Electroencephalographic findings in children with autism spectrum disorder

Introduction: Autism Spectrum Disorder is a neurodevelopmental disorder characterized by impairments in social communication, reciprocal social interaction, and repetitive behaviors and interests. It was previously known as Pervasive Developmental Disorders. It affect 1 in 88 children, Males are affected four times more than females. It has a complex and multifactorial aetiology

It is known to be highly heritable. It is frequently associated with comorbid psychopathology as high as 70%. The most common are intellectual disability, ADHD, Eating disorder, depression, sleep disorder and Anxiety disorder

There is no [gold standard] measure for assessing ASD so Diagnosis takes place typically from a complete history, physical and neurological evaluation. EEC has been the primary measure used to capture and characterize epileptiform and abnormal paroxysmal activity through the detection of focal spikes, which occur with increased frequency in ASD

Methods: Cross sectional descriptive study, conducted on 32 children attending the outpatient clinic of Special Need Center, Institute of Postgraduate Childhood studies, Ain Shams University

They underwent Thorough Full medical history, clinical examination, Clinical Psychiatric assessment using CARS, IQ test and BEG

Results: ASD is more common in males than females, although 53.1% had positive history of consanguinity but no statistically significant difference. As regarding EEG findings, 56.3% of children had normal EEG Finding; while 43.8% had abnormal EEG Findings. 50% with abnormal EEG Findings had subcortical Dysrythmia, 14.3% Generalized Epileptic Dysrythmia. There was no statistically significant relationship between different EEG Findings and CARS in the studied children with ASD

Conclusion: ASD is a neurodevelopmental disorder with altered brain connectivity

There is no agreement on EEG features in ASD. Although clinical EEG studies generally agree on the high prevalence of epileptiform abnormalities in children with ASD

Quality of life and self-esteem in Hemophilic children and adolescents

Background: The present study aimed to assess of quality of life and self esteem and to discover the relation of both to the clinical and therapeutic parameters in children with hemophilia. To achieve this target, 100 hemophilic children were included in the study. They had a mean age of 10.091 4.44. They were subjected to careful history taking and thorough clinical examination. In addition, they were subjected QOL and self esteem assessment. It was shown that 48% of the studied children are obese, the most commonly encountered manifestation was target joint 75.0% followed by gum bleeding 72%, circumcision bleeding 69.0%, epistaxis 54.0%, hemartherosis 50.0% muscle hematoma 49.0%, dental bleeding 45%, and limited joint movement 33.0%. Regarding the QOL, the present study found that it is clear that the studied children had generally poor quality of life domain. This is manifested by the mean total QOL score which is only 50.9, comparison between individual and total QOL scores in the studied age groups had revealed that children of the middle age had significantly better QOL scores when compared with the other two groups. The relatively poor QOL scores in the present study is explained by the higher frequency of joint problems which had detrimental effects on the studied children physical health and other QOL domains. Also patients with joint problems including hemartherosis, target joint and limited joint movement had significantly worse QOL score when compared with patients without, assessing patients self-esteem reveled significantly lower Coppersmith self-esteem inventory in patients when compared with controls, obese children had significantly lower self esteem scores when compared with children with normal weight. Finally, we showed a statistically significant inverse correlation between self esteem and QOL

Non-invasive positive pressure ventilation versus invasive pressure support ventilation for post extubation respiratory distress in patients recovered from respiratory failure

Respiratory failure after a planned extubation is reported to be a common event, leading to reintubation and can occur in as many as 3-20% of extubated patients. It is crucial to identify the right time to extubate a patient, since re-intubation after pre-term extubation is associated with an increased risk for nosocomial pneumonia, prolonged intensive care unit [ICU] stay and death, and also accounts for substantially increased costs. This study was planned to assess the effectiveness of non-invasive pressure support ventilation [NIPPV] as a weaning technique in patients who develop respiratory distress after discontinuation of mechanical ventilation and extubation in comparison with conventional weaning through invasive pressure support ventilation. This is a randomized controlled study, sixty patients with either type I or II respiratory failure who developed post extubation respiratory failure were enrolled; they were randomly divided into two groups to receive either NIPPV or invasive pressure support ventilation. The primary outcome measure was the technique outcone; secondary outcome measures were incidence of complications, hemodynamic parameters, arterial blood gas parameters, ventilator parameters and length of ICU stay. Despite a longer time to failure observed with invasive pressure support ventilation, no statistically significant differences were observed in success rate, hemodynamic, and arterial blood gas parameters, although incidence of complications differs greatly according to the technique used. In a heterogonous group of patients; NIPPV is not superior to invasive pressure support ventilation in patients who developed post-extubation respiratory distress after successful weaning

