Biography:

Dawn M. (Torrence) Ireland is the founder of CHERUBS – The Association of Congenital Diaphragmatic Hernia Research, Awareness and Support.   Created in 1995, after the birth of Ms. Ireland’s son, who was born with Congenital Diaphragmatic Hernia (CDH), she wished to create a supportive, collaborative community of families of researchers.   It was built upon a foundation of research, awareness and support – providing as many services and as much information as the budget and volunteer system could withstand.   With the encouragement of several prominent pediatric surgeons, CHERUBS began to have a presence at medical conferences in 1996.  By 2000, the CDH Research Survey Database was created. 

In 2017, the charity was restructured.   Ms. Ireland stepped away as President of CHERUBS and into the role of President of CDH International to further the research projects that the organization is involved in.  CHERUBS still exists as the family support division of CDH International.  

Currently, Ms. Ireland oversees CDH International which now runs the world’s largest natural history database of CDH, has 3 boards, employees, many volunteers, assists over 6300 patient families in 70 countries, presents research abstracts, and works with both the NIH and the EU.  

Ms. Ireland also is a founding member of the Rare Advocacy Movement and senior level patient advocate, mentors several other non-profit organizations, is a founding member of the Alliance of Congenital Diaphragmatic Hernia Organizations, has written/edited 4 books and spends her time between the United States and Europe to continue the organization’s growth and outreach.  

Abstract:

Purpose: Our objective was to the assess the amount of medical information retained by parents of children born with Congenital Diaphragmatic Hernia. Our goal is to review the difference in our study with the population studies of other CDH research groups such as the CDH Study Group and DHREAMS in the amount of information given and correctly retained by CDH parents.

Methods: We reviewed the answers provided to a questionnaire between 1995 and 2014. Members included 2547 survivors, 1294 non-survivors and 740 expectant or who did not follow up. Parents were asked basic medical questions as well as a detailed medical and familial history.

Results: Our questionnaire was answered by 4548 families. A higher percentage of families of non-surviving infants than surviving infants did not know if their child's CDH occurred on the left versus right side (46.8% vs 57.8%). When families were asked to further characterize the type of decent their child had, the percentage of those who did not know jumped to approximately 87%, showing that even fewer parents remembered the finer details of their child's diagnosis. Familial CDH is reported in the literature to be known in approximately 2% of all cases. Our membership reports 1.6%, which is similar to what has been reported.

Conclusion: Until this study is compared to the studies of DHREAMS and the CDH Study Group and exact patient matching occurs, it will difficult to measure the true medical knowledge that CDH parents grasp and remember.

Biography:

Marianne has completed MB ChB at the University of the Free State, Bloemfontein, South Africa and Dip For Med (SA) Clin at the Colleges of Medicine of South Africa. She is affiliated with the Departments of Forensic Medicine and Family Medicine, Free State University. She is also involved with training in Clinical Forensic Medicine for the Free State Department of Health. She is running a service for the clinical forensic assessment of children who have possibly been sexually abused. She has vast experience as expert medical witness in child sexual abuse cases. Her publications focus around practical aspects of evaluation in rape cases, child sexual abuse cases and clinical forensic documentation.

Abstract:

Perpetrators of child sexual abuse are commonly acquitted based on wrong facts. Expert medical witnesses play a major role in the explanation of medical findings. Health care providers may experience a perceived responsibility to prove that child sexual abuse has taken place. In truth, the function of an expert medical witness is to educate the courts and to introduce reliable medical knowledge to other professionals in court and thus complement the search for the truth. From the side of the courts, there still exists an expectation that child sexual abuse can be confirmed or ruled out by means of a medical evaluation. Experience shows that the question most frequently asked to an expert medical witness is to explain why the absence of confirmatory clinical signs does not exclude child sexual abuse. The aim of the presentation is to provide the basic knowledge and understanding expert medical witnesses need to step into the witness box with confidence and explain medical principles scientifically in a language understandable to people outside the medical field. The explanation of normal findings in child sexual abuse cases range over a basic knowledge of evaluation protocol; understanding of relevant aspects of acknowledged definitions, criminology, the way children express themselves, physiology and insight into the part a clinician plays in the complete investigation of child sexual abuse. The presentation introduces the examination protocol and moves on to explain why a normal or non-specific clinical evaluation does not negate child sexual abuse. The focus is on the sexual abuse of prepubertal children but touches on the sexual abuse and rape of adolescents. A brief summary of the interpretation of normal and abnormal clinical findings conclude the presentation. The presentation aims to equip health care providers to support the courts efficiently in child sexual abuse cases.

