Day 3 :
- Track 7: Pediatric Trauma
Track 8: Pediatric Diseases Diagnosis
Track 9: Pediatric Diseases Treatment
Location: Conference Hall
Session Introduction
Jichuan Wang
Children’s National Medical Center, USA
Title: Plausible values of latent variables: A useful approach of data reduction for psychiotric measures
Time : 09:30-09:55
Biography:
Jichuan Wang has completed his PhD from the Sociology Department, Cornell University and postdoctoral studies from the Population Studies Center, University of Michigan. He is a senior biostatistician at Children’s Research Institute, CNHS. He has published three statistical books and authored/coauthored more than 100 peer-reviewed journal article with more than 30 first-authored. He has been serving as editorial board members of five academic journals.
Abstract:
A challenge in application of Psychotric measures is there are too many variables/items in a scale (e.g., depression, anxiety, …). The often used data reduction approaches are to generate total scale scores or estimated factor scores. The former is simply to sum item scores and the latter is to estimate factor scores from factor analysis model. However, the problems are: the total score does not take into account of measurement errors; and using factor scores or IRT scores as dependent variables in further analysis gives biased slopes (Asparouhov & Muthén, 2010). Such biases can be alleviated by using a recently developed technique - plausible values of latent variables that are a set of generated values of factor scoroes using MCMC Bayesian approach (Mislevy, 1991; Asparouhov & Muthén, 2010). The plausible values can be estimated not only for continuous latent variables (e.g., factors), but also for categorical latent variables (e.g., latent classes). The plausible values of factors or latent class membership can be used as observed variables for further analysis and provide more accurate parameter estimates, compared with the traditional estimates of latent variables (e.g., factor scores or IRT scores). When the plausible values are used in subsequent analysis, multiple imputed plausible value data sets are used and analyzed just like multiple imputations (MI) data sets, i.e., by combining the results across the imputations using Rubin's (1987 ) method. This presentation will demonstrate how to estimate and apply plausible values of depression and anxiety scales using real-world research data.
Ping-I (Daniel) Lin
Cincinnati Children’s Hospital Medical Center, USA
Title: Unraveling novel genetic pathways in autism through gene-environment interactions
Time : 09:55-10:20
Biography:
Lin obtained his PhD and MD from Johns Hopkins University and National Taiwan University, respectively. He is trained as a psychiatrist and genetic epidemiologist. He currently holds the position of Assistant Professor at Cincinnati Children’s Hospital Medical Center in Ohio, U.S.A. His publications in the field of neuropsychiatric research have been thus far cited by 1075 studies. His current research interests have been focused on the neurobiological basis of behavioral traits that cur across pediatric psychiatric disorders.
Abstract:
Gene-environment interactions may contribute to the risk of autism spectrum disorder (ASD). Previous evidence has inconclusively suggested that prenatal exposure to some medications may be associated with the risk of ASD. Little is know whether these medications may interact with some ASD-related genes to influence the risk of ASD. I have proposed a novel multi-step approach that combines bioinformatics screening and statistical interaction scans, to identify interactions efficiently supported by convergent lines of evidence. First, we have identified overlapped genes shared by ASD and several class A-C drugs, and quantified the level of attributable risk of each drug in the context of susceptibility to ASD. We found that that ASD-related genes, such as INPP1, KIF5C, and ST7 genes, of which expressions might be perturbed by a terbutaline – a beta 2 adrenergic receptor agonist. Our genome-wide interaction scan on 3,700 cases of ASD provides further discovered several variants in the ST7 (Suppression of Tumorigenicity 7) gene were significantly over-represented in cases with prenatal terbutaline exposure compared to cases without prenatal terbutaline exposure (p < 0.0001). The convergent approach has confirmed that terbutaline may modify the effect of ST7 on the risk of ASD. These findings have also lent some support to the prior findings on the comorbidity link between ASD and cancers. Further research on the impact of terbutaline-induced in-vivo functional changes of the ST7 gene on ASD-like phenotypes is warranted to validate our screening results.
