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A 35-year-old female, known case of complete spinal cord injury, presented with cervical pain and neck deformity that interfere with her physiotherapy and occupational therapy. Two years before admission, she had a car accident which result in a complete quadriplegia. That time at another center, she underwent surgery to anterior cervical fixation of C6-C7 through insertion of cage and plate without corpectomy. Based on current radiologic images, spondyloptosis was detected at the C6-C7 with bilateral locked facet, due to hardware failure. A three approaches in one stage was performed to maintain cervical alignment that includes posterior, anterior and again posterior approach. With this manner, anterior fusion through corpectomy and insertion of expandable cage and plate as same as instrumental posterolateral fusion were done. After surgery, she was pain free and the alignment of cervical spine was maintained so she could come back to ordinary rehabilitation programs.

Lesions that spontaneously come and go in central nervous system without any treatment at different time points and at different locations (CNS) usually lead ones to think of the possibilities of multiple sclerosis. However, sometimes there are exceptions. Surgical biopsy remains an important tool for definitive diagnosis in difficult cases. We report a case of intracranial diffuse large B cell lymphoma that spontaneously disappeared without any treatment and then reappeared at different time points and different locations.

Background: A Grey 12-year-old Arabian endurance horse gelding was referred to the SHS Veterinary Center for anorexia, mild colic of 5 days duration, and melena of 1 day duration. The owner reported recurring colic, 12 episodes of mild colic in the previous year. Methods: On admission, vital signs were within normal limits and body condition score was estimated to be 3/9. Results: Packed cell volume (PCV) was 28% [reference range (RR): 31% to 47%] and plasma total protein was 58 g/L (RR: 60 to 80 g/L). Hematochezia was observed. Abdominal ultrasound examination detected no abnormalities. Over the next 12 h, the horse experienced hematochezia and several mild episodes of colic and death. A necropsy was performed. A mass arising from the right dorsal ascending colon near the base of the cecum and extending transmurally from the colonic mucosa into the mesocolon was a 8 cm × 5 cm × 8 cm firm, homogenous, tan mass. The portion of the mass that extended into the colonic lumen was pedunculated, with an ulcerated surface. The adjacent segments of colon were markedly reddened and edematous. Histologically, the mass was comprised of large interweaving sheets of small, spindle cells with ill-defined cell borders embedded in abundant myxomatous matrix. Tumor cells contained scant eosinophilic cytoplasm and oval to elongate nuclei with finely stippled chromatin and inconspicuous nucleoli. Mitotic figures were rare (1/10) high power fields. Tumor infiltrated between the muscularis interna and the muscularis externa at the myenteric plexi. Conclusion: Gross and histologic appearance, were consistent with a diagnosis of gastrointestinal stromal tumor.

Objective: Currently, Parkinson’s disease (PD) is becoming more common among younger people of ages from 30 – 40 years. The incidence is higher among patients with higher body mass index (BMI), and some reports had it that Obesity is a risk factor for PD while some reported that there is no relationship between obesity and PD. PD patient at the time of diagnosis has an above-normal BMI but which goes below normal as the disease progresses. Therefore, it is essential to explore the relationship between PD and Obesity. Methods: 349 outpatients and inpatients with PD were selected from Jiangsu University Affiliated People’s Hospital from January 2014 to December 2018, while 74 inpatients with non-cerebrovascular illness in the same period were selected as the control group. According to Hoehn-Yahr grade, Parkinson’s patients were divided into three groups. The height, weight, waist and hip circumference, total cholesterol (TC), Total Glycerol (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured and recorded. The relationship between the severity of Parkinson’s disease and blood lipids was evaluated. Results: The BMI of patients with PD in the early stage was higher than that of the control group, but lower than that of the control group in the late stage, and the level of blood lipid in the patients with early PD was significantly higher than that in the control group and patients with advanced PD, especially in TG. The waist circumference and hip circumference of the patients with early PD were higher than those in the control group, but there was no statistical difference. Conclusion: i) Obesity may increase the prevalence of PD. ii) The BMI of patients with PD shows two-way changes in different periods. iii) The BMI is higher and cholesterol is more elevated in the early stage of patients with PD, while at the advanced stage of the disease, the BMI and lipid levels of the patients showed a downward trend, which may be associated with a metabolic syndrome associated with dopamine depletion.

