ABSTRACT
Background: attention Deficit Hyperactivity Disorder [ADHD] is one of the most common neuropsychiatric disorder that affects children and young adults and cause significant functional impairment. Although there are effective medications and psychobehavioural therapies that help with management of ADHD, the medications can have significant side effects, which limit their use. There is need to explore other treatment options. transcranial magnetic stimulation [TMS] and repetitive transcranial magnetic stimulation [rTMS] are recent safe and non-invasive investigative and therapeutic tools
Aim of the work: to study the effect of repetitive transcranial magnetic stimulation on a sample of children with Attention-Deficit/Hyperactivity Disorder
Methods: the sample was consisted of [35] child; their ages were ranged from 6 to 12 years old after diagnosed clinically according to DSM-5 through a designed semi structured interview and through application of Conner's teacher-28 and parent-48 rating scales as ADHD combined type. Females were [11] children with percentage 31.4%, while males were [24] children with percentage 68.6%. All patients on the sample were not receiving any medical or behavioral therapy for ADHD
Results: means scores of inattention, hyperactivity and impulsivity were reduced significantly in the post 5 days and 2 weeks follow up [P-values > 0.001[, started to rise again in its evaluation after 4 weeks but not reaching its values before rTMS sessions. the percentage of severe cases in each scale category was dramatically decreased immediately and 2 weeks after rTMS sessions and started to rise again in its evaluation after 4 weeks but to lower percent than before rTMS sessions [70%, 100% and 60% had severe inattention, hyperactivity and impulsivity respectively before rTMS, reduced to 0%, 0%, 10% immediately and 2 weeks after rTMS but increased to [20%, 40% and 40%] after 4 weeks. no patient experienced any significant adverse effects during the study, except 3 children reported mild headache that resolved spontaneously within an hour without medication
Conclusion: this study concluded that r TMS over left dorso-lateral prefrontal cortex may be safe and effective way of providing relatively lasting relief of ADHD symptoms especially in children with severe symptoms
ABSTRACT
Few studies have estimated the psychiatric morbidity among adolescents in secondary schools in Egypt. The objectives of this study were to describe such disorders, identify those students with problems, and evaluate the relationship between their problems and some variables related to them. From September 2008 till April 2009. The study was done on 542 students [263 male [48.5%1 and 279 female [51.5%J], age range 15-18 years; those in urban 333 [61.4%] while in rural area 209 [38.61 with exclusion of deaf and blind. The researcher used Child and Adolescent behavior checklist, General health Questionnaire [GHQ], Clinical interview. Students with+ve score on GHQ were clinically interviewed, and the diagnosis of psychiatric disorders were done according to the diagnostic and statistically manual of mental disorder fourth version revised version [DSM IV TR]. About [22%] of Secondary school adolescents suffers from one or more of the psychiatric disorders as follows; Depression 21.4%, ADHD 15.9%, GAD 12.6% Adjustment disorder 12.6%, OCD 9.5%, conduct disorder 6.3%, Oppositional deviant dis. 5.6%, Separation anxiety dis. and Motor tics 4.8%, nocturnal enuresis 3.9%, social phobia 2.7%, no one complained of drug abuse or psychotic dis. The following socio demographic risk factors are statistically correlated to the psychiatric morbidity, age, sex, number of brothers, economic status and place of living. The mental health of Secondary school adolescents should be assessed, as they may be at risk for mental health problems. Preventive and therapeutic interventions are recommended
Subject(s)
Humans , Male , Female , Prevalence , Adolescent , Mental Health , Schools , Students/psychologyABSTRACT
Background: Viral infection has been implicated in the pathogenesis of bone marrow failure. We designed this study to explore the influence of chronic HCV infection on the bone marrow status in patients withliver cirrhosis presenting with peripheral blood cytopenias
