Coenzyme Q10 mitigates cadmium cardiotoxicity by downregulating NF-κB/NLRP3 inflammasome axis and attenuating oxidative stress in mice.

Coenzyme Q10 (CoQ10) occurs naturally in the body and possesses antioxidant and cardioprotective effects. Cardiotoxicity has emerged as a serious effect of the exposure to cadmium (Cd). This study investigated the curative potential of CoQ10 on Cd cardiotoxicity in mice, emphasizing the involvement of oxidative stress (OS) and NF-κB/NLRP3 inflammasome axis. Mice received a single intraperitoneal dose of CdCl2 (6.5 mg/kg) and a week after, CoQ10 (100 mg/kg) was supplemented daily for 14 days. Mice that received Cd exhibited cardiac injury manifested by the elevated circulating cardiac troponin T (cTnT), CK-MB, LDH and AST. The histopathological and ultrastructural investigations supported the biochemical findings of cardiotoxicity in Cd-exposed mice. Cd administration increased cardiac MDA, NO and 8-oxodG while suppressed GSH and antioxidant enzymes. CoQ10 decreased serum CK-MB, LDH, AST and cTnT, ameliorated histopathological and ultrastructural changes in the heart of mice, decreased cardiac MDA, NO, and 8-OHdG and improved antioxidants. CoQ10 downregulated NF-κB p65, NLRP3 inflammasome, IL-1ß, MCP-1, JNK1, and TGF-ß in the heart of Cd-administered mice. Moreover, in silico molecular docking revealed the binding potential between CoQ10 and NF-κB, ASC1 PYD domain, NLRP3 PYD domain, MCP-1, and JNK. In conclusion, CoQ10 ameliorated Cd cardiotoxicity by preventing OS and inflammation and modulating NF-κB/NLRP3 inflammasome axis in mice. Therefore, CoQ10 exhibits potent therapeutic benefits in safeguarding cardiac tissue from the harmful consequences of exposure to Cd.

Biomarker discovery and validation for gastrointestinal tumors: A comprehensive review of colorectal, gastric, and liver cancers.

Gastrointestinal (GI) malignancies, encompassing gastric, hepatic, colonic, and rectal cancers, are prevalent forms of cancer globally and contribute substantially to cancer-related mortality. Although there have been improvements in methods for diagnosing and treating GI cancers, the chances of survival for these types of cancers are still extremely low. According to the World Cancer Research International Fund's most recent figures, stomach cancer was responsible for roughly one million deaths worldwide in 2020. This emphasizes the importance of developing more effective tools for detecting, diagnosing, and predicting the outcome of these cancers at an early stage. Biomarkers, quantitative indications of biological processes or disease states, have emerged as promising techniques for enhancing the diagnosis and prognosis of GI malignancies. Recently, there has been a considerable endeavor to discover and authenticate biomarkers for various GI cancers by the utilization of diverse methodologies, including genomics, proteomics, and metabolomics. This review provides a thorough examination of the current state of biomarker research in the field of gastrointestinal malignancies, with a specific emphasis on colorectal, stomach, and liver cancers. A thorough literature search was performed on prominent databases such as PubMed, Scopus, and Web of Science to find pertinent papers published until November, 2023 for the purpose of compiling this review. The diverse categories of biomarkers, encompassing genetic, epigenetic, and protein-based biomarkers, and their potential utility in the fields of diagnosis, prognosis, and treatment selection, are explored. Recent progress in identifying and confirming biomarkers, as well as the obstacles that persist in employing biomarkers in clinical settings are emphasized. The utilization of biomarkers in GI cancers has significant potential in enhancing patient outcomes. Ongoing research is expected to uncover more efficient biomarkers for the diagnosis and prognosis of these cancers.

The Quality of Discharge Summaries at Al-Shaab Hospital, Sudan, in 2022: The First Cycle of a Clinical Audit.

