An-Najah Blogs :: Anwar Akram Issa Dudin http://blogs.najah.edu/author/anwar-dudin An-Najah Blogs :: Anwar Akram Issa Dudin en-us Sun, 24 Sep 2017 05:12:27 IST Sun, 24 Sep 2017 05:12:27 IST webmaster@najah.edu webmaster@najah.edu Metabolic Workup in a Neuro–Pediatric Unit First Alarming Resultshttp://blogs.najah.edu/staff/anwar-dudin/article/Metabolic-Workup-in-a-NeurondashPediatric-Unit-First-Alarming-ResultsPublished Articles The pediatric department of AVH is a referral center for neurological renal and unresolved pediatric subspecialties cases in addition to general pediatric cases The deserved geographical areas are the West Bank and Gaza Most of referred cases are complicated still undiagnosed and referred for diagnosis and possible therapy Some of the cases were already investigated nearby countries without having yet specific diagnosis Small and Large Heads Detected in Palestinian Newbornshttp://blogs.najah.edu/staff/anwar-dudin/article/Small-and-Large-Heads-Detected-in-Palestinian-NewbornsPublished Articles The incidence of major CNS malformations detected in the neonatal period was calculated on the last consecutive 33969 hospital deliveries and was published in the Bulletin 2003 In this short article we present few notes about the incidence of small and large heads and the possible inversion of their rates in the future Hydrocephaly is a heterogeneous entity In this study we considered the diagnosis when the head circumference was enlarged with the presence of ventricular dilatation or with abnormally enlarged ventricles even if the head circumference was not enlarged yet If no other intracranial malformation like Dandy walker or absent corpus callosum or other extra CNS malformation was found the hydrocephalus was classified as isolated Cases of hydrocephaly associated with NTD were not considered under hydrocephaly as all cases of acquired hydrocephalus due to intracranial hemorrhage or congenital toxoplasmosis Colpocephaly was considered when the volume of the frontal horns was nearly normal and there was major dilatation of the occipital horns without absence or evident hypoplasia of corpus callosum and in the absence of NTD or Arnold Chiari malformation Hydranencephaly is a condition of uncertain origin characterized by an intact skull and absence of cerebral hemisphere Holoprosencephaly is a malformation in which the prosencephalon has failed to undergo segmentation and cleavage into paired symmetric cerebral hemispheres Microcephaly was considered in this series when the head circumference was at least 3 standard deviations below the mean for gestational age Malformations associating CNS anomalies with chromosomal aberration were considered with chromosomal aberrations Diaphragmatic Hernia and Limb Reduction Defects Case Report and Reviewhttp://blogs.najah.edu/staff/anwar-dudin/article/Diaphragmatic-Hernia-and-Limb-Reduction-Defects-Case-Report-and-ReviewPublished ArticlesSee attachedCNS Vaso-Occlusive Disease in Childrenhttp://blogs.najah.edu/staff/anwar-dudin/article/CNS-Vaso-Occlusive-Disease-in-ChildrenPublished Articles Stroke is rare in children with an incidence of 26 to 311 000 000 Cerebral infarction occurs among children of all ages The causes of stroke may be thrombotic embolic or hemorrhagic Most commonly pediatric stroke is caused by structural abnormalities of cerebral vasculature inflammatory conditions that involve cerebral vessels or congenital heart disease Diagnosis still relies heavily on clinical recognition of the cardinal signs of focal cerebral injury Topographic determination of the injured cerebral area has been enhanced by the advent of neuroradiologic methods such as MRI Nonetheless several disorders may mimic presentation of focal cerebral infarction; differentiating them from stroke depends heavily on an accurate history and physical examination Saving Children Medicine in the Service of Peacehttp://blogs.najah.edu/staff/anwar-dudin/article/Saving-Children-Medicine-in-the-Service-of-PeacePublished ArticlesSee attached fileNeonatal Unit Activity at Makassed Hospital 1986-1995http://blogs.najah.edu/staff/anwar-dudin/article/Neonatal-Unit-Activity-at-Makassed-Hospital-1986-1992Published ArticlesBulletin of Palestinian