Day 1 :
- Pediatric Infectious Diseases
Location: Florence, Italy
Philippine Heart Center, Philippines
Camille-Marie Go-Cacanindin has obtained her Medical Degree at the age of 25 years from University of Santo Tomas Faculty of Medicine and Surgery and Pediatric Residency Training from Philippine Children’s Medical Center. She is currently a Pediatric Cardiology Fellow in training at Philippine Heart Center, a tertiary cardiovascular referral center.
Anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA) occur in 1 in 300 000 live births. The most common origin of the abnormal LCA is from the pulmonary truncal sinuses. The rarest form of ALCAPA presents with anomalous left coronary artery arising from the right pulmonary artery. This is a case of 1 month old female presenting with Dyspnea , 2D echocardiography revealed ALCAPA. Intraoperativley, the Left Coronary Artery was found to be originating from the Right Pulmonary Artery. The patient underwent coronary implantation and LeCompte procedure.
In the most common form of ALCAPA, the abnormal coronary artery arises from the adjacent pulmonary valvar sinus, rather than the pulmonary trunk. In this case, the Anomalous Left Coronary Artery originated the Right Pulmonary Artery. Such case has an incident of 1 in 2,000,000 live births. This is the first reported case in a tertiary cardiovascular referral center. In fetal life, this has no detrimental effect since pressures and saturations are similar in the aorta and pulmonary artery. After birth, however, the pulmonary artery contains desaturated blood at pressures that rapidly fall below systemic pressures. The left ventricle is perfused with desaturated blood at low pressures leading to infarction with ventricular dysfunction. Coronary translocation and Lecompte maneuver was done which provided relief for the patient’s condition.
Dr Barbara Fialho C Sampaio, is coordinator of clinical research and Posdoctoral Researcher in the Medical School of São Paulo University. Develop innovative diagnostic research using non-invasive techniques, which aims to create possibilities for expanding diagnosis of infectious diseases. She is focused today is on the detection of measles, rubella and mumps in human saliva, such as had developed a new diagnostic technique to detect the vaccination status of children using saliva as an alternative biological fluid to blood.
Safe and effective vaccines are a well-established public health intervention, with a major impact on the decline in the prevalence of infectious diseases, but outbreaks are occurring frequently due to primary and secondary failures. Serological control of the vaccination status and protection of a population is essential but is based on invasive blood sampling, problematic for children and teenagers. Saliva can be as acceptable alternative IgG source for children and other protected groups, due to IgG exuded in crevicular fluid. We intended to detect the prevalence of specific IgG response for measles, mumps, rubella and T. gondii in saliva samples, for evaluate vaccine efficiency and toxoplasmosis. For sampling, we promoted an interactive exhibition on hygiene in public elementary schools to collect 249 saliva samples from 7 to 13 years old students from São Paulo, Brazil. We developed and validated an IgG capture assay by solid phase S. aureus protein A, with revealing of IgG specificity by the use of biotinylated recombinant measles, rubella, mumps and T. gondii tachyzoites extract. This SpA capture assay fixes the same amount of IgG in the well, avoiding the IgG content variation in saliva. We used 50 validated positive sera from the IMTSP biorepository and as negative controls 40 pools of 4 samples from 160 discarded sera from children 6 and 10 months old, after maternal IgG clearance and before vaccination, which were in routine pediatric analysis in ICr HCFMUSP. The assays had reproducibility greater than 98% and sensitivity and specificity> 95%, using sera. Saliva and sera of 47 university students were tested for paired comparison, without discordance. We detected in the saliva from elementary students, a prevalence of 8.5% (95% CI 5-11.9%) for anti T. gondii IgG of, anti-measles IgG of 96.8% (95% CI 94.6-99%), anti-rubella IgG of 59.1% (95% CI 53-65%) and anti-mumps IgG of 57.5% (95% CI 51.3-63.6%). The prevalence of antibodies against mumps and rubella was lower than measles, as described in other reports, but this approach shows the feasibility of saliva for sustained follow-up of vaccine immune status in teenagers for devising more adequate re-immunization protocols. Our approach was efficient in all aspects, from the hygiene exhibition for sampling, the use of saliva and the development of reliable tests for the determination of the IgG protection in students and the prevention of toxoplasmosis, in declining incidence. This approach allows cheaper follow-up for IgG detection of several diseases, including vaccine control. Appropriate public health measures, such as revaccination, can be properly planned and developed for avoiding outbreaks and upsurge of controlled infectious diseases.
