Title: Vitamin D Status in Children with Asthma

Abstract:

Vitamin D status in children with asthma

Vitamin D plays an important role in general health, and has characteristics of an hormone. Recent studies proved its immunomodulatory effect in patients with asthma. The authors  analized the relationship between low serum concentration of 25-hydroxi-vitamin D (25-OH-VitD) and the incidence of exacerbations in children with asthma.

We included in th study 131 children with asthma admitted in The IIIrd Pediatric Clinic, Clincal Emergency Hospital for Children, Cluj-Napoca, in which we noted the prophylaxis with vitamin D that the patients received, serum concentration of 25-OH-VitD and other  factors that correlates with asthma exacerbation.

The prevalence of vitamin D deficit was of 58.8% in our sudy group. We noticed a statistical signifficant corellation between vitamin D deficency and the asthma exacerbation during the previous 4 weeks (p=0.02).

     In conclusion, the assesment of 25-OH-VitD status may be a usefull parameter for  monitoring children with asthma, mainly in those patients with frequent         symptoms.

Biography:

Senior Physician in Pediatrics (2000),

Doctoral Degree in Medicine (2001): “Monitoring of treatment with theophylline administered in children with asthma and in prematures with idiopathic apnea by measuring salivary level of the drug”.

Lecturer in Pediatrics (2002) at The University of Medicine and Pharmacy  “Iuliu Hațieganu”, Dpt. 9, Disc. Pediatric III, Cluj Napoca

Overspecialisation in Paediatric Pneumology

Competence in " Special Pulmonary Function Tests"

Competence in Pediatric Allergology and Immunology

Member of The Pediatric Pneumology Committee of the Ministry of Health (since 2019)

Title: Pediatric obesity an emergency crisis

Abstract:

Pediatric obesity an emergency crisis

Pediatric obesity has rapidly become one of the leading international public health challenges. Since the 1980s, rates have more than doubled for preschool-aged children (2 to 5 years) and adolescents (12 to 19 years) and have more than tripled for school-aged children (aged 6-11 years) in the United States. Childhood obesity is an issue of serious medical and social concern. In developing countries, it is a phenomenon seen in higher socioeconomic strata due to the adoption of a western lifestyle. Consumption of high calorie food, lack of physical activity and increased screen time are major risk factors for childhood obesity apart from other genetic, prenatal factors and socio-cultural practices. Obese children and adolescents are at increased risk of medical and psychological complications. Insulin resistance is commonly present especially in those with central obesity and manifests as dyslipidemia, type-2 diabetes mellitus, impaired glucose tolerance, hypertension, polycystic ovarian syndrome and metabolic syndrome. Obese children and adolescents often present to general physicians for management. The latter play a key role in prevention and treatment of obesity as it involves lifestyle modification of the entire family. This article aims at discussing the approach to diagnosis and work-up, treatment and preventive strategies for childhood obesity from a general physician's perspective.

Biography:

Ahmed Mohamed Abdelaal has completed his graduation (M.B.B.S) from the Al Zagazig University, Egypt in 1989. He then acquired his Masters in Pediatrics (M.S) and his Doctorate in Medicine (M.D) in 1994 and 2006 respectively from the same university. He is also certified in Advanced Pediatric Life Support (APLS) and Advanced Cardiac Life Support (ACLS), postgraduate in pediatric nutrition PGEN (Boston University) and ENS (Munich University). Dr. Ahmed has more than 25 years of experience in General Pediatrics with a special interest in Pediatric Hematology and have a good experience in pediatric asthma.

Title: Foreign body aspiration: An important cause of medley acute and chronic respiratory symptoms in children and its management by flexible bronchoscopy Introduction: Foreign body (FB) aspiration in airway is a common occurrence in pediatric age group, need

Abstract:

Foreign body aspiration: An important cause of medley acute and chronic respiratory symptoms in children and its management by flexible bronchoscopy

Introduction: Foreign body (FB) aspiration in airway is a common occurrence in pediatric age group, need prompt recognition and management. However, it is not always diagnosed (especially in radiolucent FB) due to non-specific symptoms of varying severity. Often the symptoms are subtle and mistaken for other more common conditions like pneumonia and asthma and do not respond as expected to standard therapy and present a diagnostic challenge. Rigid bronchoscopy still remains the gold standard in Bangladesh to remove airway FBs.

