Spinocerebellar ataxias are characterized by disturbances of the body posture and coordination and constitute one of the major causes of disability. According to the mode of inheritance and gene in which causative mutations occur or chromosomal locus, spinocerebellar ataxias can be subdivided into autosomal dominant, autosomal recessive, X-linked, and mitochondrial. Nevertheless, the high incidence of consanguineous marriages in the Arabian Peninsula and North Africa is reflected in the high prevalence of autosomal recessive (AR) disorders, in contrast to the situation in North America and Europe. The current presentation outlines a diagnostic clinical and investigational algorithm for hereditary ataxia, especially those which are treatable. Utilizing this algorithm and the power of family-based genetic studies combined with emerging DNA technology, new syndromes and diseases were identified. Those with gene identification included: 1. A new form of autosomal recessive cerebellar ataxia with epilepsy and intellectual disability. (http://brain.oxfordjournals.org/content/137/2/411) (http://www.ncbi.nlm.nih.gov/pubmed/24369382). 2. Spinocerebellar ataxia with axonal neuropathy (SCAN1; OMIM 607250; http://www.ncbi.nlm.nih.gov/books/NBK1105/). 3. Salih ataxia: (OMIM #615705, http://omim.org/entry/615705) (http://brain.oxfordjournals.org/content/133/8/2439.full.pdf+html) (http://www.ncbi.nlm.nih.gov/pubmed/23728897). These advances of pediatric neurogenetics helped in refashioning the prognosis and differential diagnosis of these diseases. It also made possible presymptomatic, prenatal, and pre-implantation genetic diagnoses for affected families.
Mustafa A. Salih (MBBS, MPCH, MD [University of Khartoum]; Dr Med Sci [Uppsala University]; FRCPCH [UK]; FAAN [USA]) currently serves as Professor of Pediatrics and Consultant Pediatric Neurologist at the College of Medicine, King Saud University (KSU), Riyadh, Saudi Arabia. He has published more than 235 scientific articles, three journal supplements, and 10 book chapters. His publications were highlighted by Nature (Nature Index). He is the International Editor of Sudanese Journal of Paediatrics and member of the editorial boards of several other medical journals. He was awarded KSU Gold Medal in 2010, and KSU Life-time Scientific Achievement Award in 2014.
In 2010 International neonatal resuscitation guidelines where changed recommending to initiate with air rather than 100% oxygen. This change in paradigm was based on 30 years of research. Still the optimal oxygenation of the newborn in the delivery room and beyond has not been clearly defined for immature infants. In this lecture the most recent results, especially regarding immature infants will be discussed. In the delivery room if ventilation is needed start with air in term or near term infants> 31 weeks GA and adjust FiO2 according to response in heart rate and oxygen saturation. For immature infants (< 28 weeks GA) start with for instance with 30% oxygen and titrate according to the response in heart rate and oxygen saturation. In immature infants is recommended to reach an oxygen saturation of at least 80% within the first 5 minutes. For newborn infants between 28 and 31 weeks gestation data are not so solid but one could start with 30% oxygen and titrate according to the response. For immature infants beyond the delivery room until 36 weeks post conceptional age it is known that a high saturation target (90-95 %) compared to a low target (85-89%) reduces mortality and NEC but increases ROP, however without increasing risk of blindness. To balance this so-called oxygen dilemma a target SpO2 of 90-94 is recommended with alarm limits of for instance 88 and 95% . 1: Stenson B, Saugstad OD. Oxygen Treatment for Immature Infants beyond the Delivery Room: Lessons from Randomized Studies. J Pediatr.2018 Jun 28.pii: S0022-3476(18)30648-6 2: Saugstad OD. Oxygenation of the Immature Infant: A Commentary and Recommendations for Oxygen Saturation Targets and Alarm Limits.Neonatology. 2018;114:69-75
Ola DidrikSaugstad, MD, PhD, FRCPE completed his PhD in 1977 at University of Oslo. He started his training as Paediatrician in 1979 at Oslo University Hospital and spent one year as a post doc at Department of Neonatology at University of California San Diego. In addition to working as a neonatologist he was director of Department of Paediatric Research and Professor of Paediatrics at University of Oslo from 1991-2018. He has published more than 450 articles registered at Pubmed and is Honorary professor at Pirogov University of Moscow and Honorary doctor at University of Athens.
Piedmont Columbus Regional is a Georgia Regional Perinatal Center with a 46-bed NICU admitting approximately 140-150 VLBW infants with ~60 ELBW. We have participated in Vermont Oxford Network quality collaboratives since 2004. In 2017 our rate of BPD/CLD had jumped to well above the network mean. We saw this as a wake-up call and joined a VON quality collaborative working with other centers to minimize lung injury in premature infants. Global aim: Decrease the rate of BPD in VLBW infants to the VON 25th centile, from 30% to 11% by October 2019. Sub Aims are to 1) reduce the use of endotracheal ventilation in infants <26 weeks gestation; 2) maintain physiologic lung volume until 32 weeks postmenstrual age; 3) achieve optimal timing for extubation and 4) acknowledge the role of infection in BPD and continue our efforts to minimize BSI and VAP. Family aims are to incorporate parents on our QI team, engage them in maintaining PEEP to 32 weeks, and to assess their understanding of how we are managing their babies. Results: Babies maintained on CPAP to 32 weeks PMA increased to 100% in the first 8 months of the initiative. The rate of non-invasive support in the delivery room has increased to 80% from baseline 57%. BPD has decreased to 20% then 15% to this point. Discussion: Quality collaboratives are an effective way to improve outcomes by implementing evidence-based potentially better practices.
David Levine obtained his MD from the Ohio State University College of Medicine and completed pediatric/neonatal training in Phoenix, Az, Los Angeles and Oxford, UK. He is the Director of Newborn Services and of the Regional Perinatal Center at Piedmont Columbus Regional, as well as co-chair of the Georgia Perinatal Quality Collaborative.
Background:Developmentally-supportive practices are proven to improve neuro-developmental outcome of preterm infants vulnerable to brain injury. Such interventions and practices are hard to implement in highly medicalised intensive care environment of the neonatal unit. We implemented a range of interventions which led to improved outcome over a period of time. Methods: We introduced environmental modification (optimization of lighting, noise reduction, quiet period), positioning guidelines, sleep protection (minimizingnon-essential clinical contact, cluster care, use of incubator covers), pain management (pain score, breast-milk, swaddling, containment), breast-milk provision (skin-to-skin, expression, early suckling),early parental interaction(unlimited access,care involvement) as developmentally-supportive practices. These practices were introduced at different stages keeping in harmony with changing culture of the unit. Ten years on these practices are fully embedded as routine. Analysis: The drive started in 2008, taking momentum in 2009. We compared key clinical indicators during 2012-13 and 2017-18 to evaluate long-term effect of such intervention. There was no significant change in the unit’s clinical practice during this period. Results:Compared to 2012-13, in 2017-18 total invasive ventilator days reduced from 373 days to 255 days,>90th centile LOS reduced from 4.9% to 3.31%, inpatient breast-milk days increased from 22.45% to 31.33%, breast-milk at discharge improved from 30.8% to 56.5% and breastfeeding at discharge for < 33 weeks babies increased from 12% to 39.8%. At 2-year 68% babies born at <30 weeks had normal neuro-developmental outcome. Conclusion:Implementation of developmentally supportive practices when embedded in unit’s practice over a length of time improve clinical and developmental outcome.
