8th Excellence in Pediatrics Conference - 2016 Book of Abstracts

Summary The Excellence in Pediatrics Conference is EIP’s annual flagship event providing best practice updates and a truly global outreach. Continuous professional development is a top priority for the Excellence in Pediatrics Institute and is placed at the heart of our annual conference’s ethos. Now in its 8th year, the Excellence in Pediatrics Conference is a dynamic, innovative, and highly engaging conference that informs its delegates of the latest scientific developments and most importantly helps them to improve the standard of care they deliver on the Monday morning after the conference.

Lipodystrophies are heterogeneous inherited or acquired disorders that are characterized by selective loss of adipose tissue and a predisposition to developing insulin resistance and its associated complications, such as diabetes mellitus, hypertriglyceridaemia and hepatic steatosis. The clinical diagnosis of lipodystrophy is made on the basis of a physical examination. Level loss of adipose tissue should be measured in a clinic, but is not crutial for the diagnosis. The prognosis for this disease is poor and patients suffer from a severe form of diabetes. Clinical case: Child R.N., 05.15.2015, was charged in Scientific Center of Pediatrics and children surgery (SCPCS) with preliminary diagnosis: Malabsorption syndrome, fermentopathy, malnutrition, celiac disease. Complaints at admission: fatigue during feeding, weakness, anxiety, unstable stool (8 times a day), abdominal distension. Health status at admission: Weight of the child was in compliance with the age, therefore, the diagnosis of malnutrition was disputable. However, a child had a elongation of the upper and lower extremities, enlargement of foot, hands. Hypertrophy of the muscular tissue of the upper and lower extremities with severe hypotrophy of gluteal muscles. Hypertrichosis, premature teething, hyperpigmentation in the axillary and inguinal regions. The enlargement of the external genitalia. Progeroid like phenotype. Hepatosplenomegaly. The following competing diagnoses were proposed: lysosomal acid lipase deficiency, progeria, celiac disease, pituitary microadenoma. The biochemistry analyses revealed the considerable increase of the total protein, a significant hypertriglyceridemia, high atherogenic index (12.3), high levels of LDL (up to 320 U/ml), cholesterol within references parameters. X rays the bones: without marked changes, bone age corresponds to the patient's age. MRI of the abdomen and pelvic organs: a significant increase of the liver, the lower contour of the right lobe is located below the iliac crest, left lobe shifted the spleen downward. Consilium conclusion: the diagnosis of acid lipase deficiency was disputable due to the lack of pathognomonic features of this disease. The study of acid lipase and beta-galactosidase activity was carried out on the basis of "Medical Genetic Research Center" Moscow, Russia. The enzyme activity in dried blood spots was within the reference range. The final diagnosis could be established only after a genetic test to identify the mutations that characterize the 4 main types of congenital generalized lipodystrophy. A homozygous mutation c.823C>T (p.R275*) on the BSCL2 gene was identified, which corresponds to the type 2 of congenital generalized lipodystrophy. Despite the fact that the second type of congenital lipodystrophy is more common than other types of the disease in the Kazakh population it was identified and confirmed for the first time. Since the prognosis of congenital lipodystrophy is unfavorable, specific therapy with Metreleptinshould be conducted. At the moment, the child's condition is stable and is under the supervision of pediatricians Introduction: Mucopolysaccharidosis (MPS) are a group of rare diseases that lead to chronic and multisyistemic disorders. They are caused by the absence or malfunction of lysosomal enzymes. MPS have a low incidence, with 1/22500. They are 6 main types of MPS, being I, II, III and IV the most common. Purpose: The aim of this work is to describe the main symptoms and surgical procedures prior to the diagnosis of mucopolysaccharidosis. Materials and Methods: Patients 0-18 years old with MPS were recruited in a Spanish reference pediatric neurology institution from January 2003 to December 2015. Symptoms, surgical procedures and psychomotor development prior to diagnosis were collected. Time to diagnosis was assessed from date of onset of first symptoms to date of diagnosis (defined by enzime assays). Results: 41 patients were included. Median age at diagnosis was 2.16 years (range 0-9.1). Main symptoms were: visceromegalies and/or umbilical/inguinal hernias 37%, otorhinolaryngological (ORL) disorders 34%, musculosketal disorders 27%, dysmorphic phenotype 27%, neurological disorders 10% and ocular disorders 2%. The most frequent initial symptoms according to MPS type were: musculoskeletal disorders (50%) in MPS1; ORL disorders (67%) in MPS2 and visceromegalies/abdominal hernias (71%) in MPS3. Psychomotor impairment was present at diagnosis in 35% patients. 41.5% patients were subjected to surgery prior to diagnosis. Most frequent procedures included: reduction of abdominal hernias (24%), ORL procedures (22%) and ventriculoperitoneal shunting 5%. 93% patients had developed symptoms during the first year of life., Nevertheless, only 59% were diagnosed with MPS before the age of 2. Conclusion: Main initial symptoms in patients with mucopolysaccharidosis include visceromegalies, abdominal hernias, ORL, ocular and, musculosketal disorders, dysmorphic phenotype and psychomotor impairment. A large proportion of patients have already been subjected to surgery at the moment of diagnosis. Most common procedure indications are ORL disorders, abdominal hernias and hydrocephalus. We consider it crucial for paediatricians to be familiar with the main symptoms of MPS and the most common surgeries of these patients. This will improve early diagnosis.  Introduction: Bone infections are an important reason for incapacity in children, affecting mostly newborn and young children. Most infections occur through haematogenous spread, but minor trauma may be responsible for about 30% of cases. Large bones are the most frequently involved, with increased severity if affecting the epiphysis. Localized pain is the main warning sign, presenting sometimes in younger children with limb immobilization or constitutional symptoms. Diagnosis requires a high index of suspicion and a prompt start of treatment is crucial for the prognosis. Complications such as limited bone movement or length can occur in prepubertal children. Materials and Methods: Case report of a 12 years old adolescent with a complication of sacroiliac joint osteomyelitis. Results: A previously healthy twelve year-old female came to the emergency department (ED) with right sacroiliac pain radiating to the knee and muscular weakness. The pain had started 36 hours before, initially on her lower back, and was getting worse. Except for tenderness on the affected region, physical examination (PE) was normal and she was discharged home with symptomatic treatment. Seven days later, she returned to the ED for similar pain now associated with morning fever. A hip CT scan was performed, revealing no relevant alterations and she was discharged home with analgesia. Eleven days later, the pain kept getting worse and was now incapacitating, associated with insomnia and anorexia, and the morning fever was higher. On PE, she had a limp and severe hip tenderness with mobility limitation. Blood tests revealed anaemia, leukocytosis, thrombocytosis and increased inflammatory markers.
Blood and urine cultures were negative. Abdominal ultrasound revealed a homogenous splenomegaly and a psoas abscess, which was confirmed by a CT scan, also showing right sacroiliitis with osteomyelitis. The patient was transferred to the Orthopaedic Department of a reference centre and the diagnosis was confirmed with MRI. The teenager was treated with flucloxaciline for 41 days and surgical debridement was required on the 25th day of admission. Staphylococcus epidermidis was isolated from surgical debridement samples. After clinical improvement the patient was discharged home with an 18 weeks course of antibiotics and is still in orthopaedics outpatient revision. Conclusion: An osteomyelitis of the sacroiliac joint complicated with a psoas muscle abscess following minor trauma is a rare event. Correct diagnosis requires an adequate valuing of clinical findings and an early detection with prompt treatment is essential to decrease comorbidities. Introduction: Deep Vein Thrombosis (DVT) is a disease rarely seen in Paediatrics. The incidence is 0.07 cases per 10,000 children aged between 1 month and 18 years with a mortality rate of 2.2. There a number of causes of DVT, and whilst infants and teenagers are most affected, it can present at any age. A prompt diagnosis is the key to achieve a better prognosis. Clinical Case: Here we describe the case of a 16-year-old female adolescent, who presented at our emergency department with severe pain in the right lower limb which intensified with walking. She started a combined oral contraceptive pill 6 months before, with no relevant past or family history of DVT. On the examination she had a cold and cyanotic right lower limb, with palpable pedis pulse and no other relevant findings. The laboratory tests showed positive D-dimer (36218ng/mL) and C-reactive protein (7.9mg/dL). The doppler ultrasound performed showed suggestive signs of phlebothrombosis in the right femoropopliteal veins, extensive deep thrombosis involving the internal gastrocnemius vein, popliteal vein and the superficial femoral vein until the common femoral vein, with almost total endoluminal hypoechogenic ultrasound signals. The homolateral superficial veins were compressible. Considering the hypothesis of DVT, she was admitted to our ward and started enoxaparin (1mg/kg bid). During the hospitalization, she displayed significant clinical improvement, with almost complete recanalization of the venous system. She completed 30 days of enoxaparin after which we switched to dabigatran on the advice of the Vascular Surgery Department. From the initial investigation, there was a strongly positive lupus anticoagulant. All the other results were normal (complement, genetic tests and coagulation study). Tests were repeated after 12 weeks (per protocol) and these showed a moderately positive lupus anticoagulant remained. As the main diagnostic hypothesis was antiphospholipid syndrome she was referred to a rheumatology consultation for further investigation and follow-up. Conclusion: Cases regarding adolescents provide new challenges as they often present pathologies that are not that common in Paediatrics. It is therefore of the utmost importance the screening and identification of the risk factors needed for an assertive diagnosis. For the orientation and therapeutics it may be important the engage with other medical specialists as in our case with Vascular Surgery and Rheumatology.

ID: 64/ OP2: 13 ORAL How Does Attire Influence the Perception of Doctors by Children and Their Parents?
Siobhan Jane McAlorum 1 , Ian Kelvin Mecrow 2 1 The University of Manchester, United Kingdom; 2 Stepping Hill Hospital, United Kingdom; siobhan. mcalorum@student.manchester.ac.uk (standard deviation £2.41 range £0.00 -£12.00), 13 patients arrived by taxi at an average cost £6.72 (standard deviation 3.74 range £1.80 -£15.00), 2 patients reported other costs associated with attending clinic at an average of £10.00 (standard deviation 7.07 range £5.00-£15.00). Conclusion: Our results demonstrate that the average cost of attending a paediatric fracture clinic appointment is £18.14, 0.30 work days and 0.55 school days. No previous studies have quantified the direct financial cost to of attending paediatric fracture clinic appointments in the UK. Along with the already established financial benefit to the NHS, employing various strategies to reduce the number of fracture clinic attendees can not only also financially benefit patients individually, but can also have financial benefits to the UK economy, and minimise the educational impact of missed school days.

ID: 107/ OP3: 3 ORAL Towards a Better Understanding of Teacher Connectedness in Adolescence: The Role of School Level Factors
Irene Garcia-Moya 1 , Fiona Brooks 1,2 , Neil Spencer 1   1 University of Hertfordshire, United Kingdom; 2 University of Technology Sidney, Australia; i.garcia-moya2@herts.ac.uk Introduction: School is an important site for young people's health and wellbeing, with teachers having the potential for being a key element of the wider public health workforce. School characteristics, such as school size and the number of different teachers students engage with, can have a significant impact in the quality of teacher-student relationships. Unfortunately, most studies in this area have tended to subsume relationships with teachers within the broader concept of school connectedness, and therefore the impact of school factors on teacher connectedness specifically has remained under-explored. Purpose: As part of the EU funded Teacher Connectedness Project, this study aimed to conduct an initial examination of the potential contribution of a wide variety of school-level factors (including type of school, single-sex vs mixed schools, school size, student-teacher ratio, mean number of students per class and percentage of female teachers) to teacher connectedness in a representative sample of English adolescents. Materials and Methods: Sample in the 13/14 edition of the Health Behaviour in School-aged Children in England consisted of 5,335 adolescents aged 11, 13 and 15 years from 48 schools (a total of 261 classes). Multilevel modelling was carried out using teacher connectedness as the dependent variable. The aforementioned school-level variables along with sex, grade and family affluence were automatically included in the model based on our literature review, whereas stepwise selection (with the criterion for entry set at the 1% level of significance) was undertaken to investigate the possibility to include additional school-level factors. Results: Grade, family affluence, student-teacher ratio, single-sex vs mixed school and school location were significantly associated with teacher connectedness (p < .01). Conclusion: It is important that the design of health interventions in schools considers how teacher connectedness changes by age and SES, since connectedness tended to decrease in higher grades and be lower in those from less affluent families. In terms of school characteristics, it was not the size of the school but the ratio of students per teacher which was significantly associated to teacher connectedness. Our results also showed more positive results in mixed schools than in all-girls schools, although this finding must be cautiously interpreted given that only 4 all-girls schools were part of the study sample. This is an aspect, nonetheless, that deserves further examination in future research.

Introduction:
Previous studies have shown that living in a disordered neighbourhood (with low social cohesion, socioeconomic disadvantages and high rates of criminality) has an effect on adolescent health and lifestyles. Specifically, findings support that adolescents living in this context and with a higher awareness of disordered neighbourhoods tend to present higher rates of alcohol, cannabis and tobacco consumption, as well as having more antisocial lifestyles and psychosomatic complaints. However, little is known about the assets of those adolescents living in an at-risk neighbourhood.
Purpose: The aim of this study is to identify risks and positive factors related to adolescent lifestyles, health and social context in a group of adolescents living in a disordered neighbourhood, compared with normative adolescents. Materials and Methods: Data comes from the 2014 edition of the Health Behaviour in School-aged Children (HBSC) study in Spain. For this study the sample includes (1) 461 students from an at-risk neighbourhood in the region of Andalusian and (2) two groups of normative students representative of the adolescent population at a regional and a national level (composed of 1,977 and 31,058 students respectively) between 11 and 16 years old. Items related to lifestyles (eating habits or risk behaviours), health (life satisfaction or psychosomatic symptoms) and social context (family and friends relationships) were selected from the HBSC Questionnaire. Descriptive analyses, as well as mean comparisons and correlational analysis were performed, using different tests for assessing the effect size.
Results: Findings showed that adolescents living in an at-risk neighbourhood presented more unhealthy habits regarding breakfast, fruit, sweets and soft drink consumption, frequency of teeth brushing, sedentary behaviours and sleeping habits when compared with the normative population. However, there were no differences in alcohol or tobacco consumption, and adolescents living in disordered neighbourhoods presented even lower cannabis consumption. Despite reporting having more sexual relationships and using condoms less frequently, girls in at-risk neighbourhoods also showed less use of the 'morning after' pill than the normative sample. In addition, adolescents in at-risk neighbourhoods reported similar or even higher levels of family and friends satisfaction as well as liking school when compared to the normative adolescents, however, showed almost double of the amount of antisocial behaviour and higher proportion of adolescents feeling low and irritable.
Conclusion: An interpretation of some unexpected findings, as well as similarities and differences between the normative and the at-risk adolescents will be discussed, attending previous literature and also differences reported between the age groups. Some implications for designing effective interventions will be also offered.

ID: 90/ OP3: 5 ORAL The Evidence and the Effect of the Economic Recession on the Health of Italian Adolescents.
Alberto Borraccino, Paola Dalmasso, Franco Cavallo, Patrizia Lemma University of Torino, Italy; alberto.borraccino@hbsc.org Introduction: In the last 10 years many countries within the European Union have faced a strong economic crisis, often referred to as the Eurozone crisis. The crisis had significant adverse political, economic and labour market effects. The Italian National Statistical Institute (ISTAT) set the beginning of the economic crisis in Italy in 2008-2009 with a peak of recession in 2012-14. Several studies showed a relationship between the crisis and reduction of many health indicators in the adult population. While the phenomenon has interested the whole population it still remains poorly explored among adolescents.

Objective(s):
The study aims to explore whether one of the economic indicator validated to be used in adolescents' surveys is able to depict the economic recession in Italy in the period 2001-2014, and whether it is possible to discuss any effect on specific health outcomes among youths. Introduction: A chronic condition during adolescence can represent a major challenge for adolescents and it may place them at higher risk for vulnerable health outcomes. However, the impact of chronic disease on Health-related Quality of Life (HRQoL) and physical/psychological functioning in adolescence is a complex phenomenon, frequently with controversial results. Purpose: Inspired by previous studies that explored and characterized Quality of Life (QoL) and psychosocial functioning in chronically ill Portuguese adolescents at a national-representative level (using the cross-sectional and international survey Health Behaviour in School-aged Children -HBSC 2010), the main aim of the present work is to assess the impact of living with a chronic disease on Health-related Quality of Life (HRQoL) and Psychosomatic Health in chronically ill adolescents in a specific clinical context. Materials and Methods: Using cross-sectional data collected in a paediatric outpatient department in a hospital setting, a sample of 135 adolescents (51.9% boys, 14±1.5 years old), having an average age of 14±1.5 years (SD = 1.5), with diabetes mellitus (DM), allergic diseases (AD), or neurological diseases (ND) was included. From these, the majority of the adolescents reported not to feel affected in regular attendance at school (82.2%), and nor in leisure time with friends (86.7%). Chronic condition was defined as a long-term disability, illness or medical condition that has been diagnosed by a doctor. The study variables were respectively measured with the KIDSCREEN-10 (HRQoL) and the HBSC Symptom Checklist (Psychosomatic Health). Comparisons by type of chronic diseases were conducted and descriptive statistics and ANOVA were performed. The significance level was set at p < 0.05.  (2) socio-economic status, (3) risk behaviors, and (4) mental health status, collected during a medical visit in an adolescent interdisciplinary clinic. We examined frequencies for a core set of registry items from 2009 -2014. Chi-square and non-parametric rankbased tests were used to evaluate differences in these responses by gender. Results: Among 2832 youth (median age 14 years (25th, 75th) quartiles = (12, 17) years, 72% female), 17% reported a history of chronic illness, 17% reported severe psychological problems, and 11% had experienced violence. Socio-economic status was measured by maternal and paternal education levels (32% of youth's mothers and 35% of fathers had completed secondary education), parental employment (52% of fathers and 21% of mothers with a stable job), and housing stability (less than 3% of youth reporting overcrowding, lack of electricity, running water, or outdoor plumbing). Youth were food secure with a median of 3 meals per day; and fairly sedentary with a median reported physical activity of less than 1 hour a week; a minority (12%) were dissatisfied with their body image. Nearly one-third (30%) of youth reported being sexually active; the median age for coitarche was 15 years, and 75% of those who were sexually active report routine condom use. Finally, the large majority (80%) reported their mood as normal, 91% felt socially accepted, and 63% had a life trajectory they were working to achieve. We found that males were more likely than females (26% vs 14%, p = 0.04) to have a history of psychological problems, and less likely (8% vs 38%, p < 0.01) to be sexually active, possibly due to the overall younger male subcohort (median male age = 13 years compared to 15 years in females). physical activity also varied significantly by gender with males reporting higher levels of activity (p < 0.01).

Conclusion:
In this young population seeking services, the prevalence of risk behaviors and mental health concerns was surprisingly low. Findings from this study underscore the importance of expanding adolescent health surveillance measures to youth outside of the interdisciplinary clinic, and in suburban and rural locations throughout the country.

ID: 45/ OP3: 10 ORAL An Epidemiological Study of Eating Disorders in Children and Adolescents-A Longitudinal Analysis of 5 Year Data in a Singapore Cohort.
Rajeev Ramachandran NUHS, Singapore; rajeev_ramachandran@nuhs.edu.sg Aim: To understand the demographics, clinical features and outcomes of paediatric and adolescent patients attending the multi-disciplinary Eating Disorder (ED) program at the National University Hospital, Singapore.

