Assessment of risk factors for leakage after repair of perforated peptic ulcer with omental patch. Retrospective study / Evaluación de factores de riesgo de fuga después de la reparación de una úlcera péptica perforada con parche de epiplón. Estudio retrospectivo

Introduction. Perforated peptic ulcer remains one of the critical abdominal conditions that requires early surgical intervention. Leakage after omental patch repair represents one of the devastating complications that increase morbidity and mortality. Our study aimed to assess risk factors and early predictors for incidence of leakage. Methods. Retrospective analysis of data of the patients who underwent omental patch repair for perforated peptic ulcer in the period between January 2019 and January 2022 in Mansoura University Hospital, Egypt. Pre, intra and postoperative variables were collected and statistically analyzed. Incriminated risk factors for leakage incidence were analyzed using univariate and multivariate analysis. Results. This study included 123 patients who met inclusion criteria. Leakage was detected in seven (5.7%) patients. Although associated comorbidities (p=0.01), postoperative intensive care unit admission (p=0.03), and postoperative hypotension (p=0.02) were significant risk factors in univariate analysis, septic shock (p=0.001), delayed intervention (p=0.04), preoperative hypoalbuminemia (p=0.017), and perforation size >5mm (p= 0.04) were found as independent risk factors for leakage upon multivariate analysis. Conclusion. Delayed presentation in septic shock, preoperative hypoalbuminemia, prolonged perforation, operation interval, and large perforation size > 5mm were detected as independent risk factors for leakage. Postoperative tachypnea and tachycardia with increased levels of C-reactive protein and total leucocytic count are alarming signs for incidence of leakage

Introducción. La úlcera péptica perforada es una de las afecciones abdominales críticas que requiere una intervención quirúrgica temprana. La fuga después de la reparación con parche de epiplón representa una de las complicaciones más devastadoras, que aumentan la morbilidad y la mortalidad. Nuestro estudio tuvo como objetivo evaluar los factores de riesgo y los predictores tempranos de fugas. Métodos. Análisis retrospectivo de los datos de los pacientes sometidos a reparación con parche de epiplón por úlcera péptica perforada, en el período comprendido entre enero de 2019 y enero de 2022, en el Hospital Universitario de Mansoura, Egipto. Se recogieron y analizaron estadísticamente variables pre, intra y postoperatorias. Los factores de riesgo asociados a la incidencia de fugas se analizaron mediante análisis univariado y multivariado. Resultados. Este estudio incluyó 123 pacientes que cumplieron con los criterios de inclusión. Se detectó fuga en siete (5,7 %) pacientes. Aunque las comorbilidades asociadas (p=0,01), el ingreso postoperatorio a la unidad de cuidados intensivos (p=0,03) y la hipotensión postoperatoria (p=0,02) fueron factores de riesgo en el análisis univariado, el shock séptico (p=0,001), el retraso en la intervención (p=0,04), la hipoalbuminemia preoperatoria (p=0,017) y el tamaño de la perforación mayor de 5 mm (p=0,04) se encontraron como factores de riesgo de fuga independientes en el análisis multivariado. Conclusión. Se detectaron como factores de riesgo independientes de fuga la presentación tardía en shock séptico, la hipoalbuminemia preoperatoria, la perforación prolongada, el intervalo operatorio y el tamaño de la perforación mayor de 5 mm. La taquipnea posoperatoria y la taquicardia con niveles elevados de proteína C reactiva y recuento leucocitario total son signos de alarma sobre la presencia de fuga.

Cardamonin exerts a protective effect against autophagy and apoptosis in the testicles of diabetic male rats through the expression of Nrf2 via p62-mediated Keap-1 degradation