Dr Ambalika Das is a Consultant Neonatologist at BHR University Hospital with over 20 years of experience of working in neonatal medicine. She has an interest in developmentally-friendlyneonatal care and established developmentally supportive practices to help improve outcome of high-risk newborns in her unit. She runs neuro-developmental screening and follow-up clinics for newborns facilitating early detection and intervention. She runs study days on Principles and practices of Developmentally-friendly neonatal care for multi-disciplinary audiences.She was the Clinical Director of Children’s services at her trust during 2012-2015. Currently she leads on Baby-friendly Hospital Initiative to improve breastfeeding within the local families.
NI may be a consequence of systemic inflammation predisposing to neuro-inflammation from exposure to CA as confirmed by funisitis at birth in TNB. Early detections of the biochemical NBM by magnetic resonance spectroscopy (MRS) and diffusion and structural brain changes by diffusion tensor imaging (DTI) may identify at risk infants for neurological deficits (ND). DTI measures random water motion and is sensitive to inflammatory changes. Fractional anisotropy (FA) quantifies the directionality of molecular water diffusion. Mean diffusivity (MD) measures overall diffusion regardless of vector. In WMI, cellular swelling and loss of extracellular matrix results in organizational disruption of fiber tracts, so that FA values are lower while MD values are higher. Thirty one neonates with confirmed funisitis underwent MRS/DTI early (<3 weeks of age); MRS with regional of interest (ROI) placed on–basal ganglia and frontal white matter (NBM--NAA, Choline, lactate, myo -inositol, creatine); and DTI regions of interest were drawn in the center of Optic radiation (OR) tracts at the level of the hippocampus. Structural development and spatial heterogeneity in OR ROI were quantitatively assessed with FA and MD, using MRICRON software. At 12 months, developmental examinations were performed using Bayley Scales of Infant Development III with scoring of the motor (gross and fine), language (receptive and expressive), and cognitive function. Decreased NAA/Cho and increased Lact/NAA in BG correlated with lower motor and cognitive composite scores respectively. Increased FA in the right OR and lower MD in the right OR correlated with better motor composite scores. Males showed increased propensity to NI with abnormal NBM.
Dr Lakshmi Katikaneni MD is a professor of pediatrics and the director for NICU Graduate Follow Up Clinic at the Medical University of South Carolina in Charleston South Carolina with four decades of experience in neonatal/perinatal medicine. Her major interests are identifying the developmental outcome of NICU graduates with a variety of pathology, including cocaine exposure in utero with quantification of exposure by hair analysis of the neonates for cocaine metabolites; hypothermia therapy for HIE neonates; ECMO therapy; neurological outcome of extreme preterm infants with BPD, IVH grade III/IV and PVL (utility of reservoir placement and repeated tapping in preterm infants with post hemorrhagic hydrocephalus); body fat measurements by non-invasive air displacement plethysmography; utility of anti VEGF medicine for severe ROP; sleep abnormalities in NICU graduates and obstructive sleep apnea; social and emotional problems and risk for Autism and ADHD in NICU graduates; Chorioamnionitis exposure in term infants and neurological outcomes and utility of brain scans.
Human milk oligosaccharides (HMOs) are the third most abundant solid component in human milk after lactose and lipid. Previously, human milk has been the only source for significant levels of HMOs. The most abundant HMO in most mother’s breast milk is 2’-fucosyllactose (2’-FL). Recently, 2’-FL has been synthesized and shown to be structurally identical to 2’-FL found in human milk. Preclinical research supports 2’-FL as a prebiotic, immune modulator, and a potential anti-nociceptive by regulating colonic contractions in mice. Additionally, emerging research in rodents supports that 2’FL reduces food allergy symptoms and reduces the severity of necrotizing enterocolitis, in part by reducing intestinal inflammation and improving mesenteric blood flow. More recent preclinical research in rodents supports that 2’FL enhances cognition via the gut-brain axis. Learning and memory skills in both young and adult rodents that are dependent on the integrity of the vagus nerve are impacted by 2’FL feeding. Clinical research demonstrated that adding 2’-FL to infant formula is safe, well-tolerated, and absorbed and excreted with similar efficiency to 2’-FL in human milk. Further, infants fed formula with 2’-FL had immune benefits similar to infants fed breast milk. New preclinical and clinical research continue to reveal novel functions of 2’FL. Ultimately, adding 2’-FL to infant formula supports immune and gut health and brings it closer to human milk.
Rachael Buck received her Ph.D. degree in immunology from the University of Cambridge, U.K. followed by postdoctoral HIV/AIDS research at The Population Council, NYC. She joined Abbott in 1995 and is a Volwiler Research Fellow and Director of preclinical research focused on immune and gut health. Dr. Buck primarily researches the components of breast milk to develop infant formulas closer to the benefits of breast milk. She also designs clinical trials to study the effects of nutrients on infant development. Dr. Buck has authored over 50 articles and patents.
Advances in neonatal and perinatal interventions over the past several decades have resulted in increased survival rates for extremely preterm and very low birth weight infants as well as decreased rates of several neonatal morbidities. Despite these improvements, over 40% of these infants experience at least one major morbidity and over half of extremely premature infants experience moderate to severe neurocognitive deficits persisting into childhood. Because of the association between prematurity, birth weight and neonatal morbidities with neurodevelopmental outcomes, clinicians must become familiar with developmental interventions that can be implemented in the NICU and their clinical implications. The purpose of this presentation is to(1) provide an overview of developmental interventions available for preterm infants in the NICU, (2) share the impact of developmental intervention on these infants, and (3) discuss the clinical implications for developmental interventions in the NICU.
Dr. Hussey-Gardner has 25+ years of research and clinical experience with infants, toddlers, and their families. She is an Associate Professor in the Department of Pediatrics where she is the Director of Maryland’s PRIDE. Since 2000, Dr. Hussey-Gardner has received over $2.5 million dollars in grants to operate and study this program. She is also the coordinator of the NICU Follow-Up Program and the developmental specialist for this program and the NICU. Dr. Hussey-Gardneris the author or co-author of 19 articles, 3 textbook chapters, and 6 web-based professional training modules. In addition, she has given over 225 presentations.
INTRODUCTION AND AIM Management of babies who develop bilious vomiting is sometimes confusing as many patients with this presentation are affected by sepsis. As the result of this many critically sick patients who are affected by a surgical condition such as malrotation with volvulus are delayed in their diagnosis and will suffer lifelong morbidity and or mortality. Understanding a simple algorithm on how to interpret and manage babies with sudden onset of green vomit is aimed to minimize complications. MATERIAL AND METHODS Practical workshop lasting 1 hour where participants are continuously involved in the discussion by the speaker. This is to ensure that the level of attention is always kept at high. The workshop will explain the epidemics, differential diagnoses, pathophysiology of neonatal bowel obstruction, prenatal and post natal management of the sick infant, imaging interpretation and contrast studies and indication for tertiary centre referral. The workshop ends with a special focus on malrotation and volvulus as its complication. The workshop aim is to make the participant not only confident but also happy in the management of neonatal bilious vomiting.
