1

GENERAL SECRETARY OF THE CONFERENCE

Prof. Dr. Faten ShalabyPRESIDENT OF THE CONFERFENCE

Prof. Dr. Osama Arafa

32

54

Prof. Maged El SheikhConsultant and head of Dermatology

department at El Galaa Military HospitalProfessor of Dermatology at the Military

Medical Academy Faculty of Medicine, Cairo University

Prof. Afaff korraaProf. of pediatrics-Head of NICUHead of pediatric department

Faculty of Medicine, Al Azhar UniversityIBCLC, DHPE

Nutritional diploma

Prof. Amina Abdel WahabProf. of Pediatrics

Ismailia Faculty of medicineSuez canal university

Dr. Mohamed El- GamasyMBBch,MSc,MD PhD,

Consultant Pediatric Nephrologist, Tanta Uni-versity Hospital.

Assistant Professor of Pediatrics, Faculty of Medicin. Tanta University.

Dr. Mohamed RifaatAssistant Professor of Otolaryngology,

Ismailia Faculty of Medicine,Suez Canal University

Prof. Atef DoniaProfessor of pediatrics , Al Azhar UniversitySecretary General of the Egyptian society

of pediatricsPresident of Al Azhar the association of

pediatrics

Prof. Hala Gouda ElnadyHead of Pediatric Pulmonary Function Unit

Center Of Medical ExcellencyNational Research Center

Prof. Mohamed KhashabaProfessor of Pediatrics / Neonatology

Mansoura UniversityPresident of Delta Scientific Pediatric Society

Prof. Maha Youssef Prof. of Pediatrics Al Azhar University

Prof. Sonia El-SharkawiProfessor of pediatrics & Head of pediatric

department Suez Canal UNIVERSITY

Honorary President of Port said Pediatrics Conference

Prof. Mohamed Al MazahiProf. of Pediatrics Damietta

Faculty of Medicine, Al Azhar University

Prof. Amany Ahmed Assistant Professor of Forensic Medicine &

Toxicology. Faculty of Medicine, Port Said University

76

Prof. Alaa SobeihConsultant of Pediatric Cardiology

Cairo University Misr University for Science & Technology

Prof. Tarek BarakatAssistant Professor of Pediatrics/ Gastroen-

trerology& HepatologyFaculty of Medicine – Mansoura University

Dr. Mohamed zannounMD Associated professor of pediatrics

Al Azhar University Damietta Head of scientific Committee of Al Menoufia

Pediatric and Neonatal Soceity

Prof. Mahmoud ElmougiProfessor of pediatrics

Pediatric department, Al Azhar Faculty of Medicine

Prof. M. Osama HusseinConsultant pediatrics & neonatology

President of Port said neonatology society

Dr. Mona AzzamMSc, MD Pediatrics, Suez Canal University

MSc HSED(c), McMaster University, Canada APLS Teaching Faculty, Sick Kids Hospital, CanadaAmerican Heart Association PALS, ACLS, BLS In-