Methods:
The case notes of all patients (n = 82) followed up by the ED Program under the adolescent medical service at the National University Hospital (NUH) Singapore between January 2011 and June 2016 were reviewed. Patient characteristics and outcomes data were abstracted and summarized.

Results:
The average age at onset of symptoms was 14.6 years. The patients were predominantly Chinese (84%) and females (93%). Majority (87%) had a diagnosis of anorexia nervosa (AN) with 9% and 5% diagnosed with eating disorder not otherwise specified (ED NOS) and avoidant/restrictive food intake disorder (ARFID), respectively. There were no patients with bulimia nervosa (BN). A large proportion (57%) of patients required inpatient management, for an average length of stay of 64 days. 9% of our patients developed refeeding syndrome during the nutritional rehabilitation, which is 15% of the admitted patients. Major depressive disorder was the most common psychiatric comorbidity (38%). Self-harm was noted in 13%, with active suicidal ideation in 6%. 13% of our patients were discharged after full remission. We did not have any mortality so far. Conclusion: Further evaluation of the low rates of patients suffering from BN, boys and patients of Malay background is required. Comorbid psychiatric conditions were common, the proportion of patients requiring inpatient care was large and hospital stay was long. This could be addressed by the addition of an integrated ambulatory day therapy program and introducing family based therapy as the recommended treatment.
teenage pregnancy is associated with adverse maternal and fetal/neonatal outcomes, with a strong negative effect in their educational, social and personal achievement. Purpose: Characterize pregnancy in adolescence regarding obstetric and fetal outcomes and neonatal morbidity at our hospital within the last 2 years. Materials and Methods: A retrospective study of medical records of all pregnant adolescents who had attended our hospital for delivery or abortion between the 1st January 2014 and 31st December 2015. Variables analyzed: maternal age, socio-demographic factors, pregnancy monitoring and outcome, type of delivery, need of neonatal resuscitation, birth weight, maternal and newborn complications, newborn destination and family planning appointment. We used the statistical software SPSS®, v. 21.0 for parameter analysis. Results: In the study period, there were 245 pregnant adolescents (7.8% of all pregnancies in our hospital). 39.2% had already had at least one previous pregnancy. The distribution by age was: 0.4% (10-13 years-old), 20.3% (14-16 years-old) and 79.3% (17-19 years-old). The rate of abortion was 40.4%, which accounts for 1/3 of the total abortion rate at our hospital. There were 2 medical interruption of pregnancy by fetal malformation. In the past two years, there were a total of 145 live births newborns of adolescent mothers (5% of all deliveries). Of those mothers, more than 1/3 were gipsy or foreign. Most of them had monitored and low risk pregnancies. We had 66% eutocic deliveries. 7.6% were preterm newborns and 3.8% of full-term newborns had low birth weight. There was no need for neonatal resuscitation in any case. 7.6% of newborns were hospitalized; the majority to solve social situation but only 1 newborn was given for adoption. Most teenagers didn't attend the follow-up in family planning appointment.

Conclusion:
The pregnancy and abortion rate in adolescence at our hospital is higher than the national average. This may be due to the unfavorable socio-economic conditions and minority ethnic communities in this area. The majority of adolescents were 17-19 years old, which can be responsible for fewer adverse obstetric and neonatal outcomes. We are concerned about the significant percentage of adolescents who had a previous pregnancy and continue without follow-up in a family planning appointment.

ID: 195/ OP3: 12 ORAL A Multi-Centric Educational Program for Training and Prevention of Food Anaphylaxis in Portuguese Schools and Pre-Schools
Francisco Introduction: Prevalence of food allergy has been raising and the nature of the condition, with the potential of developing anaphylaxis, a life-threatening event, requires a holistic approach. Anaphylactic events in schools and pre-schools are frequent and international guidelines advocate for the need of training people with closer contact to the patient. The development of educational programs for schools can be one answer for this need. Purpose of the Program: This project aims to raise awareness of school and pre-schools' staff on the necessary measures to deal with a student with the diagnosis of food allergy and how to prevent, recognize and primarily treat anaphylaxis. Program description: A group of Portuguese hospitals designed an intervention program with the support of the Portuguese Society of Pediatric Allergy (SPAP). On the participating hospitals, patients with diagnosis of severe food allergy who had prescription of epinephrine auto-injector were selected. Informed consent to perform the training session at the schools was obtained from their parents. Schools were contacted in order to present the project and to plan and schedule the session. Our target population were school and pre-schools teachers and auxiliary teaching staff as well as the kitchen, cafeteria and dining facilities' staff. A 30-minute session, delivered by pediatricians, was designed.
Background: In April 2014, the municipal water supply in Flint, Michigan changed sources from Lake Huron to the Flint River. The higher corrosiveness of Flint River water and inadequate water treatment resulted in lead contamination in household tap water. On 24 September 2015, local physicians urged Flint residents to stop using their tap water after finding high blood lead levels in local children. Although the supply has switched to Detroit water, water is still running through contaminated pipes thus causing additional leaking of lead in tap water in Flint, MI. The Flint Water Crisis increased awareness of the dangers of lead-contaminated drinking water. Pregnant women are especially susceptible to the effects of lead exposure. Maternal elevated blood lead levels are associated with increased incidence of spontaneous abortion, lower birth weight, and infant mortality. During the Washington DC Water Crisis (2000)(2001)(2002)(2003)(2004), exposure to lead-contaminated drinking water was associated with fetal death and reduced birth rates. Lead-contaminated water may be a concern around the world due to aging infrastructure. Some strategies to decrease exposure to lead in drinking waters among women include: installing a lead water filter, running tap water at least 1 minute before use, and cleaning the aerator of bathroom sinks.

Materials and Methods:
In a cross-sectional cohort of healthy children (median age 5.8 years; n = 59), DHA, choline and lutein intakes were estimated using a food frequency questionnaire. Cognitive performance including short-term memory, visual processing, long-term storage and retrieval, and general mental processing ability was assessed using the Kaufman Assessment Battery for Children. Associations between nutrient intakes were assessed using Pearson's correlation, and associations between nutrient intakes and cognitive performance scores were assessed by partial correlation controlling for other variables associated with cognitive performance in the study (child's sex, mother's age and ethnicity). To test the study hypothesis, children were divided into four subgroups based on intakes of DHA, choline, and lutein: G1 (intakes of all 3 nutrients above cohort medians; n = 15), G2 (intakes of any 2 nutrients above cohort medians; n = 14), G3 (intake of any 1 nutrient above cohort median; n = 15), and G4 (intakes of all 3 nutrients at or below cohort medians; n = 15). Cognitive performance scores were compared among the four subgroups using ANCOVA controlling for child's sex and mother's age and ethnicity. Results: Median (interquartile range) intakes of DHA, choline, and lutein in these 59 healthy children were 76 (40-127), 311 (238-400), and 2.3 (1.1-4.1) mg/day, respectively. Significant correlations were found between each pair of nutrient intakes (r = 0.42-0.67, P≤0.001). Intake of each of the 3 nutrients was significantly correlated with short-term memory (r = 0.37-0.42, P < 0.05); intakes of DHA and choline were each significantly correlated with general mental processing ability (r = 0.38-0.42, P < 0.05). Children with dietary intakes of all 3 nutrients above cohort medians (G1) had significantly better short-term memory (23.0±1.1 vs. 18.4±1.1, P < 0.01) and general mental processing ability (82.9±2.7 vs. 70.7±2.9, P < 0.01) compared to children with DHA, choline and lutein intakes below cohort medians (G4). Short-term memory scores were also significantly higher in G1 compared with G2 (19.9±1.1, P = 0.0395) and tended to differ in G1 compared with G3 (20.3±1.1, P = 0.09). No other subgroup differences were detected. Conclusion: These data suggest that higher concurrent intakes of DHA, choline, and lutein are associated with higher scores of short-term memory and general mental processing ability in schoolaged children. Potential mechanisms underlying this finding warrant further investigation.

ID: 42/ OP4: 2 ORAL Macronutrient Intake Associated with Weight Gain in Adolescent Girls with Anorexia Nervosa
Traci Lyn Carson, Charumathi Baskaran Massachusetts General Hospital, United States of America; tlcars@umich.edu Background: It is known that adolescents and women with AN severely restrict fat intake and consume high amounts of fiber. However, clinical nutrition parameters predictive of weight gain in AN treatment are not well understood. Objective: Prospectively investigate absolute macronutrient composition and changes in macronutrient composition associated with weight gain over a 6 to 12 month period. Design: This was a prospective study of 90 girls 12-18 years old. 45 subjects with anorexia nervosa (AN) and 45 healthy control subjects (HC). Subjects completed four-day food logs and underwent body composition testing using DXA. Descriptive statistics included assessment of means ± SEMs, and the Student's t test was used to determine differences between groups. For subjects without 12-month data, 6-month data were carried forward for analysis. Results: At baseline, clinical characteristics and body composition measurements did not differ significantly between the group of AN girls who did not achieve weight gain (AN-0) and those who did gain at least 10% BMI (AN-1). Total caloric intake did not differ significantly between AN-0 and AN-1 at baseline or follow up. AN-0 consumed a greater percentage of total calories from protein at baseline and follow up, compared to AN-1 (p < 0.05). From baseline to follow up, AN-1 had a significant increase in the percentage of calories obtained from PUFA (p = 0.007) and a significant decrease in percentage of calories obtained from soluble fiber (p = 0.02), compared with AN-0. Percent calories obtained from fat had a positive significant correlation with BMI at follow up (r = 0.25, p = 0.02), and absolute carbohydrate intake (r = -0.24, p = 0.02), percent calories obtained from carbohydrates (r = -0.24, p = 0.03), and soluble fiber (r = -0.22, p = 0.04) had a negative correlation with BMI at follow up. Conclusion: Consuming a greater intake of fat may assist in weight gain during recovery from AN even without a significant increase in total energy intake. Introduction: Paediatric obesity is a global, public health problem. Its prevalence has been continuously increasing, especially in developed countries, and a parallel increase is happening for obesityrelated diseases.

ID
Purpose: The purpose of this study was to characterise the group of children and teenagers reviewed in the obesity outpatient clinic in a Portuguese secondary hospital. Materials and Methods: A descriptive and observational study was conducted. Data was collected from medical records of all patients reviewed in clinic from 1st September 2015 to 31st August 2016. Information related to age, gender, anthropometry and obesity comorbidities was collected and analysed in a confidential and anonymous way. Results: Medical records of 341 patients were analysed. The final sample was constituted of 46% male, with ages between 3 and 18 years old (mean age 12,8, SD 3,2). Body mass index (BMI) was over the 95th percentile in 76% of the patients and over the 99th in 16.4%. 26.4% had insulin resistance and 19.4% had started metformin. One patient had type 2 diabetes mellitus (DM), two had impaired fasting glucose and one had impaired glucose tolerance. 27.6% had dyslipidaemia and 7.3% had hepatic steatosis. Family history was available in 203 medical records, and a history of obesity and/or type 2 DM was found in 93.6% of those.

Conclusion:
The results were comparable to those obtained in similar studies. The increase in obesity prevalence among children and teenagers is particularly alarming because obesity-related conditions rarely seen in children in the past, including type 2 DM, are increasingly diagnosed in paediatric patients.

Introduction:
Breast feeding is not only the best and complete nutrition for an infant, but offers benefits to both infant and mother like reduced incidence of multiple infections, asthma, atopic dermatitis diabetes mellitus type 2, and obesity in infants. Maternal benefits include reduction to pre-pregnancy weight, low post-partum depression rates, lactational amenorrhea Hospitals play a significant role in how babies are being fed in their first hours of life and common hospital feeding practices don't reflect necessary steps to support exclusive breastfeeding. Some common hospital practices can lead to the infant receiving formula in the first weeks of life despite mothers' dedication to exclusively breastfeed. Purpose: Our specific aim is to improve the overall and exclusive breast feeding rates at discharge to 75% using small and simple strategies.

Materials and Methods:
We focus on utilizing the "Ten steps" and evaluate the impact of small but significant changes in primary provider's (lactation consultant, nursing staff, and physicians) approach on breastfeeding rates at discharge. "Ten Steps to Successful Breastfeeding", the combined efforts of WHO and UNICEF to create a global standard to help support breast feeding within a hospital setting, was successful in increasing the hospital participation3 .We follow the Plan-Do-Study-Act format to evaluate our results. Implementation of practices like skin-to-skin, rooming in, and avoiding pacifier and formula in the early post-partum period were consistently introduced into the post-partum care. Each month the results of the changes made were reviewed, barriers identified and steps were taken to overcome the barriers with the support of the primary providers. We compared our results with the Cohort C of NICHQ results (which collects data from 81 hospitals across 3 major geographical cohorts) at monthly intervals using a chi-square analysis. Results/Conclusion: We found clinical and statistically significant improvement in exclusively breast feeding, skin to skin and parental breast feeding instructions (p < 0.001). Other indicators like overall breast feeding, and discharge support and assistance with breast feeding rates although showed clinically significant increase compared to NICCHQ, even if no statistical significance was detected due to small sample size compared to Cohort C. Based on this data, we believe that we have achieved significant strides in improving the breast feeding rates. Our success can be attributed to the hospital support staff in identifying the barriers and the most important being lack of consistency which we were able to overcome by thorough and continuous nursing staff education, scripted responses, pocket cards to answer promptly and effectively to aid in breast feeding. Introduction: New Zealand has the third highest prevalence of childhood obesity among OECD countries. Risk of later offspring obesity is associated with maternal diet and physical activity during gestation and early childhood. Reduced sleep duration may also be a risk factor. There are a number of hypotheses regarding the mechanisms for sleep-obesity associations including diet quality effecting sleep latency and duration. Purpose: To determine the effects of maternal diet during pregnancy and early childhood diet (3.5 and 7 years of age) on body composition and sleep latency and duration at 7 years.

Materials and Methods:
The longitudinal Auckland Birthweight Collaborative (ABC) Study included children born small for gestational age (SGA) and non-SGA. Data was collected on mothers at birth (n = 871), and their children at 3.5 (n = 550) and, 7 (n = 591) years. Dietary information was collected using food frequency questionnaires, and dietary pattern scores created using principal components analysis, resulting in 3 previously defined dietary patterns (Junk, traditional and healthy). At 7 years sleep duration and sleep latency were evaluated using both parent report and data collected from a single day using an G3TX Actigraph (Actigraph Ltd, Pensecola, Floida, USA). At 3.5 and 7 years Body Mass Index (BMI) was calculated (weight (kg)/height (m)) and percentage body fat (PBF) was estimated via the BIM4 (Impedimed Ltd, QLD, Australia). The relationship between maternal pregnancy diet and childhood diet at 3.5 years on body composition, sleep duration and latency at 7 years was assessed using linear regression. Results: A higher maternal healthy dietary pattern score was inversely associated with offspring Z-BMI at 3.5 years (-0.20; 95% CI -0.35, -0.05), 7 years (-0.26; 95% CI -0.47, -0.04) and PBF at 7 years (-1.81%; 95% CI -3.42%, -0.19%). A higher traditional dietary score at 3.5 years was associated with a decrease in PBF at 7 years (OR-0.86%; 95% CI -1.65%, -0.08%). There was no association of childhood dietary patterns on sleep duration and latency but a higher maternal junk dietary pattern score was inversely associated with sleep duration at 7 years (OR-14min; 95% CI -22min, -7min). Conclusion: A healthy dietary pattern in pregnancy and early childhood was associated with lower childhood BMI and PBF at 7 years of age. The study findings emphasise the importance of the influence of maternal diet in pregnancy and early childhood diet on children's body composition. The effect of diet in pregnancy on sleep duration in mid-childhood requires further investigation

Introduction:
In all recent guidelines urotherapy is the first step in treatment of enuresis. Diet adjustments are presented as an element of urotherapy, even though evidence on the possible effect of dietary adjustments in enuretic patients is limited in literature. Purpose: In this investigation we want to examine the possible effect of diet adjustments with saltand protein restriction on nighttime urine production and urinary osmolality in enuretic patients.

Materials and Methods:
A prospective study on a tertiary population of new enuretic patients aged 6-16 years. Using voiding diary's before and after diet adjustments we have sought for an effect on nighttime urine production. Urinary samples before and after diet adjustments were performed to find a difference in urinary osmolality. Results: 16 patients were included, 6 girls and 10 boys with an average age of 8 years old. No patients dropped out. 50% of the patients suffered non-monosymptomatic enuresis, 50% monosymptomatic enuresis. The majority of patients showed nocturnal polyuria following ICCS definition of 130% of estimated bladder capacity. After the diet adjustments a decrease in mean nighttime urine production was seen in the majority of patients. (figure 1) A significant decrease in wet nights was observed after diet adjustment. (figure 2) A median decrease of 1 wet night, from 7/7 wet nights to 6/7 wet nights, was observed. A median decrease of 1,5 wet nights on 7 nights with nocturnal polyuria according to the ICCS definition was observed. The result for urinary osmolality were very variable, no clear correlation could be made.

Conclusion:
Our results show, in a small population of enuretic patients, that there is a positive influence of salt-and protein restriction on nighttime urine production, number of wet nights and number of nights with nocturnal polyuria. The decrease in nocturnal diuresis was insufficient to reach complete dryness. The majority of patients suffered nocturnal polyuria, which can affect our study results. Further investigation is required to select suitable candidates for diet adjustments. . Results: Of 3099 EGD, 100 were performed for UGIB and 11 patients were excluded due to lack of complete clinical data. Study sample included 89 patients, 57% were male and median age was 7 years (range 0-17 years). In 80,9% it was the first UGIB episode and the most common presentation was hematemesis (82%), followed by melena (12,4%) and coffee-ground emesis (5,6%). There were no statistical differences between clinical presentation and admission haemoglobin (Hb) levels. Most patients (64%) underwent EGD in less than 72 hours ( < 48h in 50/89, these patients had the lowest Hb values). An aetiology was more frequently identified by early EGD, rather than later EGD (p = 0,014). 14/89 patients required transfusional support; 29% had underlying gastrointestinal/liver or neurological disease. Concerning endoscopic findings and UGIB source was: probable in 54/89; questionable 20/89 and normal 15/89. The most common diagnosis was erosive gastritis 28/89, erosive esophagitis 8/89 and esophageal varices 8/89. Lower Hb levels were associated with: a) gastric endoscopic findings (p = 0.015); b) type of drugs taken before UGIB (p = 0.007); c) NSAID's (p = 0,001); d) viral infections (p = 0,005). Erosive gastritis was significantly associated with viral infections (p = 0,047). Conclusion: Early EGD is crucial for appropriate diagnosis, helping to determine the bleeding source. Erosive gastritis was the most frequent endoscopic abnormality and was significantly associated with viral infections. Medicines, mostly NSAID's, and viral infections were probable triggers associated with UGIB and lower Hb levels.