Carlos Jose Mendoza Fox is a Pediatric Pulmonologist from Lima, Peru. He works at a public hospital (Hospital Nacional Hipolito Unanue) in a high endemic tuberculosis part of Lima. He also is the pediatric pulmonologist at two private clinics (Clinica Anglo Americana and Clinica Ricardo Palma) in Lima. Investigator on pediatric tuberculosis. Member of the central committee of the National Pediatric Tuberculosis Network of Peru, International Congress on Pediatric Pulmonology and the American Thoracic Society.
Latent tuberculosis infection (LTBI) is a persistent state of active immune response because of the presence of mycobacterial antigens without evidence of active tuberculosis (TB) disease). Children that are exposed to TB can get infected and develop the disease. Preventive therapy (PT) allows avoiding infection and disease. There is no gold standard to diagnose LTBI. We have two immunological based tests, in vivo and in vitro, based on the activation of T cell. Neither can differentiate between LTBI and active disease. There is no way to know if the infection has been cleared, contained or have a local infection.
Risk factors for progression to disease in infected patients are HIV infection, chronic kidney disease, glucocorticoid therapy, diabetes, severe underweight and others; but an important factor is the age at which the infection takes place: children under 4 years of age are at intermediate/ high risk. At least 4 different antibiotics are needed to treat TB disease, in order to avoid risk of resistance. For LTBI we only use 1 or 2 because the risk is almost non-existent. The drug used for more than 5 decades is isoniazid (INH) and reduces TB disease incidence between 60-90%. WHO has recommended the following regimens to treat LTBI: INH daily for 6-9 months, daily rifampicin (RFP) for 3-4 months, daily INH plus RFP for 3-4 months, and weekly rifapentine plus INH for 3 months (12 doses).The last one has shown non-inferioty versus 9 months of daily INH, less adverse effects and less discontinuation. The mentioned regimens are for sensible TB. Multidrug-resistant TB (MDRTB) patients take more time for sputum conversion so longer dissemination periods. Near 50% of close contacts of MDRTB patients develop LTBI. The usual standard of care is follow-up for 2 years and treatment if they present active disease. WHO has given recommendations for LTBI of MDRTB contacts: individualize cases searching for the intensity of exposure, certainty of source case, reliable information on the drug resistance pattern; confirmation of infection with tests; treatment selected according to the drug susceptibility profile of the source with preference for flurquinolones and close monitoring for 2 years.
Lady Hardinge Medical College, India
Kushala completed her MBBS from Bangalore Medical College in the year 2016. She joined her Postgraduation in Lady Hardinge Medical College by clearing one of the tough competitive exam in India. She is currently in her final year of her postgraduation and has received goldmedal in Pediatrics for best thesis during Postgraduation. She has done a lot of work in Quality improvement and antibiotic stewardship, which is the need of the hour through out the world.
Objective: To study the antibiotic prescribing practices of pediatrics residents and to measure the effectiveness of a structured educational intervention program on their empirical antibiotic prescribing practices.
Methodology: It is a time interrupted, non randomized trial conducted from November 2017 to march 2019 in Kalawati Saran Children’s Hospital, a tertiary care center in India. 200 children aged between 0-18 admitted with infectious illnesses were randomly selected and their antibiotic prescriptions at admission, adherence of prescriptions to national guidelines and the course during hospital stay was noted. A fish bone analysis for cause of not following guidelines was done. An antibiotic policy was prepared and disseminated to all the residents through seminars,posters and cellphone friendly documents. The change in prescribing patterns and the course of the child’s illness in hospital was observed by taking 50 cases each in the 1, 2, 3 and 6 months each after the intervention.
