Day 1 :
- Pediatrics | Pediatric Dentistry | Pediatric Infectious Diseases | Neonatology | Pediatric Neurology and Neurological Disorders | Pediatric Cardiology | Pediatrics Hematology & Oncology | Pediatric Emergency Medicine | Pediatric Urology & Nephrology | Perinatology
Fujairoh Hospital, UAE
Aisha Khameis Ahmed is a third-year pediatric resident in the department of pediatrics at Fujairah Hospital, UAE. She completed MBBS from the UAE University. Before joining the pediatric residency program, she worked as a General practitioner for over seven years in pediatrics.
Introduction: Galloway- Mowat syndrome is a rare hereditary renal, neurological disease characterized by microcephaly, intellectual disability, hiatus hernia, skeletal anomalies, and nephrotic syndrome. It appears to be transmitted as an autosomal recessive trait. Recently, novel causative mutations for this disease have been identified in the gene-encoding subunit OSGEP. The gene variant has not been reported before in the international database.
Case Presentation: A twenty months old Egyptian with working diagnosis of Galloway- Mowat syndrome caused by OSGEP gene (c.25 G>A p.GlySer). She was born at term by caesarean section due to twin delivery. Birth weight was 2700g. She was born with normal head circumference and weight. At the age of 3 months, mother noticed that her head circumference is not increasing compared to her twin, her current HC <3rd centile. This girl displayed various features of facial dysmorphism (microcephaly, deeply sited eyes, and high arched palate). In addition, she has spasticity, hyperreflexia, truncal hypotonia, Global developmental delay, failure to thrive and epileptic disorders. Renal ultrasound revealed bilateral early to grade 1 renal parenchymatous pathological changes. Her serum creatinine levels were 17 umol/L (low). The segregation analysis showed that both parents and her twin are carriers which supports that the variant of OSGEP is likely to be pathogenic.
Methods: This study was designed as a case report using patient clinical manifestation with a literature review, together with family study through segregation analysis that can yield robust data to re-classify a variant of unknown clinical significance.
Results: The OSGEP gene (c.25 G>A p.GlySer) is most likely pathogenic from the patient phenotype and family segregation data. However, gene functioning is the gold standard method to classify this variant which is still under process.
Conclusions: We report a familial Galloway-Mowat syndrome caused by the OSGEP gene (c.25 G>A p.GlySer) with both parents and her twin carrying a novel heterozygous. She displayed various features; microcephaly, deeply sited eyes, high arched palate, spasticity, hyperreflexia, truncal hypotonia, Global developmental delay, failure to thrive and epileptic disorders.
Chongqing Medical University, China
Time : 09:40-10:10
Fengxia Ding is a respiratory medicine physician and pediatrician from Children's Hospital of Chongqing Medical University, one of the top three children's hospitals in China. Now she is working as a post doctor in Great Ormond Street Institute of Child Health, University College London (UCL). She has been working as a pediatrician for 7 years in Children's Hospital of Chongqing Medical University and there are more than 19,000 outpatient pediatric patients visit she every year. She got a patent in respiratory diseases and she has over 30 publications focusing on respiratory disease and asthma. She has presented her clinical and research work at many conferences and got many grand’s on her researchers.
Introduction: Asthma is a common chronic disease in children and Dendritic Cells (DCs) play a crucial role in the immunoregulation of asthma. It’s reported that overexpression of the Transcription Factor EB (TFEB) alters lysosomal activity and function, enhances MHC II antigen presentation, activates CD4+ effector T cells (Teffs), thus promotes immune activation. Therefore, TFEB may play a critical role in DCs antigen presentation and Teffs activation. However, the immunoregulation role of TFEB in asthma has not been reported.
Methods: Peripheral blood was collected from asthmatic children and TFEB mRNA was detected. A House Dust Mite (HDM)-induced asthma model was established to detect the TFEB, the MHC II and costimulatory molecules (CD40, CD80 and CD86) in DCs and the CD4+ effector T cells (Teffs), including Th1, Th2 and Th17 in vivo. After TFEB was inhibited, the expression levels of MHC II and costimulatory molecules (CD40, CD80 and CD86) in DCs, the Teffs and asthma phenotype were detected. Further, the specific mechanisms were further explored.