Background The discharge summary is a vital component of the modern health system. It is defined as a synopsis of information regarding events occurring during the inpatient care of a patient, to allow for a safe, quick, and effective patient-centered discharge process. It contains important information about the patient's hospital stay, including the reason for admission, treatment received, and follow-up needed. Low-quality discharge summaries pose a great risk to patient healthcare since the most frequent reason for error in clinical settings is poor communication. In the United Kingdom, the Professional Record Standards Body (PRSB) has adopted the Academy of Medical Royal Colleges (AoMRC) "Standards for the Clinical Structure and Content of Patient Records" and produced a standard discharge summary form. This study aimed to assess the quality of discharge summaries at Al-Shaab Hospital in Sudan in terms of information, filling adequacy, and adherence to international guidelines and evaluate the discharge interviews. Methods A cross-sectional institution-based study was conducted in the period of September to December 2022 at Al-Shaab Teaching Hospital in Khartoum, Sudan. Systematic random sampling was used to select the study participants from the discharged patients. A total of 70 patients were met in their wards over a period of two months, and the contents of their discharge cards were compared to items on an online checklist based on the Professional Record Standards Body (PRSB) and the Academy of Medical Royal Colleges (AoMRC) standard discharge summary. The patients were also interviewed to assess their knowledge regarding their discharge information. Results The hospital's discharge summary form contained only four headings: date, patient name, age, and ID number. The assessed cards were found to be missing valuable information, including date of admission (missing in 83%), filling doctor's name (missing in 71%), and medication changes (missing in 70%). Only half of the summaries were clearly readable. The majority of patients had poor knowledge regarding their medication side effects (89%) and how to act in an emergency (86%), while knowledge of medication doses and follow-up details was good in 80% and 66%, respectively. Conclusion The patients are discharged with inadequately filled discharge forms. This may be due to the poor design of the form, so a newly designed form will be proposed, based on international standards. The discharge interview is also in need of improvement, to make sure patients are fully aware of their condition.

Prognostic Values of Gene Copy Number Alterations in Prostate Cancer.

Whilst risk prediction for individual prostate cancer (PCa) cases is of a high priority, the current risk stratification indices for PCa management have severe limitations. This study aimed to identify gene copy number alterations (CNAs) with prognostic values and to determine if any combination of gene CNAs could have risk stratification potentials. Clinical and genomic data of 500 PCa cases from the Cancer Genome Atlas stable were retrieved from the Genomic Data Commons and cBioPortal databases. The CNA statuses of a total of 52 genetic markers, including 21 novel markers and 31 previously identified potential prognostic markers, were tested for prognostic significance. The CNA statuses of a total of 51/52 genetic markers were significantly associated with advanced disease at an odds ratio threshold of ≥1.5 or ≤0.667. Moreover, a Kaplan-Meier test identified 27/52 marker CNAs which correlated with disease progression. A Cox Regression analysis showed that the amplification of MIR602 and deletions of MIR602, ZNF267, MROH1, PARP8, and HCN1 correlated with a progression-free survival independent of the disease stage and Gleason prognostic group grade. Furthermore, a binary logistic regression analysis identified twenty-two panels of markers with risk stratification potentials. The best model of 7/52 genetic CNAs, which included the SPOP alteration, SPP1 alteration, CCND1 amplification, PTEN deletion, CDKN1B deletion, PARP8 deletion, and NKX3.1 deletion, stratified the PCa cases into a localised and advanced disease with an accuracy of 70.0%, sensitivity of 85.4%, specificity of 44.9%, positive predictive value of 71.67%, and negative predictive value of 65.35%. This study validated prognostic gene level CNAs identified in previous studies, as well as identified new genetic markers with CNAs that could potentially impact risk stratification in PCa.

Betulin prevents high fat diet-induced non-alcoholic fatty liver disease by mitigating oxidative stress and upregulating Nrf2 and SIRT1 in rats.