Andreas C Petropoulos
Azerbaijan State Medical University, Azerbaijan
Title: Prevention of cardiac diseases. A new role for the primary care Pediatrician /Family Physician
Time : 10:40-11:05
Biography:
Andreas Petropoulos graduated from Aristotle University’s Medical School, Greece in 1989. Followed 30 year career as a medical officer, senior Flight Surgeon in the Hellenic Air-Force. Specialized in Aviation & Hyperbaric Medicine, Pediatrics, Fetal, Pediatrics and Congenital Cardiology in USA and Europe. Holds M.Sc in Preventive Cardiology. An AEPC Prevention and Heart Failure/Pulmonary Hypertension, working group’s member. Worked and lectured in Athens and Brussels universities. Currently consults in Fetal, Pediatrics and Congenital Cardiology in Merkezi Klinika and is Associate Professor at the State University and Post Graduate and CME Center in Azerbaijan. His research focuses on prevention, CVD imaging techniques, fetal cardiology, and heart failure.
Abstract:
The aim of this paper is to present to the primary care pediatricians and family practitioners the preventive, diagnostic and therapeutical measures they can apply to lift the burden of cardiac disease in childhood. Although preventive policies are long time applied both to the adult and the pediatric population the burden of cardiovascular diseases is increasing worldwide. Obesity and essential hypertension are the leading conditions in childhood. Do we know how to prevent or treat them? The use of pulse oximetry after the first 36 to 48 hours post birth increases the early detection of critical and cyanotic congenital heart diseases. When present in an initial assessment of a neonate re we aquatint with this screening method? Frequently the primary care providers are asked to evaluate a child before been involved in sports activities. What seems to be the best algorithm and when we shall reefer a child for a specialist consultation? Finally as populations are rapidly migrating around the world, is it time to remember rheumatic fever and its cardiac involvement? All above questions when answered will underline a new role for the primary care pediatrician and family physician.
Jhulan Das Sharma
Southern Medical College, Bangladesh
Title: Do preterm neonates require thyroxine replacement?
Time : 11:05-11:30
Biography:
Jhulan Das Sharma obtained MBBS ,in 1976, FCPS(Fellow of College of Physicians & Surgeons) MD(Doctor of Medicine)& PhD in 1976, 1990, 1998 & 2010 respectively . I worked as Assistant Professor in Pediatrics since 1993 to work in different Medical Colleges of Bangladesh including Institute of Postgraduate Medicine & Research, Dhaka. I worked as Associate Professor since 1999 & presently working as Professor of Pediatrics in Southern Medical College, Chittagong from January 2011. I am involved in teaching & examination of undergraduate & postgraduate examinations for last 15 years. I have 35 publications in different journals.
Abstract:
Abstract: Context: Debate still exists about the necessity of thyroxine replacement in hypothyroxinaemic preterm neonates. The dilemma is that delaying replacement will impair growth and development, especially neurological development while early replacement may have adverse metabolic effect resulting from increased oxygen consumption of preterm newborns suffering from hypoxia. Moreover once replacement is initiated, it may injudiciously be used for prolonged period. Background: Transient hypothyroxinaemia is the most common thyroid dysfunction in preterm postnatals, and is characterized by low sera levels of T4 and FT4. The aetiology is not clear, but may have been due to the withdrawal of maternal placental T4 transfer, expression of temporary HPT axis immaturity, or a nonthyroidal illness. The problem is reported to be present in majority of infants born at less than 30 weeks gestation and is associated with increases in perinatal mortality and morbidity as well as later neurodevelopmental deficits. Objectives: To compare thyroid function in preterm and term neonates and to observe whether preterm neonates with hypothyroxinaemia need thyroxine replacement at the earliest or the treatment may as well be started, with proper follow ups, at about 6 weeks. Methods: An observational study was done during the period of July 2008 to June 2010 in the neonatal and postnatal unit of the Chittagong Medical College Hospital.It focuses on comparison of thyroid function (FT4 and TSH) between preterm and term neonates aged average 7 days with all samples collected after 5 days of life, the time when postnatal TSH surge disappears. One hundred (100) preterm and 50 term infants were selected by convenient sampling. Preterm infants were stratified by postconceptional age. FT4 and TSH estimation were done by the 3rd generation two site chemiluminesent immunometric assay. Serum levels of FT4 and TSH of preterm infants were followed after 6th week (45-50 days) of their age and were compared with their 1st samples (5-11 days). Results: The FT4 level correlated positively with gestational age (p<0.0001, n=150, r=0.61) and differed significantly between adjacent gestational age groups (p=0.0001). No significant differences were found in TSH levels of such age groups of the preterms. TSH level correlated positively with gestational age in the 1st samples but in the 2nd samples significant negative correlation was observed suggesting HPT axis maturity. In preterm neonates subgroup analysis showed highly significant difference in FT4 and TSH levels between 1st and 2nd samples. Conclusion: In preterm infants born at <28 weeks’ gestation, it usually takes more than one month for FT4 levels to reach level equal to those of term infants. In this study, FT4 levels were found to increase in all infants who had initial hypothyroxinaemia and did not receive thyroxine supplementation during the first 6 weeks of postnatal life. This indicates that thyroxine supplementation should be considered if free T4 levels are persistently low after the first 6 weeks of birth. Further studies are needed before clinical application of this finding.
