Day 2 :
- Workshop
Location: Istanbul, Turkey
Session Introduction
Aziz Koleilat
Makassed University General Hospital, Lebanon
Title: Probiotics as immune modulators in prevention of intestinal infection
Time : 10:00-11:00
Biography:
Aziz Koleilat is currently working as a Vice General Secretary, Pashan Pan Arab Society Pediatric Gastroenterology Hepatology and Senior Pediatric Consultant Gastroenterology and also Asthma IBR Member Makassed General Hospital, Lebanon.
Abstract:
Use of probiotics may induce a barrier influence against common pathogens and antigens by activating macrophages, altering cytokines, increasing natural killer cell activity and/or increasing levels of immunoglobulins. Recognition of in vivo and immunomodulatory roles of probiotic bacteria is now promoting opportunities for use of these microorganisms in many fields e.g., inflammation, infection and atopy. The survival issues of probiotics are associated with their establishment in the competitive gut ecosystem. Since the generation of immunophysiological regulation in the gut depends on the establishment of indigenous microflora and on the therapeutic interventions based on the consumption of cultures of beneficial live microorganisms that act as probiotics. One of possible mechanisms of probiotics is promotion of a nonimmunologic gut defence barrier, which includes the normalization of increased intestinal permeability (dysbiosis) and gut microecology. The role and effect of probiotics in infant feeding, on the mucosal permeability and microbial flora composition and in turn on the stabilization of Th1/Th2 & IgE production has been tested. Another possible mechanism of probiotics is improvement of the intestine's immunologic barrier, particularly through intestinal immunoglobulin, alleviation of intestinal inflammatory reaction that promotes a gut-stabilizing effect. Many probiotics effects are mediated through immune regulation, particularly through balance control of proinflammatory and anti-inflammatory cytokines. So, probiotics can be used as innovative tools to alleviate intestinal inflammation, normalize gut mucosal dysfunction and down-regulate hypersensitivity reactions. There are differences that exist in the immunomodulatory effects of candidate probiotics bacteria. Specific immunomodulatory properties of probiotics bacteria should be characterized when developing clinical applications for extended target populations.
Rashida Ablatayeva
Khoja Akhmet Yassawi International Kazakh-Turkish University, Kazakhstan
Title: Successful surgical management of acute appendicitis in children using a two-looped ligation during laparoscopic appendectomy
Time : 11:30-12:00
Biography:
Rashida Ablatayeva is currently pursuing her Doctoral degree from Khoja Akhmet Yassawi Kazakh-Turkish International University, Department of Medicine. Her scientific work is connected with laparoscopic surgery.
Abstract:
Acute appendicitis is a common pathology in pediatrics. Laparoscopic Appendectomy (LA) is the main type of surgical treatment of appendicitis. During surgery stump closure is the most crucial moment. Appendiceal ligation may be performed using looped suture, stapler or clip. Closing the appendix base with knot tying is the most cost-effective method. The data of children who underwent LA from January 2017 to December 2017 were obtained from retrospectively collected database. During surgical management of complicated and uncomplicated acute appendicitis a two-looped ligation of appendiceal stump was used. Parameters like duration of surgery, use of antibiotics and analgesics, hospital stay and complications were reviewed. Extracorporeal two-looped ligation of appendiceal stump during laparoscopic appendectomy was used in 102 children (48 males and 54 females). Mean age at the date of operation was 12.02±0.33 years. Operation time was 28.04±1.02 minutes. Length of hospitalization was 6.08±0.08 days. Mean duration of antibiotic treatment was 3.52±0.09 days. Mean duration of analgesics use was 2.26±0.06 days. There were no intraoperative or postoperative complications. The two-looped ligation of appendiceal base is safe and effective during laparoscopic appendectomy in children. In our case, no complications were noted.
Manal Mohamed Helmy Nabo
Al Rayan College, Saudi Arabia
Title: Can multi-detector computed tomography classify non-compacted left ventricle in coloration to the genetic structure?
Biography:
Manal Mohamed Helmy Nabo has completed the master in pediatrics at the age 28 from Sohag University. The PhD and MD degree at the age of 34 years from Japan, Tokushima university.
