Delayed neurological dysfunction following posterior laminectomy with lateral mass screw fixation:A case report and review of literature

BACKGROUND While most complications of cervical surgery are reversible,some,such as symptomatic postoperative spinal epidural hematoma(SEH),which generally occurs within 24 h,are associated with increased morbidity and mortality.Delayed neurological dysfunction is diagnosed in cases when symptoms present>3 d postoperatively.Owing to its rarity,the risk factors for delayed neurological dysfunction are unclear.Consequently,this condition can result in irreversible neurological deficits and serious consequences.In this paper,we present a case of postoperative SEH that developed three days after hematoma evacuation.CASE SUMMARY A 68-year-old man with an American Spinal Injury Association(ASIA)grade C injury was admitted to our hospital with neck pain and tetraplegia following a fall.The C3-C7 posterior laminectomy and the lateral mass screw fixation surgery were performed on the tenth day.Postoperatively,the patient showed no changes in muscle strength or ASIA grade.The patient experienced neck pain and subcutaneous swelling on the third day postoperatively,his muscle strength decreased,and his ASIA score was grade A.Magnetic resonance imaging showed hypointense signals on T1 weighted image(T1WI)and T2WI located behind the epidural space,with spinal cord compression.Emergency surgical intervention for the hematoma was performed 12 h after onset.Although hypoproteinemia and pleural effusion did not improve in the perioperative period,the patient recovered to ASIA grade C on day 30 after surgery,and was transferred to a functional rehabilitation exercise unit.CONCLUSION This case shows that amelioration of low blood albumin and pleural effusion is an important aspect of the perioperative management of cervical surgery.Surgery to relieve the pressure on the spinal cord should be performed as soon as possible to decrease neurological disabilities.

儿童重症监护病区CRE感染的危险因素及耐药情况分析

目的研究重症监护病区患儿CRE感染的耐药情况及发生CRE医院感染的危险因素,为儿童治疗CRE感染和医院制定感染防控策略提供参考依据。方法回顾性分析2019年1月至2022年12月入住云南省某三甲儿童医院重症监护病区患儿的临床资料,将92例耐碳青霉烯类肠杆菌科细菌(CRE)医院感染的患儿纳入病例组,按1∶1随机选择同期92例对碳青霉烯类敏感肠杆菌科细菌(CSE)感染的患儿纳入对照组,进行菌株鉴定和药敏试验,分析感染菌株和耐药情况,并通过SPSS 26.0对CRE感染患儿进行单因素和多因素Logistic回归分析,探究重症患儿发生CRE感染的相关危险因素。结果CRE感染菌株检出最多的为肺炎克雷伯菌81例(88.04%),其次为大肠埃希菌5例(5.43%)。CRE组左氧氟沙星、阿莫西林/克拉维酸、头孢他啶、亚胺培南、头孢吡肟、头孢曲松、阿米卡星耐药率均高于CSE组,均显示差异有统计学意义(P<0.05)。单因素分析结果显示,留置胃管、中心静脉置管、机械通气、碳青霉烯类、抗真菌药、糖肽类及多粘菌素类抗生素使用史、抗生素药物使用种类≥3种、抗生素药物使用时间、碳青霉烯类抗生素使用时间、入住ICU时间和总住院时间均是CRE感染的危险因素,显示差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,碳青霉烯类抗生素使用史及使用时间和抗菌药物使用时间(P<0.05)是重症患儿CRE感染的独立危险因素。结论结合重症患儿CRE感染的危险因素,尽量减少穿刺置管等侵入性操作,规范抗生素药物在重症患儿治疗中的使用管理,特别是碳青霉烯类抗生素,尽可能缩短患儿入住ICU时长和总住院时长,加强对重症患儿CRE的主动筛查,制定合理有效的感染防控策略,减少重症患儿CRE院内感染的发生。

Perioperative risk factors for delayed gastric emptying after pancreaticoduodenectomy:a meta-analysis of the complications