Non-alcoholic fatty liver disease (NAFLD) is a common chronic hepatic disorder characterized by hepatic lipid accumulation. This study explored the effect of betulin (BE), a terpenoid with promising antioxidant, anti-inflammatory and insulin sensitizing effects, on NAFLD induced by high fat diet (HFD). Rats received HFD and BE (15 and 30 mg/kg) for 12 weeks and blood and liver samples were collected for analyses. HFD caused hyperlipidemia, cholesterol and triglycerides accumulation in the liver, hepatocellular ballooning, fibrosis, insulin resistance (IR), lipid peroxidation (LPO), and NF-kB p65 upregulation. BE ameliorated serum and liver lipids, blood glucose and insulin, liver LPO, prevented steatosis and fibrosis, suppressed NF-kB p65 and enhanced antioxidants in HFD-fed rats. BE downregulated acetyl-CoA carboxylase (ACC1) and fatty acid synthase (FAS), and upregulated Nrf2, HO-1 and SIRT1 in the liver of HFD-fed rats. In silico investigations revealed the binding affinity of BE towards FAS, NF-kB, Keap1, HO-1 and SIRT1. In conclusion, BE attenuated HFD-induced NAFLD by ameliorating hyperlipidemia, IR, lipogenesis, liver lipid accumulation, and oxidative stress. The protective effect of BE was associated with enhanced Nrf2/HO-1 signaling and SIRT1.

A Potential Link Between Visceral Obesity and Risk of Alzheimer's Disease.

Alzheimer's disease (AD) is the most common type of dementia characterized by the deposition of amyloid beta (Aß) plaques and tau-neurofibrillary tangles in the brain. Visceral obesity (VO) is usually associated with low-grade inflammation due to higher expression of pro-inflammatory cytokines by adipose tissue. The objective of the present review was to evaluate the potential link between VO and the development of AD. Tissue hypoxia in obesity promotes tissue injury, production of adipocytokines, and release of pro-inflammatory cytokines leading to an oxidative-inflammatory loop with induction of insulin resistance. Importantly, brain insulin signaling is involved in the pathogenesis of AD and lower cognitive function. Obesity and enlargement of visceral adipose tissue are associated with the deposition of Aß. All of this is consonant with VO increasing the risk of AD through the dysregulation of adipocytokines which affect the development of AD. The activated nuclear factor kappa B (NF-κB) pathway in VO might be a potential link in the development of AD. Likewise, the higher concentration of advanced glycation end-products in VO could be implicated in the pathogenesis of AD. Taken together, different inflammatory signaling pathways are activated in VO that all have a negative impact on the cognitive function and progression of AD except hypoxia-inducible factor 1 which has beneficial and neuroprotective effects in mitigating the progression of AD. In addition, VO-mediated hypoadiponectinemia and leptin resistance may promote the progression of Aß formation and tau phosphorylation with the development of AD. In conclusion, VO-induced AD is mainly mediated through the induction of oxidative stress, inflammatory changes, leptin resistance, and hypoadiponectinemia that collectively trigger Aß formation and neuroinflammation. Thus, early recognition of VO by visceral adiposity index with appropriate management could be a preventive measure against the development of AD in patients with VO.

Alar Cartilage Hematoma: Case Report and Literature Review.

Nasal hematomas can occur after nasal trauma. It can involve the septal, alar, or all levels, with the septum being the most commonly affected site. We present a case of alar hematoma in a five-year-old boy after nasal trauma. The patient came to the emergency room complaining of nasal pain, epistaxis, and nasal deformity. A complete ear, nose, and throat examination was performed, and X-ray and computed tomography imaging of the facial bone were done to confirm the presence of a nasal alar hematoma. The alar hematoma was successfully treated via surgical evacuation. Alar cartilage hematoma is a rare entity that can lead to undesirable complications when missed.

The Potential Role of MUC16 (CA125) Biomarker in Lung Cancer: A Magic Biomarker but with Adversity.

