers and development of a novel therapeutic strategy.
Ayse Pervanlar
Maltepe University, Turkey
Title: Sandifer’s Syndrome: Three case reports and review
Biography:
Ayse Pervanlar has graduated as MD at the age of 25 years from Karadeniz Technical University Faculty of Medicine. She has worked in the Trabzon OF State Hospital Emergency Department as a general practitioner between November 2012 and September 2013 and in Istanbul Medeniyet University as a family medicine resident between September 2013 and April 2016. She has started Pediatric Residency in Maltepe University Faculty of Medicine in April 2016 and she is currently a pediatric resident in Maltepe University Faculty of Medicine.
Abstract:
Introduction: Sandifer’s syndrome (SS) was first reported in 1962 as a combination of gastroesophageal reflux disease (GERD) with spastic torticollis and dystonic body movements with or without hiatal hernia occuring in children and adolescents. Although the true pathophysiological mechanisms of the condition are still unclear , it’s hypothesised that the position of the head provides relief from acid reflux.
Case presentations: A 3 month old female infant presented to our polyclinic with dystonic episodes accompanying duration of 30s-1min during feeding associated with vomiting for 2 months. Since the patient developed regurgitations with dystonic episodes which were followed by long lasting crying attacks, the milestones of motor and mental development were normal.The EEG and MRI were normal. We had two similar cases in our polyclinic.
Conclusion: The early diagnosis and treatment of GERD in patients with SS enhance the success of medical management.In our cases to diagnose we based on typical clinical features and on response to medical treatment with antacids and prokinetics.The paroxysmal dystonic features dramatically resolved completely after anti reflux treatment in our patients.Few reports of SS exist, yet it is probably underrecognised and mistreated, it might be on the interest to the scientific community.
Keywords: Sandifer Syndrome, Gastroesophageal reflux, Dystonia
Sung Eun Kim
Catholic University of Korea, South Korea
Title: Spectrographic analysis of normal and continuous adventitious breath sounds in children
Biography:
Sung Eun Kim is a medical doctor reading in Department of Pediatrics, Eun-pyeong st. Mary’s hospital, the Catholic University of Korea
Abstract:
Objective: Diagnosing pulmonary diseases with auscultation of breath sounds in children is often difficult because of its high dependence on the clinician’s experience of special circumstances involving children. The purpose of this study was to analyze the spectrograms of normal and continuous adventitious breath sounds to reproducibly find the appropriate character of breath sounds through a mechanical analysis.
Methods
Subject: (i) Period: May, 2019 – September, 2019 (ii) Place: Eun-pyeong st. Mary’s Hospital, outpatient clinic of Pediatrics (iii) Subject: Children visited for medical treatment (n=432).
Collection of data: Respiratory sound files were recorded (n=2217).
Instrument: Electronical stethoscope (JABES®).
Position: Right and left side of both anterior and posterior chest (total of 4).
Selection of data: Well-recorded normal and continuous adventitious breath sounds were selected. Selected files were cut into one respiratory phase unit (inspiration & expiration) Total of 289 files from 91 subjects was obtained.
Classification of selected data: Normal breath sounds, Continuous adventitious breath sounds. i. Wheezing: continuous sound over 400 Hz., mostly in expiration, ii. Rhonchus: continuous sound under 200 Hz., mostly in expiration, iii Mixed: continuous sound between 200 and 400 Hz., mostly in expiration
Data analysis: Spectrogram of 289 files was drawn and common characteristics were found.
Conclusion: In this study, typical characteristics of normal and continuous adventitious breath sounds were determined from the corresponding spectrograms. In statistics of continuous adventitious sounds, durations of wheezing, rhonchus and mixed sound showed significant difference. Number of continuous sound per files, on the other hand, didn’t show significant difference. Spectrographic data of more samples would improve our understanding of the characteristics of different breath sounds that are not well-known to date.
Hossein Ariana
Hamedan University of Medical Sciences, Iran
Title: Assessment of serum level of Troponin T in preterm infants with and without ductus arteriosus hospitalised in the neonatal care unit of Fatemieh Hospital
Biography:
Hossein Ariana is a Pediatric Assistant at Hamedan University of Medical Sciences.
Abstract:
Objective: One of the problems of preterm infant is patent ductus arteriosus (PDA(.PDA in preterm infants can lead to a left-to-right shunt and pulmonary congestion, left ventricular volume overload that can exacerbate respiratory symptoms and ventilator dependence, and morbidity and mortality. Advanced echocardiography plays a major role in the diagnosis of neonatal heart disease and myocardial function study, but early diagnostic tools are needed due to unavailability of advanced echocardiography.
