10^th Annual Congress & Medicare Expo on Primary Healthcare August 26-27, 2020 Kyoto, Japan

Biography:

Abstract:

Statement of the Problem:

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 5^th 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.

Biography:

Abstract:

Biography:

Amin Gohary is a professor in Burjeel Hospital UAE.

Abstract:

Intussusception is a common condition that present with abdominal colic and is usually diagnosed by ultrasonography with appearance of (Target Sign).

Over the last 35 years we have noticed a new phenomenon that mimic intussusception both clinically and radiologically but is not cause by bowel intussusception but by impacted stool at he terminal ileum.

Whereas  intussusceptions an emergency that require urgent attention to reduce either by air, saline or Barium and my need urgent exploration , Gohary’s phenomenon  if recognized can be treated  by simple fleet enema.

We have encountered 56 cases between 1983 and 2018 , their age varied from 9 months and 7 years

They have the common features of

1. Severe abdominal colic that is not responding to analgesic or antispasmodics
2. US feature suggestive of ileo-colic intussusception
3. No red current jelly stool .intussusception
4. Good response to fleet enemas

More recently we have encountered a subgroup pf patients that have genuine intussusception on radiological examination but not causing complete bowel obstruction and still associated with had srool in the large bowel and still needs simple fleet enema to cure.

We hope by highlighting this new phenomenon to avoid unnecessary radiological investigation and unnecessary abdominal exploration.

Biography:

Malak Alia is an Arab Board Certified Pediatrician. She earned her medical degree from Damascus University and later obtained her master's degree in Pediatrics form the same university. Subsequently she obtained Arab Board of Health Specialization in Pediatrics. She is certified in basic life support (BLS), neonatal resuscitation (NRP) and pediatric advanced life support ( PALS). Dr. Malak has 6 years experience in pediatric field and recently working as a specialist in Prime Health Group in UAE.

Abstract:

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

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

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

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

Biography:

Brankica Vasiljevic is Head of Maternity and Child Health Services in NMC Royal Hospital DIP in Dubai, UAE.After completed her MD she had completed her clinical postgraduate education (Pediatric and after that Neonatology fellowship) and academic postgraduate education (MSc in pediatric and ultrasonography field and PhD in neonatology field) at Belgrade University School of Medicine in Belgrade, Serbia.She has completed also Yugoslav School of Ultrasound and different courses in ultrasonography and echocardiography in Serbia and UK, Post Graduate Program in Pediatric Nutrition at Boston University School of Medicine and Visiting scholar and Internships in Greece (Alexandar Hospital, Iaso Hospital and Elena Hospital in Athens), USA (Morgan Children’s Hospital in New York) and Austria (General Hospital of Salzburg in Salzburg and Regional Hospital (LKHLandeskrankenhaus) in Graz).She had won the ESPNIC Educational Grant at 5th World Congress on Pediatric Intensive & Critical Care in Geneva Switzerland (2007).She was a local coordinator for International Neonatal Immunotherapy Study-INIS for Serbia and Montenegro and participated in SIOP 93-01 Study, ITP Study and Twin Birth Study.She has published more than 35 international publications in international indexed journals (100 citations), 5 chapters in various fields of neonatal medicine and have more than 30 presentations in international conferences.

Abstract:

Despite recent advances in neonatal intensive therapy, still is present significant morbidity associated with extreme prematurty that includes both short-term and long-term pulmonary,  neurologic and visual impairments. These complications of prematurity  not only affect the quality of life of these children in the rest of their lives, but can also cause numerous medical and economic burdens in the society.

No single therapy has proven to be effective in preventing or treating either developmental lung, brain and retinal injuries in preterm infants or the hypoxic-ischemic brain injury  in full-term infants.  Stem cell–based therapies are emerging as potential alternative treatment for such complex diseases (BPD, IVH, ROP and HIE) with multifactorial  etiologies.

Recently, various preclinical studies have shown that stem cell therapy significantly attenuates injuries in newborn animal models of BPD, HIE, IVH and ROP. 

Caution is warranted, however, because stem cell-based therapies for regenerative purposes represent innovation, mechanisms of action are still not completely understood, and standardization, clinical indications, timing and dosage are required to permit safe clinical translation of stem cell therapy in animal models for newborn infants in the near future,

No disclosure of any conflicts of interest.