Cardamonin (CARD) is a chalconoid with anti-inflammatory and antioxidant properties, and it is present in several plants. We sought to explore whether CARD exerts any positive effects against hyperglycemia-induced testicular dysfunction caused by type 2 diabetes and aimed to identify its possible intracellular pathways. Adult male rats were subdivided into six groups: control, CARD, diabetic (DM), DM + glibenclamide (GLIB), DM + CARD and DM + GLIB + CARD. Type 2 DM induced a significant increase in blood glucose and insulin resistance, along with diminished serum insulin, testosterone and gonadotropins levels, which were associated with the impairment of key testicular androgenic enzymes and cellular redox balance. Administration of CARD at a dose of 80 mg/kg for 4 weeks effectively normalized all of these alterations, and the improvement was confirmed by epididymal sperm analysis. After treatment with CARD, the pathological changes in spermatogenic tubules were markedly improved. Significantly, CARD upregulated testicular glucose transporter-8 (GLUT-8) expression and had inhibitory effects on elevated autophagy markers and caspase-3 immunoreactive cells. Furthermore, our results revealed that CARD was able to attenuate damage via activation of Nrf2 through the p62-dependent degradation of testicular anti-Kelch-like ECH-associated protein-1 (Keap-1). In conclusion, this study suggests that CARD provides protection against diabetic stress-mediated testicular damage. The use of CARD with conventional anti-diabetic therapy was associated with improved efficacy compared with conventional therapy alone.

Cardamonin exerts a protective effect against autophagy and apoptosis in the testicles of diabetic male rats through the expression of Nrf2 via p62-mediated Keap-1 degradation

Cardamonin (CARD) is a chalconoid with anti-inflammatory and antioxidant properties, and it is present in several plants. We sought to explore whether CARD exerts any positive effects against hyperglycemia-induced testicular dysfunction caused by type 2 diabetes and aimed to identify its possible intracellular pathways. Adult male rats were subdivided into six groups: control, CARD, diabetic (DM), DM + glibenclamide (GLIB), DM + CARD and DM + GLIB + CARD. Type 2 DM induced a significant increase in blood glucose and insulin resistance, along with diminished serum insulin, testosterone and gonadotropins levels, which were associated with the impairment of key testicular androgenic enzymes and cellular redox balance. Administration of CARD at a dose of 80 mg/kg for 4 weeks effectively normalized all of these alterations, and the improvement was confirmed by epididymal sperm analysis. After treatment with CARD, the pathological changes in spermatogenic tubules were markedly improved. Significantly, CARD upregulated testicular glucose transporter-8 (GLUT-8) expression and had inhibitory effects on elevated autophagy markers and caspase-3 immunoreactive cells. Furthermore, our results revealed that CARD was able to attenuate damage via activation of Nrf2 through the p62-dependent degradation of testicular anti-Kelch-like ECH-associated protein-1 (Keap-1). In conclusion, this study suggests that CARD provides protection against diabetic stress-mediated testicular damage. The use of CARD with conventional anti-diabetic therapy was associated with improved efficacy compared with conventional therapy alone.

Are routine post drain removal chest x-rays necessary after oesophagectomy?

Background: Routine chest X-rays (CXR) are often performed following the removal of chest drains placed during oesophagectomy. CXRs are costly and inconvenient for the patient, often being performed out of working hours. The aim of this study was to evaluate whether routine CXR is necessary following drain removal or if CXRs should only be performed when indicated by the clinical status of the patient.Methods: This was a retrospective study of oesophagectomies performed at a single high volume centre. Routine post chest drain removal CXRs were analyzed and compared to baseline post-operative CXRs. The clinical status of the patient before and after chest drain removal was recorded.Results: 188 patients were identified. 111/188 (59%) had a pleural effusion or pneumothorax on their baseline post-operative CXR. Abnormal findings on post drain removal CXR were common with 72/188 (38.3%) patients having a new or worse pleural effusion or pneumothorax. Only, 5.6% (11/188) of these patients actually developed clinical signs after chest drain removal. Of these, only 2.1% (4/188) required chest drain re-insertion. No patients underwent intervention without showing clinical deterioration. No re-intervention was prompted by CXR finding alone.Conclusions: Routine CXR following chest drain removal is unnecessary. It is safe to only perform CXRs on patients who develop clinical signs.

