1 Trans-thoracic Aortic Peak Velocity Variation for Goal Directed Fluid and Hemodynamic Therapy in Children and Postoperative Outcome: A Multicentric Randomized Controlled Trial: Editorial , Claudine Kumba
A multicentric randomized controlled trial (RCT) is in preparation. This RCT has the primary objective to determine the impact of trans-thoracic aortic peak velocity variation in goal directed fluid and hemodynamic therapy (GDFHT) on postoperative morbidity in children in major surgery. This Editorial highlights essential points of this RCT in preparation.
2 Introducing the One-Pot-Amine-Thiol-Ene Reaction to Develop Redox Responsive Nanocarriers for its Potential Use in Anticancer Drug Release , Sayan Basak
The aim to protect the healthy cells remains one of the prime challenges while designing an anticancer drug and its delivery pathway. With the advent of advanced nanocarriers coupled with stimuli-responsive polymer frameworks, the drug-loaded matrix can efficiently deliver the drug with a negligible impact on the healthy cells. The reinforced linkages (ionic and covalent) between the drug molecule and the polymer help in an enhanced encapsu-lation, thereby minimizing the faulty delivery and increasing the overall efficacy of the process. Furthermore, the integration of stimuli-responsive properties tunes the material to exhibit more precise functionalities, such as reputing of the polymer network at the desired location when excited with a specific stimulus, harmo-nizes the process to deliver drug molecules very precisely
3 The Morbidity of Anaemia in Children with Colostomies. A Cohort-Based Study , Peter Mwika, Francis Osawa, James Ndung’u and Timothy Jumbi
Introduction: Anaemia is a contributor to significant morbidity in children with colostomies. The causes of anaemia maybe be multi-factorial the effect of which may impact on the growth and nutritional aspects of the child while ultimately delaying definitive surgery. To quantify the morbidity of anaemia in children with colostomies, we sought to objectively identify the association between the presence of colonic stomas and the levels of haemoglobin and mean corpuscular volume in a cohort of children managed in a tertiary hospital in Kenya.Materials and Methods: A descriptive cohort study carried out in Kenyatta National hospital between 2015 and 2017 which recruited 40 patients in total. Blood samples were collected for haemoglobin and mean corpuscular volume levels as markers for anaemia. For comparison similar samples were collected from a pool of patients matched for age and sex with umbilical and inguinal hernia to serve as controls. Data was analysed and presented based on the hematologic indices above.Results: There were 22 (55%) cases who met the definition of anaemia based on a haemoglobin cut off values compared to 13 (32.5%) controls. Both the mean haemoglobin level and mean MCV were significantly lower in the children with colostomies.Conclusion: Colostomies are associated with anaemia in children. Identification and correction of anaemic states through screening, haematinics and colostomy care may mitigate the morbidity associated with anaemia.
4 Hyperkinetic Syndrome in Adolescent with HIV-Infection , Borysova TP, Badogina LP, Allahverdieva ZS and Samsonenko SV
A clinical case of a rare manifestation of HIV encephalopathy in a teenager in the form of generalized hyperkinesis is described. Differential diagnosis with acute rheumatic fever, systemic connective tissue disease, demyelinating diseases, tumors of the central nervous system, Wilson-Konovalov disease is presented.
5 Acid-Base Disturbances: A Key Concept to Prevent Life-Threatening State of Sick Children , Mir Mohammad Yusuf
Essentially all sick children, can lead to acid-base disturbances. Therefore, acid-base disorders need to be anticipated in all critically ill pediatric patients. Monitoring of the acid-base status will allow the early recognition of derangements and the prevention of what could become a life-threatening state. Acidosis is the most common acid-base derangement in the pediatric intensive care unit (PICU), with metabolic acidosis pH of < 7.2 potentially indicating a more severe course and worse outcome. Further assessment of the type of acidosis and the presence of a mixed acid-base disorder requires measurement of pCO2, serum bicarbonate and calculation of the anion gap. The most commonly encountered causes of metabolic acidosis in the PICU are sepsis, renal insufficiency and DKA, while Respiratory distress syndrome (RDS), Meconium aspiration syndrome (MAS) and Severe Status Asthmaticus are the usual suspects in respiratory acidosis. Alkalosis, on the other hand, is less common in the PICU. Fluid status derangements and, especially, gastric fluid depletion are the usual underlying causes of metabolic alkalosis, whereas rapid respiration secondary to lung diseases, excessive mechanical ventilation, or central nervous system diseases are the common causes of respiratory alkalosis. In the PICU, identification of acid-base derangements is followed by timely stabilization of the patient irrespective of the underlying cause. Depending on the severity of the derangement and the patient’s response to the stabilizing interventions, the underlying cause might also need to be aggressively sought and emergently reversed. Identification of the underlying cause(s) of the acid-base disorder at hand may be the final step in the management of these patients, but plays an important role both in the prevention of worsening of the derangement and other complications as well as in the determination of the patient’s overall prognosis.
6 Implementation of an Awareness Program and Lifestyle Intervention on Polycystic Ovarian Syndrome among Adolescent Schoolgirls in In , Valarmathi Selvaraj, Jain Vanitha, Fabiola M Dhanraj, Prema Sekar and Anitha Rajendra Babu
Authors share their experiences from a research on polycystic ovarian syndrome (PCOS) risk among adolescent schoolgirls in a South Indian state. One hundred and twenty school going adolescent girls from a government funded school in Southern India were assessed for PCOS risk, among which 40 had PCOS risk (moderate risk 36, high risk 4). These 40 were grouped in to either experimental or control which 20 each. Experimental group received awareness program and lifestyle modifications (yoga and exercise) by the researcher in coordination with the schoolteachers at the school premises. Pretest knowledge assessment showed, 16 (80%) in the experimental and 15 (75%) on the control group had ‘moderate’ knowledge. Post intervention, 15 (75%) had adequate knowledge in the experimental group and 9 (45%) in the control group. Knowledge score during pretest was mean 11.30; SD 4.91, t = 5.27; p = 0.000 in the experimental group, and 11.25; SD = 4.44, t = 2.85; p = 00.01 in the control group. Knowledge score of post-test was 11.30; SD 4.91; t = 5.27; p = 0.000 in the experimental and the mean 14.35; S.D 4.44; t = 2.85; p = 0.01 in the control group. Attitude score during pretest was 51.80; SD = 11.12, t = 0.01; p = 0.000 in the experimental and 53.45 SD = 5.91; t = 2.99; p = 00.01) in the control group. Attitude score during posttest was mean 53.45; SD = 5.91, t = 2.99; p = 0.1 in the experimental group and 53.45 SD = 5.91; t = 2.99; p = 00.01 in the control group. Improvements in knowledge and attitude score demonstrates the feasibility of lifestyle intervention targeted at adolescent girls, with PCOS risk, in school premises
7 Typologies of Preponderant Mindset among Single Parents of Children with ADHD , Jocelyn B Hipona
Background and Objective: There are only few researches that tackle about the parenting style of single parents and their coping mechanism in response to their emotional stress in raising a child with ADHD. The purpose of this study is to explore the livid experiences, parenting style and coping mechanism of single parents in raising a child with ADHD. This study will provide an appropriate support from the healthcare providers to minimize their emotional stress and also to raise advocacy for single parents who are exceptional in caring for their child with this kind of disruptive behavior.Methods: A qualitative research approach was utilized to describe lived experiences of single parents rearing children with ADHD and give them meaning. This study utilized apurposive sampling and collected the data in primary schools in the Philippines, which offer special education and support for children with special conditions. A total of 4 single parents participated in this study that nurtures a clinically diagnosed ADHD child. A self-made 12 items questionnaires validated by experts was applied in this research to explore the experiences of single parents raising a child with ADHD, their strength and weakness and coping skills.Results: Ideas were extracted through interview and the results revealed three different aspects in the care of these children. In cool and warm analyses, different factors show significant part in handling and caring for children. The study proved that being a single parent requires many functions and abilities. The result of this study captured the mindsets and perceptions of parents caring for children with ADHD.Conclusion: Single parents who were involved in caring for their children that is clinically diagnosed with ADHD often have a positive outlook in their status and accepted the fact that their child is suffering from this disorder. They are also working hard to sustain the needs of their children. They were able to ascertain that a child with behavioral disorder does not make a difference in disciplining a normal child. It is essential to teach the parents to set firm limits and give consequences to their child’s actions and not to be treated like a special child.
8 Offering Hydroxychloroquine Prophylaxis to High Risk Corona Warriors: Ongoing Debate , Roosy Aulakh1 and CS Gautam.
Undoubtedly, it is high time to take up the COVID-19 challenge and act aptly and promptly to prevent the exponential spread of the highly transmissible novel corona virus worldwide to encounter this ongoing deadly healthcare crisis. SARS-CoV2 virus has been demonstrated to have high transmissibility with humans worldwide being clueless on how to manage its spread.
9 Age and Gender Based Self-Reported Impact of Disclosure of HIV/AIDS Diagnosis from Adolescents Receiving Care at University Teaching Hospital, Uyo, South-South Nigeria , Dixon-Umo OT,Ikpeme EE and Ekpenyong EE.
Human immunodeficiency virus infection still contributes significantly to adolescent mortality in sub-Saharan Africa but many infected children are surviving into adolescence and adulthood. Infected adolescents need to know their status for their proper self-care and prevention of transmission. Studies on effects of disclosure from adolescents’ perspectives are few. This study sought for the self-reported impact on disclosed adolescents.
10 Presentation, Management and Pathogenesis of the SARS-CoV-2 in Children , Sam Hassan.
Background: The current pandemic due to the novel coronavirus (SARS-Cov-2) (Figure 1) that caused COVID-19 infection is the most prevalent challenge for mankind since the World War II. This is a review article about up-to-date studies of this global signifi-cant pandemic. Methods and Results: Review of current and related researches published online in English language about SARS-CoV-2 particularly in children. For the purpose of the journal citation the references reduced from 119 reviewed articles to 49 references, hence some of the references will be referred to within the text. Until now June 2020, the confirmed cases of infection globally exceeding 8.5 mil-lion cases with a mortality rate just above 6%. The confirmed reported cases are not representing the tangible scale of the pandemic due to insufficient testing programs, asymptomatic cases and false negatives following upper respiratory swabs only. The pandemic started with an epicenter in Wuhan city in China and moved like a tsunami to a second epicenter in Europe particularly Italy and Spain before it landed in the United States and the UK and lastly emerged in South America and Africa. Both adults and children are at risk of the disease however the course of the infection is milder in children. Spread of the infection may happen from any infected individual to others. Death were reported more in adults particularly the elderly and patients with preexisted comorbidities. This article is a review of the current studies focusing on the nature of the virus, immunopathology, clinical presentation in children and shading light on management and control. Conclusion: Children are less likely to show sever SARS-CoV-2 infection with lower mortality rate than adults, most likely due to their immune system. Possible causes are the molecular receptors used by the virus for host cell entry, the crossed immunity against common corona viruses and other causes need more studies. Children show milder, different or asymptomatic course, hence the number may be under-estimated. The overall consequences of the COVID-19 on children is yet to be understood especially in relation to pregnancy, new-born babies, educations, welfare and future. The post COVID-19 complications such as, psychological and mental impacts, respiratory complications and post-viral sequela yet to be identified.
11 Different Designs of Feeding Aids for Cleft Palatal Defects , Anshul Chugh, Divya Dahiya, Harleen, Sunita, Anamika and Amit Dahiya
Cleft lip and palate is a congenital anomaly resulting in functional, esthetic and psychological disharmony of the patient. In infants, parents face a major problem in feeding them because of oro-nasal communication prior to any surgical intervention. In this article, various designs of passive feeding plates have been described to meet the nutritional demands of the infants. In young children, active feeding plates help in improving functioning along with the naso alveolar moulding.
12 The Neuroautonomic Regulation Dynamic in Children with Recurrent Upper Respiratory Tract Infection and Decreased Myocardial Functional Reserve after New Rehabilitation Program , Leonid Ovcharenko, Denis Sheludko, Andrii Vertehel, Igor Samokhin, Tetiana Andrienko and Oleksandr Kryazhev
The results of rehabilitation program 1 month use in 30 schoolchildren aged 6 - 9 years with recurrent upper respiratory tract infection (URTI) and a decreased myocardial functional reserve were analyzed. We studied the dynamics of changes of the initial vegetative tone (IVT) status and the indicator of activity regulatory systems (AIRS), as well as the concentration levels of neurotrans-mitters in the blood serum (substance P, vasoactive intestinal peptide (VIP) and final stable metabolites of NO (FSM NO)). The data were obtained that in children after the rehabilitation program, significant differences were found in the improvement of the IVT and AIRS indicators, as well as in the dynamics of changes in the concentration of neurotransmitters in blood serum. Convincing data were obtained that, when positive dynamics were obtained in changes in the serum concentration of neurotransmitters, positive shifts were noted in the indicators of IVT and AIRS in primary school children. The result of the rehabilitation program was a positive trend in the indicators obtained after the Ruffier test.
13 Arsenic Effects in Cardiovascular Diseases of People Living in Contaminated Areas of Chile , Isabel Pizarro Veas, Domingo Roman-Silva and Carlos Solar Barrios
The concentration levels of As in the Chilean II Region of Antofagasta produces non cancer health outcomes such as cardiovascular diseases and in last term heart attack. On this study, the determination of total As content and main inorganic and organoarsenic species found in three heart tissues (auricle, mammary artery and fat) and the saphene vein of people living in the Chilean II Region, suffering coronary thrombosis has been carried out. Comparison with similar tissues of patients from other non-contaminated areas has been undertaken. The auricle and in less extend the saphene vein support the higher As concentration (mean values of 7.7 and 2.5 μg g-1, respectively), being As(III) the predominant species. Methylation towards MMA and DMA is not a favoured mechanism. The presence of high total As and high As(III) species content in the auricle and saphene vein of more contaminated people, the damage found in the saphene vein tissue and the global characteristics of the people under study in which the As stigmas are present in all of them, suggests that As could be involved in the cardiovascular diseases.
14 Recurrent Empyema in a Healthy 7 Year Old Boy , Gihad Alsaeed, Mohammed Mahmoud Elbarrawy, Mohamed Alsaeed, IbrahimAlsaeed.
Parapneumonic effusion and subsequent empyema are known complications of bacterial pneumonia. It is seen in approximately 2 to 12 percent of children with pneumonia and up to 28 percent of those requiring hospitalization as pneumonia [1,2]. Recurrent empyema is recurrence of empyema after its apparent healing. The incidence of recurrent empyema in children is 8.9% of empyema cases. Possible causes of recurrent empyema are recurrent pneumonia, chest surgery, immunodeficiency and chronic lung diseases. Surgical treatment of empyema is preferred by many experts more than conservative treatment alone. Recurrent empyema often needs surgical interventions to treat the cause and complications to achieve complete recovery [1,2]. We present a case of recurrent empyema in a previously healthy 7-year-old boy who had no underlying etiology inspite of extensive investigation and who recov-ered completely without open thoracotomy or video-assisted thoracoscopic surgery (VATS).
15 Risperidone Overdose with Acute Dystonia in Children - A Case Report , Rashmi Patil, Megha P, Chikkanarasa Reddy PS, Kalpana, Niharika Shetty and Sarala Sabapathy.
Prescription of atypical antipsychotics has been on increasing trend in adults and adolescents. The prescription of atypical anti-psychotics to children is very common in developed countries. However, increased trend of atypical antipsychotics in use has also been paralleled by geometric progression in the incidence of intentional and non-intentional overdose. Although, the incidence of extrapyramidal symptoms were associated with lower therapeutic risperidone. In this juxtapose we present a case report findings of risperidone overdose presenting with acute dystonia at lower dosage. Since an overdose is commonly leads to neurological and car-diovascular involvement in children and also serial electrocardial monitoring is warranted. The treatment of risperidone overdose is mainly consists of gastric lavage, supportive therapy etc. Extrapyramidal symptoms associated secondary to risperidone overdose, readily responds to anticholinergics. In Indian context, a very few case fatalities were reported.
16 The Relationship between Cigarette Smoking with Risk Taking Behaviour in Adolescents Ages 11 - 18 at a Public High School in Las Piñas City Using the CRAFFT Screening Tool , Ma Kariza V Pabelonio, Elynn L Go and Lorela L Cortez-Dy.
Background: Risk taking, to some extent, is a part of the development of an adolescent. Trying new things or experimentation are behaviours used to discover their independence as well as their identity. But some risk taking behaviours are health compromising and should be recognized early. The CRAFFT screening tool was developed to measure these behaviours to be able to gauge a level of surveillance for a child. Objective: To determine the relationship between cigarette smoking with risk taking behaviour in adolescents ages 11 - 18 at a pub-lic high school in Las Piñas City using the CRAFFT screening tool. Method: A cross-sectional study design. Purposive sampling of 615 students from an anonymous public high school in Las Piñas was done. Subjects were asked their age, sex and year level and answered a questionnaire called the CRAFFT screening tool to measure risk-taking behaviour. Z-test was used to test the proportions of the variables. Chi-square was used to test the association of smoking in the risk taking behaviour of cigarette smokers versus non-cigarette smokers. Results: Participants were a total of 615. 36.1 percent of the sample population were grade 7 students, predominated by males at 56.7 percent, mostly between 15 - 16 years old at 35 percent. 111 out of 615 were found out to be cigarette smokers and is prevalent in grade 10. In relationship of smoking with risk taking behavior, for all grade levels and for both males and females, smoking is asso-ciated with risk taking behavior. As for the age, smoking is associated with risk taking behavior in adolescents’ ages 13 - 16, however, there is no association with risk taking behavior for ages 11 - 12 and 17 - 18. Conclusion: Smoking has an association with risk taking behaviour determined by the CRAFFT questionnaire. This excludes smok-ers at the age of 11 - 12 and 17 - 18 wherein smoking had no association with risk taking behaviour.
17 Incidence of Childhood Cancers at a Tertiary Hospital in Kenya: 2009 - 2019 , Mutua Irene and Mwika Peter.
Objective: To assess the prevalence and incidence rate of Leukemia, Retinoblastoma, Wilms tumour, Lymphoma, Malignant neo-plasm of connective and soft tissue and Neuroblastoma at Kenyatta National Hospital (KNH) and to determine the age at diagnosis, gender and mortality rate of above cancer types. Design: It was aretrospective descriptive study conducted at KNH using health records fromchildhood cancer registry of children aged 0 - 12 years who were diagnosed or referred to Kenyatta National Hospital with cancer from the period January 2009 to Decem-ber 2019. Based on patient’s inpatient number, we excluded from our analyses all re-hospitalizations of the same patients avoiding duplications. Results:The prevalence of Leukemia from our study was 30.6% (n-650),retinoblastoma 23.3% (n-495), Wilms tumour 16.9% (n-359), Lymphoma 16% (n-339), Malignant neoplasm of connective and soft tissue 9.1% (n-193) and Neuroblastoma at 4.1% (n-87). Leukemia had the highest incidence rate of 70.6 per million while Neuroblastoma had the lowest at 9.4 per million children between age 0 - 12 years. All these cancer types occurred more common between age 0 - 4 years at 64% (n-1359). Males were mostly affected than females. Retinoblastoma had the lowest mortality rate at 6.9% while leukemia and Neuroblastoma had the highest mortality rate, both at 47.1%. Conclusion: Leukaemia,Retinoblastoma, Wilms tumour and Lymphoma are the most prevalent type of cancers at KNH, in that order.With this data, we hope that it will aid policy decisions with an aim of improving patient care quality.
18 Extreme Manifestation of a Familial Case of Treacher Collins Syndrome in an Infant with Arhinia, Eyelid Colobomas and Single Kidney , Srijan Singh.
Treacher Collins syndrome is an inherited disorder of craniofacial development characterized by antimongoloid slant of the eyes, coloboma of the lid, micrognathia, microtia and hypoplastic zygomatic arches. Treacher Collins syndrome is an autosomal dominant disorder with variable expression. Congenital arhinia is a particularly rare malformation due to disordered embryological develop-ment of the nose. Some cases of arhinia have been described as an extreme manifestation of Treacher Collins syndrome. We are reporting a case of extreme manifestation of Treacher Collins Syndrome which was antenatally diagnosed to have severe craniofacial anomalies. Both grandfather and father had manifestations of Treacher Collins syndrome. Clinical examination shortly after birth revealed arhinia and absent nasal bone. Baby had bilateral eyelid colobomas, flat supraorbital ridges and blepharospasm with an-otia of the right ear and microtia of the left ear. CECT scan showed hypoplastic mandibles and maxilla. Paranasal sinuses were not formed. No nasal structures were seen and nasal cavity was virtually absent. We found three equivocal examples of Treacher Col-lins syndrome with arhinia in the literature [5-7]. But the infant in our case also has single kidney and this association has not been described in literature. Confirmation would have required identification of the precise mutation in this child which could not be done as the child succumbed to sepsis on day twenty of life.
19 Different Designs of Feeding Aids for Cleft Palatal Defects , Anshul Chugh, Divya Dahiya, Harleen, Sunita, Anamika and Amit Dahiya.
Cleft lip and palate is a congenital anomaly resulting in functional, esthetic and psychological disharmony of the patient. In infants, parents face a major problem in feeding them because of oro-nasal communication prior to any surgical intervention. In this article, various designs of passive feeding plates have been described to meet the nutritional demands of the infants. In young children, active feeding plates help in improving functioning along with the naso alveolar moulding.
20 The Relationship between Emotional Intelligence and Burnout among Nursing Students , Gonen Ayala and Grinberg Keren.
Understanding the relationship between emotional intelligence and burnout among nursing students can provide insights on how to educate nursing students in effective conflict management that can occur both during clinical experience and in their future as nurses.
21 Urinary Tract Infection in Infants and Pre-school Children at a Tertiary Hospital in Uyo, Nigeria: The Prevalence, Clinical and Bacteriological Profiles , Dixon-Umo OT, Ikpeme EE and Kan KM.
Background:Urinary tract infection (UTI) is a common cause of paediatric febrile illnesses and pyelonephritis could be complicated with renal scarring, predisposing to hypertension and chronic kidney disease in later life. High index of suspicion is essential for early diagnosis and prompt treatment. Methods:A prospective cross-sectional study of 165 febrile children aged one to sixty months, using urinalysis, microscopy, culture and sensitivity was done on clean catch/midstream urine samples. Data was analyzed using Statistical Package Social Sciences version 22.0. Statistical significance value was p < 0.05. Conclusion:The prevalence of UTI among febrile infants and pre-school children was as high as 13.9% with Staphylococcus aureus being the commonest aetiologic agent. Vomiting was a significant clinical association. Urinalysis showed a low sensitivity for nitrite and leucocyte esterase depicting its low sensitivity and usefulness as a diagnostic test.
22 , Amal Shorbasy, Heba Makki and Mustafa El Kahlout.
Immune (idiopathic) thrombocytopenic purpura (ITP) of childhood is characterized by acquired thrombocytopenia. ITP seems to occur more often after a viral respiratory illness. Findings on physical examination are normal, other than the finding of petechiae and purpura. Anti-D is effective in the treatment of children with ITP (Rh-positive non-splenectomized patients) and with higher doses appears to have comparable results to IVIG. Our experience in treating children with ITP in Gaza strip hospitals is restricted to use of cortico-steroids or IVIG. No published clinical trial on safety and efficacy of anti-D in acute ITP in children in the Gaza strip.Four cases (2 males and 2 females) were admitted to El-Nasr Pediatric hospital during the period from April 2017 to December 2017 and all of them were diagnosed as acute ITP. The youngest patient was 1 year and 10 months old and the oldest patient was 11 years. Clinical presentation included skin rash 3 caseswith oral cavity bleeding in one case. All cases had history of previous URTI 1-2 weeks before the attack of ITP.Anti-D was used for allthese cases. Dose given was 50-75mic/kg. The overall response rate was 75%, three cases showed good response and platelet count was elevated within 24 hours. The duration of hospitalization for all the responsive cases was 2 days. No side effects of Anti- D were noted.
23 Commentary: Coronavirus Restrictions as Opportunities for Children’s Play , Doris Bergen.
For many years I have been observing and writing about chil-dren’s play and its great importance for their healthy development (1988, 2013, 2015). More recently, however, I have discussed my deep concerns about how many of today’s children have lost the time and space to play independently, and I have speculated about the potential negative effects of this loss of self-designed, extend-ed-time play that most children in the past experienced.
24 Development of a Predictive Model for NICU Admission in Term and Near-Term Low Birth Weight Infants , Jessica Chiang.
Low birth weight (LBW) is associated with an increased risk of perinatal complications. As a result, many institutions will routine-ly admit clinically stable infants to the Neonatal.
25 Post-Immunization Measles Antibody Levels in Children Aged 1-4 Years , Arie Dian Fatmawati.
Background:No study in Indonesia has previously investigated measles antibody levels in children aged 1-4 years by comparing the first and second immunization. Objectives:We aim to compare the protective measles antibody level after the first and second scheduled immunization. Method:This cross-sectional study involved six Integrated Service Post (Posyandu) in five Jakarta regions in June-August 2014. Children meeting the inclusion criteria proceeded with measles IgG levels examination. Correlation test assessed the relationship between the second dose of measles immunization and measles antibody levels. Results:Of 145, 125 subjects (86.2%) reached protective measles antibody levels (≥ 120 mIU/ml). Compared to other age groups, 3-4 years old reported a higher proportion of reaching protective measles antibody levels in 56 subjects (91.8%). Conclusion:The second scheduled measles immunization provides higher measles antibody levels, with 1.2 times protective levels compared to first-time immunization.
26 Acute Care and Obese Children , Fernando Palvo.
Obesity is a multifactorial chronic disease, generally preventable and affecting children and adults. The aim of this review is to briefly discuss some topics related to obese children and adolescents in acute care settings. Conclusion: Obesity causes several changes in the child's body that may affect the clinical course in a serious illness situation, however many associations are still un-clear and further studies are necessary.
27 Obstructive Sleep Apnea in Children: An Update , Minu Mumtaz OV, Ajay Rao HT, Sham S Bhat, Sundeep Hegde K, Subhathira Rajasekaran and Neha Thilak.
Obstructive sleep apnea (OSA) is one of the most common causes of sleep-disordered breathing (SDB) in children. It is associated with significant morbidity, potentially impacting on long-term neurocognitive and behavioural development, as well as cardiovascu-lar outcomes and metabolic homeostasis. The significant variance in degree of end organ morbidity in patients with the same sever-ity of OSA highlights the importance of the interplay of genetic and environmental factors in determining the overall OSA phenotype. Dentists who practice sedation dentistry should exercise extra precautions when treating patients with risk of sleep apnea. This review seeks to summarize the current understanding of the aetiology and mechanisms underlying OSA, its risk factors, diagnosis and treatment.
28 An Electron-based Paediatric Pulmonary Magnetic Resonance Imaging Device to Avoid Administering General Anaesthesia to Paediatric Patients while being Imaged by Exploiting the ‘Celalettin Tunnel Conjecture’ , Metin Celalettin and Horace King.
The ‘Celalettin-Field Quantum Observation Tunnel’ (Celalettin Tunnel) is a quantum observation technique. It is within a pneu-matic manifold of Euclidean space where the randomness of particle Orbital Angular Momentum (OAM) is mitigated via electric polarization. It is described by the Celalettin Tunnel Conjecture: The presence of an electric field affects the nuclear spin of the particles within the pneumatic manifold. The manifold, namely the IC-Manifold, or Invizicloud© is unique as its axioms are a combination of classical and quantum non-logical parameters. The IC-Manifold has a variable density and exists only according to ‘Celalettin’s two rules of quantum interaction: • Quantum interaction causes quantum observation during fundamental particle interactions with orbital angular momentum electric polarized atoms within the IC-Manifold causing depolarization. • The photoelectric effect is not limited to solids but can occur in an IC-Manifold.
29 Perceived Level of Stress, Stressors and Coping Strategies among Undergraduate Health Professional Students during their Clinical Education: A Comparative Study , Nira Tamang, Saroj Rai, Ping Ni and Jing Mao.
Purpose:This study aimed to determine and compare the stress level, stressors and coping strategies and to investigate the relationship between stress, coping strategy and demographic characteristics among undergraduate health professional students. Methods:In this cross-sectional, non-experimental and comparative study, a convenience sampling technique used to collect data from 280 students. We used a self-reported questionnaire including demographic characteristics of participants, Perceived Stress Scale, and Coping Behavior Inventory. Results:Health professional students reported overall moderate level of stress while, nursing students showed mild stress whereas dental and clinical medicine students showed moderate stress. However, students were highly stressed by patient’s care, assignment and workload, lack of professional knowledge and skills, and environment, and minimally stressed by peers and daily life and teachers and other staffs. Stay-optimistic was mostly used coping strategy by nursing students and transference by dental and clinical medicine students whereas avoidance was the least used by all. Significant correlation of stress was found with coping strategy and previous health training.  
30 The Re-Connection to Healing , Julie Rammal.
Today, the majority of us are nearly connected to 1 - 5 devices, consume and use toxic products and are no longer in harmony and alive within our own and nature’s frequency. As a result, the universe is constantly striving to regain its own internal balance through: process of elimination, illnesses, diseases, earthquakes, tsunami’s, natural disasters, and more.
31 Neurodevelopmental Impairment of Neonatal Meningitis in Full-Term and Near-Term Newborns: A Retrospective Study of One Center , Herve Berenger Chatue Kamga.
Neonates are at greater risk for sepsis and meningitis than oth-er ages. Early Neonatal meningitis due to Streptococcusgroup B is serious but uncommon disease.
32 SARS-CoV-2 (COVID-19), What We Do Not Know So Far? , Amar Al Shibli and Ghassan Ghatasheh.
Coronavirus is a single stranded RNA virus that belongs to a family of viruses called Coronoviridae, which can cause disease in both human and animals. Human coronaviruses tend to cause mild upper respiratory tract infections; on the other hand; SARS corona-viruses are sub-classes of Corona virus that cause severe respira-tory infection such as SARS-CoV and Middle East Respiratory Virus Syndrome virus (MERS-CoV).
33 Immunization Amidst COVID-19: The Relentless Mission of the Primary Healthcare Network in Lebanon , Randa S Hamadeh.
Despite the COVID-19 pandemic, the provision of quality im-munization service is continuously being delivered by the primary healthcare centres in Lebanon, reaching to vulnerable and margin-alized children with life-saving vaccines.
34 The Purpose of Temperature of a Fever in Covid-19 , K M Yacob.
All human beings and animals and amphibians affected by fe-ver plenty of times in their life time. Even though now we are liv-ing with a lot of disease related fevers with different names like Leptospira, swine flu, Chikungunya, etc. the symptoms of disease is different but symptoms of fever are same. That means there is a scientific basis, which is common for all these disease related fever and can be used to explain the secret of all disease related fever.
35 Corona 19 Vaccine. How Far We Are? , Pradyumna Pan.
As the coronavirus pandemic continues to spread unrestrict-edly, total cases in the world have crossed over 14 million, and it is still vulnerable to much of the world’s population. Despite little to no evidence of the pandemic slowing down in large parts of the world, the search for new vaccine production is advancing at a pace that has not been seen before. According to the World Health Organization (WHO), in just six months since the virus came into being, 140 vaccines under development are in the pre-clinical trial stage and 23 are in the clinical evaluation stage.
36 Urinary Tract Infection in Infants and Pre-school Children at a Tertiary Hospital in Uyo, Nigeria: The Prevalence, Clinical and Bacteriological Profiles , Dixon-Umo OT, Ikpeme EE and Kan KM.
Background:Urinary tract infection (UTI) is a common cause of paediatric febrile illnesses and pyelonephritis could be complicated with renal scarring, predisposing to hypertension and chronic kidney disease in later life. High index of suspicion is essential for early diagnosis and prompt treatment. Aim:We set out to determine the prevalence of UTI; to evaluate its clinical presentations and bacteriologic profiles among febrile infants and pre-schoolers. Methods:A prospective cross-sectional study of 165 febrile children aged one to sixty months, using urinalysis, microscopy, culture and sensitivity was done on clean catch/midstream urine samples. Data was analyzed using Statistical Package Social Sciences version 22.0. Statistical significance value was p < 0.05. Results:Of the 165 children, 23 (13 females and 10 males) had UTI (isolation of a single pathogen 105 CFU) and Staphylococcus aureus, an unusual pathogen, was the commonest isolates (34.8%). Escherichia coli (30.4%), Proteus mirabilis (26.1%) and Citrobacter freundii (8.7%) were also isolated. Vomiting was the only significant (P = 0.04) symptom among majority of subjects with Enterobacteriaceae UTI. The area under the curve (AUC) for WBC was 0.700 being higher than that of nitrite, 0.504 and leucocyte esterase, 0.467 respectively, p = 0.002. Conclusion:The prevalence of UTI among febrile infants and pre-school children was as high as 13.9% with Staphylococcus aureus being the commonest aetiologic agent. Vomiting was a significant clinical association. Urinalysis showed a low sensitivity for nitrite and leucocyte esterase depicting its low sensitivity and usefulness as a diagnostic test. Keywords:Clinical Presentations; Bacteriological Profiles; Prevalence; UTI; Febrile Children  
37 Learning to Crack the Cleft Aesthetic Code in Unilateral Cleft Lip Surgery by Younger Cleft Trainees: Using Nuances and the Innovative Taipei Pear Analogy for Inferior Turbinate-flap Floor of Nose Reconstruction , Lotha B, Bergonzani M and Zeinalddin M.
Unilateral cleft lip surgery is part and parcel of every trainee cleft surgeon’s armamentarium. As their cleft expertise is founded on solid principles and anthropometric measurements, the chances of error and iatrogenic deformity are significantly lower than that of the untrained surgeon who attempts cleft surgery. In this communication we would like to mention the possible dimensions of cleft surgery, and how one can improve outcomes by looking at different ways to ease the psychological burden of cleft children. The sequential repair makes for better aesthetic functional results and patients will be satisfied with the post-operative results when the surgery is properly executed, taking into consideration all the rules of engagement in tackling cleft challenges. Keywords: Cleft Lip; Inferior Turbinate Flap; Median Tubercle; Cleft Training
38 The Value of Osteopathy for Children. The Great Contribution of Dr. Viola Frymann, Piooner in Pediatric Osteopathy , Stefano Bonomi, and Monica Filisetti.
Osteopathy medicine is expanding in an integrated medicine perspective. Dr. Viola Frymann is an osteopathic physician who dedicated her life to the study and application of osteopathy for children. She founded the Osteopathic Center for Children in San Diego (California), and she is still recognized as an international reference point for pediatric osteopathy. A review of her work and of her scientific research shows the value of osteopathy in many areas of pediatric health care: neonatal problems, postural disorders, support to child’s development with regard to the neurological, learning and visual aspects.
39 Hyponatremia in Sick Children: A Marker of Critical Illness , Mir Mohammad Yusuf .
Children who required intensive care are vulnerable to electrolyte derangement and hyponatremia is the most common electrolyte abnormality among this population. Hence its implication is so much important with perfect interpretation. Abnormality of hyponatremia occurs in a variety of condition and results in morbidity or mortality; especially in acutely sick children indicate a poor prognosis. Moreover, a precise information on pathophysiologic implications and outcome of hyponatremia in sick children is lacking. In this review, we provide an update focused on the association between hyponatremia and critically sick hospitalized children and related concern.
40 Strategies for Quality Assurance in Pharmacodynamics Practice in Emerging Economies , Kingsley Akarowhe.
Over the last decades pharmacodynamics practice has not yielded the needed expectations in terms of enhanced quality assurance in service delivery from the study of the biochemical and physiological effect of pharmaceutical drugs on an organism. This often has made pharmacodynamics witness besetting challenges of ups and downs among practitioners. It is against this background that this paper was determined in providing strategies for quality assurance in pharmacodynamics practice in emerging economies; strategies such as collaboration/partnership; public awareness; adherence to professional ethics; training/retraining and equipping of institutions involve in pharmacodynamics with needed facilities were taking into consideration by the researchers as an avenue for quality assurance.
41 Covid-19: Challenges during Pregnancy , Harpreet Kaur Sidhu.
Covid-19 is an unprecedented situation and the whole world is grappled by this healthcare emergency. The long term impact of disease on pregnancy and fetal are still not known. So far what we have learnt from other related viral infections like influenza and SARS and MERS, these were shown to be more severe in pregnant women. But fortunately, current data does not indicate that preg-nant women are at high risk from Covid-19. At the moment very little is known about the effect of Covid-19 on pregnancy especially if infection occurs in first half of pregnancy. And though risk of in-fection is same as general population, still pregnant women are considered to be a vulnerable group due to their immune-compro-mised state. In late pregnancy, it has been seen that risk of preterm labour and delivery is high in women infected with Covid-19.
42 An Interaction of Human Health and Soil fertility: A Lost Opportunity for Producers and Consumers , Sanjay Rode.
The people, plants, animals, and insects are depending on fer-tile soil for survival and growth. Fertile soil produces quality food and nurture all species. Plants prepare food from soil and provide it to animals and human being. The domestic animals eat fodder and few provide milk. Their reproduction is depending on clean environment, soil, water and fodder. There is large-scale interde-pendence on each other of human beings, animals and plants. Soil nourishment is very important for high production and growth of all plants. Due to growth of population, technology, urbanization, there is huge demand for food. However, there is pressure to supply more vegetables and grains for population in urban areas.
43 What is Emergency Medical Service? , Pranjal Konwar.
When your State or Country has Emergency Medical Service System it helps your People in their emergency incidents such as medical, fire, crimes and in disasters to response and provide care. It is bringing the Emergency room to the door or to the site of in-cident. Emergency Medical Service is not anymore just “the ambu-lance service”; rather, it is a system known as Emergency Medical Service System where it plays an important role in the community dealing with Public Health, Public Safety and Healthcare. Tradi-tional EMS has also changed quite a bit since 32 years in US and lot more need to change in developing countries. When people do ac-cess 911 in US and 108 in India, they no longer have to find a land-line, but instead usually call using the cell phone in their pocket.