Salah Thabit Al Awaidy
Ministry of Health, Oman
Title: Epidemiology of pandemic H1N1 in Oman and public health response, 2009
Time : 11:30-11:55
Biography:
Salah Thabit Al Awaidy is a Communicable Diseases Adviser in Health Affairs, Ministry of Health, Oman. He is a medical doctor and holds a Master’s in Epidemiology. He is currently the adviser of Communicable Disease Surveillance, Elimination and Eradication of Communicable Diseases of Public Health Importance, EPI, vaccine supply chain system and IHR at the Ministry of Health, Oman. He was the Director of Communicable Disease Surveillance and Control at MoH, HQ, Oman between 1997-2011, IHR national focal point 2002-2013 and was a member in several of the professional committees namely: Strategic Advisory Group on Immunization (SAGE), WHO Geneva (2005-2007); Strategic Advisor Group on Vaccine and Store Management Training Courses (2005-2008), WHO Geneva; Strategic TB Advisory Board (STAG) 2007-2011 2014- till date. He also currently serves as IHR Emergency Committee on Polio and MERS-CoV. He has authored or been the co-author of over 35 publications on a large variety of health topics.
Abstract:
Oman has committed to the goal of eliminating measles, rubella and congenital rubella syndrome (CRS) by 2015 year. Elimination is defi ned as the absence of endemic measles and rubella transmission in a defi ned geographical area (e.g. region or country) for ≥12 months in the presence of a well-performing surveillance system and for rubella without the occurrence of Congenital Rubella Syndrome (CRS) cases associated with endemic transmission in the presence of high-quality surveillance system. Strategies to reach this goal included: a) vaccination supplemental activities with the goal of achieving high rates of vaccination coverage; and maintenance of coverage in order to increase population-wide and maintaining high vaccination coverage to increase population-wide immunity; b) syndromic surveillance programs to monitor fever and rash illness syndromes for eff ective detection of cases and serological surveillance; c) integrating these strategies into measles surveillance system; and) high-quality surveillance system, and sensitive for CRS. Measles and rubella was a leading cause of infant and child morbidity and mortality in Oman before the introduction of measles vaccine by 1975 and thereaft er until 1994. With the introduction of a second dose of measles and fi rst rubella vaccines (measles- rubella) in 1994, coverage for fi rst and second doses of measles and rubella vaccines increased more than 95% in 1996 and has been sustained at a level greater than >95% since then. A national measles and rubella (MR) immunization catch-up campaign targeting children ages 15 months to 18 years was conducted in 1994 that achieved 94% coverage. As a result, the incidence of measles and rubella have declined markedly in recent years, to ≤1 case per million persons in 2012 and to zero cases for measles and rubella in 2013 and onward. Similarly, no case of CRS has been notifi ed since 2007. Oman has made signifi cant progress toward measles and rubella elimination and has met the regional elimination goals. However, new challenges faced by Oman, for instance with increased globalization, has led to issues such as outbreaks from imported cases. Additional challenges still remain with regard to increasing identification and immunization of unvaccinated non-Omani workers and their families.