Abstract:
Isolated left ventricular non-compaction (LVNC) is a genetic cardiomyopathy. Many genes are affected in this type of cardiomyopathy. Commonly echocardiography is used for diagnosis. Recently, Multi-detector computed tomography is used in diagnosis of cardiac and extracardiac structures. The LVNC runs in families. The goal of our research to show that MDCT can diagnose LVNC clearer than echocardiography. We suggest that MDCT can detect the genetic pattern of the LVNC. This mean special shape and arrangement of cardiac muscle guide to special form of genetic disorder. There is a great advance in diagnosis and management of congenital heart disease. One of the great interests is multi detector computed tomography (MDCT). The echocardiography is the standard of the diagnosis of cases with cardiac disease. There are many types of genetic disorders that result in different arrangement of the endocardium. These differences can’t be clearly evaluated by echocardiography in contrast to MDCT. MDCT will find correlation between the morphological and the genetic pattern.
Meidelin Hoei
Ospital ng Maynila Medical Center, Philippines
Title: Clinico-demographic profile and outcome of twin pregnancies in a tertiary government hospital: A three-year retrospective study
Biography:
Meidelin Hoei completed her Bachelor of Medicine and Bachelor of Surgery degree from Suzhou University, China. She is currently pursuing her Residency in Pediatrics at one of the training institutions in Philippines, Ospital Ng Maynila Medical Center.
Abstract:
Introduction: Multiple births have been associated with increased maternal and fetal morbidity and mortality during delivery. They are associated with higher cases of prematurity and low birth weight. It is important to review trends in multiple pregnancies and their outcomes to be able to identify opportunities for intervention in improving both maternal and neonatal outcomes. The study aims to provide more data on profiles of mothers and infants born with multiple pregnancies, their outcomes providing baseline data for hospitalbased protocols and management of future multiple pregnancies.
Objective: To describe the clinico-demographic profile and outcome of twin pregnancies in a tertiary government hospital
Study Design: Retrospective descriptive cross-sectional study
Setting: Neonatal Intensive Care Unit and Delivery Room of a tertiary government hospital
Study Population: Mother and newborns born at a tertiary government hospital
Results: Among 100 twin births delivered between 2014-2016, 58% were born to the mothers from age group of 20 to <30 years old. Most of the twins were full term and delivered by caesarean section with birth weight of 1000-2000 grams. 45 babies were admitted to NICU mostly due to prematurity with respiratory distress syndrome as number one immediate cause of mortality.
Conclusion: The incidence of twin birth in Philippines is still lower than in other continents. Advanced maternal age and increase gravidity and parity may have a role in increased twinning rates. Prematurity, respiratory distress syndrome stills one of the most common complications and cause of death in twin births.
Break: Lunch Break 13:00-14:00 @ Restaurant
- Neonatal Surgery & Complications | Neonatal Nursing & Intensive Care Units | Neonatal Infectious Diseases & Antibiotics | Neonatal Pulmonary Disorder & Resuscitation | Neonatal and Pediatric Cardiology | Preconception Health or Fertility | Prevention of Major Obstetric Syndromes | Neonatal Dermatology and Allergy Oncology | Pediatric & Neonatal Vaccines | Child & Adolescent Obesity
Location: Istanbul, Turkey
Session Introduction
Rashida Ablatayeva
Khoja Akhmet Yassawi International Kazakh-Turkish University, Kazakhstan
Title: Successful surgical management of acute appendicitis in children using a two-looped ligation during laparoscopic appendectomy
Time : 11:30-12:00
Biography:
Rashida Ablatayeva is currently pursuing her Doctoral degree from Khoja Akhmet Yassawi Kazakh-Turkish International University, Department of Medicine. Her scientific work is connected with laparoscopic surgery.
Abstract:
Acute appendicitis is a common pathology in pediatrics. Laparoscopic Appendectomy (LA) is the main type of surgical treatment of appendicitis. During surgery stump closure is the most crucial moment. Appendiceal ligation may be performed using looped suture, stapler or clip. Closing the appendix base with knot tying is the most cost-effective method. The data of children who underwent LA from January 2017 to December 2017 were obtained from retrospectively collected database. During surgical management of complicated and uncomplicated acute appendicitis a two-looped ligation of appendiceal stump was used. Parameters like duration of surgery, use of antibiotics and analgesics, hospital stay and complications were reviewed. Extracorporeal two-looped ligation of appendiceal stump during laparoscopic appendectomy was used in 102 children (48 males and 54 females). Mean age at the date of operation was 12.02±0.33 years. Operation time was 28.04±1.02 minutes. Length of hospitalization was 6.08±0.08 days. Mean duration of antibiotic treatment was 3.52±0.09 days. Mean duration of analgesics use was 2.26±0.06 days. There were no intraoperative or postoperative complications. The two-looped ligation of appendiceal base is safe and effective during laparoscopic appendectomy in children. In our case, no complications were noted.