structor, USAHeart and Stroke Foundation PALS, ACLS, BLS

Instructor, CanadaPALS Advisory Board, University Health Network,

Canada

Prof. Ehab Khairy ElkhashabProfessor of Pediatrics

Head of Pediatric Clinical Nutrition UnitAin Shams University

Prof. Ahmed EllawahProfessor of Clinical Pathology

Faculty of Medicine, Al-Azhar University

98

Day1 Thursday 2-3-2017

01:30pm - 04:00pm Arrival and Registration

04:00pm - 04:30pm Opening Ceremony

06:15pm - 06:30pm Nutricia Symposium

06:30pm - 07:00pm BREAK

08:50pm - 09:00pm Swiss Lac Symposium

11:10am - 11:20am Devart Lab Symposium

Prayer Time

06:20pm - 06:35pm Hygint Symposium

06:35pm - 07:00pm BREAK

08:30pm - 09:00pm RECOMMENDATIONS & CLOSING CERREMONY

04:30pm - 06:30pmSESSION I

07:00pm - 09:00pmSESSION II

10:00am - 11:30amSESSION III

05:00pm - 07:00pmSESSION IV

07:00pm - 09:30pmSESSION V

Day2 Friday 3-3-2017

Program at a Glance Program at a Glance

1110

Day1 Thursday 2-3-2017

01:30pm - 04:00pm Arrival and Registration

04:00pm - 04:30pm Opening Ceremony Prof. Osama Arafa Prof. Sonia El-sharkawy Prof. Faten Shalaby

Chairpersons Prof. Mayvel Heshmet Prof. Afaf Koraa Prof. Sonia El-sharkawy Prof. Magda Badawy

04:30pm - 04:50pm Prof. Atef Donia Common Pediatric Problems

04:50pm - 05:10pm Prof. Mohamed Khashaba NICU graduates: How to follow?

05:10pm - 05:30pm Prof. Sonia Elsharkawy The Role of Vitamin D and Health

04:30pm - 06:30pmSESSION I

1312

Day1 Thursday 2-3-2017

05:30pm - 05:50pm Prof. Hala Gouda Is it asthma Or asthma mimics?

05:50pm - 06:10pm Prof. Maha Yossef Vitamin B12 & children brain health

06:15pm - 06:30pm Prof. Mohamed El Mazahi Nutrition of the Low Birth Weight Infants by Nutricia.

06:30pm - 07:00pm BREAK

Day1 Thursday 2-3-2017

Chairpersons Prof. Mohamed Khashaba Prof. Mohamed Elmazahy Prof. Atef Donia Prof. Mahmoud Elmougy

07:00pm - 07:30pm Prof. Maged El sheikh Pediatric skin rash. Causes &treatment

07:30pm - 07:50pm Prof. Ahmed Darweesh Pitfalls in Diagnosis in Pediatric Hematology/Oncology

07:50pm - 08:10pm Prof. Afaf Koraa Acute bronchiolitis up to date

08:10pm - 08:30pm Prof. Mohamed Elgamasy Urine analysis interpretation from pediatric nephrologist view

08:30pm - 08:50pm Prof. Amina Abdel Wahab Type 1 Diabetes Mellitus Updates in Management

08:50pm - 09:00pm Swiss Lac Symposium

End of the 1st day

07:00pm - 09:00pmSESSION II

1514

Day2 Friday 3-3-2017

Chairpersons Prof. Maha Yossef Prof. Mohamed Zannoun Prof. Hala Goda Prof. Wael Bahbah

10:10am - 10:30am Prof. Mohamed Rifaat Outcome evaluation of clarithromycin, metronidazole and lansoprazole regimens in Helicobacter pylori positive or negative children with resistant otitis media with effusion.

10:30am - 10:50am Prof. Amany Ahmed Suspended animation or apparent death: how to deal with to save souls ?

10:50am - 11:10am Prof. Mohamed zannoun Practical View in the management Of Amebiasis and Giardiasis

11:10am - 11:20am Devart Lab symposia

(Golden Session) 10 valuable gifts through the session

Prayer Time

10:00am - 11:30amSESSION III (Golden Session)

1716

Day2 Friday 3-3-2017

Chairpersons Prof. Mona azzam Prof. Amina abd elwahab Prof. Alaa Sobieh Prof. Ahmed El lawah

05:00pm - 05:20pm Prof. Osama Hussien Oral Rehydration Therapy Alternatives

05:20pm - 05:40pm Prof. Ehab Khairy Complementary feeding in children

05:40pm - 06:00pm Prof. Mahmoud Elmougy Chronic diarrhea, an approach to diagnosis

06:00pm - 06:20pm Prof. Mohamed Al Mazahi Pertussis Immune Profile after DPT Vaccination

