Sleep Problems in children with Down syndrome

Background:sleep problems are significant source of distress for families with a case of Down Syndrome [DS]. Parental perception of sleep problems is an important contributor to a family quality of life

Aim of the Work: the aim of the present work was to study the sleep problems in children with Down syndrome

Subjects and Methods: this study was carried out on 50 children with DS attending the neurology clinic in Alexandria University Children Hospital together with 50 apparently by healthy children with matched age and sex. Parents were interviewed in order to collect data using predesigned questionnaire. Sleep problems were assessed using the Children's Sleep Habits Questionnaire [CSHQ]

Results: total sleep score was significantly higher among children with DS than among those of the control group. The mean differences between case and control groups were significant regarding all subscales except that for sleep onset delay

Conclusion: sleep problems are more common among children with DS as compared with those in control group

[Assessing the effectiveness of cholera prevention campaign in students]

Introduction: cholera is an acute diarrheal disease that can cause severe dehydration and death within hours of its onset. The disease has rapid spread and is high mortal. It is mostly due to the lack of proper knowledge about prevention strategies as well as lack of personal hygiene. The Campaign also includes a series of educational activities that will be used to transfer specified information purposes. The aim of this research is to design and implement cholera prevention campaign and evaluate its effectiveness on knowledge, attitudes and practice of students

Method: 282 students were participated in this interventional study. The campaign was conducted for a period of four months using the following methods: pamphlets, banners, video playback, and training classes. After data entry into SPSS v.16, t-test and Mann-Whitney were used to analyze the data

Results: after the campaign, knowledge, attitudes and practice showed a growth of 44.6, 11.8 and 20.6 percent respectively. This study did not show a significant relationship between family size and knowledge of the students. However, there was a significant relationship between parents' level of education and their level of knowledge

Conclusion: cholera prevention campaign had positive effects in knowledge, attitude and practice of the students and prevent health related problems in the society

Preparation and antifungal activity of spray-dried amphotericin B-loaded nanospheres

Amphotericin B [AmB] which is an appropriate antibiotic for the treatment of mycosis has many toxic effects including nephrotoxicity. Recently preparation of a new drug loaded nanoparticles for the reduction of toxicity and increase in the effectiveness of AmB has been reported. The objective of this study was to prepare and evaluate in vitro and in vivo efficacy of the spray-dried AmB-loaded nanospheres. AmB-loaded nanospheres was prepared by means of nanoprecipitation method. The spray-dried nanospheres was prepared by using aerosil and AmB entrapment efficacy was measured by HPLC method. Minimum inhibitory concentration [MIC] of AmB-loaded nanospheres against Candida albicans [ATCC 90028] was determined by using microdilution method and its in vitro haemolytic effect and antifungal efficacy on infected rabbits was also analyzed. The entrapment efficacy for AmB loaded nanospheres was 65.2% +/- 3. The MIC of AmB-loaded nanospheres against C. albicans compared to the free antibiotic was lower significantly. Also, the AmB-loaded nanospheres found to be 9.5 times less toxic than free AmB on human red blood cells. In vivo testing indicated that AmB-loaded nanospheres have a stronger protective effect against candidiasis compared to the free AmB. Results of this study suggest that prepared spray-dried AmB-loaded nanospheres would be a good choice for the treatment of mycosis because of low toxicity and high stability and effectiveness

Learning critical thinking in virtual medical education: a qualitative study of faculty members' and students' experiences

Background and Purpose: Critical thinking is a high priority outcome of higher education. With the ever-increasing spread of virtual courses, enhancement in the critical thinking in distance learning has become the center of attention for the stakeholders

The present study was conducted to qualitatively examine the experiences of teachers and students in teaching and learning critical thinking in medical education

Methods and Materials: In this qualitative study, 7 E-teachers and 11 postgraduate E-students of medical education were interviewed using a semi-structured method. All interviews were tape-recorded, transcribed and then analyzed through constant comparison based on Strauss and Corbin's method

Results: Three themes were identified in this study; nature of critical thinking, critical thinking within the framework of medical education discipline; and the teaching-learning process of critical thinking in the virtual environment

Conclusion: The participants' experiences indicated that the learning-teaching of critical thinking in virtual education is affected by teaching strategies, the features of course management software, creation of a learner-centered environment and the role of critical thinking as one of the objectives of curriculum and evaluation