Kazi S Anwar
AIMST University, Malaysia
Title: Naso-pharyngeal Hemophilus infl uenzae in Bangladeshi children suffering from pneumonia: Disese severtity and possible risk factors
Time : 11:55-12:20
Biography:
Globally, pneumonia remains the leading cause of child-death more than combined AIDS, malaria and measles. Of all H. infl uenzae strains causing pneumonia in younger children, non-Hib (Hia, Hic, Hif) and non-typeable strains have started replacing b signifi cantly. Of some exsiting factors, popultion characterisitcs, child-bearing/rearing practices, housing and sanitation status remain plusible in contracting childhood-pneumonia. Th is paper describes some of such factors towards developing pneumonia in Bangladeshi children requiring immediate attention to resolve. Nasopharyngeal-swabs taken from 277 under-fi ve years pneumonic children in Dhaka Medical College Hospital (not receiving >1 antibiotic) were streaked onto supplemented chocolate-agar. Isolated colonies were serotyped and antimicrobial susceptibility were performed. While the mean age was 1.41±1.4 years, no age-specifi c gender diff erence was revealed (p>0.16). Clinically,157 children (69%) had pneumonia (Pnm) and 70 (31%) had Severe Pnm (SPnm) having the predominant signs of chest in drawing (p<0.04) and stop feeding-well than Pnm (p<0.001). While disease severity, was not assoicated with age-groups of <2, 2.1-12 & 12.1-60 months(p=0.26) a gender diff erence was observed: younger boys had SPnm more than girls (p<0.03). H. infl uenzae were isolated from 35.7% children (81/227), vast-majority being non-typeable (87.7%, 71/81) and 13.3% Hib (10/81) but Hin-types was not associated with disease severity (p>0.10). However, disease-severity was signifi cantly associated with colustrumrejection( p<0.02), bottle-feeding (p<0.04), non-vaccination (p<0.03) and some soico-economic/houshehold factors, like: tinned-roof-house (p<0.04), parental smoking (p<0.01) and cooking indoor on charcoal/wood-fi re (p<0.02). It is imparative that the aforementioned socio-cultural bariers and neglected child-caring/rearing practices as we evidenced should immediately be addressed towards preventing children from pneumonia- a potential public health issue. Further studies in this area are strongly recommend for better clarifi cations.
Abstract:
Globally, pneumonia remains the leading cause of child-death more than combined AIDS, malaria and measles. Of all H. infl uenzae strains causing pneumonia in younger children, non-Hib (Hia, Hic, Hif) and non-typeable strains have started replacing b signifi cantly. Of some exsiting factors, popultion characterisitcs, child-bearing/rearing practices, housing and sanitation status remain plusible in contracting childhood-pneumonia. Th is paper describes some of such factors towards developing pneumonia in Bangladeshi children requiring immediate attention to resolve. Nasopharyngeal-swabs taken from 277 under-fi ve years pneumonic children in Dhaka Medical College Hospital (not receiving >1 antibiotic) were streaked onto supplemented chocolate-agar. Isolated colonies were serotyped and antimicrobial susceptibility were performed. While the mean age was 1.41±1.4 years, no age-specifi c gender diff erence was revealed (p>0.16). Clinically,157 children (69%) had pneumonia (Pnm) and 70 (31%) had Severe Pnm (SPnm) having the predominant signs of chest in drawing (p<0.04) and stop feeding-well than Pnm (p<0.001). While disease severity, was not assoicated with age-groups of <2, 2.1-12 & 12.1-60 months(p=0.26) a gender diff erence was observed: younger boys had SPnm more than girls (p<0.03). H. infl uenzae were isolated from 35.7% children (81/227), vast-majority being non-typeable (87.7%, 71/81) and 13.3% Hib (10/81) but Hin-types was not associated with disease severity (p>0.10). However, disease-severity was signifi cantly associated with colustrumrejection( p<0.02), bottle-feeding (p<0.04), non-vaccination (p<0.03) and some soico-economic/houshehold factors, like: tinned-roof-house (p<0.04), parental smoking (p<0.01) and cooking indoor on charcoal/wood-fi re (p<0.02). It is imparative that the aforementioned socio-cultural bariers and neglected child-caring/rearing practices as we evidenced should immediately be addressed towards preventing children from pneumonia- a potential public health issue. Further studies in this area are strongly recommend for better clarifi cations.