Patients and Methods: The present study was conducted on 70 patients with different grades of liver cirrhosis based on Child-Pugh scoringsystem . They were categorized into those positive for HCV infection [50patients] and those without [20 patients]based on assay of anti-HCV anti-bodies and qualitative PCR for HCV-RNA. Complete blood count and bonemarrow examination have been performed to all studied patients
Results: Normal bone marrow cellularity was more evident in pa-tients without HCV infection. However, hypercellular bone marrow wasmore evident in patients with positive HCV infection .Furthermore, no significant changes in different bone marrow elements in patients with posi-tive HCV infection were demonstrated when compared to patients withnegative HCV infection [P<0.05]
Conclusion: HCV infection has no evident direct suppressive effecton bone marrow elements in cirrhotic patients presenting with mono, biorpancytopenia. Understanding the pathogenetic mechanism of cytopeniasin cirrhotic patients is important to improve the management strategy andoutcome
ABSTRACT
Background and Aim: cardiovascular autonomic neuropathy is a known, but often unrecognized complication of liver cirrhosis and it can lead to many adverse effects including increased risk of mortality. However, few published studies are available about autonomic dysfunction in non alcoholic liver disease. Considering the adverse prognostic implications of autonomic neuropathy, the aim of the present study was to assess cardiovascular autonomic function in patients with liver cirrhosis and patients with hepatocellular carcinoma
Methods: The study included 60 cirrhotic patients [13 females and 47 males with mean age 53.5+/-7.6 years], 40 patients with hepatocellular carcinoma [8 females and 32 males with mean age 54.3+7.95], and 20 age and sex matched healthy controls. Clinical examination beside laboratory and radiological investigations necessary for diagnosis were done. Cardiovascular autonomic function using the standard tests was examined in patients and controls. We studied the presence and extent of autonomic dysfunction in the patients in relation to clinical and laboratory characteristics
Results: Compared to control subjects, both cirrhotics and hepatoma cases had impaired autonomic function tests, prolonged QTc [P<0.001] and higher autonomic function scores [P<0.001]. HR response to deep breathing was impaired more in hepatoma group than in cirrhotics [P<0.001]. 54 of cirrhotics [90%] and 37 of hepatoma patients [92.5%], had abnormal results of one or more autonomic function tests. No significant difference was found between cirrhosis and hepatoma groups as regard the distribution of autonomic dysfunction [P=0.245]. Parasympathetic dysfunction was more prevalent than sympathetic one in cirrhosis group [E:11.7% and D:41.7%, VS 36.7%] and also in hepatoma group [E:27.5% and D:32.5%, VS 32.5%]. Cirrhotics with autonomic neuropathy had significantly higher rate of CV autonomic neuropathy symptoms [P=0.002], higher rate of ascites [P<0.001], lower BMI [P<0.001], lower serum albumin [P<0.001] and higher INR [P=0.008] than those without neuropathy. In patient groups, combined AD increased in frequency according to child class [P<0.001 and <0.05 respectively], also the abnormal autonomic tests were significantly related to child class, serum albumin and INR. We concluded that AD, mainly parasympathetic is present with comparable frequency in liver cirrhosis and hepatoma patients and is related to the severity of liver failure. So, the standard autonomic function tests should be used during evaluation of such cases, also HR response to DB may help in screening cirrhotics for hepatoma
Abbreviation: AD: Autonomic dysfunction: AFP: alpha fetoprotein: AN: Autonomic neuropathy: BMI; body mass index; CV: cardiovascular: D: definite; DB deep breathing: DBP: diastolic blood pressure: E: early: FBS: fasting blood sugar HCC: hepatocellutar Carcinoma: HR: heart rate; HR LS: heart rate response to standing: HRV: heart rate variability; M+SD: mean + standard deviation; PH: postural hypotension; PPS: postprandial sugar: QTc: Corrected QT interval; SBP: systolic blood pressure: VR: Valsalva ratio
ABSTRACT