Primary central nervous system lymphoma

Primary central nervous system lymphoma [PCNSL] is an extremely rare condition in childhood. We report the first case of PCNSL in a child in Iran. A nine-year-old boy was referred to Mofid Hospital with the history of headache of four months and seizure of 2 months duration. Magnetic resonance imaging of the brain revealed a hyper-intense lesion in left fronto-parietal area with secondary satellite lesions. Biopsy of the brain mass was performed. Pathologic findings showed brain lymphoma and immunohistochemistry confirmed this diagnosis. The treatment started with intrathecal and systemic chemotherapy in combination with radiotherapy

[Effects of bupivacain infiltration on insulin, glucose, prolactin and cortisol responses to operative stress after unilateral inguinal hernoiraphy among 3-7 year-old children]

Operative stress and post-operative pain are important issues in medicine. After any types of surgery, the stress hormones release responding to pain. In this study we applied Bupivacain infiltration in surgical wounds of inguinal hernia amongst children aged 3-7 years and evaluated its effects on some stress hormones and plasma levels of glucose. In this prospective study, 116 children aged 3-7 years [24 females, 92 males] undergone unilateral repair of inguinal hernia under general anesthesia at Mofid children hospital during 2005-2007, were devided into 2 groups. Perincisional wound infiltration of 1-2 mg/kg of Bupivacain was performed in experimental group. In both groups, 10-15 mg/kg of Acetaminophen suppository were recommended at the recovery room. 4 ml of blood samples were obtained at three distinct stages [preincisional stage, at the end of operation and 4 hours after operation] to measure the insulin, prolactin cortisol and glucose plasma levels of subjects. Post operative pain was measured objectively by Hannalla scale. In both groups plasma prolactin levels increased at the end of operation along with insulin, cortisol and glucose. However, these differences became statistically significant just for insulin. There were no significant differences between other variables. In addition, although the plasma concentration of above mentioned variables became lesser in the 4[th] hour of postoperative period in experimental group, there were no statistically significant difference compared to those of control group. Wound infiltration of Bupivacain decreases the stress hormones and pain during the post-operative period. We recommend this type of infiltration applying long-acting anesthetic agents with fewer numbers of side-effects

Detailed evaluation of a newly attained fungal pigment from Monascus purpureus

It is the purpose of current work to reveal the prosperity of that red pigment extracted from Monascus purpureus, when used as a natural coloring agent in some foodstuffs, as compared with a synthetic strawberry dye color. Before all, the attained pigment was evaluated for its moisture 9.45%, protein 9.30%, fat 3.90%, carbohydrates 73.37%, fiber 3.20%, and ash 0.78%, and essential amino acids content 34.38% of total proteins of every 100gm of this pigment produced energy was calculated as 365.78 kcal. Seeking a fuller imago the forthcoming conclusions were recorded when the attained pigment was applied in the those familiar foodstuffs. With the exception of ash%, other above stated chemical parameters did not vary widely. The effects of both used pigments on the Colony Forming Unit [CFU] of fresh product were clearly obvious on the reduction of values. Similar reductions were also noticed on Staphylococcus aureus and coliforms alike. Much more reductions in these estimates were further recorded by the progress of storage. The sensory judgment of ice cream was proved statistically as both used pigments were more prosperous than the natural ones. Beef burger treated with Mold pigment [MP] had a higher nutritional value than control that produced without any color additive. The nutritional value of MP samples were enhanced by increasing pigment concentration. Moreover, Synthetic Dye [SD] sample was the lowest values of the main nutrients. Data revealed that cooking loss% was lesser in all fresh pigment samples than control treatments. This characteristic was progressively increased in values by the extension of storage. However, that increase was lesser in magnitude in used fungal pigment than the corrosponding ones of control. Similar results were recorded for Water Holding Capacity [WHC]. Reversible conclusion was noticed for Plasticity. The initial total bacterial count [TBC], Staphylococcus aureus and coliform count ranged from 7.5 x 10[3] to 2.8 x 10[2] cfu /g; 2.0 x 10[2] to ND cfu /g and 3.2 x 10[3] to 2.1 x 10[1] cfu /g for control, and the different levels of the concerned pigment in the fresh samples, respectively. Extending of storage period up to 60 days the all tested total bacterial count [TBC], Staphylococcus aureus and coliform count moderately reduced. At the end of storage period for 90 days at -18°C obviously reductions for all tested bacteria. Finally, it could be concluded that the inhibition percentage of beef burger samples was increased with increasing the Monascus pigment concentration up to 0.8g / kg. With regard to color, control sample had significantly lower score compared to treated samples with Monascus or synthetic that were insignificantly different. Flavour and overall acceptability were insignificantly differed among all treatments. While, appearance of the samples was significantly changed. Monascus samples showed the highest significant score, followed by control sample and synthetic beef burgers. By increasing concentration of Monascus pigment, the color was significantly increased. Also, these treatments unsignificant differences in color was noticed. Flavour and body and texture scores were insignificantly different among all treatments