Plasma alpha-defensinlevels in smoker and non-smoker male patients with type 2 diabetes mellitus

Background: Alpha defensins were known to have broad spectrum potent antimicrobial activities

Objectives: To evaluate plasma alpha-defensin 1- 3 levels in smoker and non-smoker male patients with type 2 diabetes mellitus [T2DM]

Methodology: The subjects included 50 consecutive current smoker men with T2DM attending the outpatient clinic, Zagazig University Hospitals [Egypt], matched for age and diabetes duration with 50 consecutive non-smoker men with T2DM and 100 healthy men [50 smokers; 50 non-smokers]. Associations between a-defensin plasma levels and characteristics of participants were evaluated

Results: Plasma levels of a-defensins were significantly higher in smokers compared with non-smokers in diabetic and non-diabetic subjects [P<0.001 for all comparisons]. Ten characteristics of participants that significantly correlated with a-defensinswere further analyzed using stepwise multiple linear regression. The final model included four variables explaining 47.0% of the variation in a-defensin level. Presence of diabetes alone accounted for 32.6% of the variation. However, 40.1% of the variation in a-defensins could be explained by including current smoking

Conclusion: Plasma a-defensin 1-3 is elevated in patients with T2DM, and current smoking is combined with a further elevation. Given the known association between a-defensin and serious complications of diabetes, results of the current study should have important clinical implications in the management of patients with T2DM who smoke or think about smoking

Relação da satisfação dos familiares com os cuidados prestados em unidades de terapia intensiva: desfechos de qualidade em hospitais sauditas acreditados / Relating family satisfaction to the care provided in intensive care units: quality outcomes in Saudi accredited hospitals

RESUMO Objetivo: Identificar os níveis de satisfação dos familiares de pacientes internados em unidades de terapia intensiva. Métodos: Este foi um estudo analítico transversal. As unidades gerais de terapia intensiva oferecem uma variedade de serviços a pacientes clínicos e cirúrgicos. Para as finalidades deste estudo, um entrevistador treinado fez contato com familiares dos pacientes, antes ou após o horário de visita. Resultados: O estudo incluiu 208 participantes, sendo 119 (57,2%) do sexo masculino. Dentre os pacientes, 73 (35,1%) se encontravam em um hospital particular e 135 (64,9%) em um hospital público na cidade de Al Madinah Al-Munawarah. Todos os participantes eram membros da família ou amigos de pacientes admitidos às unidades de terapia intensiva dos hospitais. As respostas de ambos os grupos proporcionaram escores baixos nos índices de satisfação. Observou-se, porém, um escore relativamente elevado nas respostas às questões 2, 6 e 10, concernentes, respectivamente, aos cuidados proporcionados pela equipe do hospital a seus pacientes, à atitude de cortesia dos membros da equipe das unidades de terapia intensiva para com os pacientes, e à satisfação dos pacientes com os cuidados médicos proporcionados. O escore foi muito baixo para o item 11, relacionado à possibilidade de melhorias nos cuidados médicos que os pacientes recebiam. Em geral foi relatada uma satisfação maior com os serviços oferecidos pelas unidades de terapia intensiva dos hospitais públicos, em comparação com a satisfação com os cuidados oferecidos pelas unidades de terapia intensiva dos hospitais privados. Conclusão: Em geral, foi obtido um escore baixo nos índices de satisfação, recomendando-se a realização de outros estudos para avaliar a situação atual, e melhorar a satisfação e a qualidade dos serviços fornecidos pelas unidades de terapia intensiva.

ABSTRACT Objectives: This study aims to identify the satisfaction levels of the family members of patients in intensive care units. Methods: This is a cross-sectional analytical study. General intensive care units offer a variety of services to clinical and surgical patients. For the purpose of this study, a trained interviewer communicated with the families of patients, either before or after visiting hours. Results: The study included 208 participants: 119 (57.2%) males and 89 (42.8%) females. Seventy-three (35.1%) of the patients attended a private hospital, and 135 (64.9%) attended a public hospital in the city of Al Madinah Al- Munawarah. All of the participants were either family members or friends of patients admitted to the intensive care units at the hospitals. The responses of both groups yielded low scores on the satisfaction index. However, a relatively high score was noted in response to questions 2, 6, and 10, which concerned the care that was extended by the hospital staff to their patients, the courteous attitude of intensive care unit staff members towards patients, and patients' satisfaction with the medical care provided, respectively. A very low score was obtained for item 11, which was related to the possibility for improvements to the medical care that the patients received. Overall, greater satisfaction with the services offered by the public intensive care units was reported compared to the satisfaction with the services offered by the private intensive care units. Conclusion: An overall low score on the satisfaction index was obtained, and further studies are recommended to assess the current situation and improve the satisfaction and quality of care provided by intensive care units.