Manal Mohamed Helmy Nabo
Al Rayan College, Saudi Arabia
Title: Can multi-detector computed tomography classify non-compacted left ventricle in coloration to the genetic structure?
Time : 12:00-12:30
Biography:
Manal Mohamed Helmy Nabo has completed the master in pediatrics at the age 28 from Sohag University. The PhD and MD degree at the age of 34 years from Japan, Tokushima university.
Abstract:
Isolated left ventricular non-compaction (LVNC) is a genetic cardiomyopathy. Many genes are affected in this type of cardiomyopathy. Commonly echocardiography is used for diagnosis. Recently, Multi-detector computed tomography is used in diagnosis of cardiac and extracardiac structures. The LVNC runs in families. The goal of our research to show that MDCT can diagnose LVNC clearer than echocardiography. We suggest that MDCT can detect the genetic pattern of the LVNC. This mean special shape and arrangement of cardiac muscle guide to special form of genetic disorder. There is a great advance in diagnosis and management of congenital heart disease. One of the great interests is multi detector computed tomography (MDCT). The echocardiography is the standard of the diagnosis of cases with cardiac disease. There are many types of genetic disorders that result in different arrangement of the endocardium. These differences can’t be clearly evaluated by echocardiography in contrast to MDCT. MDCT will find correlation between the morphological and the genetic pattern.
Meidelin Hoei
Ospital ng Maynila Medical Center, Philippines
Title: Clinico-demographic profile and outcome of twin pregnancies in a tertiary government hospital: A three-year retrospective study
Time : 12:30-13:00
Biography:
Meidelin Hoei completed her Bachelor of Medicine and Bachelor of Surgery degree from Suzhou University, China. She is currently pursuing her Residency in Pediatrics at one of the training institutions in Philippines, Ospital Ng Maynila Medical Center.
Abstract:
Introduction: Multiple births have been associated with increased maternal and fetal morbidity and mortality during delivery. They are associated with higher cases of prematurity and low birth weight. It is important to review trends in multiple pregnancies and their outcomes to be able to identify opportunities for intervention in improving both maternal and neonatal outcomes. The study aims to provide more data on profiles of mothers and infants born with multiple pregnancies, their outcomes providing baseline data for hospitalbased protocols and management of future multiple pregnancies.
Objective: To describe the clinico-demographic profile and outcome of twin pregnancies in a tertiary government hospital
Study Design: Retrospective descriptive cross-sectional study
Setting: Neonatal Intensive Care Unit and Delivery Room of a tertiary government hospital
Study Population: Mother and newborns born at a tertiary government hospital
Results: Among 100 twin births delivered between 2014-2016, 58% were born to the mothers from age group of 20 to <30 years old. Most of the twins were full term and delivered by caesarean section with birth weight of 1000-2000 grams. 45 babies were admitted to NICU mostly due to prematurity with respiratory distress syndrome as number one immediate cause of mortality.
Conclusion: The incidence of twin birth in Philippines is still lower than in other continents. Advanced maternal age and increase gravidity and parity may have a role in increased twinning rates. Prematurity, respiratory distress syndrome stills one of the most common complications and cause of death in twin births.
Break: Lunch Break 13:00-14:00 @ Restaurant
- Poster Presentations
Location: Istanbul, Turkey
Session Introduction
June Murphy
Henry Ford Health System, USA
Title: Abnormal placentation and role of OR/IR hybrid suite for cesarean deliver
Biography:
June Murphy is currently working at Henry Ford Health System, USA
Abstract:
Introduction: Abnormal Placentation (AP) or accreta spectrum disorders carry high risk for intrapartum hemorrhage. Risk factors for AP are prior cesarean section, placenta previa, uterine anomalies, uterine surgery and multiparity. AP is reported to be the most common indication for peripartum hysterectomy and cause of hemorrhage. An obstacle to Interventional Radiology (IR) services is location away from labor and delivery. Four cases of IR/OR hybrid suite usage are reviewed in setting of suspected AP.
Case Description
Case 1: Suspected focal accreta to submucosal fibroid 33 y.o. G 2 P1001 , prior c/s focal area of adherent placenta at fundus with submucosal fibroid adherent to placenta. Given the concerns with bleeding at time of placental removal, patient had c/s at 37 weeks with delivery in hybrid suite with occlusion balloons. Blood loss was 800cc, uterus preserved. All did well.