Lung cancer is the second most commonly diagnosed cancer in the world. In terms of the diagnosis of lung cancer, combination carcinoembryonic antigen (CEA) and cancer antigen 125 (CA125) detection had higher sensitivity, specificity, and diagnostic odds ratios than CEA detection alone. Most individuals with elevated serum CA125 levels had lung cancer that was either in stage 3 or stage 4. Serum CA125 levels were similarly elevated in lung cancer patients who also had pleural effusions or ascites. Furthermore, there is strong evidence that human lung cancer produces CA125 in vitro, which suggests that other clinical illnesses outside of ovarian cancer could also be responsible for the rise of CA125. MUC16 (CA125) is a natural killer cell inhibitor. As a screening test for lung and ovarian cancer diagnosis and prognosis in the early stages, CA125 has been widely used as a marker in three different clinical settings. MUC16 mRNA levels in lung cancer are increased regardless of gender. As well, increased expression of mutated MUC16 enhances lung cancer cells proliferation and growth. Additionally, the CA125 serum level is thought to be a key indicator for lung cancer metastasis to the liver. Further, CA125 could be a useful biomarker in other cancer types diagnoses like ovarian, breast, and pancreatic cancers. One of the important limitations of CA125 as a first step in such a screening technique is that up to 20% of ovarian tumors lack antigen expression. Each of the 10 possible serum markers was expressed in 29-100% of ovarian tumors with minimal or no CA125 expression. Therefore, there is a controversy regarding CA125 in the diagnosis and prognosis of lung cancer and other cancer types. In this state, preclinical and clinical studies are warranted to elucidate the clinical benefit of CA125 in the diagnosis and prognosis of lung cancer.

A comparison between flow-regulated and adjustable valves used in hydrocephalus during infancy.

INTRODUCTION: Ventriculoperitoneal shunt insertion during the neonatal period and early infancy is associated with a high rate of shunt failure when compared to the adult population. Furthermore, the function of flow-regulated valves and differential pressure valves may be different in neonatal hydrocephalus. METHODS: A retrospective case series of all primary shunt procedures carried out during or immediately following the neonatal period, from August 2011 to February 2018 at Sheffield Children's Hospital. The total sample size was 55. This included 34 patients with adjustable valves (Miethke ProGav) and 21 with flow-regulated valves (Orbis-Sigma); however, only 53 had adequate follow-up. RESULTS: The overall 1 year shunt survival was 34% (18/53), and there was no significant difference depending on which shunt valve was implanted. The primary shunt infection rate was 11% (6/53) with S. aureus being the most common causative organism. During the first year of life, clinical signs of shunt overdrainage were seen more frequently in patients with adjustable valves than in those with flow-regulated valves (59% [19/32] versus 24% [5/21], p = 0.02). Furthermore, 2 patients in the adjustable valve group developed sagittal craniosynostosis secondary to shunt overdrainage. CONCLUSION: Shunt failure is high when inserted during or immediately following the neonatal period. Overdrainage may be less common in patients with flow-regulated valves. However, if overdrainage is observed, adjusting the setting of a differential pressure valve can effectively treat the overdrainage without the need for invasive shunt revision surgery.

Patient awareness about the indications and complications of sleeve gastrectomy.

OBJECTIVES: To assess patients' awareness of the indications and complications of sleeve gastrectomy in King Khalid University Hospital, Riyadh, Saudi Arabia. METHODS: The cross-sectional study conducted from December 2017 to May 2018 in KKUH, Riyadh, Saudi Arabia included all patients aged 18 years and older. Data collection was conducted through self-administered questionnaires. Chi-square test was performed to determine the significant differences between variables. A P value of < 0.05 was considered statistically significant. RESULT: Of 480 participants, 247 (51.5%) of them were male. The educational level of most was bachelor's degree (253; 52.7%). Most of the participants (326; 67.9%) are not aware about BMI. However, 80 (16.7%) participants knew the true answer to obese BMI. Of the total participants, 283 (59.0%) did not knew about sleeve gastrectomy indications; however, 311 (64.8%) of the participants had heard about the complications of sleeve gastrectomy. All these results are correlated with the educational level of the participants. CONCLUSION: Our study shows a lack of awareness of sleeve gastrectomy indications and complications among study population. We need to increase public awareness about sleeve gastrectomy indications and complication by proper scientific health education in the community.

