Day 1 :
Biography:
Dr. Mohamad Miqdady is American Board certified in Pediatric Gastroenterology, Hepatology and Nutrition. He is the Division Chief, Ped. GI, Hepatology & Nutrition Division at Sheikh Khalifa Medical City in UAE. Also an Adjunct Staff at Cleveland Clinic, Ohio USA. Dr. Miqdady completed his Fellowship in Pediatric Gastroenterology at Baylor College of Medicine and Texas Children’s Hospital in Houston, TX, USA. He held the position of Assistant Professor at Jordan University of Science and Technology in Jordan for six years prior joining SKMC. Main research interests include feeding difficulties, picky eating, obesity, procedural sedation, allergic GI disorders and celiac disease. He has several publications and authored few book chapters including www.uptodate.com On the Editorial Board of few journals including Gastroenterology & Hepatology.
Abstract:
It’s believed that the prevalence of atopic disorders is increasing worldwide. Gastrointestinal allergic disorders are no stranger to this phenomenon. Over the last two decades a new disease was described called eosinophilic esophagitis which simply means an allergic inflammatory reaction in the esophagus. This could be related to ingested or possibly inhaled allergens. Typically these young children present with difficulty in swallowing and dysphagia and frequently with food impaction with regular food. They have functional obstruction rather than at anatomical obstruction. During endoscopy an abnormal esophageal mucosa can be noted sometimes with some white spots indicated some eosinophilic abscesses, linear furrows and during formation of the esophagus. Biopsy should be taken to confirm the diagnosis which normally shows increased number of eosinophils. A cutoff point is described to be more than 15 eosinophils per high-power field. Typically these patients they don’t have eosinophilic infiltrates in other parts of the gastrointestinal system. The mainstay of treatment is elemental diet avoiding the commonest food allergies that includes milk, eggs, wheat, soy, nuts and seafood. In the Middle East allergy to sesame seems to be another common allergen. Also these patients that will require “swallowed topical steroid” in addition to a proton pump inhibitor. Unfortunately this is a chronic disorder and these patients need to be in diet for a long period of time with the above medications. Dilatation if required can be associated with higher increased risk of perforation.
Keynote Forum
Amin El Gohary
Burjeel Hospital, United Arab Emirates
Keynote: Vomiting of surgical significance
Biography:
Amin El-Gohary completed his MBBCh in 1972 and his Diploma in General Surgery in 1975 at Cairo University, Egypt. He was appointed as Chief Disaster Officer during Gulf War. He also held post as the Clinical Dean of Gulf Medical College, Ajman for 3 years. Prof. Dr. Amin is well known in Abu Dhabi for his extensive interest and involvement in scientific activities. He is the President of the Pediatric Surgical Association of UAE. He was awarded the Shield of the College of Pakistan and the Medal of International Recognition in pediatric urology from the Russian Association of Andrology. Prof. Dr. Amin is also the founder and member of the Arab Association of Pediatric Surgeons. Prof. Dr. Amin has an intensive academic and teaching experience, has written several publications in distinguished medical journals, and has made several poster and paper presentations in national and international conferences. Currently, he is an external examiner for the Royal College of Surgeons.
Abstract:
Learning Objectives:
1: Recognize the difference between vomiting due to medical and that related to surgical pathology
2: Discuss the different causes of surgical vomiting
3: Review the impact of bilious vomiting and its significance
Vomiting in children is common and mostly related to medical condition. However there are surgical conditions associated with vomiting which needs to be acknowledge and diagnosed early. Bilious vomiting is an ominous symptom and needs to be taken seriously. Any baby who vomits bile should be considered as having an underlying intestinal obstruction until proved otherwise.
- Pediatric-Neonatal Gastroenterology and Nutrition
Session Introduction
Ahmad Almaiman
King Khalid University Hospital, KSA
Title: Pediatric pancreatitis: An overview with minor differences
Biography:
Dr. Ahmad Almaiman is an MBBS graduate from the University of Sharjah College of Medicine in the UAE. He conducted his internship in King Khalid University Hospital in Riyadh, Saudi Arabia, after which he became a licensed General Practitioner under the Saudi Commission for Health Specialties as well as a listing in the Dubai Medical Registry in the UAE. His field of interest is Pediatrics and sub specialties of interest and previous publishing include Neonatology and Gastroenterology.
