Search

Background: Intellectual disabilities in childhood constitutes a major health problem throughout the world and a handicapping illness with long term costly treatment and bad impact on the family. It constitutes a major problem in Egypt affecting the quality of life of children and the welfare of their families. Objective: To identify the prevalence and risk factors of intellectual disabilities in children aged 2-16 years in the Pediatric Neurology Out-patient Clinic, Al-Azhar University Hospital, Assiut. Patients and Methods: The present study included one thousand (1000) children randomly selected and examined for the presence of intellectual disabilities from patient attending the clinic, ninety of them (9%) (63 males - 27 females) had intellectual disabilities. The present study has been conducted at the pediatric neurology out-patient clinic of Al-Azhar University in Assiut from 1/11/2018 to 30/6/2019. Results: There was a significant statistical attachment between intellectual disabilities and family’s socioeconomic profile in terms of residence, maternal and paternal education, and Father’s job and parent's consanguinity. In the present study the total number of cases was 90, 63 males 27 females, 76% of cases were coming from rural areas while 24% of cases were coming from urban areas. As regards the investigation, neuro-imaging (CT-MRI) was not done in (41.1 %) while normal in (38.9 %), (11.1%) with brain atrophy, (6.7%) with focal lesion and congenital brain malformation represent (2.2 %). Conclusion: Mentally retarded cases are more common in rural areas and male sex. Socioeconomic factors like education of parents and parental consanguinity play a role in the occurrence of MR.

Accurate clerking is vital in ensuring optimal management of medical patients. Previous studies have highlighted the importance of pro forma use in maintaining documentation standards. This study aimed to refine an existing clerking pro forma and explored the subsequent impact of transition to electronic patient records (EPR). A single centre retrospective analysis was conducted at Barnet General Hospital, Royal Free NHS Trust, over a year (January–December 2018). All patients (n=60) were admitted during medical take to the acute or …

Introduction Hughes-Stovin syndrome is a life-threatening disorder of unknown etiology. This condition is characterized by vasculitis, deep venous thrombosis and aneurysms that mainly involve the pulmonary arteries resulting in hemoptysis. It has been described in literature less than 40 times. However, we believe it is not very uncommon as it might be diagnosed as pulmonary embolism solely. In such cases, anticoagulation therapy augments the risk of life-threatening hemoptysis. Materials and methods We report the case of a 35 years old, Egyptian female patient with Hughes-Stovin syndrome, who initially presented with lower limb deep vein thrombosis and coughing of blood. Anticoagulation regimen for pulmonary embolism was given. This resulted in massive hemoptysis that was successfully controlled by medical therapy. Conclusion Adults who present with venous thrombosis and hemoptoic cough, with no predisposing factors of thrombosis, normal platelet count and coagulation, the possibility of Hughes-Stovin syndrome has to be considered.

Objectives: Cytoreductive surgery is the principal management for ovarian cancer. Recently there has been progressive change to more extensive cytoreductive surgery (ECS) as evidence shows this improves patient prognosis. The aim of this study is to investigate the change in histopathology work load with change in surgical practice for the treatment of ovarian cancer patients at Hammersmith Hospital, UK. Materials and methods: Specimens for patients with ovarian cancer (n=116) were selected and classified into three groups: (i) standard debulking surgery; (ii) a mix of standard debulking and ECS and (iii) ECS only. The types of specimens and numbers of blocks in each group were studied. Results: Post-hoc analysis demonstrates a statistically significant increase in the number of specimens per case from standard debulking to the mixed group (p

Nausea and vomiting are common experiences in pregnancy and it is considered as a part of normal physiology. It affects about 75% of pregnant women without a known cause. In most cases, it is a mild and self-limited condition that can be controlled with conservative measures and has no adverse fetal outcomes. Women with severe nausea and vomiting during pregnancy (NVP) may have hyperemesis gravidarum (HG); an entity distinct from NVP, which if left untreated may lead to significant maternal and fetal morbidity. The objective of this study was to assess the presence and severity of anxiety in pregnant women with and without HG. The study is a case-control study on 52 pregnant women divided into two groups: cases hospitalized with the diagnosis of HG and healthy pregnant women as a control group. All mothers in the study were evaluated by Hamilton Anxiety Rating Scale (HAM-A) and General Health Questionnaire (GHQ-28). It was revealed that most of hyperemesis gravidarum cases suffered from severe anxiety while only (7.7%) of healthy control had severe anxiety, with high statistical significant difference. The mean of Hamilton Anxiety Rating Scale (HAM-A) is statistically higher among hyperemesis gravidarum cases than healthy controls. Regarding General Health Questionnaire - 28 subscales; the mean score of somatic symptoms, social dysfunction and severe depression is statistically higher among hyperemesis gravidarum cases than healthy controls. It was concluded that anxiety and emotional distress were more common and severe in patients with HG.