ID: 35/ OP4: 9 ORAL Evaluation of a Computerized Self-Management Tool for Children with Type-1 Diabetes
Navita Dyal, Gina Agarwal, Karen McAssey McMaster University, Canada; ndyal@glitr.org Introduction: Pediatric diabetes is a rising global public health concern, with an increasing prevalence in developed and developing countries alike. The World Health Organization appeals to the medical community to develop effective interventions, which will counteract the long-term negative health outcomes and high costs associated with diabetes. Self-monitoring blood glucose (SMBG) > 3 times per day is significantly correlated with lower hemoglobin HbA1c. Poor adherance to SMBG undermines its optimal benefits, yet a significant decline in SMBG is reported after the first year of diagnosis. Purpose: KiDi SMS is an online tool developed to motivate children to self-monitor their blood glucose. Patients of McMaster Children's Hospital Pediatric Diabetes Clinic used KiDi SMS for three months. Each day that the child logs a minimum of three blood glucose readings, a game is unlocked. Once a game is unlocked it is only available until midnight. Thus, in order to unlock another game, the user is required to log three more readings the following day.

Materials & Methods:
Clinic staff identified potential participants based on their average rate of SMBG. Those who were logging their blood glucose < 3 times per day were approached. Children between the ages of 8 and 12 years of age, diagnosed with type 1 diabetes > 1 year were included. Participants were also required to have Internet access at home. Participants who were already logging blood glucose > 3 times per day were excluded. Access to this program was provided free of charge. Results: 85% of participants logged their blood glucose readings daily using KiDi SMS. This is a significant improvement in patients' self-management regime, as all participants logged their blood glucose readings < 3 times per day prior to using KiDi SMS. 82% of participants, who used KiDi SMS daily, demonstrated a mean daily frequency of at least three logs. Participants were asked if they felt more encouraged to self-monitor their blood glucose daily after participating in this intervention; 91% answered in the affirmative. Conclusion: While this study was designed as a simple feasibility study; future development of this program could whether KiDi SMS, as a cell phone application, would motivate more children to selfmonitor. A reward system for having blood glucose readings within the user's target range might be included. The study population could be broadened to include children who are currently logging ≥ 3 times per day. These additional trials may further improve KiDi SMS. Introduction: Congenital hypothyroidism (CH) is the most frequent congenital endocrine disorder (estimated incidence 1: 3000/4000 live births) and its early detection and prompt treatment are essential for the avoidance of serious consequences, especially cognitive disorders. Neonatal screening in Portugal has been implemented in 1981 and since 1983 our Pediatric Department is the treatment center of CH at the southern part of the country. Purpose: The aim of this study is to characterize patients diagnosed with CH in the second decade of neonatal screening (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002) and to evaluate clinical manifestations and prognosis according to early initiation of therapy, hormonal control and type of defect identified by scintigraphy.

Materials and Methods:
Retrospective study of data from clinical records of patients diagnosed with CH between 1993 and 2002 followed in pediatric endocrinology pediatric ambulatory. The collected data included: risk factors for thyroid disease, early and late clinical manifestations, type of defect identified by scintigraphy, initial therapy and response. It was defined good therapeutic control if TSH < 6.3 mIU/ L and total T4> 10 mcg/ dl. Results: 124 children are studied, two-thirds were females, 27.4% had family history of thyroid disease, 98 have permanent CH and the most frequent type of defect identified in scintigraphy was ectopy (n = 36). Early symptoms of hypothyroidism were present in 82.3% of cases (macroglossia as the most frequent), which may be related to the fact that the beginning of treatment migth still limited by the capacity of diagnostic methods at that time. More than a half of the children had late manifestations and school failure was the most frequent (33%). The beginning of therapy before 30 days of life was associated with better hormonal control up to 3 years (p = 0.022) and less late manifestations (p = 0.024). A higher TSH value in the first month of therapy was associated with psychomotor developmental disorders (p = 0.047). Agenesis of the thyroid gland was associated with a higher TSH value (p < 0.01) and a more difficult therapeutic control up to 3 years (p = 0.03). Conclusion: Early beginning of therapy was associated with a better hormonal control and less late manifestations. School failure is the most important late manifestation, which reinforces the need of a multidisciplinary follow-up with regular psychomotor development evaluations. Introduction: Many studies describe the characteristics of patients affected by Growth Hormone (GH) deficiency and of rhGH therapy effects both in paediatric and in adult population, but few of them offer an analysis of the follow up of patients to their final height. This lack is probably due to the shortage of regionally and nationally structured databases. Within the Italian framework of the regional project of monitoring of rhGH treatment, it is worth highlighting the existence of the Regional Registry in the Piedmont area, started in 1999.We present a preliminary analysis of that database now robust enough to offer reliable information.

ID
Purpose: The aim of our work is to describe the growth of paediatric patients affected by growth failure who were treated with rhGH.

Materials and Methods:
We enrolled 252 patients from the GH Registry who were treated for GH deficit, with a diagnosis of Idiopathic GHD (IGHD) and Organic Congenital GHD (OGHD), between January 2000 and October 2015, had completed follow up and reached their final height. For all of them, initial and final height, initial pubertal stage and parental Target Height were available. The results are based on classical statistical descriptive methods and each indicator is shown with the relative 95% Confidence Interval. The therapeutic efficacy is evaluated in terms of: -difference between the initial and the final height -difference between the final height and the parental Target Height All the evaluation are based on the SDS score. The analysis is performed with and without differentiation by diagnosis.

Results:
The parental Target was reached by 64% of patients IGHD and OGHD. Mean height gain is better for males (0.90 SDS for males vs 0.63 SDS for females). OGHD patients responded better to rhGH in comparison with IGHD subjects (improvement in 75% of OGHD vs. 68% of IGHD in term of height gain). In our cohort, 58% of female and 73% of male started rhGH in the pre-pubertal age presenting a better final height gain with respect to patients who started later. Conclusion: These preliminary analyses revealed some interesting issues to ponder, on the best period to start the treatment and on expected therapy results . These suggestions will be deepened in future analysis. Moreover, a larger cohort, comprehensive of Organic Acquired GHD, should be available in a short time from other Piedmont reference centers. In particular, a study on the effectiveness of treatments using also pre-therapy data is in progress.

ID: 57/ OP4: 12 ORAL Estimation the Effect of Prophylactic Dose of Vitamin D3 for the Correction of its Low Status of Adolescent Girls
Irina Zakharova, Tatiana Tvorogova, Svetlana Vasilieva Russian Medical Academy of Postgraduate Education, Russian Federation; zakharova-rmapo@yandex.ru Objectives & Study: Our study was performed to assess the effect of prophylactic doses of vitamin D (400 IU/ day) for the correction of low vitamin D status in adolescent girls.

Methods:
The study included 100 adolescents (mean age 14,3 ± 2 years), without chronic somatic diseases. A group of 88 girls took the drug at a dose of vitamin D3 400 IU/ day for 3 months, a group of 12 girls did not receive the drug. Estimation of blood serum levels of 25-OHD was conducted by immunochemiluminescent analysis every month within 3 months of observation. Vitamin D pronounced deficiency was defined as 25-OHD below 10 ng/mL; deficiency was defined as 25-OHD of 10-20 ng/mL; insufficiency as 25-OHD of 20-30 ng/mL; and sufficiency as 25-OHD of 30-50 ng/mL. Results: Analysis of the results showed that the average content of the starting 25-OH D in adolescents receiving drug was 12,4 ± 1,6 ng/ ml, without correction -12,6 ± 1,5 ng/ ml. Analysis of the results of the study showed that after the first, second and third months of taking the drug, the average content of 25-OH D increased to 16,9 ± 2,5 (p> 0.05); 17,7 ± 2,4 (p < 0.05), and 19,9 ± 2,4 (p < 0.001) ng/ ml, respectively. In the group of adolescents who did not receive the vitamin, the average content 25-OH D did not change and amounted after determining at 1, 2 and 3 months: 11,6 ± 1,2; 13,1 ± 2,3 and 12,4 ± 1.5 ng/ ml (p < 0.05), respectively.

Conclusion:
The study showed that the 3-month intake of vitamin D3 and dose (400 IU/ day) are not sufficient to normalize vitamin D status in adolescent girls. When selecting the dose for adolescents it is advisable to consider the number and severity of such factors as hypodinamia and increased physical activity, growth and physical development stage of puberty, insufficiency seasonal insolation and nutritional vitamin deficiency.

ID: 86/ OP4: 13 ORAL Neurological Complications in Pacients with Typical Haemolytic Uremic Syndrome-Clinical Manifestations, Evolution and Outcomes in 2 Case Study.
Anca Croitoru, Loredana-Ionela Popa, Georgiana Combei, Ioana Mihalache, Mihaela Balgradean Emergency Hospital for Children "Marie Sklodowska Curie" Bucharest, Romania; croitoru.n.anca@ gmail.com Introduction: Hemolytic uremic syndrome (HUS) is described as a multisistemic disease, that affects mainly the kidney and it is a major cause of morbidity and mortality for children under the age of 5 years. Defined by the triad: acute kidney failure, hemolytic anemia and thrombocytopenia, HUS often involves the central nervous system (CNS) -one of the life-threatening complications. Two cases with neurological manifestations, but each with different outcome will be presented. Case Reports: Case 1: 1 year and 4 months boy diagnosed with HUS, verotoxin 1 and 2-positive and Escherichia coli-serotype O26 begins, from the second day of admission to manifest extreme agitation alternating with periods of sleepiness. His state worsens with opistotonus, myoclonic seizures, alteration in consciousness. Considering neurologic complications and thinking of lesions in the basal ganglia, a CT is done that underline moderate cerebral edema. The treatment starts with corticotherapy, IV methylprednisolone -3 doses, with positive evolution and without neurological sequelae. For other possible neurological modifications the MRI exam was also done which revealed only minimal cortical atrophy. Case 2: 2 year and 4 months girl, is hospitalized with HUS diagnosis, with negative verotoxin, presents after 3 days of admission in our department, sleepiness. She becomes hyporesponsive and presents partial seizure on the left side. The first CT-points a normal image, but the second one emphasize-ischemic lesions on the right occipital region. A corticotherapy schedule was started followed by mild improvement. In this case the MRI highlighted -bilateral occipital lesions. A left external hemianopsia was evaluated as neurological sequela. In both cases, the renal kidney failure was severe requiring peritoneal dialysis for about 20 days. Conclusion: In this two case study, the presented patients diagnosed with HUS and neurological complications the evolution of the disease was moderate favorable under specific treatment. Usually in these cases, patients have also severe acute renal damage and require a dialysis procedure.

ID: 221/ OP4: 14 ORAL The Effect of Social Media Use on Teens Sleep
Shaza Ali Mohammed Elhassan 1 , Odette L. Chagoury 2 , Ruba Labwani 3 , Marwa Salah Mansour 4 1 hamad medical center, Qatar; 2 Weil Corneil,doha,Qatar; 3 hamad medical center, Qatar; 4 hamad medical center, Qatar; ALISHAZA222@GMAIL.COM Introduction: Use of social media websites is a common behavior amongst contemporary adolescents. Social networking allows an avenue for non-stop entertainment and communication. Previous research has shown that social media use in adolescents is associated with a range of sleep problems, particularly when engaging in this activity close to bedtime. Aim: To assess the current trends in technology and electronic device usage two hours before bedtime on school nights in adolescents. We obtained data on use of smart phones, ipads/tablets, laptop computers, portable video gaming devices and the impact each of these devices had upon sleep outcomes.

Methods and Materials:
In our cross-sectional study we administered a 40-item questionnaire, adapted from the Technology Use Questionnaire, originally developed for a birth cohort study. Both hospital research committee and ministry of education approved the study. The survey was completed online by adolescents (aged 12-18 years old) at schools across Doha, Qatar. We approached 1000 participants at both private and public schools. We retrieved 668(response rate was 67%)The survey was administered and completed in English (n = 542) or Arabic (n = 126), according to participant's language preference. Students were able to complete the survey in about15-20 minutes. Results: Of the 668 adolescents (49% boys) enrolled to the study, electronic device ownership was highly prevalent where 89% owned a mobile phone, 42% a portable video gaming device, 78% had a laptop, 62% an iPad/tablet and only 2% reported having none of these electronic devices. In our large sample of adolescents, 85% reported using at least one electronic device in the two hours preceding bedtime on weekdays with smart phones accounting for 43%. The majority of participants reported using smart phones for social networking (67%), viewing video content (58%), or texting (56%). Smart phones were also used two hours before bedtime on school nights, but to a lesser extent, for communicating via WhatsApp (47%), listening to music (45%), surfing the internet (44%), gaming (32%), reading (25%), Skyping (19%). Interestingly, portable telephones were less often used for their original purpose of making calls (16%) in our sample. When asked specifically about calls/text messages that awaken them from sleep, 38% reported that this occurred 'sometimes', 20% reported 'usually/always' and 40% reported that this 'never' happened and 2% did not respond. Twenty-one percent of participant's reported that they 'always' lose track of time and go to bed later than they should, 41% stated that this 'sometimes' happened, 21% reported 'rarely', and 17% reported 'never'. On weekend nights, 52% reported going to bed after midnight, of which 10% was due to social networking. Eighty percent of the sample reported waking up one or more times per night versus 20% who reported 'never' waking during the night. Conclusion: Ownership of electronic media devices was widespread in our sample of Qatari adolescents with smart phones being one of the most prevalent devices owned in this group. There appears to have been a shift in the use of mobile phones, which were originally developed for purposes of making/receiving calls. The main purpose of smart phone usage in our contemporary sample of adolescents now appears to be for social networking use and engagement in this activity appears to common before bedtime, which may have adverse consequences on sleep and subsequent daytime sleepiness levels

ID: 48/ OP5: 1 ORAL Maternal Serum Total Homocysteine and Fetal Neural Tube Defects-Effect Modification by Maternal Serum Free T4
YanHong Gu 1 , Ting Zhang 2 1 Teikyo University, Japan; 2 Capital Institute of Pediatrics, China; gyh@med.teikyo-u.ac.jp Introduction: Many factors other than folate deficiency may cause neural tube deficiency (NTDs). Thyroid hormone (free T4, FT4) influences the development of the brain in the early embryonic stage. Purpose: We attempted to explore the association between some relevant factors and NTDs in this study.

Materials and Methods:
We conducted a case-control study to estimate and compare 1) the serum FT4 level in early pregnancy, and 2) the risk for each type of NTDs, using regression analyses. Data were obtained during the period between 2003 and 2004 from pregnant women who were living in a county of Shanxi province and were visiting the same hospital for antenatal examinations.
Results: There was an FT4 surge in the control group, whereas no such surge was seen in pregnant women with NTDs before 20 weeks of gestation. There were no correlations between the urinary concentrations of iodine and serum concentrations of FT4 after adjustment for the gestational weeks and/or age. In cases with serum FT4 > 15.2 pmol/L, tHCY was not a risk factor for NTDs. However, in cases with serum FT4 less than 15.2 pmol/L, after adjusted by age and gestational weeks i) the odds ratio (OR) of a high level of tHCY (> 6 μmol/L) was 10.70 for NTDs (95% confidence interval (CI): 2.09-54.83, P = 0.004); ii) the OR of a high level of urinary concentrations of iodine (> 250μg/L) was 1.65 (95% CI: 0.61-4.49, P = 0.328); iii) the OR of positive antibody was 1.78 (95% CI: 0.66-4.77, P = 0.255). Conclusion: Serum FT4 level modifies the effect of tHCY on the risk of NTDs. In cases where the serum FT4 level was low, NTDs was associated with a lower level of tHCY, but not iodine intake and thyroid antibodies.

ID: 109/ OP5: 2 ORAL Early-Onset Neonatal Listeriosis-Case Report
Joana Soares, João Agro, Lina Winckler Centro Hospitalar de Leiria, Portugal; joana_soares@msn.com Introduction: Listeria Monocytogenes is a widely known pathogen and may be life-threatening to some risk groups. However, there are few clinical reports of neonatal infection. Case Report: We report a case of a 32-week preterm boy, born by emergency C-section because of fetal distress with presence of meconium. After delivery he presented transitory apnea followed by respiratory distress syndrome and was admitted to intermediate neonatal care. The first laboratory investigation demonstrated elevated C-reactive protein and there was evidence of neonatal pneumonia on the chest x-ray. Erythematous maculopapular rash was observed at the 4th hour of life. Empirical antibiotic therapy with ampicillin and gentamicin was started within the first hour of life. At the 30th hour of life, the initial blood culture was positive and a listeria monocytogenes infection was confirmed the next day. He responded well to the therapy with both clinical and laboratory improvements and was discharged at 23th day of life.

Conclusion:
Listeriosis is an uncommon and severe infection in neonates. It should be suspected in cases of neonatal sepsis and treated promptly in order to reduce the morbility and fatal outcomes.

Conclusion:
The work presented here demonstrates that newborns may somehow be protected againts thyrotoxics by colostrum in the early newborn period. Although the 50% of neonates had perchlorate exposure according to the MADEP reference dose, neonatal TSH, a sign of neonatal thyroid health seems not altered. Therefore, this study can be extended to an increased sample set for in-depth analysis of perchlorate exposure in neonates.

ID: 73/ OP5: 5 ORAL Counselling of Parents of Premature Babies. A Skill To Be Acquired
Zahreddin Abusalah Mediclinic City Hospital, Dubai, United Arab Emirates; zahreddin.abusalah@mediclinic.ae Introduction: Counselling of parents expecting a preterm baby is a challenging experience that requires special expertise and knowledge. Despite its importance as part of the standard care of preterm infants, there is no standard approved approach to conduct it. Aims: To highlight the importance of effective communication with parents and between healthcare professionals. To suggest a structured approach for counselling Methods: This presentation will have two main parts. It will commence by providing the audience with an overview of some of the standard approaches for counselling. The SPIKES protocol will be particularly discussed in greater details. Moreover, this part will review the available guidelines for counselling of parents of preterm infants. Outcomes of premature infants contribute to a major part of the counselling consultation with parents. Therefore, the presentation will examine the latest available evidence in the literature about various aspects of outcomes of preterm babies. The final part of the presentation will highlight several important issues that are expected to be raised in a counselling session. These issues will be explored in a question and answer format to provide a suggested practical platform for the counselling. The presentation will include video clips from my teaching video on counselling. The video was recorded with real parents of a premature baby. Endorsement of the video by the British Association of Perinatal Medicine is being sought. Conclusion: Counselling should be conducted following a structured strategy. These skills should be part of formally taught to all doctors involved in the care of preterm babies. To my knowledge, the counselling video of this presentation is the first of its kind to address this issue utilising a structured approach with the participation of real parents.

Introduction:
The rate of patients who leave the Pediatric Emergency Department (LPED) has become a clinical and medico-legal challenge. Indeed, it has been endorsed as a measure of Emergency Departments′ performance and quality of care and might be associated with poor clinical outcomes.
Purpose: Thus, we aimed to study the influencing factors and the underlying outcomes of the LPED in a Tertiary Hospital. This is the first step to address the problem and ultimately improve the health care provided.

Methods:
Retrospective study of the medical records of patients who LPED from 1st January 2014 to 31st December 2015. We analyzed the social-demographic profile, level of priority (Canadian Triage and Acuity Scale Paediatric -PaedCTAS) and outcomes of LPED. Results: Out of the 160402 visits in the 2-year period studied, we verified a 2.7% rate of LPED. Younger age was an important factor for LPED, 58.3% corresponding to children under 6 years old. There was no difference between genders. Lower acuity level was also relevant, given that 70.4% of LPED were classified as level IV (less urgent) or level V (not urgent). Still, of all urgent patients (level III) 2% were LPED. Out of the 0.3% of the emergent patients (level II) who were LPED, 25.9% sought further medical attention within 72 hours. The occupancy rate correlated with LPED and Monday was the day of the week with a higher rate. Out of the 4286 LPED, 5.4% had been referenced, 10.2% returned within 72 hours and 0.5% of the total returned and were admitted. Conclusion: Although some factors like occupancy rate are unchangeable, some measures like staff reinforcement at the busiest periods might reduce LPED. Additionally, most of LPED had lower acuity levels. Thus, the improvement of Primary Care access and health education policies could optimize health resources. Higher risk patients, however, concern us and might benefit from a closer follow up.