Aim: The main aim of this study was to emphasize the importance of considering airway foreign body as a cause of acute and chronic respiratory symptoms in children and to outline the clinical evidences of the utility and feasibility of flexible bronchoscopy for management of airway FB in children.

Methods: This prospective study was performed on children (aged six months to 16 year) having acute or recurrent or long standing, non-resolving or partially resolving respiratory complaints who underwent flexible bronchoscopy for suspected FB from July 2018 to July 2019 in a tertiary care hospital in Bangladesh. History, clinical, radiological, bronchoscopic findings and immediate effect after bronchoscopy were analyzed.

Results: The results indicated that among total 32 children, only 25% (n=8) had definite history of FB aspiration. The most frequent symptom was paroxysmal cough (72.7%) followed by wheezing, stridor and recurrent and persistent pneumonia. FB was found in 47% (n=15) children and removed successfully by Dormia basket in nine children, four by rat-tooth forceps and two by cryo probe. The most common (n=8) FB was peanut. Others are pin, metallic clip, plastic bead of Tasbih, filament of pencil torch light, custard apple seed, pea pulse, plastic safety ware joint. Thick mucus plugs were found in four children. Respiratory symptoms improved after removal of foreign bodies in all cases. Respiratory symptoms improved after removal of foreign bodies in all cases. During procedure, transient hypoxia developed in three children which were alleviated by temporary cessation of the procedure.

Conclusions: The possibility of foreign body aspiration should be considered in any child who present with acute or persistent and recurrent respiratory symptoms. And flexible bronchoscopy documented a crucial diagnostic and safe therapeutic tool for foreign body management in pediatric age group.

Biography:

Sarabon Tahura is a Medical graduate (MBBS) from Mymensing Medical College under Dhaka University and has obtained her professional degree FCPS (Paediatrics) from Bangladesh College of Physicians and Surgeon (BCPS). Afterwards, she has completed fellowship in Paediatric Intervention Pulmonology from Qilu Children Hospital under Shangdong University, China and training from All India Institute of Medical Science (AIIMS). She is the Associate Professor of Pediatric Respiratory Medicine and the 1^st Pediatric Interventional Pulmonologist of Bangladesh. She is experienced in teaching and conducting Post-graduation examinations of Pediatrics in Bangladesh. She has been published many articles under her name in different national and international journals and has been serving as an Editorial Board Member of repute.

Title: Iron deficiency anemia in children

Abstract:

Iron deficiency anemia in children

Introduction: The deficit of iron and anemia iron are considered as major problems of public health and lack of the most common nutritional worldwide due to their high prevalence, effective on growth and development, resistance to infections and linkage to mortality of less than two year babies. In Kosovo, we have no correct statistics on national level for the prevalence of iron deficiency anemia.

The purpose of the study: Was children with iron deficiency anemia and risk factors that may have affected children compared to non-anemic.

The Material & Methods: In this study are included 343 children; 244 children in the anemic study group and 99 children non-anemic in the control group.