Child Society 2001; 6:1-11Major Malformations Detected in Palestinian Newborns Hospital Based Studyhttp://blogs.najah.edu/staff/anwar-dudin/article/Major-Malformations-Detected-in-Palestinian-Newborns-Hospital-Based-StudyPublished Articles The frequencies of malformations vary among different ethnic groups In addition some of these malformations as neural tube defects are known to exhibit secular variations The present study was undertaken to give preliminary data about the incidence of major malformations detected at birth among Palestinian population living in East Jerusalem and the southern part of the West Bank Chromosomal Aberrations Detected at Birthhttp://blogs.najah.edu/staff/anwar-dudin/article/Chromosomal-Aberrations-Detected-at-BirthPublished ArticlesBulletin of Palestinian Child Society 2001; 6:25-28Central Nervous System Alformations Detected in Palestinian Newbornshttp://blogs.najah.edu/staff/anwar-dudin/article/Central-Nervous-System-Alformations-Detected-in-Palestinian-NewbornsPublished ArticlesBulletin of Palestinian Child Society 2001; 6:29-43Cardiac Malformations Detected at Birthhttp://blogs.najah.edu/staff/anwar-dudin/article/Cardiac-Malformations-Detected-at-BirthPublished ArticlesBulletin of Palestinian Child Society 2001; 6:44-49Spondylo-Meta-Epiphyseal Dysplasia Short Limb-Hand Type a Case Report in a Palestinian Childhttp://blogs.najah.edu/staff/anwar-dudin/article/Spondylo-Meta-Epiphyseal-Dysplasia-Short-Limb-Hand-Type-a-Case-Report-in-a-Palestinian-ChildPublished Articles A 13 month-old male a result of a consanguineous marriage was diagnosed to have spondylo-meta epiphyseal dysplasia SMED short limb-hand type The case is the first to be reported among Palestinians and the 12th on the disease record The patient death was due to spinal cord compression Recurrent Spinal Shock Like Syndrome a Possible Convulsive Disorder?http://blogs.najah.edu/staff/anwar-dudin/article/Recurrent-Spinal-Shock-Like-Syndrome-a-Possible-Convulsive-DisorderPublished Articles The case of a 7-month-old boy who had 5 episodes mimicking a spinal shock and followed up over 4 years is reported Taking into consideration the normal neurological development the effect of anticonvulsive drugs and after excluding other hypothesis a convulsive disorder is advanced as the most plausible explanation Guillain-Barre Syndrome among Palestinian Children Clinical Aspect and Outcomehttp://blogs.najah.edu/staff/anwar-dudin/article/Guillain-Barre-Syndrome-among-Palestinian-Children-Clinical-Aspect-and-OutcomePublished Articles Objective: Evaluation of the incidence and clinical characteristics of GBS in pediatric age The disease actually represents the major cause of acute flaccid paralysis in healthy people Populations and Methods: We reviewed the hospital records of 33 patients who were admitted to Makassed Hospital with the diagnosis of GBS from January 1986 until December 1994 Two patients whose clinical signs and symptoms did not fulfill the criteria were excluded from the study Mean age was 5 years and 3 months SD=3years range 1-14 years and most of patients 45 were between 4-6 years Males were affected slightly more than females 14:1 The initial signs of illness started 5 days prior to hospitalization Seasonal predilection was prominent as more than 77 of patients were seen in winter and spring possibly reflecting seasonal peaks of triggering factors 48 of patients had a viral upper respiratory tract infection two weeks earlier HBS antigen was positive in 10 no family history or occupational factors no history of gastroenteritis or recent vaccination were reported research for polio virus was negative in all casesTen patients30 developed severe respiratory distress which required mechanical ventilation Three patients died 10 Discussion: Available data on the epidemiology of GBS rate of 06-19 cases per 100000 populations per year with an average of 05 to 10 which is considered roughly the same throughout the world all age group included This series is relatively important knowing that the population served by this department was 540000 in 1986 and around 800000 by the end of the study in 1994 Children under 15 years represent 50 of the designed population Ramallah East Jerusalem