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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 ˂ 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 Yeşim 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 İntrahepatic 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