ID: 91/ OP5: 8 ORAL Risk of Mortality in Pediatric Intensive Care Unit Using Pediatric Risk of Mortality (PRISM) III Score
Sittikiat Sucheewakul, Kanokpan Ruangnapa Songklanagarind Hospital University, Thailand; sittikait_88@hotmail.com Background: PRISM III is the severity scoring system for critically ill children, which has been accepted to predict death. Objective: To evaluate risk of mortality in pediatric intensive care unit (PICU), Songklanagarind Hospital using the PRISM III score. Methods: We retrospectively review the computer-based medical records of patients age 0-15 years who admitted to PICU Songklanagarind Hospital between November 2013 and April 2015. Demographic data, outcomes, PRISM III score of the first 12 hour of admission were recorded. The probability of death was calculated by Pollack's equation.
Results: A total of 598 patients (median age 37.4 months, range 7.6-94) were enrolled. Thirty percent were aged less than 1 year. Fifty-five percent were male. Fifty three percent were admitted for postoperative care. Most of patients (82%) had underlying diseases. The three most common admission problems were cardiovascular (36%) followed by respiratory (30%) and neurology (19%). The median PRISM III score was 4 (IQR 1,8). The mean length of PICU stay was 3.5 days (SD 2,6) with the overall mortality was 14.2%. The death group had significant higher PRISM III score than survivors (3 VS 13, p < 0.001). The PRISM III score cut off at 9 had 75.3% sensitivity and 84.2% specificity in predicting mortality (AUC 0.79). The patients with PRISM III score ≥ 9 had 4.8 times higher risk of death than others. Using univariate logistic regression analysis, the three risk factors of mortality were the use of high frequency ventilation (OR 20.46), sepsis (OR 11.02) and peritoneal dialysis (OR 5.28). Conclusion: PRISM III score ≥ 9 has sensitivity 75.3% and specificity 84.2% to predict death in PICU. The major risk factors of death are use of high frequency ventilation, sepsis and peritoneal dialysis. Purpose: Determine the accuracy and feasibility of POC tests for WBC and CRP in a P-ED by comparison with conventional methods. Compare the patient discomfort in both collection procedures. Materials and Methods: Patients were included based on clinical criteria for blood sampling, after consent. We collected capillary blood for POC WBC and CRP measurements (spinit® BC and CRP) and venous blood for conventional analysis (UniCel® DxH 800 and DxC 600i). We measured the pain score and the hands-on sampling time for each. Statistical analysis was performed using MedCalc® version 15.8. Agreement was assessed using a Bland-Altman plot. Results: We collected 189 blood samples, corresponding to 179 patients. They were aged 0-18 years. WBC and CRP POC analysers showed good agreement with the reference methods, as illustrated by   The mean differences between POC and reference tests were 0,9 10.000/μL for total WBC (95% limits of agreement between -3,8 and +5,5 10.000/μL) and -0,2 mg/dL for CRP (95% limits of agreement between -2,5 and +2,0 mg/dL). The pain score and the hands-on time for sampling were significantly lower in the capillary puncture (p < 0,0001 for both).

Conclusion:
The POC WBC and CRP tests analysed are accurate and feasible in a P-ED. Capillary blood sampling is less painful and time-consuming than venepuncture. POC can be useful as a method of screening, helping to manage patient flow efficiently in a P-ED. Results: A total of 756 episodes were analyzed. MDI-SD was used in 41% of them. The median age was 31 months at admission and 63% of the patients were male. The spacer was more effective than the nebulizer for clinical outcomes (improvement of oxygen saturation and reduction of wheezing and respiratory distress). The median length of stay in the PED was lower for the MDI-SD group. Fewer children required admission to inpatient care when a MDI-SD was used. There was no significant reduction in the within 72 hr re-attendance rate. Preparation and delivery time by the nursing team was lower in the MDI-SD group (2 min in preparation and 5 min in delivery).

Conclusion:
The MDI and spacer combination was more effective and less time-consuming in the management of children with wheezing. Being one of the first hospitals in Portugal with this policy, we hope this study will contribute to make other hospitals implement a policy change that will lead to a higher successful treatment rate. Methods: We retrospectively reviewed our 10 patients, affected by early onset scoliosis and surgically treated with magnetically controlled growing rods (minimum follow up 6 months). There were 4 kids, males, under 6 years old (4yy 1mm-5 yy 10 mm). The aetiology was 2 idiopathic, 1 congenital and 1 neuromuscolare in congenital syndrome. In one case emiepiphisiodesis was first performed before using MCGR. In 3 cases a dual growing rod was implanted, using as distal anchors pedicle screws, as proximal anchors hooks, in one case we implanted 1 single rod. Surgical Technique red flags: • Mininvasive incision above and below • Subfascial rod • Proximal pedicle and laminar hooks (claw) • Distal pedicle screws (2 vertebras) • Prebended rods • Before insert the concave rod, then, after the first correction, insert the convex one.
• Perform the first lengthening during the first surgery Results: At a minimum follow up of 6 months and maximum 4 years, after performing minimum 2 lengthening procedures and maximum 22 per patient (lengthening performed every 60-90 days), main thoracic scoliosis was corrected from 66.3° (45-84°) to 32.7° (25°-40°) and a final follow up value of 33.1° (28-40°); mean correction was 50.6%(40-56.8%) and at follow up was 48.7 (37.7-54.5%). No neurological or infective complications occurred. In one patient a revision surgery was performed due to rod fracture, in one case we noted an adding on above the instrumentation. At final follow up, no patient presents pain or functional limitation.

Conclusion:
Those results showed that MCGR can be safely and effectively used in patients affected by early onset scoliosis, even in very young patients ( < 6 years); thanks to the new small-rod (7 cm actuator) and the easy way to pre-bending the rod can be used in very small spine instead of VEPTR-like systems and can grant a better anchor and better control of the main thoracic curve. An acceptable complications incidence (25%) if compared with literature was noted, offering excellent deformity control and functional outcome. An expert team of surgeons, anesthetists and nurses is mandatory.

ID: 79/ OP5: 12 ORAL Immigration and Adolescent Emotional and Behavioural Problems in 31 Countries: Exploring the Significance of Immigration Policies and National Level Attitudes against Immigrants
Gonneke W.J.M. Stevens 1 , Sophie D. Walsh 2 , Tim Huijts 3 1 Utrecht University; 2 Bar Ilan University; 3 University of London; sophiewalsh@gmail.com

Introduction:
The "risk perspective" regarding the impact of immigration on emotional and behavioural problems among adolescents, has emphasized, among other risks, the detrimental effects of facing prejudice and discrimination. Combining this notion with the great variation in reception of immigrants throughout Europe, it seems highly likely that the psychological functioning of immigrant adolescents varies according to the receiving country attitudes and policies toward immigrants. However, there is a notable lack of research on this topic. Purpose: This study set out to test the effect of immigrant status on adolescent emotional and behavioural problems in 31 countries. Additionally, the study examined the importance of a) national level attitudes toward immigrants and b) migration policies, in understanding cross-national differences in the impact of immigration.

Methods and Materials:
Analyses are based on 2013/2014 data from 11-, 13, and 15-year-old adolescents participating in the HBSC study in 31 countries throughout Europe (total N = 150,000). Results: Results showed lower life satisfaction in immigrant as compared with non-immigrant adolescents, and an increased risk of psychosomatic symptoms, fighting and bullying in the former group. Results also indicated that in countries with more lenient migration policies, differences in life satisfaction and bullying between immigrants and non-immigrants were considerably smaller. Higher levels of (country-level) anti-immigrant attitudes were associated with higher levels of psychosomatic symptoms in both immigrant and non-immigrant adolescents.

Introduction:
The frequency of chronic kidney disease (CKD) in children is increasing globally. CKD itself and the side effects of its treatment have many systemic and oral manifestations. Even though oral hygiene is considered to be of lower importance for patients with CKD, caries prevalence seems to be much lower in children suffering from CKD than compared to healthy counterparts. Purpose: To determine oral hygiene status index and caries prevalence of a group of children with CKD and compare results with age&sex matched controls. Materials and Methods: 55 patients with CKD (divided into 3 groups: Stage I-II; Stage III-IV and Stage V), followed by Pediatric Nephrology Department at Marmara University-Turkey were included in the study. Oral findings were collected via specific indices (DMFT, dmft, OHI-S) used in dental examination to compare with those of 60 healthy children. A questionnaire for oral habits (snack and brush frequencies) was filled by their parents. Results: CKD group showed significantly lower prevalence of dental caries than the control group. Prevalence of caries in permanent teeth (DMFT) in CKD and control group was 47,2% and 75,9%; while this was 37,1% and 91,7% for primary teeth (dmft) respectively (p < 0,005), in spite of very low frequency of brushing (more than 58% of patients were brushing less than 2-3 times a week or not brushing at all, whereas this rate was 22% in control group). Oral hygiene index scores were significantly higher in CKD groups than in control group (1,39 and 0,64 respectively, p < 0.001), meaning higher plaque & calculus deposits. Conclusion: Changes in saliva components, raised pH above critical level for demineralization, lower incidence of Streptococcus mutans are key reasons for lower caries prevalence in CKD patients. However, better appearance in a quick dental examination made by non-dentists may mask more important oral manifestations of this disease. Consequently, the clinician may not refer these patients to a specialist for treatment and worsened oral environment can remain a threat to general health. Therefore, close cooperation between dentist and pediatric nephrologist is required in the treatment of those children. Early evaluation of the oral health of renal patients is essential to eliminate potential infections from the oral cavity. Background: In pediatric population, the course of minimal change disease (MCD) usually has good prognosis. However, in less common presentations, MCD may have a poor course that makes renal biopsy a must to identify the etiology. Immunoglobulin M (IgM) occasionally deposits in the mesangium and it is seen under the electron microscopy (EM) and immunofluorescence (IF). The rule of IgM is controversial in MCD, as it is believed that it is associated with poor outcomes for MCD i.e. poor response to initial steroid therapy and deterioration of kidney function. This study aims to explore the clinical significance of mesangial IgM deposits on the outcome of MCD in the pediatric population. Methods: In this retrospective cohort study, we obtained native kidney biopsy samples for 212 children who were diagnosed with MCD from 2003 to 2014. The sample was divided according to the histopathological deposition of IgM in biopsies under IF: those whose biopsies showed IgM were labeled as IgM+IF (n = 85), while those whose biopsies showed no IgM were labeled as IgM-IF (n = 127). We reviewed hypertension, hematuria, creatinine clearance at time of presentation to our institute, response to corticosteroid (dependence, resistance and frequent relapses), response after adjuvant immunosuppressive therapy (complete remission, partial remission, frequent relapses and no response), development of chronic kidney disease (CKD) and end-stage renal disease.

Results:
Our results showed that mesangial IgM deposition in MCD was significantly associated with hypertension at time of presentation to our institute (p = 0.046). There was statistically significant association between the presence of IgM deposition and development of steroid dependence (p = 0.048). Mesangial IgM deposition was associated with development of CKD (p = 0.039).

Conclusion:
Our results indicated IgM deposition in MCD is associated with hypertension, development of steroid-dependence and CKD. We recommend a prospective study to verify the rule of IgM as a marker of poor outcomes of MCD. Introduction: Cough is a common symptom in children. Despite being commonly self-limited, it is still a motive of concern to parents. Cough and cold medications are widely used regardless of unproven efficacy and insecure safety issues. Concerns about toxicity led to an FDA recommendation against its use in children younger than 2 years old. Purpose: The aim of this study was to understand caregivers' perspective on cough, attitudes towards a coughing child, including medication use rate and impression on its efficacy and safeness.

Materials and Methods:
A cross-sectional observational study was conducted during 3 months (February to April 2016). Data was obtained through a survey applied to a sample of caregivers of children admitted to the Emergency Room of a Portuguese hospital.

Results:
We collected 220 completed surveys. Most participants were parents (94%), females (82%), mean age: 37 years. Two thirds of them were high school or college graduated. Almost one third (28%) of the children admitted were younger than 2 years (mean age: 6 years). Most caregivers (63%) agreed that cough is a defensive mechanism but more than one third (37%) believed that cough is harmful to the child. The majority of them stated feeling very worried when their child is coughing (56%) and sought medical advice (65%). Half of the participants (49%) reported using cough medicines routinely. The administration rate was higher (64%) in children aged 6 to 10 years. There were 20% of children younger than 2 years taking them. Less instructed caregivers had significantly higher rates of medication use. An even higher proportion (65%) admitted using cough medicines in the last winter, from which more than half (63%) had a prescription from a doctor: a family doctor (60%) or a pediatrician (37%). The most used drugs were expectorants (35%), antihistamines (14%) and natural products/homeopathic remedies (14%); 5% used antitussives. Most caregivers who used them had an impression of effectiveness (72%). Only one third of all caregivers agreed that cold and cough medication can be dangerous to a child.

Conclusion:
Our study suggests that cough is a worrisome and poor understood symptom to parents. We found a high rate of medication use, especially among less instructed parents. Caregivers overestimate the importance of cough and have a false sense of effectiveness and safety from cough medicines. There was also a high rate of medical prescription suggesting that not only parents but also health care professionals need educational interventions.

ID: 58/ PO1: 10 POSTER Effects of Indoor Air Pollution from Solid Fuel Combustion on Development of Children under 5 Years
Nayomi Ranathunga  Introduction: Indoor air pollution (IAP) is a significant health hazard, but more hazardous to children than to adults. Multifaceted toxic effects of air pollution damage the nervous system through diverse pathways. Exposure to indoor air pollution may affect early life development.
Purpose: The purpose of the study was to determine the effects of IAP caused by solid fuel combustion on early life development of children under 5 years.

Materials and Methods:
A prospective study was conducted in a mixed urban/semi urban area in Sri Lanka. The study population comprised 222 children under 5 years, permanently residing in the area. Development was assessed at baseline and after 12 months using the Denver II developmental assessment scale. Results: Fifty-nine percent of children were living in households using firewood or kerosene oil as the main source of cooking fuel (high exposure group) and 41% were living in households using liquefied petroleum gas (LPG) or electricity (low exposure group); 54% of children were males. There was a significant delay in language development in children in the high exposure group as compared to children in the low exposure group (p = 0.006). Delays in developmental domains were correlated: fine motor and language (r = 0.50; p < 0.001); fine motor and gross motor (r = 0.40; p < 0.001); fine motor and social development (r = 0.19; p = 0.005); language and gross motor (r = 0.49; p < 0.001), language and social development (r = 0.22; p = 0.001); and gross motor and social development (r = 0.18; p = 0.007)). Children in the high exposure group who had "cautions" (a child's inability to perform a task done by 75% of children in the same age group in the reference population) at baseline, were more likely to have "cautions" at the end of follow-up at 12 months in fine motor (p = < 0.001), social behavior (p = < 0.001), and gross motor (p = 0.003) domains, as compared to children from the low exposure group.

Conclusion:
There was a significant delay in language development in children in the high exposure group as compared to children in the low exposure group.  implementation in Portugal, n = 29 (43.9%) of type I-CL, 81 (72.9%) of type II-CLP, n = 14 (9.9%) of type III-CP and n = 1 (20%) of type IV were diagnosed in prenatal period. In the studied group, 1/3 of children had a positive family history for CLP. Since the universal bi-dimensional screening implementation in Portugal, there were more cases diagnosed in the prenatal period, with a significant statistical association (p < 0,001) between PD and CLP before and after 2001 and also before 2007 and after 2007. There is also a statistically significant association between the type of CLP and PD, with higher diagnosis accuracy for the CL and CLP (p < 0,001).

Conclusion:
The universal bi-dimensional and four-dimensional US screening implementations in Portugal are increasingly used with a superior PD accuracy in patients with CLP. Purpose: To describe a case of an asymptomatic patient with a type 1 Brugada ECG induced by fever.

Material and Methods:
A previously healthy 4-year-old boy was in control in the Pediatric Cardiology Department because his father, a 30-year-old man, had just been diagnosed of Brugada Syndrome (with implantable cardioverter desfibrillator but without genetic testing yet), a father′s cousin died of sudden cardiac death when he was 40-year-old in his country, Bulgaria. His medical history was insignificant (no syncopes, palpitations or febrile seizures), his first cardiac study was also normal (physical examination, ECG, echocardiography). As his parents were advised, the child went to the Emergency Service because he had fever (no vacinne recently), due to a respitarory viral infection without complications. The ECG performed when he had fever, 39.5°C, revealed a normal sinus rhythm but with a type 1 Brugada pattern (right bundle branch block-like morphology, cove-shaped ST elevation in right precordial leads > 2mm, followed by a negative T wave), which disappeared after the fever subsided with antipyretic drugs (fig 1). The child remains asymptomatic without treatment, he is considered to carry the disease and genetic results are still pending. Introduction: Autism is a common reason for referral to the regional genetics service. Advances in genomic medicine are improving our understanding of the genetic contribution to autism spectrum disorders (ASD). Patients show social and communication interaction problems, with restrictive behaviour. Co-morbidities commonly include intellectual disability (ID) and epilepsy. The phenotypic complexity mirrors genetic complexity, with environmental factors also impacting significantly on phenotype. Purpose: To describe and review the yield of results found after genetic assessment, for a phenotype of ASD.

Materials and Methods:
A retrospective case note review was performed on 76 sequential cases referred to the genetic clinic at the Manchester Centre for Genomic Medicine. Cases of ASD (+/-ID) referred over 16 months between August 2014 and December 2015 were identified using local referral databases. Results: Demographic details were collated, alongside phenotypic features and tests performed. 87% of those referred to the service were male, with 49% living in deprivation deciles 1 and 2 (top 20% areas of deprivation in UK). 67% were aged less than 10 years old, with 42% less than 5 years. Our tertiary service instigated genetic testing in 46% of the patients. Others were investigated by the referring team prior to appointment, or genetic testing was not felt to be required. Array CGH and FraX were performed on 80% of patients, with no pathogenic findings found. Incidental findings and variants of unknown significance were found in 4 cases. 2 families, each with two sons, consented to Deciphering Development Disorders (DDD). The study has not identified a cause so far. Conclusion: ASD is a complex multifactorial condition, and current investigation with technologies such as whole exome of genome sequencing have suggested a substantial genetic contribution. However, the tests currently being used in the NHS are not sophisticated enough to identify causes for this prevalent condition.