SIMONE RAGAZZI BORN IN CREMONA ITALY 1970 GRADUATED IN MILAN IN 1996, MARRIED WITH ONE CHILD SPECIALIZED IN PAEDIATRIC SURGERY MILAN-LONDON 2001 HAS WORKED IN PAEDIATRIC SURGERY FOR THE LAST 25 YEARS, INITIALLY IN ITALY AND SINCE 2000 IN LONDON UK. HAS SPENT 1 YEAR LADY RIDGEWAY HOSPITAL, COLOMBO, SRI LANKA IN 2007 SINCE 2009 HAS BEEN AN HONORARY SPEAKER AT LONDON CITY UNIVERSITY SINCE 2009 HAS DEVELOPED A SIMPLE AND PRACTICAL APPROACH TO THE CHILD WITH BILIOUS VOMITING WHICH IS AIMED TO MINIMIZE ERRORS AND COMPLICATIONS
Human offspring born with fetal growth restriction (FGR) are at increased risk for learning and memory impairment. Previous animal models have shown decreased postnatal neuron number in the hippocampus, a brain region responsible for learning and memory. My laboratory is interested in interrogatingthe effects of FGR on embryonichippocampal dentate gyrus (HDG) neurogenesisto alter postnatal neuronal composition and learning and memory function.In developed countries, hypertensive disease of pregnancy (HDP) is the most common etiology of FGR, therefore we created a mouse model ofFGR via athromboxane A2-analog infusion in the last week of gestation (Fung et al. 2011). Young adult mice have impaired implicit memory at 2-3 months compared to sham-operated offspring. Additionally, as early as 3 days post HDP, we saw premature neuronal differentiation along with neural stem and progenitor cell (NSPC) depletion which persisted throughout gestation. Using RNA-sequencing of hippocampus, we have also discovered that multiple gene transcripts of the Wntsignaling pathway are preferentially decreased in FGR. We are now validating this pathway as a potential molecular basis for altered embryonic HDG neurogenesisusing various Wnt/β-catenin signaling transgenic mice.The longer term goal is to harness human cord blood from normally-grown and FGR pregnancies and create inducible pluripotent stem cells which can then be differentiated to NSPCs to interrogate whether these cells behave similarly as in our mouse model. If so, we may have a way to predict in vitro which FGR offspring are at the greatest risk for learning and memory deficits.
Dr. Camille Fung obtained her MD at Jefferson Medical College in Philadelphia. She pursued her Pediatric residency at St. Christopher’s Hospital for Children, followed by a postdoctoral research fellowship on Developmental Biology and a clinical fellowship in Perinatal-Neonatal Medicine at UCLA. She became a faculty at the University of Utah and has recently established her own laboratory in addition to taking care of critically ill infants in 3 of the level III-IV NICUs in Salt Lake City. She has published 15 papers since 2010, serves as reviewers for 7 journals, and has a NIH R01 grant as a co-PI.
Indications for common pediatric ENT procedures: The view from a Pediatric Otolaryngologist. Tympanostomy tube placement and adenotonsillectomy are the most common procedures performed by pediatric otolaryngologists. Although guidelines exist for recommending these procedures, referral patterns often don’t reflect these guidelines. This talk aims to review accepted guidelines for tympanostomy tube placement and adenotonsillectomy in hopes of encouraging appropriate referrals in the future.
Dr. Laura Orvidas received her M.D. degree in 1990 from Southern Illinois University in Springfield, Illinois. She completed her residency in Otolaryngology in 1995 and spent two years training with Dr. Dana Thompson in the subspecialty of pediatric otolaryngology. She is on staff at the Mayo Clinic in Rochester Minnesota and was recently the recipient of a “best doctors in Minnesota” award. She has published more than 40 scientific papers in reputed journals.
Newborn Screening, involves a complex set of interlocking systems that use population based screening test panels to identify newborn with condition that may benefit rapid identification and treatment. The American College of Medical Genetics (ACMG) outlines the minimum criteria for which disease should be tested.This paper will briefly review the importance of Newborn Screening and will discuss its application in Saudi Arabia. It will briefly review test for: - hyperphenylalaninemia (PKU) - Tandem Mass Spectrometry (MS/MS) • Amino Acids • Organic acid metabolism • Fatty acid oxidation • Biotinidase deficiency • Congenital Hypothyroidism (CH) • Congenital Adrenal Hyperplasia (CAH) - DNA-based Techniques • Array • Sequencing, multiplex PCR • Multiplex for: Hemoglonobinopathies Transferrin Isoelectrofocusing (Tf-IEF) for congenital disorders of glycosylation (CDG) Nanochip system for heteozygote detection in Premarital Genetic Diagnostics (PGD) High Performance Liquid Chromatography (HPLC) for Amino Acids Analysis (AAA) These methods were used in this study. Birth rate between 500,00-800,000 annually, with high prevalence of some inherited conditions due to high rate of consanguineous marriage, large families, multiple marriages, tribal communities, condensed and cities and empty rural areas. High rate of hemoglobinopathies, metabolic, neurogenic, genetic diseases. The following diseases are common in Saudi Arabia; Glutaric Academia, Hemoglobinopathies, Cystic Fibrosis (CF), Congenital Adrenal Hyperplasia (CAH), Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD-D). Ministry of Health (1991), King Faial Specialist Hospital (2005), Prince Salman Disability Research Center (2005), covering one of five regions, testing only 25% of the population.
Ahmed Visiting Associate Project Scientist, Professor Stanley Nelson Laboratory, Department of Medical Genetics, UCLA, January 2018-Present. Stanley Nelson,MD, , David Geffen School of Medicine,695 Charles E.Young , Los Angeles, CA a7088,USA, email@example.com, Al Mana General Hospita, Jubail,P.O.BOX 10366, Saudi Arabia, 31961,June2010- Dec.2017 MBBS:Cairo University 1973-1980a Arab Board in Pediatrics and Neonatology: 1983-1990(King Faisal University, Saudi Arabia)Diploma of Child Health: Sep.1990 (The Royal College of Surgeons, Ireland)Observationship Medical Genetics: 1991-Boston Children Hospital, (Genetics Program): Professor Bruce Korf), Harvard Medical School,Boston, MA.Brigham Women Hospital, Patholgy: 2006, Professor Fred Bieber, at Harvard Medical School. Boston, Machessutach, USA. Master of Human Genetics: Tulane University, 2008-2010, New Orleans, USA.Dessertaion: Towards a uniform newborn screening panel in the kingdom of Saudi Arabia.PhD Genetics: Green Lake University, Orlando, Florida, USA.2008-2013; Dissertation: An Empirical Study of Medical Genetics in The Light of Alzheimer’s disease and Down syndrome: We Focused our studies in imaging Genetics of two Amyloid based diseases :( Down’s syndrome and Alzheimer Disease.)
Background.The interaction of zinc deficiency and hypothyroidism has several reported presentations. The link between hypoglycemia and hypothyroidism is also known, but uncommon. For the last 40 years, the relationship between these two phenomena was illustrated in a handful of articles. To the best of our knowledge, the sequence of hypoglycemia, hypothyroidism and zinc deficiency has not yet been reported. Case presentation. We present a six-month-old boy with the unusual combination of these three conditions, his diagnostic evaluation and management. Conclusion. We suggest that the relationship between zinc and thyroid function should be considered in any case of severe intractable hypoglycemia and extensive skin eruption. Keywords: zinc, hypothyroidism, hypoglycemia.
Dr. Michael Kalinin has completed his medical study at the age of 24 years from State Medical Academy named after Burdenko, Russia. His training in Pediatrics he completed in Israel under supervision of Tel Aviv University and Ben Gurion University of the Negev. Subspecialty in the field of Pediatric intensive care was result of fellowship program at Tel Aviv Medical center and Hospital for Sick Children, Toronto. Dr. Kalinin has several publications in different fields of medicine. Now Dr. Kalinin is director of Pediatric Intensive Care Unit at Barzilai Medical Center, Israel. He is part of academic staff of Ben Gurion University of the Negev, Israel.