Biography:

Marija Knezevic Pogancev is a Pediatrician, Neuro-pediatrician, Clinical Neurophysiologist and Epileptologist. She is a full time Professor at University of Novi Sad, School of Medicine and Chief of Department for Developmental Neurology and Epileptology, Child and youth health care Institute of Vojvodina, Novi Sad, Serbia. She is graduated from the Faculty of Medicine, University of Belgrade and Trained in Social Pediatry, Institute for Mother and Child Health Care, Belgrade, Trained in Mental Hygiene, Institute of Mental Health, Belgrade. She did her Master’s degree in Neuro-pediatry, Faculty of Medicine, University of Novi Sad and Specialization in Pediatry, Institute for Mother and Child Health Care, Belgrade. She was trained in Electroencephalography and Neurophysiology, Institute of Mental Health, Belgrade and completed her Sub-specialization in Neurology of Developmental Period, Faculty of Medicine, University of Novi Sad, and Scientist Doctor Degree.

Abstract:

Migraine triggers are exclusive occurrences inducing headache. Certain triggers do not induce headaches in everyone. Even in a certain migraine sufferer, a specific trigger may not cause head pain for each headache. This research was carried out in North Serbian Province, Vojvodina with total population of 2,031,992. from 1988 to 2012.

Method: Participants were selected by multi-study random sampling procedure. The inclusion criteria were: age 10–18, attending school, and informed consent signed by parents and adolescents. The exclusion criterion was a prior diagnosis of a disease that has headache as a symptom. The mean age of the participants was 15 years 2.5 months (range 10–18 years, SD 3.02). Study was approved by Ethical Committees of the Institute and the University of Novi Sad.   Participants filled in a semi structured screening questionnaire developed for this study (socio-demographic data, development, and headaches including triggers and therapy). The accuracy of the questionnaire was based on the International Headache Society criteria. Classification code 3 was used. The study was conducted in 3 phases. 1st - questionnaire which narrowed down the number of patients to those who had at least two headaches per month during the past year. 2nd - face-to-face interview, as well as physical and neurological examination.

Results: After diagnosing migraine (MH) or recurrent non migraine (RNMH), adolescents keep headache diary over period of 6 months, and then strictly avoid potential triggers, and continue keeping the headache dairy next 6 months. The third phase was reinterviewing them one year after. Out of 20,917 adolescents, 4,376 (20,9%) reported RNMH, and 2,008 (9,4%) reported MH. Lack of sleep as a trigger was equally reported, MH (90.6%) and RNMH (94.5%). Particular food was indicated more often as a MH trigger (72.4% vs 32%) (p<0.05). The most common dietary triggers implicated in migraine attacks were: meat (32.9%), eggs (30.5%) and aged cheese (27.7%).  Odours were reported in 80.9% of MH, and in 10% of RNMH (p<0.05). Usual daily routine disturbance was reported in 50.0% of MH and in 75.2% of RNMH  (p<0.05). Physical activity tends more often to trigger RNMH  (85.3%) than MH. (45,3%) (p<0.05). Tobacco smoking triggers similar MH in 65% and RNMH in 75%. Passive tobacco smoking triggers MH more often than RNMH (81,6% vs. 23.9%). The same is with alcohol drinking as a trigger (80,2% vs. 68%) (p<0.05). Psychical stress triggers equally RNMH   (99.6%) and MH (96,9%). "Not eaten in time" was the trigger for 65% MH attacks, whereas 32% of RNMH. RNMH were in general more susceptible to weather changes than MH (78.8% vs. 21.28%) (p<0.05). Using canonical discriminate analysis (coefficient over 0.3) MH were distinguished from RNMH according to the headache triggers. We discussed only triggers that could be avoided (sleep disturbance, food, odours, tobacco smoke, alcohol drinks). During six months after MH reported 2.8 headaches per month, and 5.7 medications used during the month. Six months after strictly avoiding potential triggers, adolescents reported 1.6 headaches per month and 2.4 medication used during the month. Our results are similar to European population studies with encountered prevalence of migraine 3-17,6% in adolescents, as well as with recognized trigger factors. General dietary restrictions have not been proven to be useful. Fatigue, mental stress, and lack of sleep are the main MH triggers in most reports. By avoiding recognized triggers, in 68% of adolescents 75% reduction of drugs used in headache therapy was achieved.