Urolithiasis visits and trends

Background: Urolithiasis is the third most frequent urological disease in the world, affecting both males and females. It is one of the most common conditions encountered in Emergency Departments [ED] worldwide

Objective: To evaluate the frequency of visits and hospital admissions related to urolithiasis. Design: A Retrospective Review. Setting: Emergency Department, King Hamad University Hospital, Bahrain

Result: Four hundred eighty-six patients were diagnosed for the first time with urolithiasis. The mean number of the patients is 40.5 per month; the highest was 70 [14.4%] patients in May 2014 and the lowest was 23 [4.7%] patients in December 2014. Four hundred four [83.1%] males were diagnosed with urolithiasis. There was almost no difference between the number of Bahraini patients and non-Bahraini patients, 237 [48.8%] and 249 [51.2%] respectively. The age group frequently affected are those between 20 to 49 years. The majority of the stones were located in the ureter and/or in the kidney. Two hundred thirty-six [48.6%] patients had ureteric stones, and 109 [22.4%] patients had kidney stones. One hundred twenty [24.7%] patients had both kidney and ureteric stones. Thirteen 13 [2.7%] patients had stones in the bladder and 3 [0.6%] patients in the urethra. Two [0.4%] patients had stones in the bladder and the kidney. Three [0.6%] patients had stones in the bladder and ureter

Conclusion: This study is the first to address urolithiasis incidence in emergency department and trends of hospitalization. Further multicentric studies investigating contributing factors and prevalence of urolithiasis are needed

Chromosomal abnormalities and autism

Background: Autism is a neurodevelopmental disorder characterized by clinical, etiologic and genetic heterogeneity. Many surveys revealed cytogenetically visible chromosomal abnormalities in 7.4% of autistic patients documented as well as several submicroscopic variants. This study had been conducted to identify some aspects that might be involved in the pathogenesis of autism which is necessary for offering proper genetic counseling to families of autistic patients and their role in the prenatal diagnosis of autism

Methods: This cross sectional study was conducted at the Child Psychiatry Clinic, Pediatric Hospital, Ain Shams University on 30 autistic patients who were subjected to the following tools: Confirmation of diagnosis using DSM-IV-TR criteria, IQ assessment using Stanford-Binet intelligence scale and assessment of severity of autistic symptoms using childhood autism rating scale [CARS]. Full clinical examination, neurological examination, EEG, audiological assessment were also done. High resolution karyotyping was done for detection of numerical or structural chromosomal abnormalities as deletion, duplication, translocation of chromosomes

Results: All the results of cytogenetic analysis were normal with no detectable numerical or structural chromosomal abnormalities. Males are affected more than females, only one case had history of drug intake [progestin], two cases had history of anti-D injection and two cases had history of diabetes mellitus during pregnancy. Four cases had history of respiratory distress and seven cases had history of jaundice. Two cases had history of generalized tonic clonic convulsion and four cases had history of EEG abnormalities. Fifteen cases of our autistic patients had mild mental retardation and six cases had moderate mental retardation

Conclusion: Chromosomal abnormalities were not detected in the studied autistic children, and so the relation between the genetics and autism still needs further work up with different study methods and techniques

Proposed model for the interface design electronic newspaper for youth of universityin light of recent technological techniques

Aims: The study aimed to identify the extent of the use of university youth of electronic newspapers and to identify the types of fonts, graphics, shapes, titles, sounds and images used in the output interfaces of those newspapers, and learn how to design a proposed model of the facade of an electronic newspaper for youth university

Sample: The study sample consisted of a sample of university youth, with a sample of the study 100 single of university youth, male and female from Damietta University

Tools: A questionnaire to get to know the views of students in the design and interface electronic newspaper that meet their needs

Results: The study found a range of results including There is a difference between the main web page of electronic newspapers and the main page of printed newspapers, where the main web page of electronic newspapers containing side list serves as an index for doors and summaries of news, and the printed newspapers are read vertically on large pages with an average 2.91, The presence of the electronic newspaper on a continuous basis where the browser able to visit the newspaper site at any time without yielding to the factor of time or time, while the printed newspaper found in specific dates and specific copies are printed and distributed in a specific area of an average of 2.74, And home electronic newspapers are Interactive between them and their users through [Comments-e-mail-electronic surveys-Social Networking-Chat-blogs], this command is not available on the home page of the newspapers printed an average of 2.70, and that 95% of respondents agree with the idea of designing the main interface for the electronic newspaper which meet their needs, and 5% of them do not agree with the idea of interface design electronic newspaper. Hence the existence of differences in the extent to approve the idea of clear design the main interface for the electronic newspaper, which means the high number of respondents who agree with the idea of the design of the main interface for the electronic newspaper which meet their needs