Background & Aims Patients with acute liver failure (ALF) have defects in innate immune responses to microbes (immune paresis) and are susceptible to sepsis. Cytotoxic T-lymphocyte−associated protein 4 (CTLA4), which interacts with the membrane receptor B7 (also called CD80 and CD86), is a negative regulator of T-cell activation. We collected T cells from patients with ALF and investigated whether inhibitory signals down-regulate adaptive immune responses in patients with ALF. Methods We collected peripheral blood mononuclear cells from patients with ALF and controls from September 2013 through September 2015 (45 patients with ALF, 20 patients with acute-on-chronic liver failure, 15 patients with cirrhosis with no evidence of acute decompensation, 20 patients with septic shock but no cirrhosis or liver disease, and 20 healthy individuals). Circulating CD4+ T cells were isolated and analyzed by flow cytometry. CD4+ T cells were incubated with antigen, or agonist to CD3 and dendritic cells, with or without antibody against CTLA4; T-cell proliferation and protein expression were quantified. We measured levels of soluble B7 molecules in supernatants of isolated primary hepatocytes, hepatic sinusoidal endothelial cells, and biliary epithelial cells from healthy or diseased liver tissues. We also measured levels of soluble B7 serum samples from patients and controls, and mice with acetaminophen-induced liver injury using enzyme-linked immunosorbent assays. Results Peripheral blood samples from patients with ALF had a higher proportion of CD4+ CTLA4+ T cells than controls; patients with infections had the highest proportions. CD4+ T cells from patients with ALF had a reduced proliferative response to antigen or CD3 stimulation compared to cells from controls; incubation of CD4+ T cells from patients with ALF with an antibody against CTLA4 increased their proliferative response to antigen and to CD3 stimulation, to the same levels as cells from controls. CD4+ T cells from controls up-regulated expression of CTLA4 after 24−48 hours culture with sera from patients with ALF; these sera were found to have increased concentrations of soluble B7 compared to sera from controls. Necrotic human primary hepatocytes exposed to acetaminophen, but not hepatic sinusoidal endothelial cells and biliary epithelial cells from patients with ALF, secreted high levels of soluble B7. Sera from mice with acetaminophen-induced liver injury contained high levels of soluble B7 compared to sera from mice without liver injury. Plasma exchange reduced circulating levels of soluble B7 in patients with ALF and expression of CTLA4 on T cells. Conclusions Peripheral CD4+ T cells from patients with ALF have increased expression of CTLA4 compared to individuals without ALF; these cells have a reduced response to antigen and CD3 stimulation. We found sera of patients with ALF and from mice with liver injury to have high concentrations of soluble B7, which up-regulates CTLA4 expression by T cells and reduces their response to antigen. Plasma exchange reduces levels of B7 in sera from patients with ALF and might be used to restore antimicrobial responses to patients.

Introduction: Inspite of extensive researches for understanding and managing neonatal sepsis, sepsis stills a major source of morbidity and mortality among neonates especially in the developing countries. It represents a diagnostic burden problem by showing minimal initial nonspecific manifestations in addition the clinical course can be fulminate and fatal if treatment is not commenced promptly. Recently neutrophil CD64 (nCD64) showed a very promising value in the diagnosis of neonatal sepsis. Aims: Our aim was to evaluate nCD64 as an early predictive and monitoring marker and the best panel of markers that can achieve the highest diagnostic and prognostic performance in this disease. Methods: The study was conducted over 11-months and included 173 sepsis evaluations, neonates classified into three groups: Documented sepsis group, Clinical sepsis group and Control group. Blood samples were collected for highly sensitive CRP (hs-CRP), complete blood count (CBC), blood culture and nCD64 (done by FlowCytometry technique). Results: Significant increase in nCD64 was found in sepsis groups compared to the control group, nCD64 has AUC=0.964 with an optimal cutoff at 42% achieving sensitivity 86%, specificity 93.3%, NPV 68.3%, PPV 97.5% and efficacy 87.7%. Combination of CRP and CD64 achieves the highest diagnostic and prognostic performance over the other hematological parameters. Conclusions: the combination of nCD64% & CRP represents the best early predictor and monitoring panel of markers that can be used conventionally in neonatal ICU(NICU), Our study suggests that nCD64% is better than CRP and is ready to be incorporated in the routine daily work as a valuable diagnostic and prognostic marker.

