Study of the effect of repetitive transcranial magnetic stimulation on a sample of children with autism spectrum disorder

Background: Autism Spectrum Disorder (ASD) is a behaviorally defined complex neurodevelopmental syndrome. ASD is one of the most common child psychiatric disorders. Despite the long history of research on ASD, no much is known yet about the exact biological causes and how the disorder can be effectively treated. Objective: To study clinical effect of repetitive Transcranial Magnetic Stimulation (rTMS) on a sample of children with autism spectrum disorder. Patients and Methods: the sample consisted of 30 children. Their ages ranged from 4 to 10 years old. After being diagnosed clinically according to DSM-5 through a designed semi-structured interview and through application of childhood autistic rating scale CARS and assessment of the degree of clinical severity of autism spectrum disorders according to DSM-5. Results: The results of the study after the completion of 12 sessions of rTMS, there was a significant difference and improvement in the severity of the clinical symptoms for ASD except for the level of activity and listening response and use of the body by comparing the severity of symptoms before and after rTMS. Comparing results before and after rTMS by the level of clinical severity of autism according to DSM-5; at the level of severity in social communication, the improvement was statistically significant (p-value 0.001). At the level of severity in restricted and repetitive behaviors the improvement was statistically highly significant (p-value <0.001). Conclusion: this study concluded that rTMS over left dorso-lateral prefrontal cortex may be safe and effective way of providing a relief of ASD symptoms

Effect of continuous professional development course of family medicine essentials on physician's knowledge, skills, and attitude among primary healthcare physicians in Saudi Arabia

Objective: This study was designed to measure the outcome of the continuous professional development [CPD] course [Family Medicine Essentials] conducted and organised by the Ministry of Health [MOH] on the knowledge, skills, and attitude of primary healthcare [PHC] physicians in patient care

Materials and Methods: This study was based on pre- and post-implementation of training evaluation, which included the seven CPD modules in family medicine customised for non-certified family physicians working at MOH and PHCs in Saudi Arabia. The study was conducted from March 2009 to 2010 and it included 259 family physicians working in PHCs and MOH. The pre- and post-test scores for mean knowledge, skills and attitude were compared using paired t-test. P < 0.05 was considered significant

Results: The results showed that the percentage of male participants [80.3%] was higher than females [19.7%]. The mean age of the participants was 39.6 +/- 8.0 years. A significant difference was found in pre- and post-test scores of PHC physicians' attitude, knowledge and skills. Attitude increased from 77.5 +/- 6.1 to 83.0 +/- 7.8 [P < 0.0001], knowledge increased from 51.3 +/- 14.8 to 66.7 +/- 14.3 [P < 0.0001] while skills increased from 41.2 +/- 20.1 to 66.9 +/- 19.1 [P < 0.0001]

Conclusion: Participants in the CPD course showed significant improvement in their level of knowledge, clinical skills and attitude in patient care. However, further case-control studies and practice evaluations are required to obtain more in-depth information on the impact of this course on PHC physicians

Live donor hepatectomy for liver transplantation in Egypt: lessons learned

To retrospectively review anesthesia and intensive care management of 145 consented volunteers subjected to right lobe or left hepatectomy between 2003 and 2011. After local ethics committee approval, anesthetic and intensive care charts, blood transfusion requirements, laboratory data, complications and outcome of donors were analyzed. One hundred and forty-three volunteers successfully tolerated the surgery with no blood transfusion requirements, but with a morbidity rate of [50.1%]. The most frequent complication was infection [21.1%] [intraabdominal collections], followed by biliary leak [18.2%]. Two donors had major complications: one had portal vein thrombosis [PVT] treated with vascular stent. This patient recovered fully. The other donor had serious intraoperative bleeding and developed postoperative PVT and liver and renal failure. He died after 12 days despite intensive treatment. He was later reported among a series of fatalities from other centers worldwide. Epidural analgesia was delivered safely [n=90] with no epidural hematoma despite significantly elevated prothrombin time [PT] and international normalization ratio [INR] postoperatively, reaching the maximum on Day 1 [16.9 +/- 2.5 s and 1.4 +/- 0.2, P < 0.05 when compared with baseline]. Hypophosphatemia and hypomagnesemia were frequently encountered. Total Mg and phosphorus blood levels declined significantly to 1.05 +/- 0.18 mg/dL on Day 1 and 2.3 +/- 0.83 mg/dL on Day 3 postoperatively. Coagulation and electrolytes need to be monitored perioperatively and replaced adequately. PT and INR monitoring postoperatively is still necessary for best timing of epidural catheter removal. Live donor hepatectomy could be performed without blood transfusion. Bile leak and associated infection of abdominal collections requires further effort to better identify biliary leaks and modify the surgical closure of the bile ducts. Donor hepatectomy is definitely not a complication-free procedure; reported complication risks should be available to the volunteers during consenting

Early infections after living donor liver transplantation in Egyptian children [single center experience]