Non-invasive proportional assist ventilation in management of severe asthma exacerbation

NIV could be beneficial in selected patients with severe asthma exacerbation [SAE]. However, its role is still not well defined. To evaluate the efficacy of NIV using proportional assist ventilation [PAV] in severe asthma exacerbation after failure of conventional medical therapt [CMT]. Thirty patients with severe asthma exacerbation were failed to respond on conventional medical therapy. NIV was applied via face mask as a last option before intubation and mechanical ventilation. The mean age was 39.2 +/- 9.7 with female predominance [19 females vs. 11 males]. The successful outcome was achieved in 23/30 patients [76.6%]. Follow up of the mean of respiratory distress and gasometric parameters before recruitment vs. 1 h after NIV in successful group showed statistically significant improvement after NIV application as follows: HR [125.4 vs. 107.4], RR [38.2 vs. 25.4], PH [7.28 vs. 7.36], PaCO2 [55.3 vs. 42.5], PaO2 [58 vs. 87] and PEFR% Predicted [39 vs. 64] respectively [P < 0.001 for all items]. Also, the same improvement was in PEFR, tidal volume, peak inspiratory pressure and triggered breaths% in successful group vs. failure group. NIV can relieve respiratory distress and improve gas exchange in the majority of patients with severe asthma exacerbation who are candidate for intubation after failure of conventional medical therapy

Efficiency of diagnostic biomarkers among colonic schistosomiasis Egyptian patients

The schistosomal parasite plays a critical role in the development of malignant lesions in different organs. The pathogenesis of cancer is currently under intense investigation to identify reliable prognostic indices for disease detection. The objective of this paper is to evaluate certain biochemical parameters as diagnostic tools to efficiently differentiate between colonic carcinoma and colonic carcinoma associated with schistosomal infection among Egyptian patients. The parameters under investigation are interleukin 2 (IL-2), tumour necrosis factor alpha (TNF-α), carcinoembryonic antigen (CEA) levels, tissue telomerase, pyruvate kinase (PK), glucose-6-phosphate dehydrogenase (G-6-PD) and lactate dehydrogenase (LDH) enzyme activities. The results revealed a significant elevation in the level of the tumour markers IL-2, TNF-α and CEA as well as the activities of LDH, telomerase and G-6-PD among non-bilharzial and bilharzial colonic cancer groups, with a more potent effect in bilharzial infection-associated colonic cancer. A significant inhibition in PK activity was recorded in the same manner as compared to normal tissues. The efficacy of this biomarker was also evaluated through detecting sensitivity, specificity, negative and positive predictive values. In conclusion, schistosomal colonic carcinoma patients displayed more drastic changes in all parameters under investigation. The combination of the selected parameters succeeded in serving as biomarkers to differentiate between the two malignant types.

Hepatic hydatid disease: laparoscopic versus percutaneous treatment

Selection of the most appropriate treatment to obtain the best results with the lowest rate of recurrence and minimal morbidity and mortality is mandatory for the management of hepatic hydatid disease. The surgical approach is the mainstay of treatment, and there has been a tendency toward laparoscopic surgery [LS], and more recently, percutaneous treatment [PT], which has become increasingly popular with revolutions in techniques. The aim of this study was to evaluate the results of the laparoscopic treatment and PT combined with medical treatment in noncomplicated hydatid cyst in the liver with regard to the technique, postoperative morbidity, safety, effectiveness, and recurrence during the 18-month follow-up period. During the study period September 2005-October 2009, a total of 50 patients diagnosed with uncomplicated hydatid cyst in the liver were prospectively assigned to either LS [n=15] or PT [n=35]; albendazole was given at a dose of 10 mg/kg twice per day starting 1 week and continuing for 4 weeks after the procedure. Patients were followed for any complication, hospital stay, or recurrence. Moreover, compliance for medical treatment and appearance of any side effect related to the drug were noted during the follow-up period. Fifteen patients underwent LS and 35 patients underwent PT. There was no statistically significant difference between both groups as regards age, sex, or mean diameter of the cysts. There was only one patient with biliary fistula after LS, whereas biliary fistula occurred in two patients after the PT procedure. Postoperative infection and abscess in the cyst cavity occurred in one patient in the laparoscopic group and in three patients in the PT group. The mean hospital stay for the LS group was significantly longer than the PT group [7.3 days vs. 1 day, respectively], P value was less than 0.001. During the follow-up period, local recurrence was seen in one patient [6.7%] in the LS group and in twp patients [5.7%] in the PT group. LS seems to be effective and safe with low morbidity and recurrence rates in uncomplicated hydatid cysts of the liver in accessible locations, but the procedure has its own disadvantages, such as limited area of surgical manipulation. PT combined with oral albendazole should be the method of choice, being safe, effective, and inexpensive, especially in the treatment of types 1, 2, and some type 3 cysts in patients who are contraindicated for surgery or general anesthesia and who do not accept surgery