44 Venezuela and the COVID-19 Pandemic , Huníades Urbina-Medina
Venezuela is a Latin American country, located in the northern part of South America, facing to the Caribbean Sea, with a popula-tion of 38 millions of people (National Institute of Statistics), how-ever, due to the increase of poverty level during the last 20 years, Venezuela had suffered one of the biggest exodus in human history, just behind the Syrian exodus during the civil war. According to the United Nations (UN), Venezuelan emigration is close to 6 mil-lion people. Long before the economic sanctions by the USA and the pandemic the rapidly and progressive decay of the Venezuelan Health System had made necessary the declaration of a Complex Humanitarian Emergency by International Organizations.
45 Spontaneous Bone Formation at Craniectomy Site in a One Year Old Child , Mehul Modi, Anitabai B, Jigesh Vaidya, Jignesh Patel and Nirmal Choraria.
Cranioplasty following Decompressive craniectomy is a common procedure done to cover the bony defect of skull. Bone regen-eration is a complex process of body involving several mechanisms. Sometimes even with bone replacement healing do not occur leading to malunion and nonunion. We report a rare case of spontaneous cranial bone regeneration at craniectomy site in one year old child.
46 Incidence of Corona Virus Disease 2019 (COVID-19) of Neonates at a Tertiary Care Hospital in Bangladesh , Maksudur Rahman, Kinkar Ghosh, Md Mahbubul Hoque and M Monir Hossain.
Background: COVID-19 has become global pandemic. It affects mainly adult with serious devastating effect in some cases particu-larly those with chronic comorbidities. It is less common in children and rare in neonate. But to date with increasing surveillances number of neonates with COVID -19 are increasing. Methods: This cross sectional study was conducted from April 2020 to June 2020 at Dhaka Shishu (Children) Hospital in Bangladesh. All admitted neonates with COVID-19were taken as cases. Neonates with suspected COVID-19 were tested for SARS-CoV2 virus by RT- PCR. Criteria for test were baby born to suspected or confirmed COVID-19 mother, exposed to relatives infected with COVID-19, related with cluster outbreak, with abnormal clinical courses such as respiratory distress, not responded to conventional treatment and abnormal chest x-ray. Data regarding gestational age, birth weight, gender, and positive cases and other findings were collected and analyzed. Statistics analysis was done by SPSS version 17. Results: During this study period total 1007 neonates were admitted. Among them 20 (2%) cases were COVID-19. Among the cases with covid19 male were 13 (65%) and female 7 (35%). Male and female ratio was 1.9:1. Term baby was 17 (85%) and preterm 3 (15%). Mean weight were 2618 ± 235 gms. Eight (40%) cases with COVID 19 lived in Dhaka and 12 (60%) cases in outside of Dhaka. Only 2 (10%) cases were positive for SARS- CoV2 virus by RT- PCR within 3 days but after 24 hours of age. Four (20%) and 14 (70%) cases were test positive at day 4 - 7 and 8 - 28 days respectively. Most of the diseases associated with COVID-19belonged to neonatal medicine (16,80%) and only 4 (20%) cases were associated with surgical diseases. In neonate two or more diseases coexist in same cases. Sepsis was present in 4 (20%) cases with COVID -19. Perinatal asphyxia and pneumonia both were present in 3 (15%) cases. Conclusion: In this study the incidence of neonates with COVID-19was 2% among the hospitalized neonates. This implies that neo-nates also be affected with COVID-19and it should be properly addressed for management of neonates with COVID-19as well as for prevention of community transmission of the disease. Keywords: COVID-19; SARS-CoV-2; Corona Virus; Incidence of COVID-19
47 Accidental Mercury Ingestion in a 2-Year Old: A Case Report , Priya B and Varshini C.
Mercury exists in three forms- elemental (liquid mercury), inorganic mercury and organic mercury (methyl mercury). Elemental mercury or quick silver is the most commonly available form that is processed from an ore called cinnabar. Ingestion of elemental mercury can occur as an occupational or domestic hazard, mishandling or as an attempt to suicide. Although the oral ingestion of elemental mercury is unlikely to cause systemic toxicity due to its poor absorption by the gastrointestinal tract, it can cause adverse effects during any developmental period. Here we present a case of a 2-year old male child who accidentally ingested mercury from a household mercury thermometer. The child did not show any severe signs of toxicity or other systemic symptoms and was stable in the 24th and 48th hours following ingestion and after the 8th week follow-up. His blood parameters, vital signs, RR, HR, LFT and RFT were normal. X-ray abdomen showed radiopaque spots. The aim of this case report is to create awareness among Paediatricians, nurses and other health care workers to understand the systemic effects of mercury and prepare them to handle such cases in the medical practice. Mercury and its toxic effects may be taken as granted in the domestic; therefore, more awareness must be created in the patient population too, to stop the domestic use of mercury thermometers and encourage the use of infrared thermometers. This case report also presents an extensive review of mercury and effects of poisoning.
48 Current Diagnostic Strategies for Covid-19 , Narayanan MP.
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first isolated from Wuhan from three patients with pneumonia. Afterwards the disease spread all over the world with high spreading rate. SARS-CoV-2 is closely related to the original SARS-CoV and it has all the features of the related coronaviruses in nature. As there is no vaccine provided yet, early diagnosis is very important for prompt management and to prevent the spread of highly contagious global pandemic. Currently nucleic acid amplifica-tion test, real-time reverse transcriptase PCR (RT-PCR) is used for diagnosis. Genes like E, N, S or ORF are targeted for screening or diagnosis. Serological assays are used for epidemiological studies and for identifying population at high risk for infection, while point of care molecular tests have the advantage of rapid, accurate and low cost which provide great help in diagnosis and quarantine of infected patients.
49 Intussusception in an Infant Complicating Dengue Infection. , Fadila and Md Faraz Omair.
Intussusception is the most common abdominal emergency in children younger than 2 years of age. A 6 month old child presented as dengue with gross abdominal distension. Dengue was managed using standard therapy as per WHO protocol, while abdominal pathology, later found out to be intussusception, required exploratory laparotomy. At the outset, abdominal distension can be misdi-agnosed as ascites due to capillary leakage seen in severe dengue infections. Although unusual, it is possible to find two concurrent illnesses simultaneously, one complicating the typical clinical course expected from the other, and this needs high index of suspicion due to its rarity.
50 Giant Hydronephrosis in a Newborn Causing GIT Obstruction: An Unusual Association. , Fadila, Md Faraz Omair and Neeta Kevlani.
Hydronephrosis in a newborn is typically asymptomatic. It is one of the most common and usually benign anomalies detected on ultrasonography, with only a minority causing significant problem requiring urgent intervention. We present a neonate with giant congenital hydronephrosis presenting with feed intolerance due to duodenal obstruction. The baby was successfully managed at our centre and discharged on full feeds.
51 Supporting Families having a Child with Intellectual Disability in COVID-19 Pandemic , Arusa Lakhani Debbie Krammer and Tazeen Saeed Ali.
The COVID-19 pandemic has devastating effects on the lives of the children and their families who have member with an intel-lectual disability. In such a distressing situation and uncertainties due to the pandemic, the relationships among the family members can become unpleasant, affecting support and cohesiveness within the family, which may have a negative effect on the child. Lack of support and socialization of these families, lead to a stress among them especially for the immediate carers. In a lockdown situation, their routine is disrupted and the parents have to pay extra attention to care for the child. Some of the strategies that are proven to be helpful for the children with an intellectual disability and their families are accessing reliable and trusted information on COVID-19, allowing the child to express his/her feelings by engaging them in different activities, open and supportive interaction among family members, and maintaining the structured daily routine that they followed before the pandemic. The educators/trainers/staffs of the school must remain in touch with the family and inquiring from them “how they are”. Telephonic or video -conferencing counseling and coaching can be offered to the family members and some important tips to overcome the stressors can be discussed. Hence, dur-ing lockdown, individualized home programs that can be carried out by family members with the child with an intellectual disability are a good way to ensure the child continues to develop their cognitive, movement, play and self-help skills. Moreover, the govern-ment cash transfer assistance should also reach those vulnerable families who have the children with disabilities. It may bring some relief to the families who are struggling to balance their finances to ensure meeting the basic needs.
52 Depression, Anxiety and Related Factors in Tunisian Caregivers of Children with Autism Spectrum Disorders: A Cross Sectional Survey. , Khaoula Khemakhem, Leila Cherif, Wiem Kammoun, Mahmoud Ziraoui, Khadija Baccouche, Lobna Zouari, Hela Ayadi, Imen Hadjkacem and Yosr Moalla.
Objective:The purpose of this study was to investigate anxiety and depression in caregivers of children with autism spectrum dis-orders and its related factors. Methods: The study was performed in the department of child and adolescent psychiatry of Sfax. It included eighty caregivers. The anxiety rating scale of Hamilton and the Hamilton Depression Rating Scale were used to assess mental health variables in these care-givers. The Childhood Autism Rating Scale was used to evaluate the severity of autism spectrum disorder. Results: More than half of the participants were depressed and anxious. The children of caregivers with depression had significantly lower mean scores of severity of autism than those with normal mood. Depression in caregivers was significantly associated with the female gender. Caregivers were significantly more depressed when their children go to speech therapy. Caregivers were more anxious when their children are males and in the rural areas. Conclusion: Given the high prevalence of anxiety and depression among caregivers of children with autism spectrum disorder, thera-peutic intervention should be considered to alleviate their suffering, taking into account the specific risk factors for each culture. Keywords: Autism; Caregivers; Depression; Anxiety
53 The Effects of Parent Ages on Birth Defects. , James A Thompson.
Background: Men and women, in the United States, are having children at considerably older ages. This changing demographic has been associated with multiple neonatal adverse birth outcomes that are currently considered to constitute a major public health crisis. The objective of this study was to evaluate the risk of parent age on birth defects and to provide results that can serve as a starting point for more specific mediation modeling. The modeling estimated the effects of parent age on birth defects controlling for confounding between maternal and paternal age and separated the mediating effect of chromosomal disorders, including Down syndrome. Methods: Data containing approximately 15,000,000 birth records were obtained from the United States Natality database for the years 2014 to 2018. A Bayesian modeling approach was used to estimate adjusted risks of parent ages both unadjusted and adjusted for the other parent’s age and for the mediational effect of chromosomal disorders, including Down syndrome. Results: Increasing maternal age was associated with increased risks for hypospadias and cyanotic congenital heart disease. Increas-ing maternal and paternal ages were associated with decreasing risks for gastroschisis. For limb reduction defect, cleft lip and all defects combined, the risk of maternal age was U-shaped with the lowest risks observed at approximately age 35y. Paternal age was not associated with an increase in the birth prevalence of birth defects. Conclusion: Advancing maternal age was associated with increased birth prevalence of hypospadias and cyanotic congenital heart disease and associated with a lower birth prevalence for gastroschisis. Both older and younger maternal ages were related to limb reduction defect and cleft lip. Advancing paternal age was not associated with an increased birth prevalence of birth defects but was associated with a decreased birth prevalence of gastroschisis. Keywords:Bayesian; Birth Defects; Maternal Age; Paternal Age
54 The Impact of a Calibration Strategy on Student Self-Efficacy in a Pharmacotherapy Course , Angela Pegram
To determine if a self-regulatory calibration strategy for teaching algorithms in a Pharmacotherapy course increases stu-dent motivation and achievement in pharmacy programs.Methods:Second-year students in a Cardiovascular Pharmacotherapy course studying cardiac arrythmias treatment algorithms completed a series of measures to assess motivation and achievement including self-efficacy for pharmacy studies, sense of belong-ing, and an atrial fibrillation (a fib) case study following a calibration intervention. The purpose of the calibration exercise was to assist students in gauging their performance in correctly using algorithm guidelines. Results:Fourteen participants completed a set of pre- and post-measures following the intervention. Based on this sample, the re-sults indicated that student self-efficacy for pharmacy studies improved significantly. Conclusion:This initial study illuminates how the use of calibration techniques supports student learning for difficult topics, such as the application of cardiac arrhythmias treatment algorithms. By providing students with a calibration technique to monitor their understanding of cardiac arrythmias treatment algorithms, students developed stronger self-efficacy for pharmacy studies.
55 The Residency Advisory Committee: Steering Pharmacy Postgraduate Training , Razan M El Melik, Wesam W Ismail, Esraa I Khader, Nabil Khalidi, Shmeylan Alharbi, Abdulmalik M Alkatheri, Abdulkareem M Albekairy,Saleh Aldekhael
To describe the structure and functions of a pharmacy residency advisory committee (RAC) that manages the postgraduate years 1 and 2 programs in a large teaching institution.Summary: Residency programs are faced with increasing number of residents and expanding specialty programs that increase the complexity of managing the diverse residency programs and require additional time commitments in order to maintain high quality learning, practice. Therefore, residency programs require a focused and centralized approach via the establishment of a pharmacy residency committee that oversees the residency programs and steers them in the right direction. Under the direction of RAC, collab-orative approach between pharmacy staff, clinicians, faculty, and managers is essential to the successful management of the staffing, clinical, academic, and professional development of pharmacy residents. Conclusion: Pharmacy residency programs in Saudi Arabia can be successfully managed by the coordination of efforts between preceptors and residents under the oversight of RAC.
56 COVID in Pediatrics and its impact in Venezuela , Huníades Urbina-Medina.
The first studies published with pediatric cases from China corroborate the impression that children are not as seriously af-fected as some adult patients, At the same time, children with co-morbidities are vulnerable to SARS-CoV-21.2 infection. The reason why most COVID-19 cases in children are less severe than adults is puzzling. This can be related to both exposure and host factors. Children are generally at home and may have relatively fewer op-portunities to be exposed to the pathogen and/or sick patients. New and unusual clinical presentations are becoming evident, such as multisystemic inflammatory syndrome in children, where the clinical picture may resemble Kawasaki disease and/or toxic shock. The child, being asymptomatic or having non-specific signs or symptoms, is an entity that facilitates person-to-person conta-gion. In addition, prevention measures such as the use of masks cannot be applied, especially in children under 1 year of age, plus the fact they can eliminate the virus through the fecal route up to 2 weeks after its presence in the respiratory tract has become nega-tive, which makes the child, especially the infant, a propagator of the disease. Venezuelan situation and specially that of children in general, is much more worrying since, the collapse in health and economics that Venezuela has been through even before the pan-demic, social inequalities, the difficulty accessing to health system, the restriction of mobility and scarcity of fuel, limits the dimin-ished population vaccination program, the closure of schools that affects children and especially girls.
57 Clinical and Demographic Profile of Extramural Neonates Admitted in NICU of Tertiary Care Hospital in Central Rajasthan , Surender S Kajla, BS Karnawat and Sharath Babu.
Objective:This study was undertaken to know the clinical and demographical profile of outborn neonates admitted in Neonatal Intensive Care Unit (NICU). Method:This prospective study was conducted in NICU of department of pediatrics, JLN medical college and hospital, Ajmer from April 2018 to September 2018. Results:Of the 1386 neonates admitted, 64.9% were males and 35.1% were females. Most cases (65.2%) belonged to the socio-economic class upper middle and lower middle. 46.7% mothers had primary education and 44% mothers had secondary education while 4.0% mothers were illiterate. Among 1386 neonates, majority of neonates (65.6%) were term while 30.7% were preterm and 3.7% were post term. Rural residency (68.8%) was far more as compared to urban residency (31.2%). Majority of neonates (80.1%) were delivered vaginally while 19.9% were delivered by caesarean section. Majority of neonates (84.2%) were delivered at govern-ment hospitals while 12.6% and 3.2% neonates were delivered at private hospitals and at home respectively. As per birth weight, 46.3% neonates were between 1.5-2.49 kg, 38.1% neonates had birth weight more than 2.5 kg while 3.7% neonates were <1 kg. Majority of neonates (78.8%) were admitted in early neonatal period. Major causes of NICU admission were Birth asphyxia (14.1%), Respiratory Distress Syndrome (RDS) of newborn (12.6%), Neonatal Jaundice (10.2%). As far as mortality is concerned, RDS of New-born (26.8%), Neonatal Sepsis (21.4%) and Birth Asphyxia (19.6%) were found to be major culprits. Majority (61%) of neonates were successfully discharged, while 24.2% died during treatment. Conclusion:The majority of morbidities and subsequently the mortalities can be reduced by improving maternal care and essential newborn care, appropriate primary interventions and timely referral to tertiary care centers for high risk cases, with better transport facilities for sick neonates. Keywords:Extramural Newborns; Neonatal Morbidity; Neonatal Mortality
58 Immediate Effects of Backpack on Ventilation amongst School Going Children Aged from 7 - 15 Years in Navsari , Hetvi Shukla, Anand Vaghasiya, Shirin Shaikh and Khevna Naik.
Background: Backpacks are used popularly by students to carry their school belongings in many countries. Therefore, serious con-cerns are being raised about the effect of the backpack on children. There is ongoing concern regarding the weight of children’s schoolbags and the negative consequences of such heavy loads on the developing spine and cardio-respiratory systems. There are various other factors which are affecting cardiorespiratory fitness in adult as well as children. A significant reduction was reported for most of the ventilatory function parameters while carrying the backpack. Purpose: To check the immediate effect of the backpack on the ventilation of school-going children aged from 7 - 15 years in Navsari. Method:210 subjects were taken in this study to check respiratory parameters. All included children were tested in standing posi-tion with the head straight after taking written consent from parents. They were further divided into three age groups ranging from 7 - 9 years, 10 - 12 years and 13 - 15 years. Spirometry was done using the spirometer of clarity medical Pvt. Ltd. Spirometer used in the study facilitates the total valuation of lung function including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow rate (PEFR). Results: With the help of SPSS software paired sample t-test was done. The parameters of FVC, FEV1 and PEFR showed a significant reduction in the data with a backpack, without a backpack and with one shoulder strap. The result of parameters was p Ë‚ 0.005 except for the value of PEFR with one shoulder strap in the third age group which was p = 0.108. Conclusion:There is a significant reduction in respiratory function (FVC, FEV1, and PEFR) in correlation with age, weight, and height and bag weight of subjects.Keywords: Age; Weight; Height; Backpack; School Going Children; Forced Vital Capacity; Force Expiratory Volume in One Second; Subjects; Peak Expiratory Flow Rate
59 The Clinicoetiological Profile of Neonatal Seizure at Level-II NICU in a Territory Care Hospital, Chhattisgarh , Ganpat Jha, Pradeep Agarwal, Subodh Kumar Saha, Mitesh Chawda, Hitav Someshwar, Ashish Wanare, Ravi Prakash Pandey and Bhushan Khadse.
We carried out a single centre, prospective, non-interventional observational study of consecutive neonates admitted in neonatal intensive care unit. We evaluated 150 neonates with seizures admitted to NICU in our centre from October 2015 to September 2017 over duration of two years. All subjects were evaluated on clinical basis; physical examination was done to look for vitals, blood pres-sure, and cyanosis.Historical evaluation included demographic details and antenatal history to know the risk factors associated with occurrence of seizures in newborn. Special emphasis was given on risk factors like maternal age, gestation, birth order, prolonged or difficult labour, birth asphyxia, sepsis, maternal diabetes mellitus, and drug consumption during pregnancy. Appropriate laboratory investigations were sent including haemogram, blood sugar, serum calcium, serum magnesium, other blood biochemistries, blood culture and neu-roimaging work up was done, if required. All data was then entered into a prestructured proforma/case history forms and statistical analysis was done.Our study revealed that the most common etiology of seizures in our series was birth asphyxia. Metabolic disturbances were 2ndmost common etiology in which hypocalcemia was the most common type. Males outnumbered females, and seizures occurred most commonly in full term neonates as compared to preterm. The most common type of seizure was the subtle type followed by tonic and then clonic and myoclonic.Birth asphyxia which was most common occurred on day of life 1. Metabolic seizures were most commonly occurred on day of life 4 to 7. Birth asphyxia was the most common etiology in both term and preterm babies. Phenobarbitone was the most common antiepileptic drug used in our study. All cases were also additionally managed for their underlying condition according to standard N.I.C.U protocols with special emphasis on hemodynamic stability. Keywords: Neonates; Seziures; Asphyxia; Metabolic; Critical Care; Epilepsy
60 Clinical Spectrum of Rheumatic Heart Disease in Pediatric and Adolescent Patients Attending B.S.M.C.H, Bankura: A Rural Tertiary Medical Center in India , Sandip Gupta, Snehansu Chakraborti and Kanak Kr. Mitra.
RHD is a major complication of Rheumatic fever, affecting children and young adults in there most productive years of life, despite found decreasing in the developed world, it is still a major cause of acquired cardiovascular mortality and morbidity in our country. In this study sample was selected randomly from pediatric and adolescent RHD patients aged upto 18 years if they fulfill the inclu-sion criteria. All the 102 children were first clinically evaluated as per case record form, then undergone serial relevant investigation. Echocardiography (2D, M-MODE and COLOUR-DOPPLER) was done.Results showed slight male preponderance among the patients, the mean age of patients was 11.43 ± 3.58 years, majority of them 85.29% were from rural areas and belong to low socioeconomic class, history of rheumatic fever in past was present in 38.23% pa-tients. Most common mode of presentation was heart failure seen in 31.37% of patients, a significant proportion of patients had re-currence of rheumatic fever (18.62%), mostly those who were non-compliant to penicillin prophylaxis, pulmonary hypertension was found in 14.7% of patients. Incidence of other complications such as stroke, infective endocarditis, arrhythmia were low as expected in this age group (upto 18 years), due to the temporal delay in development of complications of RHD.Isolated mitral valve involvement specially isolated mitral regurgitation was the commonest pattern of involvement. Most com-mon presenting symptom was dyspnoea present in 86.27% followed by palpitation, fatigue, chest pain, edema. dyspnoea of majority patients was NYHA Class I and II.Of the studied population 62.74% received regular prophylaxis and 37.25% patients had irregular or no prophylaxis. The inci-dence of heart failure, pulmonary arterial hypertension and recurrence of rheumatic fever was much higher in the latter group.
61 Comparative Analysis of Candida albicans Versus Candida Non-albicans Infection among Pediatric Patients at King Abdulaziz University Hospital , Khouloud Abdulrhman Al-Sofyani, Mohammed Shahab Uddin, Huda Saeed Alghamdi and Dalia El-Hossary.
Background: Candidemia is one of the major causes of morbidity and mortality among critically ill pediatric patients. This study aimed to determine the prevalence of Candida infection, different strains, associated risk factors, and outcomes in critically ill pa-tients with candidemia. Method: Critically ill pediatric patients with invasive candidiasis were included in this retrospective study. Patients were 14 years or younger, admitted to King Abdulaziz University Hospital from March 2018 to February 2020. Results: Out of 61 pediatric patients cases with candidemia, 23 (37.7%) patients were diagnosed with C. albicans and 38 (62.3%) with non-albicans. Species present in non-albicans Candida group included Candida parapsilosis 15 (24.6%), Candida topicalis 12 (19.7%) and Candida glabrata 4 (6.6%). Majority Candida strains were sensitive to antifungals. The main admitting diagnosis was sepsis 21 (34.4%) and the main isolation site of Candida species was blood. The main risk factors and predictors of candidemia were age younger than 5 months, presence of a central venous catheter, urinary catheter, using TPN, and blood products transfusion. Fi-nally, the number of mortalities and length of ICU stay was higher among C. albicans patients, whereas the duration of hospitalization, broad-spectrum antimicrobial and antifungal treatment, were higher among C. non-albicans infected patients. Conclusion: Although C. albicans infection cases are still dominant, however, the number of cases due to C. non-albicans infection is high. The study also highlighted some of the indicators that may help in early prophylactic intervention, which in turn can help improve the poor clinical prognostic outcome in Saudi Arabia.Keywords: Candidemia; Candida albicans;Candida non-albicans; Risk Factors; Outcome
62 Empowering Nurses on Empathy: A Quasi-Experimental Study at Kenyatta National Hospital , Karani K Anna, Gitonga G Pius and Kimani T Samuel.
Empathy is a life skill and a trainable competence. In nursing profession, empathy is highly associated with observed caring char-acteristics of nurses. Whenever empathy was offered to the patients, there was improved health outcomes for the clientele. Regard-less of the actual benefits of empathy, inconsistencies in developing and sustaining empathy were reported. The study conducted a needs analysis and implemented an intervention intended in promoting development and sustainability of empathy among nurses in Kenyatta National Hospital. A multi-stage mixed method study design was used: explanatory sequential approach (needs assess-ment) and quasi-experimental design (pre/post intervention) were applied. The study samples were; a stratified random sample of 189 nurses and a purposive sample of 16 nurses for two focused group discussions. A training intervention was implemented and pre/post scores compared. Knowledge on observable characteristics related to empathy was low during baseline (20%) however, an increase to high (90%) was reported after the training intervention. The knowledge scores on the factors that favoured develop-ment of empathy improved significantly following training (Mb = 0.50, Me = 0.87), t(385), = -12.80, p < 0.05. Similar improvements in knowledge scores were attained on the factors that hinder development (Mb = 0.48, Me = 0.88), t(385), = -14.13, p < 0.05; factors that favour sustainability (Mb = 0.66, Me = 0.83), t(385), = -6.23, p < 0.05 and factors that hinder sustainability of empathy among nurses (Mb = 0.34, Me = 0.66), t(385), = -9.75, p < 0.05. Knowledge on developing and sustaining empathy ranged between very low to aver-age before interventional training. This achievement suggests that empathy is a learnable competence. Training empathy skills can empower nurses to practice through offering training opportunities. This underscores the need to integrate empathy as a core course in both pre and in service for nurse training.
63 The Effect of Inter-Pregnancy Interval on the Recurrence Rate of Spontaneous Preterm Birth among Women who Delivered at KCMC Hospital, Tanzania: A Registry-based Cohort Study , Sophia Kiwango, Pendo Mlay, Kiondo S Kiondo, Caroline Amour, Innocent B Mboya and Michael J Mahande.
Background: Inter pregnancy interval has been associated with adverse neonatal outcomes, including preterm birth and low birth weight. Little is known on the effect of Interpregnancy interval on the recurrence of preterm birth. This study aimed to determine the effect of Interpregnancy interval on the recurrence of spontaneous preterm birth among women who delivered at KCMC hospital, Northern Tanzania. Methods: We conducted a retrospective cohort study using maternally-linked birth registry data from all recorded women who delivered two consecutive singleton pregnancies and spontaneous preterm birth in their first pregnancy from 2005 - 2015 at KCMC referral hospital. The outcome was the recurrence of spontaneous preterm birth and IPI was the primary exposure of interest. We analyzed data using STATA version 15 and estimated the relative risk and recurrence risk of spontaneous preterm birth with 95% confidence intervals using the log-binomial regression model at a 5% statistical significance level. Results: The recurrence rate of spontaneous preterm was 23.1%. IPI of ≥ 60, 18 - 23 and 12 - 17 months were associated with lower risk (RR: 0.79; 95%CI 0.53 - 1.16), (RR: 0.78; 95%CI 0.54 - 1.13) and (RR: 0.92; 95%CI 0.65 - 1.31) of SPTB in the subsequent preg-nancies compared to 24-59 months. However, these associations were not statistically significant. On the other hand, inadequate (< 4) ANC visits during pregnancy significantly increased the risk of SPTB (RR: 3.98; 95%CI: 3.05 - 5.20) in the subsequent pregnancy. Conclusion: The recurrence of SPTB is high among women in this study. The short and long IPI were all protective against the risk of recurrence SPTB while inadequate (< 4) ANC visits increased the risk. Interventions to promote optimal Interpregnancy interval and close follow-up of women at risk, especially during ANC visits, may reduce the risk of recurrence of preterm birth and associated adverse outcomes. Keywords: Inter-Pregnancy Interval; Recurrence Risk; Spontaneous Preterm Birth; Tanzania
64 Acute Diarrhea and Types of Dehydration in Libyan Children , Aisha A Sehari, Abdurrhman A Baitalmal and Ashraf M Ayad.
Acute diarrhea is a leading cause of illness in developing coun-tries. About seventeen of per cent Libyan children suffer from diar-rhea. Diarrhea causes about 12% of mortalities in children aged 0 - 5 years. The aim of this study is to estimate to estimate the types and the degree of dehydration and to find out the correlation be-tween types and degree of dehydration and contributing risk fac-tors. Seasonal variations were studied also. A retrospective study was done on all children patients admitted to Tripoli pediatric hospital during the year 2006 (from 01/01/2006 to 31/12/2006) complaining of acute diarrheal diseases, age group (one month to 60 months), with exclusion of bloody diarrhea.
65 Feasibility of Physiotherapy in Pediatric Patients with COVID-19 , Parisa Arzani.
SARS-CoV-2, known internationally as coronavirus disease 2019 (COVID-19), affects a significant proportion of people, but it has been reported less frequently in pediatrics, especially in the initial studies, in which only 0.9% of the positive cases involved children.
66 The Association between Congenital Heart Disease in Infants and Preeclampsia. , Samah Alasrawi, Mohammad Nour Alesrawi and Ahmad Al Esrawi.
Introduction: Preeclampsia and Congenital heart disease shared angiogenic pathways in both conditions. There is evidence of an-giogenic imbalance in women carrying fetuses with major congenital heart defects and in fetuses terminated because of these de-fects. Either way, the data suggested that excessive antiangiogenesis early in pregnancy may play a role in the origin of at least some congenital heart defects. Objective of the Study: Mini review of 3 international studies about the association between Congenital Heart Disease in infants and Preeclampsia. Studies: We reviewed 3 studies from Denmark, Nigeria and Canada all chord studies, some of them collected the pregnant women and others collected the infants. Results: All studies confirm the association between the Congenital Heart Disease in infants and Preeclampsia. Conclusion: The absolute prevalence of congenital heart defects was higher for infants of women with preeclampsia than those without it. So, it is important to do the screening fetal heart scan for the women who had preeclampsia and after birth Echo for their newborns. Keywords: Congenital Heart Disease; Preeclampsia
67 Pleural Effusion in the Neonatal Intensive Care Unit , Heba Azmi Makki;
The causes of pleural effusion in the neonate have a different distribution compared with those in infancy and childhood. Pleu-ral effusions are rare in the neonate and may be associated with several clinical conditions. It can cause significant respiratory morbidity. Thus, pleural effusion in the neonate requires early di-agnosis and management.
68 Quality of Life in Caregivers of Children with Autism Spectrum Disorders: A Tunisian Study , Khaoula Khemakhem, Leila Cherif, Wiem Kammoun, Mahmoud Ziraoui, Khadija Baccouche, Lobna Zouari, Hela Ayadi, Imen Hadjkacem and Yousr Moalla.
Objective: The purpose of this study was to investigate the quality of life and its related factors among caregivers of children with autism spectrum disorders. Methods: The study was performed in the department of child and adolescent psychiatry of Sfax and included eighty caregivers of children with autism spectrum disorders. The short form-36 health survey questionnaire was used to assess the quality of life among the caregivers. To evaluate the severity of autism spectrum disorders, the Childhood Autism Rating Scale was used. The anxiety rating scale of Hamilton and the Hamilton Depression Rating Scale were used to assess anxiety and depression among them. Results:Impaired quality of life was found in 60.7% of the caregivers. The quality of life was more impaired among younger children and those undergoing a speech therapy. Conclusion:The findings of this study indicate the effect of both children young age and speech therapy on quality of life, and empha-size the link between anxiety, depression and impaired quality of life among caregivers of children with autism spectrum disorders. It reiterate the need for early interventions which assist parents in better managing feelings of depression and anxiety. Keywords: Quality of Life; Autism; Caregivers
69 Awareness of Girls Regarding Brest Self-Examination in Wad Babi Secondary School July 2016 , Eman Ahmed Saad Mohmed, Nosyba Mohmed and Ryan Abd Ehbagi.
Breast cancer is the most common malignancy affecting women and second cause of cancer death in the world, with more than one million cases occurring worldwide annually. The chance of a woman having invasive breast cancer some time during her life is about 1 in 8. The chance of dying from breast cancer is about 1 in 35.According to latest WHO data published in May 2014, breast cancer deaths in Sudan reached 1,814 or 0.70% of total deaths. The age adjusted death rate is 16.48 per 100.000 of population ranks Sudan 87 in the world. This study aimed to assess the secondary school girl’s knowledge regarding breast self-examination in Wad Babi secondary school girls.The study was descriptive cross-sectional school based. A total of 75 students in wad Babi secondary school girls in July 2016 using questionnaire.About 14.7% didn’t hear about breast self-examination and 37.3% saw that five days after menstruation is the best time to do breast self-examination.About 84% of students didn’t know how to examine their breast by themselves. Pre-post-education intervention studies need to be conducted to evaluate the intervention outcomes related to breast self-examination knowledge among secondary school girls. Keyword: Awareness; Girls; Brest Self-Examination; Secondary School
70 COVID-19 Pandemic and Increased Frequency of Multisystem Inflammatory Syndrome in Children/Benghazi 2020 , Hend M Hassan, Mohamed M Sasi, Raga Elfakhrei, Hind M A Alaneezi, Amal Elfakhri and Yousif Sulaiman.
A flare-up of unidentified pneumonia in Wuhan since December 2019 has been developed which draw an extraordinary consider-ation around the globe. Primary reports from Europe and the USA found an association between severe acute respiratory syndrome coronavirus 2 in children and multisystem inflammatory syndrome in children, also known as paediatric inflammatory multisystem syndrome.This study focused on the association between COVID-19 and multisystem inflammatory syndrome in children in the Eastern region of Libya, namely Benghazi a case summary presentation. A series of 12 cases has been described in details. All cases presented with fever, skin and mucous membrane manifestations in addition to GIT symptoms. Three cases have had CNS involvement, three have lymphadenopathy, two cases with cardiac manifestations and two renal with renal involvement. Laboratory data revealed el-evated inflammatory markers namely ESR and CRP and lymphopenia. Diagnosis was based on rapid test (IgG, IgM), whereas four cases were diagnosed by PCR. The overall prognosis of all cases is very good with an average hospitalization period of 5 - 7 days. Management strategy included IV antibiotic, oral aspirin and sandoglobulin.
71 Association of Maternal Vitamin D with Neonatal Vitamin D Status and Birth Weight in Urban Population of Bangladesh: A Cross Sectional Study , Md Mostafijur Rahman, Saimon Miah, Sonia Tamanna, Md Bayejid Hosen, Tasnin Akter, TH Johra, Yearul Kabir and M Zakir Hossain Howlader.
Background: Vitamin D deficiency during pregnancy leads to poor neonatal development which has serious consequences during the later part of life. The aim of the study was to evaluate maternal and umbilical cord blood 25[OH] D concentrations and their as-sociation with birth weight. Methods: Pre-delivery maternal venous blood within a week before delivery and paired matched neonatal cord blood samples were collected from 75 pregnant women. Serum 25[OH] D was measured by high-performance liquid chromatography. Serum calcium, phosphorus, and alkaline phosphatase activity were measured by colorimetric methods. Results: Mean maternal serum 25[OH] D was 46.45 ± 5.02 ng/ml, and cord blood 25[OH] D was 21.89 ± 2.27 ng/ml. The serum 25[OH] D level of the mothers and the neonates were significantly associated (P < 0.01) with a linear correlation coefficient of r = 0.49. The mean birth weight of neonates was 2.83 kg ± 0.38 and 22% of the neonates had low birth weight (LBW) (2.33 ± 0.17). Aver-age birth weight of normal babies was 2.97 ± 0.30. The mean maternal 25[OH] D level of mothers with normal birth weight babies (n = 58; 77.33%) was significantly higher (50.41 ± 5.00 ng/mL) than that (28.24 ± 6.87 ng/mL) of mothers with LBW babies (p < 0.0001). There was a high degree of positive correlation between maternal 25[OH] D status with neonate’s birth weight (r = 0.593, p < 0.01). Conclusion: The results obtained in this study show that there is significant correlation between maternal vitamin D with neonatal birth weight in a cross-sectional urban population of Bangladesh. Keywords: Serum 25[OH] D; Pregnancy; Cord Blood; Low Birth Weight
72 Fixed Drug Eruption Induced by Paracetamol - A Case Report , Liliana Sá, Cátia Leitão, Jorge Romariz, Herculano Costa, Fátima Praça and Cláudia Pedrosa.
Fixed drug eruption can manifest as one or multiple lesions and may be caused by various types of drugs. Paracetamol is one of the common drugs prescribed as analgesic–antipyretic agent in all age group of patients. Its severity spectrum is highly heteroge-neous. Fixed drug eruption is a well-reported, but uncommon side-effect of paracetamol, usually the classic, pigmenting type most commonly found in children and adolescents. The authors report the case of an adolescent with this rare entity, warning of its clinical suspicion in cases of recurrent skin drug reactions always in the same location.
73 Rapid Assessment of Covid 19 Pandemic on Uptake of Routine Immunizations amongst Children in a Fixed Site in Yaoundé, Cameroon , Anne Esther Njom Nlend, Nga Motaze Annie and Arsene Brunelle Sandie.
Objective:To report on the tendency of immunizations uptake amongst infants in a fixed post of vaccinations, following the Covid 19 first case in Yaounde. Method:This was a cross sectional study. Data were sourced from the pediatric unit registries of ESSOS Hospital Center (EHC). We compared absolute number of expanded immunization doses received over the same period in February to April 2019 and 2020 respectively The Statistical software R version 4.0.2 was used for all computations. Results:A total of 168 and 148 babies were born in EHC during the month of February 2019 and 2020 respectively. The vaccinate rate decreased from April to May with rates in 2020 lower than in 2019 (54% (80/148) vs 81% (137/168), p < 0.001), which cor-responds to pandemic period. Conclusion:In this setting, without any reported stock outs of unit doses of routine immunization programme, a slightly decrease was observed in 2020, due to the COVID outbreak. Keywords:Covid 19; Immunization; Children  
74 Lock Down-For Better or for Worse , P Prathyusha.
During pandemic of Covid, lockdown was inevitable to help stop spread of disease and prepare better in coming days for of-ficial machinery to handle disease burden. This is akin to two sides of coin. Online lessons for students, WFH for parents, home iso-lation for senior citizens were all witnessed with a pinch of salt. While everyone was cramming to see nature healing its wounds, relationships building between cold partners, family members, it also saw raise in domestic violence due to of causes, say lost jobs, dwindling finances, heightened domestic work load in all sections of society.