Case 2: 35 y.o. G 3 p1001 C/S planned at 32 weeks given percreta, bulging lower uterine segment and pain. C/S performed in IR/OR hybrid suite. Occlusion balloons used and embolization performed. EBL was 4000 cc, 1135 cc in cell saver, 5 units of PRBC, 1 unit of platelets, 3 units of FFP, 3600 cc crystalloids. Hysterectomy performed. All did well.
Case 3: 33 y.o. G 2 P0010 33 weeks due to bleeding, placenta previa and accreta. Delivery in IR/OR hybrid suite with occlusion balloons, end embolization with gel foam. 2000 cc blood loss, preserved uterus. Next pregnancy 3 years later with previa and percreta, and urgent c/s for bleeding at 32 5/7 weeks gestation, hybrid suite was not available. C/S hysterectomy in main OR with 1200 cc blood loss and 1 liter from cell saver transfused. All did well.
Case 4: 35 y.o. G 3 p2002 with scheduled C/S at 34 weeks suspected increta, previous c/s x2, previa. C/S in IR//OR hybrid suite with balloons in place, not inflated. 3500 cc blood loss, 4 units transfused from cell saver, 1 unit of FFP, 6500 cc of crystalloid. Hysterectomy performed. All did well post op.
Conclusion: The OR/IR hybrid suite has significant utility in obstetrics in cases of AP and anticipated hemorrhage. Advanced interventions such as embolization are also helpful in decreasing blood loss. OR/IR hybrid suite usage in this setting for cesarean delivery in obstetric patients with AP, may also lead to uterine preservation through the combination of minimally invasive and standard surgical management.
Key terms: AP-abnormal placentation such as accreta, increta and percreta, IR-interventional radiology, ORoperating room, hybrid suite- IR/OR capable room, C/S- cesarean section, EBL- estimated blood loss, FFP- fresh frozen plasma, PRBC- packed red blood cells. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Researchers have reported the incidence of placenta accreta as 1 in 533 pregnancies for the period of 1982–2002 (5). This contrasts sharply with previous reports, which ranged from 1 in 4,027 pregnancies in the 1970s, increasing to 1 in 2,510 pregnancies in the 1980s Interventional Radiology services have been shown to be a useful adjunct in cases of abnormal placentation. IR Balloons have been shown to lower pulse pressure and blood loss in complicated obstetrics cases and may assist in uterine preservation and lower incidence of massive transfusion. In traditional settings, placement of catheters in IR suite and then moving patient to the OR creates an obstacle as confirming proper placement with C-ARM in OR prior to inflating leads to an extra step in management. Using an IR/ OR suite avoids need for moving patient and then confirming proper placement prior to using.
Key points in patient management
• Patients with suspected abnormal placentation or previa referred to MFM.
• Detailed fetal sonogram performed for anatomy
• Patients with sonographic markers for accreta such as hypervascularity previa, lack of retroplacental clear space, lacunar spaces identified and counseled regarding risks for AP
• Consultations with urology, interventional radiology, blood back, per fusionist for cell saver technology, gynecologic oncology for surgical backup
• Patients have MRI in third trimester if concerns for percreta
• Delivery timing at 34-35 weeks scheduled unless indicated earlier.
• NICU consultation regarding prematurity risks for newborn
• Steroid administration at 33 weeks unless indicated earlier.
• Patient in OR/IR hybrid suite
• Multidisciplinary conference and plan in third trimester to allow planning for delivery
Bahytzhan Orazaliev
Karaganda Medical University, Kazakhstan
Title: A case study patient with the neuronal ceroid lipofuscinoses
Biography:
Baurzhan Orazaliev is currently pursuing his Pediatric Intern at Karaganda Medical University. He has published 9 articles and participated to discrepancy international student conferences.
Abstract:
Introduction & Aim: The Neuronal Ceroid Lipofuscinoses (NCLs) are a group of related hereditary neurodegenerative disorders that occur at a frequency of between 2 and 4 in 100,000 live births. There is no effective treatment for NCL and all childhood forms are eventually fatal. Several forms of NCL are differentiated according to age of onset, pathology, and genetic linkage. The aim of this study was to describe the clinical and electroencephalographic findings of children with neuronal ceroid lipofuscinoses, respectively.
