Sleep Profile in Children With Attention Deficit Hyperactivity Disorder

Background: Attention deficit hyperactivity disorder [ADHD] is a common neurological disorder affecting 5-8% of school- age children and symptoms continue to mature in about 60% of cases, about 4% of adults

Objectives: To identify sleep problems and thier diagnostic characteristics that may help to better understand ADHD and to assess the severity of symptoms and their relationship to ADHD

Methodology: A case- control study was carried out on 60 children divided into: 30 children with ADHD diagnosed according to the DSM of mental disorders [5th ed.], in addition, 30 normal children as controls. the study was conducted at te institute of postgraduate childhood studies and center of psychiatry at Ain shams University in the period from April 2016 to October 2017. Complete psychological history and examination were done for each child who met the inclusion criteria. physical, neurological and psychological examination were performed using: DSM 5, conner scale, child sleep habits questionnaire and sleep laboratory at the center for Psychiatry Ain shams University

Results: The findings revealed that 18 [60%] of cases suffered from insomnia: [27.7%], primary insomnia [22.2%], primary, intermediate and final insomnia [16.6%], primary and late insomnia[11.1%], moderate insomnia and hyper hypnosis [5.5%]. there is increased instability in sleep and latency in children with ADHD. there are statistically significant differences between cases and control groups as regards longer latency, lack of sleep, slightly lower phases 3 and 4duration, longer duration of dreaming sleep [ accompanied by eye movement] and longer respone time, increased vigilance, height of the periodic leg movement

Conclusion: there is a high co- occurrence of sleep problems among children with ADHD that minimally 65.62% of ADHD cases have at least one sleep disturbance type

Establishment of callus and cell suspension cultures of cassia bicapsularis L.

Callus cultures were initiated from leaf of Cassia bicapsularis L. on solid Murashige and Skoog [MS] basal medium supplemented with different growth regulators. Excellent growth of callus was obtained in medium supplemented with 1 mg/l 2, 4-dichlorophenoxyacetic acid [2, 4-D] and grown in the dark. The obtained callus was subcultured every 4 weeks in the dark at 25°C. The Callus was compact, yellowish brown in color and used for establishment of cell suspension cultures. Maximum growth of suspension cultures was achieved in medium supplemented with 1 mg/l 2, 4-D and 0.1 mg/l kinetin. The growth rate of cells was initially slow but as the cultures proceeded, the growth increased significantly over a period of 22 days then the growth of cells was stable for 35 days

Prevalence and risk factors for spousal violence among women attending health care centres in Alexandria, Egypt

We conducted a cross-sectional survey to determine the prevalence of, and factors affecting, spousal violence among 3271 ever-married women attending 12 randomly selected family health centres in Alexandria Governorate. More than three-quarters of the participants [77%] reported experiencing spousal violence during their marital life. Emotional violence was the most common type reported [71.0%], followed by physical [50.3%], economic [40.8%] and sexual [37.1%] violence. The study confirms the high prevalence of spousal violence across all socioeconomic strata. Logistic regression analysis indicated large family size, divorce or separation, low educational attainment of husband, smoking habit and drug use in husband, husband's psychological status and history of exposure to physical violence during adolescence were associated with spousal violence. This high rate of spousal violence highlights the urgent need for government and civil society to address the issue, which hinders progress toward Egypt's development goals

Laparoscopic cholecystectomy in liver cirrhosis patients: an Egyptian experience

Cirrhosis represents a common histologic pathway for a wide variety of chronic liver diseases. Hepatitis C virus [HCV] is the most important cause of liver cirrhosis in Egypt. Although cirrhosis has been regarded as a relative contraindication for laparoscopic cholecystectomy [LC] due to bleeding complications and subsequent liver failure, several reports support the safety of LC in selected patients. A prospective study to evaluate the efficacy and safety of laparoscopic cholecystectomy in cirrhotic patients. 177 hepatitis C positive patients with chronic calculus cholecystitis, scheduled for cholecystectomy, were included in this study between Jan. 2009 and Mar. 2010 where laparoscopic cholecystectomy was performed to them after fulfilling the inclusion criteria. Two risk stratifications schemes have been used to estimate the perioperative risk of patients with cirrhosis; the Child-Turcotte-Pugh [CTP] score and the Model for End-stage Liver Disease [MELD] score. 177 liver cirrhosis patients with chronic calcular cholecystitis scheduled for LC represented the population of this study. All patients were HCV positive patients with Child A class cirrhosis and MELD score < 9. Mean surgical time: 55 minutes, surgical difficulty varied between average in 64%, moderate in 28% and extensive in 8% where 3.4% needed conversion to open cholecystectomy. Postoperative follow up of all cases was multidisciplinary approached by both surgeons and hepatologists. All cases showed sound recovery confirmed by abdominal sonar to exclude intra-abdominal collections and application of both CTP and MELD scores, where all cases kept class A Child score and MELD score < 9. Laparoscopic cholecystectomy is a safe procedure for hepatitis C positive cirrhotic patients when established risk stratifications systems such as CTP and MELD scores are used for evaluation