75 Haematological Manifestations of Inborn Errors of Metabolism , Melis Kose, and YeÅŸim Oymak.
Introduction: Multisystemic involvement of inborn errors of metabolism (IEMs) makes treatment and follow-up of these diseases difficult. Haematological manifestations are significantly important for both treatment and follow-up processes of IEMs. This study evaluated haematological manifestations that may coexist with IEM disorders and affect the diagnosis process to raise awareness of IEMs coexisting with haematological findings. Materials and Methods: In this study, medical records of 132 patients diagnosed with IEM were examined retrospectively, and the data of 43 patients with haematological findings at the time of diagnosis were evaluated. The information assessed included demo-graphic findings, diagnosis, age at diagnosis, follow-up period, haematological manifestation, and coexisting findings. Results: An evaluation of the haematological abnormalities at the time of diagnosis showed that of the 43 patients 15 (33.3%) had neutropenia, 3 (7.1%) had pancytopenia, 15 (34.3%) had iron deficiency anaemia (IDA), 15 (35.7%) had thrombocytopenia, 7 (16.6%) had coagulation abnormalities, 1 (2.3%) had hemolytic anaemia, 1 (2.3%) had hemophagocytic lymphohistiocytosis (HLH), and 7 (16.6%) had coagulation abnormalities. Overall, 15 (35.7%) patients had chronic anaemia. Conclusion:The results show that hematologic abnormalities are very common features of IEM. The findings are valuable for raising awareness of hematologic manifestations in these disorders. Keywords: Inborn Errors of Metabolism; Anemia; Neutropenia
76 An Unexpected Outcome of Congenital Intrahepatic Arterioportal Fistula with Trisomy 21 , Aktas Selma, and Nur Seyma Zengin.
Congenital intrahepatic arterioportal fistula is a rare condition and presents with symptoms of portal hypertension. Congenital cardiac anomalies are common among children with Trisomy 21 and there is also an association between Trisomy 21 and congenital vascular malformations of the liver. We discuss a patient with Trisomy 21 that presented with continuous murmur in the right upper quadrant of abdomen, thrombocytopenia and mild pulmoner hypertension and diagnosed as congenital intrahepatic arterioportal fistula by doppler USG and angiography. Surprisingly the shunt regressed spontaneously without any intervention. Keywords: Trisomy 21; Congenital Ä°ntrahepatic Arterioportal Fistula
77 Overview About What We Need to Know About DKA, Pathology, Symptoms and Treatment , Davood Amirkashani.
The most serious complication of type 1 diabetes is diabetic ke-toacidosis (DKA), though it can occur in patients with type 2 but less common. Basic pathology in DKA is hypo insulinism or lack of effective insulin action.
78 Unusual Presentation of Remethylation Disorders: A Case of Later Onset CblE Deficiency , Silvia Kalantari, Francesco Porta, Tiziana Vaisitti, Silvia Deaglio, and Marco Spada.
Methylcobalamin deficiency type CblE is a rare autosomal recessive inborn error of intracellular cobalamin metabolism. The clinical presentation is characterized by megaloblastic anemia, delayed psychomotor development, hypotonia, seizures, nystagmus, impaired visual acuity, and failure to thrive. The symptoms onset is usually within the 3rd year of life, with most children presenting within the first. The biochemical markers of CblE deficiency are hyperhomocysteinemia, homocystinuria and hypomethioninemia. We report a case of late onset (11 yo) methylcobalamin deficiency type CblE presenting with isolated macrocytic anemia and no neurological impairment. Genetic analysis of the MTRR gene allowed to identify two compound heterozygous variants, c.626C>G; [p.(Ser209*)] and c.1715C>T [p.(Pro572Leu)], which were never reported in the literature before. The therapy with hydroxocobala-min was effective on the patient anemia and allowed to reach control of the clinical picture. The aim of this article is to show that isolated macrocytic anemia and hyperhomocysteinemia may be caused by a remethylation disorder, even when the clinical presenta-tion is milder than expected. Keywords:Vitamin B12 Intracellular Metabolism; CblE Disease; Late Onset; Hyperhomocysteinemia; Macrocytic Anemia
79 Epidemiology, Clinical Profile and Immediate Outcome of Poisoning in Children in Tertiary Care Hospital , Sachin KR.
Background and Objectives:Poisoning in pediatric age group is one of the most common emergencies encountered in pediatric practice. Poisoning in children are mostly accidental, and most cases are preventable. Surge in incidence of acute poisoning episodes are attributable to increased use of various chemical substances in households. Objectives:To ascertain the epidemiology, clinical profile and immediate end result of children presented to PICU with acute poison-ing in a tertiary care hospitals attached to JJMMC Davangere. Materials and Methods: The study was an observational study conducted over a period of 1 year from December 1st 2017 to Decem-ber 1st 2018 with 273 cases of poisoning in paediatric age group. Target populations were Children with poison intake history of with or without clinical features, with uncertain history of poisoning but with clinical features of acute poisoning.Relevant investigations were done whenever required. All the cases were managed according the latest standard guidelines. Data was tabulated and statisti-cally analyzed. Results and Interpretation:Out of 273 patients admitted 113 cases (41.39%) belonged to age group between 1 to 6 years of age. where males (141) outnumbered females (132). A total of 183 cases (67.03%) were due to accidental poisoning, 77 cases (28.20%) due to suicidal and 13 cases (4.76%) were due to homicidal poisoning. Out of all major toxic agents involved, hydrocarbons (144, 52.74%) were consumed among major number of children reported. Maximum i.e. 119 cases were due to kerosene poisoning fol-lowed by 56 cases due to OP compounds. Most common symptoms observed were vomiting in 203 patients followed by respiratory distress in 107 patients and altered sensorium was observed in 77 patients. Out of 273 poisoning cases, total mortality had been reported in 11 patients (4.02%), Out of 11 cases mortality due to OP compounds stand highest (5, 45.45%). Conclusion:Parental awareness and education plays vital role in obviating the accidental poisoning in children. Keywords: Poisoning; Kerosene; Accidental; Hydrocarbons; Vomiting; Altered Sensorium
80 Time to Use the Obliviate Spell for Mcisaac Score for Childhood Pharyngitis!! , Pearl Mary Varughese, Nandita Pai and Prakash M.
Background:Though most common aetiology of acute pharyngitis is viral, antibiotics are being started aimlessly in most cases with-out prior blood tests or throat swab culture reports. This not only causes unnecessary use of antibiotics, but also antibiotic resistance in the long run. Objective:The primary objective was to validate McIsaac score for identification of bacterial pharyngitis. The secondary objective was to put forward an easy pragmatic clinical scoring system for diagnosing GAS infection in children. Materials and Methods: This was an observational study conducted over a 24- month period. The inclusion criteria included all the children 3-15 years who visited the hospital with acute pharyngitis. Exclusion criteria included those on antibiotics or unidenti-fied medication in the previous week, immunocompromised, or later found to have sinusitis, otitis media or pneumonia. Sensitivity, specificity and positive and negative LR was done for many contributing factors. . Results:The throat swab culture was positive only in 59 (72.8%) cases being Group A streptococcal pharyngitis. Palatal petechie had the best LR and a combination of factors (Positive CRP, Positive WBC; Presence of palatal petechiae and Exudates in tonsils) was a better predictive tool than McIsaac score. By using the modified score, there was only overuse of antibiotics in 5.9% cases. Conclusion:Most of the acute pharyngitis cases are viral, requiring symptomatic management and parental reassurance. McIsaac score is not a useful tool and combination of factors (Positive CRP, Positive WBC; Presence of palatal petechiae and Exudates in ton-sils) had better predictive value for diagnosing acute pharyngitis. Keywords: McIsaac Score; Streptococcal Pharyngitis; Antibiotics
81 Impact of Covid-19 Measures on Children Infection Related Hospitalization. Estimation of Causal Inference from observational Data, Using the Google Causal Impact, A Structural Bayesian Time-series Model , Mohammed Shahab Uddin and Khouloud Abdulrahman Al-Sofyani.
Introduction:Although covid-19 has numerous adverse effects on children, few beneficial effects have been observed such as adapt-ing to learn in a new digital environment, coming more closer to family, creating a bond of love, affection among the family members, and awareness of a novel disease. As a result of covid-19 measures, social distance, hand hygiene, use of face mask, the common pediatric infectious diseases, namely, influenza, croup, and bronchiolitis, essentially disappeared with social distance. The aim of our study to examine the causal impact of covid-19 measures as factual probability and the counterfactual probability for average number of pediatric admission due to Covid-19 measures, using the Google Causal Impact, BSTS model and to explore the use of this model in healthcare research Method:Study Design: A retrospective observational study. Two-time series data collected from Dec-2016 to Oct-2018 as control, and Dec-2018 to Oct-2020 as the experimental group. Our hypothetical assumption, if all the 0bserved or unobserved covariate which influence the hospitalization of children due to respiratory illness are essentially static. Our assumption during the control pe-riod the observed mean admission and experimental period predicted mean admission should not differ in the absence of Covid-19 measures. Impact of covid-19 pandemic measures on pediatric admission during the post-intervention time could be drawn by sub-tracting the factual probability of admission from the counterfactual probability of mean monthly admission. Setting: Imam Abdulrahman bin Faisal Hospital, under National Guard health affairs, located in Dammam, KSA. The Hospital is approxi-mately 100-bed capacity, Pediatric ward bed capacity twenty with average annual admission 1200, winter season exceeded the bed ca-pacity, monthly exceeding 140-150 admission. Data collection: Monthly total number of admission data collected retrospectively from the Pediatric Ward admission log book for the define time frame. Results: During the control period, the observed and predicted mean admission was statistical, not significant (P- 0.171), in addi-tion, the observed average admission during the control and predicted during the intervention, was the same. As a result of Covid-19 measures, the monthly admissions average value of 29. By contrast, in the absence of covid-19 pandemic measures, we would have expected an average admission of 87(9.4). counterfactual prediction CI [68-106]. Causal effects -58, CI (-78, -39), p values 0.001. Conclusion: Admission was appreciably diminished as a positive impact of covid-19 measures indeed, it was the opposite direction of an adult, nevertheless, it was beyond expectation for admission for pediatric age group during a pandemic. On the other hand, the Google causal Impact algorithm well fitted to explore the casual Inference, and healthcare researchers could use it for causal effect estimation for any interventional time series setup. Keywords: Positive Impact of Covid-19; Covid-19 in Children; Covid-19 Infection; Corona in Children; Structural Bayesian Time - series Model; Forecasting; Google Causal Impact
82 SARS CoV 2 and Coronaviridae in Children: An Updated Review , Claudine Kumba
Background: With more than 800000 deaths and 20 million of confirmed cases worldwide, SARS-CoV 2 is one of the worst pandemic of the last decade. Questions concern the etiology of this pandemic outbreak. Was the world prepared for this pandemic? Efforts have been oriented towards treating patients who are infected presenting severe Covid-19 and preventing the spread of the virus by several means [lockdown, quarantine, social distancing, masks, antiseptic solutions]. Whereas evidence concerning the etiology treatment is still uncertain and lacking at this moment, efforts in developing vaccines for preventing another future pandemic are organized. What lessons can we get from this pandemic? Several papers have reported that children present less severe signs and symptoms than adults. There is also evidence that children at any age can be severely affected. If children are less affected than adults, why is it so? With this serious pandemic outbreak, were we or will we be prepared in the future to face a similar serious worldwide health emergency? How will we be prepared?The Objectives of this review was to find answers to the above mentioned questions. Methods and Materials: This review was realized between 18 March 2020 and 30 June 2020 by electronic search of scientific ar-ticles dealing with Covid-19 or SARS-CoV 2 or Coronaviridae in children in Google and Pubmed databases without date limitation. 1085 articles were identified among which 200 were retained for analysis and 48 were included for the review. Results and Conclusions: Several reviews have been published today. This review brings updates on the outbreak of the SARS-CoV 2 pandemic in children. Keywords: Covid-19; SARS-Cov 2; Pandemic; Coronaviridae; Children; Review
83 Lock Down-For Better or for Worse , P Prathyusha.
During pandemic of Covid, lockdown was inevitable to help stop spread of disease and prepare better in coming days for of-ficial machinery to handle disease burden. This is akin to two sides of coin. Online lessons for students, WFH for parents, home iso-lation for senior citizens were all witnessed with a pinch of salt. While everyone was cramming to see nature healing its wounds, relationships building between cold partners, family members, it also saw raise in domestic violence due to of causes, say lost jobs, dwindling finances, heightened domestic work load in all sections of society.
84 Covid 2019 here to Remain , C V Raghuveer.
The dictum to prevent spread of Covid 19 infections in today’s Covid infested society is “wear a mask, wash your hands frequently and keep a safe distance”. It is rather unfortunate that the society has created an exas-perating situation by neglecting all the components of the dictum either individually or collectively. The reasons for this are many.
85 Together We Can Stand Against Corona Virus , Sanjay Rode.
Corona viruses are a large family of viruses which may cause disease in animals or humans [1]. The current corona virus has emerged from the Wuhan city, China. The first corona virus case was found during December 2019. A women was infected from Wuhan seafood market. The diagnosis shown that the possibility of corona virus to human could be from bat. The main symptoms of this virus to human are Fever, Cough, Shortness of breath. These symptoms can develop into pneumonia, with chest tightness, chest pain, and shortness of breath. An incubation period of current co-rona virus is 2-14 days. The transmission of the COVID-19 can oc-cur by multiple ways. The direct contact with infected people is a major cause. An indirect contact with surfaces in the environ-ment or with objects used by the infected person could be the other immediate cause of corona virus infection. It is difficult to find the infected people and places of corona virus.
86 A Case of Early-infantile Epileptic Encephalopathy with Suppression-bursts- the Ohtahara Syndrome , Srijan Singh.
Ohtahara syndrome (OS) is an epileptic syndrome with onset in neonatal period and has many clinicoelectrical characteristics, of which age dependency and evolutional change is specific. The most specific EEG feature is the suppression burst (SB). This pattern is characterized by high voltage bursts alternating with flat suppression phases at a regular rate. A term neonate presented with seizures on day three of life. Seizures were intractable. Metabolic workup for seizures was normal. Extended panel neurometabolic screen was normal and neuroimaging did not reveal any structural abnormality. EEG showed burst suppression pattern suggestive of ohtahara syndrome. Virtually all reported cases of early infantile epileptic encephalopathy (EIEE) are secondary to a congenital or acquired structural malformation of cortical development. The etiology of this syndrome remains obscure. All children with EIEE should be thoroughly investigated with MRI, CSF amino acid level determination, and detailed postmortem neuropathologic exami-nation.
87 Dealing with Moral Distress during the Covid-19 Pandemic , Adele A Webb.
During this unprecedented time in our history we find health-care providers dealing with the daily stressors of the pandemic all around the world. Concern for self, concern for family and friends as well as care fatigue are a major cause of anxiety for the nurses. Finding ways to deal with the stress and anxiety is paramount as the pandemic rages on.
88 Gilles de la Tourette Syndrome - A Severe Case in an 8 Year-Old Nigerian Male , Dr Christian Chukwukere Ogoke and Dr Emeka Charles Nwolisa.
Living with severe Gilles de la Tourette syndrome is physically and psychologically distressing for both the child and family and can impair quality of life and school attendance. Tourette syndrome is a chronic neurodevelopmental motor disorder manifesting with multiple motor and vocal tics. Tic disorders are common in school-aged children but there are few reports in Nigerian children and there is a dearth of physicians experienced in treating Tourette syndrome. This case report highlights the diagnosis and frustrations of management of severe Tourette syndrome in an 8 year-old male. More awareness of this neurodevelopmental disorder is needed in our locality.
89 Graves' Disease with Negative Autoantibodies against the TSH Receptor: 5 Cases , Aina Scatti Regàs, Ricord Pujol Borrell, Roser Ferrer Costa, Elsa Puerto Carranza and Maria Clemente Leon.
The diagnosis of GD is based on the detection of suppressed plasma TSH and TRAb [4]. However, there are patients in whom TRAb are not detected despite of having a highly suggestive clinic, hormonal profile and imaging tests. We describe 5 pediatric cases of this still little studied and understood clinical situation. The diagnosis of GD is based on the detection of suppressed plasma TSH and TRAb [4]. However, there are patients in whom TRAb are not detected despite of having a highly suggestive clinic, hormonal profile and imaging tests. We describe 5 pediatric cases of this still little studied and understood clinical situation. Keywords:Graves Disease (GD); Thyroid Stimulating Hormone Receptor (TSHR); Anti-thyroid
90 Annular Pancreas in an Eleven-year-old Male Ethiopian Child at the University of Gondar Hospital; A Case Report , Zerubabel Tegegne Desita and Andinet Dessalegn Beza.
Background: Annular pancreas is a rare congenital anomaly characterized by the presence of ectopic pancreatic tissue surrounding the duodenum. It is equally seen in the pediatric patient population and adults usually symptomatic in the first weeks of life with duodenal obstruction in children. Mostly asymptomatic in adults, but can manifest as pancreatitis, duodenal stenosis, or duodenal or gastric ulceration. A case of 11 years old patient is presented with epigastric pain and vomiting of year’s duration, in which radiologi-cal investigations showed an annular pancreas. At operation, a complete obstruction of the duodenum between its first and second parts was found caused by an annular pancreas. A gastroenterostomy was performed and the patient improved. Material and Methods: A case report documents that radiologic examination with barium meal, abdominal ultrasound and com-puted tomography (CT) scan disclosed annular pancreas with duodenal stenosis which was confirmed surgically. Results: A properly performed CT examination revealed the ring of pancreatic tissue which encircled the duodenum supplementing suggestive imaging findings seen on ultrasound of the abdomen and barium meal study. The diagnosis is confirmed and the problem is corrected surgically. Keywords: Annular Pancreas; Ethiopia  
91 On the Effect of Meteorological Parameters on the Spread of COVID-19 with Count Methodologies , Bobadoye Dotun, Oyamakin S Oluwafemi and Alabi Y Ifeoluwa.
There are confusion as to whether cold/hot weather can kill the new coronavirus (COVID-19) since most infectious disease have some form of seasonality and/or seasons at which they progress. The normal human body temperature remains around 36.5°C to 37°C, regardless of the external temperature or weather. This paper considered the relationship between the weather parameters and the spread of COVID-19 since many of the largest outbreaks have been in regions where the weather is cooler, leading to specula-tion that the disease might begin to tail off with the arrival of summer. Many experts, however, have already cautioned against bank-ing too much on the virus dying down over the summer. The results based on the active and closed cases of COVID-19 showed that infected patients in mild condition and serious/critical condition under the active cases as at today 1st of April 2020 were 95% and 5%, respectively while 81% (Recovered/discharged) and 19% (Deaths) were observed under the closed cases which was 229,344 in total as at 1st of April 2020. Also, the correlation coefficients showed that no relationship existed between the meteorological vari-ables and the confirmed cases counts due to COVID-19. Count methodologies used showed significance of the weather parameters but gave a poor fit which is an indication of data needs as covariates to the already documented records of persons diagnosed to be COVID-19 positive. Keywords:COVID-19; Meteorological Parameters; Poisson Model; Negative Binomial Model; Correlation Coefficients
92 Hospital Food Services; Dealing with Cultural Influences , Maha A Al Turki.
Diet and nutrition play an important role in promoting recovery from different illnesses. Besides health reasons and hospital envi-ronment, food habits and preferences are one of the important factors affecting food intake of hospitalized patients. Food habits are the main aspect of many cultures, and cannot therefore be easily changed, or else it will affect food intake and meals pattern. Saudi people from different distinct regions eat different foods and have different food habits. The food ingredients, type, cooking methods and preservation techniques vary among these regions. Hospitalized patients often find it difficult to adjust, from their traditional food, to a standard hospital menu. This may result in reducing intake of food and increasing risk of malnutrition. One major step in promoting good nutritional care in hospitals is to ensure that hospital menus take into consideration patients’ needs and preferences. Moreover, patients should be involved in planning their meals and choosing their food items in order to customize their dietary plan to accelerate recovery from illness and reduce the length of hospital stay. The present review discussed the difficulties that some patients admitted to one of the major hospitals in Riyadh may face with food presented to them. The process of dealing with patients to fulfill their dietary requirements and preparing meals in accordance with their tradition and preference will also be discussed. Keywords: Food Services; Food Preferences; Malnutrition; Hospital; Saudi Arabia
93 Hands of Health Care Professionals as a Vehicle for the Transmission of Hospital Pathogens , Helena Maria Dias Xavier, Gabriel Lopes Vieira da Silva and Denise Von Dolinger de Brito Röder.
Health Care Related Infections associated with the hands of health professionals has shown high rates of morbidity and mortality as a public health problem. The objective was to synthesize information about the hands of health professionals as a vehicle for the contamination of microorganisms that affect HAIs in hospitalized patients, highlighting risk factors, which etiological agents, analysis of low knowledge and adherence, in addition to analyzing improvement strategies. Articles with the descriptors were searched: Hand Hygiene; Hand Sanitizers; Health Care Associated Infections; Healthcare Workers; Infectious Disease Transmission, Professional-to--Patient., In the databases and virtual libraries: Scielo, Google scholar, Pubmed, Science direct, Web of Science and Brazilian database Periódico Capes, in the last 5 years. In total, 11,939 articles were found, after exclusion criteria 26 were used to compose the review. Among the relevant risk factors are sepsis, pneumonia, gastrointestinal and urinary tract infections, as well as surgical site infections associated with the hands of professionals. Low knowledge and lack of adherence are related to high workload associated with ina-dequate resource facilities and training strategies and ineffective hand hygiene assessment. The etiologic agents most frequently de-tected were Staphylococcus aureus, Staphylococcus coagulase-negative, Staphylococcus epidermidis, Enterococcus spp, Acinetobacter baumannii and Klebsiella spp. Practices such as encouraging the training of professionals responsible for the prevention and control of HAIs in hospitals, surveillance with physical and electronic feedback on the correct execution of hand hygiene, has proven to be effective strategies. Keywords: Hand Hygiene; Hand Sanitizers; Health Care Associated Infections; Healthcare Workers; Infectious Disease Transmission; Professional-to-Patient
94 Assessment of Transfusion Needs in Pediatric Hematology-oncology , I Lemssahli, K Hajjout1, M Benajiba and A Belmekki.
Introduction: The Rabat regional blood transfusion center (TBC) delivers LBPs to the various healthcare establishments (HE). The pediatric oncology and hematology service (SHOP) represents the most important hematology and oncology service in Morocco.The objective of this study is to assess the transfusion needs of the SHOP, the management of urgent requests and assess the feedback. Materials and Methods: This is a three-month descriptive study, from December 1, 2018 to February 28, 2019, consists of collect-ing the data noted on medical prescriptions, verifying the compliance of blood requests, evaluating the feedback and the declaration adverse transfusion reactions (ATR). The sample of our study concerns polytransfused patients from SHOP. Results and Discussion: During the period from December 1, 2018 to February 28, 2019, the Rabat TBC received 1174 applications with a total of 3834 LBPs requested.The quantitative and qualitative satisfaction of blood requests reached 83.54%.11.5% of the requests were urgent, mainly concern leukocyte-depleted platelets (75%). As for the conformity of requests, 27% are non-compliant and hinder the smooth running of the service.We also find that The Irregular Agglutinin Test (RAI) was positive in 1, 40%; the search time for compatible LBPs may exceed three days.The traceability of delivered LBPs is weak and does not exceed 10.33%, the declaration of transfusion reactions is 1, 31/1000 LBPs delivered; this rate does not reflect the reality. Conclusion: The management of polytransfused patients is a delicate mission, which requires close collaboration between the blood transfusion centre and health establishments. The availability of LBPs is the responsibility of the blood transfusion centre; the feed-back and reporting of adverse reactions are the responsibility of the healthcare establishments. Keywords: Pediatric; Hematology; Oncology; Blood Management; LBPs; Adverse Transfusion Reactions; Haemovigilance
95 A Quasi-Experimental Study of a Sensorimotor Training on Pre-Writing and Pre-Reading Skills in an Italian Elementary School with Children Aged 5 to 7 Years , Scognamiglio Riccardo Marco, Russo Simone Matteo and Fumagalli Matteo.
Objective: Our study aimed to investigate the effect of a sensorimotor training on cognitive performance, especially on pre-writing and pre-reading skills, in an Italian elementary school children. Methods: 463 elementary school children, aged 5 to 7 years (266 in the experimental group and 197 in the control group). In order to evaluate the effectiveness of the sensorimotor training, which lasted twice a week for 12 sessions, the psychometric evaluations were at before, after the training and at a follow-up after one month. We used two tests: VMI (Developmental Test of Visual-Motor Integration) that assesses the ability to coordinate body movements with visual perception; PRCR-2 (Prove di Prerequisito per la Diagnosi delle Difficoltà di Lettura e Scrittura; English translation: “Pre-writing and Pre-reading Deficits Assessment)” that assesses prewriting and prereading deficits. Results: The results of the specific sensorimotor training showed a significant effect of the training in improving performance at several PRCR-2 items, while no significant effect resulted on the performance at VMI. Conclusion: Sensorimotor training showed an improving effect on pre-writing and pre-reading skills, with a significant reduction in writing and reading deficits. Instead, no significant effect resulted on visual motor integration. Keywords: Pre-writing and Pre-reading Skills; Sensorimotor; Integrated Psychosomatic Model; PRCR-2; VMI
96 The Role of Brainstem Sensitization in the Pathophysiology of Deformational Plagiocephaly , Rene J Zweedijk.
Deformational Plagiocephaly (DP) is a common clinical presentation. There is no consensus as to the aetiology of DP, there is no risk factor that is uniformly considered as dominant. The consensus about the pathogenetic factors that are important in the onset of DP is more robust. Most cases are presented with no skull deformity at birth and most problems seem to appear at the age of two months. This implies that postnatal factors have an influence on the onset of DP. Prolonged back-laying position in combination with a restriction in motion of the upper neck area are generally considered as important factors in the onset of DP. The restriction in mo-tion can be caused by muscular and neurological reasons. The purpose of this article is to present an aetiology model as to the neu-rological aspects that may be causing plagiocephaly and how osteopathy may potentially influence the amelioration of plagiocephaly. Sensitization of the upper neck and brainstem may be caused by intrauterine positioning, traumatic birth processes or prolonged pressure on specific areas of the skull. This sensitization will increase sensitivity of touch-, pressure- and pain-fibers, muscle tone, impair muscle function and enhance postural and birth survival reflexes. The postural reflexes, in combination with impaired muscle function and the prolonged supine positioning of the infant, play a crucial role in the progress of some types of Deformational Pla-giocephaly (DP). These neurological considerations should be analyzed and treated by osteopaths and allied professions when faced with DP. Keywords: Deformational Plagiocephaly; Brainstem; Aetiology
97 Cooperative Role of Parent and Doctor in Success of Nutritional Management of Pediatric Ulcerative Colitis , Heba Azmi Makki.
Ulcerative colitis (UC ) is one of the two entities of inflamma-tory bowel diseases (IBD). It is an idiopathic chronic inflammatory disorder that involves mainly the colon. UC is characterized by pe-riods of remission and relapses [2]. The etiology of IBD is multifac-torial including genetic, environmental, microbial, and immuno-logical factors [1]. The incidence of ulcerative colitis has obviously increased. Both the evidence and also researches showed the mar-velous role of control of the disease by restricted and in the same time balanced nutritional management. The aim is to decrease the disease active status and relapses. This helps to preserve the colon, decrease the risk of dysplasia and the important point in pediatric UC is to decrease risk of growth failure.
98 Stress Coping and its Mental Health Status in Tunisian Caregivers of Children with Autism Spectrum Disorders , Khaoula Khemakhem, Leila Cherif, Wiem Kammoun, Mahmoud Ziraoui, Khadija Baccouche, Lobna Zouari, Hela Ayadi, Imen Hadjkacem and Yosr Moalla.
Background and Aims: Identifying coping mechanisms that caregivers adopt as they provide care for individuals with autism holds potential to improve caregiver well-being and promote positive social change. The purpose of this study was to investigate coping strategies in caregivers of children with autism spectrum disorders and to investigate their relationship with mental health variables. Methods: The study was cross sectional, performed in the department of child and adolescent psychiatry of Sfax. The study included eighty caregivers of children with autism spectrum disorders. Coping strategies were evaluated by the Brief COPE and mental health variables were assessed by the anxiety rating scale of Hamilton, the Hamilton Depression Rating Scale and the short form-36 health survey questionnaire. Results:More than half of the participants were depressed and anxious. Impaired quality of life was found in 60.7% of participants. The emotion-focused coping was noted in 74% of the sample. Religion, acceptance and positive reframing were the principal coping strategies used. Greater use of emotional support, humour, denial and self-blame were generally found to be significantly linked to depression (p values of 0.007, 0.009, 0.034 and 0.010 respectively). Self-distraction and behavioral disengagement were significantly linked to both anxiety (with p = 0.036 and p = 0.001 respectively) and depression (with p = 0.004 and p = 0.001 respectively). Conclusion: The findings of this study indicated the effect of both anxiety and depression on the application of coping strategies. Coping strategies in these caregivers should be increased in order to improve their quality of life. Keywords: Coping; Autism; Caregivers; Depression; Anxiety
99 Effects of Indoor Air Pollution on Stunting Among Children Aged 1-5 Years in Salyan District of Nepal , Madhu Koirala, Shalik R Dhital, Nabin Regmi, Sirjana Gyawali, Swikriti Acharya and Prajwal Gyawali.
Background: Indoor air pollution is a hidden public health concern at household level in Nepal. In rural Nepal, more than 85% of household’s basic cooking facilities producing high level of indoor air pollution. It has been hypothesized that indoor air pollution is linked to childhood stunting among many other negative impacts on health. Aim: The aim of this study was to measure the effects of indoor air pollution on stunting among children aged 1-5 years in Nepal. Methods: Across-sectional study was conducted in Salyan district of Nepal. This study included 179 households selected on conve-nience sampling principle. Exposure to indoor air pollution was assessed based on type of fuel used. Mothers were interviewed to get basic socio-economic and environmental data of a household, a trained Auxiliary Nurse Midwives monitored child stunting during the household visit. Data were analyzed using STATA 11 software. Multi-nominal logistics regression analyses were carried out to estimate the association between exposure and outcome variables at 95% confident interval with significant level of P value 0.05. Results: The moderate stunting rate was 27.7% and severe stunting was 25.4% among the children aged 1-5 years in this study area.The Brahmin and Chhetri caste children had higher odds (OR=2.66; 95% CI: 1.04-6.89) with moderate stunting relative to Scheduled caste children. The third birth order of mothers was significantly higher odds (OR=3.37; 95% CI: 1.16-9.70) with severe stunting among children aged 1-5 years compared to first birth order. Risk of stunted growth was higher among children from a family with a kitchen inside house compared to having a separate kitchen. Conclusion: There was no association of indoor air smoke and stunting among children aged 1-5 years. This study highlighted the need to conduct further study to find out further factors related to stunted growth among children under-five years. This study will be useful to further researchers and public health concern about further research on this area in large scale. Keywords: Biofuel; Stunting; Children; Indoor Air Smoke; Nepal
100 Impact of Human Rotavirus Vaccine on Acute Gastroenteritis Among Children of 0-59 Months in Sokodé (Togo) , Foli Agbeko, Mawouto Fiawoo, Enyonam Tsolenyanu, Kokouvi Evenyo Abalo, Magnoulelen N’zonou, Sollim Talboussouma, Homba Daké Batalia, Rollin Arnaud Djomaleu, Rachel Bayahou Kérékou, Manani Hemou, Mazama Pakoudjare, Koffitsè Essèboè Sewu, Bay-aki Saka, Edem Koffi Djadou, Kokou Nadiedjoa Douti and Yawo Dzayissé Atakouma.
Background: Acute Gastroenteritis (AGE) was one of the leading causes of child morbidity and mortality worldwide. Rotavirus is the leading cause of diarrhoea in children under five years, leading to severe dehydration. The monovalent rotavirus vaccine Rotarix® was introduced into the Expanded Programme on Immunization (EPI) in Togo in 2014. The aim of the study is to measure the impact of Rotavirus vaccination on Acute Gastroenteritis (AGE) in children under 5 years of age at the Regional Hospital of Sokodé in Togo. Methods: This was a quasi-experimental "before and after" study. It compared the morbi-mortality linked to AGE in children under 5 years of age, for the period before the introduction of the rotavirus vaccine (Period 1 or P1: year 2013 and 1st half of 2014) and the period after (Period 2 or P2: 2nd half of 2014 and year 2015) in the paediatric ward of the Regional Hospital of Sokodé, Central Region, Togo. Rotavirus was detected by enzyme-linked immunosorbent assay in stool samples that were sent to Lomé as part of a sentinel surveillance. Results: From 2013 to 2015, 365 records of children under 5 years of age were included (nP1 = 289; nP2 = 76). The average age of the children was 20.79 ± 10.08 months in P1 and 20.77 ± 9.46 months in P2, without significant difference (p = 0.9884). For both study periods, children under 24 months of age accounted for 3/4 of the AGE cases. The M/F sex ratio was 1.16 in P1 and 1.38 in P2 (p = 0.5068). The prevalence of AGE registered in hospital was significantly reduced from 4.80% to 1.20% (p = 0.000) after vaccine introduction. The mortality rate related to AGEs decreased from 0.12% to 0.05% with no significant difference (p = 0.1998). Rotavi-rus was responsible for 72.30% of the AGE in Sokodé. Conclusion: The rotavirus vaccine had a significant positive impact on the morbi-mortality of AGE in children in Sokodé. The educa-tion of the population must reinforce adherence to the EPI and good food and hygiene practices. Keywords: Gastroenteritis, Rotavirus, Vaccine, impact, Togo
101 Cystic Fibrosis – Alternative Therapies , Liliana Teixeira, Cláudia João Lemos and Telma Barbosa.
Cystic Fibrosis (CF) is a chronic disease with progressive and irreversible degradation of lung function, being a common indication for lung transplantation. At the stage of inclusion in the transplant list, the risk of death is already extremely high. We are presenting a clinical case of a 17-year-old adolescent with CF, severe mixed chronic respiratory failure, and chronic in-fection by methicillin-resistant Staphylococcus aureus, in the awaiting list for lung transplantation. Despite the use of non-invasive ventilation for long periods and continuous oxygen therapy, presented more frequent respiratory exacerbations, with an increased number of cycles of intravenous antibiotics. There were a clinical improvement and reduction in the number of hospitalizations after initiation of treatment with inhaled vancomycin. However, he presented progressive worsening of dyspnea in activities of daily living. After the introduction of high flow nasal cannula oxygen therapy, there was an evident improvement in signs of breathing difficulty and quality of life. In this case report, inhaled vancomycin and high flow nasal cannula had a significant role in pre-transplant supportive treatment. Keywords: Cystic Fibrosis; Chronic Respiratory Failure; Lung Transplant; MRSA; Inhaled Vancomycin; High Flow Nasal Cannula
102 Deportation of People in Latin America, Is It Possible? , Huníades Urbina-Medina.
Due to multiple problems that threaten the life of a person or group of people in their country of origin, they make the painful decision to leave their homes and land and arrive, usually illegally, to another country. The host country for international agreements, especially those that sign these agreements, has the obligation to receive and protect them. When the receiving country does not comply with these norms and proceeds to return these migrants without any investigation or giving them the opportunity to legal-ize their situation, this group of people become deportees.
103 Management of Malpositioned Peripherally Inserted Central Venous Catheter in the Upper Extremity of Neonates , Sinan Tüfekci and Hadi Sasani.
Background: Peripherally inserted central catheters (PICCs) are extensively used in neonatal intensive care. Aim: We report 12 cases of neonates with catheter management of malposition on initial peripherally inserted central venous cath-eter (PICC) placement. Materials and Methods: Between July 2018 and July 2020, a cross-sectional retrospective study was conducted on neonates hos-pitalized in the newborn intensive care unit. Patients with PICC were obtained from file records and automation system. In patients with catheter malposition, the radiological images of the catheter before and after repositioning, gender sex, gestational week, deliv-ery type, birth weight, aim of insertion, and insertion time of postnatal day were evaluated. The usability of the catheter and compli-cations after repositioning in patients with catheter malposition were determined. Results: The procedure was successful in 233 (91.7%) of 254 patients whose catheters were inserted in the upper extremity. The mean gestation week, body mass index, birth weight, and birth height were 33.92 ± 4.03 ((27-38) weeks, 1.11 ± 0.26 (0.86 - 1.66) kg/m2, 2195 (1050 - 3800)g and 42.83 ± 7.31 (35 - 54) cm, respectively. In the catheter position control radiographies, 12 (5.2%) patients with inappropriate catheter tip localization were evaluated as catheter malposition and repositioning was performed. The most common localization of catheter malposition was most commonly found in the axillary (50%), internal jugular (33.3%), and thoracodorsal veins (16.7%), respectively. Conclusion: Appropriate position of the catheter can reduce complications in patients with PICC malposition and allow long-term vascular usage. Keywords: Neonate; Peripherally Inserted Central Catheter; Radiography; Reposition; Tip Position
104 Development of a Portable Non-Invasive Oral Motor Assessment Device and its Reliability , Payam Seyedkalateh, Elnaz Pooralijani, Seyed Ahmad Hosseini, Peyman Asghari and Mehdi Nouri.
Purpose: Development of a portable non-invasive oral motor assessment device. Method: New device is designed and twenty people (11 male and 9 female) in deferent range of age with no history of swallowing, orofacial, gastrointestinal, respiratory or neurologic problem were selected. sample was evaluated twice in 15 minutes intervals with device for assessment of reliability. Result: There are correlation between the two measurements in test-retest and its significance and the degree of reliability of each measurement. Conclusion: It can be concluded that these tools have an acceptable reliability and reliability index and it can be used as a reliable instrument in the evaluation of some oral motor skills. Keywords: Oral Motor; Infant Feeding; Sucking Assessment
105 Haemovigilance Recipients at the Rabat Regional Blood Transfusion Center 2015-2019 , I Lemssahli, K Hajjout, M Benajiba and A Belmekki.
