Day 1 :
Federal University of Ceara, Brazil
Time : 10:35-11:15
Helena Lutescia Luna Coelho is a Pharmacist, PhD in Pharmacology with Post-doctoral studies from Mario Negri Institute-Milan, Italy. She was a full Professor of the Federal University of Ceará (UFC) till 2012. She was a member of the WHO expert committee selecting the first list of essential medicines for children (LEMC 2007). Currently, she coordinates the research and action group Melhores Medicamentos para Crianças (MeMeCri), and taken an initiative for better drugs for children in Brazil, working voluntarily as a Researcher at UFC.
Drug utilization in children is challenging because of the scarcity of scientific evidence as well as the inadequacy of products for this age group. A comparison between the Brazilian list of essential medicines and the WHO list of essential medicines for children (LEMc 2011) showed a satisfactory presence of the actives but an insufficiency of adequate drug formulations (dosage form and strength), mainly for neonates. These factors stimulated the creation in 2010 of an academic initiative to advocate for better drugs for children (BDFC) in Brazil, named MeMeCri (Melhores Medicamentos para Crianças), a research and action group bound to the Federal University of Ceará (UFC) and recognized by the National Research Council (CNPq). MeMecri have expanded its activities, including researchers and professionals from other Brazilian universities, advocating for BDFC in scientific and professional events and asking the attention of the Brazilian Government to this issue. Pharmacoepidemiologic and pharmacovigilance research and development of pediatric formulations are in course and some are already published. New research projects involve pharmacovigilance in neonates, drug use in mental disease in children and youth, and metilfenidate prescription in public services and development of pediatric formulations for neglected diseases. MeMecri performed two international symposiums about BDFC (2010 and 2015), inviting international and national experts. In October 2015, the Brazilian Minister of Health created a working group to elaborate suggestions about the problem of drugs for children nationwide, where MeMecri was nominated for participation.
University of Connecticut School of Medicine, USA
Keynote: Using 24-hour weight as reference for weight loss calculation to promote exclusive breastfeeding in term newborns delivered by Cesarean section
Time : 11:35-12:15
Margaret McLaren has obtained her Medical degree from United States in the year 1976. She completed an Fellowships in Epidemiology at Yale University, USA and a Pediatric Residency at the University of Connecticut. For the past 25 years, she has been serving as a Medical Director of the Newborn Nursery at Hartford Hospital. She is an Associate Professor of Pediatrics at the University of Connecticut and an Attending Pediatrician at the Connecticut Children’s Medical Center. Her major interests are breastfeeding, infant mental health, and maternal substance use.
Exclusive breastfeeding for the first 6 months of life is recommended to promote maternal and infant health. Supplementing the newborns can interfere with the successful establishment and duration of exclusive breastfeeding and are only warranted if medical indications exist, such as clinical evidence of dehydration. Loss of ≥10% of birth weight frequently triggers supplementation due to nursery staff’s concern for dehydration even if not clinically evident. Studies have demonstrated that transplacental passage of maternal intravenous fluids for epidural or spinal anesthesia may inflate birth weight. Researchers have proposed using a newborn’s 24-hour weight, after diuresis of this fluid, as the preferred reference for weight loss calculation. The mother-infant unit at Hartford Hospital, a Baby-Friendly Hospital in Connecticut, USA, implemented this recommendation into routine practice in March, 2014. To evaluate efficacy and safety of this clinical practice in decreasing supplementation, we performed a retrospective chart review on healthy full term newborns delivered by C-section in the 12 months before (n=404) and 12 months after implementation (n=263). The overall supplementation rate decreased from 43.6% pre- to 27.4% post-intervention and in first-time mothers from 51.9% to 31.0%. Among infants losing ≥10% of birth weight (n=97 and 84), the supplementation rate decreased from 63.9% to 26.2%. Hence, there was no significant increase in maximum weight loss, peak transcutaneous bilirubin level, or length of stay overall or in those with ≥10% weight loss from birth; indicating that using the 24-hour infant weight as routine reference for weight loss calculation was safe and effective in reducing supplementation.
