Background: Sleep problems are one of the main health issues raised by families. Therefore, we aimed to evaluate the sleep problems of pre-school children in Iran. Methods: Five hundred and seventy-nine children aged 3–6 years were randomly recruited from 15 kindergartens in the city of Qazvin in Iran. The Iranian version of BEARS (Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep and Snoring) and the Children’s Sleep Habits questionnaire (CSHQ) were completed by interviewers. Data analysis was performed using SPSS version 19. The data were analysed with a Student’s t-test, chi-square and Fisher’s exact tests. A P value < 0.05 was considered significant. Results: The study population consisted of 299 boys (51.6%) and 280 (48.3%) girls with a mean age of 4.1 years (SD 0.8). The mean body mass index (BMI) of the children was 15 (SD 2.1). The average sleep duration among the children was 10:54 h/day (SD 00:48). They went to bed late (23:18 h SD 00:48) and woke early (09:26 h; SD 01:00). Daytime sleepiness was reported by 6.9% of the participants. The incidence of awakening during the night, sleep-disordered breathing and snoring was 13.9%, 1.2% and 2.7%, respectively. Most of the children shared a room with their parents (87%) (P > 0.05). Conclusion: The children had sleep-related problems, including a late bedtime, delayed sleep onset, daytime sleepiness, midnight awakening, sleep-disordered breathing, and snoring. Sharing a room was very common among the Iranian children.

The risks of mercury use have prompted the establishment of Minamata Convention on Mercury which placed strong emphasis on management of mercury-added products. This convention aims to reduce and phase out the use, manufacturing and trade of mercury-added products including batteries, switches and non-electronic measuring devices. This commitment will cause significant impacts especially in the developing countries in designing the right approach to achieve it. This is also true for medical industry which is well known for the utilization of mercury-added devices and dental amalgam in its services but had embarked on efforts in eliminating mercury for many years. The experiences learned within a medical facility can be useful in efforts to meet this global ambition of mercury phase out. This paper aims to provide conceptual discussion on the challenges faced by developing countries and lessons learned from medical facility that can helps the formulation of appropriate approaches to manage mercury-added products. The paper adopted medical industry as a case study and used document analysis to discuss the issue. The main challenges identified for developing countries include lacks of capacity, funding, data and newer technologies. Based on analysis of previous studies, this study proposed a mercury management framework in medical facility and identified the recommended practices, namely technological application, policy instrument, capacity building and guidelines development. These identified approaches are found to have specific relationships between cost and potential impacts, hence giving flexibility for adoption based on the available resources in promoting better mercury management system

Background: Diabetic retinopathy (DR) is a microvascular complication of diabetes, which is a cause of visual impairment and blindness. Its development and progression have been linked to dyslipidaemia, although the link remains inconclusive. Aim: This study aimed to determine the prevalence of dyslipidaemia among type 2 diabetic patients with DR in a tertiary setting and to determine the association between dyslipidaemia and DR severity. Materials and methods: This was a cross sectional study using retrospective data of type 2 diabetic patients attending the opthalmology clinic of a tertiary centre from January 2007 to June 2014. Results of their fasting lipid profile and clinical data were retrieved from the hospital information system. Results: A total of 178 patient’s data were collected. 120 (n=67.4%) patients had non-proliferative diabetic retinopathy (NDPR) with moderate NPDR being the most prevalent. Dyslipidaemia was noted in 151 (84.8%) of the patients. Patients had a combination of more than one abnormality in the lipid profile with increased LDL-cholesterol being the main abnormality. Dyslipidaemia was however, not significantly associated with DR severity. Conclusion: Dyslipidaemia was highly prevalent in DR patients. The dyslipidaemia was however not associated with severity of DR.
Diabetic retinopathy

Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia, dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused any surgical intervention, conservative management was used.

OBJECTIVETo synthesize silver nanopaticles from leaves extract of Eucalyptus chapmaniana (E. chapmaniana) and test the antimicrobial of the nanoparticles against different pathogenic bacteria, yeast and its toxicity against human acute promyelocytic leukemia (HL-60) cell line.

METHODSTen milliliter of leaves extract was mixed with 90 mL of 0.01 mmol/mL or 0.02 mmol/mL aqueous AgNO3 and exposed to sun light for 1 h. A change from yellowish to reddish brown color was observed. Characterization using UV-vis spectrophotometery and X-ray diffraction analysis were performed. Antimicrobial activity against six microorganisms was tested using well diffusion method and cytoxicity test using 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide, a yellow tetrazole was obtained on the human leukemia cell line (HL-60).