Introduction: Haemovigilance is an element of transfusion safety. Its operating indicators are based on the traceability of transfused bags and the reporting of transfusion incidents. The objective of this study is to analyze the haemovigilance records returned to the Rabat Regional Blood transfusion center and all RAR notified over a 5-year period, in order to assess the rate of traceability and the incidence of adverse effects of transfusion therapy in healthcare services. Material and Methods: January 1, 2015 to December 31, 2019, we counted 68,106 files returned to the haemovigilance service of the Regional Blood Transfusion Center that were analyzed, for a total of 84,722 LBP traced including 181 declared incidents. Results: Feedback from delivered LBPs is very low; the traceability rate for LBPs is 20%. Transfusion incidents declaration average rate is 0.41/1000LBPs. Non-hemolytic febrile reactions and allergic reactions accounted 76% of the reported RARs. Grade 1 accounted 85.34% of RARs. The "serious" reactions (severity grade> 1) represent 10%. These reactions include one case of volume overload, 03 cases of pulmo-nary edema of which one was fatal, 06 cases of ABO incompatibility of which two were fatal, 03 cases of convulsions, and 05 states of shock of which 02cases required intensive care.The RARs were secondary to the transfusion of red blood cell concentrates in 70%. Conclusion: The rate of feedback and the number of RARs declared by the healthcare services remain underestimated. The in-volvement of healthcare establishments in the haemovigilance process is a legal obligation in Morocco since 2005, remains poorly respected to this day. Awareness and motivation of nursing staff, improvement of the RARs reporting system and redynamization of transfusion safety and haemovigilance committees (CSTH) guarantee better transfusion safety. Keywords: Haemovigilance; Feedback; Recipient Adverse Reactions; Labile Blood Products; Blood Transfusion Safety; Moroccan Legislation
106 Vitamin D Deficiency in Children: Do We Know it All? , Shagun Singh and Roosy Aulakh.
AbstractVitamin D is an essential micronutrient in maintenance of bone health in children. Deficiency of vitamin D is being increasingly reported amongst all age groups. Over the last few years, various studies have been undertaken on vitamin D status, it’s impact on health and disease and benefits of supplementation in therapeutic doses [1]. Various regimens have been described for management which include daily dosing and also single large dose (stoss therapy) administration. Compliance with daily therapy can be difficult, making high-dose, short-term vitamin D (stoss) therapy attractive to correct vitamin D deficiency. In this review we shall elaborate the existing recommendations on definitions of deficiency, prevention and treatment of vitamin D deficiency in children. Literature Review: This review has been compiled after extensive literature search using Pubmed and Google Scholar. References of the retrieved articles were further used to expand the research. Also, hand search was done from standard pediatric textbooks and Indian Journal of Pediatrics. Keywords: Vitamin D; Children; Cholecalciferol
107 An Assessment of Illness Perception of Caregivers of Children Attending Antiretroviral Therapy Clinic of a Tertiary Health Facility in North-west Nigeria , Fatima Bello Jiya, Tahir Yusuf, Nma Muhammed Jiya, Mohammed Yahaya, Paul Kehinde Ibitoye, Asma’u Adamu, Khadijat Omeneke Isezuo and Maryam Amodu-Sanni.
Background:The perception of illness among individuals is a phenomenon that has been described as processes by which Individu-als diagnosed with an illness, health threat, or an injury are said to develop an organized pattern of beliefs about their condition. These beliefs are developed not only in persons suffering from ill health but also among close companions. Objective: To determine the perception of caregivers of children infected with Human Immune deficiency Virus (HIV) attending antiretroviral therapy (ART) Clinic of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto. Methods: A cross-sectional study involving consenting primary caregivers of children aged 15 years and below diagnosed with HIV, attending ART clinic of UDUTH Sokoto. They were recruited from July to December 2018. Data collected were demographics, infor-mation regarding illness perception was adapted from the brief illness perception questionnaire and data was analyzed using SPSS version 23. Results: Ninety four consenting caregivers participated in the study. Mean age was 36.8± 8.0 with M:F of 1: 5.7. Mean age of the children was 9.1 ± 3.9, with M:F of 1.1:1.Majority 58 (6 1.7%) were of low social class. The cause of HIV was believed to be germs in 66(70.2%), with a chronic timeline by 54(57.4%) of caregivers. Sixty four (68.1%) of them perceived no major consequences on the child’s future. Majority 75(79.8%) had no control over child’s illness. Almost all caregivers 92(97.9%) believed treatment will control the infection. Fear 36(38.3%) and distress 17(18.1%) were the commonest emotions among caregivers and 65(69.1%) believed they understood child’s illness very much. Conclusion: Caregivers had good cause of illness comprehensibility. However, the perceived consequences, emotional, and personal control were low. Keywords: Illness Perception; Caregiver; Human Immunodeficiency Virus Infection; Children; Sokoto
108 46, XX Male, 46, XY Female and 46, XX- 46XY Female Variants: Rare Stories we Must Consider in the Assessment of the Disorder of Sex Development , Mohammed J Aboud, Manal M Kadhim, Noor M Abudi, Haidar M Joudi and Zeena M Joudi.
AbstractDisorders of sex development (DSD) are congenital conditions, which carried a typical or abnormal development of chromosomal, gonadal or the anatomical sex. The definitive diagnosis of DSD relies on clinical examinations, hormonal studies, gonadal histology, chromosome (karyotype) analysis and genetic testing. 46, XX testicular disorder of sex development is a rare clinical condition with a reported incidence of 1:20.000 in newborn males. People with this disorder have male external genitalia. Gonadal dysgenesis may occur in individuals with an apparently normal male who carried 46, XY chromosomal complements, and the phenotype may be indistinguishable from 46, XX gonadal dysgenesis. These individuals have a vagina, uterus, and fallopian tubes. Germ cells in the gonads are lost before birth. The phenotypic spectrum is so variable that some children are raised unequivocally as females, while others, even with mutations in the same gene, may be assigned to the male sex. Sex chromosome mosaicisms like 45, X/46, XY or 45, X/47, XYY have been documented as major causes of ambiguous genitalia. As individuals with this genetic image possess both ovarian tissue and testicular tissue, depending on the individual, gonads (ovaries or testes) may function fully, partly, or not at all. We highlighted the clinical, chromosomal, and hormonal features of three cases with such rare stories of DSD who were admitted and managed in our clinic. The important for submitting such findings will assist our team: pediatric surgeons, gynecologists, pediatri-cians and, endocrinologist to develop future management strategies when they are enrolled or confronted with such cases. Keywords: 46, XX Male; 46, XY Female; 46, XX- 46XY Female
109 Early Life Seizures: A Narrative Review and a Scheme to Recognize Them , Salvatore Michele Carnazzo, Giovanni Cacciaguerra, Giusi Maria Caltabiano, Desireè Balconara, Mattia Comella, Germana Lena, Claudia Oliva1 and Piero Pavone.
AbstractSeizures are a very frequent acute neurological event in children, caused by abnormal and excessive discharges of neurons.The recurrence of two or more unprovoked seizures characterizes the condition of epilepsy.The most recent classification of seizures distinguishes epilepsies into focal, generalized, and unknown.Seizures occurring in the first year of life might have an evolution ranging from benign to severe; in particular, febrile seizures simplexes are a group of seizures that occur with greater frequency in pediatric age and only 1 - 1,5% evolve into epilepsy, likewise Benign Familial Neonatal Epilepsy which tends to gradually disappear within the first months of life.Febrile Seizure complex (FSc) might have a variable prognosis not always predictable. Severe seizures presenting at an early age include epileptic encephalopathies a group of disorders defined based on “the notion that epileptic activity may contribute to severe neurocognitive and behavioral dysfunction above and beyond what would be expected from the underlying pathology alone”.Seizures are a frequent occurrence in the first year of life, this report aims to present the clinical manifestation of each of these disorders and provide an updated review of the conditions associated with seizures in the first year of life. Keywords: Seizures; Benign Familial Neonatal Epilepsy; Febrile Seizure Complex (FSc)
110 Malignant Type II Sacrococcygeal Teratoma-Revisiting the Role of Neoadjuvant Chemotherapy in Resource-Limited Countries: A Case Report , Chisom Nri-Ezedi, Thomas Ulasi, Ann Ikeabbah, Ogochukwu Chioma Ofiaeli, Chidera Obiora-Mmodumogu and Amalachukwu Okwukweka Odita.
Background: Sacrococcygeal teratoma is the most common germ cell tumour in childhood. Conventional management entails the complete excision of the mass, followed by platinum-based chemotherapy in malignant cases. However, several literature reports have demonstrated the benefits of neoadjuvant chemotherapy with outcomes of fewer cases of recurrence and better event-free and overall survival when compared to conventional management protocol. We advocate that such modality of treatment be adopted in resource-poor nations to reduce the burden of disease and its attendant complications. Case Summary: A 23 month old female presented in our hospital with complaints of an 8-month history of a sacral mass, urinary retention and difficulty in passage of stool. Following investigations, a diagnosis of malignant type II Altman sacrococcygeal teratoma was confirmed. Overall management consisted of two intermittent surgeries followed by a four-cycle course of platinum-based che-motherapy. A recurrence of the mass, a month after chemotherapy, complicated by urinary obstruction, hydronephrosis and acute renal failure ultimately led to the demise of the patient. Conclusion: A high index of suspicion of malignant sacrococcygeal teratoma should be made in infants and toddlers with complaints of a sacral mass and, or difficulty in passage of stool or urine. Neo-adjuvant chemotherapy may provide added benefits to improve overall survival in the management of this rare germ cell tumour. Keywords: Sacrococcygeal Teratoma; Alpha-Fetoprotein; Beta-Human Chorionic Gonadotropin; Neo-Adjuvant Chemotherapy; Plati-num-Based Therapy; Resource-Poor Nations; Childhood Tumours
111 Paediatric OPD and Immunization Services during Corona Pandemic , Vithalrao P Dandge.
Acta Scientific PAEDIATRICS (ISSN: 2581-883X) Volume 4 Issue 4 April 2021Paediatric OPD and Immunization Services during Corona PandemicVithalrao P Dandge*Sr. Consultant Paediatrician and Neonatologist, Formerly Professor and HoD Paediatrics, TNMC Mumbai and NKPSIMS, Nagpur, Maharashtra and Formerly Dean RDGMC, Ujjain and RIMS Medical College, Raipur, Chhattisgarh, India*Corresponding Author: Vithalrao P Dandge, Sr. Consultant Paediatrician and Neonatologist, Formerly Professor and HoD Paediatrics, TNMC Mumbai and NKPSIMS, Nagpur, Maharashtra and Formerly Dean RDGMC, Ujjain and RIMS Medical College, Raipur, Chhattisgarh, India.EditorialReceived: February 16, 2021Published: February 27, 2021© All rights are reserved by Vithalrao P Dandge.The most affected population during COVID-19 pandemic in In-dia and other developing countries is that of child population. As soon as the lockdown was announced in March 2020, the outpa-tient services for children in Government, Semi-Government and Private Sector were severely affected.
112 Children with COVID-19 Like Symptoms in Italian Paediatric Surgeries: The Dark Side of the Coin , Gianfranco Trapani, Vassilios Fanos, Giulia Maiocco, Chiara Peila, Enrico Bertino, Osama Al Jamal, Michele Fiore, Vincenzo Bembo, Domenico Careddu, Lando Barberio, Luisella Zanino and Giuseppe Verlato.
Introduction:Symptoms of SARS-CoV-2 infection in children are nonspecific and shared with other common acute viral illnesses (fever, respiratory or gastrointestinal symptoms and cutaneous signs), thus making clinical differential diagnosis tricky. In Italy, first line management of pediatric care is handed over to Primary Care Pediatricians (PCPs), who were not allowed to directly perform diagnostic tests during the recent COVID-19 outbreak. Without a confirmatory diagnosis, PCPs could only collect information on “COVID-19 like symptoms” rather than identify typical COVID-19 symptoms. Aim: To evaluate the prevalence of COVID-19 like symptoms in outpatient children, during Italian lockdown. To provide PCPs a risk score to be used in clinical practice during the differential diagnosis process.
113 X Linked Agammaglobulinemia with a Novel Genetic Mutation in the BTK Gene , Maryam Alsada and Khadija Abdool Abdelbary.
AbstractX-linked agammaglobulinemia (XLA) is an X-linked inherited disease caused by a germline mutation in the BTK gene leading to Bruton’s tyrosine kinase deficiency, which results in failure of B lymphocyte precursors to mature into B lymphocytes and ultimately plasma cells. This in turn will cause severe deficiencies in all types of immunoglobulins and therefore increased susceptibility to various bacteria and viruses. There are many pathogenic variants in the BTK gene that have been linked to XLA, with members in the same family showing heterogeneity. Here, we describe a case of a 22- month-old boy with XLA who was found to have a Novel genetic mutation in the BTK gene. We will investigate the various mutations described in XLA and genotype-phenotype correlations. Keywords: Primary Immunodeficiencies (PID); X-Linked Agammaglobulinemia (XLA)
114 Does Online Teaching Matters the Affective Learning Domain of Children , Ghulam Mustafa Rajput.
t is universal truth that the child education has remained the one of the main concerns for parents and is believed as the guaran-tor for the welfare of human being. For the deliverance of standard education the importance of ap-propriate environment is as compulsory as the course syllabus or curriculum. Covid-19 has affected the world economy, health status and the education of the children in particular is being compromised. It is well proved by various resources of media that show of cov-id-19 pandemic, the mindset of children for the education has been declined reasoning the closures of schools in this viral scenario.  
115 Henoch Schonlein Purpura as Possible Sole Manifestation of Covid-19 in Children , Sarah Falou, Ghina Kahil, Bassem Abou Merhi, Rouwayda Dana1and Imad Chokr.
Coronavirus disease-19 (Covid-19), which was isolated for the first time in Wuhan China, in December 2019 is an ongoing global pandemic caused by theSARS-CoV-2, a single-stranded RNA virus from the Beta-Coronaviridae family. Common presentation in-cludes respiratory symptoms ranging from a mild common cold-like illness to severe pneumonia. However, covid-19 infection exhib-its also extrapulmonary manifestations, including cardiac, dermatological, thrombotic and hepatocellular symptoms that have been increasingly reported in the last few months. Purpuric lesions have been suggested to occur more frequently in elderly patients with severe Covid-19, likely representing the cutaneous manifestations associated with the highest rate of Covid-19 related mortality. Besides, Henoch-Schonlein Purpura (HSP) is the most common form of vasculitis in children that affects several systems. It can occur secondary to upper respiratory tract infections, medications, vaccinations and malignancies. We describe herein, a case of an 8-year-old boy who presented with inability to bear weight and purpura, clinically diagnosed as Henoch–Schonlein Purpura vasculitis (HSP) with concurrent Covid-19 infection confirmed by positive PCR on nasopharyngeal sample. This case highlights a newly described presentation of Covid-19 infection. Keywords: COVID-19; Henoch-Schönlein Purpura (HSP); Arthralgia; Inability to Bear Weight
116 PICU Admission in an Asthmatic COVID Positive Child: Case Report , Sarah Falou, Ghina Kahil, Batoul Kawtharany, Samar Dalle, Zahraa Slim, Ali Jibbawi, Imad Chokr, Nawfal Nawfal, Lea Chokr1and Rabab El Hajj.
The current pandemic of COVID 19 infection globally has been associated with a variety of pediatric presentations. Children have been relatively spared from severe COVID-19-related illness. Early reports suggest that most children infected with severe acute respiratory syndrome coronavirus 2 (“SARS-CoV-2”) are usually asymptomatic, or have mild symptoms, and do not require hospitalization. What is not known is whether children with chronic respiratory illnesses have exacerbations associated with SARS-CoV-2 virus. We present an asthmatic 11-year old boy with cough, fever, and dyspnea. Reverse transcription (RT) polymerase chain reaction (PCR) confirmed COVID-19 on a nasopharyngeal sample. Ct scan chest revealed multiple bilateral diffuse ground-glass infiltrates severe in extension suggestive of COVID-19 pneumonia. His hospital stay was complicated with superinfection and severe respiratory distress that necessitate transfer to PICU with requirement of high flow nasal cannula with non-rebreather face mask in addition to asthma treatment. COVID-19 may present with mild pneumonia in children or with an exacerbation of asthma in asthmatic children. Based on an extensive search of the literature to identify children with asthma who have contracted SARS CoV-2 infection, there were a very limited number of pediatric studies that reported specific pediatric asthma and COVID-19 data. Keywords: COVID-19; Asthma; Pneumonia; Respiratory Distress; High Frequency Nasal Canula
117 Impact of Coronavirus Lockdown on Preterm Deliveries , Rafia Gul, Mussab Ahmad, Zahid Anwar, Fouzia Hasnain, Furqan Saleemn and Faiza Yaseen.
Introduction: The COVID- 19 global pandemic has impacted all domains of our sphere. WHO recommended mitigation measures to avoid its spread and lock down was one of these. The impact of lock down on perinatal period has been elucidated in different settings. During lockdown period, a varied outcome has been reported as, reduction in number of premature birth, an increase in still births as well and reduction in child birth rate. To our knowledge, such local data is lacking. We wished to study this impact in resource limited country. Objective of this Study: To document the impact of Corona-Virus lockdown on preterm deliveries. Methodology: A retrospective cohort study was conducted in Fatima Memorial Hospital, Lahore, Pakistan. Data of live births was col-lected from Fatima Memorial Hospital and Sir Ganga-Ram Hospital, Lahore, Pakistan. Analysis for live births using Microsoft Excel to calculate total number and percentages for all term and preterm deliveries (34-36+6 weeks, 28-33+6 weeks and less than 28 weeks) during Corona Virus lockdown calendar months (March - August) in 2020, 2018, 2019 and mean of aggregated period 2018-19. We calculated p value odd ratio (OR) and 95% confidence intervals for comparable gestation groups. The p value < 0.05 was considered statistically significant. Results: There were 37679 live births at FMH and SGRH from March to August calendar months during 2018 - 20. Data analysis shows that statistically significant number of preterm were born in 2020 as compared to mean of this aggregated period (2018-19) at FMH (p = 0.015, OR 0.86 and 95% CI 0.85 - 0.88), SGRH (p =0.00, OR 1.23 and 05% CI 1.22 - 1.24) and for combined data as well (p = 0.00, OR 1.19 and 95%CI 0.89 - 0.93). Moreover, neonates born at gestational age <28 weeks was statistically significant as compared to mean of aggregated period as FMH (p = 0.00, OR 1.92 and 95% CI 1.72 - 3.05), SGRH (p =0.04, OR 1.42 and 05% CI 1.34 - 1.98) and for combined data as well (p = 0.00, OR 1.36 and 95%CI 1.31 - 1.79) (Table 2). Conclusion: During corona virus lockdown 2020 (March - August) an incremental trend towards preterm deliveries (17%) espe-cially of gestational age <28 weeks (about 57%) has been documented. Possible link between premature birth and antenatal care during lock don period require further research. Keywords: COVID-19; Preterm; Antenatal Care; Lockdown; Pregnancy
118 Trichobezoar Intestinal Obstruction: Rapunzel Syndrome , Daniel López H and Jessica Franco F.
Rapunzel syndrome is a rare condition, more frequently found in young females and associated with trichotillomania, trichopha-gia and psychiatric disorders. It is due to the development of a trichobezoar composed of hair, located in the stomach and extending into the duodenum. We present a case of a 16-year-old female adolescent with a history of depression and trichotillomania; with regurgitation, heartburn and epigastralgia of 3 months of evolution, and recent vomiting, associated with a mass in the epigastrium extending to the left hypochondrium, adherent to a deep plane, painful on palpation. Upper gastrointestinal series with barium was compatible with bezoar and confirmed with an upper endoscopy where hair occupying the stomach up to the pylorus and duodenal bulb was evidenced, consistent with gastroduodenal trichobezoar. Laparotomy was performed and the trichobezoar was extracted from the entire gastric chamber and pylorus without complications, and the patient remains in control with psychotherapy. The objective of this work was to demonstrate that upper gastrointestinal endoscopy and laparotomy are the diagnostic and treatment methods of choice, respectively, in Rapunzel Syndrome. Keywords: Intestinal Obstruction; Trichobezoar; Trichophagia; Depression; Rapunzel Syndrome
119 Meconium Aspiration in a Tertiary Hospital in Southern Nigeria: Incidence, Treatment and Outcome , Nyong EE1, Oloyede IP, Motilewa OO and Ebiekpi IU.
Background: Children with meconium aspiration syndrome (MAS) are at risk of long-term respiratory and neurodevelopmental morbidity and mortality. A reduction in the risk factors and appropriate management of MAS can lead to improved survival. Objective: To determine the incidence, treatment and the outcome of meconium aspiration syndrome among neonates in Uyo. Methods: Case notes of neonates who had meconium aspiration, between 2010 and 2019, were retrieved. Information extracted were the age at presentation, gender, weight on admission, maternal and paternal demography, diagnostic criteria, treatment and outcomes. Results: A total of 45 (0.57%) out of 7845 admissions were diagnosed with MAS. The median age on admission was one hour, with a male preponderance (54.1%). Forty-four (97.8%) of our patients had a gestational age above 37 weeks. Thirty (66.6%) mothers and 32 (71.4%) of the fathers had at least secondary level of education. Forty-two (93.3%) children with MAS, were born through thick meconium (93.3%), 20 (44.4%) neonates had mild Oxygen requirement, 43 (95.6%) neonates developed respiratory distress at <24 hours of life, and 36(80%) of the neonates were born to booked mothers. Forty-two (93.3%) of children with MAS received oxygen and antibiotics respectively. Delivery via caesarean section had a positive correlation with fetal hypoxia in MAS. Forty-one (91.1%) of children with MAS were discharged. The case fatality rate of MAS in our series was 6.7%. Conclusion: The incidence of MAS, in our study is low, however the case fatality rate is still high. There is need to provide more tech-nologically advanced treatment options for MAS in our tertiary institutions in order to reduce to the barest minimum the long-term morbidities and mortality associated with severe MAS. Keywords: Meconium Aspiration Syndrome; Treatment; Outcome; Nigeria
120 Socioeconomic and Behavioral Conditions, Acess and Use of Dental Health Services by People with Autism Spectrum Disorder (ASD) in the City of Salvador, BA, Brazil , Ednaldo de Jesus Filho, Tatiana Frederico de Almeida, Sandra Garrido de Barros, Maria Isabel Pereira Vianna and Maria Cristina Teixeira Cangussu.
Aim: To characterize the socioeconomic, behavioral status, acess and use conditions of dental care services of people with ASD (Au-tism Spectrum Disorder) living in Salvador. Methods: This is a descriptive observational cross- sectional study. A sample of 70 caregivers of people with ASD was recruited from two Child Psychosocial Assistencial Centers (CAPSi) and in a special Educational Service Center (Pestalozzi Bahia) in the city of Sal-vador, state of Bahia, Brazil in 2019. Caregivers were interviewed individually by the principal researcher. Data collection was typed in the Excel®. Then, a descriptive analysis of the variables was performed in MINITAB 17. Results: Mothers were the main caregivers of people with ASD (88.4%). The majority (69,12%) stated that found it difficult to pro-vide dental care. Unsuccessful appointment scheduling was the barrier most highlighted by caregivers (52,12%). Among people with ASD, only 21.43% would be independent for oral hygiene actions. Some factors were uncomfortable, such as noise (71.43%) and a light source (67.14%). On the other hand, the white coat generated discomfort in only 38.57%. Conclusions: Most people with ASD had difficulties in accessing public dental care. Although oral problems are not so different from people with typical development, people with ASD must take a different approach. In the city of Salvador is necessary to structure and publicize public places for dental care of people with ASD. Public dental services must be able to welcome and extend the care and guidance to those caregiver for people with ASD. Keywords: Dental Health; Autism Spectrum Disorder (ASD); Salvador
121 A Case Report of Morphea in a 2 Years Old Child , Edwin Dias, Deepak K, Vijeta Rai and Sahithi Chapalamadugu.
Introduction: Morphea or Juvenile localized scleroderma is an autoimmune, inflammatory, chronic, slowly progressive connective tissue disease of unknown cause that preferably affects skin and underlying tissues, ultimately leading to scar like sclerosis. The incidence of Morphea ranges from 0.4 - 2.7 cases per 1,00,000 population. Treatment depends on disease subtypes, depth of involve-ment, stage and potential for complication. Objective: To report a case of juvenile localised scleroderma in a 2 years old male baby. Clinical Case: The case to be presented is of a 2 year old male child who had presented with multiple thick hypo pigmented patches of varying size over abdomen and scalp. Child had developed itchy white patch over 3 months duration, with the largest one measur-ing 8 cm x 10 cm.Topical steroid was initially prescribed, which was stopped after a week as there was no improvement and itching was persisting. Symptom of pruritis increased gradually over the lesions and resulted in excoriations, self-mutilation and bleeding. Similar com-plaints were present 6 months prior, which subsided on its own. Immunized as per age. Developmental milestones were appropriate for age. No similar history in the family members.Biopsy was done and diagnosed with Morphea. Initially patient was treated with topical steroids and topical tacrolimus, for a period of three weeks, which showed no improvement. Conclusion: Although Morphea causes functional and aesthetic impairment, but it is rarely life-threatening. Morphea may be self-limited, but frequently has a remitting relapsing or chronic course producing significant disease burden over time. The final response to the treatment was positive in this patient. Keywords: Morphea; Localized Scleroderma; Hypo Pigmented Patch; Alopecia; ANA Profile
122 Acute Diarrhea and Types of Dehydration in Libyan Children , Aisha A Sehari, Abdulrahman Ali Baitalmal and Ashraf M Ayad.
Acute diarrhea is a leading cause of illness in developing countries. About seventeen of per cent Libyan children suffer from diarrhea. Diarrhea causes about 12% of mortalities in children aged 0 - 5 years. The aim of this study is to estimate to estimate the types and the degree of dehydration and to find out the correlation between types and degree of dehydration and contributing risk factors. Seasonal variations were studied also. A retrospective study was done on all children patients admitted to Tripoli pediatric hospital during the year 2006 (from 01/01/2006 to 31/12/2006) complaining of acute diarrheal diseases, age group (one month to 60 months), with exclusion of bloody diarrhea. All the cases were evaluated for their clinical presentation and laboratory results. The results of the study was summarized as following: total were 675 admitted patients diagnosed as acute diarrhea which was (14.91%) out of the total admission (4526 patients) to this hospital during that year. 408 males, accounts for (60.44%), females were 267 pa-tients (39.56%). Moderate dehydration was the commonest type of dehydration (374 patients = 55.44%), followed by severe type (239 child = 35.4%) the least was mild dehydration (62 patients = 9.2%). Regarding the types of dehydration isonatremic dehydra-tion was the commonest (458 patients 67.85%), followed by hypertonic dehydration (121 patients = 17.93%), the least was hypo-natremic type (96 patients = 14.22%). Out of these children patients 8 children died (1.19%) due to complication of acute diarrhea except one child who got other major contributing cause of mortality. The peak of the acute diarrheal disease in this studied group was during winter and spring (months 2, 3, 4), total patients were (276 child 40.89%), Low incidence was reported during summer and early autumn (113 child 16.74%).So, we can conclude from our study that acute diarrheal diseases is a common problem and a common cause of emergency admis-sion to hospitals, especially those with moderate isotonic dehydration followed by severe isotonic type. Mild hypernatremic dehy-dration was the least. Dehydration is a major risk factor especially in association with other significant illness. A lower incidence of hypertonic dehydration was reported in this study compared with our previous one.We recommend that more orientation about mild hypertonic dehydration clinically.Further studies are required to identify the etiologies of diarrhea in Libyan children especially during the peak seasons and their complications.The value of ROTA virus vaccination is still to be further evaluated by multicentre studies. Keywords: Acute Gastroenteritis; Dehydration; Risk Factors
123 The Effect of Kangaroo Mother Care on the Morbidity and Mortality of Low Birth Weight Babies Admitted in Gov. Celestino Gallares Memorial Hospital , Mitzi Avis G Panuda, Anabella S Oncog and Maribeth M Jimenez.
Objective:To determine the effect of kangaroo mother care (KMC) on the morbidity and mortality of low birth weight babies admit-ted in Gov. Celestino Gallares Memorial Hospital. Methodology: This is a descriptive retrospective study of all neonates with birthweights < 2000 grams born from January 1, 2010 to December 31, 2013 (pre-KMC) and from January 1, 2015 to December 31, 2018 (post-KMC). The study proposal was duly approved by the hospital IRB. Data were gathered from the delivery book in the hospital delivery room, KMC logbook, and the patient’s chart in the Medical Records Section. Statistical analysis was done using descriptive statistics, chi-square test and Mann Whitney U test generated from SPSS version 20.0. Results:There was a higher incidence of low birth weight infants in the pre-KMC period than in the post-KMC period. Preterm births account for approximately 2/3 of all low birth weights in both groups. More infants weighing < 1000 grams were born in the post-KMC period. More infants in the post-KMC period stayed in the hospital longer (x2 = 58.67; df = 4; p < 0.001), have bigger discharge weights (x2 = 66; df = 4; p < 0.001), higher weight gain (p < 0.006) and improved outcome (x2 = 13.17; df = 2; p = 0.001). There was no significant difference in the proportion of infants according to cause of mortality between the two groups (x2 = 5.00; df = 4; p = 0.29). Conclusion:Kangaroo mother care in Gov. Celestino Gallares Memorial Hospital results in higher proportion of infants who are dis-charged improved and with weights more than 2000 grams; however, infants who received KMC stay in the hospital longer than those infants who are not managed with KMC. The incidence of sepsis as the cause of death is not reduced by KMC. Keywords: Low Birth Weight; Gov. Celestino Gallares Memorial Hospital; Kangaroo Mother Care (KMC)
124 A Study on Incidence, Risk Factors and Clinical Profile on Retinopathy of Prematurity in Preterm Babies , Chaya K A and Prakash K Wari.
Introduction:Retinopathy of prematurity (ROP) is a multi-factorial vasoproliferative retinal disorder. Prematurity being the im-portant consistent risk factor for the development of ROP, along with other risk factors like - low birth weight (LBW), very low birth weight (VLBW), extremely low birth weight (ELBW), unmonitored oxygen therapy, sepsis, apnea, blood transfusion, babies on me-chanical ventilation for longer duration [1]. Infants with birth weight < 1,250 grams (g) have 65% risk of developing ROP and 80% of those with birth weight < 1,000g [8]. Objective: Preterm babies are acutely vulnerable requiring special care to remain alive. Retinopathy of prematurity is an important complication in premature babies. Objective was to study the incidence, risk factors and clinical profile of retinopathy of prematurity in preterm neonates admitted to NICU of KIMS, Hubli. Materials and Methods: Hospital based, prospective clinical study was carried out for one year on neonates born with gestational age ≤ 35 weeks or birth weight ≤ 2000 grams during study period. They were examined by indirect ophthalmoscopy between 3 to 4 weeks after birth and followed up till retinal vascularization was complete. Antenatal and neonatal risk factors were noted. Data analyzed by using IBMSPSS20.0. Results: Hospital based, prospective clinical study was carried out for one year on neonates born with gestational age ≤ 35 weeks or birth weight ≤ 2000 grams during study period. They were examined by indirect ophthalmoscopy between 3 to 4 weeks after birth and followed up till retinal vascularization was complete. Antenatal and neonatal risk factors were noted. Data analyzed by using IBMSPSS20.0. Conclusion: Meticulous fundus examination with indirect ophthalmoscopy in all preterm babies with gestational age < 35 weeks and birth weight < 2000 grams will yield better detection of retinopathy of prematurity and prevents complications. Babies with antena-tal risk factors like multiple gestation and maternal anemia, events during NICU stay like development of sepsis, respiratory distress syndrome, apnea and oxygen therapy should be closely monitored for development of ROP. Existing non-invasive and cost effective measures for early detection of ROP should be utilized. Keywords: Preterm; Retinopathy of Prematurity; Respiratory Distress Syndrome; Sepsis; Oxygen Therapy; Premature
125 Epidemiological and Clinical Profile of Non COVID 19 Patients Admitted to Pediatric Intensive Care Unit of a Tertiary Care Referral Centre during Covid 19 Pandemic , Shalini GN, Isha Deshmukh, Rajesh Kulkarni and Aarti Kinikar.
To study the impact of lockdown during the corona virus disease 2019 pandemic, considering the limited healthcare and trans-port facilities while reaching the tertiary care hospital.It was a hospital based; observational study done over a period of 12 month consisting of pre lockdown period (December 2019 to March 2020), Lockdown (April 2020 to June 2020) and post lock-down (July 2020 to November 2020) period data of COVID-19 negative reported children admitted to pediatric intensive care unit (PICU).Out of 1019 enrolled children, total number of admissions prior lockdown was 534, during lockdown 240 and post lock down 243. Admissions from rural was significantly less during lockdown i.e., urban =80% and rural=20% whereas prior lockdown 56% from urban and 44% from rural Pune. Percentage of male children admitted was significantly more during lockdown compared to prelock-down (62.3% male and 37.7% females). The mortality rate was 6.7% and discharge against medical advice rate was significantly high during lockdown compared to pre- and post-lockdown.Our study has shown that covid-19 pandemic has strongly affected the number of PICU admissions, pattern of diseases, require-ment of ventilatory support and mortality. Provision for good healthcare transport facility and availability of primary and routine health care facilities may have led to good outcome of PICU hospitalizations in terms of recovery and mortality. Keywords: COVID 19; Pediatric Intensive Care Unit (PICU); Health Care
126 Addressing Gaps in Management of Down Syndrome (Trisomy 21) , Abdul Halim Abdul Jalil.
Down Syndrome is the most common and best known chromo-somal disorder with an incidence of 1:600 live births. It is a disor-der of the whole body involving abnormalities in physical, mental development, accompanying immune weakness and hormonal dysfunction.
127 Transfusion in Pediatric Surgical Settings: Economic Aspects and Hospitalization Costs , Claudine Kumba.
Background:An observational study published in 2017 revealed transfusion as one of the predictive factor of outcome in surgical children in terms of organ dysfunction, length of intensive care unit stay, length of hospital stay and length of mechanical ventilation. Transfusion can be a necessity and life-saving interventionin patients. Balancing the benefits and risks of this therapeutic interven-tion is mandatory to improve patient outcome. Patient blood product management protocols reduce transfusion needs and length of hospital stay. A second analysis was undertaken to determine hospitalization costs in transfused and non-transfused patients in the observational study in children published in 2017. Objectives:To determine the hospitalization costs of transfused and non-transfused patients of the observational study in 594 pedi-atric neurosurgery, abdominal and orthopedic surgery patients published in 2017.Methods: Second analysis of the database of 594 pediatric surgical patients of the observational study published in 2017. Results: Median total hospitalization costs in transfused patients were significantly twice higher {32041.97 euros [13983.82-59003.59]} than in non-transfused patients {14084.45 euros [8551.2-29124.55]}, p < 0.0001. Keywords:Transfusion; Pediatric Surgical Settings; Hospitalization Costs
128 Principles of Management of Wilms’ Tumor in Resource Challenged Nations , Vivek Gharpure and Ketaki Gharpure.
Wilms’ tumor is a common malignancy in childhood and poses special challenges in resource challenged nations. The protocols of treatment remain same in principle, and yet some modifications are needed to suit special circumstances. Lack of radiotherapy in many areas, lack of dedicated pediatric medical oncology services in most centres special pose a significant challenge. However, following SIOP framework for LMIC countries, many such challenges can be tackled successfully. Keywords: Wilms’ Tumour; Nephroblastoma; Pediatric Solid Organ Malignancy; Renal Cancer
129 CHPS (Congenital Hypertrophic Pyloric Stenosis) , Ajit Sahay.
One 34 weeker male child born by IVF aged 29 Days presented in my OPD at Santevita Hospital on 29 Nov 2020 with complaints of crying and repeated vomits for past 1 day and similar history previously as well. Suspecting Urinary Tract Infection and in back of mind CHPS, I ordered • Urine routine examination and USG abdomen. • Surprisingly both were reported normal. So, I assumed as a case of aerophagy and kept the child in obser-vation in OPD basis. The same day evening the child had repeated vomiting and was admitted at Rani Hospital. A repeat USG was done and CHPS was confirmed.
130 Gain of Function/Loss of Sanity: Pandemics and the Rise of Medical Madness , K Paul Stoller.
Gain of function research in infectious disease is nothing new to the halls of “science.” Perhaps, the most infamous example, albeit far from being openly acknowledged, is the HIV virus, which I as-sume was a very big disappointment to its creators as it took so long to kill its victims. Yes, the eugenicists among us have been up to mischief for a very long time. Before HIV is the even less known manipulation of the Borrelia bacteria (Lyme disease) as it was made more virulent in the hopes it could be a bio-weapon. Be that as it may, never before has humanity been subjected to the global destabilization program that COVID caused.
131 Re-Emergence of Meningococcal Meningitis W135 in Togo: Description of the Epidemic in Children. , Foli Yvon Agbeko, Mawouto Fiawoo, Magnoulelen Nzonou, Mawaba Peleke Hilim, Bawoubadi Wangala, Manani Hemou, Fidèle Comlan Dossou, Sollim Talboussouma, Rachel Bayahou Kérékou, Homba Daké Batalia, Rollin Arnaud Djomaleu, Kokouvi Evenyo Abalo, Mazama Pakoudjaré, Edem Koffi Djadou1, and Komi Assogba.
Background:Epidemics of meningococcal meningitis are common in several african countries, including Togo. In northern Togo, part of the “meningitis belt”, the A and C serogroups was the primary causal agents. The objective of this work was to estimate fre-quency of acute bacterial meningitis (ABM) in childhood in hospital admissions during the 2016 epidemic in Togo, to describe clinical and bacteriological features, and to measure the extent of meningococcal serogroup W135 among children. Methods: This is a cross-sectional, multi-centre study, carried out among children aged 0 to 15 years, hospitalised for ABM between 1st January and 31st March 2016 in the four district hospitals of the Central Region in Togo. The operational case definitions are taken from the WHO reference document. Results: The overall hospital frequency among children was 4.80% for suspected meningitis case, 2.86% for probable cases and 1.55% for confirmed cases. Children (0 - 15 years) accounted for 63.60% of patients hospitalised for ABM. The M/F sex ratio of chil-dren was 1.42 and the mean age was 6.51 years (7 days - 15 years) with 59.56% (81/136) beyond to 5 years. The hospitalisations occurred in February-March (97.1%). Chief presentation was high fever (77.20%) and headache (39.97%). Meningeal signs were present in 51.97%. Apart from the negative results (59.26%) on direct examination of the cerebrospinal fluid (CSF), meningococcus was the confirmed germ in 90.91%. The serogroup W135 was isolated in 55.00% and the serogroup A in 32.50%. The overall case--fatality rate was 9.55%. Conclusion: Meningococcus W135 was the agent responsible for the 2016 epidemic in Togo. Children were mostly affected. The tetravalent meningococcal A+C+Y+W135 vaccination should be instituted in Northern Togo, primarily in children under 15 years of age. Keywords: Meningitis; Neisseria meningitidis; W135; Children; Togo
132 Pattern of Neonatal Surgical Admissions in University of Uyo Teaching Hospital (UUTH), Uyo. , Eno Etim Nyong, Usen Effiong Uwah, Jacob Jackson Udoh, Paulinus Umoren Essien and Kingsley Irelosen Akhimeinho.