SCA is one of the commonest devastating neglected disorders in Sudan in North Darfur State most SCA patients are from IDP camps , nomadic tribes with low socioeconomic status . No dedicated center for SCA to provide care for those patients which poses financial, physical ,psychological burden for affected children and their families . The study aimed to evaluate the effect of the program on knowledge ,attitude , practices of Mothers of the affected children . A quasi pre-posttest design was conducted in El fasher City and three (IDPs) camps .127 mothers were consecutively selected from pediatric referral clinic over four months’ period. Fifteen mother and community outreach members from the same community were trained as peer educators to conduct the health education on SCA for the participants through home visits and community outreach group sessions using simple educational materials prepared for the study. Semi-structured questionnaire used before and after the intervention and six months following the program intervention to assess the knowledge , attitude , and care practices of participants. Data were analyzed by SPSS version 20. Significant improvement was found in knowledge , attitude and practice of caregivers about the disease after the program intervention . Before the intervention the mean hospitalization rate was 2.3 times in 6 month before the intervention where after 6 month from the intervention reduced to 1.8 time. The use of peer educators from the local community could be an effective approach for increasing knowledge, improving attitudes and practice of care towards SCA.
Fatima Alzahra Abdul Rahman .M. has recently had her PhD in pediatric and child health nursing. her expertise in teaching and passion in improving the health and wellbeing for children specially sicklers. she is a member in Sudan Sickle Cell Anemia center . had presentations in many training workshops on care and management of sickle cell anemia and integrating palliative care with SCA for nurses and community. Had teaching experience in education institutes and hospitals.
Background : The school age is a dynamic period of growth and development. During this period physical, mental and social development takes place. Objective : The purpose of the study is to observe the nutritional status and anemia among the school aged children and to compare the rural and urban children as well as to see the relationship between anemia and malnutrition. Methods : It is a descriptive cross sectional study. Data were collected from 600 primary school children of Mymensingh district for a period of one year. Results : Among the primary school children in Mymensingh district 15.1% were wasted, 22.1% were stunted, 2.3% were both stunted and wasted , 60.4% children were withinnormal limit. Malnutrition were more in rural area in comparison with urban area. In rural area severely underweight ,moderately underweight children were 62.1%, 65.6% and correspounding result in urban area were 37.9% ,34.4% respectively. In rural area severely stunted, moderately stunted children were 100% ,58.6% and in urban area they were 0% ,41.4% respectively. Again severely wasted, moderately wasted children were 62.5%, 59.5% in rural area and 37.5% ,40.5% in urban area respectively. Malnutrition among girls were more than the boys. Seventy one percent of our primary school children were anemic. Again rural children were more sufferer in anemia. Anaemia was more in low income group and illiterate mothers child. Some Anemic children were malnourished and some were not but there were significant relationship between anemia and malnutrition. Conclusions: A large portion of our primary school children suffered from malnutrition as well as anemia and both the conditions were more prevalent in rural area.
Mahammad Mahmudul Hasan havecompletedinternshiptrainingfrom Dhaka MedicalCollegefrom 5thJanuary,2001to5thJanuary,2002.ThenIhavejoined asaRegistrarinthedepartmentofpaediatricsinCommunityBasedMedical CollegeHospital,Mymensinghfrom 10th April,2002to9th December,2003.I joined22ndBCSandservedasaMedicalOfficerinKenduaHealthComplexfrom 10th December,2003to15th August,2005.IjoinedasAssistantRegistrarin DepartmentofPaediatricsinRajshahiMedicalCollegeHospital,Rajshahifrom 15thAugust,2005to14thAugust,2006.IservedasIndoorMedicalOfficerand MD (Paediatrics)traineefrom 16th August,2006to31stDecember,2012in Department of Paediatrics in Mymensingh Medical College Hospital, Mymensingh,Bangladesh.
Severalstudieshaveevaluatedtheprevalenceofvitamin D deficiencyandinsufficiencyduringadolescence, reporting a highprevalenceofvitamin D deficiencyworldwide. Anoptimalvitamin D status isextremelyimportantduringadolescence for appropriategrowthandbone mineral accrual. In addition to its role in bonehealth, severalobservationalstudieshavelinkedvitamin D deficiency to variousdiseaseconditionsduringadolescenceoradulthood, suchas cardiovasculardisorders, type 2 diabetes, asthmaandallergies, neurologicaldisorders, depression, cancerandevenall-cause mortality. However, theresultsofrandomisedcontroltrialswhichtestedtheimpactofvitamin D supplementontheriskofthesediseaseconditionsremaininconclusiveandsometimescontroversial. Hypovitaminosis D in adolescenceishighlighted as a global publichealthconcern. PracticalguidelineswillhelpcliniciansmaketheirpreventiveandtherapeuticchoicesregardingVitamin D supplementation to adolescentsand improve care management. Objectives: To present in a synthesisedmannertheavailablerecommendationsconcerningvitamin D in adolescents, mainlyitsthresholds, dietaryrequirements, prophylacticsupplementationandtreatmentofdeficiency. In thispresentationwewilltry to explore theirlevelofconsensusorpotentialdiscrepancies.
Dr. Nurmamodo completedMB.ChBdegreeattheUniversityofLisbon-Portugal in 1984. Hehasbeenregistratedwiththe GMC-UK since 1989. Heconcludedhispaediatric training in oneofthelargestpediatrichospitals in Portugal – Hospital de Dona Estefânea. Later on, due to hisinterest in neonatology, heconcludedPostgraduation in thisfield. Hismainclinicalpractice, as ConsultantPaediatrician, is hospital-basedandfocusedon general pediatrics, neonatologyandadolescent medicine. In recentyears, hisinterest in Adolescent Medicine motivatedhim to concludePostgraduation in Adolescent Medicine. Heis a FellowoftheRoyalCollegeofPaediatricsandChildHealth (FRCPCH U.K.) since 2012. Duringhiscareer, apartfromhisclinicalduties, Dr. Nurmamodo hasparticipated in a numberofotheracademicandmanagerialactivities, as follow: Memberofthe Hospital HumanizationCommitee. King’sFundHealthQualityProgramme. Participation in The Business Plan for thedevelopmentofthe Norte Alentejo Health Trust – Portugal. MemberoftheHealthComission for theWomen, ChildrenandAdolescents in the Alentejo Region – Portugal. ClinicalDirectorofthe Portalegre Hospital – 2015-16. Activelyinvolved in paediatricteachingprogrammesat a regional andnationallevel. Directorofpostgraduationstudies in the Norte Alentejo Health Trust since 2008. Participation as a memberofthe Exam Commitee for completionofpaediatricspecialisationprogramme. Since 2007, Dr. Nurmamodo istheDirectoroftheWomanandChildHealthDepartment in the Norte Alentejo Health Trust.
Healthcare-associated infections (HAI) are frequent complications in neonatal intensive care units (NICU with varying risk factors and bacteriological profile. There is paucity of literature comparing the bacteriologicalprofile of organisms causing HAI with the environmental surveillance isolates. Therefore, thisstudy aimed to evaluate demographic profile, risk factors and outcome of HAI in NICU and correlate withenvironmental surveillance.Three hundred newborns with signs and symptoms of sepsis were enrolled in the study group andtheir profile, risk factors and outcome were compared with the control group. Univariate analysis andmultivariable logistic regression were performed. Environmental surveillance results were compared tothe bacteriological profile of HAIs.We identified lower gestational age, male gender and apgar score less than 7 at 5 min, use of peripheralvascular catheter & ventilator along with their duration as significant risk factors. Mortality rate was 29%in the study group (p < 0.05). The HAI site distribution showed blood-stream infections (73%) to be themost common followed by pneumonia (12%) and meningitis (10%). Gram positive cocci were the mostcommon isolates in HAI as well as environmental surveillance.The bacteriological profile of HAI correlates with the environmental surveillance report thus insistingfor periodic surveillance and thereby avoiding irrational antibiotic usage.
