Day 1 :
- Pediatrics | Pediatric Cardiology | Pediatrics Ophthalmology | Neonatology | Pediatric Neurology
Marma Health Centre, India
Time : 11:00-11:30
K. M. Yacob, Marma Health Centre, India a practicing physician in the field of healthcare in the state of Kerala in India for the last 30 years and very much interested in basic research. My interest is spread across the fever, inflammation and back pain. He is a writer. and already printed and published nine books on these subjects. I wrote hundreds of articles in various magazines.After scientific studies, we have developed 8000 affirmative cross checking questions. It can explain all queries related to fever.
We have been hearing for centuries that ‘fever is not a disease but a symptom’. Physicians say that fever is a symptom of diseases like flu to cancer. The conservative fever definition, diagnosis, and treatments are based on fever as a symptom. All the studies related to fever as a symptom of a disease have been done without knowing the Purpose of the temperature of fever is. Without knowing the Purpose of the temperature of fever, how can fever included in the symptom definition? Temperature between 38o to 41o centigrade can be symptom of a disease? Most of the diseases may not have a fever. Sometimes it disappears. Then, is fever a symptom of which disease? Symptom Definition is the only parameter necessary for a Symptom. As with any or all other definitions, symptom definition should describe the symptom scientifically. If it cannot describe clearly, there is no use of a symptom definition. A symptom is a departure from normal function or feeling which is noticed only by a patient, indicating the presence of disease or abnormality. One cannot be understood directly the temperature is elevated in the hypothalamus. A mechanical device is necessary to measure elevated temperature in the hypothalamus. In symptom definition, fever definition can’t be found. The elevation of body temperature is not included in symptom definition.
Different cause of diseases never shows the same symptoms.
Different causes of diseases like virus, bacteria, fungi, venom, horror scene, horror dream... never shows the same symptoms. Its actions are different and sometimes opposite. No similarities can be seen between their actions. Elevated temperature or increased temperature never makes fever or symptoms of fever. It may create hyperthermia.
None of the diseases or causes of diseases require fever as its symptom.
If the mosquito bites its virus, bacteria, venom gets deposited in the body as a result according to nature and strength of Viruses, bacteria, venom symptoms like itching, pain, and signals like colour change, inflammation may occur. We can see the symptoms, Signals, and indications of the virus, bacteria, the venom which multiple or spreading or damages (disease) the body before fever emerge. Patients who have flu to cancer may not have a fever.
How can we separate symptoms of the disease and symptoms of fever and symptoms of rising temperatures?
In fever, both symptoms of disease and symptoms of Fever are included. Deduct symptom of disease from total symptoms, we will get symptoms of fever.
(Disease +Fever) - Disease = Fever.
(Symptoms of disease + Symptoms of Fever) - Symptoms of disease = Symptoms of Fever (bitter taste, body pain, fatigue to mind and body, reduced appetite, reduced motion and indigestion, internal and external discomfort…) Like that we can separate signs, signals, and actions of both fever and disease.
(Signals of disease + Signals of Fever) - Signals of disease = Signals of Fever(high temperature, shivering, unconscious,....)
(Signs of disease + Signs of Fever) - Signs of disease = Signs of Fever.
(Actions of disease +Actions of Fever) - Actions of disease = Actions of Fever. In fever does not show any actions of temperature rise.
How can we prove the fever is not a symptom?
The fever is not symptom when examined in various directions. In fever, both symptoms of disease and symptoms of fever are included. Deduct symptom of disease from total symptoms, we will get symptoms of fever. We can separate signs, signals, and actions of both fever and disease and rising temperature. Temperature between 38 degrees and 41 degrees cannot be a symptom of any of the diseases. A different cause of diseases like virus, bacteria, fungi, venom, horror scene, and horror dream never shows the same symptoms. Fever has never been scientifically proved as a symptom of a disease. Fever has the properties of adaptation. If we ask any type of question-related to fever by assuming that the fever is not a symptom we will get a clear answer. If we avoid or evade from this we will never get a proper answer to even a single question.