06:20pm - 06:35pm Pravotin the Unique solution for ID and IDA “ by Hygint Pharmaceuticals

06:35pm - 07:00pm BREAK

SESSION IV05:00pm - 07:00pm

Day2 Friday 3-3-2017

Chairpersons Prof. Faten Shalaby Prof. Osama Hussien Prof. Hanan El refay Prof. Osama Arafa

07:00pm - 07:20pm Prof. Mona Azzam 2015 American Heart Association Updates to Pediatric Resuscitation Guidelines

07:20pm - 07:40pm Prof. Alaa Sobeih Role of Penicillin in treating & protecting children heart

07:40pm - 08:00pm Prof. Ahmed Ellawah Evidence of hematological malignancy from clinical pathology point of view

08:00pm - 08:20pm Prof. Tarek Barakat Neonatal Cholestasis; practical approach\

08:20pm - 09:00pm RECOMMENDATIONS & CLOSING CERREMONY

07:00pm - 09:00pmSESSION V

1918

“Common Pediatric Problems”Prof. Atef Donia

Professor of pediatrics , Al Azhar UniversitySecretary General of the Egyptian society of pediatrics

President of Al Azhar the association of pediatrics

Pediatrics Pearls:

1-Infantile colic:

It occurs in 10% to 20% of infants. This is defined as paroxysmal attacks of crying that

last for > 3 hours / day on > 3 days / week that begin at 3 weeks of age to 3 months of

age

2-Gastroesophageal reflux and regurge:

More than 40% of infants regurge once per day

50% resolve by 6 weeks.

75% resolve by 12 weeks

95% resolve by 18 weeks

Only 1% has significant reflux with complications

3-Breast feeding issues:

Breast is the best

Lactation consultants are your friend.

Signs of inadequate breast feeding

Breast feeding strategies.

2120

NICU graduates: How to follow ?Prof. Mohamed Khashaba, M. D.

Professor of Pediatrics / NeonatologyMansoura University

President of Delta Scientific Pediatric Society

Advances in neonatal intensive care have improved the survival of high-risk preterm

and critically ill term infants. Infants who are discharged from the neonatal intensive

care unit (NICU) require continued comprehensive clinical care. Thus, the prima-

ry care provider needs to identify, understand, and manage their ongoing medical

needs. The primary care clinician plays a key role in providing optimal continuity of

treatment by coordinating transition of care from the neonatologist, providing direct

medical care, and facilitating ongoing care of the infant by subspecialists and other

health professionals.

This presentation will review the care of the infant who is discharged from the NICU.

The discussion primarily focuses on preterm infants who represent the majority of

NICU graduates, especially the issues in the care of the very low birth weight (VLBW)

infant (birth weight ≤1500 ).

The Role of Vitamin D and HealthProf. SONIA EL SHARKAWE

Professor of pediatrics & Head of pediatric department Suez Canal UNIVERSITY

Honorary President of Port said Pediatrics Conference

Vitamin D: Fat soluble vitamin Hormone precursor acts more like a hormone than a vitamin. Sunlight considered the main source of Vit D. It was proved that Vit D had multiple roles in our life: Infants who are breastfed but do not receive supplemental Vit D are at increased risk of developing Vit D deficiency or rickets. Vit D has a role in pancreatic B-cell function, Glucose metabolism , insulin sensitivity so Vit D deficien-cy may predispose to DM. Vitamin D modulates immune system/pro-inflammatory cytokines= reduction of inflammation , So it is deficiency lead to arthritis, lupus, IBS, multiple sclerosis .Also Vit D Inhibits Cell growth/differentiation , so it is deficiency may leads to Cancer (prostate, breast, colon ) . Serum 25 OH vit D levels are inversely associated with recent URI. Deficiency of Vit D may leading to cardiovascular disease, hypertension and stroke . Also it has neuromuscular stability and its deficiency leading to myofascial pain, musculoskeletal pain, myopathy. Vit D has crucial role in neuroprotection, neuro-transmission and neuroplasticity, regulates catecholamine levels ,synthesizes ace-tylcholine, serotonin and dopamine , targets factors that lead to neurogeneration .Deficiency causes death of the neurons that leads to dementia, Alzheimer’s, schizo-phrenia, depression . Vitamin D deficiency is a major contributing factor to the onset and progression of autism ,Mental illness and a high suicide rates .