Objective:To evaluate the correlation between the incidence of delayed gastric emptying(DGE)in pancreaticoduodenectomy(PD)and the perioperative possible risk factors.Methods:We searched PubMed,Embase,Cochrane Library,and Medline for studies describing complications related to PD from 2018 to 2022.Statistical analysis was performed using Stata/SE16.0 software.Results:In 6 retrospective studies,1 systematic review,and 1 randomized controlled trial(RCT)experiment,12,419 patients(2174 and 10,245 patients,respectively,in DGE and no delayed gastric emptying[NDGE]groups).The preoperative American Society of Anesthesiologists(ASA)score between DGE and NDGE groups(log odds ratio[OR]=0.23,95%credible interval[CI]:0.11-0.35,P<.01),operation time(mean diff.=21.87,95%CI:15.96-27.78,P<.01),estimated intraoperative blood loss(EIBL;mean diff.=70.67,95%CI:17.75-123.58,P<.05),postoperative pancreatic fistula(POPF)(log OR=0.85,95%CI:0.24-1.46,P<.05)were statistically significant.No significant differences in preoperative body mass index(BMI),preoperative biliary drain-age,and pancreatic texture were observed(P>.05).Conclusion:The incidence of DGE is significantly correlated with the operation time,preoperative ASA score,POPF,and EIBL,which suggests that the surgeon should thoroughly evaluate the patient through adequate preoperative examination before the operation.Finally,standardized practice and perfect technology are undoubtedly necessary to reduce complications.

Development and validation of a nomogram model for predicting the risk of pre-hospital delay in patients with acute myocardial infarction

BACKGROUND Acute myocardial infarction(AMI)is a severe cardiovascular disease caused by the blockage of coronary arteries that leads to ischemic necrosis of the myocardium.Timely medical contact is critical for successful AMI treatment,and delays increase the risk of death for patients.Pre-hospital delay time(PDT)is a significant challenge for reducing treatment times,as identifying high-risk patients with AMI remains difficult.This study aims to construct a risk prediction model to identify high-risk patients and develop targeted strategies for effective and prompt care,ultimately reducing PDT and improving treatment outcomes.AIM To construct a nomogram model for forecasting pre-hospital delay(PHD)likelihood in patients with AMI and to assess the precision of the nomogram model in predicting PHD risk.METHODS A retrospective cohort design was employed to investigate predictive factors for PHD in patients with AMI diagnosed between January 2022 and September 2022.The study included 252 patients,with 180 randomly assigned to the development group and the remaining 72 to the validation group in a 7:3 ratio.Independent risk factors influencing PHD were identified in the development group,leading to the establishment of a nomogram model for predicting PHD in patients with AMI.The model's predictive performance was evaluated using the receiver operating characteristic curve in both the development and validation groups.RESULTS Independent risk factors for PHD in patients with AMI included living alone,hyperlipidemia,age,diabetes mellitus,and digestive system diseases(P<0.05).A characteristic curve analysis indicated area under the receiver operating characteristic curve values of 0.787(95%confidence interval:0.716–0.858)and 0.770(95%confidence interval:0.660-0.879)in the development and validation groups,respectively,demonstrating the model's good discriminatory ability.The Hosmer–Lemeshow goodness-of-fit test revealed no statistically significant disparity between the anticipated and observed incidence of PHD in both development and validation cohorts(P>0.05),indicating satisfactory model calibration.CONCLUSION The nomogram model,developed with independent risk factors,accurately forecasts PHD likelihood in AMI individuals,enabling efficient identification of PHD risk in these patients.

DYNAMIC ANALYSIS OF A TYPE OF FINANCIAL RISK CONTAGION MODEL INVOLVING IMMUNITY PERIOD AND SELF-RESCUE

In this paper,we study the dynamics of a Susceptible-Exposed-Infectious-Recovered(SEIR)nancial risk contagion model with time delay.Using stability theory and Hopf bifurcation theory,equilibria stability and Hopf bifurcation are analyzed in detail.Based on the epidemic model,we improve it by taking prior prevention and self-rescue into consideration,conclude pre-ventive intensity and self-rescue capabilities e ect the number of infections.At the same time,the analytical conditions for Hopf bifurcation are obtained,and the relevant results are veri ed by numerical simulations.