Results: The result indicated that the children diagnosed with iron deficiency anemia consist more of male 57.4% compared to female 42.6% but they have no difference in the statistical significance. The age of these children consisted of approximately 19.2 months old (DS±13.7 months). Anemic children consisting of 62.2% were more often living in the city compared to those of controlling group by 52.5%; this difference had important statistical significance. The average mass of the child of birth body of the study group was 2973.5 gr while those of control group were 3405.7 gr. So, the average mass of the child of birth body of the study group (anemic) was significantly lower compared to children of the control group, which difference was statistically significant. Also, when involved in the study the average mass of the child of birth body of anemic children was much lower compared to the children of control group (difference was statistically significant.) Malnutrition was common in anemic children. Hypotrophy of the first instance was 36.5% and the second degree of hypotrophy was 6.6% of children of the study group. More than half (57.8%) of anemic children are fed with formula milk; 10.7% with commercial milk and 15.6% with natural milk or (cow milk). In 7.8% of cases they have mixed commercial with the formula milk or cow's milk and only one case was of commercial milk with cow's milk. Children of anemic group were less fed with meat, spinach, eggs; they were more fed with cereals compared with the children of control group; the difference consisted statistically significant. The average age of onset of artificial nutrition of children in the study group was 5.0 months; to children in the control group was 4.0 months without any statistically significance difference. Anemic children have started complementary food earlier than control group children with significant difference, which means that they are fed less exclusively breastfeeding and complementary feeding has started if not fed properly. Anemic children in the highest structure of anemic had their mothers anemic as well consisted of 47.1% compared with non-anemic children (27.3%) which difference was statistically significant. Bleeding during childbirth in similar structure of anemic children had mothers from (17.6%) and non-anemic from (18.2%) regardless statistically significant. Children of the study group were more often premature (14.3%) compared to those of control group (5.1%). They often resulted with lower body mass when in birth 29.1% versus 7.1%. More often twins 5.7% compared to those of control group 2.0%. To the anemic children we experienced a decrease in the number of erythrocytes, hemoglobin, MCV, hematocrit, and iron which was approximately 6.2 15.8 compared to the control group.

Conclusion: : From our data it is obvious that iron deficiency anemia is very often disease with many risk factors that can cause disease, as are the nutritional status and other diseases.

Title: Changes in cerebral blood flow and cardiac output in premature neonates in the first 72 hours of life

Abstract:

Changes in cerebral blood flow and cardiac output in premature neonates in the first 72 hours of life

Background: A major determinant of adverse neurodevelopmental outcome is the early acquisition of prematurity related brain injury associated with perturbations of cerebral hemodynamics. Several impediments however exist in establishing a causative relationship between systemic hemodynamic disturbances and prematurity related brain injury.

Methods: A nested cohort of a prospective cardiac output methods comparison in preterm infants was compiled and involved infants admitted to a tertiary level neonatal high care unit. An interim analysis of 63 premature infants meeting the inclusion criteria of gestational age between 26-34 weeks with recorded cranial ultrasound and echocardiographic data was performed. Excluded infants were those with birth weight <800 gm, gestational age <26 weeks, congenital defects and infants with asphyxia. Left Ventricular Cardiac Output (LVO), as measured by echocardiography was correlated to anterior cerebral artery flow velocities, derived from cranial ultrasound Doppler.

Results: Measurements were recorded at six hourly intervals up to 72 hours of life and analyzed in two subgroups: 31 infants (gestational age 28.6±1.25 weeks, range 26-30 weeks) and 32 infants (gestational age 32.4±1.0 weeks, range 30-34 weeks). LVO remained constant across gestational age categories. Peak-systolic flow velocity (PSV) and end-diastolic flow velocity (EDV) had initial low values with gradual increase over time. Lower mean values were detected in the 26-30-week gestational age group representing intrinsic differences in cerebral vasculature of the developing brain. Neither PSV nor EDV had a strong correlation with LVO.

Conclusion: In this population of relatively stable premature infants’ changes in PSV and EDV did not correlate with LVO suggesting intact cerebral autoregulation.

Biography:

Sebastian Gericke has obtained his MB ChB degree at the Stellenbosch University, South Africa. He is currently pursuing his Paediatric Speciality Training at Stellenbosch University.

Title: Necrotizing enterocolitis in a preterm infant newborn and role of feeding …. an update!

Abstract:

Necrotizing enterocolitis in a preterm infant newborn and role of feeding …. an update!