Pleurothotonus, commonly known as Pisa Syndrome (PS), is a rare neurological disorder characterized by lateral bending of the trunk with a tendency to lean to one side. This is typically mobile and resolves in supine position. It often presents as an incapacitating symptom of underlying neurodegenerative conditions like Parkinson’s disease, alzheimer’s disease, multisystem atrophy, dementia with Lewy bodies, progressive supranuclear palsy and even subacute sclerosing panencephalitis. It is known to be associated with neuroleptics, dopaminergic agents, valproic acid and lithium. PS is also seen in neurosurgical disorders like subdural hematoma, normotensive hydrocephalus, or as a late complication of pallidotomy in patients with PD. It can present either as an acute emergency or can develop gradually over time.PS tend to happen in coronal plane and can be controlled and managed if diagnosed in early stage. However, a chronic form known as “camptocormia” occurs often in a combined fashion with anteroposterior flexion which can improve to some extent, remain stable or even get worse. Pathophysiologic mechanism is not completely understood. This review will discuss all the updated literatures published in PS in terms of prevalence, pathophysiology, clinical manifestation, and treatment modalities.

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by progressive degenerative motor symptoms (e.g., tremors, impaired balance and gait) and nonmotor symptoms (e.g., fatigue, sleep disturbances, pain) that can negatively influence health and mental wellbeing by decreasing quality of life. It affects nearly 10 million people and more and more cases are diagnosed because of the advancement seen in movement disorder clinics and diagnostic tools worldwide. Individuals with PD also complain about anxiety arising out of these symptoms of postural instability, low back pain etc., which may lead to increased risk of falls and fall related injuries of brain, bone or other organ systems. Stress is one factor which has been shown to directly correlate to neurodegenerative pathology. Ways to reduce stress at a given point of time and across one’s life span is considered to be a prime necessity in today’s world. Various body-mind exercises like yoga, tai chi, qi gong, tango, ballet etc., has been in research for quite some time now, which has shown benefits in PD patients. In this article evidences related to yoga and its role in PD will be reviewed in a detailed fashion.

Sleep related breathing disorders (SRBD) are among seven well-established major categories of sleep disorders defined in the third edition of The International Classification of Sleep Disorders (ICSD-3), and Obstructive Sleep Apnea (OSA) is the most common SRBD [1,2]. Several studies have demonstrated that obstructive sleep apnea treatment increases the quality of life in OSA patients [3-8]. Indeed, excessive daytime sleepiness (EDS), cognitive impairment (e.g., deficits in attention-concentration, memory, dexterity, and creativity), traffic accidents, and deterioration of social activities are frequently reported in untreated patients [9-11]. Furthermore, an increase in cardiovascular morbidities and mortality (systemic hypertension, stroke, cardiac arrhythmias, pulmonary arterial hypertension, heart failure) [12], metabolic dysfunction, cerebrovascular ischemic events and chemical/structural central nervous system cellular injuries (gray/white matter) has been reported in OSA patients [13-17].  Continuous positive airway pressure (CPAP) therapy is considered the gold standard for treatment of moderate-severe OSA, nevertheless there is an increasing body of evidence supporting the usefulness of mandibular advancement devices (MADs) for improving quality of life and respiratory parameters even among patients with a high severity of OSA burden [5,10,18,19]. According to the standard of care of the American Academy of Sleep Medicine (AASM), MADs are indicated for mild to moderate OSA particularly in the context of CPAP intolerance or refusal, surgical contraindication, or the need for a short-term substitute therapy [9,15,20-22]. In Cuba, CPAP machines are not readily available; they are expensive and the majority of OSA patients cannot obtain this mode of therapy. Taking into account this problem, our hypothesis was based in the scientific evidences of MAD effectiveness, considering that low cost MADs could offer a reasonable alternative treatment for patients with OSA where CPAP technology are not handy. In this way our purpose was to assess the efficacy of one of the most simple, low cost, manufactured monoblock MAD models (SAS de Zúrich) in terms of improvements in cerebral function, sleep quality and drowsiness reports in a group of Cuban OSA patients with mild to severe disease. Outcome measures included changes in the brain electrical activity, sleep quality, and respiratory parameters, measured by EEG recording with qEEG analysis and polysomnographic studies correspondingly, which were recorded before and during treatment with an MAD, as well as subjective/objective improvements in daytime alertness. 