Macro- and micromorphology of the leaf and stem of ruellia brittoniana leonard cultivated in Egypt

The genus Ruellia L. is sometimes called Dipteracanthus, it comprises about 150 species native to tropical and temperate North and South America. Ruellia brittoniana Leonard is known as Britton's wild petunia, wild petunia, Mexican bluebell and Ruellia tweediana Grisebach. Some species of genus Ruellia are used medicinally to cure gonorrhoea, syphilis, eye sores and in renal infections

Psychosocial problems and EEG findings in children with end stage renal failure

Psychosocial disturbances are most commonly encountered problems in children with chronic renal failure and end stage renal disease but little is known about the prevalence in Egypt. The present study aimed to assess the psychosocial functioning level and EEG findings in children with chronic renal failure whether on conservative therapy or undergoing chronic dialysis. Fifty four patients with end-stage renal disease were divided into three groups: Group I: twelve patients on regular hemodialysis three times weekly. Group II: twelve patients on continuous intermittent peritoneal dialysis [CIPD]. Group III: thirty patients with CRF on conservative treatment [CTr]. The patients and controls [13 children] were assessed for psychosocial problems including depression [Children's Depression Inventory], anxiety [Children Manifest Anxiety Scale], phobia [Phobic scale for children], behavioral disturbances, and intelligence [IQ]. Also EEG was done for patients with CNS manifestations. Psychiatric diagnosis on axis I according to DSM-IV showed that HD group had more prevalent major depression compared to other CRF groups. As regard social difficulties, no significant differences were detected statistically between CRF group and control group but HD group was more significantly complaining from social difficulties than CTr and control groups. The depression was more common in HD and PD groups than CTr group with no statistically significant difference. Severe anxiety symptoms were more common among HD patients with high significant difference than CTr and control. Differences between the studied groups as regard phobic scale revealed that phobia was significantly more common among HD, CTr and CRF groups in relation to control group. The patients on HD had more fear of illness than those on PD or CTr with no statistically significant difference but a highly significant difference was found between CRF groups and control. Behavioral disturbances were more common in HD and PD groups than controls with statistically significant difference in between [p=0.05]. Nocturnal enuresis [NE] of primary type was more prevalent in HD and PD groups than CTr group with significant difference in between. Also NE was more prevalent in CRF groups than control with significant difference between HD and PD groups and controls. Statistically significant correlation [border line] was detected between NE and age of onset with higher rate of primary NE among children with early age at onset of the illness [<6y]. The highest mean of IQ was found in the control group with significant difference between it and CRF group [p<0.001]. The IQ was negatively correlated with duration of the disease [p<0.01], and age of onset of CRF [p<0.001]. The school leavers and failure were more common among RD and PD groups than conservative group [p<0.01] and control [p<0.001]. Differences between studied groups as regard global assessment score showed that HD group had lower score than other CRF groups with no significant difference but a significant difference was found between CRF groups and controls [p<0.001]. EEG findings revealed generalized slow wave activity in EEG [generalized low voltage] in all patients whether on hemodialysis [11 patients] or on conservative treatment [14 patients]. Activity of Beta and Alpha waves are mostly poor with generalized Theta and Delta waves. Psychosocial disturbances are commonly encountered problems in children with end stage renal disease. Depression was more common among HD and PD patients. High rates of phobia on phobic scales, phobia of illness, severe anxiety and behavioral disturbances were found among CRF groups. Multiaxial assessment showed significant differences in psychiatric diagnosis, educational difficulties and global function with higher rate in CRF children. Nocturnal enuresis was significantly higher among CRF children and correlated with the age at onset of illness and social difficulties. Thus proper medical support and rehabilitation programs to guard against psychiatric troubles, their causes, and their sequalae are recommended including transporting vehicles, hospital based educational programs, summer camps, peer socialization, and others