Magnetic Nanoparticles: Synthesis, Characterization and Magnetic Properties of Cobalt Aluminum Ferrite.

Nanoparticles of the ferrite system CoFe(2-x)Al(x)O4 (x = 0.0, 0.3, 0.7 and 1.0) were synthesized through the co-precipitation technique. Thermal decomposition process and formation of a single crystalline phase were followed using thermal differential analysis technique (DTA). X-ray powder diffraction patterns of the samples confirmed the formation of a nano-size single spinel phase. The average crystallite size was found to be in the range 20-63 nm for all samples. This was further confirmed by TEM of one of the samples, with concentration x = 1.0 which was found statistically to be 27 nm. This agrees well with the value of 24 nm deduced by means of X-ray diffraction method for the same sample. A considerable decrease in the intensity of the octahedral bands is observed as the aluminum concentration increases, and even vanishes completely at x = 1.0 indicating the migration of cations between the octahedral and tetrahedral sites. The magnetic hysteresis loops at room temperature showed decrease in both, coercivity and saturation magnetization as the non-magnetic Al3+ ions content increases. The relative values of M(r0/M(s) were found to be between 0.44 and 0.31 for the samples with a remarkable change in the squareness of the loops. This is highly beneficial for the microwave and memory devices applications of these nano sized ferrite system.

Synthesis and Characterization of Zinc Oxide Nanosheets for Dye-Sensitized Solar Cells.

Zinc oxide (ZnO) nanosheets were synthesized by a simple and facile hydrothermal process and characterized in terms of their morphological, structural, compositional, optical and photovoltaic properties. The detailed characterization revealed that the synthesized ZnO material possess nanosheet morphologies which are grown in very high density, possessing well-crystallinity with wurtzite hexagonal phase and exhibiting good optical properties. Further, the synthesized ZnO nanosheets were used as photoanode material to fabricate efficient dye-sensitized solar cell (DSSC). The fabricated DSSC shows an overall light-to-electricity conversion efficiency of -1.57%, open-circuit voltage (V(OC)) of 0.552 V, short-circuit currents (J(SC)) of -7.2 mA/cm2 and fill factors (FF) of 0.40.

Synthesis and characterizations of ferrite nanomaterials for phenyl hydrazine chemical sensor applications.

This paper presents the synthesis, characterization and phenyl hydrazine chemical sensing applications of Cd0.5Mg0.5Fe2O4 ferrite nanoparticles. The nanoparticles were synthesized by facile and simple co-precipitation method and characterized in detail in terms of their morphological, structural, compositional and electrical properties. The detailed characterization studies revealed that the prepared nanoparticles are grown in high density, possessing Cd0.5Mg0.5Fe2O4 composition and exhibiting spinel cubic structure. Moreover, the prepared Cd0.5Mg0.5Fe2O4 ferrite nanoparticles were used as efficient electron mediators for the fabrication of high-sensitive, robust, reliable and reproducible phenyl hydrazine chemical sensor by simple I-V technique. The fabricated chemical sensor exhibits a highsensitivity of 7.01 microA mM(-1) cm(-2) with an experimental detection limit of 3.125 mM in a short response time of -10.0 s. This work demonstrates that Cd0.5Mg0.5Fe2O4 ferrite nanoparticles can efficiently be utilized for the fabrication of highly sensitive and reliable chemical sensors.

Magnesium-zinc ferrite nanoparticles: effect of copper doping on the structural, electrical and magnetic properties.