Indian Council of Medical Research, India
Title: Evaluation of disposable bed sheets and safety guidelines for Black Dog sex workers resumes in the new normal living with Burnside Pharmacy Institute in Pune University
Time : 11:30-12:00
Rahul Hajare has been a hard worker all his academic life. After his Ph.D in Pharmacy from Bangalore which he completed with flying colours, he is fortunate to work NARI primer HIV research Institute to complete Post Doc of World Renowned Scientist Respected Dr. R.S.Paranjape., Retired Director & Scientist ‘G’ National AIDS Research Institute Pune. Dr. Rahul Hajare has Associate Professor of Medical Chemistry to Pune University (until 2020), Dr. Rahul Hajare now Principal of Ishwar Deshmukh Institute of Pharmacy affiliated to council of India.
Indian government eased isolation measures and introduced social distancing, as bars and nightclubs nationwide reopened in Low to high side category employees can villain. This has undergone and final result has publishing after the examination of skin pulp of angry employees according to their physic and anatomy of hair.Top from bottom of FormAngry employees has more likely to engage in unethical behaviour at work, a new study has revealed. Researcher has seen poverty during early service. Also, when working in the power politics institute in Pune University researcher observed that trustee take poor employees to bed hungry. To control crime researcher realised that they have to go to ethical college where they will get a mid-day meal.
Addis Ababa University College of Health Science, Ethiopia
Title: Short-and Long-term neurodevelopmental outcomes of term neonates with perinatal asphyxia admitted to neonatal Intensive Care Unit from January 2016 to December 2017
Time : 12:00-12:30
Meron Shimeles, studied medicine at Addis Ababa University College of Health Science from 2008 – 2015. After working for 2 years as general practitioner. He studied Pediatrics and child health from 2017- 2019.
Background: Perinatal asphyxia is a serious clinical problem globally resulting in million deaths and an equal number of serious neurological consequences.
Objective: To assess short- and long-term neurodevelopmental outcomes of neonates with HIE.
Methods: Institution based cross sectional analytic study
Results: A total of 154 neonates were included on the study. 56.2% were male. Majority (57.8%) were delivered in health center and 23.8% in TASH. Of the neonates with asphyxia, 27.5% had stage 1 HIE; 50.3% stage 2 HIE and 22.2 % stage 3. In hospital mortality was 22.1%. Majority of deaths (66.7%) occurred in the first 72hrs. Severity of HIE was significantly associated with mortality. (P- Value= 0.00) Prolonged hospital stay > 7 days was seen in 36 (31.3%) neonates. Oxygen support was given for > 72hours to 35(28.2%) neonates.
Data for long term outcome was available for 95 neonates. Evidence of GDD was detected in 18.9% of neonates. Language development delay occurred in 27.1%. The occurrence of delay in language development was statistically associated with the severity of HIE and the presence of seizure in first week of life. 12.5% of neonates developed cerebral palsy. Epileptic seizure occurred in 10.4% of the cases. Occurrence of seizure in first week of life is associated with future development of Epilepsy. (P value= 0.00)
Conclusion and Recommendation: HIE is a very important cause of neonatal morbidity and mortality. The study showed significant number of neonates with moderate and severe HIE and few from mild HIE developed neurodevelopmental sequel. The study recommends the BLH NICU shall strength its potential to properly investigate, image and manage patients with HIE. Another prospective study assessing long term neurodevelopmental outcomes on neonates with HIE is recommended.
Mental pain is more dramatic and painful than physical pain. It is more common and harder to bear as we know its more comfortable to complain my leg is paining despite "my head feels like hammered or poked". The aim of this study on migrant laborers working in Kazakhstan conducted aiming to discover their suffering due to the COVID outbreak. We interviewed Indian migrant workers associated with our university, were selected, questioned, and physically examined. And found whereas, in depression, a person suffers feelings of loss; we can say it is something more significant than the feeling of sadness. Depression is a severe terminology it expands for 14 days, and we clinically label a person depress when the person has at least 2 of the following three symptoms, as a medical student I remember it by pneumonic "EMI" (energy, mood and interest respectively ). Not only can these other symptoms be seen in a depressed patient like loss of concentration, guilt, sleeplessness etc.