Jericho Bethlehem and Hebron districts During the study period 3 other cases were not hospitalized as diagnosed late and remained stable and about 15 other cases without respiratory distress were kept in other facilities The annual incidence rate is estimated for the studied period at least to be 1 in 100000 for the age group of under 15 years which can be considered high for the pediatric age group in this community Further studies are indicated to confirm these data Community Acquired Bacterial Tracheitishttp://blogs.najah.edu/staff/anwar-dudin/article/Community-Acquired-Bacterial-TracheitisPublished Articles Objective: Determination of main causes of severe obstructive dyspnea SOD with emphasis on bacterial tracheitis Population and Methods: Hospital records of patients hospitalized for SOD from January 1986 to December 95 were reviewed Diagnostic criteria for BT were clinical Blood cultures and tracheal aspirates for culture were taken immediately after intubation and IV antibiotics initiated thereafter RESULTS: 202 cases of SOD were recorded including 171 laryngotracheobronchitis 1 epiglottitis and 15 BT 27 patients needed intubation including 3 LTB 15 BT and 1 epiglottitis The age of BT patients ranged between 26 days and 13 years Fourteen occurred in the cold season All patients had signs of URTI 5-120 hours prior to admission Respiratory distresses inspiratory stridor - expiratory wheezes and cyanosis were the main clinical features on admission Drooling and hyperextension of the neck were absent Twelve patients required immediate intubation 3 intubated few hours later were initially diagnosed as reactive airway disease Tracheal aspirates showed dense growth of Staphylococcus aureus in 6 Viridans Streptococcus in 3 hemolytic Streptococcus Group in 2 and Haemophilus influenzae in 4 Only one had a positive blood culture for Streptococcus pneumonia Initial chest roentgenogram showed patchy infiltrates or bilateral hyperinflation Fine mucosal irregularities of the trachea lateral neck were noted in 4 Assisted ventilation was needed in 8 patients for 4-120 hours Frequent endotracheal aspirations were necessary in all cases during the first 24 hours Extubation was possible after 24-144 hours Two patients developed adult respiratory distress syndrome one of them died Conclusion: BT is the main cause of SOD requiring intubation in this community Epiglottitis is rare Survey and Detection of Iodine Deficiencyhttp://blogs.najah.edu/staff/anwar-dudin/article/Survey-and-Detection-of-Iodine-DeficiencyPublished ArticlesBULLPALESTCHSOCVOL 3 JAN 98Iodine Deficiency Disordershttp://blogs.najah.edu/staff/anwar-dudin/article/Iodine-Deficiency-DisordersPublished Articles The four most important deficiency diseases in developing countries today are protein-energy malnutrition PEM xerophthalmia nutritional anemia and iodine deficiency disorders Control of these nutritional diseases requires systematic diagnosis of the existing situation and appropriate intervention strategies such as targeted food and specific micronutrient supplementation food fortification nutrition education and reductions in infections as well as general improvements in economic conditions and social equity Iodine deficiency is the leading cause of preventable intellectual impairment and is associated with a spectrum of neurological and developmental pathology More than one billion people are at risk The technology of iodine deficiency intervention is well established Iodized salt the preferred method is easy to produce administer in physiologic doses and is cost effective Iodine Deficiency and Neurological Implicationshttp://blogs.najah.edu/staff/anwar-dudin/article/Iodine-Deficiency-and-Neurological-ImplicationsPublished ArticlesBULLPALESTCHSOCVOL 3 JAN 98IDD Aspects Related To Supplementationhttp://blogs.najah.edu/staff/anwar-dudin/article/IDD-Aspects-Related-To-SupplementationPublished ArticlesSee attachedMolecular, antibiogram and serological typing of Staphylococcus aureus isolates recovered from Al-Makased hospital in East Jerusalemhttp://blogs.najah.edu/staff/anwar-dudin/article/Molecular-antibiogram-and-serological-typing-of-Staphylococcus-aureus-isolates-recovered-from-Al-Makased-hospital-in-East-JerusalemPublished