References:

• Spencer ND, Gimble JM, Lopez MJ. Mesenchymal stromal cells: past, present, and future. Vet Surg 2011;40:129-39.
• Park WS, Sung SI, Ahn SY, Yoo HS, Sung DK, Im GH, et al. Hypothermia augments neuroprotective activity of mesenchymal stem cells for neonatal hypoxic-ischemic encephalopathy. PLoS One 2015;10:e.
• Ahn SY, Chang YS, Sung DK, Sung SI, Yoo HS, Lee JH, et al. Mesenchymal stem cells prevent hydrocephalus after severe intraventricular hemorrhage. Stroke 2013;44:497-504.
• Park WS, Sung SI, Ahn SY, Sung DK, Im GH, Yoo HS, et al. Optimal timing of mesenchymal stem cell therapy for neonatal intraventricular tricular hemorrhage. Cell Transplant 2016;25:1131-44.
• Waszak P, Alphonse R, Vadivel A, Ionescu L, Eaton F, Thebaud B. Preconditioning enhances the paracrine efect of mesenchymal stem cells in preventing oxygen-induced neonatal lung injury in rats. Stem Cells Dev 2012;21:2789-97.
• Chang YS, Ahn SY, Yoo HS, Sung SI, Choi SJ, Oh WI, et al. Mesenchymal stem cells for bronchopulmonary dysplasia: phase 1 dose-escalation clinical trial. J Pediatr 2014;164:966-72.
• Stitt AW, O’Neill CL, O’Doherty MT. Archer DB, Gardiner TA. Vascular stem cells and ischaemic retinopathies. Prog Ret Eye Res 2011; 30:149e166e.

Biography:

Ganga S. Pilli is a professor in Department of Pathology in KAHER University’s Jawaharlal Nehru Medical College

Abstract:

Aims and Objectives: To study the Socio-demographic profile and feeding practices in children with Acute severe malnutrition admitted in Nutrition Rehabilitation Centre (NRC) of a Tertiary Care Hospital in North Karnataka.

Background: India is one amongst the countries with an unacceptably high prevalence of Severe Acute Malnutrition (SAM) among all the developing countries. SAM is a major public health issue, which affects 7.5% of under five children in India. Hence, this study was undertaken to know the contributory factors in clinical profile that can help to plan for proper management strategy.

Material and Methods: This cross-sectional observation study was carried out in NRC attached to Dept of Paediatrics of a tertiary care hospital, Belagavi, Karnataka from September 2017 to March 2018. Children aged between 6-60 months with SAM were evaluated for Socio-demographic profile and feeding practices. Data was analysed by SPSS and results were tabulated.

Results: One hundred children with SAM were included in the study.   Male (60%) children suffered more than the female (40%) children.  Majority of the children were in the age range of  6 to 24 months. About 65% of the mothers were of younger age (18 to 27 years), followed by 24% mothers in the age range of 28 to 32 years. Most of the mothers belonged to class IV and Class V socio- economic status. Marasmus was commonest type of malnutrition. History of delayed weaning was noted in 38% of the children. Average age at weaning was 7.5months. Majority of the children did not receive appropriate complementary feeds.

Conclusions: Prolonged breastfeeding more than 6 months, insufficient complementary feeds, younger age and low socio-economic status of the mothers contributes to SAM cases.

Biography:

Khadija Saif Al-A'amri is a senior staff nurse/midwife, at present working as Head of Nursing Services in the Directorate of Nursing, Dakhiliya Governorate. Development of Leadership and management skills for the first and second line nursing in-charges is one of the most priorities. Maximizing the quality of nursing practice and care delivery level is one of the main roles in this position. Khadija is taking research development into consideration as she knows it's the way for evidence-based practice that ensures approaching "Excellence". For this, she encourages nurses to undertake researches as she is "Head of Research and Development section". She hold Master in Health Studies from University of Hull in UK.

Abstract:

Objective: Early antenatal registration is one of the main missions the Ministry of Health in Oman is working hard to achieve it. Despite the availability of services, there are still many women not registering their pregnancies during the advisable period. The study was targeted to explore these factors from pregnant women perspective. Method:A cross-sectional descriptive study conducted in the biggest four Primary Health Care antenatal clinics in a Dakhiliya Governorate. A total of 276 completed questionnaires were obtained from pregnant mothers using convenience sampling with a response rate of 92%. Results: Majority of the study participants were between 26 and 30 (32.7%) years, have high secondary school were 148 (53.6%) and 221 (82.2%) were not employed. Around 152 (57.6%) registered before the second trimester. On the reasons for late registration, (41.3%) stated that they 'visited private health institutions', equal response of (26.6 %) for two reasons affected early registration were; 'didn't have any complications' and 'felt unwell at the early pregnancy'. Interestingly, 57.4% claimed that trust in the governmental antenatal care was the reason why they prefer to follow in MoH health institutions and around 42.1% have trust in the health care providers. Another interesting finding was 90.9% of participants know that antenatal services is preventive and only 9.1% said its curative. Conclusion: Based on the results of this study, good numbers of women booked at the first trimester of pregnancy and have an overall excellent perception about the importance of antenatal care. Further awareness and education is required to reduce the number of late antenatal booking.

