The value of Holter monitoring in the assessment of Pediatric patients

Aims: Holter monitoring (HM) has been established as one of the most effective noninvasive clinical tools in the diagnosis, assessment and risk stratification of cardiac patients. However, studies in the pediatric age group are limited. The present work aims at determining the value of HM in the diagnosis and management of children. Settings and Design: Retrospective study conducted at a tertiary referral arrhythmolology service.Methods and Material: Holter records of 1319 pediatric patients (54.1% males and 45.9% females) were reviewed. Their average age was 6.7± 4.1 years (5 days-16 years). Indications for which Holter monitoring was done were analysed as well as all the abnormalities diagnosed and factors that may increase Holter yield.Statistical analysis used: Statistical Package of social science (SPSS) version 9,0 was used for analysis of data. Results: The most common indications were palpitations (19.8%), syncope (17.8%), cardiomyopathy (12.6%), chest pain (10%), evaluation of antiarrhythmic therapy (6.8%), postoperative assessment (2.6%) and complete AV Block (2.4%). A sum of 141 Holter recordings were found abnormal with a total diagnostic yield of 10.7%. The highest contribution to diagnosis was in postoperative assessment (32.4%) and in cardiomyopathy (19.9%) where the most common abnormalities were frequent supraventricular / ventricular premature beats, supraventricular tachycardia, ventricular tachycardia and AV block. Diagnostic yield was low in patients with palpitations (5.7%) and syncope (0.4%). An abnormal ECG was significantly associated with a higher diagnostic yield (p=0.0001). None of the children with chest pain had abnormal Holter recordings.Conclusions: HM has an extremely valuable role in the assessment of high risk patients (postoperative and cardiomyopathy). However in children with palpitations, syncope and chest pain HM has a low yield. In this group of patients an abnormal ECG is more likely to be associated with abnormal Holter recordings

Applying Agile Software Engineering On Medical Ubiquitous Computing (MUC)

Nowadays, people are involved in using computation capabilities to meet their daily life needs although most of the time they may be unaware as to how this actually happens. Ubiquities Computing is considered the future trend for providing unlimited computing capabilities that handle every service in human life. One of the most crucial implementation of Ubiquities Computing is in Medical and Hospital Service. This is due to their great importance in saving people's lives. The huge amount of data and information delivered by MUC systems draw the attention to the necessity of having a new and modern software engineering methodology; Agile Software engineering methodology is highly considered in the matter. In this paper, we present an implementation of applying agile SWE methodology on MUC System, research related issues are also discussed

Does Spending Matter in Improving Healthcare Across MENA Region

This study addresses the impact of healthcare spending on quality of health. Particularly, it investigates the impact of health budget allocation, health system performance, a nation’s income, and demographic aspects on prompting health quality across the MENA region. The yearly data sample used covers the period 1995–2016. The estimated model is tested using the appropriate GLS random effects method. The findings do not show support for public spending on healthcare to improve healthcare quality across the MENA region. However, higher private spending on healthcare leads to lower infant mortality rates, thus improving healthcare quality. The results also show that the improvement in income per-capita for oil-exporting countries leads to improved quality of healthcare as well as in non-oil-exporting countries, however the marginal benefit is lower for oil-exporting countries, compared to non-oil-exporting countries. This might suggest that oil-exporting countries have already reached a significant floor level of infant mortality rate that cannot be improved. However, non-oil-exporting countries still have potential to reduce the infant mortality rate and improve the quality of healthcare

Diagnostic Dilemma of Cardiac Syncope in Pediatric Patients

Aims Syncope is defined as temporary loss of consciousness and postural tone resulting from an abrupt transient decrease in cerebral blood flow. The present work aimed at determining how diagnostic tests are used in the evaluation of pediatric syncope at a tertiary pediatric referral center and to report on the utility and the yield of these tests.Settings and Design Retrospective study conducted at a tertiary referral arrhythmolology serviceMethods and Material The clinical charts of 234 pediatric patients presenting with a primary complaint of syncope with an average age of 7.48 ± 3.82(3.5-16) years were reviewed by the investigators.Statistical analysis used Statistical Package of social science (SPSS) version 9,0 was used for analysis of data.Results The commonest trigger for syncope in the study population was early following exercise (n=65) and the commonest prodrome was palpitation, noted in 25 patients. A murmur was present in 19 of our patients (8.3%) while 10.7% (n=25) had abnormal ECGs. Of the 106 echocardiograms done, 14 (13.2%) were abnormal. Only two of them were missed by ECG. All patients were offered ambulatory 24 hour ECG. One patient with sick sinus syndrome was diagnosed only with Holter.Conclusions Clues to the presence of cardiac syncope may include acute onset of syncope, frequent episodes, low difference between blood pressure readings in supine and erect positions (after standing for 2 minutes) and most importantly an abnormal 12 lead ECG. Transthoracic echo and Holter monitoring have low yield in pediatric syncope

