Role of school teachers in identifying attention deficit hyperactivity disorder among primary school children in Mansoura, Egypt

There is a knowledge gap in primary school teachers that affects their ability to detect attention deficit hyperactivity disorder [ADHD]. This study measured primary school teachers' knowledge about ADHD, and implemented a training programme to improve early detection of ADHD. The prevalence and risk factors of ADHD were also studied. The training programme was implemented through a 2-day workshop for 39 primary school teachers who completed a validated Arabic version of the ADHD Rating Scale for 873 primary school children. The children's parents completed the questionnaire to explore ADHD risk factors. The teachers' pre-training knowledge scores of ADHD ranged from 17.9 to 46.2%. Post-training, their scores improved significantly to 69.2-94.9%. Prevalence rate of ADHD was 12.60%. On logistic regression, independent predictors of ADHD were female gender, unemployed fathers and rural residence. In conclusion, ADHD is a significant health problem among primary school children in Mansoura, Egypt. Efforts should be made to improve teachers' knowledge about ADHD and control modifiable risk factors

Safety and Efficacy of Mini Open Transforaminal Lumbar Interbody Fusion

OBJECTIVE: Mini-transforaminal lumbar interbody fusion (Mini-TLIF) and other minimally invasive approaches introduced for the purpose of treating lumbar degenerative disc disease and instability are achieving high success and safety rates as the conventional approaches. Moreover, it has less soft tissue damage, minimal blood loss, and less hospital stay. METHODS: A prospective study was conducted from 2012 to 2014 on 28 patients who were subjected to Mini-open TLIF combined with transpedicular screw fixation for spondylolisthesis and degenerative disc disease. Two paramedian approaches were done, 4 cm for each, to insert the pedicular screws, along with inserting unilateral TLIF cage with autologous bone graft. Decompression was done either unilateral or bilateral according to the patient side of radiculopathy. Sixteen patients (57.2%) were diagnosed with degenerative spondylolisthesis, 7 patients (25%) were diagnosed with isthmic type spondylolisthesis, and 5 patients (17.8%) were diagnosed with degenerative disc disease, 2 of them(7.1%) had previous operations at the same level. Twenty patients (71.4%) were operated at the L4/5 level, and 8 patients (28.6%) at the L5/S1 level. RESULTS: All patients were able to ambulate the next day of surgery. The mean estimated blood loss was 251.79mL. The average hospital stay was 4.14 days. The average follow-up was 9 months. The mean visual analog scale was 1.86 at discharge, 1.68 after 3 months, and 1.38 after 6 months. After 6 months of the operation, MacNab's criteria were good in 23 patients and excellent in 5 patients. We had one case with transient weakness, 2 cases of screw malposition without clinical manifestations, and one case of infection. CONCLUSION: Mini-TLIF approach is an efficient and safe approach for treating instability and degenerative diseases of the lumbar spine. The clinical outcome is encouraging and it may be an operation of choice for lumbar spinal fusion in selected patients.

Essential hypertension among Egyptian adults

Background: hypertensive diseases represent a major disease burden in Egypt. The prevalence of hypertension in Egypt in 2008 among adults of age>/= 25 was 17.6%. In 60% of patients, hypertension is usually associated with cardiovascular risk factors. This leads to increased cardiovascular morbidity and mortality. Management of hypertension in Egypt is not easy because of treatment costs and inefficient primary health care system. There is a need for developing national hypertension guidelines to improve the rates of awareness, treatment and control of hypertension with the final goal of preventing and decreasing mortality and morbidity

Aim of work: to assess the essential hypertension status among the Egyptian adult population of age>/= 25 and to study the modifiable social and environmental risk factors, health consequences, and assess the cardiovascular and non-cardiovascular complications to help disease prevention and limitation of complications

Patients and methods: this study was conducted on 312 patients of age>/= 25 with essential hypertension. All patient were subjected to full medical history and physical examination that including measurement of blood pressure [BP] and fundus examination. Anthropometric measurements including height, weight, waist circumferences, and hip circumferences were also measured. Waist to hip ratio and body mass index [BMI] were calculated. Laboratory investigations were performed including complete blood count [CBC], fasting blood glucose, measurement of creatinine, uric acid and lipid profile. Microalbuminuria was also assessed. Other investigations including electrocardiogram and echocardiograph were done