While examining the migrants, we also try to find whether it is hereditary or not as we know the first cause of depression can be biological, and it can be due to genes of depression or abnormality in the frontal lobe of the brain. In a patient suffering from depression, it observed that their frontal lobe is smaller than usual and shrink hippocampus are present in them. The remaining causes of depression also so that we can get a bigger picture of our topic, so the other causes of depression are malfunctioning of Neurotransmitter to be more definite lack of Serotonin, dopamine and non-epinephrine can cause depression but not to worry we have tablets which can increase its level in our body. We can say till now we have discussed all the causes of depression. Coming back to our research, we not only determine the depression we also focused on its severity, its possible reasons, outcomes, and we assisted them with treatment too. Almost 60% were depressed since they suffer hopelessness, loss of interest, sadness, lack of knowledge about the pandemic. 20% suffer excess sleepiness, and around 20% suffer fatigue, loss of appetite, all suffer weight gains, job insecurity. No one was observed as healthy as before due to depression. We conclude by this study demonstrates that urgent need for health and mental health care for migrant laborers needs to be provided and knowledge related to pandemic shall also be provided by the personalized conference, especially for central Asian laborers.
K. M. Yacob, Marma Health Centre, India a practicing physician in the field of healthcare in the state of Kerala in India for the last 31years and very much interested in basic research. My interest is spread across the fever, inflammation and back pain. I am a writer. I already printed and published nine books on these subjects I wrote hundreds of articles in various magazines.After scientific studies, we have developed 8000 affirmative cross checking questions.It can explain all queries related to fever.
When the disease made by virus becomes a threat to life or organs blood circulation decreases, Temperature of fever will emerge to increase prevailing blood circulation. And it acts as a protective covering of the body to sustain life. When blood flow decreases to the brain, the patient becomes fainted-delirious. If we try to decreases the temperature of fever, the blood circulation will further be reduced. Blood circulation never increases without temperature increase. Delirious can never be cured without an increase in blood circulation. The temperature of fever is not a surplus temperature or it is not to be eliminated from the body. During fever, our body temperature increases like a brooding hen`s increased body temperature.
The actual treatment to fever is to increase blood circulation. Two ways to increase blood circulation. 1. Never allow body temperature to lose 2. Apply heat from outside to the body. When the temperature produced by the body due to fever and heat which we applied on the body combines together, the blood circulation increases. Then the body will stop to produce heat to increase blood circulation. And the body will get extra heat from outside without any usage of energy.
How can we prove that the temperature of fever in Covid -19 is to increase blood circulation?
If we ask any type of question-related to fever by assuming that the temperature of fever is to increase blood circulation we will get a clear answer. If avoid or evade from this definition we will never get a proper answer to even a single question. If we do any type of treatment by assuming that the temperature of fever is to increase blood circulation, the body will accept, at the same time body will resist whatever treatment to decrease blood circulation. If we measure the heat energy used for which activities in fever, we will know the purpose of the temperature of fever. No further evidence is required to prove the temperature of fever in Covid -19 is to increase blood circulation.
Mukhdoom Rakhshan Jameel Qureshi completed his MBBS at the age of 24 years from Sharda University, Uttar Pradesh. He is currently pursuing his internship from the same institute since August 2019.
There are numerous causes of childhood tearing, among them the following are the most important:
- Nasolacrimal Duct Obstruction
- Congenital Glaucoma
- Corneal Ulcer
The commonest causes of childhood tearing are nasal lacrimal duct obstruction. This is typically due to a mucus membrane obstruction at lower end of nasal lacrimal duct estimated to be present in up to 20% of new born babies. Lacrimal apparatus comprises of lacrimal gland, accessory lacrimal gland, lacrimal passage which includes puncta canaliculi, lacrimal sac and nasal lacrimal duct. Clinical picture varies from mild watering to sticky mucopurulent discharge .In 90% children the symptoms resolve spontaneously before one year of age. Conservative treatment includes sac massage, anti-inflammatory drops or antibiotic drops. The 10% cases which do not respond to conservative treatment are subjected to probing of nasal lacrimal passage followed by syringing. Probing is done at 6 months of age and if it fails, repeat of two probing can be done at an interval of 3 months.