10 year survey on childhood CNS tumors

Tumors of the central nervous system constitute the largest group of solid neoplasms in children and are second only to leukemia in their overall frequency during childhood. The main purpose of the present study is to determine the incidence, age, sex, location and histological diagnosis of CNS tumors in children, less than 15 years of age, in the Mofid Children's Hospital, in the past 10 years. In this descriptive retrospective study we reviewed the medical records of 143 children with diagnosis of CNS tumors admitted during the past 10 years in neurology and surgery departments of Mofid Children's Hospital between the years 1996 and 2006. During the 10 year study period, CNS tumor was diagnosed in 143 patients; of these tumors, 119 were intracranial and 58 were intraspinal; 51.3% of brain tumors were located in the supratentorial and 48.7% in the infratentorial regions. The most common intracranial neoplasms were astrocytic tumors [36.8%], embryonal tumors [31.1%] and ependymal tumors [13.4%]. Of the intraspinal neoplasms the most frequently noted were embryonal tumors [37.5%], mesenchymal meningothelial tumors [20.8%], followed by astrocytic tumors [16.7%]. The median age at diagnosis was 8.9 +/- 4.1 years with a male to female ratio of 1.4:1 [P<0.5]. The most common intracranial astrocytic and embryonal neoplasms were pilocytic astrocytoma and medulloblastoma/ PNET respectively. Brain tumors in children constitute a diverse group in terms of incidence, distribution and histopathological diagnosis

Malignant giant cell tumor of soft parts in lumbosacral region

Giant cell tumor of soft parts is a rare neoplasm that mainly affects adulst and the elderly and is usually located in the extremities. Here we report a child with giant cell tumor of soft tissue, which is a very rare condition in childhood Clinical presentation: A 5 year old girl presented with a 5 month history of left lower extremity pain. She had developed paraplegia before admission. On examination, mild left lumbosacral swelling and tenderness was found. Abdominal and pelvic CT-Scan revealed an expansile lytic lesion of the left side of sacrum with significant soft tissue component extending toward the left iliac bone. Lumbar MRI revealed a space occupying lesion originating from posterior L5 elements, projecting toward the L1.Intervention: The patient underwent surgery. A firm epidural hemorrhagic tumor of L5, S1, and S2 with no spinal cord involvement was found. Partial tumor resection [measuring 3*1*0.5 cm in maximal diameter] and laminectomy was done. Primary giant cell tumors of soft tissue are distinctive, rare neoplasms that exhibit a wide clinicopathologic spectrum similar to osseous GCTs and need to be differentiated from other giant cell rich soft tissue tumors. Recognition of this tumor is important due to its behavior as a low grade malignancy, but this cannot be predicted and metastasis does occur rarely

Pleuro-pulmonary blastoma in a 4-year-old child

Pulmonary blastoma is a rare malignancy with various histopathological appearances in children which present as an intra-thoracic mass. In this case report we present a 4-year-old boy with pleuro-pulmonary blastoma which was unrecognized for several weeks and was managed as pleural effusion and pneumonia. We decided to present this case because of the diagnostic difficulties and radiographic appearances

Heart involvement in Kala Azar

Leishmaniasis is a vector-borne disease. About 30 species of sandflies are proven vectors of leishmania, the usual reservoir host includes human and domestic/wild animals. In addition, acquisition of visceral leishmaniasis as a result of blood transfusion has been documented. Visceral leishmaniasis presents in various forms. We report a three year old girl with visceral leishmaniasis and pericardial effusion. Meglumine antimoniate was prescribed for her and all her signs and symptoms plus her pericardial effusion were resolved