Biography:

Rishi Ram Kattel is  Associate professor in Department of Agricultural Economics and Agribusiness Management , in Agriculture and Forestry University, Rampur, Chitwan, Nepal.

Abstract:

In Nepal solid waste management is one of the major environmental issues, especially in the urban areas. While solid waste management (SWM) has become a major concern for municipalities and the country as a whole, the status of SWM is not fully understood due to the lack of SWM baseline data, which are also essential for effective planning. On the other hand plastics based waste management and recycling activities in the major cities of Nepal has not adopted in the sustainable manner. Such a back drop, this research attempts to assess the plastic waste released, management and recycling in supply chain in three cities in February to August, 2018. A total 150 city households level information (@ 50 HHs/city) were collected using personal interview schedule and a weekly total waste volume from household level had been taken. Further, waste collection, distribution, management and recycling data in supply chain were collected from street wrappers, small and big Kabaadi shops and plastic industries from cities using rapid market appraisal technique. This study revealed that about 47% household segregate their HH waste which is fund higher in Hetauda (83.8%), followed by Bharatpur (46.9%) and Butwal (28.6%). About 6.7% HHs have had public waste collection bin nearby their home whereas 71.1% surveyed HHs have had knowledge on solid waste management. About 40% HHs heard of importance of plastic waste recycling and majority (91%) express their readiness to segregate the plastic solid waste if recycling program is set up in municipal area. It revealed that 49% HHs concern about effect of human health and 40% concern the effect on environment from solid waste whereas 68.9% HH have preferred door-to-door type of waste disposal system. It is also noted that 23.3% of surveyed HHs in cities are practicing composting at their form yard using traditional composting methods (46.8% have used pits and 32.4% used compost bins). The household level waste composition analysis indicates that highest waste fraction is organic matter (69.4%), followed by plastic (19.8%) and 10.8% are metal, glass, paper, textile, rubbers and leather. The plastic waste composition at household source is found higher in Bharatpur (29.6%), followed by Hetauda (21.4%) and Butwal (3.8%). The average per capita waste generation per day is found to be 160 gram ranging 141-177 gram having 19.5% plastic waste in cities. For institutional establishments and sectors, the average daily waste generation is 5.3 kg. The composition of institutional waste is 30.5% organic, 29.8% plastic and 39.7% other. Similarly, the average daily waste generation from commercial establishments is 2.1 kg per shop and 9 kg per hotel or restaurant.  On an average 44.1% organic matters, 26.5% plastic and 29.4% other are found in commercial waste composition. The composition of city dumping sites waste is 83% organic matter, 15.2% plastic and 1.8% glasses from 25 kg random weight sampled from city dumping sites. Total 7789.1 MT plastic waste per year is going to landfilling/dumping sites from Bharatpur, Butwal and Hetauda cities. The benefit-cost analysis of plastic industries shows that the B/C ratio is found higher (1.66-2.75) and profitable for using plastic items as a recycling materials only as compared to industries using plastic granules as a raw materials only (1.04-1.40). An average weekly recyclable waste collection per street waste collector in city is 225 having 7% plastic whereas 1335 kg recyclable waste per Kabadi shop has been collected (14% plastic). About 10.2% plastic solid waste are recycled, burnt and buried from city. Currently, 52 MT from Butwal, 55-65 MT from Bharatpur and 25 MT from Hetauda city collect waste daily collected from all sectors and filled up in city dumping cites without any composting plants and recycling and scientific waste management practices from municipal office and its PPP model private companies.  Total 25-30 plastic recycling industries can be established in three cities whereas 17881 MT organic fertilizer per year can be produced from degradable waste in three city whereas NRs. 268.22 million (US $ 2.62 million) worth from three city will be earned per year. In supply chain management of plastic waste use, reuse and recycling, households, institutional and commercial establishments are major source of waste release in the city. This study suggests that municipal office needs to develop an appropriate policy and strategy framework together with technical guidelines on key issues such as organic composting, recycling and landfill operation from dumping sites. Furthermore, public awareness and private sectors involvement mechanism should be promoted for reduce, reuse, reduce and recycle (4R) of plastic waste as well as participatory market system development of solid waste in supply chain management though involvement of all concerned stakeholders.