Dr Harish Chellani has completed his MDPediatrics from Safdarjung Hospital, New Delhi. He is the professor and Head, Department of Paediatrics,VardhmanMahavir Medical college and Safdarjung Hospital, New Delhi, India. He has published more than 50 papers in reputed journals and has been Principal Investigator of many reputed research projects.
This project is the introduction of concept of Mother in Neonatal intensive care unit (M-NICU) and is done in an urban setting in a tertiary level hospital in New Delhi, India. A 12 bedded M-NICU has been operationalized with facilities for a level II neonatal care and provides a defined minimal care package for mothers. It has sufficient space for maternal beds, toilet and bathing facilities for mothers and a separate dining space. Newborn babies with birth weight between 1 to 1.8 kg are subjects irrespective of their gestational age and sickness. A total of 130 mother baby dyads have received intervention over a period of 7 months (Dec2017-June 2018). Presently, in South Asia region, babies with birth weight 1 to 1.8 kg are separated from mothers and shifted to NICU. Unlike, neonatal intensive care units (NICU) in the developed regions of the world, where mothers and families have access to their newborn, to stay with them and participate in care provision, in India, access by families and mothers into the neonatal units is limited. Mothers do visit the NICU in most of the centers in India, but merely as a visitor and not as a care giver. Health facilities in India are faced with the challenge of providing quality maternal and newborn care in the face of major skilled human resource shortage. The low nurse- baby ratio is a barrier to providing quality neonatal care to sick newborn. The problem was assessed by questionnaire based tool on how the family perceives the quality of care of babies admitted in NICU. Data revealed that mother infant separation leads to significant psychological stress in mothers, low breast feeding rates and short sessions of skin-to-skin contact. Mothers can contribute towards neonatal care in numerous ways - routine baby hygiene, feeding the baby, monitoring the babies on intravenous fluids, phototherapy, and providing skin-to-skin contact for longer duration. By educating mother during their stay in M-NICU, they will be better prepared for discharge. Presence of mother in M-NICU shall bring accountability on the health services to improve quality of the care. Results indicate that mothers can be easily trained to follow asepsis routines, monitor the neonates and are better prepared for post-discharge care of neonates. It shows lower sepsis rates, higher breastfeeding rates and better parental satisfaction. Overall, a positive feedback has been obtained from the patients and staff. A challenge in M-NICU is medical care of mothers. To ensure that mothers get the appropriate medical care inside M-NICU, Obstetrics departments has developed minimal care package for the mothers. They receive same post-partum care in M-NICU as they would have received in post-natal ward. A strong support, co-operation and co-ordination with the obstetricians who provide maternal care within the M-NICU are cornerstone of this project. A major impact of project is that Govt. of India has decided to expand the concept of M-NICU and reorganize all Special newborn units in the country to accommodate both baby and mother together.
SugandhaArya has completed her MD in Pediatrics from Safdarjung Hospital, New Delhi.She is Professor of Pediatrics in Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. She has published more than 20 papers in reputed journals and has been clinical investigator for reputed research projects.
Perinatal asphyxia in the neonatal brain triggers a robust inflammatory response in which nitric oxide (NO) generation plays a hazardous role. Increased levels of NO can be maintained by inducible NO synthase (NOS2A) on its own or activated by IL-1beta (IL-1β) gene transcription thus potentiating brain injury after brain ischemia. We investigated whether the risk for cerebral palsy (CP) increases when an expansion of the -2.5 kb (CCTTT)n microsatellite in the NOS2A gene and a -C511T SNP of IL-1β gene promoter occur in patients after perinatal hypoxic-ischemic encephalopathy. Genomic DNA was purified from 48 patients with CP and of 57 healthy control children. IL-1β SNP genotypes were established using a qPCR and were validated by RFLP analysis. -2.5 CCTTTn microsatellite length of NOS2 was determined by sequencing. The 14 repeat long allele of the CCTTTn NOS2A microsatellite was present in 27% of CP patients vs 12.3 % of controls, showing an odds ratio (OR)=2.6531 and 95 % confidence interval (CI) = 0.9612–7.3232, P< 0.0469. The -511 TT genotype frequency showed an OR = 2.6325 (95% CI = 1.1348–6.1066), P = 0.0189. Interestingly, the haplotype CCTTT14/TT showed an OR =9.561; 95 %, CI = 1.1321–80.753; P = 0.0164.The haplotype (CCTTT)14/TT, formed by the expansion of the-2.5 kb (CCTTT)n microsatellite in the NOS2A gene promoter and the -511 C➝ T SNP of the IL-1β gene promoter, might be a useful marker to identify patients who are at high risk for developing CP after hypoxic ischemic encephalopathy.
Juan-Antonio Gonzalez-Barrios has completed his MD from CICS-IPN, his MSc, and PhD from DFBN-CINVESTAV, Mexico and postdoctoral studies from University of Florida, USA. He is the head of Genomic Medicine Laboratory, Regional Hospital “October 1st”, ISSSTE. He has published 36 papers in reputed journals and has been serving as an editorial board member of repute.
Trauma istheleading cause of morbidity and mortality in children and youngadults, yetthereisveryLittle discussion of thesubject at majorinterventionalradiology meetings, congresses, and conferences. Thisphenomenonsuggests a knowledge gap as mostIRs are nottrained in thecare of thepediatric trauma patientwhereuniqueanatomicparameterspredispose to certaininjurypatterns. Althoughgreateffortshavebeenmade in recentyears to educatethepubliconmany safety issues, unintentionalinjury and deathrates in childrenremainhigh, thereforeIRsmust be prepared to be involved in theircare. In ourinstitutionoverthelast 30 yearswehavebeeninvolved in pediatric trauma cases spanningallageranges and anatomicregions. Webelievethatwithconstantlyimprovinginterventionaltechniques and equipment, the IR willcontinue to be anincreasinglyessentialcomponent in thetreatment of trauma in thepediatricpopulation. Therefore, weproposethatallinterventionalradiologistsstrive to understandtheuniquechallengesthese cases pose, and be prepared to intervene as needed.
Dr. Jaime Tisnadowasborn in Peru, South America, a country of 32 million. He completedhishighschooleducation at Leoncio Prado MilitaryAcademy, the premier institutionforlowereducation in Peru. Thereafter, Jaime Tisnado receivedhis B.S. and B.M., from San Marcos NationalUniversitySciencesSchool. Thereafter, he receivedhis M.D., Summa Cum Laude fromthesame San Marcos NationalUniversity Medical School, theoldestUniversity in the Western Hemisphere (Founded in 1551 bythe Kings of Spain). Thereafter, Dr. Tisnadocame to USA and begunhisillustriousacademiccareer as anintern at Greater Baltimore Medical Center, a division of John's Hopkins Hospital in Baltimore, MD., in1965-66, and thencontinued as a resident in surgery at TheStateUniversity of New York, Upstate Medical Center in Syracuse, NY., 1966-67. Dr. Tisnadothenswitchedhis post graduateeducation to a residency in Radiology at Thomas Jefferson University, in Philadelphia, PA., 1967-71. He thencompletedtwofellowships of oneyeareach in Vascular Radiology and in Neuroradiology at thesameinstitution, 1971-73. Dr. Tisnado then moved to Albany, N.Y., to beginhiscareer as an AssistantProfessor of Radiology and Director of InterventionalRadiology at Albany Medical College of UnionUniversity, in Albany, NY., 1974-77. Thereafter, he moved to Richmond, VA to the Virginia Commonwealth University, as anAssociateProfessor of Radiology and Director of Interventional Radiology, and eventuallybecameProfessor of Radiology and Professor of Surgery at thesameinstitution 1985-2010.Thereafter, Dr. TisnadobecameProfessorEmeritus of Radiology and Surgeryfrom 2010 untilnow. Dr. Tisnado has receivednumerous recognitions, certificates, awards, accolades, etc., toomany to listhere. He has published more than 100 articles in peer reviewedjournals, about 400 scientific posters and electronic and educationalexhibits, about 200 abstracts, 4 books, manychapters in books, and has presentedabout 200 papers at meetings at the local, national, international and worldlevel. Dr. Tisnado has beennamedmany times to WhoisWho in America, theBestRadiologists in America, theBestPhysicians in USA, etc. He istheonlyperson in USA and theworldwho has forever, more than 5 Fellowships in themostprestigiousprofessionalorganizations of USA: American College of Radiology, American College of Cardiology, American HeartAssociation, Society of InterventionalRadiology, Society of Abdominal Radiology and others. He alsoorganizesprofessional meetings and workshops and bringsthebest physicians in theworld to hisnative country. Moreover, Dr. Tisnado has conductedmany medical missions in Asia and in Africa in thepast. Dr. Tisnadolikes soccer (futbol), scubadiving, jogging, ski as hisactivities.