2322

IS IT ASTHMA OR ASTHMA MIMICSProf. Hala Gouda Elnady

Head of Pediatric Pulmonary Function UnitCenter Of Medical Excellency

National Research Center

Asthma pathophysiology is complex and involves airway inflammation, intermittent

airflow obstruction, and bronchial hyper-responsiveness; which is an exaggerated re-

sponse to numerous exogenous and endogenous stimuli. The degree of airway hy-

per-responsiveness generally correlates with the clinical severity of asthma. Asthma

symptoms typically include a combination of wheezing, chest tightness, cough, and

dyspnea. These symptoms are accompanied by airflow obstruction, which is at least

partially reversible. Though the above symptoms are generally associated with asth-

ma, any process that narrows the intrathoracic airways or increases airway resistance

can cause similar symptoms, and must be considered in the differential diagnosis of

asthma. So, Clinicians must maintain a high index of suspicion for alternative diag-

nosis of diseases that mimic asthma, particularly when the patient presents atypically

or fails to respond to therapy and in particular in those younger than 2 years with

new symptoms suggestive of asthma. It is also important to keep in mind that many

of these disorders can co-exist with asthma. Common conditions that mimic asth-

ma are: sinusitis , foreign body inhalation, cystic fibrosis, respiratory syncytial virus

(RSV), gastroesophageal reflux disease, bronchiectasis, upper airflow obstruction, vo-

cal cord dysfunction, vocal cord paralysis and congestive heart failure.

Vitamin B12 & children brain healthProf. Maha Youssef

Prof. of Pediatrics Al Azhar University

Vitamin B12 is a water-soluble vitamin that is naturally present in some foods, added

to others, and available as a dietary supplement and a prescription medication. Vitamin

B12 exists in several forms and contains the mineral cobalt, so compounds with vita-

min B12 activity are collectively called “cobalamins”. Methylcobalamin and 5-deoxya-

denosylcobalamin are the forms of vitamin B12 that are active in human metabolism.

Vitamin B12 is required for proper red blood cell formation, neurological function,

and DNA synthesis. Vitamin B12 functions as a cofactor for methionine synthase and

L-methylmalonyl-CoA mutase. Methionine synthase catalyzes the conversion of ho-

mocysteine to methionine. Methionine is required for the formation of S-adenosyl-

methionine, a universal methyl donor for almost 100 different substrates, including

DNA, RNA, hormones, proteins, and lipids. L-methylmalonyl-CoA mutase converts

L-methylmalonyl-CoA to succinyl-CoA in the degradation of propionate, an essential

biochemical reaction in fat and protein metabolism. Succinyl-CoA is also required for

hemoglobin synthesis.

In this presentation we will cover all these points with focus on brain health &develop-

ment in children.

2524

Pertussis Immune Profile after DPT VaccinationProf. Mohamed Al Mazahi

Prof. of PediatricsDamietta

Faculty of Medicine, Al Azhar University

Immunization against pertussis according to the Egyptian national immunization pro-

gram at 2, 4, 6 months followed by a booster at 18 months has been evaluated in chil-

dren older than 6 years, as Pertussis has become a disease of older subjects and is more

common than we realized and Large scale pertussis epidemic still occurred worldwide.

Further booster of pertussis vaccine for older children is recommended and may be

very helpful.