Results: Male patients were 134[42.9%], while females were 178[57.1%]. Their ages ranged from 30 to 85 years with a mean +/- SD of 55.16 +/- 9.4years.Dyslipidemia was found in 152 [49%] patients. Left ventricular diastolic dysfunction [LVDD] was represented in160 [51%] patients. Uncontrolled BP was represented in [73%], [66%] and [55%] of non-educated, mild to moderate educated and high educated patients respectively. Retinopathy was found in 121 [38.8%] patients, 76 [60%] patients were hypertensive diabetic and 45 [24%] patients were hypertensive non-diabetic. Albumin in urine was present in 20%of patients

Conclusion: strategies that enhance public awareness of hypertension and increase access to affordable medications are urgently needed. Prevention of hypertension needs both a population strategy and an intensive strategy focused on individuals at high risk. The complications of hypertension can be prevented by adequate blood pressure control with screening programs to identify the population at risk

Factors affecting remission for asthma exacerbation in children attending Alexandria university children's hospital

Background: the admission rate for bronchial asthma has increased dramatically all over the world. Part of this increase in hospital admissions is due to patient readmission, which has an impact on children's quality of life, lost productivity and reduced participation in family life in addition To health care cost

Objective: to identify the risk factors for readmission because of acute asthmatic attacks. If these risk factors could be eliminated, there would be potential savings for health services, familial expenses and improvement in the quality of life of the whole family

Subjects: children attending Emergency Room [ER], Pediatric Intensive Care Unit [PICU] and inpatient wards of Alexandria University Children's Hospital, Alexandria, Egypt in the period from Sept. 2013 to Jul. 2015 aged 14 years or less of both sex

Methods: case control study in children who were admitted because of acute asthma attacks. The study was divided into two groups, group readmitted within one year from first admission [group A] and group firstly admitted [group B] and the factors that might have affected readmission were evaluated

Results: age in-group A ranged 4.5-13 with mean value 9.09+/- 3.98. Age in-group B ranged 4-14 years with mean value 8.65+/- 4.01. Males are more than females in both groups, and no sex differentiation effects on readmission. The duration of the disease in readmitted group in our study ranged from 1-8 years, it is a risk factor for acute asthma exacerbation readmission. Viral infection, common cold and dust as asthma triggers are risk factors for acute asthma exacerbation readmission. Regarding disease severity it was found that there was a higher percentage of hospitalization among cases with severe and moderate bronchial asthma compared to mild cases and it was found that readmission cases had more number of acute asthmatic attacks per month and have more sleep disturbance and lack of school attendance. Regarding taking controller medication in between attacks, it was found that readmission group take more controller medication

Conclusion: the prevalence of readmission rate increased dramatically, the duration of the disease, viral infections, common cold, dust and exercise as an asthma triggers are the risk factors for acute asthma exacerbation readmission, severity of the disease and controller medications affect acute asthma exacerbation readmission

Histological study on the human gubernaculums in descended and undescended testis

The gubernaculum is a fibrous cord connecting the caudal pole of the testis with the scrotum. The regression of the extra-abdominal part of the gubernaculum in prenatal and early stage of postnatal life plays an integral role in testicular descent. Researchers claim that the undescended testis is a condition caused by failure of the gubernaculum to function, particularly in infants suffering from neuromuscular diseases and myopathies. To provide more information on the role of the gubernaculum in testicular descent, the structure of the gubernaculum was examined in cases of descended and undescended testis. The study was performed at both the light and electron microscopic levels. The gubernaculum biopsies were taken from 20 children with undescended testis, the control biopsies were obtained from 5 children [3 and 5 years old] who suffered from inguinal hernia but with descended testis. The specimens were prepared for light and electron microscopic examination. The histological examination revealed that the gubernaculum in 75% of undescended testis contained large amount of fat cells, a small amount of collagen fibers, and wide interstitial spaces, compared to the control group. The results suggest that the lack of testicular descent is probably caused by loss of retractibility of the gubernaculum

