2nd International Conference on Pediatric Oncology and Pediatric Medicine October 05-06, 2017 Las Vegas, Nevada, USA

Biography:

Andrew Ku is a senior at Bard College at Simon’s Rock. He was a Research Intern at Lucille Packard Children’s Hospital.

Abstract:

Using vascular access trainers for venipuncture education allow residents to practice fine motor skills prior to attempting on patients, where suboptimal methods can lead to variable first pass success rates. There are few studies that have looked at the use of models for pediatric vascular access training which are commercially available but expensive.¹ Ballistics gel is a relatively inexpensive material that can be used to develop low-cost and reusable models that are highly customizable. We present a phantom limb model for ultrasound-guided vascular access. The pediatric vascular access phantom limbs were made from a custom mold created with aluminum metal with the use of a CNC machine. The mold allows for placement of Cole-Parmer Luer Fittings on each end of the silicon tubing. The silicon tubing was purchased from McMaster-Carr and we tested multiple sizes. After testing multiple types of tubing we determined that the “Odor-Resistant Silicone Rubber Tubing” was far more representative of pediatric vessels than latex or vinyl tubing because of the availability in much thinner wall sizes. The 0.062 inch internal diameter tubing was the most useful for the models because smaller sizes resulted in extra luminal fluid collections more commonly. Luer locks were attached to IV tubing and saline syringes to inject fluid into the lumens of the tubing that coursed through the phantom limb to simulation ‘flash’ upon intravenous access. They were also hand pressurized with a syringe loaded at the end of the model to represent arteries. The curved surfaces of the gel models from the curved molds proved to be more realistic than the commercially available rectangular models. The ballistic gel models proved to be more effective when used with ultrasound to locate veins, and the density and characteristics of ballistic gel matched human tissue better than silicone models. The silicone tubing within the gel models prevented the needle from sticking inside of the ballistic gel compared to the models without tubing, which utilize canals formed from wire removal after model production. Using the tubing, one could observe the flash of colored fluid once intravenous access was gained on the model. The cost per ballistic gel model with silicone tubing was $11.00 each with a preparation time of 1.2 hours for 4 models. Ballistic gel models were easy to create and relatively inexpensive compared to commercial models, while retaining high customizability.¹ Future models may have curved tubing and more tortuosity to make the models more challenging. A larger quantifiable study to compare the efficacy of the models versus commercially available models in vascular access for pediatric patients is needed.

Biography:

Sanjay Mishra has completed his MBBS, MD and has five years’ work experience in the field of Hematology and Hematopathology from King George's Medical University, Lucknow, Uttar Pradesh. He is presently working as an Assistant Professor, in the department of Pathology at King George's Medical University, Lucknow, Uttar Pradesh, India.

Abstract:

Neuroblastoma is one of the most common malignant neoplasms of infancy. The tumour frequently metastasizes to bone marrow. Therefore bone marrow examination is regularly done for staging of the disease. In our study we analyzed 32 cases of neuroblastoma for bone marrow infiltration and correlation was made with their clinical parameters and their hematological profile. The age of these patients ranged from six months to 10.6 years. Male to female ratio was 2.3:1. Of these 18 (56.25) cases showed infiltration with the neoplastic cells. Of these, 12 cases (75%) were less than five years of age. There was a male preponderance with male: female ratio of 4:1 in involved cases. The patients who showed infiltration in the marrow had anemia, leucopenia and thrombocytopenia. 75% of these patients showed leukoerythroblastic picture. 12/18 cases showed rosette formation at some place on the smear.

Biography:

Oscar Eduardo Gonzalez Figueredo is Pediatric Hemato-Oncologist from Nueva Granada Military University, School of Medicine from Bogotá D.C, Colombia. He is the Coordinator of the Oncology Service in the Central Hospital of National Police from Colombia, Member of the oncology group of the National Cancer Institute from Colombia, Member of the oncology group of the Santa Fe Foundation in Bogota C.D and Member of the Colombian Society of Pediatric Hemato-Oncology. He has published papers in reputed journals and has provided speaker services for Novartis.