Pediatric Skin Rash. Causes &treatmentProf. Maged Ali Mahmoud El sheikh

Consultant and head of Dermatology department at El Galaa Military HospitalProfessor of Dermatology at the Military Medical Academy

Faculty of Medicine, Cairo University

A rash is a reaction of the skin. It can be caused by many things, such as a reaction by

contact to a skin irritant, a drug reaction, an infection, or an allergic reaction. Many dif-

ferent agents can cause similar-appearing rashes because the skin has a limited number

of possible responses. Very often the other associated symptoms or history, in addition

to the rash, help establish the cause of the rash. A history of tick bites, exposure to other

ill children or adults, recent antibiotic use, environmental exposures, or prior immuni-

zations are all important elements of the patient’s history to help determine the cause

of a skin rash in a child.

In our lecture we will focus on the most common causes of skin rash in pediatrics and

their treatment.

2726

Acute bronchiolitis up to dateProf. Afaff korraa

Prof. of pediatrics-Head of NICUHead of pediatric department

Faculty of Medicine, Al Azhar UniversityIBCLC, DHPE

Nutritional diploma

Bronchiolitis is the most common disease of the lower respiratory tract during the first year of life. It usually presents with cough with increased work of breathing, and it often affects a child’s ability to feed. In primary care, the condition may often be confused with a common cold, though the presence of lower respiratory tract signs (wheeze and/or crackles on auscultation) in an infant in mid winter would be consistent with this clinical diagnosis. The symptoms are usually mild and may only last for a few days, but in some cases the disease can cause severe illness.There are several individual and environmental risk factors that can put children with bronchiolitis at increased risk of severe illness. These include congenital heart disease, neuromuscular disorders, immunodeficiency and chronic lung disease.The management of bronchiolitis depends on the severity of the illness. In most chil-dren bronchiolitis can be managed at home by parents.Approximately 1 in 3 infants will develop clinical bronchiolitis in the first year of life and 2–3% of all infants require hospitalization. In 2011/12 in England, there were 30,451 secondary care admissions for the management of bronchiolitis. It is uncommon for bronchiolitis to cause death. In 2009/10 in England, there were 72 recorded deaths of children within 90 days of hospital admission for bronchiolitis.Bronchiolitis is associated with an increased risk of chronic respiratory conditions, in-cluding asthma, but it is not known if it causes these conditions.

The guideline covers children with bronchiolitis but not those with other respiratory conditions, such as recurrent viral induced wheeze or asthma.

Urine analysis interpretation from pediatric nephrologist viewDr. Mohamed El- Gamasy

MBBch,MSc,MD PhD,Consultant Pediatric Nephrologist, Tanta University Hospital.

Assistant Professor of Pediatrics, Faculty of Medicin. Tanta University.

Examination of the urine is often the first step in the assessment of any renal patient.

There are many pitfalls in preparation ,examination a interpretations of urine analy-

sis(routine or specific) especially in Pediatric age.

The American Academy of Pediatrics currently recommends to obtain a screening

urine analysis once at least at the preschool age and yearly in sexually active adolescents

to look for leukocyte esterase (LE) to early diagnose hidden Urinary Tract Infection (UTI).

I will summarize review of urine collection techniques , simple correct interpretation of

physical, Chemical and microbiological examination results of urine from point of my

view as a Pediatric Nephrologist.

2928

Type 1 Diabetes Mellitus Updates in ManagementProf. Amina Abdel Wahab

Prof. of PediatricsIsmailia Faculty of medicine

Suez canal university

Type 1 DM is an autoimmune disease characterized by elevated blood glucose level, ab-

normal insulin production leading to disordered carbohydrates, lipids and protein me-

tabolism. It can be associated with other autoimmune diseases as Hashimoto thyroid-

itis, autoimmune Addison disease and Celiac disease. Among the serious but avoidable

complications of diabetes are hypoglycemia and diabetic ketoacidosis.