In this paper, Mg0.5Zn0.5-Cu(x)Fe2O4 ferrites nanoparticles were synthesized by facile co-precipitation route and characterized in detail in terms of their structural, electrical and magnetic properties as a function of Cu concentration. The prepared samples have cubic spinel phase as confirmed by X-ray diffraction patterns. The decrease of the lattice constant and increase of X-ray density indicate the solubility of Cu ions in the spinel lattice. The AC conductivity measurements between 300 K and 773 K at different frequencies 1 KHz up to 1 MHz, showed two different behaviors as semiconductor-like at high temperature and frequency depending behavior associated with dispersion phenomena at low temperatures. The conduction mechanism in the system is influenced by Cu concentration and the dominant one is the hopping conduction mechanism. Dielectric measurements at the same conditions of temperatures and frequencies exhibited that the dielectric loss increases with increasing the temperature and decreasing the frequency indicating the semiconducting nature of the ferrite compounds. An anomalous behavior of the dielectric loss is observed in samples with high Cu content which explained in terms of resonance between frequency accompanied the electronic hopping and the frequency of the external electric field. The analysis of Mössbauer spectra revealed that copper free compound is super-paramagnetically relaxed in nature and zinc free compound demonstrates ferrimagnetic order. Moreover, hyperfine field spectrum shows the migration of Cu ions from octahedral to tetrahedral site in zinc free compound.

[The interest of maintenance electroconvulsive therapy in mood disorders]. / Intérêt de l'électroconvulsivothérapie de maintenance dans les troubles de l'humeur.

Maintenance electroconvulsive therapy (M-ECT) is a treatment indicated for the treatment and prevention of recurrent depression in patients who either do not respond or do not tolerate psychotropic medication. We evaluated, retrospectively, clinical response to a 6-month minimum course of M-ECT in 25 patients with a diagnosis of bipolar disorder or schizoaffective disorder according to DSM IV-TR criterion. Our study demonstrated a significant improvement of Global Assessment of functioning (GAF) scores after a six month minimum course of M-ECT (34.8 ± 12.6 vs 65.6 ± 10.8; P<0.05) as well as Brief Psychiatric Rating Scale scores (BPRS): 79.3 ± 12.4 vs 43.4 ± 10.2; P<0.05). We observed a slight increase of Mini Mental State Examination (MMSE) scores after M-ECT; nonetheless, it was not statistically significant (24.2 ± 2.4 vs 26.2 ± 2.4; P=0.2). Regarding the mean duration of hospitalizations, we showed a statistically significant decrease in the median number of days of hospitalization (72 [59-93.50] days before M-ECT vs 43 [25-76] days since the first M-ECT; P=0.017). Maintenance ECT allowed a significant improvement in psychiatric symptoms and global functioning of the patients included in this study, as well as a decrease in the number of days of hospitalization. However, our pattern is limited because of its small size; so, further prospective studies in this field, including larger population is highly recommended.

Influence of calcium ions on the structural and magnetic properties of Cd-Mg ferrites nanoparticles.

Cadmium magnesium ferrites doped with calcium having the chemical formula Cd0.5Mg0.5-x Ca(x)Fe2O4 (0.0 < or = x < or = 0.3) were prepared by the Co-precipitation method. X-ray diffraction analysis confirmed the formation of a single phase with spinel crystal structure for the samples. The lattice parameter is determined for each composition and has been found to increase from 8.505 angstroms to 8.626 angstroms with increasing calcium concentration. Cation distribution for the studied ferrite system is proposed in terms of the structural and magnetic properties by means of X-ray diffraction (XRD), infrared spectroscopy (IR), vibrating sample magnetometer (VSM) and is found to be reliable. The experimental and theoretical lattice constants show the same trend with increasing calcium concentration indicating the validity of the proposed cation distribution. The analysis of infrared spectra indicates the presence of splitting in the absorption band which may be attributed to the presence of small amounts of Fe2+ ions in the ferrite system. The appearance of a shoulder around 700 cm(-1) suggests the presence of calcium ions in the tetrahedral site. The addition of non magnetic calcium ions in the ferrites suppressed the A-interaction and developed a B-B interaction, which is reflected in reducing the saturation magnetization in the present samples. The coercive field (H(c)) is also found to increase by increasing of Ca2+ concentration and has been explained on the bases of direct relationship with anisotropy constant.

Common polymorphisms in TLR4 gene associated with susceptibility to pulmonary tuberculosis in the Sudanese.

