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Acta Scientific Paediatrics

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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.