Single-level Anterior Cervical Decompression and Fusion (ACDF) was initially performed using Iliac Crest Bone Graft (ICBG) [1]. Fusion rates improved when a surgical technique change, the addition of anterior plate fixation, was incorporated decades later [2,3]. Single level ACDFs with a machined allograft and plate fixation technique eventually became the industry standard as it demonstrated equivalent fusion rates with fewer complications than single level ACDFs with ICBG. This surgical technique was extended for use in patients with contiguous disk herniations. Multilevel ACDFs performed with machined allografts or interbody spacers and a two-level plate offered shorter operative times, less blood loss, better restoration of lordosis, and less immediate pain [4]. Successful multi-level ACDFs were strongly influenced by the bone graft source [5], the smoking addiction [6], and the construct stability [7]. Placement of two additional fixation screws in the central vertebral body, another improvement in the surgical technique, increased the construct strength compared to constructs with screws only placed into the end vertebral bodies [8]. Using allografts for multilevel ACDFs was a device disadvantage as they often resulted in high non-union rates [9,10].

Background: Pathological and nighttime sleep deprivations have substantial adverse effects on regulation of weight, sugar and blood pressure because of endothelial dysfunction, sympathetic nervous system stimulation, regulation and activation of systemic inflammation. Thus, this study was aimed to assess quality of sleep among patients with chronic illness and its associated factors at South Wollo Zone Public Hospitals, Northeast Ethiopia. Methods and Materials: The study was conducted at South Wollo Zone Public Hospitals, Northeast Ethiopia from February 15 2019 till April 15 2019. Institutional based cross sectional study design was employed. All patients with chronic illness who are on follow up in South Wollo Zone Public Hospitals were sources of population. Sample size was calculated by using EPI info version 7 and the total sample size was 344. The study employed stratified random sampling technique and study participants were selected by systematic sampling. After taking ethical approval from College of Medicine and Health Sciences Ethical Approval Committee, permission from selected Hospitals and informed verbal consent from patients, the data were collected by a tool which has 3 parts: Sociodemographic data, Pittsburgh Sleep Quality Index and factors affecting sleep quality. Data were entered in to Epi data version 4.1 and exported to Statistical Package for Service Product 25 for analysis. Different data presentation tools and binary logistic regression were enrolled by considering 95% confidence level and p value of 0.05. Result: Among the total study participants, near to one third (31.7%) of them got sleep after 30 minutes. More than one fourth of them slept for less than 7 hours. Less than half of the study participants had habitual sleep efficiency of more than 85% however 296(86%) of them did not face day time dysfunction Conclusion and recommendations: more than one third of patients with chronic illness had poor sleep quality. One third of study participants had sleep duration of less than the recommendations(less than 7 hours). Age, educational status, residence, and perception of prognosis of disease were factors that have associations with poor sleep quality among patients with chronic illness. Health care providers who are doing in chronic illness follow up clinic should be initiated to assess and screen those patients with poor sleep quality.

Repressive regulation of potassium channel genes by Polycomb group (PcG) proteins contributes to PcG protein-mediated neuroprotection against neuronal ischemic injury, as seen in an ischemic stroke. Here we asked the question whether Trithorax group (TrxG) proteins, the antagonistic partners of PcG proteins (i.e, epigenetic activators targeting the same genes) may also regulate potassium channels. Results of patch-clamp studies on cultured neuronal cells showed that inhibition of TrxG protein MLL-1 led to an increase in potassium channel activity, an unexpected effect for a presumed gene activator. In contrast, decreased sodium currents were observed with MLL-1 inhibition. Increased or decreased levels of potassium channel protein Kv2.1 or sodium channel protein Nav1.2, respectively, were seen with MLL-1 inhibition, as determined by immunocytochemistry. These results, for the first time, demonstrate an involvement of TrxG protein MLL-1 in regulating neuronal ion channels, potentially repressing potassium channel genes.

Flow cytometry (FCM) is a unique technique that allows rapid quantitative measurement of multiple parameters on a large number of cells at the individual level. FCM is based on immunolabelling with fluorochrome-conjugated antibodies, leading to high sensitivity and precision while time effective sample preparation. FCM can be performed on tissue following enzymatic or mechanical dissociation. The expression of epithelial antigens and cytokeratin isoforms help in distinguishing tumor cells from adjacent epithelial cells and from tumor infiltrating leukocytes. Tumor phenotypes can be characterized on expression intensity, aberrancies and presence of tumor-associated antigens as well as their cell proliferation rate and eventual heteroploidy. FCM can measure quantitative expression of hormone or growth factor receptors, immunoregulatory proteins to guide adjuvant therapy. Expression of adhesion molecules tells on tumor’s capacity for tissue invasion and metastasis seeding. Tumor heterogeneity can be explored quantitatively and rare, potentially emerging, clones with poor prognosis can be detected. FCM is easily applicable on fine needle aspiration and in any tumor related biological fluids. FCM can also be used to detect circulating tumor cells (CTC) to assess metastatic potential at diagnosis or during treatment. Detecting CTC could allow early detection of tumors before they are clinically expressed although some difficulties still need to be solved. It thus appears that FCM should be in the pathologist tool box to improve cancer diagnosis, classification and prognosis evaluation as well as in orientating personalized adjuvant therapy and immunotherapy. More developments are still required to better known tumor phenotypes and their potential invasiveness