Abstract:
Pancreatitis is defined as the inflammation of the pancreas. Alongside providing the regulatory hormones of insulin and glucagon, this organ aids in the digestion process by producing activated enzymes that exist near the duodenum. However, during an inflammation the enzymes self-digest the pancreas as a result of the acinar cell damage due to particular triggers. The incidence of acute pancreatitis has been increasing over the past twenty years; though the approach of managing it is similar to that of adult pancreatitis there still remains a need to convey official guidelines for pediatric management. It is convenient to understand the minor distinctions that relate to the cause and overall observation of pancreatitis as well as also being aware of any onward possible complications. Both gallstones and alcohol represent the two most common causes of pancreatitis in adult groups; while the former alongside hereditary pancreatitis and trauma are the lead causes of childhood pancreatitis. Viruses were at a previous time the mainstay in cases of acute pancreatitis but now they are intermediate. In spite of providing the same treatment used on adults there still exists a significant association with morbidity. Currently pediatric guidelines are being discussed, while adult guidelines remain in adequate service in the modern clinical setting of acute pancreatitis.
Ahmad Almaiman
King Khalid University Hospital, Riyadh, KSA
Title: Intussusception: Highlighted Aspects
Biography:
Dr. Ahmad Almaiman is an MBBS graduate from the University of Sharjah College of Medicine in the UAE. He conducted his internship in King Khalid University Hospital in Riyadh, Saudi Arabia, after which he became a licensed General Practitioner under the Saudi Commission for Health Specialties as well as a listing in the Dubai Medical Registry in the UAE. His field of interest is Pediatrics and sub specialties of interest and previous publishing include Neonatology and Gastroenterology.
Abstract:
Intussusception is a clinical disorder characterized by the telescoping of a proximal part of the bowel into its distal part. The point that invaginates into its adjacent part is known as the "Intussusceptum" (also referred to as the lead point), while the distal segment that receives the folding is known as the ''Intussuscipien''. This is one of the most important causes of acute abdomen in children, particularly infants and toddlers (3 months - 3 years), however it is a rare condition in adults and brings about a variety of symptoms and patterns; be it acute, intermittent, or chronic. This disorder particularly triggers worrisome matters that are deemed target worthy in the clinical setting. One of these matters is managing the possible shock that comes about with the excessive compromise of the mesenteric blood supply, which ends up thickening the intestinal wall leading to fatal complications of ischemia and perforation. Intussusception's diagnostic approach also happens to be its therapeutic approach, which is non-operative reduction (be it air or barium enema). The recurrence risk of Intussusception is one that demands a cautious observation in an in-patient setting, as the reduction management helps in limiting said risk allowing the recurrence to alter between 24 and 48 hours onwards. In recent years, there has been a presentation of this disorder in children who were provided with the Rotavirus vaccine bringing about different post-marketing surveillances to understand the possible risks of developing Intussesception. Along with the general overview on the topic of Intussusception the following highlights will be included: an emphasis on the potential complications of Intussesception, its distinguishing presentation between children and adults, favoring air over liquid enema in reduction management, and Intussesception's increasing risk if/when the Rotavirus vaccine is given.
- Gastrointestinal Disorders and Symptoms
Session Introduction
Romualdas Maskelis
National Cancer Institute, Lithuania
Title: Management of endoscopic treatment of gastrointestinal perforations, leaks and fistulae
Biography:
Romualdas Maskelis is currently working in National Cancer Institute, Lithuania.
Abstract:
Surgical treatment has been the mainstay for the management of GI leakage from perforations, fistulae, or anastomotic dehiscence. Moreover, in the era of minimal invasive surgery, the need for endoscopic management is increasing. The use of new endoscopic closure devices such as the endoscopic suturing system and over-the-scope clip allows endoscopicts to expand the indications of endoscopic treatment. Gastrointestinal (GI) leakage, fistulae and perforations can be seriously and life threatening. There has been a paradigm shift in the management approach of these conditions, from surgical to conservative, including endoscopic management. The systematic review of the literature form 1966 to 2013 for studies that have been published on endoscopic closure of perforations is found more than 700 studies but only included 24 cohort studies (21 retrospective , 3 prospective) in the analysis. In the past years, covered self-expanding metal stents were the mainstay of endoscopic therapy. However, two new techniques are now available that enlarge the possibilities of defect closure. In the past decades, endoscopic clip application has repeatedly been used as a minimally invasive treatment option for small leakages and fistulas of the upper GI tract. We applicate OTSC clips (OVESCO) more than for 30 patients during the last six year. Till now we don’t have randomized trials on OTSC application, and most authors provide retrospective case series with heterogeneous indications and applications. Most studies included less than 20 patients with gastrointestinal perforations. The OTSC obviously is a very effective treatment option of GI tract perforations, and in our opinion it is clearly superior to the placement of covered stents. Furthermore, in case of failure, the OTSC procedure does not impair further treatment, such as surgery. Further studies are needed to compare the novel techniques to other treatment modalities, and to define their exact place in treatment algorithms of upper GI perforations. Successful endoscopic closure of acute iatrogenic perforations in the GI tract can reduce medical costs and hospital stays and prevent the need for surgical intervention for the patient.