ArticlesStaphylococcus aureus is a major cause of nosocomial infections and a risk in patients who have either undergone surgery or are on haemodialysis The S aureus infections in patients admitted to the clinical departments of Al-Makased Charitable Hospital in Jerusalem during a period of one year were investigated Isolates included were from blood surgical wounds or other nonsuperficial sites Of 63 isolates available for analysis 46 730 expressed type 8 capsular polysaccharide; 13 207 type 5 capsular polysaccharide; only 4 isolates 63 did not express type 5 or type 8 antibodies The strains fitted in 7 different antibiogram types with the type showing resistance only to penicillin and ampicillin prevalent in 34 out of 63 isolates 540 Of the 12 methicillin-resistant S aureus MRSA isolates 191 8667 possessed the type 8 capsule and 4337 the type 5 capsule Pulsed-field gel electrophoresis of all isolates with the restriction-endonuclease enzymes Sma I revealed 34 patterns demonstrating that no single methicillin-sensitive S aureus strain was endemic in the hospital However all MRSA isolates with a type 8 capsule showed identical PFGE patterns using the 2 restriction-endonuclease enzymes Sma I and SST II Moreover type 5 isolates showed identical patterns one isolate differed from the rest with one band only These data suggest and confirm the clonality of type 5 and type 8 MRSA isolates Analysing the results of the capsular and antibiogram typing schemes in conjunction proved useful and suggested that such an analysis can be employed as a helpful epidemiological tool in hospitals with limited resources Tropical Medicine International Health Volume 3 Issue 7 Pages 576 - 583 http:www3intersciencewileycomjournal119136081abstract?CRETRY=1SRETRY=0Neural tube defect among Palestinians: a hospital-based studyhttp://blogs.najah.edu/staff/anwar-dudin/article/Neural-tube-defect-among-Palestinians-a-hospital-based-studyPublished ArticlesA preliminary study was undertaken to estimate the incidence of neural tube defect NTD among Palestinians living in East Jerusalem and the southern part of the West Bank 600000 inhabitants Between 1 January 1986 and 31 December 1993 all NTD in fetuses weighing more than 500 g or of more than 22 weeks gestation whether the product of abortion therapeutic termination stillborn or liveborn were included Mothers data recorded included age parity residential area gestational age obstetrical history and consanguinity The study included 26934 consecutive newborns registered at Makassed Hospital in the study period There were 148 cases of NTD an incidence of 549 per 1000 births The female to male ratio was 15:1 The incidences of spina bifida encephalocele and anencephaly were 223 044 and 241 per 1000 respectively The incidence of NTD increased with maternal age This preliminary report reveals a high incidence of NTD in the Palestinian community and further monitoring is necessary to confirm these findings and implement suitable policies for the detection and prevention of NTD Ann Trop Paediatr 1997 Sep;173:217-22 Acute periorbital swelling: evaluation of management protocolhttp://blogs.najah.edu/staff/anwar-dudin/article/Acute-periorbital-swelling-evaluation-of-management-protocolPublished ArticlesOBJECTIVE: Reporting and evaluating a general pediatric unit experience with a simplified protocol based on clinical signs stated on admission used to classify cases of periorbital cellulitis in potential high- and low-risk complication groups POPULATION: All children under the age of 14 years with acute periorbital swelling not resulting from an immediate direct trauma to the eye and the orbit referred to the emergency department between December 1 1986 and December 31 1992 METHOD: A high-risk case was defined by: age under two months meningeal or focal neurologic signs vision loss limitation of eye movement eye malformation or operation in the vicinity and clinically toxic child on admission Absence of these elements defined the low-risk case Initial antibiotic management was the same in both groups but work-up was different according to the classification of the case RESULTS: Thirty-four patients were included in the study Only one six months old