The impression of frictional ridges of the finger is known as fingerprints. Owing to this uniqueness, the fingerprints have long been used to identify a person since Ancient times. In any crime scene the presence of fingerprint makes the identification of the Culprit very easy. The fingerprints can also easily be embedded on any item such as paper, Clothing and body of the victim. To utilize this uniqueness of fingerprints forensic experts devised many techniques to obtain a clear fingerprint. These come under two categories i.e. Conventional and modern methods. The conventional methods are although important but there are limitations of them. Just take the example of powder method. Powder method require different powders for different Surfaces and colors, but modern method like quantum dots method can easily detect Fingerprints on all surfaces regardless of their color giving great resolution in seconds. Other methods like physical developer method is very time consuming and expensive, carbon Black method creates mess and does not work on porous surface, iodine fuming and Naphthaloflavin does have an advantage that it can bring up prints on skin also but it does not Work on metallic surfaces. VMD also fails on heavy plastic polymers and body oils. But some modern methods like nanotechnology can obtain high resolution prints old and dried prints also within 3 minutes. Laser technology is very fast, accurate and can be used for Fingerprints up toten years old also on any surface without any mess. Multimetal deposition Method can even be used to identify smokers and drug addicts and can be used Porous, non-porous and wet surfaces.

Solid tumor oncology treatments are primarily performed in the outpatient setting. However, hospitalizations are inevitable due to complications of cancer and treatment-related toxicities. With rising health care spending, the length of hospital stay (LOS) is increasingly considered a proxy for healthcare costs. There are several ongoing efforts to abbreviate the inpatient LOS and ensure a safe and timely discharge to the outpatient setting. In addition to the acute illness and the associated comorbidities, various factors affect the LOS: social determinants of health (SDOH), nutritional status in cancer patients, and end-of-life issues. Furthermore, it is unclear how the institutional policies on social distancing and visitation during the current coronavirus disease (COVID-19) pandemic may impact the LOS. The purpose of this article is to review various factors and barriers that lead to longer LOS for solid tumor patients during the COVID-19 pandemic, and identify the critical areas of quality improvement.

Introduction: Cancer treatment and prognosis depend heavily on early detection. Survival in the early stages is excellent for almost all types of cancer. Unfortunately, in Saudi Arabia, a large number of cancer patients present with advanced disease, resulting in a poor prognosis. There are three levels of delay in the management of cancer patients. The first level is the time between the first cancer-related symptoms and the presentation to the health facility, the second level is from the presentation to the diagnosis, and the third level is between the diagnosis and the treatment. This study aims to determine if there is a delay, at what level and to study the factors causing such delays.Materials and methods: Two hundred cancer patients who presented to the Armed Forces Hospital Southern Region, Oncology Department, were interviewed from January 1st to June 30th, 2018. The interviews were conducted by trained physicians familiar with the questionnaire’s contents. The questionnaire consisted of four sections: a demographic section and three more sections to identify factors causing the delay at the three levels from the patients’ perspectives. All data were analyzed using the SPSS version 20.0.Results: The mean patient age was 63 years. A total of 112 patients were female and 88 were male. The most common cancer type was breast cancer (27.5%). Among the patients, 61% were illiterate and 25.5% had elementary school degrees, 86% expressed little or no general medical knowledge about cancer. More women than men paid attention to cancer symptoms (70% vs. 54%). 75% of the patients presented to the first health facility after 2 months from the first appearance of symptoms (level 1 delay). Only 2% of the patients presented within one week. 50% of the patients received a diagnosis after visiting two health facilities. All patients were diagnosed at hospitals. 40% of patients used alternative medicines, 70% of whom thought this was the cause of their delayed presentations. 67% had their diagnosis confirmed within one month (level 2 delay), and 66% started their definitive treatment within one month (level 3 delay). 75% of the patients blame themselves for the delay. Educational level (p = 0.03), knowledge about cancer (p < 0.01), and the use of complementary and alternative medicines (CAM) (p = 0.01) were significantly associated with delayed presentation of patients to the health facility. Conclusion: There is a delay in the presentation of cancer patients (level 1) in the southern part of Saudi Arabia. Educational level, knowledge of cancer symptoms, and use of complementary and alternative medicines are the main causes. There were no delays in diagnosis and start of treatment (level 2,3).