Biography:

Sheida Naderi-Azad has completed her Bachelor of Science in Microbial and Environmental Pathophysiology from University of British Columbia and is currently an MD Candidate at the University of Toronto Faculty of Medicine. She has an expertise in immunology and oncology, with a deep interest in changing metabolic demands with aging. She has most recently completed a summer studentship at the Dana Farber / Harvard Cancer Centre. She has had numerous published articles and presentations on cancer therapeutics, inflammatory conditions and women’s health

Abstract:

Statement of the problem: While it is widely known that oxytocin can be used as an inducing and augmenting agent for labour, there is limited information on whether high-dose oxytocin results in a clinically significant change in labour. This study examines whether high dose oxytocin for induction or augmentation of labour safely shorten time to delivery.

Methodology: A systematic review of the literature was conducted using Medline, Embase, Cochrane, and Central databases. A total of 374 were included in this review. Articles were further selected based on recency of publication as well as depth of detail regarding the PG treatment regimens Inclusion criteria were women at term requiring either augmentation or induction of labour. Intervention was intravenous high dose oxytocin administration. The primary outcome was cesarian section, whereas secondary outcomes included spontaneous vaginal delivery, time to delivery, uterine hypertonus, and 5min Apgar score.

Findings: Systematic reviews report decreased rates of cesarean delivery and increased rates of spontaneous vaginal delivery, shortened duration of labour, and  no difference in rates of Apgar scores less than 7 at five minutes among studies with high versus low initial doses and incremental doses of oxytocin for labour augmentation. Findings of individual studies with respect to cesarean section and spontaneous vaginal delivery were inconclusive. Studies consistently reported shorter intervals from administration of oxytocin to delivery and higher rates of hyperstimulation in high dose regimes. Apgar rates less than 7 at five minutes were not different.

Conclusion and significance: Administration of oxytocin in regimes starting at 4 mU/min and increasing incrementally at 4 mU/min is associated with fewer cesarean sections and higher rates of spontaneous delivery without fetal comprise compared to lower dose regimes.

Biography:

Sheida Naderi-Azad has completed her Bachelor of Science in Microbial and Environmental Pathophysiology from University of British Columbia and is currently an MD Candidate at the University of Toronto Faculty of Medicine. She has an expertise in immunology and oncology, with a deep interest in changing metabolic demands with aging. She has most recently completed a summer studentship at the Dana Farber / Harvard Cancer Centre. She has had numerous published articles and presentations on cancer therapeutics, inflammatory conditions and women’s health.

Abstract:

Statement of the problem: Inadequate oxygen supply may lead to the respiratory acidosis (pH < 7.35) and increased lactate in the blood. Upon membrane rupture during labour, one can measure lactate and pH levels in a sample of blood taken from the baby's scalp. While both fetal scalpe lactate and pH have been previously used in predicting adverse outcomes in labour, there is a paucity of information on which marker is superior in this regard. This study examines the measurement of fetal scalp lactate superior to fetal scalp pH in predicting adverse fetal/newborn outcomes and successful acquisition of a usable sample among women at term in labour.

Methodology and theoretical orientation: A systematic review of the literature was conducted using Medline, Embase, Cochrane, and Central databases. A total of 250 articles were included in this review. Articles were further selected based on recency of publication as well as inclusion and exclusion criteria. Participants included women at term in labour. The intervention was fetal assessment using fetal scalp lactate. The primary outcomes were apgar scores at 5 minutes, hypoxic ischemic encephalopathy, and admission to NICU. The secondary outcomes included umbilical cord arterial pH <7, and umbilical cord arterial base deficit >12. Findings: The results indicate that there are no statistically significant differences in Apgar scores at five minutes, admission to a NICU, or hypoxic ischemic encephalopathy. There are also no statistically significant differences in rates of umbilical artery cord pH < 7 or base deficit > 12 mmol/L. There are, however, significantly higher sampling success rates for scalp lactate samples compared to sampling for scalp pH testing.

Conclusion and significance: These results indicate that the measurement of fetal scalp lactate is equivalent to fetal scalp pH for clinical decision-making to avoid adverse neonatal outcomes.  Fetal scalp lactate sampling requires less time and is associated with fewer failed sampling attempts.  Further research is needed to determine optimal values to indicate risk for neonatal morbidity