Introduction:
We are presenting a unique case of an 11-year-old girl admitted for investigation of progressive abdominal distention of more than one-year duration. Due to the complete cystic nature of the mass and its enormous size, it was not visualized by the ultrasound and was reported as massive ascites. MRI and postoperative histopathology confirmed a diagnosis of giant serous cystadenoma of the right ovary. She underwent a right ovarian cystectomy with complete preservation of both ovaries and fallopian tubes. The cyst weighted 13 kg and contained 13 liters of fluid . Case Report: Our patient is unique not only in terms of her age, but also as she posed a diagnostic challenge in many aspects. Firstly, she presented with a huge asymptomatic abdominal distention, which upon initial clinical assessment was presumed to be massive ascites. Moreover, ultrasound of the pelvis and abdomen, in our case, confirmed this clinical diagnosis of massive ascites without delineating a possible cause, necessitating an urgent MRI, which led to the final diagnosis of a giant ovarian mass. If management was undertaken in our patient on the basis of ultrasound diagnosis alone (namely, paracentesis for the presumed ascites), it may have led to erroneous transabdominal aspiration of the undiagnosed ovarian cyst. This case report emphasizes the paramount importance of considering ovarian masses in the differential diagnosis of a patient who has abdominal distention without symptoms or signs of liver, renal, or cardiac diseases. Conclusion: Ultrasound should not be the only imaging modality especially in case of massive ovarian cysts as it may mimic ascites .It is also vital to raise awareness among the population to seek medical advice as early as possible to avoid complications such as ovarian torsion, rupture, and eventually infertility in such young age group. Fertility-conserving treatments, as in our patient, need careful follow-up because of the possibility of recurrence in the remaining ovary or malignancy transformation.

ID: 85/ PO1: 16 POSTER Haemolytic Uremic Syndrome : Current Issue for Small Pediatric Age Group-Outbreak 26 Cases in Six Months
Anca Croitoru, Ioana Tieranu, Mariana Costin, Diana Costache, Madalina Grigore, Mihaela Balgradean Emergency Hospital for Children "Marie Sklodowska Curie" Bucharest, Romania; croitoru.n.anca@ gmail.com Introduction: Haemolytic uremic syndrome (HUS) is a systemic disease and one of the most frequent causes of acute kidney failure (AKF) in children. It was described for the first time in 1955 and it is represented by the triad: acute kidney failure, haemolytic anemia and thrombocytopenia. Despite the decrease in mortality caused by sepsis, in the latest years, this pathology still remains a major cause of morbidity and mortality for the children younger than five years old. In Romania, most cases are due to infection with Shiga toxin-producing Escherichia coli (STEC). Alarming for us was the rapid increasing of case numbers in the last 6 months. It was gathered an international multidisciplinary team with the participation of European Programme for Intervention Epidemiology Training (EPIET), European Centre Control (ECDC) in Stockholm, Sweden and Istituto Superiore di Sanità (ISS) in Rome, Italy testing the antibodies to the lipopolysaccharide (LPS) of six major STEC serogroups (O157, O26, O103, O111, O145, and O55) by ELISA. Purpose: To understand and recognize early the first symptoms and prevent the possible complications during the evolution and the treatment of the disease.

Materials and Methods:
A retrospective study of 26 cases of haemolytic uremic syndrome treated in the first 6 months of this year in the Nephrology Department of the "Marie Curie" Emergency Children's Hospital, Bucharest, Romania.

Results:
The age of studied patients was between 5 months and 3 years. All the patients presented at the beginning diarrhea. Some of them experienced important melenic stool, neurologic disorders of consciousness, dizziness and tonic-clonic seizures due to electrolyte imbalances. 19 children needed peritoneal dialysis between 3 and 21 days. In more than 50% of the cases the pathogen was E. Coli (most frequent serogroup O26), 1 case was diagnosed with Salmonella. Geographical distribution of the 26 cases: most of the patients were located Arges-Pitesti, but also in: Bucharest, Constanta, Craiova. Evolution: 3 cases died and the global evolution of the other 23 patients was favorable.

Conclusion:
In the great majority of the presented cases, HUS is due to STEC infections. It is a severe, life-threatening disease, but in most cases it is self-limiting with complete resolution. The treatment is supportive and aims not only AKF but also extrarenal involvement of the disease (multiple renal failure), neurological, intestinal, pancreatic, hypertension, cardiac or pulmonary impairment. The rapid and accurate diagnosis and correct supportive treatment is the key of a good outcome and evolution in HUS in children.

Keywords: juvenile arthritis, lipid disturbances, biologics, intima/media complex thickness Proatherogenous Disturbances in Children With Juvenile Arthritis
Anna Krasnopolskaya, Larisa Balykova, Anastasiya Shirokova, Elena Samoshkina Ogarev Mordovia State University, Russian Federation; abalykova@gmail.com Introduction: Close connection between autoimmune inflammation and metabolic disorders in rheumatoid arthritis has been well established, while for juvenile idiopathic arthritis (JIA) it has not been thoroughly studied. Purpose: To study the incidence and intensity of lipid disturbances in patients with JIA. Material and metods: 100 children with JIA 4-18 years of age (41 boys) were examined using clinical, biochemical methods and ultrasonic duplex scanning of vessels. 11 children had systemic onset arthritis, 35 -polyarthritis, 30 -oligoarthritis, 17 -enthesitis-related arthritis, 4 -psoriatic and 3undifferentiated arthritis. All patients received basic therapy, 12 -corticosteroids (CS) intraarticularly or as intravenous pulse-therapy, 25 -biologics, 18 out of them received TNF-α inhibitors. Results: Dyslipidemia, correlated with disease activity and intima/media complex thickness (IMCT) in carotid arteries was revealed in 40 (40%) of the examined, including all patients with systemic arthritis, 20 (54%) children with polyarthritis, 3 (10%) -with oligoarthritis, 3 (17,6%) with enthesitisassociated arthritis and 2 (50%) with psoriatic arthritis. Dislipidemia in 16% of patients was combined with abdominal obesity, in 6% -with carbohydrate disorders and in 12% -with increased blood pressure. Most often an increase in aterogenic coefficient (AC) due to the change in ratio of cholesterol of high-and low density lipoproteids (HDL and LDL) was noted. Average value of AC in JIA was higher than in control (2.9+0.2 versus 2.0+0.1, p<0.05). Decrease in cholesterol of HDL (in 29 JIA patients), as well as increase in total cholesterol (in 14 children) and triglyceride (in 5 children) concentration were revealed. Triglycerides were higher in JIA patients than in control group (1.4+0.3 mmol/l versus 1.0+0.2 mmol/l, p<0.05). Maximal prevalence and degree of lipid disorders were observed in children who received GC and whose IMCT was 0.93+0.08 versus 0.45+0.05 in control (p<0.05). Six-month use of TNF ingibitors helped to reduce carotid IMCT from 0.89+0.05 to 0.77+0.04 (p<0.05) and AC from 3.1+0.04 to 2.2+0.03 (p<0.05), to normalize lipid profile and blood pressure in 5 out of 6 children. In patients who did not receive biologics metabolic disorders remained at the original level.

Conclusion:
In both systemic onset JIА and polyarthritis with high disease activity lipid disturbances take place, which can be efficiently corrected by TNF ingibitors.

ID: 53/ PO1: 17 POSTER Identifying the Unwell Child in the Emergency Department : Which Numbers Matter?
Annalie Florence Shears University of Manchester, United Kingdom; annalie.shears@student.manchester.ac.uk Introduction: Identifying the unwell child early on admission to the emergency department allows rapid initiation of treatment and reduces morbidity and mortality. Raised respiratory rate, lactate and Paediatric Early Warning Score (PEWS) have all been identified as potential red flags for serious illness.
Purpose: This study therefore investigated respiratory rate, lactate and PEWS to find the best predictor of outcome in paediatric patients admitted to the emergency department at Wythenshawe Hospital.

Materials and Methods:
Retrospectively 412 children were identified as having had a capillary lactate sample taken on admission to the emergency department between 01.04.2015 and 31.04.2016. Their PEWS, respiratory rate and lactate on admission were extracted from their notes and correlated with admission to hospital, length of hospital stay and diagnoses of sepsis, pneumonia and bronchiolitis.

Results:
Patients with a diagnosis of pneumonia or bronchiolitis had a significantly higher mean respiratory rate than those without, however there was no significant difference in respiratory rate between patients with and without sepsis. Patients with sepsis, pneumonia and bronchiolitis had significantly higher mean lactates and PEWS scores than those without. On analysis of ROC curves PEWS was the best test for identifying patients with sepsis, pneumonia and bronchiolitis and those admitted to hospital. Conclusion: Overall PEWS was the best test for identifying the unwell child.

ID: 144/ PO1: 18 POSTER Implications of the MHRA Guidance Regarding the Precautions of Sodium Valproate in the Female Paediatric Population at a DGH
Ishani Sivarajah 1 , John Hewertson 2   1 East Midlands Deanery (University Hospital Leicester/ Northampton General Hospital), United Kingdom; 2 Northampton General Hospital; ishani36@gmail.com

Introduction:
Over the last few years there has been increasing concern with the effect of sodium valproate (VPA) on the developing foetus. Studies have shown an elevated risk of developmental problems ranging from delayed motor skills to speech and language difficulties, as well as lower intelligence quotient (IQ). These findings have triggered the Coordination Group for Mutual Recognition and Decentralised Procedures-Human (CMDh) to strengthen the warnings on the use of VPA in female patients. The Medicines and Healthcare Regulatory Agency (MHRA) have have also implemented new guidelines as a result of these findings. Purpose: The primary aim of this project was from within a typical DGH paediatric epilepsy service, to assess the impact of implementation of the MHRA guidelines. This involved identification of all female paediatric ( < 18 years) patients at Northampton General Hospital who are currently on VPA treatment.

Methods:
We collected relevant demographics from clinic letters and patient notes such as age, epilepsy type, comorbidities, previous drug treatment and duration of VPA treatment. We sought to explore prior advice given on sodium valproate to the patient and/or their carers. Results: A list of 32 female paediatric patients on VPA treatment was generated. This would represent 32/167 = 19% of the local estimated paediatric female population with epilepsy. 63% (n = 20) of the female patients were in the 10-18 age group. It was noted that more than 80% of patients who were on VPA did not have documentation in the notes or clinic letters about the risk of VPA therapy. Only 1 had documentation and the MHRA paperwork in their notes. 4/20 were in the process of being weaned off VPA and weaning is plan in another four patients.

Conclusion:
In future, all female patients on VPA will be counselled and the MHRA paperwork completed. At that time some patients will be selected for a trial of weaning VPA. Guidelines will be circulated throughout the Trust with regards to the new VPA recommendations. This has highlighted the need for a local Epilepsy Register in order to collect demographics and identify patients who are on any anti-epileptic treatment. This is not the first time there have been concerns with the long term effects of anti-epileptic medication: vigabatrin and felbemate have been found to have serious side effects after further studies. Therefore, a robust database needs to be implemented to enable to contact patients who are on antiepileptic medication.

ID: 24/ PO1: 19 POSTER Management Of The Child Referred With "Short Stature".
Kathleen Ann Brown NHS, United Kingdom; kathleen-brown1@sky.com Introduction: Growth and development is an integral part of paediatric medicine. Recognising and managing a child with short stature appropriately therefore, is an important process to do correctly and in a standardised fashion, to ensure the highest standard of quality of care.
Purpose: This audit looks to assess the current practice in reviewing children referred with short stature to paediatrics, to see if there are any changes required to improve patient care. This follows the guidance article from the BMJ ADC on the investigation of short stature. We aimed to review a number of patients referred to paediatric clinics with short stature and gather information on the consultation information retrieval, any investigations done and the reasons for this, and then the outcomes of these reviews. It is hypothesised that a streamlined process will be helpful in the review of short stature and ensure that a standardised approach is used in order to provide the best assessment and further investigation process for these patients. Materials and Methods: Patient details were obtained by searching for those < 16 years of age who had had radiological wrist imaging in a 4 year period. From this list, those who had bone age assessed were then taken from this and their records looked at on the electronic Evolve system. We used an Excel programme to collect the data. Results: Total 11 patients.

Conclusion:
These results reflect the small numbers and wide age range of children referred specifically for their short stature. From these small numbers, the majority of referrals are made by GPs. A bigger sample group would be interesting in seeing whether this was due to other children already being seen by a paediatrician having their short stature investigated as part of another ongoing review-limited by clinical coding. What this audit shows is that generally short stature is addressed and investigated. What is not clear though is what clinicians see as appropriate first line investigations and when to refer to endocrine specialists. As a result of this audit, the short stature guideline has been amended in the department and a re-audit will be under taken to assess changes in process as a result of this.

Extended Cerebral Venous Sinus Thrombosis (CVST) in a Child a Rare Complication of Recurrent Otitis Media (ROM)
Maria Vasilopoulou, Foteini Zafeiropoulou, Olga Giannouli, Zoi Mpeka, Leda Sianidou Paediatric Intensive Care Unit, Penteli Children's Hospital, Greece; fotinizaf@hotmail.com Introduction: Cerebral venous sinus thrombosis (CVST) is a serious disorder with reported incidence 0.67 cases/ 100.000 children/ year. Masked (subacute) mastoiditis refers to low grade but persistent infection in the middle ear and mastoid, occurring in patients with recurrent otitis media (ROM). Rarely it presents with intracranial complication as CVST. Purpose: We hereby present a case of a previously healthy 5-year-old girl with CVST complicating ROM.

Materials and Methods:
The patient presented in the Accident and Emergency Department with two days' history of high grade fever, vomiting, otalgia and progressive lethargy. She had history of ROM during the last six months rhinitis since 20 days. Physical examination: malaise, decreased level of consciousness, right middle ear effusion. Cranial CT: inflamed right mastoid, inflammation of the right sphenoid sinus. No abnormal cerebrospinal fluid findings. The patient was treated with ceftriaxone plus clindamycin. However, she remained lethargic with severe headache and she underwent a brain MRI which revealed thrombosis of the right lateral and sigmoid sinuses extending to the jugular bulb and internal jugular vein as well as in the lower part of the upper sagittal sinus (Figures 1, 2, 3). The patient was admitted in the paediatric intensive care unit where she was treated with vancomycin, piperacillin-tazobactam and anticoagulants (low molecular weight heparin followed by warfarin for a total of 3 months).  Results: Thrombophilia screen (C & S proteins, factor VIII, antithrombin III, factor VLeiden, prothrombin mutation 20210, homocysteine) as well as ANA, thyroid function tests, immunoglobulins and antiphospholipid antibodies were normal. The patient recovered fully and at follow-up, fifteen months later, she had no neurological sequelae and no recurrent thrombotic episodes. Conclusion: Masked mastoiditis and CVST should be considered in children with ROM and signs of intracranial infection. Magnetic Resonance Imaging is superior to Computerized Tomography in revealing this pathology. Early diagnosis and prompt treatment may prevent severe neurological sequelae and death.

ID: 218/ PO1: 37 POSTER Infection-Related Hospitalisations in Refugee Children-A One Year Study from Northern Stockholm
Olof Hertting, Rutger Bennet, Joachim Luthander, Margatreta Eriksson Astrid Lindgren Children′s Hospital, Stockholm, Sweden; olof.hertting@karolinska.se Introduction: Because of the unrest in the Middle East and Central Asia, there was a large influx of refugees arriving in Sweden in the autumn 2015. Among the refugees, children and adolescences made up a considerable part. European public health authorities issued guidelines regarding risks and management algorithms for imported infectious diseases. However, few reports have been published on the actual burden of infectious diseases in refugee children. Purpose: We sought to investigate the cause of hospitalizations in refugee children with a specific aim at reporting hospitalizations caused by infectious diseases. Materials and Methods: From all hospitalizations, infectious diseases were identified by using ICD-10 codes A, B, G00, H60-70, J03-86. L00, M00, M86 and N10. Asylum seeking children and adolescences can be identified since they are provided with a reserve number, which is temporary and used only for the health care system instead of a Swedish personal identity number. All hospitalized children and adolescence with a reserve number and an infectious diseases diagnosis were identified. Results: We found 8706 hospitalizations in children < 15 years. Of these, 2513 (29%) were diagnosed with an infectious disease. Of the 8706 admissions, 296 were asylum-seeking children and 129 of those had an infectious disease (44%). 3 children < 15 years had tuberculosis, 9 had varicella zoster, 6 had influenza and 1 had pulmonary echinococcus cyst. In adolescents > 15 years 442 admissions were identified. 17% had an infectious disease. Among hospitalized asylum seeking adolescents > 15 years, 34 (60%) had an infectious disease. 28 had proved or suspect TB, 2 had Malaria, 2 had invasive pneumococcal disease and 1 had relapsing fever (Borrelia recurrentis). Asylum seeking children and adolescents with an infectious disease diagnosis were older than non-asylum seekers. Conclusion: Asylum seeking children and adolescents are more likely to be hospitalized because of an infectious disease compared to other children. In adolescents, tuberculosis is the dominant cause of hospitalization. In younger children, influenza and varicella zoster dominated. One possible explanation for this is the crowded living conditions that followed the sudden rise in immigration. On the other The initial signs are a mild localized macular erythema in the exposed areas, which, with chronic exposure to heat, become livid and hyperpigmented. If the exposure to heat persists the appearance of bullae can occur. Histological findings of the lesions include, initially, epidermis atrophy and vasodilation and, later, hyperkeratosis and pigment incontinence. Eliminating the source of heat leads to the resolution of symptoms. For prolonged and repeated exposure there is a higher risk of permanent damages such as thermal keratosis or even squamous cell carcinoma. Clinical Case: A healthy fifteen-year-old girl presents to the emergency department with a reticulate erythema on the lower limbs. The symptoms started 3 days earlier with a mild erythema in the external surface of the right leg that evolved into a hyperpigmented reticulate erythema. Afterwards the same erythema appeared in the internal surface of the left leg. On the day she presented to the emergency department she noticed swelling of the right leg with a burning sensation. No other abnormalities were found. Further enquiry revealed the use of a steam radiator near the legs for the past two months. Avoidance of heat exposure was recommended as well as skin hydration. In reevaluation, the erythema had diminished with resolution of the edema and burning sensation. Conclusion: Erythema Ab Igne is a skin condition caused by close and repeated exposure to a source of heat. Although it is no longer a common condition is must be taken under consideration when the typical symptoms are present and there is history of direct exposure to a heat source.

ID: 56/ PO1: 43 POSTER Status of Vitamin D of Teenage Girls in Winter
Irina Zakharova, Tatiana Tvorogova, Svetlana Vasilieva Russian Medical Academy of Postgraduate Education, Russian Federation; zakharova-rmapo@yandex.ru Objectives & Study: Our study was performed to assess of blood serum levels of 25-OHD of teenage girls in a winter season.

Conclusion:
The study showed a high prevalence of vitamin D deficiency among adolescents. The results dictate the need for correction of low vitamin D status with dynamic control of 25-OHD levels in the serum of teenagers. Purpose: The aim of this study is to analyse the relationship between age at placement and health in a sample of adopted adolescent from an integrated perspective of health that includes subjective measures. Differences associated to the birth area are also explored.

Materials and Methods:
The sample was selected as part of the 2014 Spanish edition of the Health Behaviour in School-aged Children (HBSC) study. The questionnaire was answered by 394 adopted adolescents aged 11 and 18 years (47.5% boys and 52.5% girls; 39.3% domestic adoption and 60.7% intercountry adoption). Instruments included Cantril's Ladder for Life Satisfaction, Kidscreen-10, Self-Reported Health, the HBSC-Symptom Checklist for Psychosomatic Complaints and the SOC-13 scale for sense of coherence. Mean comparisons and effect size tests were used to compare adolescents adopted before the age of 2 years and adolescents adopted after that age. Results: Data analysis showed significant differences between adolescents adopted before the age of 2 years and adolescents adopted after that age in life satisfaction (p = .039). According to the birth region, significant differences were found in life satisfaction (p = .005) and self-reported health (p = .046), with the highest effect size being found for the comparisons between Spain and Asia in life satisfaction (d = .34) and self-reported health (d = .41). Conclusion: Findings show how the developmental trajectory, marked by early adversity and the subsequent change of context that adoption involves affects health and wellbeing. Specifically, earlier age at placement was associated with a higher life satisfaction. Furthermore, intercountry adopted adolescents have a better health and wellbeing than domestic ones, probably due to the special situation in the Spanish welfare system.