There is a constant rise in cases of rhino-orbital mucormycosis in people with Coronavirus disease 2019 (COVID-19). Generally, Mucormycosis develops in immunosuppression or debilitating diseases. In cases having head and neck involvement, the mold enters the respiratory tract with further involvement of nose and sinuses and there is consecutive progression into orbital and intracranial structures. Diabetes Mellitus (DM) is an independent risk factor for both severe COVID-19 and mucormycosis. The clinical examination and direct smears are helpful for early diagnosis of the disease and timely intervention. For the better prevention and management of such opportunistic infections in COVID-19 patients, it is prudent to establish prophylactic treatment protocols along with rational use of corticosteroids. We here report a case of Rhino-orbital Mucormycosis infection caused by Rhizopus oryzae in a COVID-19 patient with Diabetes Mellitus.

In vitro fertilization is one of the most common and effective procedure for thousands of couples worldwide who want to have a child and are unable to do so for various reasons. Diverse studies show that couples who conceive naturally after one year of trying had newborns with an increased risk of prematurity and low birth weight, compared with couples who conceived before completing one year of trying. Children from assisted reproduction (AR), have a 30% increased risk of prematurity and low birth weight, compared with children from infertile fathers. Regarding the conflicting results the present study aimed to record the frequency of genetic, congenital anomalies in children and adolescents who had examined in the last decade to the Clinical Genetics Clinic of the National and Kapodistrian University of Athens whose mothers had undergone assisted reproduction. The research process was conducted at the "Aghia Sofia" Children's Hospital based in Athens. However, the cases that were studied came from all over Greece. Initially, the researcher recorded the cases that came to the clinic of Clinical Genetics and whose conception occurred after technical assisted reproduction. After telephone communication and the consent of the parents, a live appointment was scheduled. In this meeting-interview all the provisions of the investigation and the protocol were asked and some elements of the medical history of the cases were confirmed. The total sample included 230 children and adolescents. The resulting data were recorded on a printed form/questionnaire. Then, they were registered electronically in the program SPSS 25.0 (Statistical Package for Social Sciences) with a specific unit code for each case/patient, followed by the processing and statistical analysis of the data as well as the recording of the results. The gender of the participants was male for 118 participants (51.3%) and 112 females (48.7%). Mean and standard deviation (SD) of maternal, paternal (at the time of delivery) age was equal to 36.38 (5.94) and 39.94 (6.58) respectively. The observed abdormalities were 35.53% psychomotor retardation, 23.68% facial abnormalities, 23.68% spinal cord abnormalities, 21.05% morphological abnormalities, 20.61% short stature, 19.74% developmental disorders, 19.30% heart disease, 16.67% neurological diseases, 14.47% genetic syndromes, 11.40% genital abnormalities, 8.33% limb abnormalities, 7.46% dermatological abnormalities, 6.14% eye abnormalities, 6.14% hypothyroidism, 5.70% endocrine disorders, 5.26%otolaryngology abnormalities, 2.63% disease of kidney, intestine, 2.19% vascular malformations. Regarding the karyotype chromosome analysis by G-banding technique, from the 230 children in: 24 (10.43%) a pathological result was found, in 158 children (68.70%) it was found normal (46, XX or 46, XY by case) without other findings, while in 48 children (20.87%) the test was not performed for various reasons. Regarding the results of molecular analysis (DNA) from the 230 children, in 50 (21.74%) a pathological finding was found, in 56 children (24.35%) no abnormalities were found and in 124 children (53.91%) no molecular analysis was performed for various reasons. In conclusion, the sample of this descriptive study is characterized as uniform in terms of the method of assisted reproduction since 96.24% had followed the classic IVF. Full-term pregnancy was associated with the appearance of malignancy and head morphological abnormalities (64.6%), normal pregnancy was associated with genetic syndromes (18.2%) and facial abnormalities (11.1%). It is recommended the screening oocyte and sperm donors in order to help protect the safety and health of donors, recipients, and future offspring. The present study confirms the association of the presence of congenital anomalies after in vitro fertilization (IVF). However, the absolute risk of developing severe dysplasias after an IVF procedure is limited.