Treatment of type 1 DM include; insulin, dietetic management, exercise and education-

al aspects. Insulin analogues helped a lot in better control of diabetes and its compli-

cations. Insulin pumps and continuous SC insulin monitoring added to better control

and flexibility in management. Recent trends in management of diabetic ketoacidosis

helped a lot to avoid serious complication of the condition and so saved lives and suf-

ferings of those population.

Outcome evaluation of clarithromycin, metronidazole and lansoprazole regimens in Helicobacter pylori positive or negative children

with resistant otitis media with effusion.Dr. Mohamed Rifaat Ahmed, MD,

Assistant Professor of Otolaryngology,Ismailia Faculty of Medicine,

Suez Canal University

•Otitis media with effusion (OME) is considered one of the most common diseases

causing conductive hearing loss in children.

•Many resistant otitis media with effusion cases to traditional treatment occurred in

the last years

•More than half the world’s population is infected by H pylori and the prevalence of H.

pylori infection can be more than 80% in children younger than 10 years old.

•Although the stomach is the natural site for H pylori, the middle-ear cavity is also

proposed as a potential site for infection

•The presence of H pylori in the adenoid and tonsillar tissue causes the nasopharyn-

geal H pylori bacteria to enter the middle ear, supported by middle ear fluid culture was

positive to H pylori

•the triple therapy could be effective in some resistant otitis media with effusion cases

3130

Suspended animation or apparent death: how to deal with to save souls?Prof. Amany Ahmed

Assistant Professor of Forensic Medicine & Toxicology. Faculty of Medicine, Port Said University

In certain conditions as electrocution, prolonged submersion especially in cold

water for example, a person may appear dead with no pulse, respiration or CNS activi-

ty but death had not occurred indeed. This person may still potentially be resuscitated

and may recover completely if properly managed. This especially occurs in children

under age of five years as they are more able to withstand hypoxic brain injury than

adults.

EVERY physician must know how to diagnose death on evidence base

and learn more about the art of preserve the feeble life.

Practical View in the management Of Amebiasis and GiardiasisDr. Mohamed zannoun, MD

MD Associated professor of pediatrics Al Azhar University Damietta

Head of scientific Committee of Al Menoufia Pediatric and Neonatal Soceity

A most important factor in the detection of amebiasis is to entertain the diagnosis first. Appropriate search for the parasite should precede other diagnostic or therapeu-tic efforts which may mask the correct diagnosis for weeks. An alert suspicious phy-sician with competence at the microscope can save the patient from amebic neurosis secondary to over diagnosis as well as chronic ill health and possible death related to underdiagnosis. As regard Treatment of Amebiasis The chemotherapy of amebiasis has been unsatis-factory, as attested by the number of available drugs and the divergence of opinion in the literature about the drug of choice. The therapeutic quandary is compounded by the toxicity of the most active drugs, the usual need for at least two agents (a poorly absorbed drug effective in the tissue lumen against cysts and another drug for the tro-phozoite tissue phase) and the difficulty in differentiating relapse from reinfection in many endemic areas where drug trials have been conducted. No treatment is effective in all cases, and repeated stool examination for at least six months is necessary for confirmation of cure. Controversy also clouds the merits of treating asymptomatic patients. Other valid arguments for the treatment of asymptomatic amebiasis include the po-tential for the infections of others and the possibility that the disease may become severe-and not properly attributed - following one of the poorly understood events which upset host-parasite balance.

3332

ORAL REHYDRATION THERAPY ALTERNATIVESProf M. Osama Hussein MD

Consultant pediatrics & neonatologyPresident of Port said neonatology society

Gastroenteritis is one of the commonest health problems worldwide & is still a major

health problem in Egypt. Although the advances in management significantly reduced

the mortality from dehydration, mainly the introduction of oral rehydration therapy

(ORT), yet it is still a major concern for both the health care providers (HCP) & the

community. Before oral rehydration therapy (ORT) was developed, intravenous fluid

therapy was the mainstay of fluid therapy for diarrheal dehydration & also there were

many homemade rehydration remedies. ORT has been modified to provide better re-

sults & tolerance. Still on the community level, there still many home based remedies

are still used. We will discuss stages of ORT evolution & also other alternatives.