Abstract:

Brain stem gliomas are a heterogeneous group of tumors regarding both clinical presentation and prognosis. They can be classified on the basis of their biological behavior, anatomical location and radiographic appearance on MRI. The choice of treatment depends largely on whether the tumor is a diffuse intrinsic pontine glioma or not. A better understanding of the biology of these tumors can be the key for progress in treatment. The purpose of this speech is to provide updated information to enable a detailed understanding of this group of tumors and thus help to optimize the management of this condition in the pediatric population.

Biography:

Maria de Spengler is currently working as an eminent Faculty member at Instituto Nacional de Estadística, Panama. She has published numerous research papers and articles in reputed journals and has various other achievements in the related studies. She has extended his valuable service towards the scientific community with her extensive research work.

Abstract:

Introduction: Early detection and prompt reference efforts, attention of premonitory symptoms and suspicion by the general physician are the main source to increase survival ratel

Methods:We revised three information sources: the tumor report of the Pathology, the registry of Panamá Children’s Hospital, and the social database of the Foundation for children with cancer of Panamá.

Inclusion criteria: Patients between 1 day to 16 years of age in the period of time between the first of January 1999 and December 31, 2016.

Exclusion criteria: Patients that at the moment of diagnosis were more than 16 years of age. Patients who are loss of the follow-up consultation. We used database Excel of Microsoft Office 2010. We calculated the percentage of patients that are alive and with no evidence of neoplasia at January 1, 2017. We divide our study in two periods January 1999 to December 2009 (Period A) and January 2010 to December 2016 (Period B), in order to study if the influence of an Educational Program was related to the survival rate. The survival rate is calculated dividing the number of patients that are alive and with no evidence of neoplasia by the total number of patients. The national educational program was performed by the efforts of four main sources: the foundation for kids with leukemia and cancer, the program for infant

Biography:

Atin Singhai is an Associate Professor at Department of Pathology, King George’s Medical University, Lucknow, India since 2011. His areas of interest include pediatric oncopathology, nephropathology and uropathology. He has published about 25 papers in journals of international repute also presented more than 15 guest lectures in various conferences across India.

Abstract:

International Society of Pediatric Oncology (SIOP) grading of childhood renal tumors receiving preoperative chemotherapy judiciously delineates subclasses and subgroups as per chemotherapy induced changes which further guides the clinicians for planning further course of management. A total of 32 cases were enrolled in our study, of which 23 received preoperative chemotherapy while 9 underwent upfront nephrectomy. All were clinico-radiologically suspicious for nephroblastoma however 4 turned out to have different histological diagnosis viz clear cell sarcoma of kidney (CCSK) in two and one each rhabdoid tumor and neuroblastoma respectively. All nine cases of upfront nephrectomy were histologically nephroblastoma and designated as controls. Significant response of epithelial and stromal elements to chemotherapy as per SIOP protocol was noted as against controls. However, blastoma predominant and diffuse anaplasia variants as well as other high risk tumors like CCSK, rhabdoid tumor and neuroblastoma had nil or minimal response and had to be considered for further chemotherapy. To conclude, management of childhood renal tumors especially nephroblastoma by SIOP protocol not only offers efficient reduction in viable tumor load but also demarcates high risk cases which require further chemotherapy.

Biography:

Ahmad Alsaleh is currently working as an eminent Faculty member at Rafic Hariri University Hospital, Lebanon. He has published numerous research papers and articles in reputed journals and has various other achievements in the related studies. He has extended his valuable service towards the scientific community with his extensive research work.

Abstract:

Introduction: Aneurysmal bone cyst (ABC) is an uncommon osteolytic lesion that occurs in 1.4 per 100,000 patients. ABCs are benign tumors with low risk of malignant transformation (osteosarcoma).

Case report: We report a case of a large ABC of the 4^th lumbar vertebra resembling a kidney mass that was presented with flank pain, urinary incontinence and neurological symptoms.

Discussion: Recurrence rate in ABC is 25% if not completely removed. Aggressive curettage with bone grafting or en bloc resection is usually recommended. Angiography was initially performed and due to the absence of mass hypervascularity, embolization was not considered and the patient underwent a complete resection in two stages.