Results: TFEB mRNA expression levels in peripheral blood of asthmatic children were significantly higher compared with healthy controls. In vivo and in vitro experiments showed that TFEB expression levels in lung tissues and DCs of asthmatic mice increased significantly after HDM treatment. Inhibiting TFEB expression resulted in a decrease in MHC II and CD40 expression in DCs, as well as a decrease in Th1, Th2 and Th17 cell subsets. Meanwhile, inhibiting TFEB expression levels decreased airway hyper responsiveness, airway inflammation, serum IgE, eosinophil and total cell count in alveolar lavage fluid in the asthma model.
Conclusions: TFEB expression is increased in asthma. Inhibiting TFEB expression levels in asthma can protect against immune over activation by suppressing MHC II and CD40 in DCs and reducing the activation of Teffs, thus playing a protective role in asthma.
Chongqing Medical University, China
Bo Liu is a cardiothoracic surgeon who has been working at the Children's Hospital of Chongqing Medical University for 7 years. His primary responsibilities include providing diagnosis and treatment for thoracic and cardiovascular-related diseases, training and educating medical students and conducting research on the mechanisms and prevention of acute lung injury. Over the course of his career, he has published numerous research articles in reputable medical journals and has been invited to speak at various international conferences. He is highly respected among his peers and patients alike for his dedication to providing high-quality medical care and his commitment to advancing medical knowledge through research and education.
Introduction: Acute Respiratory Distress Syndrome (ARDS) is a common clinical critical illness with a high mortality rate and currently lacks effective prevention and treatment measures. Imbalance in alveolar macrophage polarization plays a crucial role in the occurrence and development of ARDS, but the specific mechanisms underlying alveolar macrophage polarization are still unclear.
Methods: In vivo experiments were conducted using intratracheal administration of LPS to establish an ARDS mouse model, while in vitro experiments utilized LPS-induced MH-S mouse alveolar macrophages to observe changes in metabolism and phenotype during ARDS. The therapeutic effects of the addition of the glycolysis inhibitor 2-DG were observed and the specific mechanisms were explored.
Results: In LPS-induced ARDS mice, significant inflammatory responses and lung tissue damage were observed, accompanied by an increase in glycolysis levels. The addition of 2-DG markedly alleviated LPS-induced lung injury and reduced inflammation. Mechanistically, LPS induction increased glycolysis levels in alveolar macrophages, promoting polarization towards the M1 pro-inflammatory phenotype. Inhibiting glycolysis shifted alveolar macrophages from the M1 pro-inflammatory phenotype to the M2 anti-inflammatory phenotype .
Conclusions: Metabolic reprogramming, represented by glycolysis, plays a significant role in alveolar macrophage polarization and modulating the metabolism of alveolar macrophages may be a potential therapeutic approach for ARDS.
Marian Kamal Mankaryous Hendy is a Specialist in the Department of Paediatrics in Medcare Medical Centres. She obtained her MBBS and Master's Degree in Paediatrics and Neonatology from Assiut University in Egypt. She completed both her internship and residency at Assiut University Hospital. She started practicing as a Paediatrician at Assiut University Hospital and the Ministry of Health in Egypt. She then joined the Sohar Hospital in Oman where she worked as a Paediatric Specialist. Subsequently, she also worked as a Paediatric Specialist at Zulekha Hospital in Dubai for 5 years before joining Medcare.
Are symptoms different between Influenza and Pneumonia?
Pneumonia is a lung infection, so it has more respiratory symptoms while influenza is accompanied more by muscular aches and fatigue. Usually pneumonia takes longer to develop and can be a complication of influenza. The flu is caused by a viral infection, while pneumonia can be caused by either a bacterial, viral or fungal infection. Bacterial pneumonia can be an influenza complication. Immunosuppression is a risk factor for the secondary bacterial infection in influenza.