Addressing diagnostic delays in inflammatory bowel diseases in Germany

Inflammatory bowel diseases(IBDs),including Crohn's disease(CD)and ulcerative colitis,are chronic inflammatory conditions of the gastrointestinal tract that necessitate timely diagnosis to prevent complications and improve patient outcomes.Despite advancements in medical knowledge and diagnostic techniques,significant diagnostic delays persist,particularly in CD.The study by Blüthner et al,published in the World Journal of Gastroenterology,elucidates the diagnostic delays experienced by German patients with IBD and identifies key risk factors contributing to these delays.

Detection of schedule delay risk of empirical construction projects

In Ethiopian construction projects, schedule delay risk is a predominant issue because it is not properly addressed. Although several studies have been focused on the various effects of risk in construction projects, limited efforts have been made to investigate the typical and the overall schedule delay risk. In this study, our aim is to detect the typical and overall schedule delay risk throughout the construction project lifecycle, which consists of the pre-construction, construction, and post-construction stages, and compare the stages with each other. Common criteria, sub-criteria, and attributes were developed for all alternatives for the purpose of making a risk decision. The methodology that was followed integrated the multiplecriteria decision-making(MCDM) model of fuzzy analytic hierarchy process comprehensive evaluation(FAHPCE)and the relative important index(RII). Data were collected from 77 participants, who were selected through purposive sampling from different contracting organizations in Ethiopian construction projects by means of questionnaires that were distributed to experienced experts. The findings showed that there is a typical delay risk either in the type or in the level of the different construction activities.Consequently, the most influenced alternative is the construction stage because of the high-risk responsibility,resource, and contract condition related criteria. The postconstruction stage was the second most influenced stage because of the high-risk responsibility-related criteria. The pre-constructed stage was the least influenced stage that consist high-risk criteria of responsibility, resource, and contract condition related. These differences provided noteworthy information about risk mitigation in construction projects by identifying the exact risk level on specific activity to make appropriate decision.

医院获得性耐碳青霉烯类肠杆菌目细菌血流感染危险因素

目的分析医院获得性耐碳青霉烯类肠杆菌目细菌(CRE)血流感染的特点及影响因素。方法采用回顾性巢式病例对照研究方法,选取2020年1月—2022年12月某三级综合医院发生医院获得性CRE血流感染的56例病例为CRE组,按1∶1选择同期56例碳青霉烯类敏感肠菌目细菌(CSE)血流感染患者为CSE组,分析感染菌株和科室分布,并通过单因素和多因素logistic回归分析CRE血流感染的相关因素。结果CRE血流感染科室分布以重症监护病房(ICU,23例,41.07%)和血液科(17例,30.36%)为主;感染菌株主要为肺炎克雷伯菌(32例,57.14%)和大肠埃希菌(16例,28.57%)。单因素分析结果显示,恶性肿瘤、60 d内住院史、感染前入住ICU>48 h、机械通气、留置中央静脉导管、使用二联及以上抗菌药物、抗菌药物使用时间≥10 d均与CRE血流感染有关(均P<0.05)。多因素logistic回归分析发现,感染前入住ICU>48 h、感染前抗菌药物使用时间≥10 d是医院获得性CRE血流感染的独立危险因素(P<0.05)。结论临床尤其是ICU应关注患者的流行病学史,尽早识别CRE血流感染高危因素的患者,同时合理使用抗菌药物,规范有创操作,以减少医院获得性CRE血流感染的发生。

Risk factors for delayed intracranial hemorrhage secondary to ventriculoperitoneal shunt:A retrospective study