Biography:

Ezekiel Noah Moirana is a 38 years old, Tanzanian and a General Physician. He did his MBBS at International Medical and Technological University (IMTU) on March 2011. He graduated his MMED-Internal Medicine at University of Dodoma (UDOM) on September 2016. Currently he is working as a Physician at Benjamin Mkapa Hospital in Dodoma, Tanzania. He has done research on Microvascular complication in Type 2 diabetes and hopefully will be published in an American Journal on October. He has done research on the association of Bush meat with high blood pressure which is also waiting to be published. Also he has done research on Hepatitis B prevalence among the health workers, awareness and prevalence.

Abstract:

Background: Hypertension is one of the most common conditions in patients with type 2 diabetes. It increases morbidity and mortality if remains uncontrolled. Very few studies have been done in sub-Saharan Africa to determine degree of blood pressure control among patients with type 2 diabetes. This study aimed at determining the degree of blood pressure control and associated factors among type 2 diabetics.

Methods: A cross sectional study was conducted among type 2 diabetic patients on hypertension treatment for at least 6 months attending diabetic clinic at Dodoma regional referral hospital. A structured questionnaire was used to collect socio-demographic and clinical data. Blood pressure was taken for all participants and classified based on JNC 7. Adequate control was defined as a blood pressure of <130/80mmHg. Data was analyzed using SPSS version 16; continuous variables were reported as mean/median with respective standard deviation/interquartile range and categorical variables were reported as frequency with their respective percentages. Logistic regression was used to determine association between blood pressure control and other variables. Analysis was done at a 95% level of confidence, a p value of ≤ 0.05 was considered significant.

Results: A total of 498 participants were enrolled for the study. Out of the participants,60.8% were male, 60.2% were living in urban setting, and 68.9% were married, 93% were using oral hypoglycemic, while 42.8% are known diabetic for 6-10 years. Only 30.9% of the participants had their blood pressure controlled at the time of study. After adjustment for other variables, living in urban setting (AOR=5.85, 95% CI 3.88-6.98), being a peasant (AOR=2.01, 95% CI 1.27-3.64), and using a beta blocker (AOR=1.66 95% CI 1.23-2.08), were significantly associated with blood pressure control.

Conclusion: Very few type 2 diabetic patients with hypertension attain the recommended blood pressure target despite being on treatment. Living in an urban setting, being a peasant and the use of a beta blocker were significantly associated with good blood pressure control. Results highlight the need to scale up interventions geared at assisting diabetic patients control their blood pressure to prevent severe complication.

Biography:

Dr Asma Awadalla is a Consultant Paediatrician in the King Abdullah Specialized Children’s Hospital under Ministry of National Guard Health Affairs in Riyadh, Saudi Arabia. She is also  jointly appointed as Assistant Professor in King Saud bin Abdulaziz University for Health Science present in Riyadh, Saudi Arabia.

Abstract:

From King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia, I would like to share with other paediatricians 5 cases from the middle east:

Arthrogryposis-Renal dysfunction-Cholestasis (ARC) Syndrome:

Four cases from different ethnic groups but all from middle east  with ARC syndrome a multisystem disorder which was reported as a  rare autosomal recessive disorders. Clinical presentations, physical examinationand and  investigations including genetic tests were described.In three patients we also highlighted the course of the disease and age at death for this life limiting condition.

A rare presentation of a complicated case of hypercalcemia:

A previously healthy 11 years old boy, who presented with  right flank pain for one week. Associated with vomiting. Apart from right renal angle tenderness system exam was normal. Investigations revealed increased serum and urinary calcium with elevated parathyroid hormone level. Rt ureteric stone was evident on plain film and renal USS. The patient had  laser fragmentation of right ureteric stone then  partial parathyroidectomy. Histopathology confirmed parathyroid adenoma which was suspected on the parathyroid scan. Outpatient follow up reassuring.

A case of Agammaglobulinemia:

Nearly 4 years old boy presented with sudden onset of Rt sided weakness and left-sided facial asymmetry. He had  2 previous admission for recurrent infections. Neuroimaging consistent with occlusion of left MCA and sub-acute infarction involving fronto-pareital  lobes. Echo shoed depressed cardiac function and immune work up showed Zero Bcells consistent with Agammaglobulinemia. Stroke was  likely thrombo-embolic secondary to cardiomyopathy/ LV dysfunction as he had  dilated left atrium and left ventricle with mild to moderate mitral insufficiency and moderately depressed left ventricular systolic function. Patient was started on regular IVIG.