had a positive blood culture with Haemophilus influenzae found in the low-risk group 16 patients and no serious complication was encountered In the high-risk group 18 patients five had positive cerebrospinal fluid andor blood culture two had subperiosteal abscesses and three had intracranial abscesses In the whole series \toxicity\ was significantly associated with either positive cerebrospinal fluid or blood culture Fifty percent of positive cultures were due to H influenzae CONCLUSION: The protocol is considered practical safe and represents a suitable triage tool particularly if the high-risk age was raised to 12 months There is no necessity to perform lumbar puncture in the low-risk group Pediatr Emerg Care 1996 Feb;121:16-20 Choledochal cyst associated with rare hand malformationhttp://blogs.najah.edu/staff/anwar-dudin/article/Choledochal-cyst-associated-with-rare-hand-malformationPublished ArticlesWe report on an 8-year-old boy with choledochal cyst associated with most unusual hand malformation Review of the literature and possible etiopathogenesis are discussed Nasopharyngeal Colonization Pattern and Antibiotic Susceptibility Among Palestinian Childrenhttp://blogs.najah.edu/staff/anwar-dudin/article/Nasopharyngeal-Colonization-Pattern-and-Antibiotic-Susceptibility-Among-Palestinian-ChildrenPublished ArticlesNasopharyngeal swabs were taken from 292 Palestinian children under five years of age in order to determine the nasopharyngeal colonization rate pattern and antibiotic sensitivity of the bacterial isolates to the commonly used antibiotics Results indicate the following nasopharyngeal colonization rates: Streptococcus pneumonia 43 Hemophilus influenza type b Hib 38 Moraxella catarrhalis M Catarrhalis 42 In-vitro sensitivity patterns to Ampicillin Chloramphenicol and Cotrimoxazole for S pneumonia were 63 91 and 19 respectively while for Hib they were 50 77 and 64 respectively Bull Palest Ch Soc 1995 1:3 225-234 1995 10 pp Bacterial Meningitis among Palestinian Childrenhttp://blogs.najah.edu/staff/anwar-dudin/article/Bacterial-Meningitis-among-Palestinian-Children-1Published ArticlesA prospective study was conducted on children aged 1 month to 14 years admitted to Makassed Hospital between 1987 and 1992 with a diagnosis of bacterial meningitis The objective of the study was to examine the epidemiology of this disease During the study period 80 children met the criteria for inclusion in the study Results indicate that for children under the age of three Hib was the most common pathogen 65 followed by S pneumonia For children over the age of three S pneumonia was the most common pathogen at 42 followed by N meningitides and Hib at 29 and 13 respectively The mean duration of illness before admission to the hospital was 3 days Children admitted with S pneumonia meningitis commonly had a history of significant head trauma Fifty-four percent of the patients had received antibiotics before admission Forty percent of Hib isolates were resistant to ampicillin while one case of Hib meningitis was resistant to chloramphenicol The authors conclude that the pattern of bacterial meningitis in Palestinian population is similar to that in developed countries Significant head trauma was shown to be major predisposing factor in S pneumonia meningitis Due to the high rate of resistance of Hib strains to ampicillin the authors recommend the initial empirical use of regimens including third generation cephalosporin Bull Palest Ch Soc 1:3 235-247 1995 13 ppBacterial Meningitis among Palestinian Childrenhttp://blogs.najah.edu/staff/anwar-dudin/article/Bacterial-Meningitis-among-Palestinian-ChildrenPublished ArticlesA prospective study was conducted on children aged 1 month to 14 years admitted to Makassed Hospital between 1987 and 1992 with a diagnosis of bacterial meningitis The objective of the study was to examine the epidemiology of this disease During the study period 80 children met the criteria for inclusion in the study Results indicate that for children under the age of three Hib was the most common pathogen 65 followed by S pneumonia For children over the age of three S pneumonia was the most common pathogen at 42 followed by N meningitides and Hib at 29 and 13 respectively