SETTING: Host genetic risk factors influence susceptibility to tuberculosis (TB). There is ample evidence supporting the involvement of toll-like receptor 4 (TLR4) in mycobacterial infection. OBJECTIVE: To study the relationship between the TLR4 gene and TB susceptibility in the Sudanese population. DESIGN: A case-control study was conducted among 207 patients with pulmonary TB and 395 healthy controls. Ten tag single nucleotide polymorphisms (SNPs) of the TLR4 gene were genotyped using restriction digestion or hybridisation assays, and analysed. RESULTS: The genotypes were in Hardy-Weinberg equilibrium. After controlling for sex using the Mantel-Haenszel test, four SNPs showed significant differences between cases and controls, even after correction of multiple comparisons by Bonferroni procedure. The Mantel-Haenszel estimates of allelic odds ratios for the high-risk alleles were 1.67 for rs1927911 (P = 0.0001), 1.85 for rs5030725 (P = 0.0008), 2.14 for rs7869402 (P = 1.87e-07) and 2.31 for rs1927906 (P = 1.23e-10). Haplotype analysis showed that rs1927911 and rs5030725 were in one haplotype block, and rs7869402 and rs1927906 were in another haplotype block. Conditional haplotype analysis suggested the presence of one causal variant downstream of a recombination hot spot at the 3' region of the TLR4 gene. CONCLUSION: This is the first study to show that common TLR4 polymorphisms are associated with TB susceptibility in the Sudanese population.

Clear cell meningioma of the fourth ventricle in a child: a case report and literature review.

Clear cell meningiomas are rare meningioma variants and are recognized as World Health Organization grade II tumours. They may be difficult to manage given their propensity to recur early especially if present in surgically challenging locations. We describe a rare case of a fourth ventricular clear cell meningioma without dural attachment in a 14-year-old boy with an unusual presentation of failure to thrive. The case is presented in detail and a review of the recent literature is discussed.

Care of children with brain and spine tumours - a review of practice.

Aims and method were to assess the current practice in paediatric tumour management by the departments of neurosurgery and oncology, compare these with nationally agreed recommendations and examine for areas of improvement. Patient records were identified from departmental databases - 30 patients treated from October 2004 to May 2006. Factors assessed included treatment timelines (e.g., referral to admission and imaging, admission to surgery, surgery to further treatment), imaging, MDT discussion, and paediatric neurosurgery & neuro-oncology treatments. Of acute referrals, all patients were admitted within 2 days. All surgery was undertaken by a dedicated paediatric neurosurgeon with paediatric anaesthesia. All cases were discussed in a neuro-oncology MDT prior to surgery and 97% after surgery. In the first 6-months 57% received adjuvant treatment within 40 days; in the remaining period this improved to 91%. When measured against recognised benchmark standards, the SCH paediatric neuro-oncology service appears satisfactory. This study has identified the need to improve certain aspects of care to offer further improvements to the specialist service delivered.

Vagus nerve stimulation in children with intractable epilepsy: indications, complications and outcome.

PURPOSE: To analyze the indication, complications and outcome of vagus nerve stimulation in intractable childhood epilepsy. MATERIALS AND METHODS: We retrospectively reviewed the data of 69 children who had insertion of vagal nerve stimulator (VNS) between June 1995 and August 2006 for medically intractable epilepsy. Outcome was based on the Engel's classification. Statistical analysis of the data was also done to see if any of the parameters significantly influenced the outcome. RESULT: Thirty-eight patients (55.08 %) had a satisfactory outcome (Engel class I, II or III), and in 31 patients (44.92 %), there was no worthwhile improvement of seizures (Engel class IV). There was no statistical significance between the type of seizure and outcome (Fisher's exact test, p = 0.351). Statistical analysis also showed that the following parameters did not significantly influence the outcome (p > 0.05): age at insertion of VNS, age of first fit, duration between first fit and insertion of VNS and the length of follow-up. Complications included infection, lead fracture, fluid collection around the stimulator, neck pain and difficulty swallowing. CONCLUSION: Vagus nerve stimulation is a relatively safe and potentially effective treatment for children with medically intractable epilepsy.