Day 2 :
Keynote Forum
Singer Michal
The Edmond and Lily Safra Children’s Hospital, Israel
Keynote: Waze to the oncology patient that is heading forward to an incredibly difficult path, a long one and dangerous.
Time : 10:00-10:40
Biography:
Abstract:
Background: The treatment of leukemic child is a complicated and long chemotherapy treatment that usually takes two years. The existing protocol is in an international format that intended to the medical staff who familiar with the medical terms, shortcuts and symbols. The protocol consists number of chemotherapies i.v, p.o and i.t , some of them require hospitalization and some are given in the day care department.
The goal: Creating a new booklet that is deigned to use as a map of the therapy plane. The booklet describes the therapy for each day in a table that includes all the medicines, related information for each medicine or medical examination. The purpose of the booklet is accessible the medical protocol in order to increase the knowledge of the patient and his family and to increase their involvement in the therapy. All that in order to improve the safety and the quality of the therapy.
Method: step 1: Identifying a complicated/long medical protocol that has the most potential to benefit from a detailed map in a booklet.
Step 2: Acquaintance and understanding of the chemotherapy protocol. Identify the characteristics, the important needs and the required information that is necessary for the success of the treatment.
Step 3: Building an integrative table that consists all the medicines and examinations per day with all the relevant information that identified as important for the success of the treatment.
Step 4: Graphic design and translation for other languages (Russian, Arabic and English).
Viewing data: A booklet has been built for ALL-BFM-95 protocol in children with Acute Lymphoblastic Leukemia for high risk groups, duration 2 years. During 2019 the booklet was handed to 7 patients before starting the treatment. Out of them 2 patients already finished the treatment and 5 were still in middle of the treatment. Evaluation of the patients and their parent’s satisfaction was done by questionnaires. The questionnaires were given to the patients that finished at least half of the treatment. There were 3 main topics in the questionnaire: expanding the knowledge of the patient, developing same common language among staff members and patient and reducing patient’s anxiety.
Conclusions: 100% of the patients indicated to a very large extent that the booklet increased their knowledge in regards of their treatment. 57% of the patients indicated to a very large extent that the booklet contributed to a better communication with the staff, and 43% of the patients indicated to a large extent. 14% of the patients indicated that the booklet contribute to decrease the level of anxiety to a very large extent, 14% indicated in a large extent and 62% indicated in a medium extent.
Summary: patients and their parents can benefit from the booklet and can be more involved in the process of the treatment by using it. During 2019 booklets were produced for two more protocols: Langerhans cell Histiocytosis (LCH) and protocol for low grade glioma in children, those booklets haven’t been handed to patients yet.
- 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.