Patient perceptions regarding information given on hospital discharge in Almadinah Almunawwarah, Kingdom of Saudi Arabia

Patients must be the focus when planning a hospital discharge process. Patient discharge information is what the patients and/or their families expect to receive from the health professionals whom treated them before they are discharged from a hospital or clinic. This information is given in terms of the physical, psychological, and social aspects in relation to the various health conditions. The objective of this study is to investigate patients' perception and satisfaction regarding the information given to them on hospital discharge. This is an observational and analytical cross-sectional study implemented in the city of Almadinah Almunawwarah, Kingdom of Saudi Arabia. Time bound sampling technique was used over a period of three months to interview patients or those who accompany them in the outpatient clinics at public and private hospitals in Almadinah Almunawwarah. A self-administered questionnaire was used to assess the level of satisfaction with the quality of the information given to patients or those who accompany them on their hospital discharge. The mean age of the participants was 34.23 +/- 9.34 years. Public hospitals had more admissions among the sample, accounting for around 63% compared to 37% for private hospitals. Satisfaction with information about what the patients need to do after leaving the hospital and about the potential complications of their medical problems was higher in private hospitals [P < 0.05*]. Satisfaction with information about dietary plans and the arrangements done by the hospitals for the follow-up after discharge was highly significant in private hospitals compared to public hospitals [P < 0.001**]. Patients admitted for causes related to obstetrical or gynecological issues were more satisfied with the information about whom to call in emergency situations [P < 0.05*] and on how to care for surgical or wound sites [P < 0.01**]. There is an urgent need for health planners and professionals to formulate detailed, written patient discharge information plans that have all the information the patients may need during and after their discharge from the hospital/clinic

Patient satisfaction from dental services provided by the college of dentistry, taibah university, Saudi Arabia

Quality is a major concern of health care agencies all over the world. Patients' satisfaction has been investigated in many colleges of dentistry in various countries. Dental complaints made by patients may cause a great deal of anxiety and stress among dental care providers. It is important for the profession to promote high standards of professional conduct among dentists. The aim of this study is to determine patients' satisfaction regarding the quality of dental care at dental clinics of the College of Dentistry at Taibah University. A cross sectional analytical observational study was conducted at the dental clinics of the College of Dentistry at Taibah University. A random sampling technique was employed over a threemonth period;March 1st-May 31st 2012. A self administered [Arabic/English] questionnaire was used. A total of 202 patients qualified for the study, but only 162 agreed to participate with a response rate of 80.19: [55.6%] were Saudi nationals and 44.4% were Non-Saudis. The overall ranking of factors related to satisfaction revealed a mean percentage of 79.5% agreement for the 4 disciplines of satisfaction denoting a high level of satisfaction. The association between respondents' nationality and the characteristics of the four disciplines of satisfaction revealed significant difference between Saudi and Non Saudis. The majority of patients were satisfied with the patient-dentist interaction, technical competency, administrative efficiency and clinic set up environment at the dental clinics of the College of Dentistry at Taibah University. Continuous evaluation of patient satisfaction is to be part and parcel of the oral health care delivery by the College of Dentistry at Taibah University to ensure patient satisfaction.

Neurology intensive care unit-symptomatic nosocomial urinary tract infections: management and prognosis

Background: nosocomial urinary tract infection [NUTI] is the most common infections in intensive care unit [ICU] with a considerably high mortality and morbidity rates. It is a cause of concern and major pool of resistant pathogens

Objective: this is a prospective study conducted to detect the frequency of NUTI, common microorganisms, the risk factors and mortality in neurological ICU [NICU] at Mansoura University Hospital

Patients and methods: the current study enrolled patients who were admitted to NICU for >/=48 hrs. From August 2009 to Sept 2010. Three hundred ninety-six patients [190 males and 206 females with median age 60 years] were enrolled in the present work NUTI were diagnosed according to the CDC definition for patients who had urinary catheters. The following risk factors, age, sex, length of stay, duration of catheterization, immuno-compromised and risk of mortality, were studied. As well, isolation, identification and antimicrobial susceptibility were performed. An Enterobacter cloacae outbreak of UTI was detected. Typing and tracing of the source of infection was confirmed using ERIC-PCR