Larry Olson
Emory University School of Medicine, USA
Title: New methods to identify and cure a common cause of medically intractable epilepsy
Biography:
Larry Olson is a child neurologist at Emory University and Children’s Healthcare of Atlanta with 30 years of experience in epilepsy surgery evaluations using EEG and neuroimaging. For the past 7 years he has had a major focus on using freely available software to improve on the sensitivity of conventional neuroimaging for epilepsy surgery, especially in common cryptogenic cases.
Abstract:
Epilepsy is the most common neurological disease in childhood, and fourth most common in adults. Up to 30% of cases cannot be controlled with medication. The most common cause of these medically refractory seizures is a focal cortical dysplasia (FCD), a localized region in the cortex where neuronal formation, migration or lamination is abnormal. These are often seen with high resolution MRI, and are easily resected with a cure rate of up to 85%. However FCDs are also very often “cryptogenic”- extremely small, subtle or inapparent on MRI. This talk will explore why conventional neuroimaging frequently fails, and the development of new methods of image processing which combine MRI and positron emission tomography (PET) in novel ways to expose otherwise invisible FCDs. This process permits successful surgical cures of an otherwise lifelong disease with a significant morbidity and mortality.
Taosheng Huang
Cincinnati Children's Hospital Medical Center, USA
Title: Application of whole-exome sequencing to identify novel disease causing genes associated with mitochondrial disease
Biography:
Taosheng Huang is a physician-scientist. Currently he is a professor with tenure in Human Genetics, Director, Program of Mitochondrial Medicine, Associate Director of the Molecular Diagnostic laboratory at Cincinnati Children's Hospital Medical Center (CCHMC). Dr. Huang graduated from Fujian Medical University in 1983 and received his Ph.D. study at Mount Sinai Medical School in 1991. Dr. Huang completed his pediatrics residency at Georgetown University Hospital in 1996 and his clinical genetics and clinical molecular genetics fellowship at Harvard Medical School in 1999. Dr. Huang was a faculty member at the Children’s Hospital, Harvard from 1999-2001. In 2001, Dr. Huang moved to the University of California, Irvine as an independent investigator to study the molecular basis of genetic syndromes. Clinically, Dr. Huang is interested in mitochondrial disorders, genetic syndromes with congenital cardiac defects. He has been actively engaged in many programs in China. Dr. Huang is an honorable professor of Peking Union Medical School, a member of the special committee for Yusheng Yuyou of People’s Republic of China, advisory board member to Chinese Ministry of Health for targeted therapy and a principal investigator for birth defect control program of Chinese Ministry of Health.
Abstract:
Advances in next generation sequencing technology have resulted in a rapid increase in the molecular characterization of mitochondrial disease. Recent years, our laboratory has successfully used whole-exome sequencing to identify many novel disease causing genes associated with mitochondrial disease. The mitochondrial asparaginyl-tRNA synthetase (NARS2) mutations cause Leigh syndrome and nonsyndromic hearing loss (DFNB94). We found that some mutation can disrupt dimerization of NARS2 and decrease steady-state levels of mt-tRNAAsn without aminoacylation defects. The cells with NARS2 mutations also display impaired oxygen consumption rate and OXPHOS deficiency that can be rescued by overexpression of wild type NARS2. Recently, we found that recessive SLC25A46 mutations cause optic nerve atrophy and axonal peripheral neuropathy. SLC25A46, putative mitochondrial carrier gene, is human homologs of Ugo1p. Furthermore, we demonstrate the SLC25A46 role in mediating mitochondrial morphology in vitro and in vivo. In zebrafish we found that loss-of-function affects the development and maintenance of neuronal processes and causes abnormal mitochondrial fusion morphology. Our result show many disease causing genes associated with mitochondrial disease are yet to be identified and whole-exome sequencing is very cost-effective for this process.