ID: 233/ PO1: 45 POSTER Intention to Use Emergency Contraceptive Pills of Female Students in a College of Pathum Thani Province, Thailand
Chokchai Munsawaengsub  of female teenagers, while being 42.5 per 1,000 of female teenagers in Southeast Asia. Thailand was ranked the second in the region, and has been growing. In 2000, the rate of live births by teenage mothers was 31.1 per 1,000, but was 47.9 per 1,000 in 2014. According to the Bureau of Reproductive Health of Thailand, the rate of vocational diploma students experiencing sexual intercourse was higher than other groups and 90.0% used condoms or emergency contraceptive pill (ECP). The researcher realized the intention to use ECP of female students is essential. It could determine and predict the ECP use behaviors of teenagers. Purpose: To study the intentions to use and the factors associated with an intention to use emergency contraceptive pills of female students in a college in Pathum Thani province, Thailand. Materials and Methods: By applying the "Theory of Planned Behavior" of Ajzen. Studied samples included 207 female students aged 18-24 years. Data were collected by a self-administered questionnaire in March 2016. The 84-items questionnaire inquiring demographic data, knowledge about ECP, attitude toward ECP use, peer influence, perceived ability to control ECP use behavior, and the intention to use ECP. Data were analyzed by percentage, mean, standard deviation, Chi-square test, One-way ANOVA, and independent t-test. Results: About 68.6% of female students were aged less than 20 years (average age is 18.97 years), more than half (54.6%) had a low intention of using ECP. Unprepared to have sex was the highest reason to use ECP; on the other hand, the lowest intention was in cases with multiple partners. Knowledge about the ECP was significantly correlated with an intention to use ECP among the female students (p-value = 0.003). More than half (54.1%) had a poor level of knowledge about ECP.
Most were not aware of the ECP precautions and side effects (ectopic pregnancy, miscarriage, etc.). Peer influence was significantly correlated with an intention to use ECP (p-value = 0.001).

Conclusion:
The findings can be used in the development of guidelines for providing female students with proper knowledge about ECP, especially precautions and side effects. Creating leaders for giving consultation, attention, and providing information on the ECP so as to acquire accurate information and reduce the misuse of medicine.

ID: 237/ PO1: 46 POSTER Association Between Relational Bullying and Health Related Quality of Life Among English Adolescents
Kayleigh Chester 1 , Neil Spencer 1 , Lisa Whiting 1 , Fiona Brooks 1,2 1 University of Hertfordshire, Hatfield, United Kingdom; 2 University of Technology Sydney, Ultimo, New South Wales, Australia; k.chester2@herts.ac.uk Introduction: Bullying is a relatively common occurrence in schools worldwide. Bullying behaviours can be broadly categorised into physical, verbal, relational and cyber. Relational bullying describes behaviours which cause harm to the victim through the systematic manipulation and destruction of peer relationships. Fewer studies have examined the health outcomes associated with the specific sub-type of relational bullying. Purpose: The purpose of this study is to examine the association between adolescent's experience of relational bullying and health related quality of life (HRQL) whilst controlling for confounding variables.

Materials and Methods:
The present study draws on data from 5335 young people aged 11-15 years who participated in the 2014 English Health Behaviour in School-aged Children (HBSC) study. Data was collected through self-completed questionnaires. A multilevel regression model examined the association between experiencing relational bullying and adolescent HRQL, whilst controlling for physical and verbal forms of bullying and demographic factors (age, gender, ethnicity, socio-economic status). Relational bullying was assessed via three items measuring different relational bullying behaviours, with young people categorised into no victimisation, monthly or weekly victimisation. HRQL was measured via KIDSCREEN-10 which generates an overall score, with higher scores indicative of positive HRQL. Results: In all, 16.6% of respondents reported experiencing relational bullying in the previous two months. Girls were slightly more likely than boys to report being victimised in this way; 19.7% of girls compared with 13.7% of boys. Relational bullying was associated with a significant decrease in KIDSCREEN-10 score. Young people who reported weekly relational bullying had an estimated 5.352 (95% confidence interval (CI), -4.178, -6.526) decrease in KIDSCREEN-10 score compared with those not experiencing relational bullying. The association between relational bullying and KIDSCREEN-10 score was equal for girls and boys. Weekly verbal bullying was associated with an estimated 2.446 (95% CI, -1.21, -3.682) decrease in KIDSCREEN-10 score. There was insufficient evidence to demonstrate an association between physical bullying and HRQL.

Conclusion:
The current study demonstrates relational bullying is associated with poorer HRQL. The negative association with HRQL is the same for both girls and boys, questioning the perception of this behaviour as a predominantly female problem. The findings suggest relational bullying may be the most harmful form of victimisation, with relational bullying associated with a greater estimated decrease in KIDSCREEN-10 score than physical and verbal bullying combined.

ID: 174/ PO1: 47 POSTER Contribution of Different Socioeconomic Indicators to Adolescents Eating Behaviors
Concepción Introduction: Parents influence their children's eating behaviors by controlling the availability and accessibility of food, their own eating habits as well as through the food-related parenting practices they apply. A wide body of research supports that these factors are related to socioeconomic circumstances. However, the relationship between the family's socioeconomic level and healthy adolescent eating habits is not clear. It is during this period that other contexts acquire more importance, as well as the adolescents' increased independence allowing them to take more responsibility about food choices and consumption. Purpose: The aim of this research is to analyse if there is a relationship between socioeconomic factors and adolescent eating habits, after controlling the effects of gender and age. This study employs different socioeconomic indicators to understand if the varying results reported in the literature are due to the use of specific measures to assess the adolescent's socioeconomic status or because adolescence is a period in which the importance of family-related factors decrease in importance.

Materials and Methods:
Multiple logistic regression were performed in a sample of 6,851 adolescents between 11 and 16 years old (53.8% girls, mean age = 13.79, SD = 1.68) who participated in the 2014 edition of the Health Behaviour in School-aged Children (HBSC) survey in Spain. Questions about the frequency of breakfast, fruit, sweets and soft drink consumption were selected from the HBSC Questionnaire. In addition, to evaluate the socioeconomic position of the adolescents the following indicators were employed: the education and occupational level of both parents and family material affluence. Results: Girls and older adolescents showed less likely to eat breakfast. In addition, girls showed lower rates of soft drink consumption and older adolescents higher rates of sweets consumption. Education level was the variable most associated with adolescent eating behaviours, specifically, the education level of the mother was significantly associated with breakfast, fruit and soft drink consumption. Family material affluence showed an effect on adolescents' fruit consumption. No significant effects were found between father and mother's occupation and adolescents eating behaviors. Conclusion: Indicators for assessing the socioeconomic position of the adolescents showed different relationships with adolescents eating habits. Parental educational level, and specifically, maternal educational level showed to be a major contribution for establishing adolescent eating habits.
Interventions to promote healthy eating habits during adolescence should focus in the inequalities produced by the educational level of the parents.

ID: 68/ PO1: 48 POSTER Trends in the Sexual Behaviour of 15-year olds in Scotland: 2002 -2014
Fergus Neville  Introduction: Early sexual initiation and inadequate contraceptive use places adolescents at increased risk of unplanned pregnancy and sexually transmitted infections. These behaviours are patterned by gender and may be linked to social inequalities. Purpose: This paper examines trends in sexual initiation and contraceptive use by gender and family affluence for Scottish adolescents. Materials and Methods: Cross-sectional data from four nationally representative survey cycles (2002,2004,2010,2014) (n = 8,895) (mean age = 15.57) were analysed. Logistic regressions examined the impact of survey year on sexual initiation, condom use and birth control pill use at last sex; as well as any changes over time in the associations between family affluence and the three sexual behaviours. Analyses were stratified by gender. Results: Between 2002 and 2014, adolescent males and females became less likely to report having had sex. Low family affluence females were more likely to have had sex than high family affluence females, and this relationship did not change over time. Condom use at last sex was reported less by males since 2002, and by females since 2006. Low family affluence males and females were less likely to use condoms than high family affluence participants, and these relationships did not change over time. There were no effects of time or family affluence for birth control pill use. Conclusion: There has been a reduction in the proportion of 15-year olds in Scotland who have ever had sex, but also a decrease in condom use for this group. Economic inequalities persist for sexual initiation and condom use.

ID: 214/ PO1: 49 POSTER Acute Gastro-Enteritis in Children aged 6 Months to 6 Years Presenting at the Out of Hours Service: A Qualitative Study
Heleen A Russchen, Inge Nederveen, Jan Schuling, Marjolein Y Berger University of Groningen, University Medical Center Groningen, Netherlands, The; h.a.russchen@ umcg.nl Introduction: Acute gastroenteritis in young children is a common reason to visit the general practice or out-of-hours service (OHS). Dehydration is the most dangerous complication, leading to hospital admission. Although estimating dehydration by a general practitioner (GP) is ambiguous. Purpose: To describe and get insight in GPs experiences regarding management of children with AGE during out-of-hours care. Methods: A qualitative study, using semi-structured interviews with GPs working in OHS in Groningen. Analysis was based on grounded theory and constant comparison using open, axial and selective coding. Results: In total 9 GPs were interviewed. Observation of the child during the consult gives the GP the most information about the presence of dehydration. There is heterogeneity about the value of the information obtained by physical examination. Inadequate coping from parents with the situation is an important reason to refer, even if there's no medical necessity. Not-knowing the children and parents, high workload and minor possibilities for follow-up make the situation more difficult in the out-of-hours setting.

Conclusion:
The general appearance and the parent's story are the most important factors for GPs to assess dehydration in children. Anxiety and inappropriate coping from parents is an important factor to refer children with AGE to hospital. To improve care for these children, there must be attention for characteristics of the patient, the parents, the GP himself and the setting of the out-of-hours service.

ID: 34/ PO1: 50 POSTER Atrophic Gastritis in Children with Celiac Disease
Valeria Novikova  To determine the prevalence of atrophic gastritis in children with celiac disease. To determine the frequency of Helicobacter pylori (H. pylori) and antiparietal cell antibodies as a possible causes of atrophic gastritis. Materials and Methods: 88 children of both sexes at the age of 3 to 17 years were examined. The study involved 54 children with different clinical forms of celiac disease (CD). The diagnosis was confirmed according to ESPGHAN criteria: was biopsy-prove, was based on clinical manifestation, positive serological and genetic data. 34 children with chronic gastritis and excluded celiac disease were a control group. All patients underwent a same examination: histological examination of gastric biopsies, histological verification of H. pylori infection and biopsy urease test, identification of antiparietal cell antibodies by enzyme immunoassay (ELISA). The biopsies were evaluated by a single pathologist who was blinded to all clinical data Results: In the group of patients with celiac disease chronic isolated corpus gastritis was diagnosed more frequently than in the control (61.1% and 5.9% p < 0.01) biopsies of the gastric corpus mucosa in patients with CD was characterized by neutrophilic infiltration in comparison with control (53,7% and 26.5% p < 0.05). The difference in antrum samples was not received (7,4% and 14.7 p>0.05). Fibrosis in the lamina propria of the gastric corpus was more prevalent in CD group (53.7% and 26.5% p < 0.05). For gastric antrum the difference wasn't obtained (68.5% and 55.9% p>0.05) Among patients with CD we found gastric corpus atrophy in 11 cases and in the antrum in 8 cases.
In control group corpus atrophy was in 4 cases and antrum atrophy was in 5 cases. Thus, the statistical difference in groups hadn't been received (35,2% and 26.5% p>0.05) In a majority of patients in both groups H. pylori was diagnosed (53.7% in the CD group and 55.9% in the control group p>0.05). Nevertheless antiparietal cell antibodies in the control group were not revealed. While we detected them in the CD group in 4 cases (0% and 7.4% p < 0.01) Conclusion: Atrophic gastritis was common for both groups. H. pylori rate was statistically equal. Nevertheless antiparietal cell antibodies were observed in CD group only, with the prevalence 7.4% or 1:13.5

ID: 169/ PO1: 51 POSTER Neonatal Tetanus: Case Report
Ana Maria Bradeanu, Roxana Balaceanu, Melania Iancu, Bogdan Ciocea Emergency Children's Clinical Hospital "G. Alexandrescu" Bucharest, Romania; anamariabrad@yahoo.com Background and Aims: Neonatal tetanus, one of lethal consequences of unassisted deliveries and non-sterile umbilical cord care practices, has become a very rare infectious disease in Romania but it is still common in developing countries. Methods: We present a case of a seven-day-old male baby referred from a pediatric hospital to our unit for progressive difficulty in feeding, fever, bradycardia, trismus, generalized muscle rigidity and spasms.

Results:
The patient was born in a rural household from a non-vaccinated mother. Both the pregnancy and the delivery were unattended and the umbilical cord was cut with a non-sterile device. Because of severe respiratory distress symptoms and continuous muscle spasm the baby was mechanical ventilated for 41 days; he also received IV immunoglobulin, antibiotics concomitant with continuous Midazolam and Rocuronium infusions. The patient was discharged after 78 days without residual stiffness.

Conclusion:
Neonatal tetanus, a severe, often fatal disease, can be eliminated through immunization of pregnant women and promotion of more hygienic deliveries and cord care practices. Problem: To comply with ACGME requirements, most training programs adopted new resident schedules that resulted in an increased number of patient handoffs. Inadequate sign-out has been associated with adverse events.

Aim:
To study the quality of the sign out before and after the introduction of the new float system schedule.

Methods and Intervention:
The study was conducted in Hamad general hospital, pediatric residency program using a survey to examine the characteristic and the content of the sign out. The survey was collected before and after introduction of the float system to compare the two schedules with total of 38 responses and 42 responses respectively. Results: With comparison to the old conventional schedule, the new float system had significant decrease in duration of sign out, 90% (< 1hr) vs 63% (p value 0.0063). The environment of the sign out was reported as quiet or with minimal interruption in 77% vs 49% (p = 0.007). There was no statistically significant change between the two systems with regard to SBAR use for standardized communication and no significant change in critical elements missing 14% vs 19%( p = 0.7). The overall safety rating for 4&5 out of 5 was 62% for the float system compared to 81% previously( p= 0.08). Conclusion: Using float system had showed improvement in the environment of the handover, decreased the duration of the timing needed to complete the sign out with no difference in usage of the standardized SBAR format and no change in critical information missing. However, the overall safety rating showed some decrease. Further monitoring for the sign out to quantify and identify barriers to safe and complete sign out is needed to improve the quality of the sign out.

ID: 168 / PO1: 53 POSTER Title Case Diagnostic Problems in a Case of Gastric Obstruction of a School Age Child
Luiza Bordei 1 , Victoria Hurduc 1 , Gabriel Becheanu 2 , Doina Anca Plesca 1 1 Department of Pediatric Gastroenterology "Dr. Victor Gomoiu" Clinical Children Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; 2 Victor Babes National Institute, Bucharest, Romania; luizabordei@gmail.com Introduction: Gastric outlet obstruction encompasses a broad spectrum of conditions that prevent the gastroduodenal contents passage, characterized by persistent nonbilious vomiting. Materials and Methods: A 12 years old girl, without familial/personal history who was admitted in our hospital for loss of appetite, epigastric pain, vomiting, weight loss (5-6 Kilograms/previous month), with normal stools. Physical Examination: Poor nutritional status (wasting), pale teguments, intermitent bilious vomiting, epigastric pain, without abdominal mass. Laboratory Investigations: Moderate inflammatory syndrome associated in dynamics with biological electrolyte imbalances and ultrasound aspect of diffuse liver steatosis with gastric stasis and significant parietal thickening. Esophago gastro duodenoscopy: Papulo-erosive phlegmonous gastritis with marked parietal infiltration and thickened deformed antropyloric region with histological and immunohistochemical features of chronic active non-atrophic gastritis, important nonspecific lymphocytic inflammatory infiltrate without Helicobacter pylori infection and epithelial/lymphoid tumor proliferation. Parenteral antibiotics, prokinetic agents and proton pumps inhibitors were initiated with unfavorable evolution, requiring magnetic resonance imaging practice who revealed antropyloric circumferential parietal thickening and perigastric lymph nodes metastases strengthening the suspicion of malign etiology. The reassessment of immunohistochemical markers revealed a large B cell lymphoid proliferation/Burkitt lymphoma CD20+. Thoracic computed tomography was performed for the evaluation of secondary determinations and showed a nodular lesion in the upper lobe of right lung sugestive for pulmonary tuberculosis. The clinical evolution was favorable under chimiotherapy and tuberculostatic treatment, with partial remission of tumor and progressive attenuation of gastric obstruction.

Conclusion:
We presented a case of non-Hodgkin gastric lymphoma grade III without medullary/ CNS invasion, rarely repoted in children in which the most frequent sites is ileocecal region and who particularly associatted pulmonary tuberculosis. Cervical trauma in children are often misunderstood and treated incorrectly. Injuries of the cervical spine are relatively rare in children but are a distinct clinical entity compared with those found in adults. The unique biomechanics of the pediatric cervical spine lead to a different distribution of injuries and distinct radiographic features. The treatment of cervical spine injuries in children must be founded on an understanding of spine development. Differences in injury patterns, interpretation of radiographic studies, and management of injuries are a direct result of the unique anthropometrics and biomechanics of a child. The literature specifically addressing cervical spine injuries in children has been scarce; most studies have been focused on adults. In more recent years, as distinct aspects of the pediatric spine have been better appreciated, more attention has been given exclusively to injuries of the cervical spine in younger patients. We describe two cases of cervical trauma of different entity for which the incorrect evaluation of the trauma led to a difficult diagnostic-therapeutic path.

ID: 70/ PO2: 1 POSTER Incontinentia Pigmenti (Bloch-Sulzberger Syndrome): A Rare Case Report with Dental Defects
Nihan Tugcu, Basak Durmus Marmara University, Dentistry Faculty, Dept. of Pediatric Dentistry, Istanbul,Turkey; altinokbasak@ yahoo.com Introduction: Incontinentia pigmenti (IP) is an uncommon X-linked dominant genetic syndrome, which predominantly includes ectodermal, mesodermal, neurological, ocular and dental abnormalities. Cutaneous manifestations are classically subdivided into 4 stages: vesicular, verrucous, hyperpigmented, and atrophic. Various hair and nail abnormalities, dental anomalies, and ophthalmologic and neurologic deficits are associated with the disorder. The condition is lethal in the majority of affected males in utero and variably expressed in females. Dental characteristics such as hypodontia, delayed eruption and conical shape may be used to identify the syndrome with ectodermal features.
Purpose: The aim of this case presentation is to document and management of the dental manifestations of a girl with IP. Case report: A 8-year-old girl referred to the Dept. of Pediatric Dentistry, Dental School, Marmara University, Istanbul, Turkey for abnormal dentition. An oral examination with panoramic radiograph was performed. The oral mucosa was normal however clinical and radiological dental examination of the patient showed characteristics of dentition seen in IP such as hypodontia, partial peg-shaped Introduction: Ewing sarcoma family of tumours (ESFT) are primary malignant tumours that develop in bone and soft tissue and represent the second most common musculoskeletal cancer in children. These tumours often metastasize, primarily to the lungs and other bones. According to published evidence prognosis varies depending on age, tumour volume and presence of metastasis at diagnosis.