Complementary feeding in childrenProf. Ehab Khairy Elkhashab

Professor of Pediatrics Head of Pediatric Clinical Nutrition Unit

Ain Shams University

Is defined as the process starting when breast milk alone is no longer sufficient to meet

the nutritional requirements of infants, and therefore other foods and liquids are needed,

along with breast milk.

When breast milk is no longer enough to meet the nutritional needs of the infant, com-

plementary foods should be added to the diet of the child. The transition from exclusive

breastfeeding to family foods, referred to as complementary feeding, typically covers

the period from 6 to 18-24 months of age, and is a very vulnerable period. It is the time

when malnutrition starts in many infants, contributing significantly to the high prev-

alence of malnutrition in children under five years of age world-wide. WHO estimates

that 2 out of 5 children are stunted in low-income countries?

Foods should be prepared and given in a safe manner, meaning that measures are taken

to minimize the risk of contamination with pathogens. And they should be given in a

way that is appropriate, meaning that foods are of appropriate texture for the age of the

child and applying responsive feeding following the principles of psycho-social care.

3534

CHRONIC DIARRHOEA, AN APPROACH TO THE DIAGNOSISProfessor Mahmoud Elmougi

Professor of pediatrics Pediatric department, Al Azhar Faculty of Medicine

Chronic diarrhoea (> 2 weeks) comprises a large group of conditions of diverse aetiol-

ogy. The aetio-pathogenesis includes: impaired digestion e.g. cystic fibrosis, biliary ob-

struction, enzyme deficiency e,g, lactase deficiency, mucosal disease e.g. coeliac disease,

anatomical abnormalities e.g. short bowel syndrome, metabolic e.g. abitalipoproteimia.

Diagnosis may be challenging and sometimes needs elaborate laboratory studies.

However and on the other hand, proper history and clinical examination clinch the

diagnosis in most cases without the need of referral to specialized centres. Certain key

questions are crusial e.g. effect on growth and weight, relation to diet, systemic symp-

toms and type of stools.

The history begins with exploring the duration of diarrhoea and is it continuous or

intermittent, type of diarrhoeal stools: watery, bloody or steatorrhoea. Relation to food

intake is important to find e.g. introduction of wheat (coeliac disease), animal milk (an-

imal milk protein allergy). Look for manifestations of weight loss, deficiency of miner-

als and vitamins. General examination may show fever, pallor, dehydration, skin rash

and clubbing. The perianal area may be reddened due to acid stools.

2015 American Heart Association Updates to Pediatric Resuscitation GuidelinesDr Mona Azzam

MSc, MD Pediatrics, Suez Canal UniversityMSc HSED(c), McMaster University, Canada

APLS Teaching Faculty, Sick Kids Hospital, CanadaAmerican Heart Association PALS, ACLS, BLS Instructor, USA

Heart and Stroke Foundation PALS, ACLS, BLS Instructor, CanadaPALS Advisory Board, University Health Network, Canada

Every five years the American Heart Association updates its resuscitation guidelines.

The latest evidence-based consensus was reached in 2015 and dissemination initiated

in 2016.

These included crucial recommendations in CPR, arrhythmia management, shock

therapy and treatment of the most common emergency respiratory problems in chil-

dren and infants.

In this presentation we will use scenarios to emphasize these changes and explain the

scientific rationale behind them.

3736

Role of Penicillin in treating & protecting children heartProf. Alaa Sobeih, M.D.