Jessica Furtado
University of Toronto, Canada Holland-Bloorview Kids Rehabilitation Hospital, Canada
Title: Pediatric medical trauma and resilience: Exploring children’s perspectives
Biography:
Jessica Furtado is currently pursuing Masters in Social Work from the University of Toronto, Factor-Inwentash Faculty of Social Work. Previously, she has completed an Honors’ Bachelor of Applied Science in Child, Youth, and Family Studies and is a Registered Early Childhood Educator. She is currently completing a research placement at Holland Bloorview Kids Rehabilitation Hospital, where she is working on her Master's thesis exploring children's perspectives of pediatric medical trauma and resilience. She hopes to complete a PhD in the future and practice as a clinical researcher in pediatric health and mental health.
Abstract:
Pediatric medical trauma (PMT) is a form of childhood trauma that includes the physical and psychological effects of injuries, pain, and illness, as well as the experience of hospitalization, medical treatments, and other procedures. The effects of PMT can trigger a range of mental health concerns such as acute stress disorder, post-traumatic stress disorder, depression and anxiety. Yet few studies have explored resilience in children experiencing PMT, particularly from a child's perspective. Thus, this study will use semi-structured interviews to explore the experiences of ten to twelve English-speaking Specialized Orthopedic and Developmental Rehabilitation (SODR) inpatients aged 6-12 at a children’s rehabilitation hospital located in Toronto, Ontario. The four main research questions to be explored are: 1) In what ways do children consider their medical experiences traumatic, or not? (2) How do children understand resiliency? (3) In what ways do children perceive themselves as resilient, or not? (4) What factors promote and inhibit resiliency? The interviews will be recorded and transcribed verbatim, then analyzed phenomenologically to better understand the lived experiences of child participants. The findings of the study will be used to inform future clinical practice, as trauma work intersects with a variety of professions. Social workers are well positioned to organize, build connections, and lead inter-professional teams that could benefit from a trauma-informed and resilience-based model. Therefore, using a strengths-based resiliency framework has the potential for direct positive effects for affected children, as well as for their families and other systems.
William Bonadio
Maimonides Medical Center, New York
Title: Management of pediatric perforated appendicitis: Comparing outcomes using early appendectomy vs. solely medical management
Biography:
William Bonadio MD is currently an attending Physician of Pediatric Emergency Medicine at Maimonides Medical Center in Brooklyn, NY. He has published more than 100 papers in reputed journals and has been serving as an Editorial Board Member of repute.
Abstract:
Background: There is controversy regarding whether children with perforated appendicitis should receive early appendectomy [EA] vs. medical management [MM] with antibiotics and delayed interval appendectomy. Objective: To compare outcomes of children with perforated appendicitis who receive EA vs. MM. Methods: Case review of consecutive children aged <18 years with perforated appendicitis who received either EA or MM during an 8-year period. Criteria for hospital discharge included patient being a febrile for at least 24 hours, pain-free and able to tolerate oral intake. Results: Of 203 patients diagnosed with perforated appendicitis, 122 received EA and 81 MM. All received parenteral antibiotic therapy initiated in the ED and continued during hospitalization. There were no significant differences between groups in mean patient age, mean CBC total WBC count, gender distribution, rates of ED fever, or rates of intra-abdominal infection [abscess or phlegmon] identified on admission. Compared to patients receiving MM, those receiving EA experienced significantly fewer: 1] days of hospitalization, parenteral antibiotic therapy and in-hospital fever; 2] radiographic studies, per-cutaneous drainage [PD] procedures, and placement of central venous catheters performed; 3] post-admission intra-abdominal complications; and 4] unscheduled repeat hospitalizations after hospital discharge. Only 1 EA-managed patient developed a post-operative wound infection. Conclusions: Children with perforated appendicitis who receive EA experience significantly less morbidity and complications vs. those receiving MM. The theoretical concern for enhanced morbidity associated with EA management of perforated appendicitis is not supported by our analysis.