Material and Methods: In this prospective cross sectional study, 33 neonates with PDA and 30 neonates without PDA at the age of 3-5 day were selected by simple sampling method from hospitalized neonates in NICU of Fatemieh Hospital in Hamadan. They were examined in terms of PDA and were classified into two groups: with PDA and without PDA. Then they were examined regarding the serum level of troponin T and myocardial function studies by conventional and tissue Doppler echocardiography. Data was analyzed by SPSS software version 21 at 95% confidence level.
Results: The mean and standard deviation of serum levels of troponin T in neonates with and without of PDA were 351.88 ± 413.43 and 302.00 ± 240.90 nanogram / liter(ng/l), respectively (P = 0.120) that was not statistically significantbuton the fourth day of birth it was 624.67 ± 741 and 316.00 ± 286.90 ng/l, respectively (P = 0.036) that is statistically significant. The correlation coefficient between serum levels of troponin with RMPI and LMPI was positive at 0.518 and 0.562 (P <0.001) and with TAPSE index minus 0.015 (P = 0.906).
Conclusion: In preterm infants, there is a correlation between right and left myocardial performance with serum troponin T level. Therefore, measuring serum levels of troponin T on the fourth day after birth can be helpful in detecting patent ductus arteriosus.
Keywords: Troponin T, Preterm neonates, patent ductus arteriosus
Biography:
Shirley Ferlina Lasmono is a pediatrician graduated from Pediatric department of University Airlangga Surabaya. She is working as a pediatrician in Madura Island to improve the child health there. Shirley has published some papers during the residency and has been serving as a speaker and committee in some medical seminar.
Abstract:
Pulmonary arterial hypertension is a common complication of uncorrected left-to-right shunt congenital heart disease. Beraprost have been used widely to treat pulmonary arterial hypertension in adult. However, the efficacy of the drug in Indonesian children has not been investigated. This study aim is to evaluate the efficacy of Beraprostin treating pulmonary arterial hypertension related toleft-to-right shunt congenital heart disease. A randomized controltrial was used in this study between April to September 2017 in Cardiology outpatient clinic of Dr. Soetomo General Hospital. Subjects aged 2-12 years with pulmonary arterial hypertension randomly received Beraprost 0.35mcg/kg eight hourly for 12 weeks. Efficacy was evaluated by echocardiography and adverse effect was monitored. Data were analyzed by statisticals of tware using t-test and Mann Whitney test with significance level set to 0.05. All procedures were approved by hospital ethics committee and registered at the Clinical Trials.gov. Twenty two children were recruitedin to the study. Resolution of Beraprost in decreasing pulmonary arterial pressure was -21.32 ± 11.06 mmHg (p = 0.034). Adverse effects reported were headache. As conclusion, Beraprostis effective and safe as initial pharmacologic treatment in treating pulmonary arterial hypertension related to left to right shunt congenital heart disease.
Keywords: Beraprost, pulmonaryarterialhypertension, congenitalheartdefect, left-to-rightshunt
Sujata Sai
Manipal Hospital, India
Title: Torsion of a splenule in a case of splenogonadal fusion mimicking strangulated inguinal hernia
Biography:
Sujata Sai is a resident in surgery at Manipal Hospital, Bangalore. She is passionate about saving and changing lives. She also enjoys blogging about her experiences as a surgical resident. She has consistently done excellently academically, and has excelled in multiple extracurricular activities as well – She has given the Trinity College of Music Piano exams, is a part of several volunteer organizations for social service and participates in several sports as well.
Abstract:
Introduction: Splenogonadal fusion (SGF) is a rare congenital anomaly which occurs due to an abnormal fusion of splenic tissue with the derivatives of the perimesonephros. It usually presents as an inguinal hernia, testicular mass or undescended testis. To the best of our knowledge, this is the first time, SGF presented as a strangulated inguinal hernia.
Case: A six-year-old boy with an acute painful left inguinal swelling since that morning. General examination- tachycardia.
Groin exam- A tense, tender, irreducible left inguinal swelling with normal bilateral descended testes. USG- A soft tissue swelling as the content of the hernia with reduced vascularity.
DDx- ?torsion of supernumerary testis
Intra operative findings: Left indirect inguinal hernia. No omentum/ bowel, but a purplish mass connected distally to upper pole of the left testis and proximally entering the peritoneum through a fibrous cord Fibrous cords – 360° torsion → early gangrenous changes. Histopathology revealed a fibroelastic capsule covering a tissue comprised of red pulp, white pulp, dilated sinusoids; consistent with an ectopic spleen.
SGF is a rare entity - less than 200 cases reported till date.The etiology is unknown. Treatment of choice-Complete excision of the splenic tissue with preservation of gonad. Unfortunately, 37% of the reported cases underwent unnecessary orchidectomy as many surgeons were unfamiliar with SGF.