- General Pediatrics
Centro Hospitalar Sao Joao , Portugal
Time : 12:15-12:45
Tania Sofia Leano Martins has completed her Medical Schooling from Medical School of Porto with 15 values and now is pursuing Pediatrics Specialty. She is a Trainer of advanced support of pediatric life as part of the Portuguese pediatric resuscitation group and Volunteer Teacher of pre-graduated Pediatrics practical and theory classes of Master degree in Medicine from Oporto Medical Schools. She has attended several courses with evaluation like 11th European Postgraduate course in Neonatal and Pediatric Intensive care. She has presented several clinical studies in national and international conferences and published in the form of book chapter themes: Tuberculosis in pediatrics age and Neutropenia in Pediatrics.
Introduction: Neonatal convulsions, with an incidence of 1.8-3.5/1000, are the most common symptoms of neurological dysfunction and may result from functional organic or metabolic disorders. Phenobarbital remains first therapeutic line drug with less than 50% effectiveness.
Aim: Aim of this study is to determine etiology, complementary means of diagnosis, treatment performed with special attention to the use of lidocaine as drugs of 3rd or 4th line and its efficacy in refractory seizures.
Methods: A retrospective review of refractory seizures admitted to the neonatal intensive care unit of a tertiary hospital in Portugal between 2009 and 2015. Results: Seven newborns (5M/2F) were diagnosed with refractory seizures (one preterm). Delivery dystocia em 6. Average birth weight was 3177 g. Perinatal asphyxia is the main cause in (3/7), ischemic/hemorrhagic stroke in 2, hypoxia associated to a cardio-pulmonary disease and one KCNQ2 gene mutation in 1 case. Imaging and electrophysiological studies were performed in all cases. First line drug was phenobarbital in all cases; 2nd line midazolam 5/7 and levetiracetam and phenytoin 1/7; 3rd line lidocaine in 5/7 and levetiracetam and clobazam 1/7, 4th line levetiracetam 3/5 and midazolam and lidocaine 1/5; 5th line thiopental 2/3 and lidocaine 1/3. Lidocaine was not associated with cardiac electrical changes and resulted in seizure control in 3/7. All infants underwent EEG control and kept antiepileptic therapy to discharge. Conclusions: The use of lidocaine resulted in a moderate control (42% crises) without cardiac effects. Lidocaine should therefore be considered earlier in the treatment of seizures in the neonatal period.
Cairo University, Egypt
Title: Ante Grade Flow in Anomalous Left Coronary Artery from Pulmonary Artery- Clinical implications
Time : 12:45-13:15
Yasser Sedky has completed his MD from Cairo University, Kasr Eleiny School of Medicine. He has been working in the field of Pediatric Cardiology since 2007. He is pediatric cardiology consultant at ASWAN Heart center and lecturer of Pediatrics at Cairo University Hospital. He has published more than 5 papers in reputed journals.
Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly that usually presents in childhood. It results in Left ventricular (LV) ischemia with resulting LV dysfunction. This ischemia results from retrograde flow into the pulmonary artery which can act as a coronary steal. We here report antegrade flow detected in ALCAPA caused by severe pulmonary hypertension. Anatomic correction of ALCAPA is the preferred surgical option and should be performed as early as possible.
Kathleen Kenney-Riley EdD, APRN, BC is a Pediatric Nurse Practitioner with a focus in adolescents with lupus. She has 25 years of clinical and research experience in children with chronic conditions and her research interests are in the area of quality of life, communication with health care providers and methods of improving patient/provider discordance in chronic illnesses. She serves the Editorial Board for the Pediatric Nursing and is a voting member of the Childhood Arthritis and Rheumatology Research Alliance (CARRA). She has conducted a secondary data analysis of CARRA data on adolescents with lupus and providers discordance levels.