Allergic fungal sinusitis diagnosis and endoscopic management

Diagnosis and management of fungal affection of the sinuses gained much interest in the last few years. It is important to suspect, correctly diagnose and treat the condition. In a trial to achieve such target the present study was planned utilizing the endonasal endoscopy. The study included 20 patients with chronic sinusitis, subjected to full history ENT examination, endonasal endoscopic examination, CT scan study, preoperative nasal smear and culture for fungus, as well as preoperative laboratory investigation. Findings were collected criteria for diagnosis are proposed, Patients went FESS which proved to be an effective way for management of allergic fungal sinusitis [AFS]. Postoperative follow up extended for one year. It was found that suspicion of AFS should be put in mind in patients with chronic sinusitis having longstanding history, resistant to medical treatment with history of hypersensitivity, unilateral or asymmetry of the lesion with discharge of mucin and characteristic CT scan findings as bone ghosting, heterogenous unilateral [or asymmetric] sinus opacification with calcium deposits as well as polypi. Preoperative nasal smear were positive in 20% of cases while Postoperatively they were positive in 80% of cases. Aspergillus fumigatue represented 65% and Aspergillus flavus in 15%. Short course of steroids was used as well as application of local antifungal cream. One year postoperatively 80% of patients got healthy mucosa with no mucin and only 20% of patients got edematous or polypoid mucosa without mucin. The use of the sinuscope proved to be effective in diagnosis, surgery and follow up of AFS cases. The goals for surgery are to remove polypi, diseased tissue, fungal mud and mucin as well as to ensure good ventilation and drainage of the sinuses

Oral rehydration fluid as an early postoperative fluid therapy in pediatric surgery

In this study, oral rehydration fluid was used to substitute the classical methods of intravenous fluid therapy in 161 children underwent a wide variety of surgical procedures. The failure rate was 4.9% [it was necessary to rehydrate the child through the intravenous route]; but, in the rest of the cases, the fluid was given successfully. The statistical analysis of those cases showed that there was no significant difference in the clinical or laboratory criteria selected for the evaluation of electrolytes and hydration status before and 12 hours after oral rehydration solution [ORS]; these criteria included weight, pulse rate, urine osmolarity, hematocrit value, serum sodium [Na] and potassium [K]. This new application of ORS as a postoperative fluid therapy in pediatric surgery can avoid the complications of intravenous fluid therapy and may enable the small and discrete hospitals to deal with these delicate cases

Cytokine patterns, neutrophil chemotactic activity, complement component-3 and circulating immune complexes relationship to clinical staging and treatment of breast cancer

Breast cancer cell behaviour from growth to spread may be regulated by cytokines. The exact role of these cytokines however is not fully understood. We aimed to study the level of IL-1, IL-2, IL-4, CI, C3 and CIC in premenopausal breast cancer females in relation to different clinical stages before and after 3 and 6 cycles of CMF and CAF. The study included 36 premenopausal females; twenty four were with recently detected breast cancer of clinical stages II, III, IV and twelve were normal healthy control. Breast cancer group was divided into two subgroups. The results revealed a remarkable statistical significant decrease [P<0.001] in the level of cytokines, C1 and C3 in both malignant subgroups before chemotherapy when compared to control group. On the other hand, there was a statistical significant increase [P<0.001] in the level of CIC in both malignant subgroups before chemotherapy when compared to control group. Also, there was a statistical significant increase [P<0.001] in the level of CIC in patients with clinical stage IV when compared with patients of clinical stages II and III before chemotherapy. There was no statistical significant difference in all studied immunological parameters between both malignant subgroups after 3 and 6 cycles of chemotherapy. There was positive correlation between the different immunological parameters after 6 cycles of chemotherapy in both malignant subgroups. In conclusion, the suppressive immune response may have a role in the pathogenesis of breast cancer. Chemotherapeutic drugs may improve the immune response in some breast cancer patients while in other cases they may cause more impairment of the immunity. The suppressive immune effect is more pronounced by CAF regimen than CMF and in advanced clinical stage IV than in clinical stages II and III breast cancer patients

Prevalence of behaviour disorders in a sample of Egyptian urban and rural primary school children