Minimally invasive surgery brings benefits to neonates, in complex procedures, that requires specific training. As an example, esophageal atresia with fistula distal to trachea, which since 1999 is used to correct it, this in reference centers, by experienced surgeons, not by residents in training, with consequential limited experience in the correction of this malformation. However, the results are similar to those of open surgery, training and learning curve are required to make it by Thoracoscopy. For an ethical learning curve, it is required: physical simulators that provides limited skills, virtual trainers that are expensive and non-easyavailable for this procedure, or animal models that simulate the anatomy of the malformation. Research hypothesis;We propose the possibility of creating an economic model in rabbit cadaver to develop initial thoracoscopic capacities to solve this malformation. Objectives;As primary objective, to reproduce in a rabbit carcass the model of esophageal atresia with fistula distal to trachea simulating the intrathoracic stage of the malformation. As secondary objectives tocreate a useful, and economical model that is accepted by our colleagues . Methodology;First stage, we determine the ideal placement of trocars for the optic lens ,the instruments, and selected the optimal suture and needle. In the second, the replicaof EA in a Rabbit corpse was performed(A model) . Third stage, the model was evaluated by 14 pediatric surgeons in a pediatric endosurgery workshop and course in CáceresSpain. And in the fourth we apply progressive intraluminal pressure into de esophagus, lookingover the presence of leakage in the esophageal anastomosis performed Results;During the first stage, approaching through the left wall of the thorax, we determine the proper location for camera and Instruments, we also determine the type and length of the suture and size of the needle. In the second, the malformation was reproduced in the corpse of Rabbit. In the third,aevaluation survey for the model was requested to attendees of the course, we obtained the following results; 9.77 to the need for use of animals for surgical training. 8.63 in similarity of model 8.71 for the degree of difficulty of the procedure. 8.77 to the utility of the model and 9.15 for the possibility of standardizing the model for global use Finally in the fourthwe exiled the Esophagus 2 cms proximal and distal to the anastomosis, thenit is hermetically connected one end to a probe and water is instilled increasing the Intraluminal pressure Discussion; It is reported that fails while performing the surgical technique due to inexperience in correcting an EA, constitutes the third cause of death. However, being a procedure with a high degree of difficulty, the proposed model is similar in thorax size and visors disposition on a human neonate and is useful for the initial development of basic skills for thoracoscopic resolution of esophageal atresia. Conclusions 1.-The model mimics the INTRATHORACIC scenario of esophageal atresia in anatomy and dimensions. 2.-Enables the development of initial surgical skills for thoracoscopic repair. 3.-Avoids using live animals in the initial phase of the model. 4.- The model was accepted by a population of pediatric surgeons, both nationally and internationally the results of the research encourage us to move forward to reproduce the model in a live rabbit.
Hugo Staines-Orozco was born in Juárez City Chih. Mex. Obtained his MD at Autonomous University of Chihuahuawas a pediatric surgery Resident during 4 yearsat the National Institute of Pediatrics in Mexico City, inwhich was chief of surgical residents 1980/81. In 1990 culminates specialization in biomedical teaching by the UACJ. He held academic visits at the Methodist Hospital in Houston Texas, the Boston Children’s Hospital and the Hospital For Sick Children in London. In the professional area 1983 to 93, head of PaediatricsUnit of the General Hospital of Ciudad Juárez and from de1993 to 96 Director of that institution. He has been president of professional colleges at local, state and national level as: Medical College of Cd Juárez State College of Pediatric Surgery of Chihuahua and Mexican College of Pediatric Surgery Mexican Board of Pediatric Surgery At the Autonomous Universityin Ciudad JuárezMexico hasheld different academic and administrative positions such as: Founder and Head of the Residency in Paediatrics for 15 years, head of the Department of Medical Sciences 6 years, Director of the Institute of Biomedical Sciences 6 years and General Director of extension and student services of UACJ from 2012/13. At the University of Texas at El Paso USA, from 2008 he is an been named Friend at the health Sciences Department and Co-Director of 2006 to 2009 of the MSc in Health promotion funded by USAID, UTEP and UACJ. He Founded and was editor of the journal "Medical expressions" for 12 years and a member of the editorial board of the Journal “Science in the border" of the UACJ, both indexed and have ISSSN. Has presented more than 130 lectures or research work inforums and congresses in more than 30 cities in Mexico, and more than 20 conferences and papers in cities of the United States of North America (New York, Houston, San Diego, Tucson, Phoenix, El Paso, Cincinnati, Denver, Las Cruces, Ruidoso and Albuquerque.Also, hasgiven lectures and presented papers regarding Pediatric surgery in Congresses settled in Spain (Madrid, Toledo, Girona and Salamanca), and Cuba (Havana). His scientific production is integrated by more than 40 articles as author or coauthor that have been published in peer review and indexed journals of Mexico, USA and Spain. He is author or coauthor of chapters in several books. His participation in research projects presented in pediatric surgery forums has been awarded in 1 World Congress, 3 Mexican Congresses and one in the state of Chihuahua. From 2004 to date, he participates in research projects anchored by the University of California in San Diego, Universidad de Extremadura in Spain, the European Community, CoNaCyT and the National Institutes of Mental Health in the United States. From 2004 until2020 wasawarded theProMeP profiletitle, that gives the Mexican Ministry of Education to highly qualified teachers. Since 2009 he is a member of the National System of Researchers CoNaCyT level I In2014 was selected as a member of the Mexican Academy of Pediatrics, since Sept 2016 until 2018 is president of the Mexican Board l of Pediatric Surgery Currently is Full Time Professor of Pediatrics, in UACJ Medical School and Associate professorin the PediatricResidency Program, both in the UACJ.
Immunity to varicella and measles have not been compared in HIV seropositive and seronegative pregnant women and their infants. Antibody levels to varicella and measles were evaluated in 14 HIV seropositive and 34 seronegative pregnant women, 14 HIV exposed and 26 un-exposed cord bloods, and followed-up prospectively in 23 HIV exposed and unexposed infants around 3- 7 months of age by ELISA (99 samples) and by EIA (13 samples) for measles and by immunofluorescence (IFA) for varicella. Correlates of immunity were defined as antibody levels measles (> 1.09 OD ratio or EIA) and >1:8 IFA for varicella. Antibody levels were correlated with T cell counts in HIV seropositive mothers. Mean (range) ages of women at time of serologic tests were 27 (18-40), and 25 (15-41) years for HIV and control groups, respectively. Antibody levels to measles were significantly (P= 0.04) lower in cord bloods of HIV exposed infants compared to the controls. T cell counts were lower in HIV seropositive women non-immune (268/mm3) to measles compared to those immune (618/mm3), but insignificantly (P= 0.07). Immunity to measles and varicella as recognized by antibody levels declined significantly in both HIV exposed and unexposed infants by 3- 7 months of age.