RESULTSUV-vis spectral analysis showed silver surface plasmon resonance band at 413 nm. X-ray diffraction showed that the particles were crystalline in nature with face centered cubic structure of the bulk silver with broad beaks at 38.50° and 44.76°. The synthesized silver nanoparticles efficiently inhibited various pathogenic organisms and reduced viability of the HL-60 cells in a dose-dependent manner.

CONCLUSIONSIt has been demonstrated that the extract of E. chapmaniana leaves are capable of producing silver nanoparticles extracellularly and the Ag nanoparticles are quite stable in solution. Further studies are needed to fully characterize the toxicity and the mechanisms involved with the antimicrobial and anticancer activity of these particles.

Anti-Infective Agents ; chemical synthesis ; pharmacology ; toxicity ; Bacteria ; drug effects ; Candida albicans ; drug effects ; Cell Line, Tumor ; Eucalyptus ; chemistry ; Humans ; Metal Nanoparticles ; chemistry ; toxicity ; Plant Extracts ; chemistry ; pharmacology ; toxicity ; Plant Leaves ; chemistry ; Silver ; pharmacology ; toxicity

STUDY DESIGN: Retrospective clinical study. PURPOSE: The purpose of this study was to determine what percentage of patients who underwent nonoperative management of unilateral non-displaced or minimally displaced facet fractures progressed radiographically and to determine what percentage of patients required surgical intervention and to identify risk factors for failure of conservative management. OVERVIEW OF LITERATURE: According to most commonly used classification systems, unilateral, non-and minimally displaced facet fractures are be amendable to nonoperative management. METHODS: A retrospective review of the Trauma Registry of a Level I trauma center was performed to identify all patients diagnosed with a non- or minimally displaced unilateral facet fracture which was managed nonoperatively. Several demographic variables and clinical outcomes were recorded. Using computed tomography scanning and plain radiographs, fracture pattern, listhesis, displacement, angle and percentage of the facet that included the fracture were determined. Radiographic progression was defined as the occurrence of listhesis of more than 10% of the anterior-posterior dimensions of the inferior vertebral body during radiographic follow-up. Failure of conservative management was defined as a patient requiring surgical intervention after initially being managed nonoperatively. RESULTS: Seventy-four patients were included. Fifteen patients (20%) progressed radiographically. However, only 2 developed radicular symptoms and none developed myelopathy or other catastrophic cord related symptoms. Seven patients (9%) underwent surgery. Indications for surgery included significant radiographic progression and/or radicular symptoms. Risk factors for failure of conservative management included presence of radiculopathy at the time of presentation, a higher body mass index, increased Injury Severity Score, greater initial fracture displacement and more than 2 mm of listhesis. CONCLUSIONS: Patients with non-displaced or minimally displaced facet fractures who do not have neurological symptoms at the time of presentation can safely be managed conservatively with careful observation and follow-up.
Body Mass Index ; Classification ; Clinical Study ; Follow-Up Studies ; Humans ; Injury Severity Score ; Radiculopathy ; Retrospective Studies ; Risk Factors* ; Spinal Cord Diseases ; Trauma Centers

The development of intelligent software in recent years has grown rapidly. Mobile health has become a field of interest as a tool for childcare, especially as a means for parents of children with diverse diseases and a resource to promote their health conditions. Current systematic review was conducted to survey the functionalities of available applications on the mobile platform to support pediatrics intelligent diagnosis and children healthcare. Results which met the inclusion criteria (such as patient monitoring, decision support, diagnosis support) were obtained, assessed and organised into a checklist. In this study, 379 potential apps were identified using the search feature in Apple App Store and Google Play Store. After careful consideration of the selected apps, only three (Google Play Store) and one (iTunes Store), fulfilled all the general inclusion criteria and special criteria, such as intelligence tools. The results showed that Artificial Intelligence (AI) was used minimally in diagnostic apps due to a limited amount of mobile hardware and software, such as the reliable programming of intelligent algorithms.

A 2-year-old girl who was under genetic follow up for developmental delay and dysmorphism was accidentally found to have bilateral optic disc swelling during screening examination. She showed response to optokinetic drum examination and the anterior segment examination was unremarkable. Optic disc swellings were seen in both eyes. Lumbar puncture shows high opening pressure of 50 cm H2O with unremarkable CSF analysis. MRI of brain was done and showed features in keeping with mild cerebral atrophy, with no evidence of hydrocephalus or space occupying lesion. She was diagnosed with idiopathic intracranial hypertension and oral acetazolamide 125mg bd was commenced. However, papilloedema persist despite medical therapy. Ventriculoperitonel shunt was inserted to reduce the csf pressure. This case report highlights the importance of considering idiopathic intracranial hypertension as a cause of optic disc swelling in pre-pubertal children because delay in diagnosis and treatment may permanently affect visual function especially in children.