BACKGROUND Delayed intracranial hemorrhage(DICH),a potential complication of ventriculoperitoneal(VP)shunts,has been associated with high mortality,but its risk factors are still unclear.AIM To investigate the risk factors of DICH after VP shunts.METHODS We compared the demographic and clinical characteristics of DICH and non-DICH adult patients with VP shunts between January 2016 and December 2020.RESULTS The 159 adult VP shunt patients were divided into 2 groups according to the development of DICH:the DICH group(n=26)and the non-DICH group(n=133).No statistically significant difference was found in age,sex,laboratory examination characteristics or preoperative modified Rankin Scale(mRS)score between the DICH and non-DICH groups(P>0.05);however,a history of an external ventricular drain(EVD)[P=0.045;odds ratio(OR):2.814;95%CI:1.024-7.730]and postoperative brain edema around the catheter(P<0.01;OR:8.397;95%CI:3.043-23.171)were associated with a high risk of DICH.A comparison of preoperative mRS scores between the DICH group and the non-DICH group showed no significant difference(P=0.553),while a significant difference was found in the postoperative mRS scores at the 3-mo follow-up visit(P=0.024).CONCLUSION A history of EVD and postoperative brain edema around the catheter are independent risk factors for DICH in VP shunt patients.DICH patients with a high mRS score are vulnerable to poor clinical outcomes.

Impacts of the Financial Factors on Schedule Delays Risk of the International Contracting Projects: Evidence from Highway BOT Pro-jects in Vietnam

Vietnam has become a major market for construction enterprises from East Asian countries, especially from China, to participate in international project contracting, but serious schedule delays have important adverse effects on local government and foreign investment companies. Based on international engineering contracting mode of Vietnam highway BOT construction projects, we discussed the drive financial factors of schedule delays, using the methods of exploratory factor analysis and questionnaire survey, and evaluated the effects of various factors which are through regression analysis. The empirical results show that the five categories of financial factors, including the policy change, slow payment, financial mismanagement, financial market changes and lack of fiscal, have significant effects on schedule delay. Furtherly, we suggested that strengthening policy research and improving financial management ability should be used to reduce the influence of relevant financial factors on schedule delay, to improve the profitability of international businesses and the motivation of foreign enterprises to participate in Vietnam highway project.

Perioperative risk factors associated with delayed graft function following deceased donor kidney transplantation:A retrospective,single center study

BACKGROUND There is an abundant need to increase the availability of deceased donor kidney transplantation(DDKT)to address the high incidence of kidney failure.Challenges exist in the utilization of higher risk donor organs into what appears to be increasingly complex recipients;thus the identification of modifiable risk factors associated with poor outcomes is paramount.AIM To identify risk factors associated with delayed graft function(DGF).METHODS Consecutive adults undergoing DDKT between January 2016 and July 2017 were identified with a study population of 294 patients.The primary outcome was the occurrence of DGF.RESULTS The incidence of DGF was 27%.Under logistic regression,eight independent risk factors for DGF were identified including recipient body mass index≥30 kg/m^(2),baseline mean arterial pressure<110 mmHg,intraoperative phenylephrine administration,cold storage time≥16 h,donation after cardiac death,donor history of coronary artery disease,donor terminal creatinine≥1.9 mg/dL,and a hypothermic machine perfusion(HMP)pump resistance≥0.23 mmHg/mL/min.CONCLUSION We delineate the association between DGF and recipient characteristics of preinduction mean arterial pressure below 110 mmHg,metabolic syndrome,donorspecific risk factors,HMP pump parameters,and intraoperative use of phenylephrine.

Controlling the Risk of Construction Delay in the Middle East： State-of-the-Art Review

The financial crisis in late 2008 arrested economic development in the construction sector in the Middle East, with the result that investors＇ confidence in the sector is severely depressed. Delays constitute one of the highest impediments to project success. In this respect, the traditional management is no longer sufficient for construction project success. The objective of this study is to conduct a literature review to identify additional effective measures for controlling the potential delays risks in construction projects in order to maximize the opportunities for success in those projects. Thirty-six scholarly articles published between 2000 and 2011 are reviewed to identify related MDRC （measures for delays risks control）. This survey reveals that 60% of the studies are related to decision-making, performance, risk management variations and poor management knowledge of stakeholders and that 20% of these studies are undertaken in the Middle East. A further 25% of the studies are related to the lack of financial risk by stakeholders, and of these 14% are in the Middle East. A knowledge gap is identified in terms of project performance, stakeholder management and risk management, which are seen as significant measures of success in controlling project delay.