Results: NUTI frequency rate was 20.5%. The NUTI rate were high among old age, female, prolonged hospitalization, catheterization and immunocompromised patients. The mortality rate among NUTI patients was not significantly high. E. coli was the most common isolate [27.3%] which had maximum sensitivity to amikacin followed by meropenem. ERIC showed the same banding patterns among isolates from the three patients and hands of a nurse who was considered as the source of the outbreak

Conclusion: prevention of NUTI clearly represents a real challenge that faces the health care field especially in ICUs. No doubt, effective interventions will be a critical step in the battle against antibiotic resistance and outbreak emergence in ICUs

Women and epilepsy: Sudanese experience

Epilepsy is equally prevalent in men and women. However, for women there are unique concerns related to hormone effects on seizures and the effects of seizures and antiepileptic drugs [AEDs] on reproductive health. Some AEDs reduce the efficacy of oral contraceptive agents, increasing the probability of unplanned pregnancies. Seizure frequency may change during pregnancy, seizures may cause pregnancy complications, and the treatment of a woman with epilepsy must consider all these issues. To study the clinical presentation of epilepsy among adult Sudanese females and to verify aspects of epilepsy specific to women. This is a cross sectional descriptive non intervention clinical based study; it was carried out in Elshaab Teaching Hospital and El-shiekh Mohamed Kheir charity clinic, from February-2008 to June-2008. 630 female patients with epilepsy were included in the study. The study showed that 72% of the patients had generalized epilepsy and 28% had partial epilepsy, primary epilepsy is more common than secondary epilepsy, 54% of our patients had warning symptoms and 39.7% had triggering factors, irregular menstrual cycle was observed in 28%, 22% of our patients had catamenial seizures, 7.1% had increased frequency of seizures during pregnancy. Obstetric complications were common among our studied group. The incidence of infertility increased among our studied group. Women had differences in presentation and control of epilepsy that must be understood and considered when treating women with epilepsy

Study the relationship betweeen intercellular adhesion molecules [ICAM] and insulin resistance among type 2 Egyptian diabetic patients with nephropathy

Type 2 Diabetes is the common form of diabetes accounting for 90% of diabetic cases. As the incidence of type 2 diabetes is increasing the development of diabetic nephropathy. Nephropathy is one of the serious long-term complications of diabetes and may develop in 30-40% of diabetes mellitus patients. Endothelial inflammation has been implicated in the development of diabetic nephropathy. Type 2 diabetic patients usually present endothelial dysfunction. Reduction of endothelial function in type 2 diabetic patients stimulates inflammation and increases the levels of circulating soluble adhesion molecules [Intercellular adhesion molecules [ICAM]]. Cell adhesion molecules are important in promoting the inflammatory response. The aim of the present study is to determine plasma concentration of ICAM-1 as a marker for endothelial activation among type 2 diabetic patients with or without nephropathy [as tool in early diagnosis of nephropathy as major diabetic complications] also to explore the relationship between plasma level of ICAM-1 and insulin resistance in the studied patients. This study includes 70 subjects; 50 patients with type 2 diabetes mellitus were divided into two groups; First group consisted of 20 type 2 diabetic patients without complications. The second group comprised 30 type 2 diabetic patients with nephropathy. The third group [healthy controls] includes 20 non-diabetic subjects without a family history of diabetes mellitus. The results show that the mean sICAM-1 level was significantly higher in the diabetic patients with nephropathy than in those without nephropathy and in the controls .Also insulin level increase in diabetic patients than control. In addition positive correlation between ICAM-1 and insulin resistance in studied subjects. It can be concluded that the association between ICAM-1 expression and insulin resistance found in this study is consistent with clinical evidence relating insulin resistance and inflammation and high levels of sICAM-1 suggest that sICAM-1 may play a role in the development of nephropathy in patients with type 2 diabetes mellitus and can be use as a marker for early diagnosis of nephropathy as a major diabetic complications