The object of the study was to investigate the prevalence of behavior disorders in children of both rural and urban areas, and the risk factors associated with disorder in the sample. A clinical survey was done in elementary urban and rural schools in scholar year 1993-94. 1706 pupils; 892 from rural area, 814 from urban area were studied. The total number of cases elicited in this study was 132 and another 132 children were non cases served as control. Complete physical and neurological examination, psychiatric interviewing based on DSM III R, an Arabic version of Eysenck personality questionnaire; one for adult and the other for children and IQ assessment. It was found that the prevalence rate of behavior disorder among children was 7.74%, 5.16% among children of rural area, 10.57% among that of urban one with a ratio of 1: 2. The prevalence among boys was 11.41% and 4.01% for girls with sex ratio 2.31: 1. A prevalence among private school was 10.1%, while among public school was 11.5% without any statistically significance. As regard the risk factors using logestic regression analysis and odds ratio. Only 12 factors from 22 appeared as independent risk factors

Adjuvant systemic treatment after resection of colorectal carcinoma utilizing 5-fluorouracil versus 5-fluorouracil plus levamisole

The study included 90 patients with resected stages B2-C colorectal carcinoma. All patients received localized postoperative radiotherapy to a dose of 5000-5500 cGy. Patients were divided into three treatment groups. Group A: receiving no adjuvant systemic treatment [Controls], group B: receiving 5-fluorouracil [5FU] alone [450 mg/m[2] IV bolus for 5 consecutive days] repeated every 28 days; and group C: receiving 5FU as in group B/ and levamizole [Lev] [50 mg, 3 times daily for 3 days and repeated every 2 weeks]. Adjuvant treatment in groups B and C was given for one year. The follow up ranged between 25-62 months [median 3.5 years]. Patients of 5FU/Lev group showed significantly lower recurrence rates than controls [P<0.025], but no difference in rate of recurrence between 5FU group and controls. The advantage of 5FU /Lev group over controls in reduction of recurrences was significant only in patients with stage C disease [P<0.01]. Also patients treated by 5FU/Lev combination showed significantly better overall survival compared to controls [P<0.05]. Toxicity of 5FU/Lev combination was mild and consistent with what might be expected with 5FU alone. 5FU /Lev is tolerable adjuvant therapy to patients with colorectal carcinoma with significant reduction of recurrence rate and significant improvement of overall survival

Bacteremia in non-prolonged febrile patients

Sixty febrile patients were studied and divided after the results of blood culture into 2 groups: -Group I : 40 patients with bacteremia, as cases. - Group II : 20 patients without bacteremia, as control. The mean age and the male : female ratio in the 40 bacteremic cases showed no significant difference when compared to controls, while the mean temeperature of the bacteremic group showed significant increase when compared to controls. As regard pulse and blood pressure, there was a statistical difference between both groups. Also leucocytosis and high E.S.R. were characteristics of bacteremia. The main pathogens isolated from the blood were Salmonella, Streptococcus pneumonia, Staphylococcus aureus, E. coli and Klebsiella pneumonia. The major sources of bacteremia were gastrointestinal tract, respiratory and urinary tracts. An index of Summation of features including : chills, Change in Mental status, blood pressure less than 90/70 mmHg, E.S.R. greater than 30 mm/h and W.B.Cs. greater than 15000/mm3 were diagnostic aids for bacteremia

Tuberculosis prevalence, risk factors, and psychiatric comorbidities in primary school Egyptian children

This study aimed to determine the prevalence of tuberculosis and to test for the risk factors and psychiatric disorders among children of primary school of different age groups whether vaccinated or not with BCG as well as designing a clinical survey setting elementary school in the scholar years 1989-91 in different areas of Cairo. The subjects of this study were 16109 pupils [9049 males [7985 vaccinated and 1064 non-vaccinated] and 7060 females [6021 vaccinated and 1039 non- vaccinated of whom 50 were non-tuberculous and served as controls. All children were subjected to the following investigations: Tuberculin testing, radiological investigations, complete medical examination, two questionnaires presented to parents and teachers, IQ assessment, structured psychiatric interviewing based on DSM III criteria and a modified junior EPQ for personality assessment. Results of this study showed that active TB was found in 0.31% of school children with age range 6-13.5 years [50%], symptoms and signs of TB positive family history of contact was found in 22% of total cases, the prevalence of extrapulmonary and pulmonary TB was 6% and 94%, respectively. When compared with a matched control group they showed higher neuroticism and less sociability, the difference was statistically highly significant and more behavioral as well as emotional disturbances in the form of food refusal, night terrors and mares, attention deficit disorders without hyperactivity, anxiety, depression and adjustment disorders. Moreover, impaired scholastic achievement was noted. The current work recommended early detection and prompt treatment of TB among adults and children and psychiatric skill training of school physicians for the best possible learning environment and health of children