National O.O. Bogomolets Medical University, Ukraine
Time : 14:00-14:30
Maidannyk V.G., Burlaka Ie.A.working as a professor and head of the depatment of pediatrics in National O.O. Bogomolets Medical University, Ukraine.
Vascular endothelial cells play a major role in maintaining cardiovascular homeostasis. In addition to providing a physical barrier between the vessel wall and lumen, the endothelium secretes a number of mediators that regulate platelet aggregation, coagulation, fibrinolysis, and vascular tone. In diabetes mellitus type I (T1D) progression of cardio-renal disorders, i.e. arterial hypertension and its complications, diabetic nephropathy (DN), is still the most important side-effect. There are data about the role of Vitamin D in T1D and its complications in adults. However, this issue remains to be open in pediatric practice.
Aim of the Study: To study the levels of Vitamin D, Endothelin-1 in children with T1D and DN and to find out the network of these markers inter-relation.
Material and Methods: 36 children T1D aged 6 to 17 years hospitalized in Endocrinology unit in Children Clinical Hospital №6 (Kyiv, Ukraine) studied. Vitamin D3 levels measured using ELISA assay and commercially available kit (Vitamin D3 (human) ELISA kit (BioVision, USA). Endothelin-1 levels measured using ELISA assay and commercially available Endothelin-1 ELISA kit (Abcam, USA). Results processed using STATISTICA 6.0 and non-parametric statistical method (Mann-Whitney test).
Results: In our study normal level, insufficiency and deficiency of the Vitamin D defined as - ≥ 30 ng/mL, 21-29 ng/mL and ≤ 20 ng/mL, respectively. All patients included into the study during the period September-May. We show that the most prominent Vitamin D3 deficiency detected in the group of patients with diabetic nephropathy (DN). In control group Vitamin D3 was detected at level 35.68 ± 1.56 ng/mL, in patients with T1D – 32.37 ± 5.1 ng/mL, in patients with DN – 19.39 ± 1.76 ng/mL (р<0.01 as compared to control group). Analysis of the Vitamin D3 levels and the disease course show negative correlation (R=-0,79, р<0,001).In all children with T1D and DN increased level of ET-1 measured.
Conclusion: Our data show the prominent deficiency of Vitamin D in T1D patients and patients with DN, increased ET-1 level (a potent vasoconstrictor peptide). We hypothesize that Vitamin D deficiency is a result of toxic effect of glucose. Increased ET-1 in all patients is a sign of early microvascular changes and resistant vessels damage leading to DN progression and arterial hypertension. All mentioned above changes accompanied by reduced O2-Hb dissociation as a result of increased level of HbA1C and may be a reason of cellular hypoxia.
Sao Paulo Federal University (UNIFESP), Brazil
Title: Patients with pediatric prostheses suffer from mismatch and early calcification, which causes a high number of reoperations
Time : 14:30-15:00
Miguel Angel Maluf is an Associate Professor of Cardiovascular Surgery and is the Chief of Pediatric Heart Surgery at Sao Paulo Federal University.
Background: Patients with pediatric prostheses suffer from mismatch and early calcification, which causes a high number of reoperations
Methods: Expandable Polyurethane Stent Valve – EPSV, is composed by flexible polyurethane (PU) cusps is grown on the top of an expandable cobalt-chrome alloy stent, including the formation of three leaflets. Physical, Hydrodynamic, Animal studies, were performed following: ISO 5840-3, 2015.
Results: Physical Tests. Result of study of surface scanning of pre and post crimp stent, showed no structural modification of the PU. Hydrodynamic test showed a pressure gradient oscillation between 5 to 20mm, in basal or stress conditions respectively. Experimental studies. Sheep were subjected to 3D echo-Doppler study, in 6th follow-up months, which showed satisfactory hemodynamic performance, with low transvalvular gradient (M = 6.60 mm Hg). Ultra structural Study: Six stents were explanted after 20 days to 21 months of follow-up to Ultra structural analysis. All of which revealed no presence of calcium growth and prostheses structure was intact.
Conclusions: Expandable Stent valve and PU no Calcification is good expectations for pediatric use.