Islamic funds are an upcoming alternative to conventional funds, aided by the increasing prominence of Islamic finance. This paper contributes to the extant literature by comparing the performance of Islamic and conventional funds during crisis and recovery periods. In contrast to most previous literature, we focus on the countries of the Middle East and North African region (MENA), which represent an appealing context to study both from a financial and socioeconomic point of view due to recent events in the area. To this end, we consider a linear model control- ling for the bias of omitting relevant benchmarks. Although this methodology is now widely accepted in the financial literature, it is less common when evaluating Islamic mutual funds, but it is particularly appropriate when the aim is to focus on markets where Shari’ah-compliant investments are in home territory. Our results show that the relative performance of Islamic and conventional funds must be tempered by several factors such as the (geographical) context in which the investment is made. Considering all the MENA region, Islamic funds perform, on average, slightly worse than conventional funds. However, if the analysis is restricted to GCC countries, the result is the opposite. This evidence holds for both crisis and recovery periods. In addition, the performance gap between the two types of funds either widens or shrinks when considering recovery or crisis times, reinforcing the views that Islamic funds are more stable in hazardous times.

Background β-thalassemia major (β-TM) is a common inherited hemolytic type of anemia. Repeated blood transfusions predispose β-TM patients toward peroxidative tissue injury because of secondary iron overload. Objectives This study aimed to evaluate the effects of iron overload on antioxidant enzymes and liver cell damage in β-TM patients undergoing regular blood transfusions. Patients and methods This prospective case–control cohort study included 30 pediatric patients with a confirmed diagnosis of β-TM on regular blood transfusions and 20 age-matched and sex-matched healthy children attending the Qena University Hospital, Pediatric Clinic. Blood samples were withdrawn from each patient to measure serum levels of ferritin, glutathione peroxidase (GPX), and superoxide dismutase (SOD). Results Total bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), and ferritin levels were significantly higher in the β-TM group (P Conclusion Impaired levels of antioxidant enzymes SOD and GPX in patients with β-TM on repeated transfusion, in addition to excessive free iron concentration, iron overload may attribute to oxidative damage in these patients. Antioxidant systems that compensate for reduced lipid peroxidation to lower tissue damage are needed.

INTRODUCTION: The incidence of pulmonary fungal infection is increasing worldwide, particularly in critically ill patients. OBJECTIVE: The objective of this study was to assess bronchoalveolar lavage (BAL) as a diagnostic specimen for clinically and radiologically suspected fungal pneumonia in critically ill children. METHODS: Thirty-five children who were admitted to the PICU of Ain Shams University because of their critical illness were included. All children underwent full medical history; thorough clinical examination, including general and local chest examination and basic laboratory investigations (from that, the Pediatric Risk of Mortality [PRISM] score was calculated to evaluate the critical illness severity); chest imaging; and bronchoscopic collection of BAL and microbiological assessment of BAL and blood using direct microscopic examination, cultured on Sabouraud dextrose agar, and fungal antigen detection using the enzyme-linked immunosorbent test for both Aspergillus galactomannan antigen and Candida mannan antigen. RESULTS: Pulmonary fungal infection was documented in 77% of the studied children. BAL investigations proved to have a higher diagnostic yield in comparison with blood. Positive fungal antigens in BAL fluid were significantly higher than positive BAL fungal cultures in studied children. Analysis of the risk factors for fungal infection among the studied patients revealed that prolonged PICU stay (≥1 week) and high PRISM score (mean: 35.9 ± 6.46) were significant risk factors for fungal infection. CONCLUSIONS: BAL fluid investigation has a significantly higher diagnostic value for pulmonary fungal infections than that of the blood. The results may be further improved especially if both culture and antigen fungal detections are combined.