The importance of incorporating patients’ subjective assessment of their disease status into assessment/treatment plans as a means to improve patient compliance and communication with providers has been increasingly reported in the literature. This study evaluated the level of discordance between adolescent lupus patients’ perceptions of the overall disease activity and their providers’ rating of disease activity. A secondary data analysis was done of 861 lupus patients (ages 12-23 years) using data from the Childhood Arthritis and Rheumatology Research Alliance registry. Findings demonstrated the relationship between global assessment of disease as reported by patient and by provider was very weak (r=0.26). Indeed, teens as a group reported themselves to be significantly sicker than their healthcare providers did (p<0.001). There was a significant association between teen’s pain ratings and their rating of their disease activity (p<0.05). Assessment of the relationship between providers’ rating of disease activity and their lab values found no significant correlation between those lab values (normal or abnormal) and the provider’s rating of disease activity. Further, teens who did not have labs reported by the provider had a significantly higher discordance score than those who did (p <.01). This is concerning when considering the importance of provider/patient communication, and understanding one another, to determining level of disease activity and management options. This initial study demonstrates a significant need to determine which variables influence the patient/provider communication in order to develop interventions to improve this relationship, promote compliance and reduce negative outcomes in all adolescents with chronic illnesses.
Centro Hospitalar Sao Joao , Portugal
Time : 15:00-15:30
Tânia Sofia Leano Martins has completed her Medical Schooling from Medical School of Porto with 15 values and now is pursuing Pediatrics Specialty. She is a Trainer of advanced support of pediatric life as part of the Portuguese pediatric resuscitation group and Volunteer Teacher of pre-graduated Pediatrics practical and theory classes of Master degree in Medicine from Oporto Medical Schools. She has attended several courses with evaluation like 11th European Postgraduate course in Neonatal and Pediatric Intensive care. She has presented several clinical studies in national and international conferences and published in the form of book chapter themes: Tuberculosis in pediatrics age and Neutropenia in Pediatrics.
Introduction: Congenital pulmonary malformations (CPM) are rare with an incidence of 30-42/100,000. Clinical presentation varies from asymptomatic with late diagnosis, until early and severe clinical manifestation, requiring early surgical intervention. Aim: Aim of this study is to determine the incidence, prenatal diagnosis, complementary means of diagnosis and treatment.
Methods: Method used in this study is a retrospective review in a neonatal intensive care unit in a Tertiary Hospital between 2001 and 2015.
Results: 24 cases were identified in which there were 11 cystic adenomatoid malformations (45.8%), 7F/4M. Prenatal diagnosis was found in 100% of cases with mean gestational age 23s, right 54.5%. Prenatal diagnosis in 2 cases was not confirmed postnatally, two with later diagnosis of esophageal atresia and lymphangioma and 1 awaits confirmation. Symptomatic at birth and with associated malformations were 18.2%. All patients underwent computed tomography (CT) chest that corroborated the diagnosis in 72.7%. Undergoing surgery were 72.7% (63.6% lobectomy). Nine (37.5%) pulmonary sequestration: 7 extra-lobar (4 left / 3 right) and two intra-lobar (1 left/1 right), 6M/3F. Prenatal diagnosis was done in 88.9% and correct in 25%. Symptomatic at birth were 22.2%. Associated malformations were in 44.4%. Within the extra sequestration lobar 55.5% underwent surgical excision and 100% of intra-lobar embolization of vessels by catheterization. Four pulmonary emphysema were identified (16.6%), 3M/1F. Without prenatal diagnosis, asymptomatic at birth and right location were seen in 100%. Malformations associated at 75%. All underwent lobectomy by thoracotomy. Conclusions: In recent years, improve in general orientation of CPM due to prenatal and postnatal diagnosis is more accurate, allows the early establishment of an appropriate therapeutic guidance.
