هواي مرات المرضى ينسون أو يتجاهلون أعراض مهمة طبيًا وتساعد بالوصول للتشخيص، لكنهم يعتقدونها غير مهمة خاصةً إذا ما جانت تزعجهم بشكل جبير.

من الشائع جدًا أنْ يشتكي المريض من ألم قوي، لكنه يتجاهل أو ينسى تغيّر لون الإدرار أو الطفح الجلدي.

Patients usually only report the symptoms that capture their attention or disrupt their life. They don't report the most important nor the most medically relevant ones. Patients typically report pain, nausea, itching, vertigo, fatigue more than heartburn, a simple rash or discoloration, forgetfulness, "some stiffness" in the morning, or sleep disturbances.

Lipoproteins & Fat transport in the body

Most adenocarcinomas are resistant to radiotherapy alone

والعُهدة على القائل

Anterior wall: Primarily formed by the aponeurosis of the external oblique muscle; laterally reinforced by the internal oblique muscle.
Posterior wall: Composed of the transversalis fascia and medially reinforced by the conjoint tendon (a fusion of the internal oblique and transversus abdominis aponeuroses).
Roof (superior wall): Formed by the arching fibers of the internal oblique and transversus abdominis muscles.
Floor (inferior wall): Constituted by the inguinal ligament, with medial reinforcement from the lacunar ligament.

Seizures occur more often in the neonatal period than at any other time of life; during this period, they most often occur within the first week of life. Reported incidence ranges from 1.5 to 5.5 per 1000 in newborns and may be even higher in premature infants. Most neonatal seizures (approximately 85%) are acute provoked seizures (previously called acute symptomatic seizures), occurring as a consequence of a specific identifiable etiology.

Importantly, neonatal seizures are not generalized but focal (either unifocal or multifocal).

Most neonatal seizures are electrographic-only, characterized by the presence of an electrographic seizure on EEG that has no overt clinical manifestations.

Electrographic-only seizures were previously termed "subclinical" or "silent" seizures. A preverbal infant cannot communicate sensory phenomena associated with seizures (e.g., a visual change associated with an occipital seizure or a sense of déjà vu due to a temporal lobe seizure), and unless the seizure originates in or migrates to the motor cortex, there will generally not be a clear abnormal movement. 

An infant with electroclinical seizures may have resolution of the clinical seizure with treatment but persistent electrographic-only seizures (electro-clinical uncoupling).

Focal clonic seizures can be differentiated from tremor or clonus by restraint of movement. Tremor or clonus can be stopped by restraint, though clonic seizure activity cannot, and muscle twitching can still be felt in the restrained limb.

Myoclonic seizures are distinguished from clonic seizures by the regular rate of repetition of clonic seizures, and the fact that myoclonic seizures are nonrepetitive and erratic.

neonates may experience normal physiologic myoclonus during active sleep (the precursor of REM sleep). Myoclonus may also occur during non-REM sleep and has been referred to as benign neonatal myoclonus.

Common causes of acute provoked seizure in neonates.

Treatment algorithm of neonatal seizures

Treatment algorithm of neonatal seizure unresponsive to anti-convulsants

باختصار، رگعه بفيتامين B6, نفسه pyridoxine.

وإذا ما فاد، رگعه بالمركب الفعال من B6, نفسه PLP.

وإذا ما فاد رگعه بـ folic acid analogue, اللي هو Leucovorin.

وإذا ما فاد رگعه بـ B7, نفسه الـ Biotin.

ليش هالموضوع مهم كلش؟
لأن مرات يجيك طفل مولود قبل ساعتين كلشي ما بيه بس فجأة يدخل بنوبة صرع ما تستجيب لأي دوة تنطيه. بس بمجرد ما تنطيه شي تافه مثل فيتامين B6 تلكاها توقفت والطفل رجع طبيعي، لأن عنده وحدة من عشرات الأمراض النادرة اللي نسميها inborn errors of metabolism