Consultant of Pediatric CardiologyCairo University

Misr University for Science & Technology

Primary prevention of acute rheumatic fever is accomplished by proper identification and adequate antibiotic treatment of group A β-hemolytic streptococcal (GAS) tonsil-lopharyngitis. Penicillin (either oral penicillin V or injectable benzathine penicillin) is the treatment of choice, because it is cost effective, has a narrow spectrum of ac-tivity, and has long-standing proven efficacy, and GAS resistant to penicillin have not been documented. For penicillin-allergic individuals, acceptable alternatives include a narrow-spectrum oral cephalosporin, oral clindamycin, or various oral macrolides or azalides.The individual who has had an attack of rheumatic fever is at very high risk of developing recurrences after subsequent GAS pharyngitis and needs continuous anti-microbial prophylaxis to prevent such recurrences (secondary prevention). A recurrent attack can be associated with worsening of the severity of rheumatic heart disease that developed after a first attack, or less frequently with the new onset of rheu-matic heart disease in individuals who did not develop cardiac manifestations during the first attack. Prevention of recurrent episodes of GAS pharyngitis is the most effec-tive method to prevent the development of severe rheumatic heart disease. The rec-ommended duration of prophylaxis depends on the number of previous attacks; the time elapsed since the last attack, the risk of exposure to GAS infections, the age of the patient, and the presence or absence of cardiac involvement. Penicillin is again the agent of choice for secondary prophylaxis, but sulfadiazine or a macrolide or azalide are acceptable alternatives in penicillin-allergic individuals.

Evidence of hematological malignancy from clinical pathology point of viewProf. Ahmed Ellawah

Professor of Clinical PathologyFaculty of Medicine, Al-Azhar University

It was not easy to establish an early diagnosis for hematological cancers such as

leukemia, lymphoma and myeloma, because of the ill-defined symptoms at the ini-

tial phase. Hence, there might be multiple primary healthcare consultations before

referral to the specialties, leading to excessive intervals between symptom onset,

help-seeking and diagnosis It was also reported that delayed diagnosis was asso-

ciated with increased complication events in patients with hematological cancers

Besides, more than 60 subtypes of hematological cancers had been identified over

these decades and many of them were characterized with unique clinical presenta-

tions and prognosis, making it difficult for further differential diagnosis of hema-

tological malignancies from benign disorders.

As a consequence, it had been great challenges for clinicians to diagnose hemato-

logical cancers promptly. Active laboratory consultation, first described and clini-

cally practiced by clinical pathologists in Japan, was mainly composed of laboratory

comments and liaison service for selectively abnormal results of laboratory testing

It was reported that such proactive consultation by clinical pathologist (PCCP)

could help clinical diagnosis and therapeutic strategy .Therefore, we conducted this

study to evaluate the effect of PCCP on the help-seeking to diagnostic interval in

hematological cancers.

3938

Neonatal Cholestasis; practical approachProf. Tarek Barakat

Assistant Professor of Pediatrics/ Gastroentrology & HepatologyFaculty of Medicine – Mansoura University

Jaundice is a common clinical finding in the first 1 to 2 weeks after birth and usually re-

solves spontaneously. Any infant who is jaundiced beyond 2 weeks of life needs further

evaluation to rule out neonatal cholestasis.

Neonatal cholestasis is defined as impaired canalicular biliary flow resulting in accu-

mulation of biliary substances in blood and extrahepatic tissues. These infants should

always have fractionated serum bilirubin levels checked to differentiate the conjugated

hyperbilirubinemia of cholestasis from unconjugated hyperbilirubinemia that is usu-

ally benign.

The differential diagnosis of cholestasis is extensive and a systematic approach is help-

ful to quickly establish the diagnosis. Biliary atresia is a common cause of neonatal

cholestasis and affected infants need surgery before 60 days of life for better prognosis.

Premature infants have multifactorial cholestasis and need a modified approach to the

evaluation of cholestasis.

Management of cholestasis is mostly supportive, consisting of medical management of

complications of chronic cholestasis like pruritus and nutritional support for malab-

sorption and vitamin deficiency.