The aim of this study was to evaluate the usefulness of noninvasive assessment of common carotid artery [CCA] intima-media thickness [IMT] in prediction of presence and severity of coronary atherosclerosis. B-mode ultrasound of carotid arteries was performed on 80 patients [mean age 51 +/- 6 yrs., range 40-60: 43 were males] who had coronary angiography performed within 3 months. -4ccording to the results of coronary angiography patients were divided into control group [normal coronary angiography no=18] and coronary disease group [22 patients with single vessel disease and 40 patients with multivessel disease]. Diabetic patients and those with peripheral artery and cerebral vascular diseases were e-duded from the study. IMT less than 1.0 mm was considered as normal. IMT equal or more than 1.0 mm was considered as initial atherosclerotic lesion of carotid arteries, and IMT more or equal to 2.0 was considered as a sign of mild carotid plaque
Results: the IMT of the common carotid artery in coronary heart disease group and in control group was 1.05 +/- 0.65mm and 0.58 +/- 0.20mm respectively, [P<0.00l].There was no any sign of carotid atherosclerosis in the majority of patients without overt coronary lesions [control group]: 88.9% of them 11ad normal [< 1.0 mml carotid IMT. The remaining 11.1 % of patients of this group showed only moderate thickness [< 2.0 mm], and no one had signs of carotid plaque [IMT more than 2.0 mm]. Single-vessel disease was associated with significant increase of IMT. Signs of carotid atherosclerosis were observed in 3 1.8% of patients [22.7% with IMT 1.0- 2.0 mm, and 9.1% with IMT more than 2.0 mm], albeit 68.2% of patients had normal IMT. 62.5% of patients having multivessel disease have had signs of carotid atherosclerosis on ultrasound examination. 30% of them showed IMT more than or equal to 1.0 mm while in 32.5% of them carotid ultrasound detected severe increase of IMT [more than or equal to 2.0 mm]. Only 37.5% of patients had normal carotid IMT. The sensitivity of IMT 1 .0-2.0 mm in multi-vessel CAD was 62% with specificity 86%. Using criterion IMT more than 2.0mm the specificity dramatically rose to 95%, whereas sensitivity lowered to 32%
Conclusions: the common carotid artery IMT measured by simple, noninvasive method is greater in patients with coronary artery disease as compared with that in patients without the disease. IMT showed good correlation with the severity of coronary atherosclerosis, especially in patients with multi-vessel disease, having worse long-term prognosis. The ultra-sonographic screening of carotid arteries thus offers a valuable complement to other noninvasive tests used for the initial identification of patients with ischemic heart disease. However, standardized protocol for IMT measurements is needed before it can be widely implemented in the clinical practice
ABSTRACT
The aim of this work,was to evaluate plasma Ang II level in essential hypertensive patients and to verify its relation to the presence and severity of coronary artery disease. Fifty eight patients with essential hypertension and ischaemic chest pain [group A] together with twelve healthy normotensive volunteers [group B] were included in this study.Thorough clinical examination, resting ECG, plain chest X ray, routine laboratory investigations, angiotensin II [Ang II] serum level and echo-Doppler were done for all individuals. Coronary angiography was done fore the group A patients only. The statistical analysis of the results pointed out, a sign higher level of Ang II in group A [38.3 +/- 2 pmol/L] than in group B [24.9 +/- 9 pmol/L] and that its level in group A patients were positively correlated sign to left ventricular mass index and left ventricular wall motion score index but negatively to E/A ratio. Ang II level was significantly higher in hypertensive patients with coronary artery disease [group AII] [59.1 +/- 2 pmol/L] than those with normal coronaries [groupAI] [31.9 +/- 1 pmol/L]. Group All patients with three vessels disease had a sign higher Ang II level than those with two or one vessel coronary artery disease. Ang II level was sign higher in group All patients with LAD coronary artery lesion than those without. Concluston:Patients with essential hypertension had a significantly higher Ang II level than normotensives. Ang II Level was positively correlated significantly to the presence, number and severity of coronary artery lesion in hypertensive patients. Patients with LAD lesion sign had a higher Ang II level than those without