Two  cases  of disseminated BCGgitis secondary to interleukin 12 defeciency and BCG-osis:

The first case is an 18 moth old boy presented with dissaminated BCG infection  (left axillary lymph node and splenic  abcecces) secondary to IL-12 deficiency on antiTB medication. The second case is a six month male infant with BCG related axillary lymphadenitis.

Biography:

Pendo Masanja, RN, MSPN, a pediatric nurse practitioner and Assistant Lecturer at the University of Dodoma (UDOM), Tanzania. She has over 9 years of experience as a clinician, mentor and tutor on maternal and child health; 6 years in clinical field as a midwife and general nurse currently working  as Assistant at School of Nursing and Public Health. She had a bachelor’s degree in nursing at St. Johns University of and   master degree  in science of Pediatric nursing at UDOM Tanzania, presented her study on “Predictors of neonatal sepsis” on the 2017 Tanzania Public Health Association Scientific Conference, on final steps to publish her two studies papers on pediatric infectious disease journals.

Abstract:

Background: Early onset neonatal sepsis contributes significantly to the burden of neonatal morbidity and mortality in the first week of life. In Tanzania, neonatal sepsis accounts for 32% neonatal illness and leads to 29% of newborn deaths yearly. The objective of the study was to assess predictors of early-onset neonatal sepsis among neonates.

Methods: A hospital based case-control study of randomly selected 105 cases and 217 controls in 3 hospitals in Dodoma region. Cases were neonates diagnosed with neonatal sepsis and controls were neonates without neonatal sepsis. Controls were matched to the cases by mother’s age and parity at a ratio of 1 case to 2 controls. A semi-structured questionnaire was used to collect information about the potential predictors; including maternal and neonatal factors as well as intrapartum emergency interventions.Descriptive and inferential statistical analyses were employed to measure the independent association between independent variables and the outcome of interest.

Results: Most (92.5%) of neonates were born at term and 7.5% were premature.Average birth weight was 3 kilograms and 16% neonates had low birth weight (<2500 grams). Up to 33% of the newborns had early-onset neonatal sepsis. After adjusting for confounders, the maternal factors which showed  significant association with early-onset neonatal sepsis were maternal history of chorioamnionitis [AOR=1.910,p=0.042,95%CI:1.022-3.56], HIV status [AOR=2.909,p=0.012,95% CI:1.020-8.296], prolonged rupture of membrane [AOR=2.857,p=0.014, 955CI: 1.233-6.619] and multiple digital vaginal examinations during labor [AOR=5.178,p=0.026,95%CI: 1.220-21.986].Neonatal factors; perinatal asphyxia  [AOR=6.781, p=0.006, 95%CI: 1.725-26.652]. 

Conclusion: Maternal infection(s), obstetric complications and substandard procedures during labor and delivery have significant effects on the occurrence of early-onset neonatal sepsis. Prevention of early-onset neonatal sepsis could be achieved by addressing maternal obstetric and neonatal related conditions.

Biography:

Omer Ahmed has joined The American Hospital, Dubai (in 2009), after 15 years as a Consultant Paediatrician in UK. He is a Fellow of the Royal College of Physicians of Ireland and the Royal College of Paediatrics and Child Health UK. His Paediatrics training was in Sabah Hospital- Kuwait, Alder Hay Hospital-Liverpool, Great Ormond Street and The Royal Free Hospital in London before taking a Consultant post in Stevenage, Hertfordshire UK. Earlier in his career, Dr

Ahmed has worked in Sudan, Libya and Kuwait. His experience covers wide areas in Child Health as a General Paediatrician. Dr Ahmed has several publications and presented/attended in several Paediatrics meetings and conferences.

Abstract:

HSP (Immunoglobulin A Vasculitis- IgAV) is the most common form of systemic vasculitis in children. Although in the great majority of cases HSP is self-limited, the symptoms and signs it bears are very scary for parents and families.

The lecture would start by presenting general classification/Incidence of Vasculitis in children to be followed by the clinical manifestations, pathogenesis, diagnosis, and differential diagnosis of HSP.

General careful evaluation of Purpuras in children is extremely important for early diagnosis and treatment. The Differential diagnoses are presented. Complications of HSP are outlined in the lecture.

HSP management outline guidance including renal involvement are briefly presented including some controversies along this line.