The mean duration of illness before admission to the hospital was 3 days Children admitted with S pneumonia meningitis commonly had a history of significant head trauma Fifty-four percent of the patients had received antibiotics before admission Forty percent of Hib isolates were resistant to ampicillin while one case of Hib meningitis was resistant to chloramphenicol The authors conclude that the pattern of bacterial meningitis in Palestinian population is similar to that in developed countries Significant head trauma was shown to be major predisposing factor in S pneumonia meningitis Due to the high rate of resistance of Hib strains to ampicillin the authors recommend the initial empirical use of regimens including third generation cephalosporin Bull Palest Ch Soc 1:3 235-247 1995 13 ppAcute Periorbital Swelling: Evaluation of Management Protocolhttp://blogs.najah.edu/staff/anwar-dudin/article/Acute-Periorbital-Swelling-Evaluation-of-Management-ProtocolPublished ArticlesThe article documents a retrospective study of the management of acute periorbital swelling in children referred to the emergency room at Makassed Hospital in Jerusalem between 1986-1992 The aim of the study was to evaluate the protocol used in the management of these cases The protocol uses a number of certain criteria to define high risk cases The results of the study indicate that the protocol is practical and safe A number of adjustments to the protocol are suggested Bull Palest Ch Soc 1995; 13: 299-309 The Prevalence of Toxoplasma Antibodies among Palestinian Womenhttp://blogs.najah.edu/staff/anwar-dudin/article/The-Prevalence-of-Toxoplasma-Antibodies-among-Palestinian-WomenPublished ArticlesThe article reports a study of the prevalence of anti-Toxoplasma antibodies among Palestinian women Data were collected from deliveries registered at Makassed Hospital in Jerusalem in 1990 A high prevalence of antibodies was found reaching 498 of the sample In the discussion the authors compare their results with results of other studies from other countries in the region Bull Palest Ch Soc 1994; 12: 215-220 1994 6 pp Clinical Aspects of Vitamin K Deficiency in the First Year of Lifehttp://blogs.najah.edu/staff/anwar-dudin/article/Clinical-Aspects-of-Vitamin-K-Deficiency-in-the-First-Year-of-LifePublished ArticlesNineteen cases were hospitalized in the neonatal intensive care unit in Makassed Hospital between October 1986 and November 1993 as a result of hemorrhagic diseases caused by vitamin K deficiency Their records were reviewed and clinical aspects examined The authors recommend systematic administration of intramuscular injections of 1 mg vitamin K immediately after delivery for hospital deliveries and within the first six months of life for home-delivered infants Bull Palest Ch Soc 1:1 87-95 1994 9 pp Intrauterine Growth in Weight, Length and Head Circumference as Estimated from Live Born Palestinian Newborns at 30-42 Weeks Gestational Agehttp://blogs.najah.edu/staff/anwar-dudin/article/Intrauterine-Growth-in-Weight-Length-and-Head-Circumference-as-Estimated-from-Live-Born-Palestinian-Newborns-at-30-42-Weeks-Gestational-AgePublished ArticlesThe article presents a study of anthropometric measurements of 2062 Palestinian neonates born at Makassed Hospital Jerusalem between 30 and 42 weeks gestational age Measurements utilized are weight length and head circumference Results of measurements were found comparable with results reported in studies from the United States and Canada Bull Palest Ch Soc 1994; 12: 151-161 1994 11 pp Foreign Body Aspiration Among Palestinian Childrenhttp://blogs.najah.edu/staff/anwar-dudin/article/Foreign-Body-Aspiration-Among-Palestinian-ChildrenPublished ArticlesA review of the records of 110 children admitted to Makassed Hospital between 1986 and 1992 with the diagnosis of foreign body aspiration Results include:- 74 of the cases were between nine months and three years of age- The male to female ratio was 3:2- Most foreign bodies were lodged in the right main bronchus- The most common foreign bodies were melon seeds- The most common presenting features were chocking and or acute respiratory distress- Overall mortality rate was 18 Bull Palest Ch Soc 1:1 47-55 1994 8 pp