Background:Surgery in the newborn period is a significant contribution to the specialty of Paediatric Surgery and this involves the surgical management of some of the congenital conditions which form the bulk of these neonatal surgical conditions. The pattern of these surgical presentations has not been documented in Akwa Ibom State. Objective: To describe the pattern of neonatal surgical admissions seen in the early years of existence of the University of Uyo Teach-ing Hospital, Uyo. Subject and Method:A retrospective study of sixty-nine neonatal surgical cases seen over the first five years of existence of this hospital (2002 - 2006) was done. The information on age of admission, sex, weight, diagnosis, etc. were obtained from the admission register and case files. Results:Eighty-nine (89.86%) of the cases were outborn. The mean age of presentation was 6.67 days. The male: female ratio was 1:5:1. Thirty (43.8%) were discharged while thirteen (18.84%) died. Of those who died, omphalocele constituted the highest mortal-ity of 53.85% while spina bifida constituted the highest percentage among those who were referred (40%) and amongst those who “left against Medical Advice” (31.25%). Conclusion: It is anticipated that with the growth of the hospital, improved neonatal facilities, more paediatric surgeons, avail-ability of neonatal intensive care unit and a neurosurgeon, the outcome will improve as better peri-operative care, better trained inter-related sub-specialists, better imaging and laboratory facilities are desirable to enhance the outcome and survival in neonatal surgery here. Keywords: Admissions; Congenital; Neonatal; Surgical
133 A Case Report of Meconium Plug Syndrome with Intestinal Obstruction in a SGA, Preterm 34 Week Gestation Baby , Edwin Dias, Shwetha P N, Vinod Prem Singh and Kiran Raj H.
Introduction: Meconium plug syndrome is most commonly seen in sick, premature infants and those having small left colon. Inci-dence of meconium plug syndrome ranges from 0.5-1 case per 500 live-births. Clinically, presents with inability to pass meconium, distended abdomen, vomiting. Objective: To report a case of meconium plug syndrome in a Small for Gestational Age (SGA), preterm baby. Clinical Case: The case to be presented is of a SGA, preterm boy baby who had presented at 24 hours of life with abdominal disten-sion and not passed meconium since birth. Abdominal x-ray suggestive of dilated bowel loops with no air fluid levels. Treated by suppository and rectal thermometer passed cautiously at 72 hours of life, following which thick gelatinous mucoid material -meconium plug was expelled out. On day 4 of life, baby still did not pass meconium. Hence, nasogastric tube was inserted per rectally and bowel wash was given. About 30ml of meconium was aspirated. Abdominal distension gradually reduced. On day 5 of life, baby passed about 5ml of well-formed meconium followed by normal passage of meconium. Conclusion: Meconium plug can be relieved by glycerin suppository. Rectal irrigation with pre-warmed 0.9% normal saline may also help in relieving meconium plug. Contrast enema helps in delineating the meconium plug as well as to relieve obstruction, therefore acts as both diagnostic and therapeutic tool. The overall outcome of the baby for the treatment provided was positive and child im-proved symptomatically. Keywords: Meconium Plug Syndrome; Hirschsprung’s Disease; Cystic Fibrosis; Glycerin Suppository; Contrast Enema
134 A Comparative Analysis of the Serum Electrolytes, Urea and Creatinine Profile of Children on Diuretic Therapy for Cardiac Anomalies-related Heart Failure. , Petronila Tabansi and Onubogu UC.
Introduction: In Nigeria, children with acquired and congenital heart diseases (CHD) lack timely access to corrective surgeries due to scarcity of cardiac surgical centers and high cost of care; hence they are placed on diuretic therapy for prolong periods for symp-tomatic relief of the ensuing heart failure. Electrolyte imbalances such as hypokalemia and hyponatremia are known complication of diuretic therapy and have an adverse effect on morbidity and mortality of these children. Considering the risk posed by diuretics, and the inherent risk for renal injury due to hypoperfusion from heart failure, it becomes imperative to monitor their electrolyte, urea and creatinine levels for early intervention and a better outcome. Aim: To determine the serum electrolytes, urea and creatinine values of children with cardiac pathologies in heart failure and make comparison with healthy controls. Methodology: This was a prospective case-control study of children with cardiac pathologies on diuretic therapy for heart failure and their age and sex matched healthy controls. Biodata, echocardiography diagnoses and blood samples for serum electrolytes, urea and creatinine were obtained and comparison made. Results: There were 83 (50%) Subjects and 83 healthy Controls with age range from 2 days to 16 years. Majority of the study popu-lation were less than 1year of age. Acyanotic CHD was the commonest cardiac pathology detected in 55 (66.3%), while acquired heart diseases constituted 3.6% of cases. Subjects had significantly lower levels of sodium (p = 0.0001), potassium (p = 0.0001) and bicarbonate (p = 0.004); and higher levels of urea (p = 0.014) and creatinine (p = 0.002). Among Subjects, the Mean sodium and bicarbonate levels were lowest in those with cardiomyopathies while Mean potassium level was lowest in those with cyanotic CHD. There were significant intergroup differences in Mean serum creatinine (p = 0.000). Conclusion: Children on diuretic therapy for heart failure had comparatively lower levels of serum electrolytes, urea and creatinine. Keywords: Cardiac Pathologies; Diuretics; Heart Failure; Serum Electrolytes; Urea and Creatinine
135 Study of Knowledge, Attitude, and Practice Regarding COVID-19 to Improve Safety Practice among Health Care Workers. , Safaa ELMeneza and Amel Gaber
Background: Healthcare workers are more vulnerable to COVID-19 infection both physically and psychologically. Aim: The aim of this study was to estimate the gap in the knowledge, attitude and practice of the HCWs regarding COVID-19 in order to improve safety care and promote focus training to protect HCWs from adverse events /infection. Methods: A cross sectional survey was applied from May 2020 to July 2020 involving 127 health care workers from Al-Zhraa Uni-versity hospital. Results: The highest response rate to survey was from nurses (51.97%), 37% of the respondents had 3-9 years of experience. Edu-cational status varied from diploma of nursing in 44.1% to MD in 11.8%. There was association of knowledge with education, years of experience, female gender, work in frontline, and non-overworked. P values were < 0.00001, 0.0017, 0.019, < 0.00001 respectively. Fear was recorded among 81.10% and 55.9% had confidence in defeating COVID-19 virus. Practice were assessed through seven items. Maintained quarantine with family was reported among 74.8%, 29.92% did not receive training for COVID-19 infection pre-vention. 52.76% did not follow protocols to deal with PPE, 97.63 wear mask when contact with patient, 81.1% was refrained from shaking hands and 55.9% avoid patients with signs and symptoms suggestive of COVID-19. Conclusion: HCWs of AL-Zhraa University hospital had significant knowledge, attitude and positive practice to COVID-19. However, residents need focused on job training regarding mode of infection of COVID-19, use of PPE and apply suitable PPE for the provided care. Keywords: KAP Study; Patient Safety; COVID-19; Health Care Workers
136 Perinatal Testicular Torsion; Understand the Urgency and Tactis , Muhammed Riaz ul Haq.
Testicular torsion in the newborn was first time reported by Taylor in 1897. But it took a long time for it to be known as a vas-cular emergency that needs immediate diagnosis and urgent sur-gery. Neonatal testicular torsion also known as perinatal testicular torsion (PTT) has significant controversies regarding its etiology, presentation, surgical management and outcome.
137 The Relationship between Anemia in Pregnancy and the Demographic Variables among Pregnant Women Attending Antenatal Clinic at Diwan Polyclinic: A Cohort Study in Oman , Hind Alharassi, Nawal Alhadhrami and Zainab Al-Mukhaini.
Abstract Background: Pregnancy-related anemia is a serious health problem worldwide and carries high risk of morbidity and mortality for mother and fetus alike. No national data on anemia in pregnancy in Oman. Aim: This study is to explore the prevalence of anemia in pregnancy in Oman and its relationship to different demographic features to enable delivering optimum patient care. Design: A retrospective quantitative study conducted for a cohort of pregnant ladies attending Diwan polyclinic-Muscat in Sultanate of Oman in 2015 looking at the prevalence of anemia in pregnancy and its relation to obstetric (gravidity and parity) and non-obstet-ric (age, education, employment, adherence to iron supplementation, BMI, nutritional history) demographic variables. Method: A total of 1065 pregnant ladies attendee in year 2015. After identifying anemic ladies using WHO cut off point (Hb < 11.0 g/dL) at and after applying exclusion criteria (inherited blood disorder), the sample size was 169. Only 129 out of 169 were reached. Questionnaires were distributed to participants after gaining verbal consent. Part A was about personal demographic data and was completed by participants while part B was clinical demographic data and was completed by researchers. Results: Data was processed by SPSS (22). Average age was (29.45 ± 5.33). The prevalence of anemia was 16%. There was significant negative correlation between hemoglobin and gravidity ([r(129) = -0.312, P < 0.05) and between hemoglobin level and parity (r(129) = -0.287, P < 0.05) but no statistically significant relationship between hemoglobin level and other demographic variables. Conclusion: Prevalence of anemia in pregnancy is 16%. Gravidity and parity are significant factors leading to anemia in pregnancy. Keywords: Oman; Anemia; Pregnancy; Prevalence; Nutrition; Factors; Gravidity; Parity
138 Study on the Antibiotic Resistance of Streptococcus pneumoniae Strains Present in the Paediatric Population , Loredana Matei, Aurel Nechita, Irina Profir, Mihailov Oana Mariana and Anisoara Munteanu.
Background:Antibiotic resistance is an issue whose characteristics are always dynamic, being by definition a crisis in the medical world. Currently, the studies in the specialized literature confirm the need for comprehensive efforts to minimize the rate of microbial resistance to antibiotic therapy, by studying the emerging microorganisms and the mechanisms of resistance of antimicrobial agents. Method: Current research aims to analyzed the distribution of the incidence of Streptococcus pneumoniae detected over a year, focu-sing on the particular characteristics of this pathogen (sensitivity to antibiotics, but also resistance). Results: For the patients hospitalized during 2019 in “Sfântul Ioan” Emergency Clinical Hospital for Children in Galati, an average total number of 230.42 was detected, which is associated with a standard deviation of ± 55.348 strains. The analysis of bivariate correlations with Pearson index demonstrates by its sig values of <0.05 the existence of statistical significance between the seasonal predisposition of antibiotic sensitivities of Streptococcus pneumoniae strains, but also the correlations between sensitivity - resistan-ce for this pathogen. Conclusion: One of the most important current issues in the medical world is the increase in resistance of Streptococcus pneumoniae, the pathogen being one of the main causes of development of otitis, pneumonia, meningitis and even septic states. The antibiotic resistance of pneumococcus is increasing worldwide, documented in the case of beta-lactams and macrolides in the first place. Keywords: Streptococcus pneumoniae; Antibiotic Resistance; Sensitivity
139 COVID-19 in the Children: A Practical Review , Mohammad Ashkan Moslehi.
Abstract Since the outbreak of the new coronavirus infection in December 2019, the China epidemic situation has been initially controlled, but the situation is still grim globally. In this pandemic, compared with adult cases, children have relatively fewer cases, milder symp-toms with better prognosis. The spread of risks poses new challenges for approaching, prevention and treatment in the children. This review summarizes the early medical information in order to further guide the management of children with COVID-19 infection. Keywords: COVID-19; Children; Coronavirus Pneumonia
140 A Perspective in Antenatal Care: A Short Emphasis on Hydration, Essential Fatty Acids and Micronutrients , Mohammed Ayed Huneif and Ramadhan Oruch.
Antenatal care of women is a vital issue with regards to health promotion for forthcoming infants. This type of medical care should start before the onset of a pregnancy. Antenatal care facilitates early and continuous assessment of the potential health risks during pregnancy both for pregnant women and their fetuses. To achieve this, especially in primigravida women, a complete medical history should be recorded at the first prenatal visit. Control of chronic diseases such as diabetes, hypertension, and psychiatric ailments must be carried out.Healthy nutrition is important to re-enforce the immune system of pregnant women and thus aid their forth-coming infants to fight infection. The aim of this work was to pinpoint the significance of healthy nutrition to antenatal caregivers in different maternity stations, junior doctors at medical centers, medical and nursing students and also pregnant women per se. Keywords: Pregnancy; Antenatal Care; Lipids; PUFAs; Micronutrients; Fat Soluble Vitamins; Reactive Oxygen Species; Antioxidants; Neural Tube Defects
141 Recent Approaches in the Management of Difficult to Treat Asthma in Pediatric Population - A Brief Review , Edwin Dias and Shwetha N.
Introduction:Pediatric patients with difficult-to-treat asthma experience a heavy burden of exacerbations, symptoms, therapeutic failure, adverse drug reactions, and increased health care costs. Frequent cough, dyspnoea, chest tightness, and wheeze interfere with normal daily activities, sleeping, overall quality of life, and education of children. Difficult-to-treat asthma affects a small group of children with asthma but represents a challenging mix of misdiagnosis or incorrect diagnosis, multiple co-morbidities, severe air-way pathophysiology, inadequate self-management, and treatment complications. Thus management of such cases requires beyond pharmacotherapy of asthma because patient-related and disease-related domains need to be considered first. Therefore, prevention of asthma exacerbations is an essential goal in difficult-to-treat asthma therapy and requires more focused individualized treatment that involves the elimination of risk factors, treatment of co-morbidities, treatment with anti-asthmatics, and improving medication adherence. Methodology:A brief review of all the relevant standard articles was conducted. Result:The study involved a brief review on assessment of risk factors in the pediatric population with difficult-to-treat asthma and pharmacological management i.e. optimal use of long-acting muscarinic antagonist (tiotropium), and biological monoclonal antibody treatment (Omalizumab, Mepolizumab, Dupilumab, and Benralizumab) which were found to be safe and effective in the pediatric population. Conclusion:Management of difficult-to-treat asthma in the pediatric population requires the elimination of modifiable risk factors, treatment of co-morbidities, and treatment of exacerbations with newer agents which were found to be effective in reducing hospi-talizations and frequent Emergency Department visits. Thus individualized treatment must be preferred in these patients. Keywords:Difficult-to-Treat Asthma; Pediatrics; Risk Factors; Recent Approaches; Management  
142 Case Series of Holt Oram Syndrome , Chakradhar Maddela.
Pre-axial upper limb skeletal deformities involving thumb and radial bones are commonly associated with congenital cardiac defects. The common deformities are hypoplasia or aplasia of thumbs and radial bones. Skeletal involvement may be unilateral or bilateral. Atrial septal defect of ostium secundum is the most commonly associated congenital cardiac defect. Other possible cardiac defects are ostium primum variety of atrial septal defect, ventricular septal defects, patent foramen ovale and electric cardiac conduc-tion abnormalities. The incidence is 1 in 1,00,000 live births. This syndrome involves TBX5 gene defect on long arm of chromosome 12. The most common inheritance pattern is autosomal dominant variety. New mutations are common. Antenatal detection by mid-trimester anomaly scan is possible. Recently, we detected three cases of Holt Oram Syndrome at our health care facility during 2016 - 2019. These cases were pre-sented with full spectrum of skeletal and cardiac defects in one case, near total expression in one case and partial expression of physi-cal features in another case. Thumb abnormalities and cardiac defects involving atrial septal defect were found in all cases. All cases underwent second trimester anomaly scans but missed antenatal detection and lost potential antenatal counselling with parents. Keywords: Heart Hand Syndrome; Thumb hypoplasia; Atrial Septal Defect (ASD); Forearm Skeletal Defects
143 Main Clinical Sequels in Patients Affected by Covid-19: A Systematic Review , Lysandro Pinto Borges, Adriana Gibara Guimarães, Fernanda Camargo Mendonça de Araujo, Jessiane Bispo de Souza, Daniela Raguer Valadão Souza, Aline Fagundes Martins, José Melquiades de Rezende Neto, Luis Eduardo Cuevas and Ricardo Queiroz Gurgel.
In view of the appearance of several sequelae due to infection by COVID-19 and the need to seek knowledge about this new dis-ease, this review aimed to identify the main clinical sequelae in patients affected by COVID-19. The literature search was performed in the PubMed, SCOPUS, Web of Science and Science Direct databases and were included in a total of 16 studies. The main sequelae found were cardiac, neurological and pulmonary, other sequelae were also found such as kidney injury, gastrointestinal symptoms, joint pain, fatigue, excessive sweating and hair loss, however, in smaller proportions. These data provide a health team, during spe-cific treatments of COVID-19, to avoid these sequelae, enabling health professionals to develop new treatment strategies, as well as more assertiveness in the diagnosis and thereby optimize the survival of the patient. Keywords: COVID-19; Kidney Injury; Gastrointestinal Symptoms; Joint Pain; Fatigue
144 Double Burden of Malnutrition among Nepalese Ever Married Women: Findings from the Nepal Demographic and Health Survey, 2006, 2011, and 2016 , Ramesh Prasad Adhikari, Ajay Acharya, Keshav Prasad Adhikari and Nawaraj Upadhaya.
The double burden of malnutrition, or the co-existence of overnutrition and undernutrition, is a public health concern in Nepal. This paper examines the prevalence and determinants of the double burden of malnutrition among ever married women of reproductive age using data from three consecutive Nepal Demographic Health Surveys (NDHS). Data on ever married women (N = 17,073) from the 2006, 2011 and 2016 NDHS were used. Under-weight (BMI < 18.5) and overweight/obesity (BMI ≥ 25) were measured based on WHO BMI cutoff scores. We fitted multinomial regression models weighted and adjusted for possible socio-economic confound-ers. The results confirm the existence of a double burden of malnutrition among ever married women in Nepal. Between 2006 and 2016, the prevalence of overweight/obesity increased from 10% to 27% and the prevalence of underweight decreased from 24% to 14%. Women with higher educational attainment were at lower risk of underweight and at higher risk of overweight/obesity (un-derweight adjusted relative risk [ARR] = 0.97, 95% CI 0.96, 0.99: overweight/obesity ARR = 1.03, 95% CI 1.01,1.05). Compared to the poorest women, the richest women were at a significantly lower risk of underweight (ARR = 0.34, 95% CI 0.27, 0.43) and higher risk of overweight/obesity (ARR = 10.75, 95% CI 8.01, 14.43). Women belonging to the Dalit caste were at risk of both underweight and overweight/obesity. Education, wealth quintile and caste/ethnicity are risk factors for the double burden of malnutrition among ever married women in Nepal. Considering these factors during the design and implementation of nutritional interventions could support reductions in the prevalence of underweight and overweight/obesity among this population. Keywords: Underweight; Overweight/Obesity; Married Women; Double Burden of Malnutrition; Nepal  
145 Gun Violence and Mental Health , Mohinder Thapar.
Mental health is a very complex subject. People with severe mental health problem are not the people generally who indulge in Gun violence. Most often the people who have personality related problems are more prone to use the guns to achieve their goal. This is an issue of personality which is very complex. So many factors can change one’s personality, even from one moment to another. Development of personality starts from the day one a person is born, due to the interaction of genetic makeup and the environ-ments in which one is raised and psycho-social inter-action also moulds ones personality. Out of the multitude of factors, the most important is the feeling of power to react with environments. Mon-ey, position, social status and so many others factors provide the sense of power in one’s personality. Even holding a weapon in ones hand also imparts the sense of power. As soon as one takes the gun in ones hand the sense of power to alter the environments runs in the mind and alters the personality of the individual. This is similar to having power of the position such as president, governor, any or elected official or chief, directors etc. or if one gets rich and acquire lot of wealth which are also powers and changes the psyche of the person and alters the personality of the individual. I can quote sev-eral example of this metamorphosis in the personality of American presidents and other dignitaries.
146 The Bearer Blob- Pityriasis Rosea , Anubha Bajaj.
Pityriasis rosea is an acute, benign, self-limiting cutaneous con-dition composed of papules and squamous lesions. As pityriasis annotates “fine scales”, a characteristic appearance of a “herald patch” and subsequent scaly, elliptical spots are configured upon the trunk and proximal extremities, delineating a “classic Christ-mas tree” appearance. Pityriasis rosea or “rose coloured scale” is additionally denominated as pityriasis circinata, roseola annulata and herpes tonsurans maculosus. Majority of instances of common Pityriasis rosea manifest a classic morphology and distribution. The benign, cutaneous eruption is devoid of permanent sequelae and generally does not mandate therapeutic intervention.
147 Infantile Colic , Osama Abdulhafez.
It is not uncommon for a pediatrician to receive many cases of colic, especially in the first three months of life and many of those doctors have come to know that it is not a serious problem and that they must convey this impression to the parents and advise them to relax and create a calm atmosphere around their baby, because he/she may be affected by their anxiety. Colic for babies at this age is described as excessive crying poorly understood.
148 Need for Developmental Assessment , A Demerdzieva, O Lekovska, N Angelkova, S Jordanova-Cacanovska and N Pop-Jordanova.
Introduction: When we start our work as medical professionals the most important was improving and understanding physical growth and nutrition. Today we know that as much important as good knowledge in physical examination is adequate assessment of personality and social development which is crucial for appropriate developmental assessment. In this context early identification of developmental delay is not just responsibility but either obligation of all health care professionals, especially pediatricians. Aim of the Study: The aim of this study is to analyze developmental monitoring based on parents informations in our hospital in order to find out which percentage of referred children has to be followed further and has to start with early intervention. Our ap-proach to developmental monitoring is: we start the pediatric assessment by taking very careful history of child. Second step is very careful examination in order to find if the child has same kind of organ dysfunction. In second step crucial is neurological examination especially if we know that children with developmental disabilities have very high rate of seizure disorder, structural MRI abnormali-ties - especially frontal atrophy... Pediatrician has to be aware that observation of the parent-child interaction also, may be an aid in identifying children with delayed development. Methodology and Sample: The developmental monitoring in 465 children at the age of 12 - 60 months, referred as children with developmental delay according to primary care pediatricians, special educators or family members in the period of 4 years (from January 2016 until the end of 2019) was implemented. The assessment of the evaluated sample is done using CDC developmental milestone checklist (Centers for Disease Control and Prevention) for specific ages -12 and 18 months and 2,3,4 and 5 years. To assess behavioral and emotional problems, physicians need information from family and people who see children in their everyday contexts. Results: The results were presented for each group separately. Conclusion: Research indicates that the first five years of a child’s life are critical to brain development, academic achievement and later life outcomes. The right developmental and behavioral assessment can change the trajectory of a child’s life forever. Keywords: Medical Professionals; Physical Growth; Nutrition; Developmental Monitoring  
149 Welcoming Happy Primary School , Kinzang Wangchuk.
To begin with, on the joyous occasion of Sherig Century Cele-brations, I too would like to extend my Tashi Delek to everybody and would like to take this opportunity to share some of my feel-ings on Primary education in Bhutan and welcoming happy Pri-mary school. I feel deeply humbled for having given this opportunity despite my limited knowledge on the present primary education scenario, to speak a few lines about primary education and the architects of our primary education – our primary teachers. My write up is par-ticularly focused on welcoming primary school teachers as they have the most crucial role to play in shaping our children’s destiny, and of course, welcoming our children too. If our primary teach-ers are able to create the most appropriate platform for our young minds to flourish, we would have already built a secure future for them. Let’s not forget His Majesty the fourth Druk Gyalpo’s noble words, “The future of our nation lies in the hands of our children”.  
150 Epidemiological and Clinical Profile of Non COVID 19 Patients Admitted to Pediatric Intensive Care Unit of a Tertiary Care Referral Centre during Covid 19 Pandemic , Shalini GN, Isha Deshmukh, Rajesh Kulkarni and Aarti Kinikar.
To study the impact of lockdown during the corona virus disease 2019 pandemic, considering the limited healthcare and trans-port facilities while reaching the tertiary care hospital.It was a hospital based; observational study done over a period of 12 month consisting of pre lockdown period (December 2019 to March 2020), Lockdown (April 2020 to June 2020) and post lock-down (July 2020 to November 2020) period data of COVID-19 negative reported children admitted to pediatric intensive care unit (PICU).Out of 1019 enrolled children, total number of admissions prior lockdown was 534, during lockdown 240 and post lock down 243. Admissions from rural was significantly less during lockdown i.e., urban =80% and rural=20% whereas prior lockdown 56% from urban and 44% from rural Pune. Percentage of male children admitted was significantly more during lockdown compared to prelock-down (62.3% male and 37.7% females). The mortality rate was 6.7% and discharge against medical advice rate was significantly high during lockdown compared to pre- and post-lockdown.Our study has shown that covid-19 pandemic has strongly affected the number of PICU admissions, pattern of diseases, require-ment of ventilatory support and mortality. Provision for good healthcare transport facility and availability of primary and routine health care facilities may have led to good outcome of PICU hospitalizations in terms of recovery and mortality. Keywords: COVID 19; Pediatric Intensive Care Unit (PICU); Health Care
151 COVID 19 Pandemic - A Reflection , Abdul Halim Abdul Jalil*
As of August 2021, The World Health Organisation (WHO) has reported 210 million Covid 19 cases and 4.5 million deaths. It has been 20 months since the pandemic started. Different countries respond differently enabling us to analyse and pinpoint strategic factors that can be successfully used to mitigate or contain the pan- demic.
152 Innovative Neonatal Laryngeal Mask for Airway Management in Piglets: a New Device for Potential use in Preterm and Term Neonates , Ayoob Ali*
Background: Endotracheal intubation is an intricate process critical to maintaining airways during advanced neonatal resuscitation and administering surfactant to treat respiratory distress syndrome in premature infants. Although modern medical technology has created less strenuous means of maintaining airways during general anesthesia, these tools present evident limitations in many pre- term and full-term babies. We examined the safety and efficacy of using a new device, the Neonatal Laryngeal Mask (NLM), to manage airways while inducing surgical plane anesthesia in piglets as well as facilitate tracheal catheterization to administer medication into the lungs. Methods: Six piglets of domestic breed aged 3 - 7 days old and weighing 2300 - 3000 grams were used in this study. We moni- tored physiological parameters including, core body temperature, heart rate, end-tidal carbon dioxide (EtCO2) and oxygen satura- tion (SaO2) tracing before and after insertion of the NLM. Postmortem autopsy was conducted to examine the trachea and lungs to determine the extent of the spread of methylene blue as a measure of successful catheterization. Results: There were no statistically significant differences present while maintaining normal physiological parameters before and after NLM insertion. This was noted when examining heart rate (U-value 14, p = 0.416), average core body temperatures (U-value 18, p = 0.468), SaO2 levels (U-value 14, p = 0.315), and EtCO2 levels (U-value 11, p = 0.416) in all piglets. Postmortem analysis confirmed the presence of methylene blue in the entire airway from the trachea to the lungs, reflecting proper catheter placement through the NLM into the lungs.Conclusion: The new NLM device provides a safe and effective method for maintaining a patent airway and catheterizing a model system for pre-term and full-term infants. These findings are promising towards mitigating the current risks associated with caring for these populations and support further examination within human subjects as an investigational medical device
153 “Tongue Tie” in South East Nigeria- The Practice, The Myths, The Rip Offs , Assumpta Udechi Chapp-Jumbo1, Nneka Chioma Okoronkwo2* and Stella Nnenne Ijeoma
This cross sectional study sets out to elucidate the myths and practices surrounding ankyloglossia also known as ‘Tongue tie’ among mothers in an immunization clinic in south East Nigeria. The prevalence of frenotomy was 27.3% and the reasons for the procedure were mainly concerns about delay in speech, problems with quality of speech or coercion by health workers who put fear of possible speech problems in the mothers. The level of education or the place of delivery did not affect the prevalence of the practice. Complications of frenotomy like bleed- ing was found in 13.3% of those that had the procedure. A call is made for health education of mothers, health workers and those caring for newborns to prevent the unnecessary use of this procedure so as to avoid serious complication. It will also help mothers to seek attention for suspected ankyloglossia from those who have the skills to make proper diagnosis and intervention.
154 Influence of Coronavirus 2 Pandemic on Acute Surgical Abdomen in Pediatrics: Retrospective Cohort Study , Claudio Racana1,3, Ignacio Alonso1,4, Marcelo Barrenechea1,5, Romina Gagliardi1,4, Carlos Giuseppucci1,6, Nieves Gomez1,4, Gisela Kesseler1,4*, Ignacio Montes1,4, Ana Laura Naso1,4, Carolina Perez Espinoza1,7, Matías Sprovieri1,4 and Luis Gamba1,
Purpose: Retrospective evaluation of Coronavirus 2 (SARS-Cov-2) associated with surgical acute abdomen in our hospital. Methods: Observational and retrospective study, that includes patients age 0-18 years old, whose diagnosis was surgical acute abdo- men. The evaluated periods were April to June 2019 and April to June 2020. The variables have been analyzed: demographics, clinical history, current preoperative disease, surgical procedure and evolution. Results: Study included 205 patients, 127 from 2019 (0.6% of procedures) and 78 from 2020 (1.7% of procedures). In 2020 patients took longer to consult and longer delay in entering the operating room. There were no significative differences about severe forms of presentation or complications. Either were no differences into hospital stay. Conclusion: SARS-Cov-2 pandemic had no influence on the evaluated patients. Also protocolizing inpatient care had no negative impact on patients. It is important to highlight that SARS-Cov-2 gets confused with surgical acute abdomen in pediatric patients
155 Future First Responders can be as Young as Nine Years Old , Kathleen E Jones*
Violence is on the rise in America. Since the start of 2021, in the United States there have been 232 shootings, up from the 2013 number of 166 mass shootings, with around an astonishing 43,000 deaths by gun violence in 2020 per GunViolenceArchives.org. Much has been learned from each tragic event such as faster response time for medical help, learning how to instruct lay people in the community to help those injured on the scene, how to survive an active shooter event, and the need for the survivors to seek out mental health services in the afterward of such a horrific event. At one time the current practice revolved around combat care, then it transitioned to a very different practice, but it has once again returned to a military-based on-scene care. There has been the emer- gence of stressing this knowledge of skills by the Stop the Bleed (STB) campaign, which teaches lay people with no medical back- ground, how to care for victims by calling 911, to identify the severity of the bleeding, to use of tourniquets, compression, packing of wounds, and reducing the risk of death. STB is a very successful program. However, when one looks back at the targets of vicious shootings, schools are a commonplace as 38 percent of shootings occur in schools. Currently, there is no education program for teen- agers or children, yet they are the first ones at the scene and if they were equipped with knowledge, perhaps they could save lives. A presentation was done with teenagers in a North Carolina high school in Hickory successfully. Elementary school age children were then considered as a pilot for how young a responder could be. The sample size of four children ages six years-old to nine years-old were examined. The hypothesis answered is how young can a successful participant be for the Stop the Bleed education program? In conclusion, it is noted that children are underused in emergent situations and can be trained effectively with optimal long-term recol- lection of skills taught at nine years of age.
156 Clinical Profiles of Children (0 - 18 Years Old and 364 days) with Coronavirus Disease 2019 (COVID 19) at St. Luke’s Medical Center Quezon City , Arvee Riza R Aquilizan*, Elynn L Go and Imelda Luna
Background: Coronavirus Disease 2019 (COVID-19) has become a worldwide dilemma still with increasing number of pediatric cases reported. Thus, it is important to know the clinical profile of these pediatric patients to further understand its course and out- come of management. Objective: To describe the clinical profiles of confirmed COVID-19 pediatric patients at St. Luke’s Medical Center Quezon City from March to September 2020. Design: This research is a descriptive cross-sectional study. Subject: This study included all pediatric patients (0 - 18 years and 364 days old) confirmed COVID- 19 at St. Luke’s Medical Center Quezon City. Methodology: A review of the electronic and written medical records was conducted. Data analysis: Data will be presented as descriptive statistics using frequencies, proportions, means and standard deviation. Results: A total of 90 pediatric patients were included. Majority of the children belonged to the 11 - 15 years age group and 76% were seen at the emergency department. Forty-six (51%) of them were female and forty-four (48.9%) were male. Most of the pa- tients (59 patients, 68.6%) had known exposure to confirmed family members. Sixty-two of the subjects (68.9%) had mild signs and symptoms while twenty-five (27.8%) were asymptomatic. The most common symptoms seen in our subjects were fever (40%), and respiratory symptoms like cough (30%) and rhinorrhea (22.2%). Other notable symptoms were anosmia (8.9%), and dysgeusia (6.7%). Most of the children had normal chest x-ray findings (60.7%). In the laboratory findings of these patients, it was noted that majority had neutrophilia (74.2%). Almost all of the patients were discharged (98.9%) and was given supportive management. Conclusion: Children with COVID-19 presented with milder clinical course and rarely we encounter critical cases compared to in- fected adults. Early detection is the key to prevent further spread of this disease but a lot of our patients were asymptomatic hence diagnosis is a challenge for pediatricians. Proper quarantine precautions must be emphasized to primary caregivers of these patients.
157 A Systemic Investigation to Compare the Relationship of Sleep Disturbances and its Outcomes in Normal and DS Children , Priya Chandrasekhar1*, Varshini Chandrasekhar1 and Surekha Ramachandran2
Background: Down syndrome (trisomy 21) is a genetic disorder caused by the presence of all or a portion of a third chromosome 21. OSA is one of the most common co- morbidities in people who have DS. There are lot of research happening to understand the correlation between the DS and OSA in children. Objective: The main objective of this pilot study was to determine the sleep characteristics and daily life habits in a group of children with Down syndrome, as well as to find out the relation between sleep disturbances and daily life habit achievement when compared to normal children in relation to sleep pattern with age differences. Methods: Totally 49 DS children were identified at different ages. We selected 3- 5 yrs 15 children, 5 - 8 yrs 8 children, 8 - 10 yrs 11 children, more than 10yrs we selected 15 children randomly. Normal children served as control and the normal children data was used only for comparison only. Results: The bedtime resistance of the children with DS had symptoms of falling asleep in own bed. The sleep behaviour of the chil- dren with DS had earlier wake times and bedtimes, leading to significantly (**p < 0.01) more hours of sleep during nights, largely due to significantly earlier bedtimes. There was mild statistically significant (*p < 0.05) difference in the amount of sleep time compared to normal children. In night waking of the children with DS had difference when compared to normal children, leading to troubling in getting sleep during nights after the child wake up. The morning waking of the children with DS was identified that the child wakes up by own. It is also noted that the child is tired during day and some sleep during day time which is also significant (*p < 0.05). Conclusion: The behaviour and growth of the children improve after successful treatment of obstructive sleep apnea syndrome. The understanding of the sleep fragmentation in children with DS may lead to more appropriate treatment, resulting in an improvement of their psychomotor development
158 COVID 19 Pandemic - A Reflection , Abdul Halim Abdul Jalil*
As of August 2021, The World Health Organisation (WHO) has reported 210 million Covid 19 cases and 4.5 million deaths. It has been 20 months since the pandemic started. Different countries respond differently enabling us to analyse and pinpoint strategic factors that can be successfully used to mitigate or contain the pan- demic.
159 Acute Myocarditis as Myocardial Infarction Mimic: Presentation of Case and Review of Literature , Lea B Abucejo, Anabella A Salise-Oncog* and Julia B Maape
Chest pain is a common symptom that results in visits to the emergency department. When it occurs, family members become worried because of the association between chest pain and cardiac disease. Although chest pain is rarely associated with serious diseases, failure to perform a timely diagnosis may result in fatalities. This is a report on a 13-year-old obese boy who initially presented with abdominal pain and diarrhea and who subsequently com- plained of progressive chest pain that eventually radiated to the left arm. Initial diagnostic tests showed ST segment elevations and elevated CKMB and troponin I. He was initially managed as myocardial infarction. A 2-dimensional echocardiogram showed a low ventricular ejection fraction. Monitoring of the electrocardiogram and the cardiac enzymes showed rapid reversal of the previously seen abnormal findings, which is atypical of the course of myocardial infarction. The history, physical examination, and diagnostic findings fulfilled the criteria for acute myocarditis. Acute myocarditis can mimic myocardial infarction and should also be considered in a patient presenting with chest pain in the Emergency Room. The clinician should be cognizant of the features outlined in this study that would help in the differential diag- noses of children presenting with chest pain. Myocarditis should be considered more than myocardial infarction in younger infants presenting with acute coronary syndrome whose ECG findings show multiple rather than single coronary artery involvement.
160 Effectiveness of Matrix Rhythm Therapy with Traditional Physiotherapy for Child with Spastic Diplegic Cerebral Palsy from 13 Months to 7 Years Age: A Case Report , Sonali S1 and Edwin Dias2*
This case study shows the effectiveness of matrix Rhythm therapy for 13 month old girl with Cerebral palsy. The aim was to find out the effectiveness of matrix rhythm Therapy when combined with traditional physiotherapy to improve gross motor function.. Before starting physiotherapy treatment the girl had lots of impairments on gross motor function and GMFCS level was 3. On Denver developmental scale evaluation she was 8 month behind in two subgroups of gross motor and fine motor. MACS level was 3. CFCS level 1. The child still continues Physiotherapy session at the age of 7 years once a month. After receiving intensive Physiotherapy she improved in gross motor function specially sitting standing walking stair climbing and jumping. As well improvement was seen in balance and posture. The modified Ashworth scale, goniometry evaluation, GMFM-88, MACS, CFCS, Pediatric Berg balance scale were used as outcome measure. There was drastic improvement seen in GMFM SCORE after Matrix Rhythm therapy combined with traditional physiotherapy for this type of cerebral palsy.