Our Literature Review Study Reflects: The light on some chemical substances which are widely used in many and different aspects of our children daily practices and try to get the answers for the following important questions. Do these chemicals that our children are widely exposed to since even their prenatal period and throughout their lives have real high risks and dangers on their health? Is the use of these chemicals essential for our kids or we can avoid and replace them with other non-risky substances and hazardous chemical free products...!! Recently, a lot of systematic review studies have been done to investigate the possible relations between the most common chemical substances that we use daily and possible risks and health problems that may affect our children. Among the chemicals that have been studied intensively in the last few years are phthalate, bisphenol A and parabens which are known endocrine disruptors due to their anti-androgenic and/or estrogenic effects!

The Purpose & Objectives of Our Study: The main objective of this study are to provide an overview of some widely and commonly used chemicals that are introduced to many of the products essentially used by our children daily, and the possible relations between their use and some of the common health problems and disorders that affect children in order to raise the awareness among parents and health care providers regarding their potential health impacts on children and to provide a proper guidance that help to minimize the avoidable exposure to these risky chemicals and replace them with hazardous chemicals free products till we get enough studies that prove or disprove their risks and effects.

Methods & Results: Our study tries to search through, emphasis on and spot the light on the use of three chemical substances (paraben, phthalates and bisphenol A) that are commonly and widely used in most of our children life aspects, searches for their possible risks and hazards on our kids' health, tries to get relations and connections between these substances and common pediatric health problems and disorders. In our study we reviewed the data collected from many evidences based systematic reviews and Cohort studies have dealt with these hazardous substances and stated the high incidence of their risks and their bad impacts on our kids' health and prove the relation of these chemicals to certain respiratory problems specially wheezing in childhood, ADHD, some atopic conditions and endocrine disruptions among children.

Recommendations: Our study concluded and suggested that it is better to eliminate exposure to these chemicals as evidences are rising against their safety. It's very important to increase the awareness among parents and health care providers regarding the possible risks of these chemicals and provide them the most proven practical tips for their avoidance. Further epidemiological studies should be conducted in the future to enhance our knowledge in this area.

Biography:

Dr. Amr Hawal is a Pediatrician and Neonatologist whose experience in the field spans 20 years, backed by a higher education degree from Ain Shams University in Egypt, one of the oldest and top-ranking universities in the MENA region. He is known for his astute skills in evaluation and strong passion for improving healthcare and wellbeing. He is pioneering an open and contextual evaluation model based on constructive responses, which has led in the creation of new methods to improve pediatric healthcare, neonatology and pediatric nutrition.

Title: The proper delivery pressure for cardioplegic solution in neonatal cardiac surgery – an investigation of biomechanical and structural properties in neonatal and adult coronary arteries

Abstract:

The proper delivery pressure for cardioplegic solution in neonatal cardiac surgery – an investigation of biomechanical and structural properties in neonatal and adult coronary arteries

Introduction: One of important issues in pediatric cardiac surgery is myocardial protection. When cardioplegic solution is injected into coronary arteries with a pump to ensure myocardial protection, it is necessary to determine the correct delivery pressure to avoid damage of the heart.

Methods: We investigated 12 coronary artery specimens without cardiac pathology retrieved from autopsies of neonates 9.3±9.7 days old and weight 3.99±0.7 kg and compared them to seven adult specimens with no detected atherosclerosis. Specimens were pressurized from 0 to 200 mmHg with the step of 20 mmHg, while maintaining the length of the sample in situ. Structural damages were investigated afterwards with light microscopy and immunohistochemistry.

Results: There was a rapid increase of strain until the inner pressure reached 80-100 mmHg, whilst the increase of stress in the wall of neonatal coronary arteries was less rapid. When the internal pressure exceeds 100 mmHg, the strain of the arterial wall increases much slower, but the wall stress and modulus of elasticity begin to increase rapidly - the structural elements of the arterial wall have been straightened and possible damage may appear. Results were compared with biomechanical properties of arterial wall of adults and differences had been found. Morphologic examination of tensile properties revealed prominent affection of the vascular wall of neonates with accentuated redistribution (loosening) of medial myocytes and adventitial vasa vasorum after being pressurized with the inner pressure of over than 100 mmHg.

Conclusions: Our experimental results show that the delivery pressure of the cardioplegic solution in neonatal coronary arteries should not exceed 100 mmHg. A raised inner pressure may increase the risk of structural damage of the vascular wall leading to the injury of myocardium.