Case Report: A male patient of 14 years at the time was born with a body weight - 3400, height - 50 cm at birth by Caesarean section, during pregnancy, the mother had a mitral valve insufficiency. The child developed according to age till 4 years. He was complained to lack of walking, hand tremor, weakness in the lower limbs, Vinpocetine 5mg and Hopantenic acid 750 mg per day was administrated. At the age 5 years was complained to generalize myoclonic seizures by every hour and a slack paraparesis. MRI and EEG at the age 5 years revealed mixed hydrocephaly and disorganization of cortical rhythm, irritation of medium structures, damage to stem structures. Electromyography admitted degenerative changes with a decrease in bioelectric activity in the muscles of both limbs. Treatment scheme was Valproic acid 500mg per day, however progressed delay mental and psychomotor development, increasing paroxysmal myoclonic seizures. Phenotypic changes developed such as severe deformity of the skeleton, the underdevelopment of the middle third skull, while forming of trema and diastema (Fig. 1), cachexia. In the following years, he exhibited a progressive loss of expressive language and only can follow commands to smile or look in all specific directions and became bed-dependent, also present amaurosis. Multiple pathology of internal organs is also noted (Tab.1). thrombocytopenia developed (PLT 30*109/l) (Tab.2) due to VPA 800 mg per day
Results: Karyotype analysis report a single specimen has not detected any abnormalities in structure, karyotype 46,XY. The test based on Clinical Medical Institute of Urumqi General Hospital, Landzhou Command, PLA. In 2017 MRI demonstrated residual organic encephalopathy with atrophy of the large brain, gray matter, which is characteristic for NCL. Based on genealogical tree (Fig.4), was admitted a consanguineous marriage (first-degree cousins).
Conclusion: Based on MRI, phenotypical changes and genealogical tree of this patient, enzymatic and genetic studies should be performed since accurate enzymatic or molecular diagnosis will enable treatment and family counseling. Better awareness of the disease will facilitate timely strategies for the specific management of NCL disease will decrease a high mortality rate. Disease-specific management, genetic counseling, and new therapies in development for NCL disease make early and accurate diagnosis of this severe neurodegenerative disease essential.
Adeviye Elçi Atılgan
Necmettin Erbakan University, Turkey
Title: Which surgical technique is most effective for postpartum hemorrhagic cases?
Biography:
Adeviye Elçi Atılgan got high quality basic medical education at UludaÄŸ Üniversity Faculty of Medicine in the period of 2002-2009 in Turkey. She is also member of Society of Ürogynaecology in Turkey She had master certificate on Urogynaecology surgries from BahçeÅŸehir University, She also got three other certificas on Emergency Obstetric Attention, Laparoscopy and Histerescopy from Ministry of Health in Turkey. She has contınued experience on Cosmetic Vaginal Surgery by successfully Master Course on March in 2015 in Athens –Greece by DR Alexandros Bader and got Master degree certificate on Cosmetic Vaginal Surgery.
Abstract:
Objective: To determine the most effective surgical method in postpartum hemorrhagic cases, this is a preventable and threatening mother’s life.
Method: This study was retrospectively reviewed from file archives and electronic file environment of Necmettin Erbakan University, Meram Medical Faculty Hospital, Gynecology and Obstetrics Clinic and patients who underwent a surgical procedure due to Postpartum Hemorrhage (PPH) between January 2010 and December 2014.
Results: Between January 2010 and December 2014, total 19535 deliveries were performed in our hospital. 48.6% of the deliveries were by cesarean and 52.4% by Normal Spontaneous Vaginal (NSD) route. 320 of these patients required surgical intervention in 240 of them. The most frequent etiologic cause for surgical intervention was found to be the uterine atony and placenta previa. The most effective surgical technique we used in this period in PPH patients was Acar technique (87.4%). The incidence of peripartum hysterectomy was 0.21/1000 in this period and one mother lost her life due to pulmonary embolism after hysterectomy.
Conclusion: As a result of this study, we found that acar technique was the most effective, fast and easy to administer in PPH management, with the least post-operative complication rate, requiring minimal blood and blood product replacement, minimum inpatient hospital stay. The clinician needs to be ready for PPK management at all times as surgical technique, experience and equipment, while increasing factors such as increased cesarean ratios, increased placental adhesion anomalies, increased maternal age, increased treatment pregnancies and multiple pregnancies are increasing day by day. They must follow new developments in this regard closely, be encouraged to apply new techniques, perform fast, effective and least invasive applications so as not to put the patient's life in danger.