161 Edwards Syndrome - A Rare Trisomy , Márcio Luís Duarte1,2, Thaís Amanda Frank de Almeida Alves3, Marco Antonio Alves Braun3, Lucas Ribeiro dos Santos2,3 and Élcio Roberto Duarte4
Chromosome 18 trisomy is a chromosomal disorder due to the presence of an extra 18 chromosome, mosaic trisomy, or partial 18q trisomy. The prevalence of live births is estimated at 1: 6000-1: 8000. The ultrasound is vital for the suspicion of chromosome 18 trisomy, especially when the changes refer to the clenched fists with overlapping fingers. However, the diagnosis of certainty is still the karyotype because, in some cases, changes may not be seen on ultrasound examination. We report a case of a 39 years-old woman perform an obstetric ultrasound at about 22 weeks showed the “lemon head” sign and constantly clenched fists of the fetus during the exam, suspecting Edwards Syndrome. After birth, at physical examination, the fists clenched with the fingers of both hands. The karyotype confirmed the trisomy of chromosome 18
162 Clinicobacteriological Study of Neonatal Septicemia with Special Reference to Sepsis C-Reactive Protein and Procalcitonin , VL Jayasimha1 and Shaswati Dey
Background: Neonatal sepsis can be described as an invasive bacterial infection which occurs within a month of life. Neonatal sepsis can present in two forms based on the age of onset, the one within 48hrs of birth is early onset sepsis (EOS) and the other late onset sepsis (LOS) which occurs after 48hrs after the birth. The incidence is 11 - 24.5/1000 live births in India. Aim of the Study: This study aims at giving an outline of the load of bacterial sepsis in the developing countries in newborn popula- tion. The focus will be on the pathogens mostly implicated, their antibiotic susceptibility patterns, and management and finding out the diagnostic performance of procalcitonin and C-reactive protein in the intensive neonatal care unit as a early diagnostic marker. Methodology: This study was conducted in Department of Microbiology at of S.S. Institute of Medial Science and Research Centre, Davangere. As per the criteria by Vergnano, clinically diagnosed neonates with septicaemia are included in the study. The study group comprised of 145 suspected cases of neonatal septicaemia in the neonatal intensive care unit. Blood culture by automated blood culture system was done along with C Reactive protein estimation by Nephelometry and Procalcitonin by Immunofluorometry. Results and Discussion: In the present study out of total 145 cases, female were 64 (44%) and males were 81 (55%). In this study clinical feature like seizures and hurried breathing, grunting are seen in most of the neonates with Klebsiella pneumoniae, E. coli and S. aureus as major organisms. In this study out of 145 cases CRP positive cases were 51 (35%) and CRP negative cases were 94 (64%).In this study out of 62 blood culture positive cases, CRP was positive in 32 cases and out of 83 blood culture negative cases 64 were negative.In this study, among 62 positive blood cultures 48 cases had positive procalcitonin. We found positive procalcitonin in 36 cases where blood culture was negative. Out of 83 blood culture negative cases 47 had negative procalcitonin. In this study < 0.5 ng/ml PCT was found in 61 (42%), 0.5 - 2 ng/ml was found in 45 (31%), > 2 ng/ml was found in 39 (27%). It has sensitivity of 57.14% and specificity of 77.05%, positive predictive value of 77.4% and negative predictive value of 56.63%. Keywords: Neonatal Septicemia; C-Reactive Protein; Procalcitonin; Early Onset Sepsis (EOS); Late Onset Sepsis (LOS
163 Shared Leadership Practice in Samtenling Primary School , Kinzang Wangchuk1*, Rinzin Dorji2 and Karma Tshering3
I worked in a small primary school for many years. I feel I have less experience in leadership. It is never, ever a goal of mine to meet the expectations of my subordinates and students. I am not satisfied with my teachers and school’s performance. This realization inspired me to do action research to improve my leadership style and promote shared leadership.For collecting baseline data, I used three tools: interviews, survey questionnaires, and observation. My critical friend assisted me in maintaining field notes and interviewing other colleagues. The analysis of baseline data collected from five teachers proved three main areas of my concern for effective leadership; collaborative decision making, effective job delegation and proper communication. The concept of shared leadership, of course, flies in the face of the traditional idea of how a school should operate: one person in charge and the others follow. But in a team of specialists, for example, one expert usually does not have the know-how to understand all the facets of the job at hand. Instead, a better approach is to share the duties, so the person in charge at any moment is the one with the key knowledge, skills and abilities (KSAs) for the aspect of the job at hand.When the KSA requirements change, a new expert should step in. In this article, we share some preliminary insights from our in-progress, multi-tasked study of shared leadership—labeled "Share the Lead"—to help put an exclamation point on the kind of ideas included throughout this special issue. In summary, the early evidence on shared leadership demonstrates that it can have a powerful performance impact on, and through, teams. Nonetheless, shared leadership, we must emphasize, is not a replacement for leadership from above. It should only be considered for situations where the tasks of the people involved share a certain degree of interdependence.Post intervention data was collected using the same tools. There has been some improvement in all the three areas of my concern identified from the baseline data analysis. More parents and teachers took part in the decision-making process. They were more open and shared their concerns about students’ development. Teachers became more responsible and punctual in their duties. Students’ participation also increased in decision making processes. When a leader fails to unite and build a team, it’s impossible to accomplish goals. In a situation where there is no collaborative ef-fort, a leader becomes impoverished and fails to succeed at the end. The whole atmosphere gets disrupted and ultimately affects the learning outcome of the students. The relationship amongst staff becomes fragile. Students’ faith in teachers diminishes, which leads to disruptive behaviors. Eventually, there is no room to create a conducive learning environment.
164 Mooren's Pseudoulcer Revealing Chronic Atrophic Polychondritis   , Biram Codou Fall, El hadji Daouda Niang, Assane Sall, Amadou Fall Cisse, Ahmadou Gaye, Aly Salane, Aichetou Fall, Bamba Diaw and Souhaibou Ndongo
Introduction: Atrophying polychondritis is a rare auto-immune disease characterized by recurrent episodes of inflammation of car- tilage tissue. Ocular involvement may occur in 60-70% of cases. Moreen’s pseudo-ulcer is a rare complication. It is serious because of the visual prognosis. We report a case of Mooren’s pseudo-ulcer revealing atrophic polychondritis. Observation: A 49 year old female patient, followed in ophthalmology for a pain in the left eye associated with chemosis, lacrima- tion, photophobia and a decrease of visual acuity in the right eye. The ophthalmological examination showed a superinfected pseudo Mooren’s ulcer of the right eye on slit lamp examination. She consulted dermatology for an irritative dermatitis of the feet. She was re- ferred to internal medicine for an opinion on an inflammatory auricular swelling. On examination, she presented a chronic polychon- dritis with (Chondritis of the right ear with atrophy, nasal chondritis without «saddle» or «marmite feet» deformity, chondro-costal chondritis) without hypoacusis, without vestibular syndrome; a chronic peripheral polyarthritis, and not deforming. Biology showed a moderate chronic inflammatory syndrome. Immunological investigations were negative. Cardiovascular and respiratory function tests are in progress. The diagnosis of chronic atrophic polychondritis was retained in the presence of 2 major and 1 minor crite- ria according to the Michet criteria and the presence of 4 out of 6 criteria according to the McAdam criteria. A treatment based on methylprednisone and Azathioprine was prescribed. The patients showed good progress under treatment with improvement of polyarthritis, polychondritis and ocular inflammation. Conclusion: Atrophying polychondritis is a rare autoimmune disease with a recurrent and sometimes severe course. Ocular in- volvement is usual during the course of the disease and can be inaugural as shown in this observation. The présence of a Mooren’s pseudo-ulcer should be investigated for this etiology.
165 Covid 19 Situation Update in the Pediatric Population at EHU Oran   , Djamila-Djahida Batouche, Sid Ahmed Bakri, Houcine Saddok, Dalila Ali-Amar, Radia Dali-Youcef, Douniazed Badsi, Soulef-Amel Saadi, Nadia-Faiza Benatta and Chafika Manouni
Today we have enough scientific publications showing that the majority of children infected with SARS-CoV-2 have a very favor- able outcome. At present, morbidity in children remainslow and deathis an extremely rare event. The purpose of this article is to describe the pediatrics pecificities of covid 19 viral infection in children admitted to EHU Oran. Materials-methods:Were corded over a 10-month period (March 1 to December 30, 2020) the data using a pre-established survey sheet. We are included all children under the age of 17. For each patient, we are studied the socio-demographic parameters, the clinical signs at the consultation, the results of the PCR and the child’s fate. Result: 302 children admitted with a mean age of 8.04 ± 0.2 years were the subject of the study The children were most often asymptomatic and very few children had presented a mildform (digestive pain, fever, cough, rhinorrhea), all were hospitalized with their parents, in different hospital service welcoming covid pathology at EHUO. The PCR was positive in 40% of the children. A multisystemic inflammatory syndrome in post covid 19 was noted in three patient. Conclusion:Children represent only a small percentage of cases of acute SARS-CoV-2 infection and are generally asymptomatic, or have mild to moderate symptoms
166 Does Physical Deconditioning in Chronic Low Back Pain Exist? A Systematic Review   , Ivan PJ Huijnen, Bart C Bongers, Bart CA Pepels, Harriet M Wittink, Jeanine A Verbunt and Rob JEM Smeets
The primary aim of this systematic review was to critically appraise the different methodologies used in studies to evaluate aerobic capacity in patients with chronic low back pain (CLBP). The second aim was to evaluate whether aerobic capacity of patients with CLBP differs from aerobic capacity of healthy age- and sex-matched subjects. PUBMED, EMBASE, Web of Science, PEDro, and Cochrane databases were searched. A critical appraisal was performed on methodological quality of the used protocols using a self-designed assessment list. A total of 28 studies were included in this review. Eleven studies (39.3%) used maximal exercise testing and seventeen studies (60.7%) used submaximal exercise testing. Large differences exist concerning the used exercise test protocols and methodologies to assess aerobic capacity of patients with CLBP. Similarly, large differences were found in how aerobic capacity of patients with CLBP was compared with age- and sex-matched healthy controls. Based on the results of the included studies, most studies found a lower aerobic capacity in patients with CLBP compared with age- and sex-matched healthy controls. It can be concluded that it is not clear whether deconditioning is present in patients with CLBP. There are several points that warrant cautiousness before drawing a defini- tive conclusion.
167 Impact of Oral Zinc Supplementation on Glycemic Control in Type 2 Diabetic Patients: Single-blinded Randomized Controlled Trial   , Almass F Hassan, Maged S Khattab, Abdelrauof M El Deib, Hind M Salama, Mohamed A Mohamed, Hassan A Shora and Ismail Dahshan
Objective: Type 2 diabetes mellitus is one of the world’s most prevalent and fatal diseases. Zinc is involved in metabolism of glucose via its participation in insulin crystallization and signaling. This study aimed to evaluate the effect of zinc supplementation on glyce- mic control in type 2 diabetic patients. Materials and Methods: The participants consisted of 200 type 2 diabetic patients attending the family medicine outpatient clinics in Suez Canal University who were randomly assigned into two groups, intervention, and control group. The study was approved by Ethics Committee of Suez canal University and all participant’ consent was assured. This study was carried out between April 2019 and June 2019. The intervention group received oral capsule of zinc sulphate (25 mg) daily, the second control group was given pla- cebo, identical for 12 weeks. outcome measures consisted mainly of Glycated haemoglobin (HbA1c %) that was assessed at baseline and after 12 weeks. Follow up visits were conducted at the 4 th, 8th and 12th week from beginning of the study to check adherence to treatment every visit by interview and pill counts. Results: Glycated haemoglobin (HbA1c %) was significantly reduced in zinc group compared to placebo group (p = 0.008). Conclusion: Zinc supplementation addition to routine management of adult type 2 diabetics on oral hypoglcemics only may improve glycemic control in this short single blinded randomized controlled trial.
168 A Study on Histopathological Association of Endometrial Hyperplasia with Estrogen Receptor, Progesterone Receptor Status   , Siva Kaliyamoorty, Varadharajaperumal Radhakrishnan, Mutharasu Arasu and Jawahar Ramasamy
Endometrial hyperplasia is defined as an abnormal proliferation of the endometrium with increased gland to stroma ratio and abnormalities in epithelial cells linked to prolonged exposure to estrogen stimulation. Endometrial curettings and hysterectomy specimens diagnosed with Endometrial Hyperplasia cases diagnosed with histopathologically were subjected to Immunohistochem- ical examination for Estrogen and Progesterone receptor status using DAKO monoclonal Estrogen Receptor (ER) and Progesterone Receptor (PR) antibody kit. A semiquantitative scoring system (H score system) has employed and a composite score of grade of intensity and percentage of stained cells. Most of the cases received and taken up for study belonged to the Reproductive age group of 18-46. The commonest clinical diagnosis of these cases was Dysfunctional uterine bleeding. Simple hyperplasia without atypia (SH) was found to be the commonest histopathological diagnosis in patients with Dysfunctional uterine bleeding. H scores of ER and PR in the glandular epithelial cells of these cases was showed PR scores being higher than ER in cases of SH. With the advent of newer hormonal therapies which can prove beneficial in avoiding surgical management, knowing the status of estrogen and progesterone receptors in the hyperplastic endometrium can prove a better therapeutic option compared to hysterectomy. Hormonal therapy using progestins can be tried before surgical management in patients with endometrial hyperplasia because the receptor status is favorable
169 Eye Care Practices and use of Surma in Newborns   , Saima Pirzada, Zahid Anwar, Nazia Iqbal, Rafia Gul and Fatimah Noor
Background: We conducted this study to document the methods prevalent in our population for eyecare and use of Surma in neo- nates. Methods: A 6-month study was done in Fatima Memorial Hospital, where mothers and female attendants of newborns were inter - viewed according to a formatted questionnaire, recording data about socio-demographics of participants, practices for eye care in newborns, and use of Surma. Results: We interviewed 1425 females (mothers and attendants of newborns) in our hospital. Of participants, the mean age was 30 years, 33% were either illiterate or had not completed primary schooling, 73.4% were married, 49.5% were stay-home and 84.5% resided in Lahore. For eyecare after birth, 60% would use clean water, 18.9% had no knowledge, and 5.5% would use unsafe meth- ods like antimicrobial agents. Medical personnel had guided females and families in 49%. Of the counselling by relatives (14.3%), grandmothers were a common influence. Majority (69.3%) of participants intended to use Surma, usually once a day, commonest reason being beautification of eyes and face. There was no correlation between initial eye care method, intention to use Surma, and socio-demographics. Conclusion: We should educate our community and medical personnel, about safe eye care practices in neonate
170 Central Sensitization Mechanism in Chronic Knee Osteoarthritis   , EF Turovskaya, LI Alekseeva, EG Filatova, EL Nasonov and Cara Chimienti
Pain is the main symptom of osteoarthritis (OA). Currently, there are few mechanism-based treatments that provide adequate and satisfactory pain control. Hence, there is a need to investigate pain mechanisms in OA. Objective: To assess key mechanisms for pain in chronic OA. Subjects and Method: 89 women aged 45-65 years with chronic knee OA pain were included in a prospective observational study. The study included clinical rheumatologic and neurological examinations, screening neuropathic pain scales (DN4 and Pain DE- TECT). Functional status and disability was assessed by WOMAC scale. Emotional disturbances (depression and anxiety) were exam- ined by Hospital Anxiety and Depression scale. Knee joint instrumental examination involved radiographic and ultrasound studies. Results: Neuropathic pain scales data demonstrated neuropathic descriptors present in OA patients such as: an electric shock, burn- ing, numbness, and pins and needles. Neurological examination revealed no somatosensory deficit. Examination of the sensitive sphere indicated hyperalgesia in 53.7% of patients with OA. Patients were divided in accordance with presence or absence of secondary hyperalgesia (41.5% and 58.5%). The presence of sec - ondary hyperalgesia was characterized by more pronounced pain on VAS - 5.9 ± 1.5 cm (? = 0.013), a significantly higher level of depression - 8.9 ± 2.9 (? = 0.003), and more pronounced disturbance of joint function (WOMAC 1184 ± 365mm (? = 0.009)). Ex- amination of mood also revealed an increased level of anxiety in patients with secondary hyperalgesia - 8.9 ± 2.9, but no significant differences were recorded (? = 0.082). Secondary hyperalgesia was not associated with structural changes in a joint. Conclusion: Our findings have demonstrated that in the pathogenesis of chronic pain in knee OA, two mechanisms take place: no- ciceptive and central sensitization. In one-third of patients central sensitization is predominant and determines the neuropathic pattern of pain. CS is characterized by the absence of neurological deficit and absence of pain intensity associated with structural changes in a joint. Therefore, one of the main ways of controlling pain should also target CNS mechanisms, including anticonvulsant, and antidepressant agents
171 Quality New-born Care - A Way Forward , Sushma Krishnegowda
Quality care at birth is one of the most important factors in re- ducing the neonatal morbidity and mortality. It is shown that 10% of the world’s population have disability due to various causes. 15- 20% of them are affected by Cerebral Palsy. In India, the incidence is around 3/1000 live births. Prematurity and Birth Asphyxia are one of the major risk factors of cerebral palsy. Despite improved neonatal care and advanced technology, increasing incidence of CP has been observed, which is of great concern
172 Economic Analysis of Covid-19 Diagnostic Kits in India , Jitendar K Sharma1, Umesh Gupta2, Greeshma Gopalan3, Keerthan RM3 and Kavita Kachroo
Introduction: Ever since the first case was reported in December, in China, Coronavirus disease 2019 (COVID-19) has spread over 218 countries and the casualty prediction of the third wave in India. Making it an absolute necessity for a rapid and accurate detec- tion and diagnosis of the infection for prevention and containment of the disease. Molecular testing (RT-PCR) is considered to be the gold standard for COVID-19 diagnosis is considered accurate. Methods: The primary COVID-19 diagnosis is done by Polymerase Chain Reaction (PCR) testing. The most common method used for identifying the genetic material from the SARS-CoV-2 is the real-time polymerasechain reaction RT-PCR. A decision analytical model was prepared for RT-PCR testing for COVID-19 diagnosis by selecting three Made in India diagnostic kits (RT-PCR-X, Y and Z) using Tree Age Pro software. Results: From the economic evaluation, NMB (Net Monitory Benefit)for RT-PCR Y being ? 45,43,740 higher and is the most cost- effective intervention as it saves more money compared to other interventions per DALY averted. Conclusion: Incremental cost-effectiveness ratio (ICER) was calculated, and it is identified that RT-PCR Y is cost effective at ? 850 per DALY averted.
173 Vaccination for Covid-19 and Human Papillomavirus: A Comparative Study , Jitendar Sharma1, Umesh Gupta2, Pudi Nagaseshu3*, Kavita Kachroo4 and Greeshma Gopalan5
Introduction: This review focused on two scenarios like HPV vaccination and Covid-19 vaccination. In the First scenario Covid 19 Vaccinations are known to boost immune system and it acts as a shield which fight against virus. In India Bharat Biotech in collabo- ration with the Indian Council of Medical Research had developed a vaccine Covaxin. The importance of covid-19 vaccination is to avoid severity and deaths from corona virus. Although, HPV vaccine and Covid 19 vaccines are different from each other and they are different in formulations affect and their usage, storage and type of administration, they are to be safe and effective. Hence, this article focusses on both covid 19 and HPV vaccination showing difference in costing, lives saved and budgetary impact. In the second scenario the importance of HPV vaccine is it protects against certain types of HPV that can lead to genital warts or cancer. In 2019 National immunization programs have been implemented in 124 countries and thus most of the girls and women were vaccinated by preventing cervical cancer. Results and Discussion: Vaccines are saving millions of lives each year and they are most reliable and cost-effective for public health interventions. The efficacy of different Covid -19 vaccination m-RNA-1273 (70.4%), AstraZeneca (78%), Sinovac (94.5), Sputnik (91.4), Covaxin (81%), Covishiled (90%), m-RNA-BNT162B2 (94.1%). Gardasil has 98% efficacy and the efficacy of Cervarix is 91%. Conclusion: The efficacy of Covid 19 vaccination saves lives and 2,07,421 lives saved correspond to 1,506,501 QALYs gained for covid 19. Total Lives saved by HPV vaccination for 9 to 14-year-old is lesser than 42, 000 annually
174 Early Screening for Autism Spectrum Disorder in Ex-preterm Infants: A Tunisia Prospective Survey , Ben Touhemi Donia1,4*, Khemakehem Khaoula1,4, Majdoub Yosra2,4, Hadjkacem Imen1,4, Boudabous Jaweher1,4, Hamida Nedia3,4, Ayadi Hela1,4 and Moalla Yousr1
Purpose: The aim of the study was to screen autism spectrum disorder (ASD) in preterm children (born before 37 weeks of gesta- tion). The study also aimed to identify maternal and neonatal risk factors associated with a positive screen. Method: Sixty-four ex-preterm children were recruited for a two-round examination at the age of 18 and 24 months. All children were accompanied by one of their parents. The consultation included a psychiatric interview and mainly the filling of the Modified Checklist for Autism in Toddlers (M- CHAT) scale. Results: Thirteen (20.3%) of the 64 Ex-preterm children were screened positive on the M-CHAT at 18 months compared to six (11.76%) of the 51 infants who were re-examined at 24 months. The follow-up interview revealed that three of the preterm children were diagnosed with autism based on the DSM 5 criteria. The positive screened preterm children were born after 32 weeks of gesta- tion and displayed higher incidence of pathological fetal heart rate. In addition, chorioamniotitis was significantly associated with positive autism screening. Multivariable analysis showed that only pathological fetal heart rate was independently associated with M-CHAT-positive screen (odds ratio 9.25, p=0.02, 95% confidence interval 51.3-62.09). Conclusions: Our study as well as literature studies provide evidence that prematurity increases the risk of ASD. A pathological fetal heart rate and chorioamniotitis were significantly associated with positive autism screening. The nature of the associations between prematurity and this risk remains unclear.
175 Faecal Calprotectin in Inflammatory Bowel Diseases , MP Narayanan and DM Vasudevan
Background: Inflammatory bowel diseases (IBD) are chronic intestinal disorders of unknown etiology and with a typically relapsing course. Faecal calprotectin (FC), an important granulocyte cytosolic protein, is closely correlated with faecal excretion of 111 indium labelled leucocytes, deemed to be the gold standard for measuring intestinal inflammation. Assessment of faecal calprotectin levels has been proposed as a non-invasive test for the direct evaluation of intestinal inflammation in patients with IBD. Since mucosal heal- ing of ulcers reduces the need for surgical intervention and hospitalization in IBD, we examined the reliability of calprotectin levels in reflecting mucosal disease severity. The aim of the study was to compare faecal Calprotectin with the standard disease activity indices (UCAI and CDAI) of inflammatory bowel diseases (Ulcerative colitis and Crohn’s disease). Methods: Patients diagnosed to have IBD based on clinical, endoscopic and histological examination were included. Ulcerative colitis activity index (UCAI) and Crohn’s diseases activity index (CDAI), were calculated. Faecal calprotectin was estimated by a commer- cially available quantitative ELISA test. Results: Forty-three patients were included in the study, 20 patients with Ulcerative colitis (UC) and 23 with Crohn’s disease (CD). Patients with active CD (CDAI > 150) were 18/23 (78%) and with active UC (UCAI > 2) were 17. Mean hemoglobin was not different in both the groups. Mean ESR was raised in both groups (37 in UC, 31 in CD). Mean CRP was raised in both groups (UC 49 ± 60; CD 19 ± 19). Mean UCAI was 7 (SD ± 3) and mean CDAI was 212 (SD ± 89). Mean faecal calprotectin was 890 (SD ± 503) in UC patients and 641 (SD ± 739) in CD patients. Faecal calprotectin was higher in active cases compared to those in remission but the difference did not achieve statistical significance. Correlation of faecal calprotectin with CDAI was strong (P = 0.0008) whereas correlation of faecal calprotectin with UCAI was weak (P = 0.274). Conclusion: Faecal calprotectin correlated strongly with CDAI but weakly with UCAI. The difference in patients in remission vs ac- tive disease (as categorized by UCAI and CDAI) was not statistically significant. Keywords: Inflammatory Bowel Disease; Crohn’s Disease; Ulcerative Colitis; Faecal Calprotectin; Endoscopy; Diagnosis; Biomarker
176 Screening for Children's Obstructive Sleep Apnea Syndrome as Part of the French Dental Prevention Program M’T Dents "LuvUrtheeth" , Victoire Kouakou*
To screen Obstructive Sleep Apnea Syndrome in a population of preventive-conscious children in a private paediatric dentistry practice, within the French dental health prevention program called “M’T dents” LuvUrtheeth. Parents of children aged 3-6 years answered a 20-item questionnaire collecting symptoms of OSAS, from January 2015 to July 2019 for a prospective, mono-centric, observational study. A questionnaire, developed and made available to parents during the dental prevention visit, collected self-reported information on the identification of at least three symptoms of OSAS. This approach made the screening legal. The polysomnography, allowed to confirm the diagnosis and to indicate the severity of OSAS. 103 children were screened with a mean of the Obstructive Apnea Hypopnea Index (O-AHI) of 5.6 for various symptoms: snor - ing, mouth breathing, nocturnal hypersudation, bruxism, morning fatigue, attention and concentration disorders, enuresis, eating difficulties, obesity, somniloquy, sleep-walking. To promote and improve an early detection of OSAS, the French dental preventive device “M’T dents” which is now aimed at children from 3 years old, implemented since April 2019 constitutes an interesting way to investigate paediatric population. Keywords: OSAS; Paediatric; Early Screening; French Dental Preventive; “M’T Dents” Program
177 Antibiogram of Extended-spectrum Beta-lactamase (ESBL) and Non-ESBL Producers in Urinary Tract Infections in Children: A Six-year Retrospective Study , Bhaskar Shenoy1*, Archana M2, Ranjeeta Adhikary3 and Bhavana MV4
Objective: Urinary tract infection (UTI) is a common infection in children, due to the increased prevalence of antibiotic-resistant, extended-spectrum beta-lactamase (ESBL) and non-ESBL producers. Analyzing antibiotic sensitivity data and monitoring the chang- es in the susceptibility profiles is crucial for accurate diagnosis and treatment. This study aimed to retrospective analyze in vitro susceptibility profiles of gram-negative bacteria isolated in urine samples in a single institution. Methods: Antibiotic sensitivity data were collected retrospectively from 1372 patients, aged 0-19 years, who were suffering from UTI. Data was analyzed for the prevalence of ESBL and non-ESBL producers. Wilcoxon Rank Sum Test, Chi-square test and odds ratios were used to compare the mean age, find the association and relative odds of having infection. Cochran-Armitage test was used to analyze the trend of antibiotic susceptibility test (AST) pattern. p- value of <0.05 was considered as statistically significant. Results: A significant difference in the mean age and association between sex and ESBL and non-ESBL UTIs were noted (p < 0.05). Out of 1417 bacterial isolates from 1372 urine samples, E. coli (84.12%), followed by K. pneumoniae (12.63%) were the most pre- dominant. Imipenem, meropenem, and ertapenem along with amikacin and netilmicin were highly effective against the ESBL pro- ducers; however, an increased resistance towards imipenem and meropenem was noted against non-ESBL producers (p < 0.001). Conclusion: Carbapenems were effective against ESBL producers, along with amikacin and netilmicin. A declining AST pattern was observed for majority of antibiotics, except gentamicin against non-ESBL producers, suggesting the need for the practice of antibiotic stewardship.
178 A Near Fatal Miss - Airbag Related Polytrauma in a Child Presenting as Multiple Air Leaks and odontoid Fracture , Ravi Sharma1*, Ajay Singh1, Tibin Johny1, Rajiv K Bansal1, Neeraj K Sharma2, Ajay Sharma2, Sanjay Narwani3, DP Sharma4 and Pradeep
Airbags have changed the pattern of fractures seen in road traffic accidents, reducing morbidity and mortality. However in young- er patients and patients of short stature who are sitting in front seat, severe spinal injuries can still occur even with deployment of airbags. Airbags related injuries can occasionally present with unusual presentations. The majority of airbags associated injuries are minor. We present a rare fatal manifestation of airbag related polytrauma in a 3 year old male child presenting as lung contusion, air leaks and odontoid fracture presented as respiratory failure and unstable spine.
179 Giant Cell Hepatitis with Autoimmune Hemolytic Anemia- Case Report , Barreto Julie1*, Ribeiro Hildenia1, Coelho Fabiana1, Lustosa Amalia1 and Moraes Carlos2
Giant cells hepatitis associated with autoimmune hemolytic anemia is a rare pathology. An autoimmune disease characterized as a serious liver disease associated with hemolytic anemia. It is still little described in the literature, it has a restrict number of case reports and its pathophysiology is unclear. This study presents a report of two cases of patients diagnosed with giant cells hepatitis associated with autoimmune hemolytic anemia in their first year of age. They show different evolutions of the same pathology dis- playing the possibilities of manifestation regarding the hepatic and pathological involvement. The patients had severe evolutions, without any response to the first therapeutical measures, had a surprising improvement with the use of anti-b-cell monoclonal anti- body treatment, rituximab. The cases of liver disease associated with autoimmune hemolytic must undergo a liver biopsy as early as possible in order to reach a definitive diagnosis. The use of rituximab associated with immunoglobulin infusion has been shown to be an effective treatment and may be considered a first-line therapy, along with a short period of corticotherapy.
180 Role of Probiotics in Pediatrics , Abdul Halim Abdul Jalil
Probiotics are increasingly being used in pediatrics because of the health benefits attributed to them. Probiotics are defined as “live microorganisms, which when administered in adequate amounts confer a health benefit on the host” [1]. The probiotic concept was first introduced by the Nobel Prize laureate, Ilya Ilyich Mechnikov in 1908 during his study about yogurt-derived health- boosting effects on Bulgarian peasants. Metchnikoff considered the lactobacilli as probiotics (“probios”, conducive to the life of the host as opposed to antibiotics); probiotics could have a positive influence on health and prevent aging
181 Dental Caries Workshop Prevention Model for Primary Schools , Najat Abdrabbo Alyafei
ntroduction: Dental caries, which is a form of dental infection, involves cavity formation or tooth destruction. In pre-primary and primary school children, dental caries prevalence is high under the circumstances of insufficient provision of awareness coupled with a decrease in interventional and preventive measures. Methods: A total of eight participants attended the workshop, four each from a private school and a public school. The centre stage approach, based on diagrams with the most important item placed at the centre of the diagram, was used to obtain participants’ view to co-produce the school oral health programme Results: Schools, teachers, parents and pupils play a comprehensive, progressive and collaborative role in preventing the progres- sion of dental caries, tooth destruction and any kind of dental infection. Behavioural affirmative strategies, workshops, awareness programmes and activities are altogether important in promoting oral health in children. Conclusion: In order to reduce the prevalence of dental carries among school children, there is a need for a comprehensive school oral health policy with teachers and parents involved actively in its implementation. Keywords: Dental Caries; Preventive Measures; Behavioural Strategies; Prevalence; Qatari Primary Schools
182 Profile of Xpert MTB/RIF in Children with Suspected Tuberculosis in Tertiary Hospital in Surabaya, Indonesia , Adwina Nurlita Kusuma Wardhani and Retno Asih Setyoningrum
Background: The accurate diagnosis of childhood tuberculosis remains a major challenge. Molecular diagnostic tests with Xpert MTB/RIF are more rapid and cost-effective compared to the conventional culture techniques used for diagnosis and drug-resistance testing. This study aims to describe the characteristics of children with suspected tuberculosis tested with Xpert MTB/RIF in a ter- tiary hospital in Surabaya, Indonesia. Methods: A descriptive study was conducted on children with suspected tuberculosis in an academic teaching hospital in Surabaya, Indonesia between January 2016 and December 2020. Clinical materials were submitted to the laboratory for examination-including sputum, pleural fluid, and gastric aspirate-and the Xpert MTB/RIF test was performed. Outcomes described as Mycobacterium Tuber- culosis (MTB) detected, MTB not detected, rifampicin-sensitive, and rifampicin-resistant. Results: Among 887 subjects during five years study period, 253 (28,5%) were sputum samples, with others from gastric aspirate, cerebrospinal fluids, feces, material from abscesses, and other biopsy specimens or resected tissue. The total number of MTB de- tected was 155 (17,5%) with the majority collected from 109 (70,3%) sputum samples, and the highest number of MTB Detected was found in age 10-18 years old 105/155 (67,7%). Drug sensitivity test showed 13 (8,3%) rifampicin resistance with all samples were sputum, while 142 (91,6%) subjects showed no rifampicin resistance. Conclusions: Sputum was the largest sample collection of children tested with Xpert MTB/RIF, it showed a considerable amount of MTB positivity, with the majority aged 10-18 years old. Drug sensitivity test showed rifampicin-resistant results came from sputum samples. Keywords: Tuberculosis; Children; Xpert MTB/RIF; Profile
183 A Paediatric Magnetic Resonance Imaging Technique Substituting Fluid-Attenuated Inversion Recovery Time of the Ernst Angle on Protons Within Paediatric Anatomy to Removing the Need to Administer an Anaesthetic Newborns, A Short Communication. , Metin Celalettin
Within the boundaries of extant Magnetic Resonance Imaging (MRI) technology for paediatric patients, after 30 days of age, an intravenous sedative is administered. MRI is a non-invasive imaging procedure that uses a powerful magnetic field and radiofrequen- cies and records neuro-anatomical structures at an anatomical target location. Imaging anatomical abnormal and normal tissues in specific cases necessitate accepting the risk of causing harm to an infant. This article explores the benefits of an MRI using an alterna- tive to the imaging protocol
184 Prenatal and Early Postnatal Diagnosis of Congenital Toxoplasmosis: Retrospective Study , Liliana Sá,Ana Maria Ferreira, Teresa Pinheiro and Teresa Caldeira
Background: Congenital toxoplasmosis occurs when there is a maternal primary infection during pregnancy and transplacental transmission of the parasite occurs to the fetus. The incidence is about 1- 10/10.000 births. It is a preventable disease with possible severe consequences. In the postnatal period, diagnosis is established by the persistence of anti-Toxoplasma IgG by 12 months of age. Methods: We performed a retrospective study of children with suspected congenital toxoplasmosis born in our hospital between 2008 and 2018. The aim was to define the clinical and serological characteristics of children with congenital toxoplasmosis to opti- mize diagnostic work-up and treatment. Results: Of the 51 suspected cases only 7.8% proved to be infected. Seroconversion occurred mostly in the 1st trimester (49%). Am- niocentesis was performed in 39.2% of women and all tested negative in the polymerase chain reaction for Toxoplasma gondii DNA detection in the amniotic fluid. 60.8% of women were treated with spiramycin. All children were asymptomatic at birth except for one that presented with chorioretinitis. 68.6% of infants started treatment immediately after birth (40% spiramycin, 57% pyrimeth- amine/sulfadiazine). Median treatment duration was 2.4 months and interruption was determined by a negative polymerase chain reaction for Toxoplasma gondii in peripheral blood. None tested positive for toxoplasma specific IgM nor polymerase chain reaction test. In two cases anti- Toxoplasma IgG tested positive after the first year of life and treatment was re-introduced. No significant im- pairments were detected. Conclusions: Given the characteristics of this infection, to confirm or exclude congenital toxoplasmosis several serological and para- sitological tests are required
185 A Comprehensive Clinical Approach to Hypoxic Ischaemic Encephalopathy in Term Infants: A Review , Chakradhar Maddela
Introduction: Hypoxic ischemic encephalopathy (HIE) is the manifestation of multi-organ dysfunction after perinatal asphyxia. Out of 135 million live born babies in each year globally, there were 1.2million intrapartum still births, 717,000 intrapartum neonatal deaths, 1.15million cases of neonatal encephalopathy (NE), 287,000 neonatal deaths due to NE and 413,000 babies survived with neurodevelopmental impairment [1]. The incidence of HIE is 1-2 per 1000 births in rich countries and 10-20 per 1000 births [2] in low to middle income countries. Approximately ninety nine percent of HIE case related deaths are taking place in developing coun- tries. It is a huge burden on these countries for tackling. The available trusted specific treatment, therapeutic hypothermia (HT) is less implemented and showed varied results of outcome. There was not much progress in preventing these deaths in low to middle income countries (LMIC). Methods: An online and manual literature search was conducted in November 2021 through PubMed, Cochrane library, Google Scholar, Online Google chrome search, texts and articles related to the title topic with keywords HIE, Post-resuscitation neonatal care, term infants, management and comprehensive approach. Articles were also collected from citations and references of the searched study papers. Search restricted to English language, free full text articles, human and neonates - term and late preterm. Animal stud- ies and studies involving preterm infants were excluded. Eighteen study articles from PubMed, 17 articles from Cochrane library and another 22 articles relevant to the title topic were collected. These articles were analysed after going through the tile and abstract sections. Results: The collected study papers were narrated with the following subheadings - definition, pathophysiology, HIE staging, cool- ing criteria, cooling in High income countries (HIC), HIE and cooling in LMIC, HIE and therapeutic strategies at low resource setting (LRS), cooling HIE cases who do not fit into cooling criteria, newer potential therapeutic strategies for HIE, outcome predictors of HIE, counselling for parents, long-term health problems and conclusions. Definition: Asphyxia is a clinical condition that occurs from inadequate gas exchange and characterized by hypoxia, hypercarbia and acidosis. Perinatal asphyxia occurs during or prior to labour. Perinatal asphyxia is failure to initiate and sustain breathing at birth (World Health Organization 1997) [3]. HIE is the multi-organ manifestation after perinatal asphyxia. “NE is a syndrome of disturbed neurological function in the earliest days of life in an infant born at or beyond 35 weeks of gestation, manifested by a subnormal level of consciousness or seizures and often accompanied by difficulty with initiating and maintaining respiration and depression of tone and reflexes.