Acute Guillain Barre Syndrome in childhood: clinical, electrophysiological and immunological study

Acute Guillain Barre Syndrome [acute GBS] is one of the leading causes of acute flaccid paralysis [AFP] in children. The syndrome has been recognized as a heterogeneous disorder with different subtypes, by clinical, electrophysiological and pathologic criteria. The disease may present with a wide variety of clinical presentations as well as prognostic outcome. The study was conducted on all children with acute GBS attending Alexandria University Children's Hospital during the period from September 2000 to September 2001 for the purpose of characterization of acute GBS in Egyptian Children and its relation to presumed infection with Cytomegalovirus [CMV] or Epstien-Barr virus [EBV]. All clinical, laboratory and electrophysiological data of the children with acute GBS who are admitted to the hospital during the period of the study were evaluated. Serum IgM titer against CMV and EPV were assessed and correlated with other patients'data. Thirty five children were admitted to the hospital during that period. Sixty age and sex matched healthy children were included as controls for studying IgM titre of EBV and CMV. Affected children were 22 boys and 13 girls. Their ages ranged between one and 10 years. Eight cases did not have preceding illness before the disease. The initial symptom was motor in 11 cases, sensory in 2 cases and mixed in 22 cases. Ascending paralysis was dominant in all cases except three who had descending paralysis. Only five cases did not exhibit severe pediatric GBS [grade 4 or 5] according to the functional grading system. Twenty nine cases exhibited the major electrophysiological type of acute inflammatory demyelinating polyneuropathy [AIDP]. Albuminocytologic dissociation was encountered in 25 cases. Two cases died in the acute phase, one was left with residual neurological deficit while the rest recovered completely. There was a statistically significant difference between cases and controls as regards the IgM titre against CMV virus [P < 0.05] while IgM titres against EBV were not statistically different from the control group. In addition children with presumed Prior CMV infection tended to be younger in their age significantly more than those with presumed EBV infection [r = 0.382, P = 0.003]. The only significant association was the relation between the type of initial symptoms versus the IgM titre against CMV and EBV where sensory symptoms were prominent more significantly among cases with presumed CMV infection than those with presumed EBV infection [P<0.005]. Acute GBS demonstrates diverse clinical, electrophsyiolgical and laboratory dilemma. Clinical and electrophysiological criteria remain the most important prognostic factors. Despite its initial grave presentation, early institution of therapy using intra-venous immunoglobulin [IVIG] or plasma exchange ensures dramatic recovery in most of cases. The underlying etio-pathologic mechanisms are still not properly understood. Their clarification might have its impact on better delineation of clinical presentations, outcome and prevention

adjuvant effects of IL-12 and BCG on autoclaved leishmania major vaccine in experimental cutaneous leishmaniasis

Cutaneous leishmaniasis is a universal disease causing skin ulceration and deformity. A reliable vaccine remains to be a possible practical means of control. The amastigotes multiply intracellulary in macrophages provoking a cell-mediated type of immune response. IL-12 is the central cytokine of CMI. It is produced by sensitized macrophages, stimulates both Th 1 and NK cells to secrete IFN-gamma which in turn activates the intracellular killing of Leishmania in macrophages via increased oxygen radicals. This work aimed mainly at studying the adjuvant effect of IL- 12 on autoclaved L. major [ALM] vaccine, compared to that of BCG in L. major infection. The material included five groups of Swiss albino mice; the test group infected after receiving ALM + IL-12, a non-infected control group, and three other control groups infected after receiving ALM + BCG, IL-12 alone and BCG alone L. major was cultured to provide promastigotes for vaccine and infection. The measured parameters included the lesion size, type and progress; the parasite density and the level of IFN-gamma in serum. The results showed that the best protection against challenge infection was obtained by ALM + IL-12 followed by ALM + BCG. The former is recommended for use as a vaccine with regards to its proved efficacy and known safety