Delays to Large Construction Projects in Ghana： A Risk Overview

Delay to large scale projects, which is as a result of actions or inactions of some project stakeholders, is becoming a global phenomena and Ghana is no exception. The objective of the research is to identify, rate and rank the most significant risk factors that causes delay on projects and examine the social impact of these delays to recommend modalities to help mitigate these risk factors. The study adopted quantitative methods with the distribution of 144 questionnaires to built environment professionals receiving a response rate of 75.7%. The instrument listed 58 common factors under eight categories that contribute to the causes of delay for respondents to rate. Analysis of data non-parametric test revealed that client, contractor, material and finance category factors significantly resulted in the schedule delay of large infrastructural projects. The survey analysis revealed that micro-factors that result in delays to large construction projects are time constraint, cost overrun, payment problems, dispute and litigation. The research recommended the following modalities to minimize such delays： availability of resources, improved communication and coordination, proper scope definition and feasibilities, utilization of modern technology, appropriate application of technologically based systems and competent project management＇s structures.

A Critical Review of Post Endoscopic Sub-Mucosal Dissection (ESD) Delayed Bleeding Risk Factors

Endoscopic sub-mucosal dismemberment (ESD) has become a settled strategy for treatment of shallow neoplasms in the gastrointestinal tract. In three local areas, ESD was introduced to overcome traditional endoscopic mucous resection (EMR) and inadequate resection of the EMR, combining mouth, stomach, and the colon, for early disruptive sores. ESD was grown first in Japan since that nation has the highest predominance of gastric malignant growth on the planet. Endoscopic sub-mucosal analyzation causes enormous fake ulcers with more severe dangers of intra-usable and deferred postoperative draining. However, there is no agreement in regards to the ideal peri-usable administration for the anticipation of free draining and the advancement of ulcer mending. The hugeness of this investigation is to locate a superior procedure to bring down the hazard post ESD draining and to plan to defeat the confinements of regular EMR (endoscopic mucosal resection) and fragmented resection for early malignant injuries in the three districts which incorporate throat, stomach, and colon. However, it has considered a standard in Eastern Asian nations and Japan because of the incredible importance of ESD. The EMR and ESD approaches are discussed in this report. Thus, the warning factors for early gastric neoplasms of PPB after ESD were established, and a superior technique was created to mitigate the danger of ESD dying. EMR was already widely used for treating early neoplastic sores in the gastrointestinal tract;colon adenoma and colorectal tumors are widely acknowledged.

Analysing Delay Impact from Potential Risk Factors on Project Delivery of Oil and Gas Pipeline:A Case Study in IRAQ

The aim of this paper is to present the design and specifications of an integrated Delay Analysis Framework(DAF),which could be used to quantify the delay caused by the Risk Factors(RFs)in Oil and Gas Pipelines(OGPs)projects in a simple and systematic way.The main inputs of the DAF are(i)the potential list of RFs in the projects and their impact levels on the projects and the estimated maximum and minimum duration of each task.Monte Carlo Simulation integrated within@Risk simulator was the key process algorithm that used to quantify the impact of delay caused by the associated RFs.The key output of the DAF is the amount of potential delay caused by RFs in the OGP project.The functionalities of the developed DAF were evaluated using a case study of newly developed OGP project,in the south of Iraq.It is found that the case study project might have delayed by 45 days if neglected the consideration of the RFs associated with the project at the construction stage.The paper concludes that identifying the associated RFs and analysing the potential delay in advance will help in reducing the construction delay and improving the effectiveness of the project delivery by taking suitable risk mitigation measures.