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

role of fine needle aspiration cytology and imprint cytology in cervical lymphadenopathy

To determine the diagnostic accuracy of cervical lymphadenopathy by fine needle aspiration [FNAC] and imprint cytology [IC]. This study included 94 patients with cervical lymphadenopathy. This study was carried out in the Departments of General Surgery and Pathology, King Fahad Hospital, Hofuf, Kingdom of Saudi Arabia, from June 2001 through to July 2002. They were subjected to clinical examination and FNAC of one of the enlarged lymph nodes. This was followed by IC and histological examination of this lymph node after its excision. Clinical examination was correct in 78% of the cases. The overall accuracy of fine needle aspiration was 93%. It was accurate on all cases of reactive hyperplasia, 93% of tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma, 86% in non-Hodgkin's lymphoma, and 91% of metastasis lymphadenopathy. On the other hand, the overall accuracy of IC was higher than that of fine needle aspiration, being 97%. It diagnosed all cases of reactive hyperplasia and non-Hodgkin's lymphoma, 97% in tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma and 95% in metastasis lymphadenopathy. These techniques proved to be reliable, rapid, and inexpensive procedures in diagnosis of lymphadenopathy. They can differentiate well between inflammatory and neoplastic lesions, in cases of lymphoma, cytological diagnosis should be followed by histological diagnosis for accurate classification and grading

Eye changes in cerebral palsy

This study was conducted to evaluate the different eye changes in cerebral palsied [cp] children. It included 70 CP children [45 boys and 25 girls] among those attending the Pediatric Neurology Outpatient Clinic at Alexandria University Children's Hospital with age range from 4 to 96 months. Cerebral palsy was due to perinatal causes in 57.1% of cases while postnatal and prenatal causes accounted for 28.6% and 5.7% respectively. The etiology of CP was unknown in 8.6% of cases. Most of the cases were of the spastic type [62.8%]. Dyskinetic CP accounted for 14.3%; ataxic CP for 14.3% and the mixed type accounted for 8.6%. The majority of cases were profoundly handicapped [55.7%]. Multiply handicapped CP children accounted for 92.9% while those with a single other deficit were 7.1%. Visual problems occurred in 64.3% of cases. These included bilateral cataract in 1.4%, ocular motility disorders in 51.4%, refractive errors in 58.6% and abnormal fundoscopy in 14.3%. Sixteen cases had examination of their visual evoked responses [VERs]. Abnormal VERs occurred in 43.7% of them. Visual problems were significantly higher in CP cases due to perinatal causes [P<0.05]. Also, visual problems were significantly higher among the spastic group [P<0.05]. Thorough ophthalmological assessment should be done as early as possible for all cases at high risk of CP or already having established CP and should be done periodically for early detection and proper management of the associated visual problems to limit their handicap. Visual evoked responses' examination is a valuable diagnostic tool for early detection of cortical visual impairment in CP cases

Bacteraemia following diagnostic and therapeutic ERCP

Thirty patients undergoing endoscopic retrograde cholangiopancreatography [ERCP] were studied. Blood samples were taken just before, 5 minutes after cannulation of the papilla and, 15 minutes after the end of examination. The samples were cultured for both aerobic and anaerobic organisms. Seven cases [23.3%] showed positive cultures. The isolated organisms in 4 of them were considered as normal commensals of the skin. While in 3 cases [10%], the organism, were considered pathogenic. We concluded that ercp is a safe procedure and not accompanied by bacteraemia except in the immunocompromised cases. Thus, the immunocompromised patients should be considered a high risk for the development of bacteraemia following ERCP. The use of prophylactic antibiotics is recommended before and after procedure in all immunodepressed patients and patients with chronic valvular diseases

one year-trial of low fat, high carbohydrate diet in subjects with mammographic dysplasia