In flu season, every one of all ages is at risk of influenza, but the children are more vulnerable. Every region across the world is susceptible to the contagious respiratory illness, it can range from mild to severe in illness, so many patients with the flu recover within a few days, but some people can develop complications. One of the most significant complications is Pneumonia. One-third of pneumonia cases develop from a respiratory virus, with the flu the most common.
Viral pneumonia in healthy people goes away in 1 to 2 weeks, but cough and fatigue may last for many weeks. Viral pneumonia can be serious and life-threatening in people with other medical illnesses. The best thing for a quick recovery from the influenza is rest and hydration, sometimes antiviral medication as oseltamivir can help to avoid complications as Pneumonia, especially in the immunocompromised patients, it can reduce the severity and duration of the symptoms as well.
Simple sanitization by wiping the surfaces with simple detergents, diluted bleach, or hydrogen peroxide, can help stop the spread of the influenza virus and control its seasonal breakdowns. Fortunately, there is a vaccine for both diseases, you can administer a pneumococcal vaccine (PCV15, PCV20 or PPSV23) and also influenza vaccination, this helps a lot to reduce the prevelance of both influenza and pneumonia in the pediatric population.
CMC Vellore, India
Mary Anbarasi Johnson working as a professor and Head in pediatric nursing department, CMC Vellore. She worked as Clinical Nurse Specialist in PICU for a year and as Assit Professor in USA for two years. She also worked in administration (Assistant Director of Nursing) in nursing, in Saudi Arabia Defence Sector. She is very much interested in reviewing articles. She have published in 70 national, international journals and presented in around 30 national and international conferences.
Acute respiratory infections are the most common causes of under-five morbidity and mortality in India. The government and private sectors have taken lot of initiatives in bringing down the number of deaths and hospitalizations due to ARI .The management involves a combination of supportive care, specific treatments based on the underlying cause of the infection, and preventive measures. ARIs can range from mild illnesses, such as the common cold, to more severe conditions, like pneumonia or bronchiolitis. It's important to note that the management may vary depending on the specific diagnosis and severity of the infection. Always consult a healthcare professional for personalized advice.
Here are some general guidelines: Supportive Care: Ensure the child gets enough rest and stays hydrated. Encourage frequent breastfeeding or fluid intake for infants, and offer plenty of fluids to older children. Adequate rest helps the body fight off the infection, and proper hydration prevents dehydration, especially if there is a fever.
Fever Management: If the child has a fever, acetaminophen or ibuprofen can be used under the guidance of a healthcare provider. Avoid aspirin in children due to the risk of Reye's syndrome.
Steam Inhalation: Steam inhalation may provide relief for nasal congestion, but it should be used cautiously to prevent burns. Make sure to supervise and maintain a safe distance from hot water.
Nasal Saline Drops: For infants or young children with nasal congestion, saline drops can be used to help clear the nasal passages and improve breathing.
Antibiotics (if bacterial): Antibiotics are not effective against viral infections like the common cold but may be necessary if a bacterial infection, such as bacterial pneumonia or a severe ear infection is present. The decision to prescribe antibiotics is usually based on the child's symptoms and clinical examination.
Antiviral Medications (if viral): In certain situations, specific antiviral medications may be prescribed for certain viral infections like influenza (flu). These medications work best when started early in the course of the illness, so prompt medical attention is essential.
Cough Management: Avoid over-the-counter cough and cold medications in young children, as they can have limited efficacy and may cause side effects. Instead, consider using honey (for children over one year of age) to soothe a cough or other age-appropriate remedies recommended by a healthcare provider.
Hospitalization (if needed): In severe cases, such as severe pneumonia or respiratory distress, hospitalization may be necessary for monitoring and advanced medical care.