Gulhane Military Medical Academy, Tukey
Time : 16:20-16:50
Suzi Demirbag has completed his MD from Gulhane Military Medical School and Post-doctoral studies from same center. He has published more than 37 papers in reputed journals
Hirschsprung’s disease (HD) was first described by Herald Hirschsprung in 1886. HD is one of the most important cause of the constipation in childhood. It occurs one in 5000 live birth and male/female ratio is around four. Failure to diagnose the problem may cause morbidity and sometimes mortality. Hirschsprung associated enterocolitis (HAEC) is a severe results of the disease and responsible for 50% mortality associated with HD. HAEC is a potentially deadly complication of HD and characterized by fever, abdominal distention, vomiting, diarrhea, sepsis and if not treated appropriately may result with mortality. Despite a lot of clinical and experimentally studies, the exact mechanisms underlying HAEC are still unclear. This presentation mainly focuses on risk factors, early diagnosis and current treatment protocols for HAEC.
Tawam hospital- United Arab Emiratis University, UAE
Time : 16:50-17:20
Mustafa Alabdullatif has completed his Master’s degree and Arab Board of Pediatric from Aleppo University. He worked in different hospitals in KSA, and UAE. Currently, he is working at one of the best tertiary hospital in UAE.
Introduction: Chromosomal microarray (CMA) is frequently performed as part of the diagnostic work-up for children with dysmorphic features, developmental delay, growth failure, and congenital anomalies. The traditional microarrays were designed for detection of gene copy number variations (CNVs) by comparative genomic hybridization (CGH), and were popularly called array CGH. The second type of arrays containing a high density of probes for single nucleotide polymorphisms (SNPs) reveals both CNVs and absence of homozygosity (AOH) areas in the genome. AOH areas can be explained by consanguinity or uniparental disomy (UPD). Previous studies has demonstrated 10-15% detection rate for pathogenic CNVs using CMA. The role of CMA in diagnosing genetic disorder in highly consanguineous community such as in UAE has not yet been described. Herein, we present the yield of CMA performed at the Tawam Hospital, Al-Ain, UAE during one year period.
Methods: The results of CMA performed in the Genetic Clinics in Tawam Hospital during the period from November 2014 to October 2015 were collected. The CMA tests, which used both SNP and array CGH methodologies, were performed in a certified clinical lab in USA. We evaluated the indication for the CMA testing and the yield of positive tests which included CNVs, candidate gene in AOH areas that could explain the phenotype, and UPD.
Results: CMA tests were performed for 136 patients. The indications included developmental delay, dysmorphic features, growth failure, and multiple congenital anomalies. Consanguinity and AOH areas of more than 4% were seen in 76 (56%). A definite diagnosis was reached based on this test in 30 patient (22%), including 23 patients with CNV (deletion or duplication); 1 patient with UPD (Russell-Silver syndrome); and 6 patients cases were found to have mutations in genes in the AOH area (5 alpha reductase deficiency and alacrima, achalasia, and mental retardation syndrome, Hair-Cartilage syndrome, Deafness autosomal recessive 1A, and Polycystic kidney infantile).
Conclusion: CMA is one of the commonest tests performed in the diagnostic work up of genetic diseases. The yield of CMA can be higher in communities with high consanguinity rates due to the utility of AOH areas, suggesting candidate genes that can explain the phenotype.
Habana University School of Medicine, Cuba
Title: Prediction instrument for obesity in adolescents at the Policlínico Universitario “Manuel González Díaz”
Time : 17:20-17:50
Carlos Enrique Piña Borrego has completed his Medicine and Post-graduation studies in Neonatology. He did his Specialization of First degree in Family Medicine from University in Havana, Cuba and Specialization of Second degree in Pediatric. He has done his Master’s degree in Integral Attention of Child from Pinar del Río University, School of Medicine. He is an Aggregate Investigator and Assistant Professor from Artemisa School of Medicine, Havana University School of Medicine, Cuba. He has published more than 10 articles in reputed journals.
