Apparent life-threatening events in neonatal period: clinical manifestations and diagnostic challenges in a pediatric referral center

Apparent Life-Threatening Events [ALTEs] is an episode that is frightening to the observer and is characterized by some combination of apnea, color change, altered muscle tone, choking, and gagging. This study was designed to evaluate and follow up neonates who presented with clinical manifestation of an ALTE in a year. In this prospective observational study, all of the neonates with episode of ALTE who were admitted to the Children's Medical Center [CMC] in Tehran, from June 15[th] 2010 to May 14[th] 2011 were enrolled in the study. Data from patients consisting of history, physical examinations, and paraclinical findings were recorded in a checklist and all followed up 3 to 6 months after discharge. During the study period 18 neonates were admitted due to ALTE episode[s] with mean age of 15 +/- 13 days. Nine [50%] neonates had previous attacks of ALTE. The most frequent complaint was cyanosis in 12 [67%] and apnea in 8 [44%] patients. In 10 [56%] the event lasted less than one minute, 13 [72%] were awake, 17 [95%] in supine position and 13 [72%] on their parent's lap. Primary antagonistic impression on admission was sepsis in 11 [61%] and concomitant seizure in 5 [28%]. The most common final diagnosis according to repeated physical examinations, result of paraclinical investigations and follow up was sepsis 4 [22%] and aspiration 9 [50%]. ALTE recurred in none of the neonates during follow up. The rate of ALTE seems to be higher than in this study owing to high incidence of recurrent ALTE. Although most of these attacks regress spontaneously, more attention should be paid for the underlying diseases

[ effect of early clinical experience on attitude of medical students toward basic sciences courses]

Background and Objective: Nowadays early clinical experience [ECE] in Medical education has been developed with the aim of establishing efficient relationship between basic sciences courses and clinical education. This study was done to evaluate the effect of early clinical experience on the attitudes of students in Sari School of Medicine toward basic sciences courses

Methods: This interventional study [before and after] was done on all Sari Medical students in the 4 th semester of basic sciences program. An ECE program in 8 sessions was designed and developed during the 4th academic semester. Attitudes of the students toward clinical importance of basic sciences courses were asked before and after the program by a valid and reliable questionnaire. Data were analyzed using Wilcoxon, Chi-square and McNemar tests and through SPSS 13 software package

Results: From 47 students, 42 ones were participated in the study [response rate= 89%] of whom, 25 ones were female [60%]. Early clinical experience could only affect the attitude of students in neuroanatomy course [P<0.01] Although this program was efficient in increasing students' motivation in some aspects such as voluntary attendance in hospitals during vacations, various methods of integration and using more clinical-based teaching pathways are required for enhancing students' attitudes toward basic sciences courses

Conclusion: ECE program, by itself, can not improve attitude of students toward basic sciences courses, but can enhance students' academic motivation during the basic sciences program of Medicine