Multiple Lambl's excrescences with subvalvular extension, a rare cause of cryptogenic stroke: treated by port-access cardiac surgery.

A young male patient was evaluated for a cardiac cause of ischaemic stroke. In the work-up, a tumour was detected on the subvalvular apparatus of the mitral valve for which operative removal was scheduled. A port-access procedure was applied as a novel way of treatment. On thoracoscopic intracardiac inspection, however, multiple tumours were seen attached to the chordae tendineae and to the anterior leaflet of the mitral valve. It was decided to not to perform a plasty but to remove the valve in toto and insert a mechanical valve prosthesis. The tumours were diagnosed as multiple giant Lambl's excrescences.

Short report: suboptimal diabetes care in high-risk diabetic patients attending a specialist retina clinic.

AIMS: Individuals with diabetic retinopathy (DR) represent a high-risk group who would benefit from intensive metabolic control and risk factor management. This brief report examines quality of care among diabetic patients attending a tertiary retinal clinic. METHODS: A cross-sectional survey, notes review, and slit-lamp examination was conducted in 139 diabetic patients attending a specialist retinal clinic to assess the quality of comprehensive diabetes care. DR was graded according to the Early Treatment Diabetic Retinopathy Study scale. RESULTS: The prevalence of non-proliferative DR (NPDR) and proliferative DR (PDR) was 39.6 and 35.2%, respectively. The prevalence of microalbuminuria in patients with no DR, NPDR and PDR was 32, 54.1 and 68.8%, respectively. Glycaemic control was suboptimal (mean HbA(1c) 8.0 +/- 1.8%) and 15.8% were current smokers. Drugs affecting the renin-angiotensin system were used by only 61.9% of patients with both DR and microalbuminuria, and aspirin by only 35.3%. CONCLUSIONS: These data suggest that diabetes care in this high-risk population with established microvascular complications was suboptimal. Specialist clinics dealing with diabetic complications may be a setting where quality improvement strategies to reduce morbidity and mortality should be focused.

Relations of some sociocultural variables and attitudes and motivations of young Arab students learning English as a second language.

This paper examined a number of variables pertaining to the sociocultural outlooks of 412 young Arab students learning English as a foreign language and the relation of their attitudes and motivations prior to their learning of the language. Analysis indicated clearly that certain variables appeared to be correlated with their attitudes and motivations more than others. Most of the students had maids in their homes, and the presence of a maid was associated with most of the psycholinguistic variables tested. Their previous learning experience of the language was positively correlated as was their knowledge of English stories. Having some sort of English games had the highest correlations (.25 to .41). Potential pedagogical implications of these results were discussed.

Factors affecting child development in madinah, saudi arabia.

INTRODUCTION: This paper addresses an important pre-requisite for promoting child health; namely the promotion of sound child development. OBJECTIVES: The study aimed at identifying factors affecting child development in Madinah, Saudi Arabia. DESIGN: A cross-sectional study with a multi-stage stratified random sample of children. SETTING: Well-baby clinics of the primary health care centers in urban and rural areas of the Madinah region, North-western Saudi Arabia. PARTICIPANTS: A sample of 1219 "normal" children below the age of six. INTERVENTION: Tools used for the study were the modified and translated Denver Revised-Pre-screening Developmental Questionnaire (R-PDQ), and the Denver Developmental Screening Test (DDST) kit together with a social questionnaire. Logistic Regression analysis was used to show any significant association(s) between the study variables and the 104 developmental items in the R-PDQ. RESULTS: Eight variables were found to be strongly associated with each of the developmental items. Mothers' education was found to be significantly associated with 21 developmental items. Number of children in the household was next to mothers' education in its association with child development. Place of residence and gender were found to be significantly associated with seven and one abilities respectively. CONCLUSION: Findings emphasized the importance of girls and mothers' education as an aid in stimulating the development of their children and enabling mothers to prepare children for school. Adequate birth interval, and prolonged breastfeeding are recommended to enable mothers to care for their children, communicate with them and foster sound development. Scrutinizing the child's home environment and involving parents in the developmental progress of their children are also considered important. More stimulation and educational play are recommended for rural children and male urban children.

Translation and adaptation of the revised Denver pre-screening developmental questionnaire for Madinah children, Saudi Arabia.

A childâs development is largely connected with environment, and so tools used in developmental assessment and screening should be modified to match the local environment of children. The experience and findings of such modifications is important to child health workers. The objectives of this study were to describe the method applied in translating the Revised Denver Pre-screening Developmental Questionnaire (R-PDQ) as a developmental screening tool, and to describe and analyze changes introduced to the R-PDQ after translation, adaptation and validation for Saudi children. To adapt the R-PDQ, three steps were taken: translation from English to Arabic using cross-translation method, piloting the Arabic translation on 65 children and mothers, and conducting the questionnaire on a random sample of 1219 children to introduce final necessary changes. The English R-PDQ went through major changes to make it valid for use in Saudi culture for evaluation of a childâs development. Changes were made in the content of the questionnaire, age intervals, as well as normal age of developmental abilities and the order of acquiring them. Changes in the R-PDQ items were pertinent in language and personal-social items. No major changes were introduced in fine-motor or gross-motor items. This study demonstrates a model in adapting a developmental screening tool, and illustrates the need for standardization of âimportedâ developmental screening tools before using them.