Conclusion: ABC can mimic renal cell carcinoma and other malignant bone tumors. In huge tumors with a difficult location as in our case, we recommend a two stage procedure for huge tumors to ensure a complete resection and hence lower recurrence rate and better outcome.

Biography:

Priscila Bacarin Hermann was graduated from Federal University of Paraná, Brazil in 2005 in Biochemistry. She has worked at Pequeno Príncipe Children’s Hospital in the laboratory of clinical analyzes. She has obtained her Master’s degree and PhD in Pharmaceutical Sciences from Federal University of Paraná, Brazil in 2011 and 2015, repectively. She is a Professor at Campos de Andrade University Center, Brazil, since 2012. Since 2014, she is a Member of Brazilian Army, serving as Pharmaceutical Lieutenant at General Hospital of Curitiba, Paraná, Brazil.

Abstract:

Sickle cell disease is one of the most common hematologic disorders in the world and is a serious public health problem in many countries. It has been suggested that oxidative stress plays an important role as a pathophysiological factor and contributes to the complications of the disease. Monitoring oxidative stress involves different parameters associated to pro-oxidant and antioxidant biomarkers. This study aimed to standardize methods to measure eight parameters of oxidative stress in erythrocytes from children with sickle cell disease, comparing with the same parameters in erythrocytes from healthy children. All blood samples were analyzed for methemoglobin, reduced glutathione, thiobarbituric acid reactive substances, percentage of hemolysis, reactive oxygen species and activity of the enzymes glucose 6-phosphate dehydrogenase, superoxide dismutase and catalase. Data were analyzed using Student’s t-test and were expressed as the mean±standard deviation. A p-value of <0.05 was considered significant. The differences were significant between children with sickle cell disease and the control group for the parameters methemoglobin, thiobarbituric acid reactive substances, hemolysis, glucose 6-phosphate dehydrogenase activity and reactive oxygen species with higher levels in the patients than in the controls. These parameters have shown great utility as biomarkers of disease severity, which can provide more complete information on the treatment and monitoring of patients with sickle cell disease.

Biography:

Nancy E Cisneros began her career as a broker and processor of almonds and pistachios in 1990 in California’s Central Valley.  While growing her business, she married her life partner whom took the reins of the company to allow Nancy to follow her dreams of delivering compassionate health care to children with cancer.  Nancy completed her undergraduate nursing education in 1999 and quickly found herself in the role of bedside Oncology RN.  With her sights set on pediatric oncology in the public health sector, she took a position as pediatric oncology case manager in home health with Sutter Care at Home in 2002.  Developing effective forms of communication, documentation, and care delivery used in Sutter, she declared to complete her graduate school education in slow steady pace.  This year, Nancy completed her MSN with emphasis in nursing education and as a clinical nurse specialist.  The graduate school capstone project she created was geared towards pediatric oncology and has been adopted by several home health agencies as a working case management paradigm.  Still excited to grow, learn, and give; Nancy started a community health education company with her husband along with a non-profit for children and young adults suffering cancer and other life-threatening diseases with her siblings.

Abstract:

Problem

This project author recognized a deficiency in home-based care regarding a lack of a standardized pediatric case management model.  Due to this deficiency, and through evidence-based research, many post-bone marrow pediatric patients treated at hospitals are often not discharged home for aftercare and are kept in the hospital causing a great financial burden to the stakeholders along with added stress to patient and family. 

Purpose

The purpose of this capstone project is to provide through evidence-based practice that Registered Nurse (RN) case managers quarterback patient-and family-centered care through coordination, teamwork and collaboration within a vast interdisciplinary team; meeting positive outcomes/ goals, while decreasing re-hospitalizations that can offload the financial health costs. 

Goal

This capstone project seeks to position the pediatric cancer patient and family/caregivers as the core team member(s) and the drivers of a collaborative patient-centered care model in the home-based setting. The proposed model will evidence the unique aspect of teamwork and collaboration with the inter-disciplinary care team in the home health setting and the inter-disciplinary oncology treatment team based in the hospitals responsible for delivery of in-patient and follow-up medical care. 

Objectives

This author will demonstrate through education and leadership, the best practices to employ home-based patient-and family-centered care directly to the pediatric patient with the assistance of the larger interprofessional team.  The RN case manager’s knowledge will be gained and competencies met through observing YouTube video simulation of central line access with lab draw, and effectively communicating through coordination with the home health and hospital teams. 