Single chamber pacemakers versus dual chamber pacemakers the effect on cardiac physiology

The aim of this study was assessment of cardiac functions and quality of life in DDD versus VVI pacing modes. Thirty patients had DDD pacing with a primary diagnosis of acquired symptomatic bradycardia were reprogrammed to VVI mode for four weeks. They were followed by transthoracic echocardiographic examination during DDD pacing mode and restudied after reprogramming to VVI pacing mode. Parameters observed were chamber dimensions [MM], chamber volumes, systolic functions, cardiac output [Simpson's method],Colored jet area method to assess Mitral regurgitation [MR] and Tricuspid regurgitation [TR] and Estimated Systolic Pulmonary Artery Pressure [ESPAP]. Thirty patients were mean age [47.9 +/- 13.2], 10 males and 20 females, Three patients only were hypertensive [10%]. There were significant decrease of the following parameters including LV systolic function [EF% [P value=0.002], CO [P value=0.008]] Left ventricular end diastolic diameter [P value=0.03] and Left ventricular end diastolic volume [P value=0.04] in VVI mode. There were significant increase in Right ventricular end diastolic diameter: [P value=0.004], the incidence and degree of TR [P value=0.03] in VVI mode. There were no statistically significant difference between both modes as regard; Left ventricular end systolic diameter and volume. Left atrial dimension, Incidence and degree of MR and Estimated Systolic Pulmonary artery Pressure. From the present study we concluded that; Cardiac functions and quality of life are better in DDD mode compared to VVI mode

Evaluation of beneficial effects of steroids in head trauma

Road traffic crashes account for most serious head injuries, and the global burden of head injury can be expected to rise with the increasing use of vehicles in Asia and Africa. The overall incidence of adrenal insufficiency in critically ill patients approximates 30%, with an incidence as high as 50 to 60% in patients with septic shock. To re-evaluate the beneficial effects of I.V. steroids [dexamethasone], for 48 hours in the critically ill head trauma patients; to assess the prevalence of adrenal insufficiency in the critically ill head trauma patients, its relation to the seventy of the lesion and outcome. Prospective randomized controlled study, included 19 cases [patients who received I.V. steroids 8mg dexamethasone within 8 hours of injury, every 8 hours for 48 hours and 22 controls [patients who did not receive steroids]. 10.53% of cases died compared to 18.18%. of controls, the difference was not statistically significant, impaired circadian rhythm defined as p.m./a.m. cortisol >0.5 was found in 84% of mild head trauma, 80% moderate head trauma and 66.67% of severe head trauma, a.m. and p.m. cortisol levels were higher in moderate than mild TBI and the difference was statistically significant p-values 0.006 and 0.023 respectively. Altered circadian rhythm and adrenal insufficiency is common among critically ill head trauma patients, steroids resulted in decreased mortality among patients who received steroids and among patients with adrenal insufficiency who received steroids, however, the difference was not statistically significant

Congenital heart diseases in children with oral clefts

Oral clefts are common birth defects often known to be associated with other congenital malformations, Congenital heart diseases [CHDs] are found to be the most common, islolated, associated malformations. The purpose of this study is to detect the prevalence of CHDs in patients with oral clefts. We studied 105 patients presented to CUCH [Cairo University Children Hospital] over one year. A full history and physical examination in addition to full echocardiographic examination were done to all patients. The mean age was 18.9 +/- 18.2 month. 58.1% of patients were males. 55.2% patients had both cleft lip and palate [group 1], while 30.5% had cleft palate [group2], and 14.3% had only cleft lip [group 3]. CHDs were found in 21 patients [20%] compared to 0.1% in general Egyptian population. Type of cleft did not correlate with the frequency of CHDs with a P value = 0.336. ASD was the most common detected defect followed by PDA. Other congenital malformations and dysmorphic features were detected in [9.5%] patients. Cleft patients with CHDs had a statistically significant higher percentage of associated other congenital malformations and dysmorphic features compared to cleft patients with normal heart [a p value = 0.026, <0.001 respectively]. The high prevalence of congenital heart disease in cleft patients may justify a routine echocardiographic screening for all patients with oral clefts