Material and Methods:
We conducted an observational retrospective descriptive study, where we analysed all paediatric patients with ESFT diagnosed between 2001-2010 in a Portuguese Paediatric Oncology Reference Centre. Results: We identified 28 patients diagnosed with ESFT, 57% (16) of them were female and median age at diagnosis was 9.9 years, with 50% of patients younger than 10 years-old (yo) at diagnosis. Half (14) of the tumours were localized in long bones and pelvis. At time of diagnosis 25% (7) of the patients had metastatic disease (MD), and most of them (86%) were older than 10 yo. Median tumour volume was 58.5 mL in patients who died while it was 111 mL in survivors. All patients were treated with chemotherapy (28), 79% (22) were also submitted to surgery, 75% (21) received additionally radiotherapy, and 61% (17) were treated with all three modalities. Eleven (39%) patients experienced a recurrence of the disease. Five and ten year overall survival (OS) for the whole cohort was 68% and 59%, respectively. Patients aged above 10 years, patients with MD at diagnosis and those patients that experienced a relapse had an increased odds of death [odds ratio (OR) = 4.11, P = 0.072; OR = 20.13, P = 0.006 and OR = 15.34, P = 3x10 -5 respectively]. The majority (84%) of survivors experienced some long-term sequelae, mostly orthopaedic. Conclusion: In our series patients diagnosed under the age of 10 yo had a better outcome. However, the tumour volume was not associated with any outcome. Patients with MD at diagnosis and those who relapsed had a poor prognosis. New therapies from large cooperative trials are needed to improve the prognosis in these groups of patients.

ID: 162/ PO2: 8 POSTER Homocystinuria: Before and After Neonatal Screening
Introduction: Autoimmune hypophysitis (AH), also called lymphocytic hypophysitis, is a rare cause of pituitary gland inflammation, more so than granulomatous and xanthomatous hypophysitis. It must be carefully differentiated from common pituitary lesions due to the recurrent nature of the disease. AH usually occurs in pregnant or postpartum women and presents with symptoms of raised intracranial pressure, rarely presenting in childhood and adolescence. Initial treatment is glucocorticoid therapy and surgery if symptoms persist. Recurrence or persistent symptoms may require immunosuppressive therapy. Case History: A sixteen year old adolescent girl presented with three months of headaches, diplopia, polyuria, polydipsia and secondary ammenorrhea. Clinically, she had right lateral rectus palsy with normal pupillary reflexes. There was no other cranial nerve involvement or focal neurological deficit. Suspecting a pituitary tumor, magnetic resonance imaging (MRI) of the brain was done, which showed a large enhancing mass in the sellar and suprasellar region with figure of '8' configuration, indicative of a pituitary macroadenoma. Blood investigations were suggestive of central diabetes insipidus (DI), central hypothyroidism, hypocortisolism, hyperprolactinemia with low gonadotropin levels. She underwent a craniotomy for excision of the mass. Histopathological evaluation showed plasma cell rich lesions and lymphoplasmacytic infiltration suggestive of lymphocytic hypophysitis or langerhans cell histiocytosis, which was ruled out with immunohistochemistry. She was started on hydrocortisone, levothyroxine and desmopressin. Following surgery her symptoms subsided and her thyroid profile normalised. Cyclical estradiol and medroxyprogesterone were started for secondary ammenorrhea. Four months post surgery, she presented again with headache, diplopia and polyuria. MRI brain was repeated which showed reduction in size of the sellar and suprasellar mass. However, meningeal thickening with enhancement along the right cavernous sinus. with reduction in calibre of the cavernous segment of the right internal carotid artery was noted. Following pulse methylprednisolone therapy, her headaches reduced and oral steroids were continued. The dose of desmopressin was modified and DI was controlled. Patient is on follow up and planned for immunotherapy if follow up MRI does not show regression of the inflammation. Conclusion: Autoimmune hypophysitis is very rare in children and adolescents and must be considered as a differential diagnosis for pituitary lesions. When identified AH must be evaluated and treated aggressively with steroids, surgery and hormonal supplementation as required. Close followup is necessary to detect tumor recurrence and to provide a stable hormonal milieu. Immunomodulating agents like rituximab and methotrexate, may be considered for recurrent and steroid unresponsive lesions.

Introduction:
The Jarcho-Levin Syndrom or autosomal recessive spondylo costal dysostosis (ARSD) is a rare disease of varying severity, due to defective segmentation of the vertebrae and ribs, The incidence and prevalence are unknown. Purpose: Prenatal diagnosis by ultrasound can be done as early as 16 weeks of gestation after conception. Management should aim at aggressive neonatal care, prevention and apt treatment of respiratory infections. Observation: This is the case of a male new born admitted at birth for immediate respiratory distress. Born following term pregnancy complicated by gestational diabetes, born by cesarean due to macrosomia. Immediately intubated and ventilated for respiratory insufficiency. Clinically it presents: a short neck and reduced mobility, a short thorax and a small size. Thorax radiographic examination revealed hemivertebrae and deformities of the ribs. Echocardiography revealed a pulmonary stenosis with PAH. The evolution was marked by the appearance of a junctional tachycardia requiring the use of cordarone and a failure of the weaning machine. Conclusion: The ARSD can be responsible for respiratory failures, which could be severe, leading to a life-threatening risk during the first year of life. Prenatal diagnosis is possible using ultrasound. The diagnosis is clinical and can be supported by an ultrasound examination and x-rays of the spine. Purpose: From this case we take stock of this disease and emphasize the importance of prenatal diagnosis Materials and Methods: We report the case of a newborn in whom the diagnosis was suspected by noting a post axial hexadactyly. Observation: Lyed is a newborn from a consanguineous marriage of a second degree with family history of blindness in three paternal cousins. His mother aged 30 years has had a previous pregnancy complicated by hydrocephalus with vermis hypoplasia on fetal MRI and bilateral pyelectasis. She gave birth to a stillborn female macerated, bearer of abnormal ends (Polydactyly) and abdominal distension with hydrocolpos strongly suggesting McKusick Kaufman syndrome. The current pregnancy occurring after a birth interval of 5 months, passed without incidents. The newborn presented a post axial hexadactyly with a clinical examination otherwise normal. Transfontanallar ultrasound showed moderate ventricular dilatation, renal ultrasound initially objectified bilateral pelvicalyceal expansion which revealed to be normal following a second control. The eye fundus showed a discrete pallor without signs of retinal disease. Echocardiography has not been made due to the unavailability of pediatric ultrasound. During the following 8 months, the infant was hospitalized 2 times for bronchiolitis and presented a good psychomotor development . The genetic study is ongoing. Conclusion: Most of the MKKS gene mutations are responsible for the Bardet -Biedl syndrome. The existence during infancy of common phenotypes of both syndromes is a risk of misdiagnosis, and encourages advise to wait a few years to eliminate the possibility of the Bardet-Biedl syndrome, particularly after a retinal damage search . Prenatal diagnosis of the McKusick -Kaufman syndrome is possible by viewing an abdominal mass and polydactyly during the obstetrical ultrasound. Genetic counseling may be of benefit for families of people with this disorder.

ID: 207/ PO2: 19 POSTER Tuberous Sclerosis-The Need for a Multidisciplinary Management Program
Introduction: Tuberous sclerosis (TS) is a rare autosomal dominant progressive neurocutaneous syndrome characterized by the development of multiple hamartomas in different organs. It is caused by a mutation in either tumor suppressor genes TSC1 (located on chromosome 9q34, codes for protein hamartin) and TSC2 (located on chromosome 16p13.3, codes for protein tuberin). As a multisystemic disease, morbidity and treatment burden especially for neurological manifestations are significant.
Purpose: Characterization of all TS patients followed-up in a Portuguese pediatric tertiary center.

Materials and Methods:
We retrospectively reviewed the records of all children with TS presently followed-up at our hospital and collected data on demographic, genetic and diagnostic characteristics. Number of subspecialty clinics frequented by each child was recorded. Neurological examination, EEG and MRI results were obtained. Epileptic status and treatment were assessed. Results: Twenty-one patients are presently followed-up, 16 are male (76%), median age of 14.
Prenatal diagnosis was possible in 6 patients (29%). Most common clinical features at diagnosis were hypomelanotic macules (100%), angiofibromas (62%) and angiomyolipomas (52%). Of the 18 patients who have had renal ultrasound, 61% have multiple renal cysts. Nineteen patients (90%) have epilepsy, 17 (81%) cognitive deficiency and 14 (67%) behavioural problems, in most cases ADHD. Brain MRI was performed in all patients and the most frequent changes are subependymal nodules (100%) and cortical dysplasia (76%). Eleven patients (52%) have at least one relative with TS, namely one of the parents in 91% of cases. Genetic study was performed in 10 patients (8 with a TSC2 mutation and 2 with a TSC1 mutation). These patients are followed-up on average on 5 different subspecialty clinics (min 1-max 10), most commonly Neurology, Cardiology, Ophthalmology and Dermatology. At least 8 have appointments on other hospitals. Conclusion: Our patients present several disease comorbidities and are followed-up by multiple subspecialties. The creation of a multidisciplinary clinic was found to be of paramount importance in order to articulate care and supply better quality of life for patients and their families. With the collaboration of all the different subspecialties it is possible to establish a protocol based follow-up and treatment plan, which will reduce hospital visits while addressing the patients' needs.

ID: 131/ PO2: 20 POSTER When One Eye Doesn′t Follow the Other-Report of 4 Cases of Brown Syndrome
Ana Introduction: Vascular malformations can be subdivided into high-flow (arteriovenous malformation and arteriovenous fistula) and low-flow lesions (venous and lymphatic malformations). For the purpose of this poster, we concentrate solely on paediatric vascular malformations, utilising cases from our institutions. Case Reports: Diagnostic and Interventional radiology can play a vital role in paediatric vascular malformation diagnosis and therapy, as the sole therapy of choice or as an adjunct to surgery. Lowflow malformations are congenital deformities of venous or lymphatic vessels or both. They commonly present before the age of 2 years. The most common site for low-flow malformations is the neck and face followed by the limbs, trunk, internal viscera, bones, and skeletal muscle. Ultrasound and MRI are the most common imaging modalities used to visualise low-flow vascular malformations. Key imaging characteristics include partially solid multicystic multispatial masses with fluidfluid levels and phleboliths. Sclerotherapy is the initial therapy for slow-flow malformations and is especially useful for mostly cystic masses. Surgical excision is helpful for solid or incompletely sclerosed lesions. High-flow vascular malformations are divided into arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs). AVMs are congenital lesions that can be single, multiple, or part of a genetic disorder. They occur most often in the cranium, bone, muscle, and subcutaneous fat. On the other hand, AVFs are acquired and most frequently occur in the brain. All cross-sectional imaging studies have the ability to show the key features of high flow vascular malformations, including a mass-like cluster of arterial and venous structures with little to no intervening solid tissue. Embolisation is treatment of choice for high-flow vascular malformations. Surgery or a combination of therapies may be necessary in some cases.

Conclusion:
The key learning points are the (1) pathology, (2) main clinical features and (3) the role of imaging in the diagnosis and management of paediatrics vascular malformations.

ID: 105/ PO2: 22 POSTER Pustular Psoriasis in a Child
Barathi Rajendra KK Women's and Children's Hospital, Singapore; Barathi.Rajendra@singhealth.com.sg Introduction: Childhood psoriasis is not uncommon. However children tend to present with guttate or plaque psoriasis. This is a case of a young child with generalized pustular psoriasis which is rare in childhood.
Purpose: To describe an unusual diagnosis of a pustular rash in a child.

Materials & Methods:
A 6 year old Chinese boy, who was previously fit and well, presented with a 3 week history of a rash. The rash had started as a few pustules over the trunk and gradually spread over larger areas of the trunk and limbs. There was no previous history of rash, medical illness or a family history of any rashes. He had not consumed any oral medications or used any topical treatments. Fever and systemic symptoms were absent, there was no preceding illness and no pruritus. Results: On examination, he was well thrived and his vital signs were stable. Examination of the trunk revealed scaly, erythematous papules scattered over the trunk, with some lesions displaying yellowish crusted pustules around the papules. There were more discrete papules and pustules over the limbs. There were no scalp or genital lesions, no nail changes or mucosal involvement and no swollen joints. The initial diagnosis considered was acute localized exanthematous pustulosis. A gram stain and microcopy of the pustular contents did not reveal any organisms and bacterial culture was negative. Routine laboratory tests were all normal (Full blood count, renal panel, liver function tests, C-reactive protein). Over the next 2 days, more pustules appeared over the limbs as well as the penile area. The erythematous papules were also enlarging and some areas were coalescing into plaque like lesions. A skin biopsy was arranged. Histopathological examination of a punch biopsy sample revealed a mildly hperkeratotic stratum corneum, with a focally acanthotic and spongiotic epidermis. There was a superficial perivascular infiltrate of lymphocytes, histiocytes and neutrophils. The findings were supportive of a diagnosis of pustular psoriasis. The child was commenced on oral Acitretin, with an increasing dose regimen over the next few days. As the lesions continued to progress, Ciclosporin was started 2 days later. The child remained systemically well with gradual resolution of some of the smaller skin lesions over the next few days. He was discharged to outpatient care on the medications above. Conclusion: Although rare, pustular psoriasis can present in children and should be considered as a differential diagnosis of a pustular rash. Children's height, weight and calcaneus BMD were measured, and moderate and severe low BMD were defined as -2 < Z-scores≤-1 and Z-scores≤-2 respectively. Chi-square test and variance analysis were used in univariate analyses, and logistic regress was conducted to examine the potential related factors of severe low BMD. Results: 2474 children with effective data were included in the analysis, and the male-female ratio was 1.2. Of 2474 children, 23.3% and 30.3% children's weight and height were lower than the average level. The proportion of moderate and severe low BMD were 39.6% and 13.1% respectively. The SOS-scores presented a up-trend (P≤ 0.01), and boy's SOS-scores was higher (P < 0.01). The incidence of low BMD decreased with the time (P < 0.01), and the degree of low BMD among girls was worse (P < 0.01).The incidence of severe low BMD were associated with gender, weight the degree of physical activity and the the frequency of eating snacks (P < 0.05). Multiple logistic analysis results showed that the risk of severe low BMD among girls was 2.3 times higher than boys [Odd Ratio (OR) = 2.3, 95% Confidence Intervals (CI) = 1.40, 3.87), children with higher father's education degree and caesarean section delivery mode were more susceptible to severe low BMD, and the ORs were 2.0 (95% C.I. = 1.04, 3.82) and 1.67 (95% C.I. = 1.01, 2.76), respectively. Less snacks and higher weight were the positive factors of severe low BMD, and the the ORs were 0.6 (95% C.I. = 0.45, 0.86) and 0.8 (95% C.I. = 0.71, 0.90). Conclusion: Children's growth development and BMD, higher rates of malnutrition and low BMD, is poor in Jiangxia district, and girls are more susceptible. Nutrition and health promotion activities on health eating habits and physical activity should be carried out for the rural pre-school children to improve the physical and bone health in the future, especially for girls.

ID: 102/ PO2: 24 POSTER A Case of Ulcerative Colitis Developed After a Living Donor Renal Transplantation for Four Years
Yuko Hamasaki, Yusuke Takahashi, Mai Kubota, Seiichiro Shishido Toho University Faculty of Medicine, Japan; yuhamasaki@med.toho-u.ac.jp Ulcerative colitis (UC) is unidentified diffuse nonspecific inflammation of the large colon. We experienced the UC that developed newly four years after renal transplantation. Case Study: 9 year old, girl. She was a chronic renal failure due to hypo-dysplastic kidney. So she received renal transplantation from her mother when she was 5 years old. The maintenance immunosuppressive agents were methylprednisolone, tacrolimus and mycophenolate mofetil (MMF). Two years after transplant, antimetabolite agent was changed from MMF to mizoribine because she was continued verruca vulgaris. Allograft function was stable. At 9 years old, bloody stool was appeared. Bloody stool lasted, and she progressed to anemia. She was admitted into the previous hospital and received colonoscopy. Flare, erosion and edema were identified from transverse colon to rectum, but there were not findings of posttransplant lymphoproliferative disease. She was transferred to our hospital for treatment. She was a weight loss of 3 kg and wasting significantly at the time of the admission. Immunosuppressant was tacrolimus 3mg/day and prednisolone 5mg/day. Mizoribine was stopped. The blood test results were as follows; WBC 22700/μl, Hb 8.6g/dl, Plt 362000/μl, CRP 2.3mg/dl, TP/Alb = 6.1/2.6g/dl, BUN 10mg/dl, Cr 0.67mg/dl, ESR 23mm/h. She was managed in total parenteral nutrition, but bloody stool lasted. She received colonoscopy again in our hospital. The result turned worse remarkably and showed findings of severe UC. Pediatric UC activity index (PUCAI) was 85. She was prescribed mesalazine (5-ASA), steroid enema, increased tacrolimus (trough level was changed from 2-3 to 10ng/ml) and steroid. One week after start of therapy, PUCAI was improved to 5. Tacrolimus was reduced after two weeks and started azathioprine. She started elemental diet; after all she had elemental diet 600Kcal and low residue diet 1000Kcal at the time of discharge.

Introduction:
The cyclic vomiting syndrome is an idiopathic disorder characterized by recurrent, stereotypical, self-limiting episodes of vomiting with symptom-free intermediate periods.
Purpose: The presentation of the cyclic vomiting syndrome in an adolescent girl. Materials and Methods: A 15 years old girl was submitted to the Pediatric ER with reported multiple episodes of vomiting (> 25) within hours, intense nausea and abdominal pain. It was in the first 24 hours of menstrual period. She had a history of 4 more similar episodes during the past 10 months, with an average frequency of one episode every two months. All episodes were associated with menstruation an exhibited stereotypical symptomatology. Furthermore, she presented elevated prolactin levels and her symptoms did not improve with treatment. She reported symptom free periods between the episodes. The patient was hospitalized in the pediatric department for 8 days for investigation. Gastroenterological, neurological assessment and CT/ MRI, gynecological and psychiatric assessment as well as control of metabolic diseases took place and organic disorders were excluded. By the end of the menstrual period the adolescent's condition was gradually restored. She received symptomatic treatment. Results: Based on the latest guidelines of NASPGHAN the patient was diagnosed with cyclic vomiting syndrome. Regarding the therapeutic approach there is no approved medication. Treatment is individualized. Initially in the precursor stage NSAIDs and ondansetron were administered. But the patient relapsed and therefore prophylactic treatment with antidepressants (SSRIs) begun. We discussed the addition of carnitine, coenzyme Q10 and contraceptive medication with low estrogen content. Decline of the intensity of symptoms and reduction in frequency of the episodes were observed.  (rs1544410), ApaI A>a (rs7975232), and TaqI t T>t (rs731236). Several studies with small data sets that suggested an association between these SNPs and type 1DM had inconsistent results. This present meta-analysis aims to demonstrate the associations between type1 DM and VDR gene polymorphisms ApaI, BsmI, FokI and TaqI, with the largest data set, to rule out genotype-phenotype correlation of type 1 DM in children.