Experimental trichinosis: parasitological, electrophysiological and biochemical studies

Trichinosis is a parasitic infection affecting the gut and the muscles causing mild gastrointestinal symptoms followed by periorbital oedema, muscle pains, fever and eosinophilia. The infection evokes functional disturbances in physiological effector systems. Furthermore, several biochemical changes are associated with the infection. Therefore, this work was carried out to study the electrophysiological changes in intestine, striated and cardiac muscles by electromyography [EMG] and to assess the biochemical changes through measurement of serum cholinesterase and intestinal myeloperoxidase activity [MPO] in both light and heavy infected experimental animals by Trichinella spiralis [T. spiralis]. Electrophysiological results showed increased contractility of the smooth muscle layers of the intestine only early in the infection, whereas both striated and cardiac muscles showed increase in the contractility with the progress of infection in both light and heavy infection. Significant myocardial dysfunction in the form of bradycardia, in addition to major histopathological changes in the heart occurred from the beginning of the infection and increased till the end of the study. Biochemical study showed gradual increase in serum cholinesterase, while, the intestinal MPO showed increase only in the early stage of the infection. It was noticed that all changes were more pronounced in the heavily infected group than the lightly infected one

Effect of sperm DNA fragmentation on pregnancy rate after intracytoplasmic sperm injection

To evaluate the degree of DNA fragmentation in human sperm used for ICSI to determine the effect of sperm DNA fragmentation on fertilization rate, embryo cleavage rate, embryo quality and biochemical pregnancy rates after ICSI. Design: Prospective, analytic descriptive study. Settings: Tertiary care fertility clinic. Patient[s]: Fifty couples undergoing ICSI treatment due to male factor infertility. Intervention[s]: The percentage of spermatozoa with DNA fragmentation was determined using the method f terminal deoxynucleotidyl transferase mediated UTP- biotin end- labeling [TUNEL] Main Outcome Measure[s]: The percentage of spermatozoa with DNA fragmentation was correlated with semen analysis parameters, ICSI fertilization rate, embryo cleavage rate, embryo grades and biochemical pregnancy rate. Result[s]: The mean [ +/- SD] percentage of spermatozoa with DNA fragmentation was 30.2 +/- 13.8%. A significant negative correlation was found between the percentage of sperm with DNA fragmentation and the concentration and motility of the ejaculated sperm. In addition, a significant negative association was found between the percentage of sperm with DNA fragmentation and fertilization rate, embryo cleavage rate, embryo quality and biochemical pregnancy rate. Conclusion[s]: Detection of DNA fragmentation in human sperm could provide additional information about the biochemical integrity of sperm and may explain fertilization failure after ICSI. By learning more about the fundamental mechanisms that cause sperm DNA fragmentation, it should be possible to develop more precise tests to describe defects and then to develop new therapeutic modalities designed to overcome these specific defects

comparative efficacy study of praziquantel and albendazole treatment in experimental schistosomiasis

The currently used drug for chemotherapeutic control of schistosomiasis is praziquantel [PZQ]. Albendazole is a broad spectrum antiparasitic drug that showed trematocidal activity. The present study aimed at testing the effect of albendazole on experimental schistosomiasis mansoni infection using PZQ as therapeutic control. Swiss strain albino mice were infected with Schistosoma mansoni [S. mansoni] cercariae. Drugs were given orally on the 45[th] day post infection [PI] for 2 successive days. Mice were sacrificed on the 47[th] day PI and subjected to parasitological and scanning electron microscopic [SEM] studies. Albendazole caused a significant reduction in worm load and those recovered were shorter as measured by the camera lucida. By SEM, perfused S. mansoni albendazole treated worms showed surface tegumental changes. Albendazole is a promising drug for treatment of schistosomiasis

Effect of glycyrrhiza [glycyrrhiza glabra] and henna [lawsonia inermis] plant wastes on controlling the root-Knot nematode, meloidogyne incognita on eggplant [solanum melongena]