I have a background in Pediatrics and Pediatric Infectious Diseases, including Board Certification and recertification, as well as expertise in evaluating immunities to vaccine preventable infections in HIV-infected and HIV-exposed children. My research in this area was initiated as a fellow at Mount Sinai Medical Center, New York, where I evaluated the immunogenicity to the hepatitis B vaccine in HIV-infected children. Subsequently, I was able to successfully develop and conduct an RC1 research project
Antibiotics are among the most commonly used medicine, in both community and hospital setting, all over the world especially in countries where no strict guideline to regulate their use. In Iraq, only a few studies conducted to describe the antibiotic prescription pattern in general hospitalsand even less in pediatric hospital. Objective: To describe the patterns for antibiotics used in Elwia pediatric teaching hospital in Baghdad, Iraq Type of the study: Descriptive cross sectional study. .Methodology: The study was conducted at AL-Elwia Pediatric Teaching Hospitalduring the year 2016. A random sample from all the prescriptions sheets, of patients consulting outpatient clinic or admitted to different departments were studied for different parameters in different departments of the hospital. Results:A total number of 9440 prescriptions, were collected and analyzed.The age group 1-5 years was the most common group consulting the hospital followed by those below 6 months of age. About 51% of all patients were males. The study revealedthat 87.56% of all patients consulting the hospital were received antibiotics. The highest rate of antibiotic used was in inpatient department (99.9%) followed by NNCU (92.11%). Amoxicillin was the most preferred antibiotics by pediatrician in outpatient, inpatient and ER department. Conclusion: The results of this study indicate that there is, in general, overuse of antibiotics in all hospital departments when compared with other developing countries. Keyword: antimicrobial, misuse, pediatric, Iraq
Professor Isam Jaber AL-Zwaini is the Head of the Department of Pediatrics at AL-Kindy Medical College, Baghdad University, Iraq. He is an associate member of the Royal College of Paediatrics and Child Health. He was a consultant pediatrician at Ramadi Maternity and Children Hospital, AL-Anbar Governorate, Iraq from 1996 to 2005. He served as lecturer at the Department of Pediatrics, College of Medicine, University of AL-Anbar from December 1996 to August 2001. He is Assistant Professor since 2001 and Head of the Department of Pediatrics since September 26, 2016.
It’s a clinical case presentation of a male Preterm infant Newborn (+31 wks) who was delivered in our hospital & transferred to our NICU because of Prematurity, VLBW & need to respiratory support. Baby shortly undergo Necrotizing Enterocolitis (NEC) on 5th day of life shortly after start of expressed milk feeding …! Which was early detected by use of Near Infrared Abdominal spectroscopy (NIRS). Baby was deteriorated clinically in a couple of hours & undergo intestinal perforation with peritonitis , So, Abdominal exploration surgery with intestinal resection & end – to end anastomosis was done urgently. Baby improved gradually & early feedings was started & gradually increased up to full feedings with use of Human Fortified Milk (HMF) & probiotics , Prebiotics. Findings:The Study stated the evidence-based Feeding Strategies guidelines for necrotizing enterocolitis (NEC) among very low birth weight infants& Role of trophic feedings, Probiotics, Prebiotics & micronutrients in Prophylaxis, Prevention & Management of NEC. Recommendations: 1) -Prematurity is the single greatest risk factor for NEC & avoidance of premature birth is the best way to prevent NEC. 2)-The role of feeding in the pathogenesis of NEC is uncertain, but it seems prudent to use breast milk (when available) and advance feedings slowly and cautiously. 3)-NEC is one of the leading causes of mortality, and the most common reason for emergent GI surgery in newborns. 4)-NEC remains a major unsolved medical challenge, for which no specific therapy exists, and its pathogenesis remains controversial. 5)-A better understanding of the pathophysiology will offer new and innovative therapeutic approaches, and future studies should be focused on the roles of the epithelial barrier, innate immunity, and microbiota in this disorder. 6)-Bioinformatics modeling is a new emerging strategy aimed at understanding the dynamics of various inflammatory markers and their application in early diagnosis and treatment.
Dr. Amr I.M. Hawal has his expertise in evaluation and passion in improving the health and wellbeing. His open and contextual evaluation model based on responsive constructivistscreatesnewpathwaysfor improvinghealthcare specially in Neonatology field. He hasbuiltthismodelafteryearsofexperienceinresearch,evaluation,teachingandadministration both in hospital and education institutions. Our case presentation was done in one of the biggest & modern of art & advanced NICU based on tertiary generation level in the region (Latifa Hospital, DHA, Dubai, UAE).
Dany A. Hamod has completed his MD from Kaunas Medical University and Pediatrics studies from Saint George Hospital University Medical Center, Dr Hamod Completed his fellowship in Neonatology from Paris. He is the Head of the Neonatal intensive care, and recently appointed the Head of the Post-Graduate Medical Education at SGHUMC. He has published more than 18 papers in reputed journals and has been serving as an editorial board member of repute.
When the disease becomes threat to life or organs blood circulation decreases, Temperature of fever will emerges to increase prevailing blood circulation. And it acts as a protective covering of the body to sustain life. When blood flow decrease to brain, the patient becomes fainted-delirious .If we try to decreases temperature of fever, the blood circulation will further reduced. Blood circulation never increases without temperature increase. Delirious can never be cured without 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 body due to fever and heat which we applied on the body combines together, the blood circulation increases. Then body will stop to produce heat to increase blood circulation. And body will get extra heat from outside without any usage of energy. How can we prove that the temperature of fever 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 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. No further evidence is required to prove the temperature of fever is to increase blood circulation.
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,. I am a writer. I already printed and published nine books in 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 with fever
Infants born at low birth weight (LBW) are at increased risk for developmental delays. The benefits of intervention with this population are clearly documented. As such, it is important to intervene early. The purpose of this presentation is to (1) provide an overview of LBW and prematurity, associated developmental delays, and the benefits of intervening early; (2) share the components of Maryland’s PRemature Infant Developmental Enrichment (PRIDE) program, a model of collaboration between a Level IV NICU and a local early intervention program, in a major urban city in the United States, that begins in the NICU and continues until the child is 3 years of age; (3) highlight the impact of this model on enhancing program outcomes obtained over the course of 5 years with 412 program participants; and (3) discuss the implications of serving this population on a large scale.
Dr. Hussey-Gardner has 25+ years of research and clinical experience with infants, toddlers, and their families. She is an Associate Professor in the Department of Pediatrics where she is the Director of Maryland’s PRIDE. Since 2000, Dr. Hussey-Gardner has received over $2.5 million dollars in grants to operate and study this program. She is also the coordinator of the NICU Follow-Up Program and the developmental specialist for this program and the NICU. Dr. Hussey-Gardner is the author or co-author of 19 articles, 3 textbook chapters, and 6 web-based professional training modules. In addition, she has given over 225 presentations.