186 Knowledge, Attitudes, and Practice of Pediatric Nurses Regarding Asthmatic Patient - Care in Gaza , Khalid Jamal Khadoura , Mohammed Mushtaha , Fathi Mikki , Rawan Ashraf Mesleh , Ahed Asaad Altubji, Areej sameh Abed Al Hady and Doha Younis Abu Jazer
Background: Bronchial asthma is the most cause of hospitalization among children particularly before 6 years. This study aimed to assess the level of nurses’ knowledge, attitudes, and practices toward bronchial asthma disease in pediatric departments in Gaza strip hospitals. Methods: A descriptive-analytic cross-section design was conducted among one hundred sixty-nine nurses who work in different pediatric departments across the Gaza strip Pediatric hospitals. A structured self-administered questionnaire was distributed among nurses, 90.53% were responded from both sexes. Likert scale (three points) questionnaire was designed to measure the knowledge, attitude, and practices of nurses. Data were analyzed by Stata software version 14. Results: The study showed that the majority of the sample were females (55.56%), and two-thirds of the nurses were married (66.67%) with a mean age of 33 (SD = 8) years which ranged from 21 to 55. Furthermore, almost half of nurses had five to ten years of experience (43.14%). The study showed more than two-third of nurses have good knowledge. Remarkably, about half of nurses (47.06%) did not know that asthma complications may lead to death. Regarding attitude, 41.7% of nurses have a negative attitude towards asthmatic patients, but 36.8% of them have a positive attitude and 24.56% have a fair level of attitude, Moreover, 69.1%of nurses have a good practice and 17.2% of them have a fair level of practice, but 13.2% have poor practice. Conclusion: The study concluded that the knowledge and practices of most nurses were satisfactory while only less than half of the nurses had positive attitudes towards nursing care of asthmatic patients. However, there was no statistically significant relationship between the knowledge, attitudes, and practices of the nurses with other independent variables
187 Parent Implemented Language Intervention through Bluetooth Enabled Device: A Preliminary Investigation in Three Pediatric Patients , Mereen Rose Babu, Shalini Mathew, Aruna Radhakrishnan, Sneha Mareen Varghese and Murali Pradyumna
Over the past decades, language intervention programs have undergone several alterations as a result of changing demands and technological advancements, and rightfully so. With documented evidence suggesting success when parents take the lead in facilitat- ing speech and language development, the aim of this study was to observe changes in parent interaction skills and communicative behaviours of children when a Bluetooth enabled mobile phone was used to deliver a parent-implemented language intervention. If effective, the Bluetooth-enabled method would eliminate the need for a speech-language pathologist’s physical presence or in- terference during sessions. Three parent-child dyads participated in this descriptive case study. Each child was diagnosed with a pre-existing language disorder (with or without comorbid conditions). After detailed language assessment of the child and rating the parent skills using the Parent Rating Scale, each dyad underwent a training procedure for 3-5 sessions. The mothers were taught to modify their interaction through “PRIDE” skills. Post training, the dyads were observed and differences in parent interaction skills and child communicative behaviors were noted. Parents reported improved practice of the prescribed behaviours after Parent-Child Interaction Therapy sessions, indicating positive outcomes in all dyads. PCIT had a favorable impact on all three participants, as evi- denced by improvements in verbal imitation, spontaneous verbal utterances, pragmatic skills, and behaviour regulation. This study’s findings contribute to the expanding body of evidence that supports the use of PCIT in a variety of therapeutic settings. Focusing on parent abilities as key language stimulator can help with manpower concerns. Future research should focus on the generalization and maintenance of learnt behaviours and skills. The efficacy of the study protocol must be tested particularly for tele-therapy prac- tices which will be useful in challenging times like the COVID-19 pandemic.
188 A Future for the World’s Children: Possibility or Impossibility? , Doris Bergen
A wonderful report on the needs of the world’s children, with strong and well documented recommendations for enhancing their development, was published in February of 2020 by the Lan- cet Commission, under the auspices of the World Health Organiza- tion [1]. However, it was published just as the first alarms were being raised about the coronavirus and, unfortunately, its message as well as any will to address the needs reported in the document, were lost in the “survival” mode activities that most countries in the world have been focused on since that time
189 Pediatric Dentistry Amid COVID-19 Pandemic , Lakshmi Thribhuvanan
The COVID-19 pandemic had made disastrous impacts and aftereffects in different sectors of our society. The virus had not confined to the health sector alone, its impact has fallen as a logged hurdle to the world economy thus creating a greater havoc to humanity [1] Dentistry too is not exempted from the clutches of COVID-19 outbreak. The pandemic has forced every individual in adapting in new lifestyle changes and habits for chances of better resistance survival against this deadly pandemic. Pediatric Dentistry practices also required sequential and orderly modifications which could be employed to both the dentist and the patients in the routine dental practice considering the fact that the dental personnel are prone to COVID-19 exposure through saliva and aerosols from the working environment. COVID-19 pandemic is expected to continue for a much longer time than expected. Until the pandemic settles down, dental treatment will be sought out only in times of emergency as when needed 
190 A Transient form of Insulin-Requiring Diabetes Mellitus on a 15-Year-Old with Wolf-Hirschhorn Syndrome , Ana Bernardo Ferreira1 ; Teresa Amaral Pinheiro; Ana Luísa Barbosa 2 , Catarina Matos de Figueiredo ;Sara Oliveira ; Sónia Aires
Wolf-Hirschhorn Syndrome is a rare disorder caused by a deletion in the short arm of chromosome 4. Depending on the genetic defect, phenotype variability can be extensive, with multi-systemic involvement. Diabetes mellitus classification depends on clinical characteristics, clinical course, and laboratory findings and has important implications. The authors report a case of a 15-year-old girl with Wolf-Hirschhorn Syndrome, who presented with Hyperglycemic Hyperosmolar Status and was diagnosed with diabetes. Insulin treatment was suspended four years after the diagnosis. The complexity of the case and the difficulties on classifying and understanding this transient form of pancreatic endocrine insufficiency are discussed
191 Adoption of Learning Techniques for Enhancing Student Performance , Kinzang Wangchuk
This essay on Adoption of Learning Techniques for Enhancing Student Performance presents the worldwide issues related to student learning using various learning techniques in this modern world relating to children’s learning. To make the essay rich and easy to understand for readers, it includes an action plan. To make the action plan easy to understand, a literature on education, its importance and emerging challenges of education has been highlighted in the introduction of the essay. The introduction describes the importance of education along with the emerging challenges due to the fast growing world of science and technology. In the emerging challenges, the focus is more on the quality of education. To address this properly, a brief note on the education system in Bhutan and a brief explanation on importance of education is given in Bhutan is discussed. This is further carried on with the emerging issues of quality of education in Bhutan. The essay discusses about the rapidly developing world and the growing expectation of the people around the globe for good education. This is further explained by the growing expectation of people giving birth to people thinking, assessing and determining the quality of education. The essay further progresses on with the description on the ten adopted learning techniques for enhancing student performance. The learning techniques are further linked with how it can help reduce or eliminate the issues of degrading quality of education. The next discussion in the essay is about adopting learning techniques to enhance student performance. The review of the literature that is used is used in framing an action plan that is used to implement the learning techniques that is further made as the leadership action plan. The essences of leadership philosophy and leadership qualities are discussed. Owing the importance given to leadership direction, several leadership philosophy related with the execution of the plan is also mentioned in the plan. The leadership plan included proper strategies identified to put the action plan into actions effectively. The plan also identified the strength and weaknesses of the chosen learning techniques. Its feasibility in implementation as implementation issue is also studied and presented. Further the essay also reflected on the work I carried out to complete the action plan. It is further strengthened by the examples I provided on the areas where I demonstrated leadership, professionally and personally. Lastly my experiences in working with teams and leading them are also highlighted.  
192 Organization of Neonatal Transport Service with Regional Perspective - Review Article , Chakradhar Maddela
Neonatal transport system is primitive in India. High risk deliveries are not always anticipated. Many sick neonates are transferred to higher care centre by attendants on two wheelers, three wheelers, vans, buses, and ill-equipped general ambulances. As a result of which, these sick babies are prone to develop morbidities like hypothermia, hypoglycemia, hypoxaemia, hyper-carbia and multi organ dysfunction even when they reached higher care centre. This may result in higher morbidity and mortality leading to high infant mortality. Hence, there is an urgent necessity to establish dedicated neonatal transport service system in the country. Organized patient transport system always yields better health outcomes than self-transport system.
193 Sleep-Wake Cycle , M Martell
Along the days following birth, a series of emotional manifestations emerge between the baby and the people around him, especially the parents. Like all people, adults or children, the new - born has a sleep-wake cycle during the day. The newborn’s cycle is shorter than that of the adult and is repeated between 6 and 8 times in the first days. Its duration is between 3 and 4 hours. The length of the sleep period is variable ranging from 2 and a half hours to 4 to 5 hours. In the first weeks the newborn sleeps 16 to 17 hours a day.
194 Building Blocks for Development , Sujata Noronha
In India out of 27 million children born every year 3.5 million babies are born preterm. These preterm babies (<37 week) are at a higher risk of development delay in comparison to term born infants. According to recent studies children born preterm are at a higher risk of cerebral palsy, development delay, autism spectrum disorder, ADHD, Behaviour concerns and learning difficulties.
195 SARS-CoV-2 Infection Inhibition by Gene Manipulation , Muhammad Imran, Qadir Nouman Ijaz
Owed to unique coronavirus (Covid-19) outbursts, the year 2020 perceived an unforeseen contagion condition. If the patient has concomitant diseases at once, the situation can become unfluctuating shoddier. The privation of identification for a viral related con- tagion due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered liable for the fiasco of practicable han- dling. Clustered regularly interspaced short palindromic repeats (CRISPR)/Cas system has made it possible the use of sophisticated technologies in order to modify target genes. Furthermore, it is presently being employed to prevent viral reproduction. As a result, it’s possible that SARS-CoV-2 communal could be destructed by CRISPR/Cas system by preventing viral replica and contamination by means of a precise marked RNA sequence and host components. Furthermore, pathologies and Covid-19 increase the global incidence of deaths, resulting in this contagion. Genomic editing using CRISPR/Cas to damage viral structures (in this case SARS- CoV-2) could be a protective method. Additionally, PAC-MAN in combination with CRISPR/Cas effectively destroys the particular RNA sequence to block viral reproduction. As a result, we believe that combining antiviral Pac-Man like CRISPR enzymes in human cells with the CRISPR/Cas system could be proved beneficial in battling SARS-CoV-2-caused worldwide contagions. This is a substitutive pandemic-prevention strategy that involves viral suppression to degrade the SARSCoV-2 target RNA structure
196 Inherited Metabolic Disorders - Relevance of Newborn Screening in India , MP Narayanan
Congenital metabolic disorders/Inherited metabolic disorders caused by deficiency of enzymes which result in substrate accu- mulation and cause mild or sever neurologic/psychological mani- festations. This leads to death or permanent disability of the child. Some forms IEMs cause isolated stable mental retardation (MR) and global developmental delay [1]. About 25 million babies were born per year and infant mortality rate of 35 /1000 live births were reported in India [2]. Around 500 inborn errors of metabo- lism (IEM) were present in Indian population and it is stated that 1:20 Indian have some form of disorder or birth defects [3]. Pooled birth prevalence of IEM in the Eastern Mediterranean region is about 75.7/100 000 live births.
197 Teacher’s Workload and its Efficacy in Classroom Teaching in Primary Schools Under Punakha Dzongkhag , Sangay Dorji ;Samten Wangchuk
Teachers’ workload is associated with effective classroom teaching and learning. The academic performance of the school is determined by the amount of teachers’ workload. Primary school teachers’ workload is challenging for effective classroom teaching and learning. Therefore, the purpose of this study was to study the teachers’ workload of primary school teachers in Punakha dzongkhag. The study involved potential additional work areas that burden primary school teachers. The study employed mixed-method design. Survey questionnaires and interview were used to collect data. The target population comprised of primary school teachers and parents in Punakha dzongkhag. The entire population was 79 participants from nine primary schools and a few Extended Classrooms (ECRs). Out of 79 participants, 30% was taken for random sampling. Five teachers were selected from primary schools and one teacher from Extended Classroom for the interview. Mixed gender was selected for the interview. Ten parents were interviewed from different primary schools. Quantitative and qualitative data were presented separately and analyzed. The data triangulation was done in the findings and discussions. The study findings showed that teachers’ over workload has a negative impact on classroom teaching and learning due to limited time for lesson planning and tasks assessment. Teachers in primary schools had to devote certain time doing non-academic activities. Study found that even among the primary schools, teachers working in schools with less than 100 students had to shoulder more responsibilities. In smaller primary schools, staffing pattern is different whereby certain support staff are not entitled. Therefore, the researcher recommends Ministry of Education to reconsider pupil-teacher ratio and relook into the staffing pattern in primary schools. Primary school teachers need to specialize in a maximum of two subjects to enhance effective classroom teaching.
198 Botulinum Toxin A (Btx-A) Injection: A Rare and Complicated Pediatric Case from Kurdistan, Iraq , Nizar Bakir Yahya ;Hevan Adel Al-Atroushy;Stefano Maiandi; Federica Buzzi ;
Botulinum neurotoxin is the most potent poison known to humans. The active form of the Clostridium botulinum spore produces a neurotoxin that causes paralysis. Many botulism presentations are subtle and difficult to diagnose. However, botulinum can also have therapeutic uses, and the indications are different, including the reduction of muscle spasticity in pediatric patients. The thera- peutic use of botulinum toxin can cause several complications, including the possibility of developing botulism. Treatment of botulism consists of administration of antitoxins, hospitalization, close monitoring, and respiratory support as need- ed. The mortality rate of patients who develop botulism has dramatically decreased in developing countries but not in low-middle income countries because resources are severely limited. We report the first case of botulism after botulinum injection in a patient with hypoxic ischemic encephalopathy. The diagnosis was very complicated and late given the scarce resources present in Kurdistan, Iraq. The patient required advanced and long-lasting care. The child was hospitalized for 92 days, 56 of which the patient was on mechanical ventilation. The patient was treated without any antidote as it was not present, and he had no further neurological sequelae following the event.
199 Dupilumab Successful Treatment of a Child with Severe Atopic Dermatitis , Ana de Carvalho Vaz;João Oliveira;Diana Pinto; Fernanda Teixeira; Ana Rita Araújo; Laura Marques
Poorly controlled moderate-to-severe atopic dermatitis in children and adolescents can result in growth failure, impaired quality of life of patients and their families and a significant increase in healthcare expenses. A 9-year-old boy with severe atopic dermatitis, who was initiated on off-label treatment with dupilumab and presented a significant improvement in dermatitis and quality of life. This case highlights the great potential of dupilumab in the treatment of severe atopic dermatitis in the pediatric population
200 Comparative Study of Nutritional Status and Academic Performance in Schools with and without School Canteens in South-west Benin , Charles Patrick Makoutode*, Daniel Agueh, Luc Djogbenou, Colette Azandjeme and Jacques Saizonou
Introduction: Food is recognized as an essential factor for school performance because poor nutrition among school-aged children seriously compromises their health and their ability to learn. The purpose of this study was to compare nutritional status and aca- demic performance in schools with and without school canteens; and identify factors associated to school performance. Methods: This was a cross-sectional analytical study which took place from May 26 to June 12, 2020 in public primary schools in rural Ouidah districts with or without government school canteens. A total of 366 pupils were surveyed, including 183 in canteen schools and 183 in schools without canteens. Data on nutritional status, school performance, socio-demographic characteristics, individual characteristics and diet were collected. Results: The prevalence of thinness was higher in schools without canteens (44.81%) compared to schools with canteens (28.96%). The prevalence of stunting was also higher in schools without canteens (26.23%) compared to schools with canteens (19.67%). However, overweight was higher in canteen schools (1.09%) compared to schools without canteens (0.00%). Academic performance was acceptable among 51.37% of pupils in canteen schools, compared with 40.44% among pupils not benefiting from the school canteen project. In multivariate regression, factors associated to academic performance were, the sixth-grade class (OR = 12,03 avec IC 95% = [4,15-34,82]), moderate chronic malnutrition (OR = 6,67 avec IC 95% = [2,12-21,00]), the consumption of meat, fish or eggs 3 to 6 times a week (OR = 0,13 avec IC 95% = [0,01-0,97]), non-consumption of legumes in a week (OR = 9,12 avec IC 95% = [5,75-42,64]), vegetables consumption 1 to 2 times in a week (OR = 10,63 avec IC 95% = [2,09-53,99]) and the non-consumption of dairy products in a week (OR = 8,52 avec IC 95% = [3,32-21,88]). Conclusion: These results show that malnutrition is a health problem that remains present in schools in Benin and that it affects the academic performance of pupils. Actions to improve the food supply of the school feeding program and to extend it to all schools in rural districts as well as in urban districts are necessary.
201 Primary thoracic synovial sarcomas (SS) typically occur as chest wall masses, although they rarely arise in the lung and pleura. Primary pulmonary and mediastinal SS is very uncommon in comparison with metastatic sarcoma and might arise in the tracheo- bronchial tree manifesting as an endoluminal mass, generally in adults. Signs and symptoms may additionally consist of wheezing, persistent pneumonia, bronchial asthma, chest ache, recurrent cough, atelectasis, hemoptysis, and weight loss. Because of the hetero- geneity of signs and symptoms, clinical diagnosis may be tough. Herein, we present a case of primary endobronchial and mediastinal SS in a young female presenting with cough and expectoration associated with haemoptysis and breathlessness on exertion for one week with particular emphasis on the radiologic and pathologic findings of this rare lesion , Krishna Kumar M
Primary thoracic synovial sarcomas (SS) typically occur as chest wall masses, although they rarely arise in the lung and pleura. Primary pulmonary and mediastinal SS is very uncommon in comparison with metastatic sarcoma and might arise in the tracheo- bronchial tree manifesting as an endoluminal mass, generally in adults. Signs and symptoms may additionally consist of wheezing, persistent pneumonia, bronchial asthma, chest ache, recurrent cough, atelectasis, hemoptysis, and weight loss. Because of the hetero- geneity of signs and symptoms, clinical diagnosis may be tough. Herein, we present a case of primary endobronchial and mediastinal SS in a young female presenting with cough and expectoration associated with haemoptysis and breathlessness on exertion for one week with particular emphasis on the radiologic and pathologic findings of this rare lesion
202 A Modern Assessment of the Nutrition of Children Living in Environmentally Unfavourable Conditions in Uzbekistan , Dachanov BA;, Kobilov EE;Turamtocatch SN;Shamirzaev HM
The research was conducted in order to learn and assess hygienically the condition of actual nourishment of examined children. It was found out that, daily food of the children consists of more vegetable than necessary, and meat products are less. Protein and animal fat shortage and abundance of carbohydrate caused the disbalanced of chemical composition of food of the children. Calorie content of the food is increased bу the high amount of carbohydrate. Nourishment of the children and composition of food do not meet the hygienic demands and regulations must bе established.
203 Energy Alterations in Children with Insomnia and What Can We Do to Improve Their Sleep , Huang WL
Insomnia in children and adolescents are common condition in my daily practice. In an article written by Oerkermann., et al . (2007) entitled Prevalence and Course of Sleep Problems in Child- hood, the authors are saying that 12% of the children reported to have sleep difficulties such as difficult in initiating and maintaining the sleep is the most common sleep problems in childhood
204 Major Factors Affecting Women’s Participation in Educational Leadership: A Case of Bhutan , Tshegyal Dawa;Duptho Ugyen
The number of women assuming educational administration roles such as the head of departments, academic coordinators, principals and vice principals is very negligible or minimal in the Bhutanese educational context. This research is therefore, aimed towards identifying the critical factors affecting the participation of women in educational leadership positions in Bhutan, and exploring and recommending relevant strategies or possible interventions to encourage more participation of women in educational leadership positions The research study is primarily descriptive in nature; interview questionnaires were distributed to35 respondents who were pre-selected using non-probability sampling method from which only 21 respondents participated in the study. The respondents included female teachers and women principals from 5 schools and 4 women leaders under Ministry of Education in Thimphu. A set ofinterview questions consisting of both open ended and closed ended questions were used for the respondents to fill up and return in person or through emails. The qualitative data obtained from the interview schedules was analyzed and recorded in hard copy during the work in progress phase.It was later compiled and after the compilation, spreadsheet and word document, supported by thematic analysis coding, was used to analyze the data. The study findings revealed that the under-representation of women in leadership positions is dueto the gender biases shown in favor of males and against women, with the assumption that womenare weak and do not have the required potential and capability to lead. The findings further specifically indicated that there are too few role models or mentors in the system, policies addressing gender imbalance are not implemented in the system, and poor or no incentives for women to take up leadership positions from the authorities. On top of all, socio-cultural factors such as family responsibilities, lack of confidence, no gender equity in assigning leadership positions and women being weaker sex affect women to take up leadership position in education. Based on the findings, some of the policy interventions such as equal representation of male and female candidates, institution of mentor-mentee programs, better incentives, introduction ofwomen or gender sensitization programs are recommended. The study therefore found out that in Bhutan, women have not received equal treatment in terms of availing opportunities for leadership positions. Hence, a fewer women leaders in the Ministry of Education  
205 Academic Performance of Day Scholars Versus Boarders in Norbugang Central School , Tshering Gyelltshen;Chencho Dorji
It is a generic perception of parents that boarders would outperform the day scholars in the academic sphere owing to the fact that they are armed with better facilities in terms of readily availability of time and both human and material resources since they have the privilege of using them at any point of time as required. Every parent wishes to put his/her child as a boarder whichhas emerged as a pressing challenge. Owing to such generic perception of the stakeholders the school is currently undergoing bitter experiences of admission pressure. Institution of boarding or day school plays an instrumental role in determining the academic performance of a school in this competitive globalized world. The stakeholders like government, educationists, curriculum designers, police maker, parents, principal, teachers, guardians etc. have greater roles to play to make their best choice in educating their children as crucial investment for good return. There arecertain variables or elements that are responsible for the academic performance of students be it boarder students or day students in any context of location. There are also other essential factors responsible for academic performance in terms of sex in boarding or day scholars. As such, there is a grave need of stakeholders as above to know which of their children (male or female, boarder or day scholar perform better in academic sphere. Thus,this paper will help us determine better about the academic performance of boarders and day scholars in the field o various variables in Norbugang Central School during the academic session2021 and do necessary interventions accordingly. In order to determine the academic performanceof day scholars and boarder students of Norbugang Central School, annual examination record ofstudents for 2021 ranging from classes VII-IX was used. Annual examination was conducted to determine the competency of students based on the taught concepts entailing divergent questions such as multiple choice questions, objective type of questions, open ended questions and short essay questions that were principally aimed at testing criticality, creativity of students. The academic performance of students were categorized as outstanding, distinction and divisions as reflected below: 1. % > = 45(45-100) % 2. % > = 60(60-100) 3. % > = 70(70-100) 4. % > = 80(60-100).
206 Persistent Sinus Tachycardia as an Early Marker in Kawasaki Disease , Gunjan Baweja;Dr. Rajdeep Singh
Kawasaki Disease (KD) causes coronary artery lesions which can be prevented if KD is diagnosed and treated early. We present a 6-month-old child with persistent sinus tachycardia who evolved to develop KD. Persistent sinus tachycardia must not be disregarded as can be an early marker of Kawasaki Disease
207 Multiple Sulfatase Deficiency: A Clinical Report with Neonatal Presentation , Srushti Gandhi;Snehal Mallakmir;Rashid Merchant
Multiple Sulfatase Deficiency is a rare autosomal recessive inborn error of metabolism caused by mutations in the sulfatase modi- fying factor 1 gene which encodes the formylglycine-generating enzyme, and resulting in accumulation of sulfatides, sphingolipids, sulphated glycosaminoglycans and steroid sulphates in various tissues. More than fifty different mutations and less than hundred cases have been published so far. We report a new case of MSD presenting in the neonatal period with respiratory distress, feeding difficulty, hypotonia, ichthyosis and dysmorphology. This patient was detected with a known homozygous pathogenic variation in SUMF1 gene c.1043C>T (p.A348V).
208 A Case Report of a Child with Langerhans Cell Histiocytosis , Srushti Gandhi;Rashid Merchant;Snehal Mallakmir
Langerhans cell histiocytosis (LCH) is a rare clonal disease of the monocyte-macrophage system, comprising of uncontrolled pro- liferation of CD1a+/CD207+ dendritic cells (DCs). It has a wide range of symptomatology making early diagnosis and intervention extremely challenging. LCH may range from mild single system involvement with isolated skin or bone lesions to life-threatening multi-system involvement. Furthermore, when risk organs are involved, even with aggressive treatment, 10-year survival rates are only 50%, further emphasizing the need for maintaining a high index of suspicion and early intervention. We present the case of a 2-year-old girl who arrived at our clinic with a painless lump over the head following a trivial head injury, and on further evaluation was found to have histopathologically confirmed multisystemic LCH. Response to treatment has been favourable.
209 Role of Primary Vats for the Treatment of Empyema Thoracis in Children , Ali Raza Brohi;Naseem Mengal;Abdul Lateef Leghari
Introduction: Empyema is an entity frequently encountered in pediatric age group. It is the collection of suppurative fluid in the pleural cavity secondary to bacterial pneumonia and may include other causes such as malignancies and immunological disorders. Different guidelines are available for management of empyema in adults however there is no consensus on management of empyema in children. Generally accepted treatment modalities in the order of minimal to most invasive include Antibiotics, Intercostal Chest Drainage, Fibrinolytic Therapy, Video Assisted Thoracoscopic Surgery (VATS), and open thoracotomy, with open thoracotomy usually being restricted to treating the most advanced stages i.e., stage 3. Material and Methods: This is a retrospective descriptive study conducted at Maternal & Children Hospital; a tertiary care hospital in Nawabshah, Pakistan built with the intention to provide better maternal and child care to the surrounding urban and rural areas. The duration of this study was 6 years (January 2015 to January 2021) during which a total of 65 patients diagnosed with stage II and some stage III empyema were enrolled via non-probability consecutive sampling Results: A total of 65 patients were enrolled during the 6-year period of the study, of which 38 were males and 27 were females, with ages ranging from 2 to 11 years and a median of 6 years. 40 patients (61.5%) underwent primary VATS, whereas the remaining 25 patients (38.5%) underwent secondary VATS (VATS after chest tube for drainage initially). The duration of stay ranged from 3 to 10 days, with a median of 6 and 8 days for Primary and Secondary VATS. Conclusion: Primary VATS is a better modality and, in our experience, should be preferred over simple chest tube drainage where possible. As presented above, the level of complexity is generally lower if opted for earlier. The procedure is simple to learn and will also act in smoothening the learning curve for other thoracoscopic surgeries
210 Characterization of Frequent Users of a Pediatric Emergency Department in Level II Hospital and What Changed with the COVID Pandemic , Teresa Pinheiro;Ana Torres Rebelo;Joana Monteiro ;Teresa Caldeira
Before the COVID pandemic, the Pediatric Emergency Department (ED) had been experiencing a progressive overload due to an in- creasing of visits, but this high demand for emergency pediatric care does not always translate into serious conditions requiring hospital attendance. Frequent users, defined has having eleven or more admissions per year, are often associated with inadequate emergency visits. We performed a retrospective study of admissions to a Portuguese pediatric ED during the year of 2018, and we described the characteristics of its frequent users. The aim of this study was to compare the utilization of ED by the frequent users throughout 2018 and during the first year of the COVID-19 pandemic. In 2018, we identified 123 frequent users representing 1% of the patients that sought ED care and accounting for more than 5% of the total visits. In 2020, during the first year of the pandemic (from March 1st, 2020, to February 28th, 2021) we observed a significant reduction in all ED visits, as well as frequent users. The average age of patients changed significantly in the two periods (2,44 vs 4,65; p 0,000), with no gender differences. In both years, most children didn ́t have a relevant pre-existing medical condition, but 45,5% frequent users in 2018 had a least one previous hospitalization, compared to just 26,5% of the frequent users in 2020 (p < 0,05). To our knowledge, these are the first data on frequent user’s attendance during the pandemic compared to what happened previously. And if before we had a population of small children with inexperienced parents that don ́t make the correct use of primary care, during the pandemic, anxiety and psychosomatic symptoms were predominant.
211 Preventing Professional Burnout , Kathleen E Jones
The present-day pandemic has closed many professionals off from one another during times of quarantine, while offering a platform to work from home. This has had benefits and negatives, with professional burnout occurring more than ever before. A Gallop Poll in the United States of America reports that 30% of workers are stressed to the point that their work is directly affected, while another 40% are actively dealing with burnout, with 62% worried about their professional futures. Burnout occurs, it begins typically with feelings of waning passion, then work begins to suffer, followed by making poor choices of coping with the issues at hand, and then ending with the worker being completely disengaged. Identification is key. This paper offers how to identify professional burnout, and how to quell it and reverse its effects. The concept of professional burnout is likened to the simile of a fire burning as an example of the experience process.
212 Growth: Postnatal Growth Rate , Miguel Martell
Growth and development are the most important biological sensors to detect the state of health in the individual and in the population. The strategy for implementing continuous monitoring in the evolution of these two parameters must be carefully evaluated. The inter- action between growth, development and education is responsible for the socio-cultural formation of the individual and his integration into society. Any measure of measuring the variable can be used, but some are more advantageous such as the rate of growth per unit in preterm and low birth weight.
213 Organochlorine Pesticides in the Breast Milk of Lebanese Women: Magnitude of the Environmental Burden 25 Years After Banning their use , Fares Florence
Breast milk contamination with organochlorine pesticides reflects long periods of inadequately and sometimes uncontrolled pollution of the environment. Among other fat-soluble substances, they accumulate in fatty tissues, get biomagnified through the food chain and are subsequently transferred from lactating mothers to their offsprings. Their toxic effects are dose related. The goals of this study were to de- termine the levels of organochlorine pesticides in the milk of lactating mothers in the region of Beirut years after banning of their use. 60 samples of breast milk were collected, and mothers were asked about their demographic features and behavioral and dietary habits. We used the CPG-MS method for organochlorine levels measurements. 55% of samples were tested positive for at least one organochlorine pesticide and 16.7% of these levels exceeded Maximal Residue Limits. DDE, a metabolite of DDT is the most encountered contaminant (35% of samples). Lindane levels are the most toxic. No correlation was found between the levels of organochlorine pesticides and the demographic and behavioral features of the population. Fish consumption was correlated with p-p’DDE levels (p = 0.036), poultry con- sumption was correlated with p-p’DDD (p < 0.01), and total DDT levels (p < 0.01) and milk consumption was correlated with HCB levels (p = 0.023). No correlation was found between organochlorine pesticides levels and maternal consumption of fruits and vegetables
214 Comprehensive Clinical Approach to Nutritional Management in Preterm Infants: Review Article , Chakradhar Maddela
Introduction: Nutrition is “the process of providing or obtaining the food necessary for the health and growth of cells or organisms” [1,2]. Preterm extremely low birth weight infants (ELBW) are born in mid trimester of pregnancy and experience sudden interruption of intrauterine nutrition at birth and delay in establishment of full enteral nutrition in postnatal life. Foetus multiplies in weight five times during last trimester and maximum accretion of nutrients occurs during same period of pregnancy [3] (Fenton 2013). These babies are prone to develop extra uterine growth restriction (EUGR) in early infancy, [4] Embleton 2001. Parenteral nutrition (PN) is a mandatory life saving and nutrition promoting intervention for preventing EUGR, tissue breakdown and achieving optimum nutrition, growth and development until full enteral feeds are established. Hence, assessment of nutritional needs, early aggressive parenteral nutrition and early trophic feeds within 24 of life [5], incremental increase in enteral feeds with extracted fresh human milk, full enteral feeds, breast milk fortification, preterm formula feeds and post discharge plan are crucial in the nutritional management of extremely low birth weight infants. Methods: A Boolean literature search conducted in February 2022 through online databases - PubMed, Web of Science (WOS), Google Scholar, Cochrane library, Researchgate and manual search for scientific articles and texts with the title topic and keywords - preterm infants, nutrition, needs, requirements and management. The retrieved articles were screened with title and abstract for interested study research title. Retrieved 33 articles from PubMed, 10 from Cochrane library, 27 from WOS, 6 from Google scholar, 2 from researchgate and 12 from other sources. Articles were also searched through citations and references from collected study articles. Study restricted to articles written in English language. The following filters were used in retrieving study articles - free full text articles, Human, Newborn, Systematic reviews, meta-analysis, randomized control trials (RCTs), Clinical trials and Reviews. Animal studies were excluded. The re- trieved articles were screened for the interested research title topic after going through the article title and abstract. A total of 32 study papers were analysed. Results: The collected study papers were narrated with the subheadings - definition, nutritional needs of ELBW infant, TPN, enteral nu- trition (minimal enteral nutrition, MEN and nutritional feeds), human milk fortifier, feeding intolerance, nutritional assessment, catch up growth and feeding advice at discharge.
215 Early Childhood Caries - A Definitive Prerequisite for Caries Assessment Tools , Lakshmi Thribhuvanan
Dental caries is an irreversible microbial disease of the calcified tissue of the teeth, characterized by demineralization of inorganic portion and destruction of organic substance of tooth which often leads to cavitation [1]. Dental caries is a rapidly progressing dis- ease in the developing countries like India where the resources are inadequate for dental treatment. It has been estimated that nearly 60-70% of all restorations were done on previously restored teeth, with secondary carious lesions
216 Diagnostic Dilemma of Pseudodementia: A Case Report , Roosy Aulakh1;Harbir Sekhon
The term “pseudodementia” has attracted much controversy. Some neurologists are of the opinion that no such condition exists, while others seem to disagree. There is evidence that older patients suffering from depression may be at risk for subsequent dementia. Some studies have indicated that “pseudodementia” may well lead to an irreversible dementia. The present case illustrates a different and more favorable outcome. An elderly man with major depressive disorder, single episode, was misdiagnosed with dementia and subsequently Parkinson’s disease due to symptoms of significant cognitive impairment and classical symptoms of Parkinson’s disease. These diagnoses were made due to limited or no response to inadequate antidepressant treatment, memory enhancing agents and side effects induced by standard treatment for Parkinson’s disease. After discontinuation of all prior medications, which included L-dopa, amantadine, ropinirole, donepezil, memantine, paliperidone, sertraline, a trial of high-dose selegiline at 60 mg per day produced substantial improvement with complete resolution of cognitive impairment and disappearance of signs of “Parkinson’s disease”. Clinicians should rely on careful history taking, physical and mental status examination and response to previous treatments before making a tentative diagnosis of “dementia”, “Parkinson’s disease” or “pseudodementia”. The outcome, as this case illustrates is markedly affected, sometimes to the detriment of the patient.
217 Infantile Macrocephaly and Autism Spectrum Disorder Diagnosed with PTEN Hamartoma Tumor Syndrome: A Case Report , Liliana Sá ;Ana Rebelo ;Ana B Ferreira;Ana Rita Soares;Catarina Matos de Figueiredo; Virgínia Monteiro ;Joana Monteiro
ntroduction: Loss of function of the PTEN tumor suppressor gene, due to heterozygous mutation, gives rise to a wide variety of disorders, including macrocephaly/autism syndrome, PTEN hamartoma tumor syndrome, and Cowden syndrome, characterized by high risk of developing thyroid and breast cancer at young age. Case Report: A 2-years-old male infant with simple macrocephaly was referred to the Developmental clinic due to global deve- lopmental delay, with special impairment in speech. On physical examination, he had peculiar facies, with mild and nonspecific dysmorphia, and macrocrania with dolichocephaly. There were no stigmata of neurocutaneous disease. At the age of 5 years and 6 months, the heterozygous de novo variant c.302T > C (p- lle101Thr) in PTEN gene was identified, classified as probably pathogenic. Meanwhile, the patient was diagnosed with autism spectrum disorder with moderate developmental delay. Discussion: The morbidity and mortality of this syndrome is associated with a higher incidence of cancers, most of them curable if early detected. The correct diagnosis, allowing the establishment of an adequate surveillance program, is therefore essential
218 Idiopathic Pulmonary Hemorrhage in Saudi Girl Mimicking Iron Deficiency Anemia , Majed Alharbi;Abdulrahman Alrshoudi;Essa Alrashidi; Ahmed Al Enizi
We report an extremely rare case of a 7-years-old girl diagnosed with IPH at the age of 18 months successfully treated with azathioprine which, to the best of our knowledge, is the first case in Saudi Arabia. The girl was found to have hemolytic anemia with diffuse fluffy bilateral shadows in chest x-ray in addition, hemosiderin-laden macrophages in the bronchial wash were positive. Workup for vasculitis, immune diseases, and connective tissue disorders were negative. The patient was started on Methylprednisolone and azathioprine which showed a notable effect in reducing the frequency and severity of the pulmonary hemorrhage in comparison to prednisolone alone. This case was reported to highlight the importance of attention to detailed history in suspected cases and to demonstrate the need for IPH management in the pediatric age group as there is no standard management
219 Idiopathic Pulmonary Hemorrhage in Saudi Girl Mimicking Iron Deficiency Anemia , Majed Alharbi;Abdulrahman Alrshoudi;Essa Alrashidi; and Ahmed Al Enizi
We report an extremely rare case of a 7-years-old girl diagnosed with IPH at the age of 18 months successfully treated with azathioprine which, to the best of our knowledge, is the first case in Saudi Arabia. The girl was found to have hemolytic anemia with diffuse fluffy bilateral shadows in chest x-ray in addition, hemosiderin-laden macrophages in the bronchial wash were positive. Workup for vasculitis, immune diseases, and connective tissue disorders were negative. The patient was started on Methylprednisolone and azathioprine which showed a notable effect in reducing the frequency and severity of the pulmonary hemorrhage in comparison to prednisolone alone. This case was reported to highlight the importance of attention to detailed history in suspected cases and to demonstrate the need for IPH management in the pediatric age group as there is no standard management
220 Cardiac Findings in Childhood Syncope , Shahram Sadeghvand;Parya Tobeh ;Akbar Molaei and Roghyieh Ebrahimi
Background: Various causes can lead to a transient decrease in consciousness, which can be traumatic or non-traumatic. Non-trau- matic causes include syncope, seizures, and metabolic disorders. Syncope is a common problem in children. The aim of the present study was cardiac findings in patients with syncope referred to a pediatric clinic. Methods: This is a cross-sectional study of children who referred to the clinic of Tabriz Children's Hospital with at least one episode of syncope. Patients data including number of syncope events, factors leading to syncope (including prolonged standing, hyperven- tilation, mental stress, exercise, and prolonged starvation); Any aura before syncope (including confusion, palpitation, decreased vi- sion, nausea, sweating, and paleness); Patient medications and family history (including syncope, sudden death, and cardiovascular disease) were recorded. The patient's clinical examination information including heart rate, systolic and diastolic blood pressure in the supine and sitting position (after standing for 2 minutes) was recorded. Cardiopulmonary findings were recorded. 12-lead elec- trocardiography was performed for patients and information including heart rhythm, heart rate, P wave voltage, QRS length, heart axis and QTc were recorded. If there is a positive electrocardiographic or clinical result, 2D Doppler echocardiography was performed for patients and the results were recorded. Findings: In this cross-sectional study, 100 children who referred to the clinic of Tabriz Children's Hospital with at least one episode of syncope were enrolled. The mean age of the children was 8.54 ± 2.70 years ranging from 2.5 to 16 years. The average number of syncope episodes at the time of study was 4 syncope with a range between 1 and 12 syncope. In terms of gender distribution, 44 children (44%) were boys and 56 children (56%) were girls. The family history of syncope was positive in 7 children (7%). The most common cause of syncope in children studied was syncope following exercise (33%). The most common aura was palpitation with a frequency of 29%. In the studied children, abnormal ECG was observed in 11 children (11%). Abnormalities included prolonged QTc in 4 cases, ventricular hypertrophy based on high voltage in 2 cases, atrial enlargement in 2 cases, abnormal axis in 1 case, complete heart block in 1 case, and supraventricular tachycardia in 1 case. Conclusion: The use of an appropriate history and clinical examination along with ECG is of great value in the diagnosis of syncope with cardiovascular causes in children. It is also best to have echocardiography instead of echocardiography for all patients who are suspected and have an abnormal ECG. It was also observed in this study that the main defaults of cardiac syncope include early syn- cope with common periods, abnormal ECGs, and higher sitting and standing blood pressure differences
221 Macrophagic Activation Syndrome Related to Measles in a Child , F Safi1; Manel Hsairi1;A Ben Halima;A Abdennadher; L Gargouri; and A Mahfoudh
Measles is a highly contagious infection whose frequency has been clearly reduced thanks to vaccination. It can rarely lead to complications, which are represented mostly by pneumonia, diarrhea or otitis, less commonly, encephalopathy and hepatitis. Macro- phagic activation syndrome is a severe systemic manifestation which can rarely been associated with measles. We present a case of haemophagocytic syndrome caused by measles in a 14-month boy.