Dry powdered root of glycyrrhiza and henna leaf powder were applied at the rates of 0.1, 1 and 10 g/pot for controlling Meloidogyne incognita on eggplant cv. Pusa Purple Long under greenhouse conditions. The higher rates [1 and 10 g] of glycyrrhiza did not decrease the number of galls and eggmasses, and plant growth parameters increased over those of the check. In contrast, increasing rates of henna powder reduced the numbers of galls and eggmasses in an increasing manner. Meanwhile, plant growth parameters insignificantly decreased in comparison with the check. Lower C/N ratio appeared to affect microbial activity resulting in lowering nematode population

Vertical and horizontal distributions of plant - parasitic nematodes associated with banana CV. Williams under flood irrigation regime

Under flood irrigation system, the vertical and horizontal distributions of plant-parasitic nematodes associated with soil and roots of banana cv. Williams were investigated. The sampling data generally indicated that the highest population density of parasitic nematodes viz. Criconemoides spp., Helicotylenchus exallus, Hoplolaimus spp. and Meloidogyne incognita were concentrated at soil depth layers of 0-15 cm, and 16-30 cm at the horizontal distance of just beneath the plant base [zero cm] and 40 cm from the banana pseudostem base which is correlated with the growth and distribution of the feeder roots of banana. These sites should be considered as the best sampling points for such coin habiting nematodes

Histopathological changes induced by either Root - Knot or spiral nematedes on banana roots

Cross and longitudinal sections in roots of banana cv. Williams infected by either Meloidogyne incognita or Helicotylenchus dihystera showed that the histological alterations induced in roots infected with M. incognita were displayed by the giant cell formation in both cortical and stelar regions. The giant cells were, always, in clusters each containing 3-6 cells. Roots infected with H. dihystera showed small brown lesions around the penetratedsites in the cortical layer causing considerable cell wall damage. The walls of the invaded cells by the nematodes were heavily stained with safranine indicating the presence of lignin, while healthy cell walls were lightly stained

Aerobic exercise training can control aging circulatory changes in healthy elderly subjects

Aging is characterized by general and gradual decline of physical and physiological capacities. The aim of this study was to determine the role of aerobic exercise training in controlling the normal biological aging changes in the circulatory system. Subjects and Twenty-four healthy elderly subjects, their age 65-75 years, divided into two equal groups. The training group received treadmill walking exercise for 3 months, where the control group received no any treatment intervention. Measurements of Maximal oxygen consumption [Vo2 max], Ankle brachial pressure index [ABI] and Heart rate [HR] were taken before the study and after three months at the end of the study. Results showed a significant improvement in measurements of Vo2 max, ABI and HR in the training group only with no significant improvement in the control group. The difference between the two groups was significant

Vaccination trial against experimental trichinellosis using autoclaved trichinella spiralis larvae vaccine [ATSLV]

The autoclaved Trichinella spiralis larvae vaccine [ATSLV] was tested and showed unpredictable effect on the immune system of mice experimentally infected with T. spiralis. The vaccine was given with Bacillus Calmette-Guerin [BCG] as an adjuvant at different durations and by different routes of administration. The best result was achieved by given the vaccine twice intradermally with two-week interval as evidenced by a significant reduction in adult and larval count, as well as reproductive capacity index. Histopathologically, there was a significant reduction in the number of the encysted larvae, which showed degeneration and hyalinization of the cyst wall accompanied by early pericystic fibrosis

Ultrastructural and immunological features of experimental cutaneous leishmaniasis after treatment with intralesional hypertonic sodium chloride and CO2 laser rays

This study investigated the mechanism of action and efficacy of CO2 laser rays and hypertonic sodium chloride [NaCl] with different concentrations in the treatment of cutaneous leishmaniasis [CL] as assessed clinically, parasitologically, histopathologically by light and transmission electron microscopy [TEM] and immunologically by RT- PCR for gene expression of interleukin-13 [IL-13]. Eighty mice were divided into four groups: The first was non-infected control group [n=16], the second was infected and served as non-treated control [n=16] as well as the third [n=32] and fourth groups [n=16] were subjected to NaCl injection and CO2 laser, respectively. The results showed that the clinical healing by CO2 laser was nearly similar to the normal appearance, but differed according to the concentration of NaCl as confirmed by the ultrastructure and immunohistopathologic features of the host cells and surrounding skin tissue. IL-13 mRNA was significantly decreased after treatment denoting that Th2 cytokine [IL-13] is important for the development of strategies to prevent the induction of the pathologic processes. It was concluded that CO2 laser and 7% NaCl are good modalities for CL treatment and were recommended, wherever possible