Biography:

Normunds Sikora has completed his Residency in Cardiac Surgery in 2008. Afterwards, he finished his PhD in Riga Stradins University. He has done efforts to improve the quality of cardiopulmonary bypass in cardiac surgery in Latvia working as Cardiac Surgeon and Specialist in cardiopulmonary bypass in Clinic for Pediatric Cardiology and Cardiac Surgery, Children’s University Hospital, Riga, Latvia. He is also an Assistant Professor in Riga Stradins University, Department of Surgery. He has established Latvian Society of Cardiopulmonary Bypass being its President currently. He is a National Delegate in European Board of Cardiovascular Perfusion. He has established National Education Program in Cardiovascular Perfusion being its Director currently. He has over 10 papers in different local and international medical journals.

Title:  Clinical decision-making styles and critical thinking skills among general care nurses in Malaysia

Abstract:

           Clinical decision-making styles and critical thinking skills among general care nurses in Malaysia

The aim of this study is to assess the relationships between critical thinking skills and types of clinical decision-making among general care nurses in Malaysia. This quantitative descriptive correlational study was conducted in nine public hospitals from Peninsular Malaysia. Five hundred and forty nine nurses recruited via multistage cluster sampling, completed the demographic data questionnaire, Health science reasoning test (HSRT) and 24-item Nursing Decision-making instrument (24-NDM). The results of the study show that nurses’ average HSRT score was 13.8±3.4 which meant the majority of them failed to manifest critical thinking skills. In addition, the results show that 65.2% of the nurses studied were more inclined in making quasi-rational decisions, with 24.6% inclined towards analytical-systematic decisions, whereas only 10.2% displayed intuitive-interpretive decisions (=268, df=2, p<0.001). With multinomial logistic regression, only education qualification is significantly associated with the nurses’ critical thinking score, whereas years of working experience and education qualification significantly predicted types of clinical decision nurses made (p<0.001). Finally, there is significant positive relationship between critical thinking skills and clinical decision-making, which accentuates the positive results yielded from previous studies. This finding provides further evidence that critical thinking and clinical decision-making are both interrelated. Since clinical decision-making cannot be easily taught in nursing curricula, cultivating critical thinking among nursing students perhaps is the right remedy for producing future nurses who can make effective clinical decisions.

Biography:

Khatijah Lim Abdullah has completed her Doctorate from the University of Southampton UK. She is currently a Professor in Nursing in University of Malaya, Malaysia and Vice President for Qualitative Research Association Malaysia. She has published more than 50 papers in reputed journals and is presently the Chief Editor for Malaysian Journal of Qualitative Research.

Title:  Overpopulation and Voluntary Family Planning: Setting a New Health Political Agenda

Abstract:

                              Overpopulation and Voluntary Family Planning: Setting a New Health Political Agenda

Voluntary family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through use of all available contraceptive methods. Family planning is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national and regional development efforts.

Contraceptive use has increased in many parts of the world, especially in Asia and Latin America, but continues to be low in sub-Saharan Africa. Nevertheless ‘Three Successful Sub-Saharan Africa Family Planning Programs’ show how African best practises of Ethiopia, Rwanda and Malawi share a common strategy: Contraceptive prevalence has risen steadily from a low starting point and moved upward sharply in most years in all three countries: from 2000 to 2011 in Ethiopia from 6.3% to 27.3%, in Rwanda from 5.7% to 45% and Malawi from 26.1% to 42.2%. Such progress is helping these countries move closer to what the development community calls “the demographic dividend”.In particular these achievements have been possible due two main strategies:

1) countries dramatically reduced financial barriers to access modern contraceptives.