Liver transplantation [LT] has become an established therapeutic option for a large variety of fulminant and chronic liver diseases. Postoperative infections are the major cause of morbidity and the leading cause of mortality. The aim of this work was to investigate the incidence, types and possible predisposing factors for infection after living donor liver transplantation [LDLT] in children occurring early in the post operative period. We enrolled 22 children [10 boys [45.5%] and 12 girls[54.5%]] who underwent LDLT from 2003 to 2010 at National Liver Institute, Menofiya University, Egypt, the mean age +/- SD was 5.59 +/- 4.45 years [range, 7 months to 17yr] . We retrospectively investigated the proven episodes of bacterial, viral, and fungal infections. There were 62 infections episodes in 18 [81.2%] of 22 patients [2.8 infections/patient], two or more infections occurred in 14 out of 22 transplanted children [63.6%], bacterial infections accounted for 41 episodes of infection [66.1%], Viral infections accounted for 10 episodes of infection [16.1%] while fungal infections accounted for 11 episodes of infection [17.8%].The most common sites of bacterial infection were chest [24.4%], bile ducts [cholangitis] [17.1%] the blood stream [bacteremia] [12.2%] ,and abdomen either peritonitis or intra abdominal abscess [9.8%]. Most of the bacterial infections were polymicrobial mainly with gram negative bacilli occurred within the first month after LDLT. The most common causes of viral infection were cytomegalovirus in 4 patients, Epstein-Barr virus in 2 patients, Herpes Simplex virus types I and II presented in 4 patients. The mortality rate due to infection was 18.2% mainly caused by bacterial infection. This study found that infection is one of the important causes of morbidity and mortality after LDLT, so careful monitoring and management of infections is crucial for improving the outcome of LDLT in children

Living related liver transplantation pediatric patients [a single center study]

This study included all pediatric cases that had done Living related liver transplantation [LRLT] in National Liver Institute [NLI], Menoufiya University from April 2003 to August 2007; they were 15 children, 8 were males and 7 were females. Their ages ranged between 1 year and 14 with a mean of 6 +/- 5.5 years. The indications for LRLT were Biliary atresia [BA]: 6 cases [40%], Budd Chiari syndrome [BCS]: 3 cases [20%], Bylers disease; 2 cases [13.3%], congenital hepatic fibrosis [CHF]: 2 cases [13.3%] [cirrhosis due to hepatitis C [HCV]: one case [6.7%] and hepatoplastoma: one case [6.7%]. The mean of follow-up was 30 +/- 20 months [range: 1-52 months]. The mean of pediatric end stage liver disease [PELD] score in deceased patients [20 +/- 11] was higher than the survivors [9 +/- 8] [P<0.05]. Seven mortalities [46.7%] occurred and the main causes of death were sepsis, vascular complications and chronic rejection, The over all patient survival in six month, first and second year were 73.3%, 667% and 53.3%, respectively The best first year patient survival was in BA cases [100%] while the worst was in BCS patients [33.3%]. In conclusion, LRLT is a successful therapy for infants and children with end stage liver diseases. It seems that the primary liver disease has no impact on the early results of LRLT except BCS where the cause of early mortalities where related to the recurrence of the disease. Implementation of education program for donors [the family] and candidates for LRLT is necessary to fulfill the criteria required for successful LRLT. Appropriate timing, meticulous surgical procedures, and comprehensive management of complications are crucial for successful outcome with LRLT

Epidemiological and clinical study of Kawasaki disease in a tertiary hospital in Makkah

This study involved 36 Kawasaki Disease patients diagnosed during the period from September 2000 to August 2004 at Al-Noor Specialist Hospital, Holy Makkah. Collected data included clinical features, laboratory results, echocardiogram findings, treatment, complications, and outcome. The average of 9 patients were diagnosed yearly, their age ranged from 6 months to 11 years and male to female ratio was 3.5:1. The clinical presentations were fever, skin rash and oral mucosa abnormalities [100%], desquamation of finger tips [88%], edema of palms and soles [77%], conjunctivitis [66%], and cervical lymphadenopathy [58%]. Seventy eight percent of cases presented in the summer and spring. Laboratory data showed leucocytosis, thrombocytosis, and high ESR. Echocardiography showed left coronary artery dilatation in 15 patients [42%], 10 of them [28%] had also right coronary artery dilatation. Coronary artery lesions had regressed in 11 cases [31%], while 4 patients [11%] progressed to giant aneurysms. Intravenous immunoglobulins [IVIGs] and aspirin were given. Neither cardiac dysfunction, nor valvular affection was observed; also, no recurrence and none died. In conclusions; although Kawasaki disease is a rare disease, 36 cases were diagnosed in Holy Makkah in 4 years, 4 of them progressed to giant coronary artery aneurysms. Increased awareness of the disease could help in early diagnosis and treatment and lower the rate of complications

Distal hypospadias repair using modification of the tubularized incised plate urethroplasty snodgrass operation: New concepts

There is no single, universally applicable technique for hypospadias repair. The Snodgrass tubularized entirely incised urethral plate [TIP] urethroplasty is a recent contribution, which becomes a popular technique for repair of distal [anterior] hypospadias. It simplifies the decision-making algorithms in hypospadias surgery with achieving good functional and cosmetic results. Eighteen boys with distal hypospadias have been subjected to Snodgrass repair with new concepts in modifications to avoid postoperative external meatal stenosis and the need for regular postoperative dilatations. No single recurrence, meatal stenosis, skin loss or penile torsion occurred in this work. Only one [5.6%] case with minimal fistula occurred due to mild infection treated conservatively. All patients had a vertically oriented slit-like normal positioned external meatus. These modifications could add more functional and cosmetic results to the Snodgrass repair