Results: The commonest reason for not following antibiotic guidelines was found to be subjective variation in how each resident perceives the severity of sickness of a child and that the guidelines were not easily accessible. The adherence of empirical antibiotic prescriptions was 59% before intervention which improved to 72% in the first month, 90% in the second month, 86% and 78% in the third and sixth month respectively (p=0.01).The children in non adherent group were more likely than the children in adherent group to have their antibiotics changed during the course of their treatment (p=0.03). There was no significant difference in duration of stay and the outcome in the adherent and non-adherent group.
Conclusion: Quality improvement interventions can lead to appropriate use of antibiotics in hospitalized children with no negative consequences and prevents antibiotic resistance.
- Pediatric Nursing
All India Institute of Medical Sciences, India
Mrs Era Deepika Dayal has completed her masters in Nursing (Pediatrics) at the age of 28 from Christian Medical College, Vellore. She is currently working as a Nursing tutor at College of Nursing, All India Institute of Medical Sciences. She has presented papers at International levels and has been part of the organising committee and Speaker for many National and International Conferences and Workshop.
Methodology: Using quasi-experimental before and after design, this study was done over 6 weeks. Using consecutive sampling technique, children who met the inclusion criteria were included. CMC PAC score was marked for the children being admitted to the selected areas (nurses were blinded to the score in the control group). The patients in the control group received standard care, whereas patients in the experimental group received care based on CMC PACS. Clinical Outcome Indicator was used to assess the clinical outcomes at 48 hours of hospitalization. Quality of Nursing Care Observation Checklist was used to assess the quality of nursing care every 12th hourly. One week between control and experimental groups was used to educate nurses and doctors regarding the CMC PACS based protocol. Satisfaction Questionnaire was used to determine their satisfaction.
Results: Majority of the population were male, well-nourished infants and had medical diagnosis. Majority of children in both groups had low risk of deterioration (CMC PACS < 4) at admission (80.6%) and also at 48 hours of hospitalization (90.3%). No significant difference occurred in the clinical outcomes (‘p’ value = 0.435). Significant improvement was seen in the quality of nursing care (QNC) across both groups (p<0.001). A weak negative correlation existed between the QNC and the risk of deterioration at 48 hours (r = -.080). QNC and clinical outcomes had no significant association (p= .116). Majority of the registered nurses were GNM (72.5%), <30 years old (82.4%) with < 3 years of experience (70.6%). Majority of the health care workers were moderately satisfied (52.9%- nurses, 77.8%-doctors).
- Pediatric Radiology
Hamad Medical Corporation, Qatar
Hissa Mohammed has completed her MSc in Medical Imaging from University of Aberdeen. She is the radiology supervisor in communcable disease Centre in Qatar. She has published 2 papers in online journals regarding pediatric patient care in radiology department.
Background: Effective communication in this process plays a positive role because through various studies it is noticed that when radiographer and nurses talk politely and nicely with the paediatric patients during diagnostic imaging procedure then it delivers positive impact in their mind. Radiographer has the responsibility for ensuring effective communication in order to accomplish successful imaging (Dunlop, 2015). Through various studies it is analysed that talking nicely with paediatric patients release dopamine chemical in their brain which makes them feel comfortable. Thus, it is extremely essential that members of radiologist and team members should incorporate polite tones while talking their patients because it will resultant in obtaining successful imaging in effective and efficient way possible. Although effective communication also resultant in creating better relationship (Perry, et. al., 2018).
Summary of work: It analyzed that effective communication between radiographer and paediatric patient helps the radiographer in getting clear and successful imaging. In this study, it is suggested that when radiographer although, it is also analyzed that effective communication helps radiographer in building effective relationship with patients. Patients also feel good and satisfying when they observe that tone for their radiographer is extremely polite.
Findings: From the analyses it is investigated that effective communication by a radiographer plays a vital role in successful imaging of the patients (Dunlop, 2015).
Discussion: Effective communication leads to successful imaging procedure and it also deliver benefits in reduction of radiation dose in ASD patients.
Conclusion: It is concluded that effective communication between radiographer and paediatric patients during imaging process has two main fundamental benefits. Firstly, effective communication helps in accomplishing successful imaging during the process. Secondly, it also resultant in creating better relationship between radiographer and paediatric patients.