222 Follow Up the Children with Ocular Lesion Induced by Two Common Intrauterine Infections (Cytomegalovirus, Toxoplasmosis): A Cohort Study in Tehran, Iran , Mohammad Vafaee-Shahi ;Samileh Noorbakhsh;Leila Tahernia ; and Sarvenaz Ashouri
Background: Intrauterine infections lead to involvement of various organs in fetus, including the eye. The aim of this study was to determine the frequency and clinical response of ocular lesions to specific drugs in infants with congenital Toxoplasma and cyto- megalovirus infections. Methods: This historical cohort study was performed in the pediatric and ophthalmology department of Hazrat Rasool Akram Hos- pital in Tehran from October 2011 to November 2017. Patients included 78 infants with intrauterine infection (proven) and ocular involvement (cataracts, glaucoma, and retinitis). Infants who did not undergo additional and diagnostic tests, eye examinations, follow-up and did not receive effective treatment were excluded from the study. Three patients expired during the study. Finally, 37 patients (including 25 patients with cytomegalovirus and 12 patients with toxoplasma) were included to assess and the clinical response to ocular lesions was evaluated for one year. Results: Of 12 cases with toxoplasmosis, 5 patients received complete treatment and 4 patients had appropriate clinical responses. Of 25 patients with CMV, 18 patients received complete treatment and 9 patients had appropriate clinical responses. Conclusion: Successful treatment will be obtained in near 80% of ocular toxoplasmosis, so anti toxoplasma treatment is recom- mended in all confirmed cases. About 50% of CMV infected cases (with hearing loss, ocular involvement) might respond well to antiviral therapy, We recommend anti CMV treatment in any age (< 2 years old) but it is not indicated in CMV infected cases with severe brain involvement
223 Vitamin D - A Fundamental Paradigm Shift in Pediatrics?, Abdul Halim Abdul Jalil
Vitamin D deficiency/insufficiency in reality is a pandemic that is frequently undiagnosed and untreated [1-3] Research findings to date appear persuasive enough for clinicians to reconsider current clinical applicability of vitamin D supplementation
224 Twelve Months of MIS-C: Does Increasing Experience Improve Resource Utilization?, T Shea Osburn;Victoria Acharya;Rhonda Keosheyan;Chloe Kupelian DO;Nicole Webb
Objective: Define the clinical characteristics, outcomes, and resource utilization patterns in pediatric patients with Multisystem Inflammatory Syndrome in Children (MIS-C) hospitalized at our center over the first year of the pandemic. Methods: Retrospective case series of patients < 22 years with a discharge diagnosis of MIS-C between 5/1/20 and 4/30/21.Demo- graphic, clinical, and outcome data was collected and analyzed. We then performed an analysis comparing resource utilization in the first six months of the time period to the second six months in the time period. Results: Forty eight percent (38/81) of our population had a greater than 2g/dl drop in their hemoglobin during their hospitaliza- tion. 73% (59/81) had a 1g/dl or greater drop. Of the recommended labs, CRP (100%), D-dimer (98%), Ferritin (91%), ESR (87%) Procalcitonin (85%), Fibrinogen (85%) and BNP (85%) were most frequently abnormal. Triglycerides (17%), PT/PTT (50%) and LDH (59%) were least frequently abnormal. Between the two defined time periods, there was no statistically significant improve- ment in the number of lab draws obtained aside from lab draws for triglycerides (p = .049). Conclusions: Our clinical findings are consistent with those already published in the literature. Outcomes were also positive, with no deaths in our cohort and 83% had no cardiac abnormalities six weeks after admission. Laboratory resource utilization was sub- stantial and did not improve over the first year of MIS-C cases at our organization. Our patients with MIS-C did frequently experience significant drops in their hemoglobin. There is likely opportunity to refine the available guidelines for the management of MIS-C.
225 Suicide Ideation and Behavior Among Adolescents Admitted in Governor Celestino Gallares Memorial Hospital in the Midst of the Covid-19 Pandemic, Kahra Christy E Jumawan, Anabella S*, Maribeth M Jimenez and Joy A Bueno
Objective: To determine the incidence and risk of suicide ideation and behavior of adolescents admitted in Governor Celestino Gal- lares Memorial Hospital (GCGMH) in the midst of the COVID-19 pandemic. Keywords: Suicide Ideation; Adolescents; Covid-19 Design: This is a descriptive cross-sectional study. Participants: This study involved adolescents 10 to 17 years and 364 days who were admitted at the pediatric and surgical wards of GCGMH from November 11, 2020 to November 10, 2021 excluding those discharged against medical advice or per request, and those diagnosed with neurodevelopmental disorders. Total population enumeration was utilized. Methodology: A one-on-one guided interview using the Columbia-Suicide Severity Scale (C-SSRS) screener version was conducted in a vacant room without the parents around after an informed consent from the parents and an informed assent from the adolescent were obtained. The interview was conducted on the day of patient’s discharge. The data that were gathered were duly recorded and tabulated. Conclusion: Suicidal ideation is seen in 20% of hospitalized adolescents during the COVID-19 pandemic. A vast majority of adoles- cents with suicidal ideation is females. Adolescents at high-risk for suicide are females aged 16 - 17 years. Results: There were 7 out of 35 (20%) adolescents who wished to be dead. Suicidal thoughts were seen in 4 adolescents (57.1%) who wished to be dead. Of these 4 adolescents, 3 (75%) had thoughts of the method by which to commit suicide. Two of the 4 adoles- cents (50%) had suicidal intent without a specific plan and 2 adolescents had suicidal intent with a specific plan. All the 4 adolescents with suicidal intent had suicidal behavior (100%). Six of the 7 adolescents are girls 16 to 17 years old, and 1 was a 16-year-old boy. All the 4 adolescents with suicidal thoughts and behavior were girls. All these 4 adolescents were considered to have high suicide risk according to C-SSRS. All the other 31 adolescents were considered to have low suicide risk.
226 The Lymphatic Bursa - Oral Lympho-Epithelial Cyst, Anubha Bajaj
Lympho-epithelial cyst is a rare, non-odontogenic, benign, soft tissue developmental cyst emerging within the oral cavity. Oral lympho- epithelial cyst predominantly appears within ventral surface or posterolateral lingual margin, floor of mouth, soft palate, buccal mucosa, hard palate, labial mucosa, palatoglossal fold, tonsillar pillar, lip, glossodesmus fold or retro-molar region. The asymptomatic lesion can represent as a miniature, painless lump or a yellowish white, soft to firm, submucosal nodule of around ~one centimetre magnitude. Cyst cavity is layered with attenuated, para-keratinized, ortho-keratinized or non-keratinized stratified squamous, pseudo-stratified columnar, respiratory metaplastic, ciliated pseudostratified or ciliated columnar epithelium with mucous or goblet cells and intensely infiltrated by mature, small lymphocytes configuring germinal centres
227 Absolute Neutrophil Counts and Neutrophil to Lymphocyte Ratio as Early Predictive markers of Dengue Severity among Children admitted in Governor Celestino Gallares Memorial Hospital: A 5-Year Retrospective Study, Kristine M Prayon and Anabella S Oncog*
Background: Dengue fever is known to have an unpredictable course and outcome. Because of this uncertainty, diagnostic tools for early detection of severe dengue should be developed. Studies on the correlation of degrees of neutropenia and Neutrophil-Lympho- cyte Ratio (NLR) with dengue severity on the pediatric population are scarce, and its clinical significance is still uncertain. Objective: To determine the correlation of Absolute Neutrophil Counts (ANC) and Neutrophil-Lymphocyte Ratio (NLR) during the acute phase of dengue infection with the development of severe dengue among children admitted at Governor Celestino Gallares Memorial Hospital (GCGMH). Results: Out of 912 eligible patients, 584 subjects were enrolled. Abnormal ANC was noted in 41.4% of subjects where, 21.6% had mild neutropenia, 17.8% had moderate neutropenia and 2.1% had severe neutropenia. Almost 44% of subjects had high NLR. There was no significant association noted between ANC and dengue severity. However, a trend towards increasing risk for severe dengue was noted with increasing severity of neutropenia. No significant association was also noted between NLR and dengue severity. Conclusions: There is no significant correlation between neutropenia during the febrile phase of dengue infection with the develop- ment of severe dengue in pediatric patients. However, a trend towards increasing risk for developing severe dengue as the severity of neutropenia increases was noted. High NLR during the febrile stage of dengue, likewise, is not significantly associated with progres- sion to severe disease. Methodology: This is a retrospective descriptive correlational study. The charts of children aged 0-18 years with laboratory-con- firmed dengue who were admitted to GCMGH from January 1, 2016 to December 31, 2020 were reviewed. Data collection was done using simple random sampling. Data were analyzed using frequency, percentage, median and standard deviation. Chi-square test was used to determine the association of ANC and NLR with dengue severity
228 Primary Ciliary Dyskinesia: An Uncommon Cause of Neonatal Respiratory Distress, André Costa Azevedo*, Ana Isabel Sequeira, Dalila Rocha, Isabel Soro, Beatriz Sousa, Armando Laranjeira
Primary Ciliary Dyskinesia is a rare and genetically heterogeneous disorder characterized by immobility, dysmotility or absence of cilia, causing chronic oto-sino-pulmonary disease. Approximately 50% of patients have situs inversus totalis. Genetically, the most common genes involved are DNAH5 and DNAI1. Newborns with Primary Ciliary Dyskinesia may have respiratory distress with mild transient tachypnoea or mild hypoxemia, rhinitis or atelectasis, usually associated with poor feeding. Six days after birth, a full-term male newborn was admitted to the paediatric emergency department for intermittent respiratory distress, mainly during breast- feeding, associated with nasal congestion and sporadic productive cough. Physical examination revealed acrocyanosis, jaundice and bilateral basal crackles. Preductal pulse oxygen saturation was 90% on room air requiring supplementary oxygen therapy. Chest X-ray demonstrated dextrocardia. Echocardiography confirmed dextrocardia without structural heart disease. Abdominal ultra- sound showed the presence of situs inversus totalis, with no other malformations. During the hospitalization nasal congestion, cough and hypoxemia progressively resolved. Coexistence of total situs inversus and unexplained newborn respiratory distress suggested the presence of Primary Ciliary Dyskinesia. Genetic testing showed two different variants of DNAH5 gene confirming the diagno- sis. The infant was referred to a Paediatric Pulmonology centre and Paediatric and Otorhinolaryngology outpatient clinic. He also started chest physiotherapy sessions and immunoprophylaxis against respiratory syncytial virus. Although neonatal presentation is unusual, Primary Ciliary Dyskinesia should be considered for neonates presenting with respiratory distress of unclear cause. Early diagnosis is important in order to decrease damage to the respiratory system from recurrent infections and improve the quality of life and prognosis
229 Unusual Cause of Complex Enteroenteric Fistulae in Children: A Warning Letter to the Parents, Mohamad Daboos;Mohamed Mahfouz;Dalia Gad; Mabrouk Akl; Mohamed El-Sayed;Omar Alsamahy2, Medhat Ibrahim;Riadh BenMalek; Gamal Al-Saied; and Mohamed Negm
Background: Foreign body (FB) ingestion is a common problem in infants and children. Most of them pass spontaneously via gas- troentstinal tract. Some of them are potentially dangerous and may be fatal. Patients and Methods: Six children (4 boys and 2 girls) have swallowed multiple high strength and powerful rare earth element Neodymium magnets. Their ages ranged between (nine months to six-year-old). Four cases were subjected to open and two for lapa- roscopic exploration (one ofthem converted to open). Results: multiple perforations of small intestine were found in four cases and multiple complicated enteroenteric fistulae in the other two cases. Simple closure of small bowel perforations were done in four cases and resection anastomosis were done in the other two cases. There was complication either intraoperative or postoperative. Conclusion: Ingestion of Neodymium magnetic beads by children or co-ingestion of other metallic objects. are very hazardous. Early endoscopic removal is recommended if the patient presents immediately after ingestion. Surgical removal (laparoscopic or open) is mandatory in such cases. Awareness of parents through media is required to abandon the purchase of toys with high-strength magnetic beads or buckyballs
230 Editorial on Blood Disorders, Vithalrao Dandge
There are many blood component disorders in human beings like Sickle Cell Disease, Thalassemia and Hemophilia which are prominently observed in India amongst all the bleeding disorders. Sickle Cell Disease (SCD) and Thalassemia got lot of attention in recent past from Govt. and Non-Govt. agencies for its diagnosis, management and rehabilitation etc. But the important third bleed- ing disorder i.e. Hemophilia is not getting proper attention from various Govt. and Non-Government agencies even our medical fraternity (doctors of various specialities) is not fully aware about the implications and sufferings of Hemophilic patients and hence we need to give more importance to the diagnosis, treatment, he- reditary aspects and long term management of these patients with making Anti-hemophilia factors available in plenty at cheaper rates throughout our country.
231 Laparoscopic Inguinal Hernia Closure is Safe and Effective Technique in Children, Ali Raza Brohi;Naseem Mengal, Imran Ali Bajwa, Muhammad Saleh Khaskheli and Rafia Tabbasum
Introduction: Inguinal hernia is a common pediatric surgical problem in children having an incidence of 0.8% to 4.4%. Open her- niotomy is still the procedure of choice even after the advent of minimal invasive surgery due to anesthetic considerations, increase recurrence rates in laparoscopic hernia repairs. Laparoscopic inguinal hernia repair has obvious advantages like cosmetically better outcome, shorter operative time, early recovery, dealing of unidentified opposite site hernias with decrease risk of damage to sper- matic cord in males and wound infections. Material and Methods: We reviewed the medical records of the 175 patients who underwent laparoscopic inguinal hernia closure from January, 2015 to December, 2021 at Peoples University of medical health sciences, for women. We reviewed the demographic data, laparoscopic findings, operative time, hospital stay, post-operative complications and follow-up. Results: During this six-year study period 175 patients were operated by laparoscopic technique. The mean age of presentation was 1.6 years (range 1~ 3, with ± 0.73 SD). 83% were boys and 17.1% were girls. The mean operative time for unilateral hernia was 22.5 mins (± 10.394 SD) and 45mins (± 6.93SD) for bilateral hernia. The hospital stay was 24hrs in most cases except in few where there was gut involvement. Conclusion: Laparoscopic inguinal hernia repair is a safe technique in an expert hand and have an advantage of ligating sac without dealing the cord in male patients, assessing contralateral PPV and simultaneously dealing the contralateral site preventing the future metachronous hernia.
232 Feasibility of Oesophageal Atresia and Distal Tracheoesophageal Fistula Repair by Thoracoscopic Method, Ali Raza Brohi;Naseem Mengal; Zubair Ahmed
Introduction: In neonatal population, esophageal atresia with or without fistula is a rarer congenital anomaly having an incidence of 1/3000-5000 live births [1]. Traditionally it was repaired by posterolateral thoracotomy but this approach is associated with mus- culoskeletal morbidity. Since the first repair, made the paediatric surgeons confident then they started to bring refinements in their techniques, and led to adoption of this technique in many institutions worldwide. Material and Methods: This is retrospective study conducted from June 2015 to June 2021 in pediatric surgery department at Peoples University of medical and health sciences Nawabshah Sind, Pakistan. We reviewed the medical records of 85 patients who underwent thoracoscopic esophageal atresia. Data collected included newborn age and weight at the time of surgery, operative time, days of hospitalization, time to start first feed and post-op complications. Results: Total 85 patients were operated thoracoscopically having mean age at the time of surgery was 3 days because most of patients coming late in our hospital and mostly they are diagnosed postnatally. Weight of patients at the time of surgery ranges be- tween 1.5-3.5kg. Contrast swallow post operatively done in all case on day 5 out of which in 15 (18%) cases leak was confirmed and majority heal spontaneously in 10 -15 days. Conclusion: Thoracoscopic primary repair of esophageal atresia with distal fistula is feasible then open thoracotomy in terms of visualization of structures, advancement in instruments and refinements in technique to prevent high rate of complications.
233 A Case Report on Omphalitis, Bruna Suda Rodrigues ; Deborah Desiree Coelho Marra ;Márcio Luís Duarte;Élcio Roberto Duarte
Omphalitis is characterized by a bacterial infectious process that affects the umbilical scar and adjacent regions, it showed up through purulent drainage or with stinky odor at periumbilical region, local edema and erythema. In severe cases, the infection can spread through the abdominal wall, back, and perineum, and if not treated properly, it can progress to neonatal sepsis. The authors present a case report of a 4-day-old, low-birth-weight male patient born at 38 weeks gestational age. At admission, the newborn was with significant jaundice, umbilical stump in mummification process, localized tumor hardened at the base and edematous, with periumbilical erythema, without signs of pain on palpation or signs of incarceration, possibly corresponding to om- phalitis. The physical examination confirmed the diagnostic hypothesis, leading the patient to successful treatment with intravenous antibiotic therapy.
234 Does the Treatment of Asthma and Allergic Rhinitis Decrease the Likelihood of an Obstructive Sleep Apnea Work-up and Treatment?, Pushpom James;Steven Daoud, Seleshi Demissie, Raisa Saab ; Philip Roth
Introduction: Obstructive sleep apnea hypopnea syndrome (OSAHS) is an independent risk factor for asthma exacerbations [1]. Since there is an overlap in symptoms between OSAHS and bronchial asthma, with good control of a patient’s asthma and allergic/ non-allergic rhinitis, there should be fewer patients warranting work-up and treatment of obstructive sleep apnea. Methodology: The goal was to determine the change on the sleep related breathing disorder scale (SRBD) once a patient’s asthma and allergic/non-allergic rhinitis had been controlled [2]. Two questionnaires were administered on patient’s first visit, the SRBD scale and depending on age, the Asthma Control Test (ACT) or Childhood ACT. These questionnaires were readministered on a sub- sequent visit once their asthma and allergic rhinitis were controlled [3]. Results: A total of 68 patients were recruited. 40 completed 2 visits according to protocol. Of these, 28, that is 70% of patients showed improvement on the SRBD scale once their asthma and allergic/non-allergic rhinitis were controlled. Conclusion: By controlling a patient’s asthma and allergic/non-allergic rhinitis, we can increase the specificity of the SRBD scale in asthmatics. This may improve screening for pediatric obstructive sleep apnea in children with asthma with more appropriate usage of diagnostic tools such as polysomnography and perhaps decrease the use of unnecessary treatments and surgeries, such as, tonsil- lectomy and adenoidectomy.
235 Heroes, Champions and Achievers of Tomorrow, Mickey Mehta
The human society today is distraught, and the fabric of our human civilization is completely torn apart. People want instant gratification and the value systems are also lost. This time more than any other time, it is imperative to look into grooming chil- dren’s characters and personalities for the better evolution of man- kind. Those were the days when there were the gurukuls where the Ramas, Krishnas and Arjunas were groomed. Let’s bring those days back! If not a gurukul, at least through a system of bringing up children and through processes which lead them towards transfor- mation and towards evolution.
236 BCG Adverse Effects in Infants - Case Series, Chakradhar Maddela
Bacillus Calmette-Guerin (BCG) is widely using vaccination for prevention of tuberculosis in children globally. BCG adverse effects are uncommon. Common adverse effects include BCG abscess, non-suppurative and suppurative lymphadenitis and rarely BCG dis- seminated disease. Common therapeutic strategies for BCG complications include wait and watch policy, needle aspiration, antibiotic therapy and surgery. Correct guidelines when and how to manage BCG complications are not available. We came across four cases of BCG adverse effects recently. All four cases were noted, followed up and presenting as case series with literature review on how to treat.
237 Inborn Errors of Metabolism- Role of Tandem Mass Spectrometry in Newborn Screening, MP Narayanan
Inborn errors of metabolism (IEM) are genetic defects involv- ing disorders of enzyme activities in which the toxic substances accumulates and causes neurologic manifestations. This may lead to death or permanent disability of the child. Newborn screening (NBS) is the detection and early intervention is pre-symptomatic newborns with inborn errors of metabolism to prevent adverse outcomes of the disorder. NBS is done by analysis of biomarkers in blood by a spectrum of analytical methods. The introduction of tandem mass spectrometry for newborn screening is a technologi- cal breakthrough which is used across the globe nowadays. The power of NBS is enormously enhanced by tandem mass spectrom- etry (MS/MS) by the ability to analyze several metabolites simul- taneously in the same dried blood spot (DBS) with increased sen- sitivity and specificity. NBS programs tend to focus on three groups of metabolites: amino acids fatty acid oxidation intermediates and short chain organic acids.
238 Evaluation of a 16 Days Neonate with SIDS: A Case of Massive Breast Milk Aspiration, Edwin Dias; Vandana GP and Kavya
This case concerns a 16 days old neonate with massive milk aspiration resulting in sudden infant death syndrome (SIDS). The syndrome is defined as an unexplained death seen in an apparently healthy baby of less than one year and it usually happens while the baby is sleeping. In past this situation was also recognized as “aborted crib death” or “near miss SIDS”, but in present time these terminologies are not being used. Instead, acute life-threatening event (ALTE) is the terminology used which is defined as “an episode that is characterized by combination of central or obstructive apnea, colour change (usually cyanosis, but occasionally erythematous or plethoric), marked hypotonia (limpness), choking or gagging” [1]. Although the cause is unknown, it appears that SIDS might be associated with defects in the portion of an infant’s brain that controls breathing and arousal from sleep. Besides brain defects, respiratory infection and low birth weight are also the physical factors associated with SIDS. Milk aspiration happens when either food or liquid is inhaled into the lungs. It is commonly observed in babies with weak sucking, choking or chronic coughing while feeding, which often leads to respiratory symptoms. The most common cause is Gastroesophageal reflux disease (GERD), swallowing dysfunction, and neurological dysfunction called cerebral palsy. Aspiration may cause aspiration pneumonia which is an inflammatory condition occur due to irritative gastric contents.
239 Reliability of Continuous Glucose Monitoring in the Management of Paediatric Dumping Syndrome: A Mini Systematic Review and Our NICU Case Report, Desirée Balconara;Salvatore Michele Carnazzo; Giusi Maria Calta- biano;Giovanni Cacciaguerra; Raffaele Falsaperla;Martino Rugg- ieri;Tiziana Timpanaro
Background: The role of continuous glucose monitoring (CGM) is widely recognized in the management of the diabetic patient, but is not routinely used to detect pediatric dumping syndrome, especially in infants admitted to NICU. Aim: The purpose of this study is review systematically the available literature and point out the usefulness of continuous glucose monitoring in pediatric patients for the early interception of dumping syndrome, follow up and orienting therapeutic strategies, proposing the advantage in terms of reliability and tolerability compared to the heel glucose prick with glucometer and suggesting its application in NICU context. Method: The search is carried on PubMed and Google Scholar database by screening all types of studies, with the keywords “continu- ous glucose monitoring”, “CGM”, “pediatric dumping syndrome” and these exclusion criteria “ diabetes mellitus” “adult dumping syn- drome”. We examinate all publications obtained from the search strategy and assessed the full text of studies potentially relevant for inclusion. Our search identified 9 eligible articles. Moreover, we report our case about a newborn affected by a congenital myasthenic syndrome presenting dumping syndrome. Results: All the studies cited show the reliability of CGM in detecting glycemic fluctuations, compared to single and intermittent glucose samplings. Glycemic trends helped to adopt the best therapeutic strategy on a case-by-case basis. Conclusions: Our paper strengthens the evidence on the usefulness of CGM in pediatric dumping syndrome, considering the out- comes reached in all 17 patients studied, in term of safety, reliability, non-invasiveness. Furthermore it suggests the potential future diffusion of this technology that is still little used routinely in NICU departments.
240 Endometrial Aromatase and Effect on Endometrial Implantation in Postmenopausal Patients, Shawky Badawy
Aromatase is an enzyme that converts testosterone to estradiol and androstenedione to estrone. Studies showed that this enzyme is present in endometriosis cells and the eutopic endometrium of these patients [1]. However, aromatase is not present in the normal endometrium. It is suggested that aromatase in the endometrium helps the growth and implantation of the endometrium in various locations leading to the development of endometriosis [2]. Biopsies taken from endometrium of patients that have no endometriosis, did not show any aromatase. This can be used as a test to check if patients have endometriosis
241 Trend in Childhood Mortality After Pneumococcal Conjugate Vaccine (PCV-13) and Rotavirus Vaccines Introduction in the Nouna Health and Demographic Surveillance System, Burkina Faso, Mamadou Bountogo;, Eric Nebié; S Pascal Zabré;Seraphin Sim- boro1, Ali Sié; Nicolas Meda2 and Edouard Betsem
Background: Pneumonia and diarrhea remain two leading causes of children under 5 years mortality. PCV-13 vaccine and rotavirus vaccine were introduced into the Burkina Faso EPI in 2013. Given the diversity of circulating serotypes and vaccine schedules, the WHO recommended an evaluation of their actual effectiveness after their introduction in different countries. This study, using an interrupted time series analysis, proposes to evaluate the effectiveness of PCV-13 and rotavirus vaccine on under 5 years mortality. Methods: The study used interrupted time series designs with a pre-intervention period from 2009-2013 and a post-intervention period from 2014 to 2015.The monthly mortality rate ratio was the variable of interest. A generalized linear model was applied using log-transformed mortality rates as outcomes, with a Poisson distribution, adjusted. Results: The infant mortality rate ratio was 0.84 (95% CI = 0.58-1.22, p = 0.37) 0.90 (95% CI = 0.70-1.15, p = 0.43), 0.84 (95% CI = 0.68;1.02, p = 0.09) on children aged 0-59 months, 0-11 months, 12-59 months, respectively. Although not statistically significant, the results in this study showed a 16% decrease in mortality in children aged 0-59 months Conclusions: A positive effect of the newly introduced rotavirus and 13-valent pneumococcal conjugated vaccine was observed in the current study and needs to be consolidated in a bigger population size
242 Venous Thrombosis as A Complication of Primary Nephrotic Syndrome, Ceballos Gabriela E;Plos Carlos, Rodríguez, Margaret Bell;Añasco Daiana and Liern Michael
Introduction: Children suffering from nephrotic syndrome have an increased risk of arterial and venous thrombosis, depending on their location and extent, they can be life-threatening. Objective: To describe a clinical case of complicated nephrotic syndrome with venous thrombosis. Description: 5-year-old boy diagnosed with minimal nephrotic syndrome diagnosed by renal biopsy presenting at 10 days consulta for pain and erythema on the right side of the neck of 24 hours of evolution. Diagnosis: deep vein thrombosis in confluent yugulo right subclavian. It was performed or inter consultation with hematology and initiation or anticoagulation. At the 3rd month of the anticoagulant treatment, Doppler echo was performed with a control of the blood, which was normal. Conclusion: Thrombotic complications, although they are usually rare in pediatric patients with nephrotic syndrome (approx. 20%), should be diagnosed early through the clinic, imaging studies and laboratory with dosage of antithrombin III, platelet count and fi- brinogen, avoiding major complications. Prophylaxis with anticoagulants is discussed, it is of great importance to balance risks and benefits of this.
243 Importance of Genetic Testing in the Diagnosis and Management of Atypical Hemolytic Uremic Syndrome, Binata Marik
Hemolytic anaemia, thrombocytopenia, and acute renal failure are the three components of hemolytic-uremic syndrome (HUS). Shiga toxin produced by E. coli is the main culprit (STEC HUS) . The absence of STEC infection distinguishes atypical HUS (aHUS) from conventional HUS. A normal level of ADAMTS13 can also help distinguish it from thrombotic thrombocytopenic purpura (TTP). Atypical HUS can appear at any age, from infancy to adulthood. The cases with hereditary origins make for about 60% of aHUS
244 Time to Cessation of Breastfeeding and Its Determinants among Mothers Who Have Children Birth to Three Years of Age in Mekelle Town, North Ethiopia: Retrospective Study, Tesfaye Techane Kelal;Aklilu Bezu Dinkesa
Background: Data on time to cessation of breast feeding and its associated factors are scarce in Ethiopia. Hence, the present study aimed to assess the time to cessation of breast feeding and its determinants among mothers with children from birth to three years of age at Mekele town, Tigray. Methods: Community-based cross-sectional retrospective study was conducted on 554 women, who have children from birth to three years of age in the in Mekelle town from March to July 2019. Participants were selected using systematic random sampling technique. Data was collected using interview administered questionnaire. The collected data were entered into Epi Info version 7.2and exported to statistical package for the social science version 20.0 and analyzed using descriptive statistics, Bivariate and Multivariate Cox regressions. Results: The overall incidence rate of cessation of breast feeding before 2 years of age was 3.017 per 100 person-months (95% CI: .027- .033). Number of children [AHR 1.4; 95%, CI: 1.005, 2.04], intended breast feeding duration [AHR 0.72; 95%, CI: 0.77, 0.91], type of first feeding [AHR 3.93; 95%, CI: 2.09, 7. 39] and timing of complementary feeding started [AHR 0.44; 95%, CI: 0.40, 0.75] were factors significantly associated with time to cessation of breast feeding before two years of age at p < 0.05. Conclusion: The incidence rate of cessation of breast feeding before 2 years of age was relatively better when compared with previous study. However several factors affecting time to cessation of breast feeding were identified. These factors should be targeted to achieve appropriate duration of breast feeding
245 Anaphylactic Reaction in a Child After Dose of Pfizer-BioNTech COVID-19 Vaccine, Reem W Alreshidi ;Malik Almalki ;Shaker Alreshidi ; Mohammad Almalki
Background: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected millions of people of all ages worldwide to date. The majority of confirmed cases were among adults and approximately 2% of the confirmed cases are for children. Covid-19 vaccine had high safety and efficacy. Nevertheless, adverse reaction has been reported, approximately 90% of all vaccine recipients reported local and at least one systemic reaction. In this case report, we report a case of anaphylactic reaction in a child after dose of Pfizer-BioNTech COVID-19 vaccine. Up to our knowledge, this is the first case to be reported of anaphylactic reaction in a child after dose of Pfizer-BioNTech COVID-19 vaccine. Observations: A 13 year old boy, presented to our paediatric emergency department (PED) with anaphylactic reaction, complaint of rash and shortness of breath (SOB) 13 minutes after received first dose Pfizer-BioNTech COVID-19 vaccine. management involved systemic epinephrine, antihistamine and steroid. Conclusions and Importance: Due to the recent authorization of COVID-19 vaccine in children of 12 years or older, children with anaphylaxis post- vaccination are expected. In addition to the necessary observation at vaccine centre, necessary supplies to immediately manage anaphylaxis, should be available in vaccination centres
246 Retrograde Intrarenal Surgery with Holmium Laser for Treatment of Bilateral Kidney Lithiasis in 1 Surgical Stage, in a Pediatric Patient, Bertuzzi E ;Venturi F, Hails E, Renzi M, Sanmartino M and Buniva C
We report the case of a 7-year-old female patient with a medical history of B acute lymphoblastic leukemia associated with bilateral kidney stones with recurrent urinary tract infections, in which bilateral laser retrograde intrarenal surgery (RIRS) was performed as complete resolution without new urinary complications.
247 Molecular Mechanisms, Clinical Approach to Diagnosis and Competent Care of Craniosynostosis, Gayatri Nerakh
Craniosynostosis is defined as a partial or complete premature fusion of one or multiple cranial sutures resulting in distortion of skull shape and craniofacial dysmorphism. It is a heterogeneous condition with non-genetic and genetic etiology. The prevalence of craniosynostosis is 1 in 2000 and 1 in 2500 live births and is the second most common craniofacial anomaly after cleft lip/palate. Understanding the pathogenesis of craniosynostosis is very important. Knowledge of perinatal presentation of syndromic and non-syndromic craniosynostosis helps in appropriate genetic evaluation. Neurological abnormalities can be prevented/improved by early diagnosis and treatment for those who require surgical intervention
248 Type B natriuretic peptide (NT-PROBNP), A Multipurpose Biomarker? A Possible Use in Pediatric Pneumology, Giovanni Cacciaguerra, Monica Palermo, Salvatore Michele Carnazzo, Giusi Maria.Caltabiano, Desiree Balconara, Maria Papale, Giuseppe Fabio Parisi and Salvatore Leonardi
B-type natriuretic peptide is a neurhormone isolated in ventricular cardiomyocytes and influences the balance of sodium and water by inducing natriuresis, diuresis and vasodilation, counter acting the renin-angiotensin-aldosterone system. The N-terminal pro-B natriuretic peptide (NT-proBNP), formed by 76 amino acids, has no bioactivity, the bioptive peptide is composed of 32 amino acids and derives from the cleavage of a precursor molecule. Type B natriuretic peptide is secreted mainly by the ventricles in re- sponse to the increase of left or right ventricular pressure and volume loads. Historically, B-type natriuretic peptide levels are related to one’s severity and prognosis congestive and left ventricular heart failure. However, some studies have shown that NT-proBNP levels can also be elevated in diseases not purely cardiac such as acute infections, such as sepsis and other diseases in children. The association between serum levels of NTproBNP now measured in series and severity is the goal of numerous studies of the disease in children with pulmonary arterial hypertension (PAH)
249 Phocomelia: A Case Report, Edwin Dias; Abu Farhaz Ali and Kavya
To report a case of left upper limb phocomelia in a monochorionic, onoamniotic twin pregnancy. It is an extremely rare congenital disorder. On antenatal ultrasound examination it was not associated with any other major anomalies. The differential diagnosis of this condition includes thrombocytopenia-absent radius (TAR) syndrome and Robert syndrome. Twin A was affected, twin B was normal. On the basis of Normal karyotyping and with no other major structural anomalies the eading diagnostic case encompasses of either TAR syndrome or Robert syndrome.
250 Impact of Mobile Phones on Teenagers in Trashi Yangtse: Parents’ Perspectives, Tashi Dorji;Sonam Jamtsho
Background: In Bhutan, young people have dramatically increased their use of mobile phones.It has been discovered to have favorable impacts on young entrepreneurs in Phuentsholing and cheese and butter traders in distant Sakteng. However, not all youths in the kingdom are affected in the same way by cell phones. Mobile phones have made life easy and inexpensive for teenagers to contact friends and access information [31]. However, the strong social setting in Bhutanese family lives has been destroyed by the widespread availability of information and the introduction of mobile phones. This study examines how mobile phones affect teens in Trashi Yangtse from the views of parents who have frequent interactions with children. Objectives: This study was conducted to actually find out the impacts on of mobile phones on teenagers of Trashi Yangtse from the perspectives of parents. It was carried out to • Understand the teenagers’ mobile phone usage in Trashi Yangtse; • Comprehend the impact of mobile texting messages on the communication and proper language skills of teenagers and • Evaluate the physical safety aspects and psychological effects of excessive mobile usage by teenagers. Methods: Quantitative method was employed to explore the research problem. The data was collected through questionnaires (13 closed questions). The questionnaires were handed out to teenager’s parents in Trashi Yangtse in five different locations. The respondents had teenager’s from13 to 19 years old and they were broadly divided into seven ethnic groups. 44 parents had filled in the questionnaires and handed over to researcher personally while 36 parents emailed the filled in questionnaires. Results: This study focused on the understanding the impact of mobile phones from parents’ perspective. The findings from this study revealed that the parents’ perception about the use of mobile phones by teenagers in Trashi Yangtse are significantly geared towards having immense negative impacts. The findings are briefly mentioned below: • Happiness rate of parents: 58.8% of parents mentioned that they were ‘Unhappy’ to find their teenagers using mobile phones. • Safety of teenagers with mobile phones: The results revealed that cumulatively 73.8% of teenagers’ parents felt ‘Unsafe’ and ‘Very unsafe’ to let teenagers use mobile phones by their teenagers. Of all, 87.6% of teenagers’ parents felt ‘Unsafe’ and ‘Very unsafe’ with teenagers falling under the age category of 15 - 16 years old. • Loss of proper language skills: The results revealed that the loss of proper language skills was most common in female teenagers. 43.8% of female teenagers’ parents revealed that their teenagers have lost proper language skills very much due totext language. And of all, these female teenagers were under the age category of 17 - 19 years old