Aortic elastic-properties in offspring of hypertensive patients

The main objective of this study is to detect the changes might affect the elastic properties of large central arteries in normotensive offspring of known hypertensive parents, and to compare these changes to normal age-matched offspring of normal individuals. Also, to correlate age and gender effects on the results obtained. Arterial stiffening is associated with a number of known cardiovascular disease risk factors, raising the possibility that increased arterial stiffness may be a marker for advanced atherosclerotic vascular disease. The vascular dynamics of children with a parental history of hypertension is a cornerstone of early detection of functional and morphologic abnormalities of the arterial wall that may be responsible for many cardiovascular and cerebro-vascular complications in their future life. The study includes sixty subjects [ages 15-30 years], all were clinically healthy by applying exclusion criteria, full history and clinical examination. They are divided based on their family history of hypertension into two groups, group-I 30 offspring with a parental history of hypertension and group-Il 30 off-spring of normotensive parents. All subjects were evaluated to obtain systolic, diastolic and pulse pressure readings then, M-mode echocardiography is done to study their aortic elastic properties. After collection of both clinical [blood-pressure] and Echocardiographic data, analyses of the results revealed a significant elevation of all blood pressure parameters in group-I than group-Il with systolic Bp of mean +/- SD [118.5 +/- 9.7 in group-I versus 106 +/- 4.9 mmhg in group-Il], diastolic Bp [66.8 +/- 5.7 for group-I versus 62.8 +/- 8.0 mmhg in group-II] and a net increase in pulse pressure in group-I than group-Il [51.6 +/- 10.5 versus 43.1 +/- 6.2]. Comparing aortic diameters of two groups revealed that, a non-significant increase in systolic diameter in group-I [p=non-significant], significant increased diastolic diameter in group-I with mean +/- SD [29.8 +/- 2.3 versus 28.0 +/- 1.3 mm in group-II, p=0.01]. Group-Il subjects exhibit an increased Ao-diameter change property with mean +/- SD [3.7 +/- 0.4 versus [2.6 +/- 0.5 mm in group-I] reflecting impression of enhanced their aortic elastic feature. Comparing aortic stiffness parameters in between the two groups revealed a significant [p=0.001] difference in all parameters. Group-I showed decreased aortic strain, decreased distensibility and increased aortic stiffness in relation to group-II with Ao-strain of mean +/- SD [8.9 +/- 1.8 in group I versus 13.4 +/- 1.6 for group-II], Ao-distensibility [3.1 +/- 0.8 in group-I versus 5.0 +/- 1.1 cm2 dyne-1 in group-Il], and Ao-stiffness is [0.21 +/- 0.02 in group-I versus 0. 12 +/- 0.02] in group-Il. In a trial to study the effect of blood pressure on aortic stiffness, It was found that, systolic blood pressure is positively correlated to increased aortic stiffness, with p-value of 0.001 and coeffIcient correlation r 0.66 and is negatively correlated to both aortic strain and distensibility [p value 0.001, r - 0.61 and p 0.001 and r - 0.57] respectively. Correlation made to study the effect of age and gender on Ao elastic properties revealed that, there's a positive age related increased aortic stiffness [p value = 0.02, r 0.28] and a negative correlation to aortic distensibility [p = 0.01, r - 0.32]. Detection of the effect of gender variation on the results was obvious in group-I as males were found to have a significantly [p=0.001] higher Ao stiffness than females with mean +/- SD [0.20 +/- 0.002] in males versus [0.14 +/- 002] in females. Females are found to have a significant higher aortic strain and distensibility [p=0.001 for strain and 0.03 for distensibility] with mean +/- SD Ao strain [12.2 +/- 2.3 for females and 9.7 +/- 2.9 for males], however, Ao distensibility was [4.4 +/- 0.9 for females and 3.6 +/- 1.7 for males]. Group-I was found to have a higher PP and less change in Ao diameters between systole and diastole, and this is reflected on increased Ao stiffness parameters in their results with lower distensibility and strain. Age is found to be highly correlated to increased Ao stiffness and decreased distensibility. Also, males possessing a higher than females Ao stiffness results

Study of the neurologic soft signs in a sample of obsessive compulsive patients and its correlation with the severity of obsessive compulsive symptoms and the degree of insight