Introduction and Purpose:
The syndrome of resistance to thyroid hormones (RTH) is a rare genetic disorder characterized by decreased end organ responsiveness to thyroid hormones (TH). This can occur as a defect in one of the six major steps required for secreted TH to exert its action on target tissues. The first recognized and more common defect involves the TH receptor beta (THRB) gene. Clinical manifestations are variable. Patients may be asymptomatic or present with manifestations suggestive of hypothyroidism, with elevated levels of thyroid hormones and non-suppressed thyroid-stimulating hormone (TSH). Goiter is present in nearly 95% of the cases. Material and Methods: Case report of two half-siblings with RTH. Results: We describe two half-siblings diagnosed with RTH. At 16 years old, the girl was referred to the Paediatric department due to goiter. Apart from menstrual irregularities, she was assymptomatic and, except for a low body mass index and goiter, physical examination (PE) was normal. She had sightly increased fT4 with normal fT3 and TSH levels. Anti-thyroid antibodies were negative and ultrasound showed an enlarged thyroid gland with homogeneous structure. These blood results remained stable for the following two years and, at 17 years old, she had both fT3 and fT4 increased with normal TSH values, and raised blood lipids. Under the suspicion of RTH, TSH alfa-subunit was measured (ratio alfa-subunit/TSH < 1), followed by molecular studies, which detected a mutation on the THRB gene, consistent with the diagnosis of RTH. Cerebral MRI was normal. At 2 years old, the boy was referred to the Paediatrics department due to failure to thrive. He had increased fT3 and fT4 with normal TSH. Molecular studies revealed the same mutation on the THRB gene, diagnosing RTH in both siblings.

Introduction:
The incidence of food allergy in schools is increasingly rising that most schools will have a student or few that suffer from an allergy accounting for anaphylaxis It's crucial that schools are well informed about allergies and fully equipped in order to be able to tackle this vulnerable population. Aim: To assess different types of allergies at schools in Qatar. To highlight the challenges and barriers facing the school personnel in recognising students with severe allergies. Method and Materials: This was a cross-sectional study with a target population of 128 schools in Qatar. Response rate was 50 schools (39%). We used a telephone-administered questionnaire for school caregivers' of allergic children who previously visited either pediatrics emergency department or allergy clinic age from 1-14 years from August 2015 to October 2015. Results: 20 school caregivers' claimed they don't know of any child with allergies in their schools. 12 out of the 20 said that the students' families didn't inform them. Another 20 schools claimed they are not allowed by school administration to administer any allergy medication. The male to female distribution is 30 (60) to 20(40). The most common type of allergy is food 30 (60%) followed by multiple allergies 7 (14%) and unknown allergies 7 (14%). With nuts accounts for 20 (66%) and peanuts being the commonest and accounts for 12 (60. The ages with the most common allergies are 3-6 years 14 (28%) and 9-14 years 14 (28%).the age with the most common type of allergy in percentage.

Conclusion:
The fundamental challenges that the schools face are limited communication between families and schools and insufficient support from school administration and supreme council of education. Another challenge was lack of enough nursing staff especially at the private schools. School staff should be adequately knowledgeable about their student allergies to reduce emergencies and fatal reactions, and this can be accomplished by specific educational interventions and improvements in school health policies. These findings suggest that a larger study is needed to reinforce those outcomes. Introduction: Anaphylaxis is a life-threatening condition that can occur in patients with diagnosis of food allergy. Anaphylactic events in schools and pre-schools are frequent as meals are served and children spend there the majority of their weekdays. Early recognition of anaphylactic reactions and prompt treatment can be life-saving. A multi-center educational project, supported by the Portuguese Society of Pediatric Allergy, was designed in Portugal in order to train the schools' and pre-schools' staff on this subject. Purpose: To characterize the patients diagnosed with food allergy and potential for anaphylaxis in a Portuguese regional hospital and to evaluate the impact of an educational program on anaphylaxis at their schools/pre-schools. Materials and Methods: An analysis of clinical records of the outpatient clinic of our hospital was performed. 26 patients with diagnosis of severe food allergy who had prescription of epinephrine auto-injector were selected. Variables regarding the patient and the disease were collected. All the patients were contacted and the parent's consent to develop an educational program with their children' school staff was obtained. Schools were contacted in order to present the project and plan the session. It included the definition of food allergy and its clinical presentation, preventive measures and recognition of anaphylaxis and its treatment, including intramuscular epinephrine administration with hands-on training with a placebo and questions and answers session. Follow-up data was collected. Results: 67% of the selected patients were male and 33% were female. 33% had 1 event of anaphylaxis before the diagnosis while 46% and 21% had 2 and 3 events, respectively. The allergens identified were fish/shellfish in 27% of the cases, nuts/dry fruits in 23%, egg in 19%, milk in 19% and fruits in 15%. The first symptoms of food allergy were on average at 33 months of age, mainly with cutaneous and respirator manifestations. 100% of the parents consented on the session at their children' school. 21 sessions were already performed, reaching 150 members of schools' staff. Average follow up time after the session was 617 days with a maximum of 943 days. Zero anaphylaxes occurred among the intervened patients during the follow up time.

Conclusion:
Anaphylaxis is a life-threatening condition that can easily be avoided and treated if recognized early. Our results demonstrate that an educational program designed for school staff can be effective on the prevention of anaphylaxis and can lead to a total absence of anaphylactic events.

Conclusion:
Our research results shine light on different areas of deficiencies in knowledge at both families and schools level. Well-structured courses and campaigns should be established at the level of the community to raise the awareness of caregivers of this vulnerable population. Improving communications between families and school caregivers will bridge the gap in their knowledge.

ID: 3/ PO2: 37 POSTER The Role of Teachers' Concerns in Screening Preschool Children for Developmental Delays: The utility of the PEDS in Singapore
Jennifer SH Kiing 1 , Yiong Huak Chan 2 , Maureen Neihart 3 development and bonds, affiliative behaviors, and promotes parental nurturing and increases the salience of social stimuli. It is very important that testosterone exhibits opposite effects from oxytocin on diverse aspects of cognition and behavior. Autism is related to increased testosterone also (males are affected more frequently, extreme male brain theory, testosterone-related medical conditions and prenatal androgen exposure contributes to the development of ASDs). Studies show lack of mirror neuron activity in several regions of autistic brain. Mirror neurons are involved in social interaction and empathy. Autistics have great difficulty attributing wants and needs to others, or what others are thinking and feeling (theory of mind deficit). But, love and empathy are unbreakable related to each other. Conclusion: It is possible that autism constitutes the nosological equivalent of love and compassion deficiency (including lack of self-love) and aggression predominance (including self-destructive behaviors) in contemporary world. From this point of view, it is essential for families, who intend to be parents, especially mothers-to-be, to live in an environment full of love, sympathy, compassion and help and decreased prenatal stress. It is very important for societies to offer full support for mothersto-be in this direction. In addition, WHO declares that love is the most important thing to bring up and nurture healthy children (security is the second one and food, education and other values follow).

ID: 154/ PO2: 39 POSTER Cranioencephalic Malformations and Orofacial Clefts-A Review of a Portuguese Central Hospital
Cristina Ferreras  Results: There were 568 patients with OFC, of these 101 (18%) had CEM which 64% were female. CEMs have been classified into five groups: i) cephalic perimeter alterations (42%), subdivided in macrocephaly (17%) and microcephaly (83%); ii) brain malformations (25%) subdivided in corpus callosum involvement (63%), holoprosencephaly (26%) and cerebral hypoplasia (1%); iii) cranial malformations (15%); iv) CRF disorders or congenital hydrocephalus (10%); and v) neural tube defects (8%). CP was the most common OFC, found in 55% of patients with CEM. Twenty -four per cent had family history of CEM and OFC. Fifty five per cent of patients with CEM had an identified syndrome. Development delay was present in 35% of these patients, 25% had neurossensorial deafness and 6% epilepsy. Conclusion: Due to the increased risk of associated CEM in children with OFC further diagnostic investigation is essential, especially using methods, such as magnetic resonance imaging of central nervous system. Considering the variety of changes, it is necessary that these patients are followed in reference centers. Introduction: Children with Down Syndrome (DS) have deficits in balance, co-ordination, and gait throughout childhood and adulthood. Purpose: The aim of this report was to present a case to evaluate the acute effects of "Kinesio Tape" (KT) application on balance in 19 year-old adolescent with DS.

Materials and Methods:
A 19 year old male adolescent with DS who had no visual or hearing disorders was able to walk independently. He had moderate intellectual deficiency but was able to follow simple verbal instructions. The case was prepared with comfortable clothes to improve his compliance before bandaging. Berg Balance Scale (BBS) was used to evaluate balance. It consists 14 items and each item is scored between 0-4, the maximum score is 56. Each item of BBS was described to the case verbally and visually, each item was repeated 3 times with 30 seconds intervals and the lowest score was recorded. 5m x5cm KT (Kinesio Tex Gold) was applied bilaterally to feet, lowermiddle trapezius muscles and internal-external oblique abdominal muscles for foot stability, scapular stabilization and postural stability, respectively. BBS was repeated again after KT. Results: The total BBS score was initially 48 and 50 after the application. The difference was observed in 13th item (standing unsupported one foot in front) and 14th item (standing on one leg) of the scale. While the score of 13th item was 1 (needs help to attain position but able to stand 15 seconds feet together) before KT, after the application the score changed to 2 (able to place feet together independently but unable to hold for 30 seconds). While the score of 14th item was 1 (tries to lift leg unable to hold 3 seconds but remains standing independently) before KT, after the application the score was changed to 2 (able to lift leg independently and hold ≥ 3 seconds).

Conclusion:
Our results showed that the patient had an improvement in total score of BBS with triple application of KT. To reduce the learning effect, each item of BBS was repeated 3 times and the lowest score was marked. In the light of this finding larger sample studies which display the effects of KT on balance in adolescents' with DS are needed. There is no conflict of interest.

ID: 12/ PO2: 41 POSTER Wheel Injury in Young Cyclists
Mikhail Mikhovich, Leonid Glazkin, Mikhail Gavrilenko, Sergei Romanenko Mogilev Regional Children's Hospital, Belarus; glazkinl@gmail.com Introduction: Bicycle is a very popular way of transportation and recreation in children, but it can be a source of serious damage. 428 children with bicycle injury turned to the emergency room of Mogilev Regional Children's Hospital in summer days of 2015.
Purpose: Research the special category among the bicycle injuries-damage, which are obtained when leg of a child falls between wheel and fork. A child gets injured while riding on the frame or the trunk without special seat. Not only extensive damage but fractures of the long bones occur.

Materials and Methods:
We analyzed 20 cases of such trauma that were treated in May-June 2015. 10 boys, 10 girls, the average age was 3,5. Results: In 80% cases damage was on the external surface of the ankle, in 15% -on the posterior surface of the heel, in 1 case -on the internal surface of the ankle. In most cases besides the main damage multiple compressions of the leg and foot were observed. 50% children have fractures of the leg in the lower third. 1 child has compression fracture of the heel. Cast with padding used in treating all fractures. "Window" in the cast need for dressing. Ointment dressings were applied on the soft tissue damage. Necrectomy was performed in 8 cases, skingrafting not needed.

Conclusion:
The average duration of treatment in the hospital with this pathology greatly exceeds average duration of treatment with other trauma. Common average duration of treatment with trauma in 2015-9,2 days and with this pathology-14,3 days. Minimal changes in the social sphere can lead to appear of new types of injuries or to increasing the number of infrequently occurring injuries. In recent years there has been increase of bicycle-wheel injury. This damages needs longterm treating. It requires active preventive measures.

Introduction:
Preventing asphyxial practices is a public health priority, as choking "games" are not rare and can lead to death. School is a good place to observe those practices (as they begin mostly at school, sometimes in kindergarten) and to organize prevention (all children being in school; breathing and identification of dangerous games being part of French school curricula). Purpose: The regional national education services of Midi-Pyrénées mobilized for several years, in partnership with the pediatric emergency department in Toulouse.
Step by step the awareness around those behaviors and their risks has risen. Methods: First, we conducted a survey among a representative sample of 1.023 2nd and 3rd graders, that lead to a pediatric thesis. The findings were alarming (≥1/3 of students having already practiced various "games" of asphyxia; 1/3 of them starting in kindergarten), and shared with the school doctors of the region, together with a clinical presentation on consequences of asphyxial practices. Following, a kit (slide-show, back-ground papers, prevention materials…) was created with school doctors for them to be able to act upon any case. Further, the regional representant of the Minister of education informed management school staff that the topic of chocking games should become a key component of school-climate and that school doctors could intervene at hand on this topic. Since then, a surveillance system around new cases happening in school is established, based on a common awareness by school and by the hospital children emergency ward. Conclusion: School doctors, through their unique position within school and their expertise on students' health, have a key role to play in screening and preventing asphyxial practices, in close collaboration with emergency pediatricians and private practitioners in charge of children and their parents. A regional coordination is an important condition to create and make alive such a network.

ID: 118/ PO2: 43 POSTER Post-traumatic Myositis Ossificans : A Case Report of Spastically Quadriplegic 16-Year Old Patient after Traumatic Brain Injury
Suncica Martinec, Valerija Pavic-Haluzan, Gordana Cesarec Special hospital for medical rehabilitation Krapinske Toplice; suncica.martinec@sbkt.hr Introduction: Post-traumatic myositis ossificans (PTMO) is a condition that in 11-22% follows traumatic brain injury. Hip region is the most commonly involved. Imaging studies are crucial for distinct staging of maturity of the lesion and therefore appropriate intervention. Purpose: to describe phases of PTMO by using high resolution ultrasound (HRUS), power Doppler, radiographs and Multisliced Computed Tomography (MSCT) and discuss their usage in distinct phases. Materials and Methods: case report of spastically quadriplegic 16-year old patient after severe traumatic brain injury who developed PTMO. Follow up consisted of using imaging methods of PTMO 3 months, 6 months and 9 months after traumatic brain injury. Results: in early stage PTMO high resolution ultrasound showed heterogeneous hypoechoic soft tissue masses with hyperechoic core. Positive power Doppler signal was detected. By maturing of the lesion peripheral lamellar calcification and posterior acoustic shadowing were seen using HRUS. In the late, mature stage completely calcified periphery with acoustic shadow were seen. Power Doppler signal was negative. Early radiographs showed soft tissue edema. By maturing of the lesion well-defined peripheral calcification with coarser central calcification developed. In the late phase PTMO presented as dense calcified lesion in whole. MSCT in early stage showed pale calcification and soft tissue swelling. Maturing of the lesion showed peripheral calcified rim with central zone isodense to muscle. In mature phase dense ossificate was seen. Conclusion: Ultrasound combined with power Doppler is the most usefull diagnostic imaging modality for early, immature phase PTMO diagnosis and evaluation of the maturity of the lesion. MSCT optimally evaluates both calcifications as well as soft tissue.

ID: 114/ PO2: 44 POSTER Current Practice in The Identification and Management of Neonatal Sepsis in Rural Uganda
Rebecca Ann Squires 1 , Kayleigh Else 1,2 , Joanne Moffatt 1,2 1 Swindon Academy, University of Bristol; 2 Great Western Hospital NHS Foundation Trust; rs1715@ my.bristol.ac.uk Introduction: Neonatal sepsis is estimated to account for 25% of the 4 million neonatal deaths globally per year (1). 99% of these deaths occur in low and middle-income countries where the identification and treatment of neonatal sepsis is commonly inadequate. Infectious illness accounts for 24% of neonatal deaths in Uganda (2). Research suggests that current practice in Uganda does not meet WHO standards. Barriers to improving care include lack of antenatal care and maternal education, and limited access to health facilities. Purpose: To identify the current practice in identification and management of neonatal sepsis in rural Uganda and identify barriers to improvement.

Materials and Methods:
The setting was Villa Maria Hospital, Masaka, Uganda. Cases of neonatal sepsis over the previous 12 months were identified and a retrospective review of case notes was performed. Outcomes were; demographics, birth history, source of sepsis, investigations performed, type and duration of treatment and clinical outcome. Provision of postnatal education on warning signs was also collected. Informal interviews with staff were performed to obtain an overview of current clinical practice. Results: 37 cases of neonatal sepsis were identified with a mortality rate of 29%. 90% of these babies were not delivered in a hospital. A diagnosis of infection was made clinically as investigations such as blood cultures were not available. Intra-partum risk factors for early-onset sepsis (EOS) were not documented in the notes and prophylactic intra-partum antibiotics were not administrated.

ID: 75/ PO2: 52 POSTER The Assessment of Physical Activity of Students at Lower and Upper Secondary Schools Belonging to the Network of Health Promoting Schools in and around Tarnów
Małgorzata Kołpa 1 , Aneta Grochowska 1 , Małgorzata Schlegel-Zawadzka 2 , Agnieszka Jankowicz-Szymańska 1 1 State Higher Vocational School in Tarnow, Poland; 2 Jagiellonian University Medical College, Krakow, Poland; apea1@op.pl Introduction: Health behaviours and lifestyle are considered to be the main health determiners. Thus, it is important that young people present positive attitudes, and avoid negative behaviours. Researches on health behaviours are an important method of measuring health of the population, especially for the realization of goals connected with health promotion and prevention of diseases. Purpose: The aim of the research was to evaluate the influence of the pro-health activities undertaken by schools that belong to the network of Schools that Promote Health as a lifestyle for young people, including physical activity.

Materials and Methods:
The survey was carried out in lower secondary and secondary schools from Tarnów and its neighbourhood belonging to the Network of Health Promoting Schools, in two stages: stage I involved students beginning education in a school while stage II was conducted during their final year of education there. The survey was commenced upon obtaining the acceptance and the written consent from the school Administration, parents and students. Each student was informed about a possibility to withdraw from the survey at any stage. The Bioethical Committee of the Regional Medical Chamber in Tarnów gave consent for the survey no. 8/01/77/2010. To analyse the physical activity of students a Modified Physical Activity Questionnaire for Adolescents was used. The obtained results underwent statistical analysis with the use of the Statistica PL 9.0 program. Results: The test was taken by 663 students from five schools that promote health, including 336 girls (51%) and 327 boys (49%). Physical activity is vital for correct development of children and adolescents. Most of the student respondents (98.9%) claimed that they take part in physical education classes. Neither the year of research, nor sex had influence on the declaration of participation in the PE classes and the regularity of that participation. Indeed, boys exercised more often comparing to girls, (test I-p = 0.0045, test II-p < 0.0001). Additionally, girls limited frequency of physical activities between the tests (p = 0.0036). The physical activity undertaken by boys was much higher, than that undertaken by girls. They were gasping substantially more often and had a fast heartbeat rate (test I-p = 0.0390, test II -p = 0.0069). Boys substantially better graded their physical fitness comparing to girls (test I: C-39.4%, D-25.9%,-p = 0.0004, test II: C-38.8%, D-21.4%,-p < 0.0001) The girls' grade fell down significantly (p = 0.0329). Conclusion: Physical activity differs among adolescents depending on sex. Students exercised with less regularity, but in general boys exercised more often, than girls, had longer trainings, better graded their physical fitness, and took part in competitions more frequently.

ID: 46/ PO2: 53 POSTER Oral Health Opinions and Practices of a Group of Pediatricians
Ece Yılmazkasapoglu, Ecem Akbeyaz Sivet, Betul Kargul Marmara University, Dental School, Turkey; bkargul@marmara.edu.tr Introduction: A pediatrician is a primary care physician who deals with the medical care of infants, children and adolescents. Oral health care is certainly substantiated as an integral part of general health. There are conflicting results presented till date on the subject of knowledge, attitude and practice of pediatricians on the oral hygiene.