Biography:

Slobodan Marinković has completed his PhD at the age of 31 years from Belgrade University and postdoctoral studies from Laboratory of Neurophysiology, Panum Institute in Copenhagen (Denmark). He spent 3 months at George Town University, Washington D.C., USA. He has published 2 international books, four chapters in 2 other books, 8 national books, more than 60 papers in reputed journals and has been serving as an editorial board member of repute. He has about 1200 citations in the international publications. He has been a chairman person on three occasions. He is a Full Professor of Anatomy at University of Belgrade, and a Visiting Professor at Shinshu University, Matsumoto, Japan. 

Abstract:

A 5-year-old girl was presented with multiple malformations of her vertebral column and spinal cord. The following vertebral abnormalities were observed: C7 – agenesis of the left part of the body; T1 and T2 – an incomplete vertical cleft of the left pedicle; T3 – agenesis of the right arch; T4 – absence of the right pedicle, and a cleft of its arch; T5, T7 and T12 – agenesis of the right half of the body, hypoplasia of the right half, and defect of the left arch; T6 – a vertical cleft of the body, agenesis of its arch, and enlarged vertebral foramen; T8 – a defect of the left arch, and enlarged vertebral foramen; T10 and T11 – absence of the arches, a cleft of the right half of the body (T11), and duplication of the vertebral foramen; T12 – duplication of the vertebral foramen; L1 – small defect of the right half of the body, arch agenesis, and duplication of the vertebral foramen; L3 – a mediosagittal cleft of its arch; L4 – agenesis of the left arch; S3 – a mediosagittal cleft of the body; from L5 to S3 – a complete absence of their arches. A partial or complete agenesis of the ribs 5-7 and 12 was seen. The spinal cord was duplicated at the level between the T6 and T10. The embryologic basis of these extremely rare malformations was considered.             

Biography:

Dr. Wassil Nowicky is Dipl. Ing., Dr. techn., DDDr. h. c., Director of “Nowicky Pharma” and President of the Ukrainian Anti-Cancer Institute (Vienna, Austria). Has finished his study at the Radiotechnical Faculty of the Technical University of Lviv (Ukraine) with the end of 1955 with graduation to “Diplomingeniueur” in 1960 which title was nostrificated in Austria in 1975. Inventor of the anticancer preparation on basis of celandine alkaloids “NSC-631570”. Author of over 300 scientific articles dedicated to cancer research. Dr. Wassil Nowicky is a real member of the New York Academy of Sciences, member of the European Union for applied immunology and of the American Association for scientific progress, honorary doctor of the Janka Kupala University in Hrodno, doctor “honoris causa” of the Open international university on complex medicine in Colombo, honorary member of the Austrian Society of a name of Albert Schweizer. He has received the award for merits of National guild of pharmacists of America. the award of Austrian Society of sanitary, hygiene and public health services and others.

Abstract:

Xeroderma pigmentosum (XP) is a genetic disorder of DNA repair in which the ability to repair damage caused by ultraviolet (UV) light is deficient. Multiple basal cell carcinomas (basaliomas) and other skin malignancies frequently occur at a young age in those with XP. In fact, metastatic malignant melanoma and squamous cell carcinoma are the two most common causes of death in XP victims. This is a very rare disease. The incidence differs regionally and is between 1:40000 (Japan) and 1:250000 (USA). About 250 XP patients live in the USA, about 50 in Germany, mostly children. The life expectance is low; usually they die in the first decade. If left unchecked, damage caused by UV light can cause mutations in individual cells DNA. XP patients are at a high risk (more than 2000 times over the general population) for developing skin cancers, such as basal cell carcinoma, for this reason. A report on the successful using NSC-631570 in a XP patient suggests this drug can be very useful also in this hereditary disease.

Patient S.S., an eight year old boy, was presented with an ulcering lesion of the nose. As he was 10 month old, xeroderma pigmentosum was diagnosed. Until the age of three years the number of skin lesions increased considerably. In May 2002 skin cancer (squamous cell carcinoma) at the nose was diagnosed, T4NXM0, histologically verified. From May till June 2002 three cycles of chemotherapy were administered (cyclophosphamide, vincristine, and vinblastine). The therapy failed and the tumors grew up. Clinical investigation in April 2004 revealed deforming malignant melanoma of the nose with invasion into the cartilage of nasal septum, measuring 3x3 cm. On 20 May 2004 the therapy with UKRAIN was started, 5 mg intravenously twice a week, up to a total dose of 85 mg. One month after the last administration of UKRAIN a complete regression of the tumor was revealed. The skin defect was partially replaced with connective tissue. Xeroderma skin lesions improved throughout the body.