Outcomes and Results

With the utilization of this proposed project, the pediatric post-bone marrow transplant cancer patient has enhanced home-based care outcomes and decreased risk of re-hospitalization, which has significantly impacted more than forty patients during 2016.  Additionally, the patient can be treated safely in their home setting which significantly decreasing the cost of care to the insurance companies, the hospitals, families, along with the security for the pediatric patient to be treated in their own loving homes.

Biography:

Alysa Fairchild is committed to highest standard of excellence at Department of Radiation Oncology, University of Alberta in Canada.

Abstract:

Introduction & Aim: Radiotherapy (RT) and quality assurance (QA) programs aim to standardize RT delivered on multicenter clinical trials to minimize variables that may confound the validity of results. Our objective was to review available evidence for correlation of RT quality with clinical outcomes within pediatric multicenter clinical trials.

Methods: A Medline, Embase and Cochrane Central Register of Controlled Trials literature search was performed restricted to English but with no date limits. Candidate studies accrued children with age <21 years or median age <15, were led by any cooperative group, published in full and described central subjective ± objective assessment of RT protocol compliance (quality). Data abstracted included assignment of violations in relation to clinical outcomes (locoregional and/or distant failure, progression-free survival [PFS], overall survival [OS]).

Results: 27 multicenter studies described in 26 articles met inclusion criteria. Disease sites were medulloblastoma (M; 9 trials), rhabdomyosarcoma (RMS; 7), Hodgkin’s (H; 4) Supratentorial Primitive Neuroectodermal tumor (SPNET; 3), Ewing’s (E; 3) and Acute Lymphocytic Leukemia (ALL; 1). Deviations were found in 0-77% of RT plans reviewed. 10/27 reported that dose and/or field deviations significantly affected clinical outcomes in the form of inferior overall survival (N=1), PFS (4), local PFS (1), local control (3) and any recurrence (1). One study suggested improved PFS with local field RT deviations versus without. Studies reporting a significant relationship between RT quality and clinical outcomes were: 4 M, 3 SPNET, 2 H, 1 E and 1 RMS.

Conclusions: Overall, the weight of the evidence suggests that suboptimal RT negatively impacts clinical outcomes in pediatric multicenter and cooperative group trials.

Hypothesis: The hypothesis is that radiotherapy not delivered in accordance with study protocol specifications leads to worse clinical outcomes.

Biography:

Maria de Spengler is currently working as an eminent Faculty member at Instituto Nacional de Estadística, Panama. She has published numerous research papers and articles in reputed journals and has various other achievements in the related studies. She has extended his valuable service towards the scientific community with her extensive research work.

Abstract:

Introduction & Purpose: Everyday this tumor typical of early infancy has better results in terms of long-term survival. For the authors, treating retinoblastoma is an open book. Retinoblastoma is a pathology that requires a multidisciplinary approach. We still have a lot to learn. We want to share with the primary care pediatrician some important facts about retinoblastoma.

Material & Methods: This is a descriptive, retrospective, transversal and single institution study that includes all retinoblastoma patients, diagnosed between the first of January 1996 and December 31, 2016. All the participants must have finished treatment at the moment of data collection (January 2017) and must be active in the follow-up clinic. Those patients that were missing from the follow-up for more than a year were excluded.

Result: The age range at diagnosis is between 3 and 70 months. The average age at diagnosis is 21.3 months. One patient in our series had Wolf-Hirschhorn Syndrome. 68.4% of our cases received chemotherapy and 41% received chemo and radiation therapy. An attempt was made to preserve the eye in 26.3% of cases. What gave the indication to proceed with enucleation was retinal detachment in 66.6% of the cases, progression of the disease in the remaining 33.3%. In the series there is a percentage of 80.6% of patients who are alive and free of disease. Of the 25 patients who were alive at their last appointment, 42.1% had 10 or more years of survival. Of the survivors, 85.7% have completed their education.

Conclusion: Today we have a great challenge to contribute to the quality of life of the survivors of childhood cancer. As a society we must create the best conditions for inclusion.