The IX t h Makassed Medical Congress - American University of Beirut

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T h e I X t h M a k a s e d M e d i c a l C o n g r e s s Hemoglobinopathies: - sickle cell anemia , refractory to other treatments - thalassemia Usually with geno identical donors in that case Metabolic diseases: Mucopolysaccharidosis, Gaucher’s disease as soon as possible if there is a good geno identical donor Some rare diseases such as osteopetrosis Severe Congenital Immunodeficiencies (SCID) In that situation, BMT is an emergency Best situation is geno identical BMT ,but if it’s not possible, if there is no pheno identical donor, neither geno identical blood cord, haplo identical BMT is sometimes realized with father or mother’s marrow Since 30 years, there were a lot of progress in BMT: - better understanding of haematological diseases - easier acces to pheno identical registers - better prevention and control of GVH disease Though BMT is still a heavy treatment Indications have to be discussed by hematologists, , transplanters, taking in account the hematologic disease, the type of donor( geno or pheno identical), the type of graft: BM, PSC(peripheric stem cells), Blood Cord Parents, geno identical brothers or sisters, patient need a lot of explanations and have to be supported by medical team before, during and after BMT PEDIATRIC HEMATOLOGY ONCOLOGY Samar Muwakkit MD Iron deficiency anemia is the most common hematologic disease of infancy and childhood. It is estimated that 30% of the global population suffer from IDA, most of which are from developing countries. We measured the prevalence of transferrin saturation (TS)
(P=0.006, odds ratio=4.59), respectively. IDA is common in Lebanese children and is associated with increased blood lead levels, lack of iron supplementation, and cultural dietary habits. Remedial measures such as iron fortification of commonly consumed food are needed on the national level. Lead exposure must be controlled and awareness must be raised about the potentially devastating consequences of combined iron deficiency and lead poisoning on young children. NON-INVASIVE VENTILATION IN CHILDREN: INDICATIONS AND PREDICTIVE FACTORS FOR THE OUTCOME Francis Leclerc MD-PhD Non-invasive ventilation (NIV) provides respiratory support without endotracheal tube or tracheostomy. It usually refers to continuous positive airway (CPAP) or bilevel positive airway pressure (BiPAP) delivered through nasal prongs, facemasks or head boxes. Many evidence is accumulating that it may be beneficial for children with acute respiratory failure (ARF). In a 5-year retrospective study, 83 of 114 children (77%) were treated successfully with NIV; the success rate was 100% for acute chest syndrome, 92% for immuno-compromised children, 87% for community acquired pneumonia, while only 22% for acute respiratory distress syndrome (ARDS) (1). In a 3-year prospective study, 32 episodes of ARF in 26 children (pneumonia: 46%) were treated with NIV by a volumetric ventilator; there was a clinical (at 2-4 hours) and radiological (at 24 hours) improvement and only 4 children required intubation (2). The mechanism by which NIV acts was recently studied by Essouri et al. in 12 children with hypercapnic ARF by the mean of an esogastric catheter: the authors observed that NIV was associated with a significant improvement of breathing pattern, gas exchange and respiratory muscle output (3). Also, NIV limits alveolar collapse (1). NIV includes simpler technology and equipment allowing use in settings other than critical care units; this means that patients may benefit from additional respiratory support earlier in the progression of their illness. Furthermore, NIV is associated with less need for sedation and a decrease in nosocomial ventilator associated infections. This is, at least partly, due to the diminished need for intubation, as reported by Yanez et al in their prospective randomised controlled study (intubation rate: 60 % in controls, 28% in NIV group) (4). When use NIV for acute respiratory failure? Whilst for some problems, such as upper airway obstruction, stenting of the upper airway with CPAP is often adequate to improve overall ventilation, there are other conditions where additional BiPAP to enhance minute ventilation is used. For ARF, a combination of factors determines whether assisted ventilation is needed, most commonly the degree of respiratory distress and whether the child is tiring, exhausted, unable to vocalise, looking frightened, has altered conscious level or deteriorating vital signs. The child’s clinical condition usually guides the need for intubation and critical care, but continuous measurement of pulse oxygen saturation (SpO 2 ) and PtcCO 2 (5) (as NIV is generally used for hypercapnic ARF) may help identify the progression of respiratory failure and allow for earlier intervention with NIV. Several papers have summarized the published evidence on NIV for ARF in adult patients: the results are presented in table 1 (6-8). The authors of these meta-analyses concluded that NIV for ARF was supported by strong evidence from patients with chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema 59
Page 1 and 2:
The IX th Makassed Medical Congress
Page 3 and 4:
CONGRESS PRESIDENT Said Sayegh, MD,
Page 5 and 6:
GENERAL INFORMATION
Page 7 and 8: • Target Audience: Physicians, Pr
Page 9 and 10: Durriya Sinno, MD Pediatrics Americ
Page 11 and 12: Moderators
Page 13 and 14: PEDIATRICS Bassem Abou Merhi, MD Pe
Page 15 and 16: Maroun Sokhn, MD Pediatrics Saint G
Page 17 and 18: Scientific Program
Page 19 and 20: Session 3: Intensive Care Neonatolo
Page 21 and 22: Session 1: Pediatric Intensive Care
Page 23 and 24: 8:00 - 8:05 08:05 - 08:10 Welcome r
Page 25 and 26: Cardiology Session III: Interventio
Page 27 and 28: Cardiology Session VI: Intervention
Page 29: Cardiology Symposia (NON-CME) Frida
Page 32 and 33: T h e I X t h M a k a s e d M e d i
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The IX t h Makassed Medical Congress - American University of Beirut

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