Jing Zhang
Capital Medical University, China
Title: A preliminary study on multivariate prediction of seizure outcome after epilepsy surgery
Biography:
Jing Zhang has completed her PhD from the University of Minnesota and Post-doctoral work from Mt. Sinai School of Medicine. She has published more than 20 papers in peer-reviewed journals.
Abstract:
Surgical outcomes of epilepsy surgery vary across patients, and clinicians need to estimate possible outcomes before surgery. The aim of this study was to identify predictors of seizure outcome one year after surgery for patients with drug-resistant epilepsy. Twenty-three patients with Temporal Lobe Epilepsy (TLE) who underwent surgery were included in the study. Their demographical information, seizure history, findings of EEG and neuro-imaging tests (mainly Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS), intracranial EEG (icEEG) findings, seizure outcome and pathological findings were reviewed. Bi-variate analyses were performed to examine the uni-variate association of each variable with the outcome and exclude the most insignificant ones. The remaining data were randomly assigned to the training and test sets and three multivariate analysis approaches (Logistic Regression (LR), Linear Discriminant Analysis (LDA) and Artificial Neural Network (ANN)) were performed repetitively. Model performance was compared using Receiver-Operating Characteristic (ROC) analysis. Re-sampling the data to the training and test sets resulted in large variations in the classification accuracies of each multivariate approach. The ROC results indicated that the medium classification performances were moderate. Important outcome predictors identified included EEG lateralization score, icEEG lateralization score and the presence of Hippocampal Sclerosis (HS). The results suggested that multivariate models could predict seizure outcome after TLE surgery with moderate accuracy. Further studies are needed to improve prediction accuracy and identify reliable predictors of seizure outcome.
Ji-hong Zhou
Third Military Medical University, China
Title: Studies on road traffic death in middle school and high school students of China in 2013
Biography:
Ji-hong Zhou has completed his PhD in Traumatology from Third Military Medical University. He is the Director of Institute for Traffic Medicine, Daping Hospital & Research Institute of Surgery, TMMU. He has published more than 200 papers. He is the Director of East Asia of International Traffic Medicine Association, the Chairman of Society for Traffic Injury and Trauma Data Bank of Chinese Society of Traumatology (CST), the vice-chairman of Chinese Society of Traumatology and Society for Injury Prevention and Control.
Abstract:
Objective: To find effective ways for road traffic death (RTD) prevention and control by analyzing characteristics and causes of RTD in middle school (MS) and high school (HS) students of China in 2013. Materials & Methods: RTD data and population data of children from 12 years old to under 18 years old in 2013 were collected from: (1) Annual statistics report on road traffic accident of China in 2013, by Transportation Bureau, Ministry of Public Security. (2) Annual demographic data by China State Statistics Bureau. Children were divided into 2 groups: (1) middle school (MS) group were 12-14 years old children, (2) high school (HS) group were 15-17 years old children. The epidemiologic characteristics of accident reasons, transport modes, death causes of injuries and time-distribution features were analyzed. The mortality per million populations (MPMP) was calculated based on each population respectively. Results: Road traffic accidents (RTA) caused 1679 deaths in 12-17 years old children which accorded for 42% of total children RTD (1679 persons/3994 persons) and its MPMP was 18.21 in China in 2013. Deaths were 479 persons, MPMP was 11.40 and ratio of male and female (RMF) was 1.66 in MS group. Deaths were 1200 persons, MPMP was 23.92 and RMF was 2.74 in HS group. The main RTA reason was caused by motor vehicle violation (MVV) (92.3%, 1550 cases/1679 cases). Main reasons in MVV were driving without license (26.8%), not giving way by law (6.6%) and speeding (5.9%). The MPMP caused by MVV were 10.54 in MS group and 22.07 in HS group. Main traffic modes were motor vehicle passenger (MPMP 4.55), walking (MPMP 2.26), driving motor vehicle (MPMP 1.93) and driving non-motor vehicle (MPMP 1.86), and were 39.87%, 19.83%, 16.91% and 16.28% of total deaths