Rajindra Hospital, India
Time : 15:00-15:30
Vandana Yadav is a paediatrician working in Department of Pediatrics Govt. Medical College/ Rajindra Hospital Patiala, India.
Aims and Objectives: To determine the incidence and to characterise the determinants of red blood cell transfusions in critically ill children during prolonged PICU stay.
Material and Methods: Study was conducted on patients admitted to PICU of Govt Medical College Patiala from April 2018 to July 2018. Age, Sex, Chief complaints, General physical and Systemic examination was noted on predesigned proforma. Haemoglobin, RBC transfusions and its indications were monitored in each case from day of admission till discharge or death.
Results: A total of 184 children were enrolled (remained for > 48 hours in the PICU). 38% children were anemic in the PICU (18.5% on admission, 19.5% developed anemia). 26% percent of children received transfusions; 43% of total transfusions were on Days 1-2. Significant predictors of initial anemia development >48hours after PICU admission were age 28 days or younger, presence of shock on admission, having a respiratory comorbid condition. Predictors for receiving RBC transfusion: age 28days or younger, presence of moderate or severe anemia, presence of shock on PICU admission and high mean volume per kg of blood loss from blood draws.
Conclusions: A significant proportion of critically ill children receive at least one red blood cell transfusion during their PICU stay. Younger age, presence of anaemia, severe critical illness, MODS and blood draws are the most significant determinants of red blood cell transfusions in PICU.
IMS & SUM Hospital, India
Title: Snake bite-A neglected menace: A prospective observational study in a tertiary care paediatric ICU
Time : 15:30-16:00
Shatabdi Giri has completed her MBBS degree at the age of 25 years from Berhampur University, Odisha, India and postdoctoral studies from IMS & SUM Hospital, Bhubaneswar, India on June 2020. Now she has applied for fellowship in Paediatric neurology. She has published 5 papers in reputed journals.
Snake envenomation is a well-known cause of morbidity and mortality in India. In 2009, WHO declared snake bite a neglected disease. The objective of my study was to study clinical profile, complications and outcome in pediatric cases of snake bite and to highlight the atypical presentations of snake bite. A prospective observational study was done in PICU of our Hospital from June 2017 to June 2019 and the results were:-56.8% of 109 cases were non-poisonous snake-bites. Out of 47 cases admitted to PICU,68.08% developed cellulitis at the site of bite with staphyloccoccus aureus being the commonest organism isolated(56.25%). Edema at site of bite(hematotoxic) and ptosis(neurotoxic) were most common initial presentation. 36.17% of patients received ASV and first aid within 6 hours of snake bite. The morbidity and mortality was significantly less(p<0.05) as compared to those who hadn’t received ASV. 12.76% of cases with normal CRT presented with features of coagulopathy. DIC(58.33% of hematotoxic bites) and respiratory paralysis(68.75% of neurotoxic bites) were the commonest complications. Renal replacement therapy was required in 6.38%, transfusion in 10.63% cases and case-fatality-rate was 12.7%. There were a few atypical presentations of snake bite mimicking Gullain-Barre-Syndrome , acute onset encephalitis, intracerebral hemorrhage and cortical blindness. The conclusion of my study was:- Most snake bites are non-poisonous. Early first aid and ASV administration has better outcome. Fibrinogen levels are more reliable than CRT to diagnose coagulopathy. Acute onset of atypical presentation should always be evaluated for snake envenomation in suspected cases to prevent morbidity and mortality.(249 words).