Relationship between life style and the performance of daily activities in elderly

Normal age related changes result in some decline with functions for elderly persons.The rate and degree of these changes are influenced by many factors. The purpose of this study was to determine the relationship between life style and the ability for performing the daily life activities. The study focused upon determinants as muscle strength, joint range of motion, ability for performing activities of daily living [ADL] and instrumental daily activities [IADL] as ways for evaluation. Eighty elderly subjects [40 males and 40 females], their age ranged between 65 and 75 years, all of them were in a good health condition. Subjects were divided into two equal groups. Group A, contains 40 subjects who's doing various aerobic and walking exercises. Group B, contains 40 subjects who's living a sedentary life without any special activities. Measurements the range of motion for the upper and lower extremities, muscle strength for selected muscle group in upper and lower extremities were evaluated. In addition two self-report scales were used to determine the ability for performing the activities of daily living. Significant values were measured for the experimental group regarding the ability for performing most of the activities, while the control group showed reduction in scores of performance. This study found that active life style is essential for keeping healthy life of the elderly

Influence of ankle range of motion on balance performance in diabetic elderly subjects

There is a correlation between balance performance and ankle joint range of motion in elderly subjects. The aim of this study was to determine the effect of change in ankle joint range of motion on performance of balance with diabetic elderly subjects. Thirty diabetic elderly subjects, divided into two equal groups. The experimental group received mobility exercise for two months, where the control group received no physical therapy. Measurements of ankle range of motion and balance performance recorded before and at the end of the study. The experimental group showed a significant improvement in performance of balance with improving the ankle range of motion, while the control group showed no significant improvement

Serum level of soluble interleukin-2 receptors during acute asthma exacerbation, and its relation to severity and response to bronchodilator therapy

Lymphocytes are prominent among the inflammatory cells infiltrating the asthmatic airways and T-cell activation appears to be a characteristic feature of acute asthma. In patients with acute asthma who respond well to bronchodilator therapy, the main mechanism of airflow obstruction is smooth muscle contraction, while in patients with poor response the main mechanism is airway inflammation. This study was conducted on 60 children with acute exacerbation of bronchial asthma. They were divided into three groups [mild, moderate and severe] according to the severity of the acute attack, utilizing a clinical scoring system and through measuring Peak Expiratory Flow Rate [PEFR], and oxygen saturation. Serum level of sIL-2R was measured using enzyme-linked immunosorbent assay both in the studied cases and in 20 healthy controls. The mean serum level of sIL-2R in the studied cases [5207.5 +/- 2084.9 pg/ml] was significantly higher than its mean level in controls [1742.5 +/- 801.9 pg/ml] [t=9.37, P=0.000]. Its mean level in severe exacerbation [8090.8 +/- 1222.6 pg/ml] was significantly higher than its mean level in moderate exacerbation [5255.0 +/- 1112.8 pg/ml], that was significantly higher than its mean level in mild exacerbation [3164.6 +/- 990.8 pg/ml] [F= 77.36, P=0.000]. There was a significant negative correlation between the levels of sIL-2R and both the baseline PEFR [r = -0.710, P=0.000] and oxygen saturation [r = -0.521, P=0.000]. After receiving bronchodilator therapy, the mean level of sIL-2R in cases with no or partial response [6486.8 +/- 1900.4 pg/ml] was significantly higher than its mean level in cases with complete response [4088.1 +/- 1534.9 pg/ml] [t=5.406, P=0.000]. A higher level of sIL-2R at acute asthma exacerbation was associated not only with more severe exacerbation but also with a lower degree of bronchodilator responsiveness