Facilitated percutaneous coronary interventrion: a new treatment strategy for acute myocardial infarction

Restoring patency of infarct related artery [IRA] is the ultimate goal which can be achieved either pharmacologically [using thrombolytic therapy] or mechanically [through percutaneous coronary intervention [PCI]. The latter needs a sophisticated setup, an equipped Cath. Lab. and a skilled team. Such a system might not be always available, and a full dose thrombolytic therapy is the next best alternative. Recently there is a trend towards "facilitated PCI" whereby low dose thrombolytic and/or antiplatelet therapies are used prior to primary PCI, aiming at an early, complete, and sustained epicardial flow and myocardial perfusion. To compare the efficacy and safety of facilitated PCI with standard primary PCI, we studied 40 pts with acute myocardial infarction [AMI] divided into 2 groups. A study group consisted of 20 pts [18M, 2F, mean age 46.3 +/- 11.5y], all received 750.000 u of streptokinase combined with GP IIb/IIIa receptor inhibitor "tirofiban" 0.4ug/kg/min over 30min followed by 0.1ug/kg/min over 48 hours. Twenty pts [15M, 5F, mean age 54 +/- 8.6y] served as control group [no thrombolytic nor antiplatelet therapy]. Both groups underwent PCI within [73 +/- 18min] from randomization. Angiographic patency was expressed in terms of TIMI flow grading system, ECG criteria comprised extent and rapidity of ST segment resolution and laboratory criteria involved early peaking of CK-MB within 12 hours from randomization. Besides clinical evaluation in terms of major adverse cardiac events [MACE], echocardiographic parameters [LVEDD and LVEF] were used to assess LV function before and after PCI and monthly thereafter for 6 months. Compared to the group subjected to PCI alone, those who had preceding adjunctive pharmacological therapy "facilitated PCI" exhibited significantly greater TIMI 3 flow [84%: vs 60%, p<0.05], smaller LVEDD [5.0 vs 5.5, p<0.05], significantly higher LVEF [55.4% vs 50.7%, p<0.05] and lower rate of MACE [0% vs 20%]. Patients with facilitated PCI also exhibited significantly higher ST segment resolution, [58% vs 45%, p<0.05] and earlier peaking of CK-MB [85% vs 35%] compared to control group. Facilitated PCI offers an excellent way of circumventing the time delay preceding PCI that is frequently encountered on hospital admission of pts with acute MI. Through combining interventional, fibrinolytic and GP IIb/IIIa inhibitor therapy, facilitated PCI provides a more rapid, complete and sustained patency of IRA than primary PCI alone without the adverse effects of full dose thrombolylic therapy and a with better outcome in terms of lesser MACE and preserved LV function

Aortic root distensibility in patients with coronary artery disease

An important determinant of myocardial performance, namely cardiac afterload is largely dependent upon aortic root distensibility [AD], peripheral arterial resistance and end systolic wall stress. The latter can be reliably measured by using m-mode and 2-D echo whereas AD used to be a neglected parameter. In patients with ischaemic heart disease, the question always arises whether AD could in a way or another predict coronary arterial pathology /= 200 and /or LDL >130mg/dl in 21pts and HTN in 17pts. Following clinical evaluation including 12 lead ECG, m-mode and 2-D echocardiography, all pts underwent diagnostic CA and were subjected to transoesophageal echocardiography [TEE] using phased array multiplane 32 elements transducer [5MHz] mounted on the tip of 100cm gastroscope with Acuson Sequoia C256 system. Transoesophageal [TEE] was done while the pts in the left lateral position. The studies were recorded on videotapes for off-lines analysis. Images of the aortic root were obtained in an angle of about 120 degrees. Aortic root was measured in systole [maximal diameter] and diastole [electrocardiographic Q-wave] 3cm from cusps insertion using the trailing edge-to-leading edge method. Measurements were taken in 3 cycles and the mean value was taken, with the difference in diameter delta d as a measurement of aortic root excursion, delta p as the pulse pressure, and d=diastolic aortic root diameter. AD was expressed as =2xdelta d / delta pxd. According to CA, pts were divided into those with diseased coronary arteries 74.4% and those with a normal CA 25.6%. Compared to the normal CA group, AD was insignificantly different from that into pts with diseased CA 23.9 vs 21.4, p value = 0.573. Patients were then stratified into two groups with an age of 50yrs, SBP of 130mmHg, DBF of 80mmHg, serum cholesterol >200 and /or LDL >/= 130mg/dl and presence of DM serving as arbitrary dividing limits