Valencia High School, Canada
Time : 16:00-16:30
Bridget Yang is a senior at Valencia High School. She was diagnosed with scoliosis at the age of 11 and is deeply interested in scoliosis related research and improving the quality of life of those affected by the disease
Scoliosis treatment often involves the wearing of a back brace. A variety of back braces are used to treat scoliosis, but there is no data that shows that one brace is superior in terms of efficacy. Although it is clear that one’s quality of life is negatively affected by the wearing of a scoliosis brace, little data is available on how different types of scoliosis braces affect one’s quality of life. An online survey was conducted to gather data on patients with scoliosis. Collected data included demographics, clinical information, treatments administered, compliance, and involvement in selecting the back brace used in treatment. In addition, the Scoliosis Research Society-24 (SRS-24) questionnaire was used to determine subject satisfaction and performance; the SRS-24 measures pain, self-image, function, level of activity, and satisfaction. Almost all respondents (96.9%) wore a brace as part of their treatment; 43.8% of patients had surgery; and 38.7% were prescribed exercises as part of their treatment. Satisfaction with wearing a scoliosis brace was low with 28.1% of respondents reporting they “hate” their brace, and 43.8% stating they “dislike” their brace. The total mean SRS-24 score was 3.6, and there was no correlation between type of back brace and SRS-24 scores. Data collection is ongoing: to date, 32 subjects have responded. Through my findings, it is apparent that scoliosis impacts the quality of life of adolescent females. However, there was no apparent correlation between the type of brace worn and attitudes towards wearing the brace on the SRS-24 score.
Hoi lun shing is working as a consultant in Colchester General Hospital, United Kingdom
Thyroid hormone resistance is a rare condition where there is an impaired sensitivity of target tissues to thyroid hormone. This leads to a situation where both the thyroid hormone levels and the thyroid stimulating hormone (TSH) are raised, as TSH is not suppressed as would normally be expected. Incidence of this condition is around 1 in 40,000 live births. TR-beta gene mutation is the most common cause of thyroid hormone resistance. Clinical manifestations are dependent on the type of mutant thyroid hormone receptor and each target tissue’s predominant thyroid hormone receptor expression. Affected patients can present with a range of hyperthyroid or hypothyroid signs and symptoms. Majority of the cases described so far have an autosomal dominant inheritance. In this case series, we describe two young children and their father who have thyroid hormone resistance. They all possess a TR beta- gene defect secondary to a heterozygous mutation. Due to the widely variable signs and symptoms and the non-typical trend of laboratory markers in thyroid hormone resistance, it can be difficult for the clinician to diagnose if one is not familiar with it. Thus, this entity should be taken into consideration when one encounters a patient with elevated serum FT4, unsuppressed TSH and decreased serum T4/T3 ratio.
Kyungpook National University,Korea
Title: The effects of helmet therapy, relative to the size of the anterior fontanelle in patients with nonsynostotic plagiocephaly: a retrospective study
Time : 17:00-17:30
KangYoung Choi is working in Kyung-Pook National Uniersity, as associate professor. And Choi have MD and DDS of Korean border, and have lots of plastic & reconstructive surgery experiences. His professional area is congenital paediatric disease such as cranial facial deformity, cleft ip palate, head/facial reconstruction In 1995.5 he had studied in Oral and Maxillofacial Surgery, Osaka University, Osaka, Japan. And in 2003.2. And he had studied in Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA. In 2004.3.He has published more than 30 papers in reputed journals and has been serving as an Chief in editor of ACFS and several editorial board member.
Many studies have reported on the importance of treating patients with nonsynostotic plagiocephaly using helmets, a non-surgical treatment. We retrospectively examined the effects of helmet therapy according to the size of the anterior fontanelle.
We enrolled 200 patients with nonsynostotic plagiocephaly who received helmet therapy between January 1, 2016 and December 31, 2018. We collected data pertaining to age at treatment initiation and treatment duration. We measured anterior fontanelle size using X-ray imaging and divided patients into one of three groups according to the structure’s size. Group A was 0~25%, Group B was 25~75%, and Group C was 75~100% of anterior fontanelle size. Helmet treatment feasibility was evaluated using Cranial vault asymmetry (CVA), Cranial vault asymmetry index (CVAI), Anterior symmetry ratio (ASR), Posterior symmetry ratio (PSR), and Overall symmetry ratio (OSR) at baseline and at the end of the treatment. (Fig. 1,2,3)
The average starting age was 20 w (12–40 w). The mean treatment period was 13 w (10–24 w). Group A had 53 cases, Group B had 102, and Group C had 45. The CVA differences between groups were 6.8mm (A & B), 9.5mm (A & C), and 2.7mm (B & C). The CVAI differences between the groups were 7.28% (A & B; p=0.001), 8.9% (A & C; p=0.003), and 1.62% (B & C; p=0.381). There were no interval changes for ASR in Group A; Group B changed 1% from 0.9 to 0.91, Group C changed 2% from 0.89 to 0.91. For PSR, Group A changed 6%, from 0.82 to 0.88; Group B changed 10%, from 0.79 to 0.89; and Group C changed 17%, from 0.73 to 0.9. In Group A, OSR changed 5%, from 0.85 to 0.90; in Group B, it changed 9%, from 0.81 to 0.90; and in Group C it changed 13%, from 0.78 to 0.91. There was no difference in the effects of helmet therapy according to the sex of each group.