Academic achievement and psychiatric morbidity among deaf children

This study included 25 deaf children, 25 hard of hearing [HOH] children and 25 controls. The age of evaluation was from 7 to 11 years. Academic achievement was assessed using review of school's marks, teacher questionnaire and parent interview. The subjects and the controls were subjected to complete psychiatric interview, physical and neurological examination, audiometry and draw a man test [intelligence test]. The results revealed that deaf children and HOH children had low intelligence than the control group, although there is no difference as regards the academic achievement between the three groups which may be due to the different schools and the different teachers who assess the scholastic achievement of the cases and of the controls. It was found that 28% of the deaf group compared with 20% of the control group had behavior disorders, meanwhile the HOH group exhibited higher percentage [40%] of behavior problems. Many associated disorders were presented, such as speech, sleep, eating and physical disorders. It was found also that the presence of hearing difficulty pushed the parents to over protect their children, in spite of that some of the parents tried to behave with deaf children in a way not markedly different from others

Assessment of self concept and physical growth in children suffering from congenital heart disease

The aim of this work was to assess the self concept and the physical growth of children with congenital heart disease. This study included 50 children with non-cyanotic congenital heart disease [25 boys and 25 girls] and 15 children with cyanotic congenital heart disease [10 boys and 5 girls] and compared with 50 healthy children [26 boys and 24 girls]. The results showed that the children suffering from congenital heart disease had low self concept and had variable degrees of growth retardation. The growth retardation was more pronounced in the cyanotic group than the non-cyanotic group

Disruptive behaviour disorders in primary school children

The current study was undertaken to study the disruptive behaviour disorders in primary school cnildren and to compare between the males and females. We collected the cases from two primary schools in shoubra [in north cairo] during the school year 1990-1991. The total number of children in the two school was 1085 [571 boys and 514 girls]. Results revealed that disruptive behavior disorders were present in 74 children [6.8%], 51 males [8.9%] and 23 females [4.5%]. The incidence of attention deficit hyperactivity disorder, conduct disorder and oppositional defiant disorder were 2.4%, 1.3% and 3.1% respectively. The male to female ratios were 1.9:1, 3.7:1 and 2.1:1 respectively. Otherwise, there was insignificant difference between males and females except in the family size distribution although in both groups the family of 5 or 6 members was the most common

Conversion disorder in adolescence

As the researches regarding this topic in Egypt are actually few, hence, it was thought of utmost necessary to undertake a work to study conversation disorder in adolescence in Egypt. Structured psychiatric sheet was applied to all the students registered in Qalyoub Preparatory School during the year 1988 - 1989 [730 students]. 34 students were found with histories of conversion disorder. These cases were thoroughly studied by comparing with 34 controls selected from the same school and matched for age, sex and social class. The female: male ratio was 1: 0.7, the mean age was 14.29 +0.99. 73.5% were from low social classes, 71.6% came from large families but the disorder was insignificant. The cases showed scholastic retardation while conversion disorder could occur in students with low, average or high intelligence. All the cases complained of family communication problems with significant difference. 41.7% had an aggressive father and 47.1% had an aggressive mother, while 26.4% had an overprotective father and 38.23% had an overprotective mother but with no significant difference with the controls. The predominant conversion symptom was seizure, all the cases had psychological stresses before the onset of conversion disorder. The cases scored high neuroticism, psychoticism and low extroversion

Fracture of the penis: clinical experience and surgical treatment

Nine patients with penile fractures were treated surgically between 1982-1991. Of these 9 patients who underwent immediate surgical exploration, evacuation of hematoma and repair of the tear in the tunica albuginea, 8 had no resultant penile deformity and 1 had mild shaft curvative on erection, while all retained normal erectile potency and normal sexual performance. The hospital stay was brief [mean 4.66 days]. In view of these good results we advocate early surgical repair as the treatment of choice for patients with penile fractures