Is to detect the presence of Neurologic Soft Signs [NSS] in a group of patients having Obsessive Compulsive Disorder [OCD] and its correlation to the clinical presentation of OC symptoms and the degree of insight. 50 patients with OCD and 50 healthy subjects were assessed for the presence of NSSs by using physical and neurological examination of soft signs scale [PANESS]. In the patients group, Yale-Brown OC scale [Y-BOCS], and scale to Assess Unawareness of Mental Disorder will be used to evaluate the severity of OC symptoms and the degree of insight. The total mean NSS score was significantly higher in patient group compared to control group [P=0.000] as regard the following items of PANESS [balance, motor movement, and graphesthesia]. The total NSS score was positively correlated with total OC symptoms score and duration of illness. Also, patients with poor insight had a significantly higher soft sign mean score than patients with good insight. Neurological soft signs are likely to relate to both structural and functional brain abnormalities that the affected regions of the brain for NSS probably resemble those in OCD, and that NSSs may be followed by the symptoms of OCD

Cognitive effects of antiepileptic drug therapy on children born to epileptic mothers

Is to evaluate the long term effect of antiepileptic drugs [AEDs] on some cognitive functions in prenatally exposed children of mothers with epilepsy. Thirty children aged between 5 and 12 years, born to mothers with epilepsy were recruited from epilepsy clinic of neuropsychiatric Department of Alexandria Main University Hospital. Fifteen of them were exposed to AED in-utero and fifteen were unexposed. We compared them with control group of 15 children matched for age, education, and socio-economic level. Structured interviews, electroencephalogram and psychometric tests, Wechsler Intelligence Scale for Children III [WISC III] were applied to each child. Children of mothers with epilepsy have lower scores in the mean verbal, performance, as well as full scale IQS. Children exposed to valproate monotherapy and those exposed to polytherapy have reduced verbal IQ compared with other study group and control children. This study highlight the potential harmful effects of in-utero exposure to AEDs on neuropsychological development. The pattern of cognitive changes depends on two factors, one of them is exposure to seizures, the other is whether the mothers' were on monotherapy versus polytherapy

Assessment of physicians' recordings in admitted patient's charts: Al-Gaumhoria Teaching Hospital, Aden

This study was designed to assess the admitted patient's charts at Al-Gaumhoria Teaching Hospital, Aden. The total patients' charts were 172 [60 from the medical wards and 112 from the surgical wards] who were admitted to the medical and surgical wards during September to November 2005 and discharged alive. Fourteen variables from the chart were chosen. They were demographic data, date of admission, chief complain, history of present illness, past history, family history, physical examination, differential diagnosis, initial therapy, signature and stamp of physician who admitted and discharged the patient, final diagnosis, daily follow up, and date of discharge. The parameter for the findings was the percentage of registered and unregistered variable. For the total charts, we found deficiency in recording the variables of signature and stamp of physicians by discharging patient 65.1%, final diagnosis 55.8%, demographic data 43%, date of discharge 40.1%, family history 34.3% and past history 27.9%. The rest unregistered variables ranged between 12.2% and 3.5%. We concluded that negligence of physicians and deficiency in recording the full items in patient's chart is attributed to the following factors: deficiency of supervision of head of departments, deficiency in knowledge of medical ethics and importance of patient's chart, deficiency of guidelines and lack of the coordination between faculty of medicine, teaching-hospitals administrations and the Yemeni Council for medical Postgraduate studies

Role of infra-popliteal balloon angioplasty in the management of critical limb ischemia

The purpose of this study was to evaluate the patency rate and effectiveness of the percuatanous trans-luminal angioplasty [PTA] as a primary therapy for infra-popliteal occlusive disease. Twenty patients had angioplasty for Critical lower limb ischemia due to infra-popliteal disease between May 2005 - May 2007. We collected data on patient demography, symptoms, as will as pre and post procedure ankle - brachial pressure index [ABI] and angiographic findings. Thirteen men and 7 women had a mean age of 62 years. Risk factors included smoking in 70%, diabetes in 60%, hypertension in 40%, and end -stage renal disease in 1%. The indication for intervention were persistent rest pain in 50%, foot ulcer 30% and gangrene of foot or toes 20%. Immediate results were good in 19 patients with one case of technical failure .Three patients had restenosis at mean period of 7 months. There was one major and three minor amputations. Average follow up was11.2 months. The mean post procedural increase in ABI was 0.29. PTA of the infra-popliteal vessels has low morbiditiy, high success rate, and acceptable patency rate