respectively. In these deaths, 55.4% passengers were by motorcycle, 97.4% motor vehicle drivers were motorcycle drivers, and 94.6% non-motor vehicle drivers were bicycle riders. In HS group, main traffic modes were driving motor vehicle (MPMP 9.39) and motor vehicle passenger (MPMP 8.19), 96.2% drivers were motorcycle drivers with RMF 10.78, 57.4% passengers were by motorcycle with RMF 1.43. Brain injury was the main death cause with MPMP 8.69 (accounted for 76.2% of total) in MS group and MPMP 19.24 (accounted for 80.4% of total) in HS group. Brain injury was much more in male than that in female. RMF was 1.53 (MPMP 10.34:6.74) in MS group and RMF was 2.55 (MPMP 27.01:10.60) in HS group. In MS group, RTD were high in August, October and September with 11.69%, 10.65% and 9.19% of total deaths respectively, but lowest in January with 5.64% of total. It was the highest in August in male with 13.71% of total and the highest in October in female with 12.22% of total. RTD were more on Sunday, Friday and Saturday with 17.95%, 17.95% and 17.54% of total respectively. RTD was the most on Sunday in boy with 23.92% of total and was the most on Friday in girl with 21.11% of total. In HS group, RTD were the most in July and August which all were 10.42% of total, and the lowest in January with 6.92% of total. RTD were 10.58% and 10.35% of total in August and July in boy respectively and RTD were 10.59%, 9.97% and 9.97% of total in July, August and January in girl respectively. RTD were the highest on Sunday (16.83%) and Friday (16.17%) and the lowest on Thursday (10.23%). Conclusion: The RTD rate of middle school and high school children were very high. It is prominent in high school children that its MPMP reached to 23.92. Motor vehicle violation was the first reason for these RTD, but reasons of traffic modes couldn't be ignored that the most were caused by motorcycle and bicycle. Motorcycle driver was the most part of RTD and followed by passenger of motorcycle in high school students, and male was far more than female. RTD rate was the highest in summer vacation for boys, and the death peak was located in the summer vacation and the followed two months in girls. About 80% of deaths were due to brain injury. It is very important that to enhance education and management of the traffic safety and law in middle and high school students, to ban motor vehicle drive for under 18 students and to improve the ability of first aid and medical care for child brain injury.
Sunil Kumar
Lady Hardinge Medical College, India
Title: Nasal bacterial colonization in cases of idiopathic epistaxis in children
Biography:
Sunil Kumar has completed his MS, DNB from Delhi University. He is presently the Head of Department of Otorhinolaryngology and Head & Neck at Lady Hardinge Medical College, New Delhi, India. He has published various national and international papers in reputed journals.
Abstract:
Epistaxis is one of the most frequent emergencies in the practice of otorhinolaryngology. It has been shown to affect 10% of the entire population. Recurrent idiopathic epistaxis in children is repeated and self-limiting nasal bleeding for which no specific cause is identified. By far the most common cause is trauma, either nose rubbing or digital trauma associated with inflammatory or infective cause. Nasal colonization with Staphylococcus aureus has recently been postulated to play a role in this process. Its colonization causes inflammation, crusting and new vessel formation leading to epistaxis. Trials showing benefit from antiseptic cream also provides supporting evidence for an infective cause for epistaxis. However, there is marked paucity in literature on the role of nasal bacterial colonization in the children. Thus, the present study was aimed to evaluate the role of nasal bacterial colonization in cases of idiopathic epistaxis in pediatric age group: A descriptive, hospital based, observational study in our hospital was performed with total 112 pediatric patients in the age group 4-16 years. Group A (control): 56 patients with no epistaxis; Group B (epistaxis): 56 patients with idiopathic epistaxis. A swab for microbiological evaluation was taken from the anterior nasal cavity of each child. A highly significant association between nasal colonization with pathological Staphylococcus aureus and idiopathic epistaxis was found and was also associated with statistically significant number of crusting and presence of dilated blood vessels on the anterior nasal septum.