Although evidence is increasing about the influence of dietary fat on breast cancer risk, little information exists about the effects of dietary fat on the human breast. In this study the effect of dietary fat reduction on mammographic dysplasia [Nodular or sheet-like areas of radiological density] was elicited. Women with mammographic dysplasia were randomely allocated to a control group, with the advice of maintaining a balanced diet [38% of calories as fat], or an intervention group, in which they were taught to reduce dietary fat to a target of 15% of calories. A total of 54 patients participated in this study. Nearly 25% of both the intervention group and the control group failed to provide data after 1 year and dropped out of the study. Food records and chemical analysis of duplicate meals, and serum cholesterol measurements were assessed for the rest. Comparison of mammograms before and after one year of dietary fat reduction showed significant influence on the extent and density of mammographic dysplasia. Surgical biopsies performed at the end of the study showed six cancers in the control group and one in the intervention group which constitute four times the number expected. This study confirms the relationship between dietary fat, mammographic dysplasia and the potential risk of breast cancer

metabolic and hormonal profile of diabetic children on CSII

To assess the correction of the metabolic and hormonal profile in diabetic children as normoglycemia is reached, two groups [newly-diagnosed and chronically-treated] were treated with the insulin pump. Fasting and postprandial levels of metabolites and hormones were measured before and after 10 days of pump treatment. Normoglycemia resulted in correction of fasting plasma free insulin and growth hormone, a decrease of plasma glucagon with significant hypokalemia in newly-diagnosed diabetic children. A fall in [VLDL + LDL] cholesterol levels was accompanied by a substantial increase in HDL cholesterol concentration. The postprandial blood glucose and free insulin were similar to that of control subjects. These changes suggest that optimal glycemic control is achievable at the expense of increased insulin action despite absence of peripheral hyperinsulinemia, and that the normalisation of the metabolic and hormonal profile is not absolutely possible with this mode of therapy

Plasma estradiol concentration in healthy post menopausal women with dietary fat reduction

Concentrations of bound plasma estradiol were significantly [P < 0.1] reduced in eighty five healthy postmenopausal women after 12 weeks of participation in a low-fat diet program. Nonsignificant reduction in estrone sulfate and sex hormone-binding protein were observed. An average reduction in daily dietary fat from 70.3 to 30.5 g. was also accompanied by an average reduction of 14 mg/dl in total plasma cholesterol [P < 0.001], and an average weight loss of 4.1 kg [P < 0.001]. There is a relation between the 19 percent reduction in plasma estradiol and the incidence of breast cancer and further studies to elucidate this relationship are needed

effect of treatment of Grave's disease on the course of ophthalmopathy

The incidence and progression of ophthalmopathy were compared retrospectively in 150 patients with Graves' disease treated with either radio-active iodine [131 I, N = 50], antithyroid drug [N=50]. None of the patients received prior treatment for hyperthyroidism. The severity of ophthalmopathy at presentation, as analyzed according to the modified NOSPECS classification and the thyroid function were similar in the three treatment groups. Six Patients had ophthalmopathy at about eighteen months before the development of biochemical hyperthyroidism [range 3 to 24 months]. For patients with ocular signs at presentation, the incidence of progression of ophthalmopathy was similar with each form of treatment. As a group, all forms of treatment resulted in improvement of ophthalmopathy with the control of hyperthyroidism. Forty six patients with no eye sign at presentation developed post-treatment ophthalmopathy. 131I and surgery were associated with more severe eye disease [NOSPECS Class 4-6] although the incidence of post-treatment ophthalmopathy was lower than with antithyroid drug treatment [2 percent versus 7 percent respectively]. Among the patients characteristics, male sex, older age [>35 ys] and lower initial T4 levels were found to be correlated with a higher chance of developing severe post-treatment ophthalmopathy. Furthermore the progression or development of ophthalmopathy could occur equally during hyper, hypo-, or euthyroid state. We conclude that the incidence and the degree of progression of ophthalmopathy in patients who already had exophthalmos before treatment were not influenced by the form of therapy for thyrotoxicosis, but 131I treatment and surgery were associated with the development of more severe post treatment ophthalmopathy compared to antithyroid drug treatment

diagnosis of euthyroid graves disease

Twenty patients complaining of eye symptoms, nervousness, palpitation and fatigue and suspected of having grave's disease were diagnosed as euthyroid grave's disease by laboratory data. Antithyroid antibodies and an abnormal TSH response to exogenous TRH were demonstrable denoting abnormalities of the hypothalamo-hypophyseal thyroid axis