Role of mri in detection of repaired cleft palate muscles and correlation to speech

Background: Cleft palate is a birth defect when the roof of the mouth contains an opening into the nose. It occurs in about 1:2 per 1000 births. These disorders can result in speech disorders, feeding problems and frequent ear infections. It is the result of tissues of the face not joining properly during development. Speech therapy and dental care may also be needed. Approximately 30 percent of patients having undergone cleft palate repair require secondary surgery for velopharyngeal dysfunction. Magnetic resonance imaging [MRI] is one of the common used tests in variable fields of medicine and surgery. Now trials are done for use of MRI in the postpalatoplasty velopharyngeal dysfunction patients

Objective: This study aims to detect static craniofacial and velopharyngeal measures of repaired cleft palate patients specially repaired muscle state [levator veli palatini muscle] by using MRI and correlate these data to speech state

Patients and Methods: this prospective study conducted in AlAzhar and Beni-suef University Hospitals in the period of February 2018 till November 2018. It is conducted on twenty children who complained of post-palatoplasty velopharyngeal dysfunction and examined by nasendoscopy and speech analysis then MRI palate was done using 1.5 T MRI; to correlate MRI data to speech data

Results: our statistical results revealed significant decrease in the velopharyngeal variants than normal ranges. That prove that static MRI is a valid procedure for diagnosis of anatomical abnormality. But after correlation with speech data it showed that it should be accompanied with dynamic procedure [e.g. Nasendoscopy] especially in patients with normal ranged anatomy

Conclusion: this study was done in variant range of children who suffer from post-palatoplasty speech abnormality, scanned by MRI palate and correlate these data by speech data. Static MRI is efficient technique to demonstrate structural defects in these patients

Evaluation of circumcision in male babies during neonatal period

Circumcision is one of the oldest surgical procedure performed today. The present study was performed to find a suitable age for adequate and satisfactory circumcision in male babies. It includes 100 male babies; fifty were circumcised early in the neonatal period and the other fifty at around 5 months of life. Tight frenula band was present in 60% of the early circumcised group and in [16%] of the late circumcised group. Easy retraction of the prepuce was done more frequently in the late group. Wound crust formation, infection and perimeatal inflammation occurred in 40%, 28%, 12% of the early group, while in the late group it was 6%, 10%, 4% respectively. In conclusion, Circumcision in male babies performed later around 5 months of age is more easier and results in fewer complications than circumcision done in the early neonatal period

Efficacy of long acting theophylline as a single therapy in the management of mild persistent asthma

Medications for management of asthma in pediatrics include both relieves and controllers. Controllers are medications taken daily on a long term basis to achieve and maintain control of asthma. Theophylline has anti-inflammatory, immunomodulatory and bronchoprotective effects that contribute to its efficacy as preventive therapy for chronic asthma. The present study aimed to evaluate the pattern of prophylactic asthma medications used in asthmatic children in Fawzy Moaz allergy, Ministry of health, Alexandria and to spotlight on the role of long acting theophylline in the chronic management of asthma. In the present study, most cases of mild persistent asthma [96.2%], received long acting theophylline only for prophylaxis. In patient with moderate persistent asthma, [67.8%] were on low dose inhaled steroid and long acting theophylline while, [32.2%] were receiving moderate dose inhaled steroid only as a prophylactic therapy. Throughout the follow up period, the frequency of exacerbation was reduced to less than once month in 96.1%, 94% of asthmatics receiving long acting theophylline only and inhaled steroid only respectively with no statistically significant difference. Regarding asthmatic children who required shifting up in prophylactic therapy, 21.1% and 31.6% of those on long acting theophylline only and inhaled steroid only respectively required stepping up in prophylactic medications

Heart rate variability in patients with unstable angina

Objective: the aim of this work is to study HRV parameters in patients with unstable angina

Materials and Methods: the study comprised 50 patients with unstable angina; 35 males and 15 females with mean age 45 +/- 94 yrs. beside ten healthy control subjects. All patients and control subjects were subjected to thorough history taking, full clinical examination, electrocardiography, routine laboratory investigations, assessment of heart rate variability [HRV] using time domain [NN 50 and RMSSD] for non-spectral analysis and frequency domain [LF, HF and LF / HF ratio] for spectral analysis, echocardiographic examination and coronary angiography

Results: there was significant global reduction in HRV parameters in patients with unstable angina compared to control group as mean NN 50 was 3.2 ms in patients compared to 20.1 ms in control group [P < 0.01]. Mean RMSSD was 10.1 ms in patients us 42.1 ms in control group [P < 0.01], HF was 50 ms2 in patients us 350 ms2 in control group and HF was 32.5 ms2 in patients compared to 246 ms2 in control group. However, there was no significant difference between the patients and controls as regards LF/HF ratio [P > 0.05]. Mean W H F ratio was significantly higher. Among patients who experienced recurrent chest pain during hospitalization as the mean LF/HF ratio among five patients who developed recurrent chest pain was 1.9 vs 1.5 in other patients [P < 0.05]. There was significant correlation between HRV and both EF [r = 0.8, P < 0.05] and severity of coronary artery disease [r = 0.7, P < 0.05]. There was no significant correlation between HRV and age [r = 0.2, P > 0.05, end systolic diameter [r = 0.3, P > 0.05] and end diastolic diameter [r = 0.02, P > 0.05] of the left ventricle

Conclusion: all parameters of HRV except LF/H.F ratio were significantly lower among patients with unstable angina compared to control group. HF/HF ratio in particular was significantly lower among patients who experienced recurrent chest pain during hospitalization. Finally there was positive correlation between HRV parameters .and both EF and severity of coronary heart disease

Comment: HRV can be a useful parameter for risk stratification of patients with unstable angina