Preventive Measures: Encourage proper hand washing to reduce the risk of transmission of infections. Immunization against preventable diseases like influenza and pertussis (whooping cough) is also essential to reduce the severity and spread of respiratory infections. Remember that self-diagnosis and self-medication are not recommended, especially in children. If your child has symptoms of an acute respiratory infection, it's important to consult a healthcare professional for proper evaluation and management. They can provide accurate diagnosis, appropriate treatment, and guidance on home care. The speaker would high light on the intensity of the problem in India and the management modes including nursing care.
University Hospital Center, Croatia
Darko Richter is pediatrician, subspecialist in allergy and clinical immunology. He studied and worked in Zagreb, Croatia. Retired from the University Hospital Center Zagreb in 2020. Active in Derma Plus Polyclinic since. The main field of interest: Pediatric allergy, immunodeficiency and vaccines. Authored and co-authored more than 120 articles in medical journals, and 26 chapters in 13 medical textbooks in Croatian and English. Invited lecturer on more than 150 occasions of professional, academic, and sponsored lectures. Scopus H-index 15. President, Croatian Pediatric Society – Zagreb (2009 - 2013). Founder and first President, Section on Pediatric Allergy and Clinical Immunology, Croatian Pediatric Society (2010 - 2020).
Statement of the Problem: The initial COVID-19 vaccination campaign did not meet expectations due to errors in the roll-out strategy that did not take into account the incubation, index of reproduction, and duration of humoral immunity.
Purpose: To point out the factors those were neglected in creating the COVID-19 vaccination strategy.
Methodology: Critical observation of what has been done in comparison to what should have been taken into consideration from the outset.
Observations: It has been known for at least 50 years that humoral immunity following a 2-dose primary immunization last 4-6 months. Thereafter, short-incubation diseases (<8-9 days) need periodic boosting to maintain a steady protective antibody titer. In long-incubation infections, there is enough time to mount an anamnestic response to avert clinical disease, and boosters are not indispensable. Unless the herd immunity of 45% population had been attained during the B1 strain (reproduction index 1.8) predominance in Europe, no interruption of pandemic spread could have been hoped for. Instead, the pandemic spread on, “breakthrough” infections were infections that appeared after the waned specific antibody titers, and new variants allowed to boom with immune evasion and increasing reproduction index and transmissibility. Moreover, it was not appreciated that more generous spacing between the doses increased immunogenicity and that a single vaccine dose at the appropriate (3-6 months) post-recovery interval induced powerful hybrid immunity. Indeed, as of mid-2022, mRNA vaccines have been offered as a series of 3 doses at intervals of up to 8 weeks for the primary series, and at least 5 and 4 months for doses 3 and 4, respectively.
Conclusion and Significance: COVID-19 pandemic could have been controlled in the initial phases of the vaccination campaign if a faster roll-out or a 3-dose schedule had been adopted from the outset.
Kamaran Charitable Hospital, Yemen
Title: Children, sickle cell anemia, expected death: The psychological impact on mothers and fathers and their inability to treat
Time : 14:30-15:00
Fawzi Algadri, a pediatrician and former director of the Public Health and Population Office in the directorate, has experience in management, including planning, follow-up and evaluation in order to improve primary health care. He is currently working in Kamaran Charitable Hospital, Yemen, as a pediatrician. He worked in many government and private hospitals in Sanaa and another province.
Children who suffer from sickle cell anemia, and there are more of them here. They are liable to die at any moment without realizing it, but here lies the major problem with the great psychological impact of the father and mother who realize that their son or children will leave them one day, in succession It is a feeling mixed with pain, confusion and frustration for the parents. But it is somewhat mitigated by the fact that the children are unaware of what awaits them. Therefore, when you look, they smile and laugh at you, the pain squeezes inside you, and you see the children’s innocence gradually withering in front of your eyes as a doctor, so how will it be in front of the mother and father? The psychological suffering of the father and the father needs great psychological support in order to prevent reaching addiction to what relieves them of feelings. Here they resort to khat, which is a narcotic plant that contains Cathinone (an amphetamine-like stimulant).