Total thyroidectomy with capsular dissection and limited nerve exploration versus conventional thyroidectomy

Thyroidectomy is considered a routine surgical procedure and should be associated with a low complication rate. Eighty-eight patients with bilateral benign primary thyroid disease were chosen to be subjected to bilateral total thyroidectomy. Patients were randomly divided into 2 equal groups: group I, -were subjected to the standard thyroidectomy with a lower collar incision, flap dissection, upper polar mass ligation, dissection of the inferior thyroid artery, identification of the recurrent laryngeal nerve [RLN] throughout the course to the larynx [lateral to medial dissection], inferior thyroid artery [ITA] ligation, followed by lower polar devascularization and gland excision. Group II, The procedure entailed careful capsular dissection [medial to lateral dissection] while keeping the thyroid gland under tension through medial traction. Only after the ligament of Berry's is explored, no further exploration for the RLN is attempted. The anesthesiologist checked the vocal cords soon after endotracheal extubation using the deep extubation technique. Direct laryngoscopy is preformed in the 3[rd] postoperative day or at the time a patient has hoarseness or difficulty breathing, and repeated after 6 months, Patients had their calcium level evaluated 5 hours postoperatively and the morning following the operation. Hypoparathyroidism is assigned temporary [less than 6 months] and permanent [more the 6 months] after thyroidectomy. The operative time was shorter in group I [109 +/- 24 min] than in group II [133 +/- 38 min]. The means post-excisional glandular weight was lower in group I [78.77 +/- 34.75 gm] than group II [81.35 +/- 31.76 gm]. The number of patients with postoperative cord paresis was higher in group I than in group II [2 patients in group I versus I patient in group II], the number of patients showing permanent vocal cord paresis after 6 months was higherin group I [cone patient] while no patient had permanent vocal cord paresis in group II. The whole incidence of moderate and severe hypocalcaemia was higher in group I than in group II. The procedure of capsular dissection was associated with prolonged operative time but however had a better outcome regarding hoarseness of voice and preservation of the parathyroid functions than the conventional technique

Markers of cardiovascular disease in women with subclinical hypothyroidism

The relationship between sublinical hypothyroidism and astherogenic lipid profile is still controversial. This study evaluate some of the risk markers of cardiovascular disease in a group of women with subclinical hypothroidism, including biochemical and inflammatory markers as well as echocardiographic study. Twenty-three patients were compared with thirteen euothyriod. TSH, FT4, FT3, total cholesterol, low- density lipoprotein, high- density lipoprotein, triglycerides, CRP and IL-6 were done as well as echocardiographic examination.Significant increase in total cholesterol [P < 0.01], LDL-c [P < 0.01] and TG [P=0.0025] in subclinical hypothyroidism [SCH] patients versus control group. CRP and IL-6 were positively correlated with abnor malities in LV morphology and mass in SCH versus control group. A significant, diastolic dysfunction indicated by Significant. Prolongation of the isovolumic relaxation time [P < 0.001] and Significant. Reduction of the early diastolic mitral flow velocity/ late diastolic mitral flow velocity ratio [P < 0.001]. Serum total cholesterol, low- density liporpotein cholesterol, triglycerides, CRP and IL-6 are increase in women with subclinical hypothyroidism. Echocardiographic findings suggest that subclinical hypothyrodism causes diastolic dysfunction

Malignant otitis externa in upper Egypt: why do not all diabetics have malignant otitis externa?

Eighteen diabetic patients [7 men and 11 women, with an age ranged between 50 and 75 years] among 1730 cases of malignant otitis externa in the ENT Clinic at Assiut University Hospitals were studied and treated in this work. This group consisted of seven men and eleven women. Diabetes was long-standing in all patients and uncontrolled, except in one. Laboratory investigations in the form of high and low-density lipids, ESR, creatinine and blood sugar curves were done to all patients. Biopsy for histopathological examination was taken from the granulation tissues or aural polyp. Computerized tomography of the temporal bones and radioisotope bone scan using technetium 99 MDP was done to all patients in the Nuclear Medicine Unit in Assiut University Hospitals. The clinical features and presentation were summarized. The strategy of the diagnosis and treatment was discussed. The combination of antibiotic and drugs that improve microcirculation was found to be essential in treatment of malignant otitis externa. Liporegulation drugs are also valuable in controlling high levels of LDL. ESR is a useful tool to monitor patients with MOE during treatment and in the follow up