Abstract : Background: Obstructive sleep apnea (OSA) is a common problem estimated at 2-5% in the school-aged children. As obesity prevalence is increasing universally, OSA is estimated to be higher than their lean children. Obesity related OSA is increasing in all age groups including younger children. The aim of this study is to focus on the importance of OSA among obese preschool children and to determine what risk factors are associated with OSA. Methods: A retrospective chart review for children ≤6 years is identified from tertiary centre in Saudi Arabia who had a polysomnography (PSG). Obesity was defined by a BMI of > 95th percentile for age. OSA was diagnosed if the obstructive apnea hypopnea index (OAHI) was greater than 1 event per hour. Results: There were 4 children identified; the mean age was 4.5 years meaning BMI was 28(SD ± 1.2). the prevalence of OSA in those children was high. Conclusion: Young obese children should be assessed for OSA. A history of snoring and daytime sleepiness should facilitate referral for a PSG, especially in resource-limited settings.

Keyword : _Obesity. Obstructive sleep apnea. Sleep-disordered breathing. Pediatrics_

Abstract : Spleenic abscess is a rare entity, with a reported frequency of 0.05-0.7%.Its reported mortality is still high, up to 47%, and has the potential to reach 100% among patients who do not receive antibiotic treatment. It is more common in the presence of infection at different primary sites, especially endocarditis or in cases of ischemic infarcts that are secondarily infected. Immunosuppression and trauma are well-known risk factors. Recently, intravenous drug abusers and alcoholics have shown an increased incidence compared to other high-risk groups. However, encountering this entity in general population is uncommon. Clinical examination and laboratory findings are not constant; thus, imaging is a necessary tool for establishing the diagnosis, with a choice between ultrasound and computed tomography. If untreated, the mortality reaches almost 100%. Treatment includes conservative measures and surgical interventions. Spleenectomy has been the preferred approach in most centers. More recent studies have suggested the use of advanced and alternative options, including laparoscopic surgical and percutaneous interventions. Changing trends, in view of the importance of immunological role of spleen, have emphasized more on spleen preserving protocols, especially in children and young patients, and in cases of solitary abscess with a thick wall. Conducted a literature review by analysis of various high-risk groups, presentation, diagnosis and treatment of splenic abscess and have presented a case report here. Spleenic abscess is an infrequent clinical entity and carries a very high mortality in the untreated cases. Pathognomic clinical features of left hypochondrial pain, splenomegaly, fever and leucocytosis are present in only one - third of the cases. Diagnosis is mostly done by imaging, either Abdominal Sonography or CT Scan. So far no prospective study has been done to rationalize the management, probably due to paucity of cases. Antibiotics alone or with percutaneous drainage under imaging control are successful in many cases. Failed aspirations and splenic abscesses with concomitant pathologies need spleenectomy. Spleenectomy and complete removal of the source of the infection is still the mainstay of treatment. Detailed review of the available literature of the clinical problem and various methods of treatment of spleenic abscesses are discussed in this article.

Keyword : spleenic abcess , urinary tract infection , immunocompetent

Abstract : ABSTRACT Clinical reasoning skills are considered as essential domain needed to be acquired to become a good physician The Diagnostic Thinking Inventory (DTI) is a tool used for measuring critical thinking skills namely flexibility in thinking and evidence for Structure in memory. To measure the clinical reasoning skills among medical students in Alzaiem Alazhari University.. It is cross-section study which was conducted at the Faculty of Medicine, Alzaiem Alazhari University (AAU) Khartoum,to measure clinical reasoning skills using the diagnostic thinking inventory(DTI) of 5th(92),9th(63) semester & the newly graduate (62) a total of 181students . The study population (74%) were under graduate (in 5th&9th.Semester), while the remainder were newly graduate (26%),all were scored high levels .Tests of correlation, for the 3 subgroups, for DTI scores the flexibility of thinking & Structure of Knowledge and the standard of Bordage, Grant & Marsden in 1990 (81.6& 87.4) for the students in 5th. Semester were 0.004 &0.000 for the 9th Semester students were, 0.001 & 0.000while for the newly graduate students were 0.424&,0.003 which were significant at P>0.05 using one sample t test &Nonparametric test ( Wilcoxon Signed Rank Test) was used when the data distribution was not normal. The correlation, for the 3 subgroups using one-way ANOVA was not significant (0.893& 0.680). DTI is an appropriate instrument for a comparative survey of self-assessed clinical reasoning among students at different semesters. The curriculum of AAU faculty of medicine is integrating basic and clinical sciences in solving community, family and individual health problems according to known methods of problem solving. In addition started teaching clinical reasoning skills earlier so, DTI scores were found to be high in all subgroups 5th, 9th & the newly graduate. There is Conclusive evidence that critical thinking skills and abilities can be taught, so medical curriculum should be integrated & based in problem based learning so as to graduate student with Critical thinking & good clinical reasoning skills. Keywords: Clinical reasoning skills,, Medical students, DTI, Curriculum

Keyword : Clinical reasoning skills,, Medical students, DTI, Curriculum