It is classified by the World Health Organization among narcotic herbs, and it is very, expensive and affects the level of family income, and therefore the results of addiction to it lead to bad results in children’s nutrition on the one hand, and also from the psychological aspect of the father and mother on the other hand These children suffer from pain on a semi-monthly basis, if not weekly, and they need medication daily. Of course, the costs of medication are high, and the income of families is very little, if not non-existent for some. In the meantime, what is the position of the father and mother when they see their son or children in pain and cannot help them because of their inability to buy medicine? It is a painful, frustrating, cruel feeling that squeezes the heart of the father, so he looks at the sky confused, while the mother sheds tears and weeping.
The father and mother resort to consuming khat to escape from the painful reality in their lives, which leads to a further deterioration of the health of the children and weakens the financial condition of the family. As for the mother and father, addiction to khat causes many psychological problems. The purpose of my words, as a pediatrician, is to study an existing situation that I see increasing day by day. It has psychological repercussions on fathers and mothers, as well as on affected children after they reach adolescence and begin to realize the problem and its repercussions, and the impact of bullying by their schoolmates on them, and these children cannot continue studying as a result of repeated bouts of illness, which makes them lag behind others in studying. Addiction to khat has led to the emergence of many cases of psychological depression among mothers and fathers. The results of the treatment are not satisfactory because it is difficult to obtain medicines due to the high cost and the inability to buy. The number of those who suffer from a psychological impact is very large, according to the statistics of our fellow psychiatrists.
Ministry of Public Health, Thailand
Sarawut Boonsuk is the Deputy Director-General of the Thai Ministry of Health. He has a bachelor's degree in medicine from Rangsit University and diplomas in Preventive Medicine (Epidemiology), Thai Medical Statistics and Clinical Epidemiology. He also holds a Master of Public Health including a PhD in Clinical Tropical Medicine from Mahidol University and recently completed the Doctor of Public Health Program (International Program) in 2022. He focuses on maternal and child health, specifically preventing HIV and HBV transmission from mother to child. He worked as co-director of mother and child work and collaborated with UNICEF, WHO and UNFPA to reduce HIV transmission. Thailand is the first ASEAN nation to receive WHO certification. He is also studying ways to decrease HBV transmission among mothers with positive HBeAg test.
The Hepatitis B virus remains a major public health problem worldwide, especially in developing Asian countries. Thousands of Thai children under 5 have HBV from mother-to-child transmission. 90% of HBV-infected infants develop hepatic cancer. Since 2017, Thai national guidelines recommend mothers with high viral load or HBeAg positivity use TDF to prevent HBV transmission to their children. However, many Thai mothers do not receive treatment to prevent mother-to-child transmission. This study evaluated Mother-to-Child Transmission rate and factors (MTCT). The retrospective cohort study evaluated 342 women with hepatitis B were studied. From 2018 to 2020, the mothers must be HBsAg-positive. TDF is used for MTCT.
Collected information such as underlying disease, ANC visit, HBeAg status, viral load level and mode of delivery, infant's body weight, active-passive immunoglobulin and breast milk status. Multivariable binary regression was used to evaluate MTCT and risk factors. There were 42.40% (145) infants born from mothers who received TDF and 57.60% (197) infants born to non-TDF-used mothers. 52.92 percent were uninformed that they had hepatitis B and more than half (52.34 percent) were diagnosed as hepatitis B positive during their pregnancies. All 342 infants received hepatitis B vaccine at birth, 323 infants received Hepatitis B Immune Globulin (HBIG) and hepatitis B vaccine and 5.56% (19) did not receive Hepatitis B Immune Globulin (HBIG). The overall MTCT incidence rate is 0.88 percent, the MTCT rate among TDF mothers is 0.69 percent and the MTCT rate among non-TDF mothers is 1.02 percent. However no association between risk factor and MTCT among mothers HBsAg positive. In HBsAg-positive mothers, TDF reduced mother-to-child transmission (0.69 vs. 1.02). In uninfected infants, TDF efficacy is 32% and relative risk is 0.679%. No mother-to-child transmission of hepatitis B occurred because all infants received HBIG. TDF was not associated with mother-to-child hepatitis B transmission.