Tumor-Immune Interaction System with the Effect of Time Delay and Hyperglycemia on the Breast Cancer Cells

Breast cancer in women is a complicated and multifaceted disease. Studies have demonstrated that hyperglycemia is one of the most significant risk factors for breast cancer. Hyperglycemia is when the sugar level in human blood is too high, which means excess glucose. Glucose excess can encourage the growth, invasion, and migration of breast cancer cells at the cellular level. Though, the effects of glucose on the dynamics of breast cancer cells have been examined mathematically by a system of ordinary differential equations. However, the non-instantaneous biological occurrences leading to the secretion of immuno-suppressive cytokines by tumors to evade immune surveillance and the immune cells’ derivation of cytokines to attack the tumor cells are not yet discussed. Therefore, investigating the biological process involved in the dynamics of tumors, immune and normal cells with excessive glucose concentration is inviolable to determining the best procedure for controlling tumors’ uncontrollable growth. Time delay, denoted by τ, is used to describe the time tumor cells take to secrete immunosuppressive cytokines to evade immune surveillance and the time immune cells take to recognize and attack the tumor cells. We have studied the local stability analysis of the biological steady states in both delayed and non-delayed system. The Routh-Hurwitz stability criterion is used to analyze the dynamical equilibrium of the cells’ population. Hopf bifurcation was analyzed by using time delay s as a bifurcation parameter. The analytical results suggest an unstable scenario for a tumor-free equilibrium point as normal cells are bound to grow to their carrying capacity. The result predicts a stable system for coexisting equilibrium when the interaction is instantaneous (τ = 0). However, when τ > 0, the coexisting equilibrium point switches from stable to unstable. The numerical results not only validate all the analytical results but also show the case of possible situations when glucose concentration is varied, indicating that both tumor growth and immune system efficiency are highly affected by the level of glucose in the blood. This concluded that the delay in the secretion of cytokines by immune cells and derivation cytokines by the tumors helps to identify the possible chaotic situation under different glucose concentration and the extent to which such delay can have on restoration of the normal cells when glucose concentration is low.

Factors influencing prehospital delay for patients with acute myocardial infarction

Objective To investigate the influencing factors for prehospital delay in patients with acute myocardial infarction (AMI). Methods A total of 807 consecutive patients with AMI who presented to the emergency department of Beijing Anzhen Hospital were analyzed. The influence of several potential risk factors on the prehospital delay time (PDT) was evaluated by comparing patients admitted more than 2 hours after onset of chese pain with those admitted within 2 hours after onset. Results Among 807 patients, 402 came to the hospital within 2 hours while the others arrived at the hospital after 2 hours. The median PDT was 130 min. Among the potential variables, advanced age, history of diabetes mellitus, occurrence of symptom at night and use of emergency medical service significantly affected PDT by multivariate analysis. Conclusion Interventions aimed at reducing the prehospital delay in AMI should primarily focus on the awareness of the risk and help-seeking behavior of patients.

Prediction of delayed graft function using different scoring algorithms: A single-center experience

AIM To compare the performance of 3 published delayed graftfunction(DGF) calculators that compute the theoretical risk of DGF for each patient.METHODS This single-center,retrospective study included 247 consecutive kidney transplants from a deceased donor.These kidney transplantations were performed at our institution between January 2003 and December 2012.We compared the occurrence of observed DGF in our cohort with the predicted DGF according to three different published calculators. The accuracy of the calculators was evaluated by means of the c-index(receiver operating characteristic curve).RESULTS DGF occurred in 15.3% of the transplants under study.The c index of the Irish calculator provided an area under the curve(AUC) of 0.69 indicating an acceptable level of prediction,in contrast to the poor performance of the Jeldres nomogram(AUC = 0.54) and the Chapal nomogram(AUC = 0.51). With the Irish algorithm the predicted DGF risk and the observed DGF probabilities were close. The mean calculated DGF risk was significantly different between DGF-positive and DGF-negative subjects(P < 0.0001). However,at the level of the individual patient the calculated risk of DGF overlapped very widely with ranges from 10% to 51% for recipients with DGF and from 4% to 56% for those without DGF.The sensitivity,specificity and positive predictive value of a calculated DGF risk ≥ 30% with the Irish nomogram were 32%,91% and 38%. CONCLUSION Predictive models for DGF after kidney transplantation are performant in the population in which they were derived,but less so in external validations.