- Liver and Biliary Diseases
Session Introduction
Mohammed Shafiqul Islam Bhuiyan
US-Bangla Medical College and Hospital, Bangladesh
Title: Isolated hepatosplenic tuberculosis: A rare case report
Time : 16:00-16:40
Biography:
Mohammed Shafiqul Islam Bhuiyan has completed his MD in Gastroenterology from Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. He is currently working as an Associate Professor and Head of the Department of Gastroenterology, US-Bangla Medical College, Narayanganj, Bangladesh.
Abstract:
Tuberculosis is common in Bangladesh. It rarely involves the liver and spleen and when it does so, it is usually associated with disseminated disease. This is case report of a patient with isolated tuberculosis of the liver and spleen. A 55 years old female presented with fever with chill and rigor and upper abdominal pain. USG revealed multiple hypoechoic lesions with central echogenicity in liver and spleen. CT scan showed multiple mixed density lesions in the liver and spleen. AFP, CEA and CA-19-9 were normal. As temperature was not subsided with antibiotics, pus from liver and spleen was aspirated and sent for gram and AFB stain, C/S, malignant cell and Gene Xpert. All but Gene Xpert reports were negative. A detailed workup failed to identify other focus of tuberculosis. CAT-1 Anti tubercular started and the fever subsided. The patient gained weight on the subsequent follow up. Tuberculosis should also be considered in the differential diagnosis for multiple nodules in the liver and spleen along with other diagnosis, though it is rare. Gene Xpert is a good diagnostic tool.
A.K.M Shafiqul Islam
BIRDEM General Hospital, Bangladesh
Title: Correlation between serum complement C3 and FIB4 Index with stages of fibrosis of liver by fibroscan in NAFLD patients
Biography:
Abstract:
Introduction & Objective: Despite the high prevalence of NAFLD non-invasive markers of disease activity and severity remain limited. Different modalities are available for predicting severity of NAFLD with different sensitivity and specificity. A single, cheap, widely available marker with high sensitivity and specificity is yet to be identified. The current study intends to find out the utility of serum complement C3 and FIB4 Index to predict stages of fibrosis of liver in NAFLD patients.
Method: This observational cross-sectional study was done at department of GHPD, BIRDEM General Hospital, Dhaka, during the period of January 2016 to October 2017. A total of 105 sonographically diagnosed NAFLD subjects attending at OPD and admitted in that Hospital were included in the study. Statistical analysis was done with SPSS version 16.
Result: Out of 105 subjects, 70 (66.7%) were female and 35 (33.3%) male. Serum complement C3 (mg/dl) 142.30±21.02 (mean±SD). USG of W/A or HBS showed 61 (58.10%) had grade I, 33 (31.43%) grade II, 11 (10.48%) grade III fatty liver disease. Fibroscan showed no fibrosis in 31 (29.52%), F1 stage of fibrosis in 22 (20.95%) and F2 in 22 (20.95%). FIB4 Index was 1.22±0.76 (mean±SD). Pearson correlation test showed stages of fibrosis by fibroscan had significant positive correlation with FIB4 index, weak positive correlation with BMI (kg/m2), weak negative correlation with serum complement C3 and almost no correlation with grading of fatty liver on USG (Spearman’s correlation).
Conclusion: The positive correlation of stages of fibrosis by fibroscan with FIB4 index was significant whereas negative correlation with serum complement C3 was not so significant statistically. Sensitivity and specificity of serum complement C3 and FIB 4 index as fibrosis marker was not so significant. Serum complement C3 and FIB4 index may not be used as a marker of severity of fibrosis.