2) huge task shifting, reducing physical distances from the poorest to the provision of services have been done with training schemes: provision of long-acting family planning methods shifted from doctors (therefore from hospitals) to nurses at the health centre level while provision of condom and pills shifted from nurses (health centre level) to trained community health workers, present in every single village. most recent WHO published data estimate that 214 million women of reproductive age in developing regions who want to avoid pregnancy are not using a modern contraceptive method: a huge unmet need. According to WHO and UNFPA, providing access to these women would prevent 67 million unintended pregnancies and would reduce induced abortions from 48 million to 13 million. It would also reduce maternal deaths by 76,000 per year, new-born deaths from 2.9 million to 660,000 per year and HIV infections in new-borns from 130,000 to 9,000.

Biography:

Michele Usuelli has lead and managed the neonatal emergency transport system, STEN. He is lead and managed clinical and research program of Neonatal care in developing countries for 7 years. He is a senior neonatologist at 3rd level NICU with capacity of managing up to 25 ventilated newborns, pre-post operatory management of surgical newborns, intensive/subintensive NICU and the biggest public in Italy. At present on leave. Since May 1st I have been elected in the regional assembly of Lombardy. (In Italy health is directly managed by regions).

Title: An online education program on safe sleep infant: Exploring the impact on the Role of Community Pediatric Nurses and Midwives during Covid-19, a pre-experimental study

Abstract:

An online education program on safe sleep infant: Exploring the impact on the Role of Community Pediatric Nurses and Midwives during Covid-19, a pre-experimental study

Objectives: To explore the impacts of an online education program on postnatal care and infant care in remote Jordanian rural.

Methods: This is a pre-experimental, one group pretest posttest education intervention conducted among a purposeful sample of 25 community pediatric nurses and midwives who worked in a primary health center, located in three borderline departments in the north-western Jordan in Irbid governorate. The study collected both qualitative and quantitative data.

Results: Providing an online health education program on postnatal care and infant care safe sleep infant care to medical staff in remote areas enhances their ability to share up-to-date information with parents P>0.5. There was an improvement in accessing online professional resources and prevention recommendations on postnatal care and infant care after participation in the online health education program. This study impact on staff practices in educating mothers regarding mostly important issues regarding covid-19 crises including symptom, prevention, treatment of the symptom and how they deal with their infants during this crises. Using online education technology and social media have been identified as a cost-effective strategy, supporting timely precise professional education

Conclusions: Technology plays an active role and can be used in health education programs in remote areas, where information can be communicated to health staff regardless of distance.

Keywords: Health promotion; learning strategies; Social Media; Mobile Technology; Professional development; Facebook; WhatsApp

Biography:

Dr Shereen HAMMADNEH, An Associate Professor, Department of Maternal and Child Health, Princess Salma College of Nursing, Al-Bayt University in Jordan. Dr Hamadneh is also a registered dietitian and nutritionist, whose research focuses on maternal and child health, nutrition, and toxins and developed several intervention programs for community and especial for rural and remote areas and refugees. Dr Shereen developed an educational package to improve childcare practice in Jordan and reduce the risk of sudden and unexpected infant deaths. This project was the first of its kind in Jordan, funded through Australian aid. She established the "Happy Child and Happy Family" association in 2016 to achieve its goals and enhance the quality of childcare in Jordan and run several volunteer activities, training, and charities that help improve childcare practice and promote healthcare awareness.

Title: Cow Milk Protein Allergy; Update and Challanges

Abstract:

Cow Milk Protein Allergy; Update and Challanges

Cow’s milk protein allergy (CMPA) is caused by a reproducible immune-mediated response to milk proteins and tends to present during the first few months of life. This response can vary significantly from an immediate reaction within 2 hours of ingestion to a more delayed reaction, which can occur anywhere between 2 and 72 hours later. A delay in diagnosis can cause significant child and parental distress, while overdiagnosis can lead to an unnecessary elimination diet. CMPA can be confused with lactose intolerance which is a non-immune mediated response as a result of lactase enzyme deficiency. We review the diagnosis and management of CMPA in this article along with future directions.

Biography:

Dr. Mahmoud Metwaly Taha has a master degree in paediatrics and neonatology awarded from Zagazig university, Zagazig, Egypt. Currently working as senior neonatologist at Saudi German Hospital, Aseer, KSA