An allergy is an immune malfunction whereby a person's body is hypersensitized to react immunologically to typically non-immunogenic substances. Allergies affect people from the early stages of their life and continue until their late adult ages. The allergic march refers to the natural history of allergic or atopic manifestations characterized by a typical sequence of clinical symptoms and conditions appearing during childhood and persisting for several years. The neonate is born with a distinct immune system that is biased against the production of T-helper cell 1 (Th1) cytokines; which may guard against rejection of the “foreign” fetus by the mother’s immune system. There are many risk factors that increase the incidence of neonatal allergies. Neonatal allergies could present by different non-specific symptoms and signs.Food proteins demonstrated to cross the placenta and can be detected in amniotic fluid. Exposure to small quantities of food antigens from mother’s diet thought to tolerize the fetus, by means of IgG1 and IgG3, within a “protected environment”. Neonates may develop allergy to cow’s milk proteins present in mother’s milk or in hydrolyzed cow’s milk infant formulas which can be assessed by intestinal permeability measurements. The allergy to cow milk protein may progress from dermatitis or hives to vomiting & wheeze to Asthma and Anaphylaxis. Neonatal latex allergy could appear in neonates in NICU undergoing multiple surgical procedures esp. myelomeningocoele. Various reactions to latex may persist chronically or precipitously develop into hypotension and anaphylaxis. Prevention of natal allergy can be done through following different steps
Prof Mohammed El beltagi is a professor of Pediatrics on Tanta university, Egypt and Arabian Gulf University, Bahrain. has completed 25 years workin in the pediatric field. He authored many books and published more than 50 papers in reputed journals and has been serving as a reviewer and an editorial board member in many scientific journals of repute.(
The relationship found between physical and chemical problems of brain tissue especially cerebral neurons has very close relation with mental problems and therefore wide variety of our social behaviors including encounter with life difficulties, marriage, divorce, relatives' death, envy, patience and main decisions of life such as purchasing house and automobile and others. This difference can be affected by chromosome, environmental or both problems before or after birth. Addiction can be involved in the above-mentioned antisocial cases. Generally, addiction to drugs is one of the subsets of "addiction" definition. Brain problems as one of the important risk factors can directly and indirectly play a significant role in individuals' tendency-and-increase of their tendency toward addiction. At the first stage, through recognizing disease causes and at the second stage, treatment of the disease will be easier .Considering articles presented in the congresses held from 2008 to the beginnings of 2010 on neuronal problems and addiction, it is conclude that the information has quantitatively and qualitatively grew and scientific content of the more novel articles has enhanced than before. During two years, the problem and its title was the same but the content has undergone changes corresponding with medical progresses through time and they have become richer from scientific viewpoint. The present article is the most complete and perfect of them. These researches and recognizes can open a new horizon in significantly treating and preventing from addiction. The present study poses a question regarding whether some of addicts, no all, suffer from brain disease before tending to this antisocial behavior. Purposes: Why people become addicted? How they can be treated? To find answers, the process of this problem should be scientifically, environmentally and socially studied. This article considers its origin reasons from medical perspective. . Introduction: "Addiction can be defined as kind of malfunction of human ordinary needs to a stimulant". Some believe that drugs and addictive habits root from our other internal deep powers; our need to innovation, revival and being alive. There is a power inside us.
Mahdi Akhbardesh had board in Nutrition from Tabriz Medical Sciences university. Clinical nutritionist. Medical researcher. Medical council NUMBER: 1434.First Iranian member of American Dietetic Association (ADA). First Iranian Active member of medical research council in American Academy of Anti Aging society. Member of medical research council in European Union anti Aging.Top selected in national student research Festival in 2010. Top selected in international medical scientific festival in IBN SINA in 2010. Having more than 130 medical papers in all medical areas (psychiatry, cardiology, dermatology, addiction,stemCELL , depression and anxiety and specially about Stomach Cancer Global and state medical congress from (Norway. USA, France…) and having 40 medical articles in valid medical researches journals and 9 medical abstract in the journal with ISI-Index rank. Continuous senior research member of IRAN Nutrition Association. Member of Iranian society for reproductive MED. Member of the American federation of Youth medical scientists. Active member of administration of IRAN genetics association. Member of the research center on endocrinology and obesity at university of ShahidBeheshti. Top selected of medical article in the scientific journal about anti-aging process ofettla. at newspaper 2007.
Aim: To explore how breastfeeding help transfer of maternal premade immune cells to booster the newborn immunity. Methodology: We searched thoroughly the pubmed and medline for the most recent evidence based studies that support the role of human breast milk in enhancing the neonatal immunity. Keywords: human milk, breast milk, innate immunity, colostrum. Conclusion:Breast milk is a unique source of immune cells and bioactive factors; that support the human infant’s optimal growth and development. These findings opens the door to future studies of breast milk and its effect on the immune system and the developing infant.
Neonatal Intensive Care Unit (NICU) clinicians must frequently relay difficult news to patient families, and the need for formal training for NICU trainees to develop this skill has been established. Although previous studies have shown improved trainee self-efficacy and comfort in handling conversations after formal communication training, it remains unclear whether these interventions lead to improved objectively assessed short- and long-term performance. We implemented a simulation-based intervention emphasizing an established protocol for delivery of bad news for 15 fellows in the BCM Neonatal-Perinatal Medicine fellowship program in the 2013-2014 academic year. Simulations involved video-recorded encounters between each fellow and a standardized parent (SP) involving communication of difficult news. Each fellow was evaluated before (preintervention), immediately after (postintervention), and 3-4 months after the intervention (follow-up) with an (a) evaluation of video-recorded sessions by two expert raters blinded to the timing of the encounter (blinded rater evaluation[BRE]), (b) Self-assessment questionnaire, (c) Content Test evaluating knowledge of taught concepts, and (d) SP evaluation (SPE). Results of the study showed that, while all fellows displayed improved Self-Assessment and Content Test scores at post-intervention with retention at the follow-up assessment, the BREs showed no statistically significant improvement in postintervention scores and showed a decline in follow-up scores. SPEs showed no difference in scores at all three assessment stages.These results highlight the importance of objective assessments in evaluating the utility of a simulation-based communication curriculum and elucidate that, for objective assessments, the perspective of the person receiving the information may affect the perceived effectiveness of the encounter
Dr. Nada Ghoneim completed her medical degree at the University of Texas Southwestern Medical School in Dallas, Texas. She completed her Pediatric Residency and Neonatal-Perinatal Medicine fellowship training at Baylor College of Medicine in Houston, Texas. After training, she has worked as a Neonatologist in Connecticut, USA and Abu Dhabi, UAE. She has published papers in peer-reviewed publications and has been involved in research which she has presented nationally in the USA. She has received awards for her research in family-centered care and communication as well as for projects she developed for health advocacy for children. She has also been involved in multiple educational and teaching activities and is a certified instructor for neonatal resuscitation.
The golden hour is giving high-risk neonates the best possible start. Concept derived from adult trauma, Idea that first hour of care is critical. It carries risks of short and long-term injury, lifelong developmental delay & even death. Neonatal-perinatal medicine version of the golden hour involves systems, personnel, knowledge, communication, and practice to ameliorate the demands of multitasking on those providers caring for the most critically ill of patients at their most vulnerable time. Medical interventions provided to the neonate during this golden first hour of life can have significant implications on immediate survival and long-term morbidities. The care in these first minutes can translate into lifelong medical problems. “Golden Hour” is multitasking, it Include adjustment of thermoregulation, resuscitation, respiration, management, circulation, infection prevention, arrange for appropriate transfer and developmentally supportive care. Delayed cord clamping, delivery room temperature stabilization, strategies to establish functional residual capacity and gentle ventilation, early administration of dextrose and amino acid infusions, antibiotics when indicated and timely successful placement of peripheral or umbilical venous catheters are areas of focus during golden hour care. Taking the right steps in this "golden hour" is of great significance for the infants' mortality and later morbidity.