Obesity is one of the principal non-declarable diseases affecting children and adolescents. With the objective of developing a predictive instrument to identify high-risk adolescents with obesity, a cohort prospective study was carried out at the Policlinic "Manuel González Díaz", Bahía Honda City from 2013-2014. It was developed in three stages; in the first stage, 1800 adolescents from 10-19 years of age were included. The prevalence was identified and the most relevant characteristics of obesity were described (defined as body mass index >97th percentile according to age and sex). In the second stage, we identified the possibility of the diagnosis of factors that increase the probability of obesity. The third stage elaborated and validated an obesity predictor instrument from the results of initial stages. To apply the instrument to sample A for internal elaboration and validation, sensitivity was 77.78% and specificity was 86.11%. Area under the curve (AUC) receiver operating characteristic (ROC) was 0.86, whereas for sample B the sensitivity was 79.63% and specificity was 92.13%. Positive predictive value (PPV) was 83.5% and negative predictive value (NPV) was 90.05%. The instrument allows predicting the risk for developing obesity in adolescents with acceptable sensitivity and high specificity. Hence, its routine application will be interesting in pediatric health consultations.
Universidad de Cartagena, Colombia.
Time : 17:50-18:20
Fernando Gabriel Manzur Jattin, has completed his Master´s degree at European board accreditation in cardiology: Exploring the clinical value of innovaation in lipid management, Universidad de Sevilla: Maestría en ensayos clínicos, Universidad Católica San Antonio: Master universitario en avances en cardiología, Maestría en imágenes cardiovasculares, Universidad de Padova. And postdoctoral studies from Harvard medical school: Evaluating the value of cardiovascular therapeutic, Sociedad latinoamericana de hipertensión, Consenso latinoamericano de hipertensión síndrome metabólico y diabetes mellitus: Guías latinoamericanas de hta. The European Board For Accreditation in Cardiology: 21 CME, Universidad De Harvard: ENSAYO SOLID TIMI 52, Sociedad Europea de Cardiología: Terapia de lípidos, Sociedad Chilena De Cardiología: Ecocardiografía Avanzada, Universidad Del Magdalena: Experto En Buenas Practicas Clínicas, The European Board For Acreditation in Cardiology EBAC: International CME Program in Cardiology University Of Miami: Curso de Postgrado en Cardiología Clínica, Mayo Clinic: A Case Based Approach to Ischemic Heart Disease Management. He is member of: Gobernador, Ispc, Ispc, Fellow Facc, American college Of Cardiology, Miembro Correspondiente, Sociedad Chilena De Cardiología, Fellow Honorario, Sociedad Internacional De Ecocardiografía, Ex Presidente Y Miembro Honorario, Sociedad Colombiana De Cardiologia, Miembro Correspondiente, Sociedad Brasilera De Cardiología, Miembro Correspondiente, Sociedad Argentina De Cardiología, Miembro Correspondiente, Federación Argentina De Cardiología, Socio Correspondiente, Sociedad Chilena De Cardiología, Miembro Activo Colegiado, Federación Médica Colombiana, Socio Numerario, Sociedad Castellana De Cardiología, Miembro Numerario, Sociedad Española De Cardiología, Miembro Consejo Superior, Universidad De Cartagena, Fellow European Society Of Cardiology, Sociedad Europea De Cardiologia, Miembro Emérito Sociedad Colombiana de Cardiologia, Miembro Honorario, Federación Diabetologica De Colombia, Miembro Honorario, Sociedad Dominicana De Cardiología, Presidente De Los Consejos Científicos De La Sociedad Interamericana De Cardiologia, Sociedad Ineraméricana de Cardiologia. He has published more than 67 papers in reputed journals, and written 11 books.
Canakinumab is a totally human monoclonal antibody anti-IL-1β developed by Novartis, whose mode of action is based on the neutralization of IL-1β signaling, which leads to suppression of inflammation in patients with autoimmune disorders. The IL-1β acts as a mediator of the peripheral immune response during infection and inflammation. By the antigen-antibody binding, canakinumab inhibits the action of IL1-β avoiding its pro-inflammatory effects. Currently, it is being evaluated as a new possible agent directed against IL-1β, with the goal of reducing the rate of cardiovascular events and new onset diabetes.