Nanjing Medical Universtiyy, China
Title: Hemodynamic effects of dobutamine versus dopamine in preterm infants: an update meta-analysis
Time : 17:30-18:00
Li Jiang has completed her MD at the age of 35 years from Nanjing Medical University. She is a pediatric cardiologist (associate chief physician) in the field of stuctrual congenital heart disease. She has published more than 10 papers in reputed papers.
Hemodynamic effects of dobutamine versus dopamine in preterm infants: an update meta-analysis: It is a meta-analysis to compare the effects and safety of dobutamine versus dopamine in preterm infants with abnormal hemodynamic status. Study sources were up to 2017 for RCTs in which dobutamine and dopamine treatment was adopted. Included studies were conducted on preterm infants with abnormal hemodynamic status that reported mortality < 28 days, treatment failure and organ effects. 7 articles were included with a total 286 patients. 5 studies reported mortality (180 patients), 4 studies reported P/IVL (145 patients), 4 studies reported P/IVH (160 patients), 2 studies reported severe P/IVH (105 patients), 3 studies reported NEC (140 patients), 2 studies reported BPD (55 patients), and 6 studies reported treatment failure (266 patients). Meta-analysis showed an increased probability in treatment failure using dobutamine treatment (RR, 1.67; 95% CI, 1.14-2.45; P = 0.008), whereas there was no significant difference in mortality < 28 days (RR, 1.16; 95% CI, 0.70– 1.91; P = 0.57), P/IVL (RR, 2.90; 95% CI, 0.93-9.11; P = 0.07), P/IVH (RR, 1.23; 95% CI, 0.73-2.08; P = 0.44), severe P/IVH (RR, 0.58; 95% CI, 0.21-1.62; P = 0.30), NEC (RR, 2.21; 95% CI, 0.60-8.09; P = 0.23) and BPD (RR, 1.04; 95% CI, 0.38-2.82; P = 0.94) between two groups. Dopamine was more effective in treatment success in therapy of preterm infants with abnormal systemic hemodynamic status. No difference was found existed in mortality < 28 days and incidence of adverse organ effects in two groups.
Govt. Medical College/ Rajindra Hospital, India
Time : 18:00-18:30
Vandana yadav is working as a Pediatrician in Govt. Medical College/ Rajindra Hospital, India
The most common sodium change observed in diabetic ketoacidosis (DKA) is hyponatremia with corrected sodium being in the eunatremic range. Although mild hypernatremia can be seen in 30% of patients presenting with DKA, extremely severe hypernatremia in the range of 190 mEq/L in DKA has been reported very rarely. We present a case of severe DKA in a 13-year-old girl with serum sodium of 193 mEq/L with intact neurological recovery.
A 13-year-old girl admitted with altered mental status, known case of type I diabetes mellitus and diabetic ketoacidosis (DKA) had a rapid rise in serum sodium from 155 mEq/L (corrected sodium 162 mEq/L) at the admission to 193 mEq/L within 36 hours of admission despite standard fluid and insulin therapy recommended for the treatment of DKA. The patient was in shock. During her illness, renal functions and GCS further deteriorated. The child was kept on non-invasive ventilation with continuous monitoring of vitals and urine output, started on insulin infusion, careful fluid titration to bring down the sodium and glucose gradually and maintain tissue perfusion. She had a prolonged Intensive Care Unit and hospital stay but recovered completely without any neurological sequelae.
Extreme hypernatremia is a catastrophic condition that is known to be associated with death or severe neurological sequelae in survivors. The intact neurological survival was probably related to the very gradual reduction in serum sodium to normal levels over almost 7 days using a pathophysiological-based fluid management.