Malicious User Attack in Cognitive Radio Networks

Signal detection in cognitive radio network (CRN) is influenced by several factors. One of them is malicious user that emulate primary user (PU) signal. Emulation of PU signal causes detection error. This paper investigates the impact of malicious user attack to PU signal detection. A number of malicious users are randomly deployed around secondary user (SU) at a certain distance. They attempt to attack primary signal detection that is transmitted from 100 km to SU receiver. Then, the received signal power at secondary receiver and the performance of probability of false alarm and probability of miss detection under two hypothesis of Neyman Pearson criterion are studied. The derived results show that a number of malicious users has a significant impact to the performance of received power at SU and detection error rate

High-Throughput Sequencing and Metagenomic Data Analysis

Metagenomic approaches are a growing branch of science and have many applications in different fields. Metagenomics seems to be the ideal culture-independent technique for unraveling the biodiversity of soils and to study how this biodiversity is affected with continuously changing conditions. In addition, its application in clinical and diagnostic approaches was reported. The emergence of several next-generation sequencing (NGS) strategies enriched the metagenomics. The combination between NGS and metagenomic approaches helped the investigators resolve several issues regarding the microbial diversity and the functions and relationships among different microbial flora. A number of NGS approaches were developed including Roche/454 pyrosequencing, Illumina/Solexa sequencing, and Applied Biosystems/SOLiD sequencing. In this chapter, different NGS platforms are discussed in terms of principle, advantages, and limitations. In addition, third-generation sequencing technologies are also addressed

The Effect of Different Irrigant Activation Methods on Postoperative Pain After Endodontic Retreatment

Objective: This study was designed to evaluate the effect of different irrigant activation methods on post operative pain after endodontic retreatment. Materials and Methods : Seventy eight patients need non surgical retreatment in mandibular first molar were involved in the study. The retreatment was performed in two visits ,at first visit cases were randomly divided into three groups according to methods of irrigant activation after root canal retreatment with protaper next rotary Ni-TI system. Group A (n=26) Root canals were irrigated using 2.6% sodium hypochlorite (NaOCl) with manual dynamic agitation using master cone Group B (n=26) Root canals were irrigated using 2.6% sodium hypochlorite (NaOCl) using ultrasonic machine (ultra-x) for 60 seconds. Group C (n=26) Root canals were irrigated using 2.6% sodium hypochlorite (NaOCl) with NaviTip (29-gauge 27 mm) with double side tip. At second visit after one week, obturation was performed using modified single cone technique ans access cavity was filled with coronal restoration. After two visits root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48 72 hrs and one week post-obturation. Data were statistically analyzed with a significance level of P ≤0.05. Results: At 6,12,24 hrs, there was significant difference between the groups in pain intensity where control group C (Navitip with side vented needle) showed more pain scores than in the intervention groups (Ultra X and manual dynamic agitation). On the other hand, at 48, 72 hours and 7 days post- operative ,there was no statistically significant difference in pain among tested groups. Conclusion: Agitation of the irrigation is reliable safe to clinican and effective as final step irrigation protocol with successful management of postoperative pain in retreatment cases. The intensity of postoperative pain decreased with time regardless of final irrigation protocol used

Surgery for recurrent high-grade gliomas: The dilemma of debate

Background: Treating recurrent gliomas is a big dilemma in the literature and no uniform protocol is approved to treat such disappointing problem. Although improvement in the RT techniques, new CTX techniques and new techniques including targeted therapy and gene therapy; all fail to dramatically improve the outcome and solve the problem of significant mass effect when the recurrent tumor is big So resurgery play a role in treating such challenging problem. The aim of the study: to assess the goal and outcome of surgery in treatment of recurrent malignant glioma. Methods: We retrospectively analyzed the data of 56 patients who were operated upon for recurrent or progressed high grade gliomas in the Mansoura neurosurgery department allover 2007 to 2016. We have excluded patients with recurrent thalamic gliomas and patients with Kps score less than 70. Results: 12 patient underwent sterotactic biopsy for their tumor and were sent for adjuvant radiotherapy, 29 patients underwent partial tumor resection and gross total resection was done in 15 patients. The median time to progression was 5 months. All patients were sent after surgery for poster radiotherapy and chemotherapy. The median overall survival was 4 months. Conclusion: Recurrent high grade glioma is one of unsolved problem and optimal management is no longer available. Redo surgery is quiet challenging with higher minorities and no add to overall survival. Surgery is indicated to relieve significant mass effect. Outcome of surgery is better for those who did aggressive surgical resection at initial surgery than those who did only partial resection