Causes of developmental delay in children of 5 to 72 months old at the child neurology unit of Yaounde Gynaeco-Obstetric and Paediatric Hospital (Cameroon)

Background: According to the World Health Organization, about 5% of children world-wide of 14-year-old and under have a moderate to severe developmental disability, and up to 15% of children under 5-year-old are developmentally delayed. Purpose: To determine the prevalence, socio-demographic profile, aetiologies, and the clinical presentation of developmental delay in children less than 6-year-old at the child neurology unit in a university-affiliated hospital in Yaounde. Materials and methods: It was a crosssectional descriptive study carried out in Yaounde Gynaeco-Obstetric and Paediatric Hospital (Cameroon) from August to December 2012. Children aged between 5 - 72 months with a developmental quotient less than 70 were enrolled. Developmental delay (DD) was diagnosed and classified using the Denver developmental screening test (DDST). Data concerning the child (age, gender, severity of DD), the mother (age, age at conception, educational level, marital status), history of pregnancy and delivery, perinatal and postnatal events, results of para-clinical explorations (EEG, CT-scan, genetic tests), the severity of DD and the probable or demonstrate cause of DD were recorded on a standardized questionnaire. The chisquare test was used to compare variables. Results: During the study period, 2171 children aged 5 - 72 months consulted the paediatric department of the hospital, 296 were examined at the child neurology unit of which 153 had a developmental quotient less than 70, giving a hospital prevalence of 7.0% and a prevalence of 51.7% at the child neurology unit. The mean age was 26.6 ± 18.0 months and there were 56% males. The main reason for consulting was tonus disorder (43.8%) and the developmental area of parental concern was the motor domain (90.2%). Regarding the clinical presentation, 75.2% of our population were children with cerebral palsy. DD was severe, mild, moderate and profound respectively in 14.2%, 13.5%, 12.2%, and 11.1%. Gross DD represented 90.2% of all DD children. The causes of DD were hypoxic-ischemic encephalopathy (41.8%), epilepsy (13.7%), sequelae of meningitis (6.5%), sequelae of kernicterus (6.5%), and infectious embryofoetopathies (5.2%). Conclusion: Developmental delay is frequent in paediatric neurology, with perinatal disorders being the leading aetiologies in Cameroon. Prevention of perinatal hypoxic-ischemic encephalopathy risk factors needs to be reinforced.

Cost Risk Appraisal： An Application of Project RiskManagement Process in Libyan Construction Projects

Projects delay and cost overrun have become general facts in the construction industry. Project cost risk analysis considers the different costs associated with a project and focuses on the uncertainties and risks that may affect these costs. An implementation of PRM （project risk management） process on regional construction project has been carried out to maximize the likelihood of project meeting its objectives within its constraints. Qualitative and quantitative risk analyses have been carried out. The qualitative analysis is presented in a table that shows top ranked risks in Libyan construction projects based on probability-impact grid technique. In quantitative risk analyses, Mont Carlo simulation technique has been conducted to quantify and evaluate the overall level of risk exposure associated with the project completion cost. A project simulation uses a model that translates cost uncertainties into their potential impact on project objectives. A frequency curve model that represents simulation results of project completion costs has been constructed. The frequency curve model shows all possible outcomes of expected project cost at different probabilities. Project manager or decision maker can select the appropriate project budget. If a probability of 0.95 confident project budget is selected that means cost overrun risk can be minimized to a probability of 0.05. It is very helpful for project manager to take decisions based on information that shows project completion cost and its associated probability rather than usin single information of estimated cost.