Purpose: The sinusoidal obstruction syndrome (SOS) of the liver is an obliterative vasculitis that involves the terminal branches of the hepatic venules and sinusoids. When it is not treated, it will be a serious risk of mortality. Here, we aim to present our patient who has been associated with recurrent cholangitis attacks due to cholelithiasis and choledocholithiasis and is associated with sinusoidal obstruction syndrome with the literature.Description of the case: A 30 years old male patient had complaints of abdominal pain and nausea for a long time. The patient had a history of choledocholithiasis and cholangitis attacks. Although ERCP was performed and a stent was placed in the biliary tract, his jaundice did not disappear. Liver function tests were high. Tumor markers were negative.Methods: We could not make a definitive diagnosis with imaging methods and biopsy and we planned surgery. We performed segmental liver resection and biliary diversion in the surgery. Histopathological examination of the resected liver tissue was compatible with SOS.Conclusion: Many studies have been done on the etiology of SOS and different causes have been revealed. Accompanied with clinical findings, a definitive diagnosis is made with the exclusion of the presumptions considered. Surgery can be performed for both diagnostic and therapeutic purposes. If patients with elevated liver function tests and bilirubin have long-term abdominal pain, SOS should be bear in mind.

COVID-19 is a disease that is caused by SARS-CoV-2 and very speedily spreading all over the world. The blood group’s effect on COVID-19 is not clear. The main aim of this article is to determine the relationship between sensitivity of COVID-19 and ABO blood group. For this study we have observed that the individuals with blood group A are at higher risk of getting COVID-19 because they contain the higher concentration of Angiotensin-converting enzyme-2 that provide the site to virus for entry. But in other blood groups the natural Anti A antibodies block the interaction between host receptor and virus and disturb their interaction. Certain studies show that the infectivity and mortality rate in covid patients is not affected by AB blood group system. But according to research, increased ventilator usage, ICU stay was observed in critically ill patients with AB blood group than of other blood groups. O blood group has proved to be protective against SARS-CoV-2 due to the presence of both anti-A and anti-B antibodies as they prevent the binding of the spike protein S of the virus with the ACE2 receptors which are present on the surface of cells. Moreover, furin also plays a major role in penetration of virus in the host cells. Furin is required for the activation of the spike protein S of the virus and due to the low efficiency of furin cleavage in blood group O it is protected from SARS-CoV-2 and other chronic diseases. Mortality rate of covid 19 depends upon the environmental factors, number of people living in the area and also some economic factors. The different strains of COVID-19 effect the different people differently and as the time passes the strain of COVID-19 has changed and thus according to this the mortality rate of different provinces and areas varies due to environmental factors. Pregnant women have no any kind of transportation of covid to their fetuses but mostly patients of blood group A are being affected by COVID-19 and hence their fetuses are somehow effected. And those pregnant women having blood group O does not have any risk of COVID-19 of severe stages.

Objective: To determine the needs and level of coping in siblings of people with Down Syndrome. Methods: Descriptive, cross-sectional study, carried out in 2016. Sample consisted of 30 siblings of people with Down Syndrome between 6 and 60 years old. Using non-probability convenience sampling. Two instruments were used to collect the information: a) a validated sociodemographic and needs survey of the siblings, designed by the authors, and b). Callista Roy adaptation and coping survey validated. Results: 60% of the siblings report not having felt judged by other people when presenting their brother/sister with Down syndrome. 73.3% of the siblings did not receive information about Down Syndrome from a nursing professional, the need to strengthen the nursing care provided to the siblings of people with disabilities in this regard is evident. 53.3% of these present a medium level of coping with respect to the condition of having a brother with Down syndrome. Conclusion: Identified needs were: time needs, affective needs, family needs, social needs, economic and access to information needs. Highlighting these needs allows the nursing professional to identify and consider the siblings of people with Down Syndrome have different needs than the rest of the family nucleus. Where interventions aimed at reducing the harmful effects and enhancing those characteristics of gain related with having a brother with Down Syndrome.

Background: Early-initiation of breastfeeding is putting the newborns to the breast within the first hour of life. It is the first critical time they contact their mother outside of the womb. The current study aimed to assess the early initiation of breastfeeding in the study setting. Objectives: To assess the level of early initiation of breastfeeding and its associated factors among mothers who had a baby of less than the age of 24 months in Jeju Woreda, Arsi Zone, Oromia, Ethiopia, 2019.Methods: A community-based cross-sectional study conducted involving 487 mothers from September 18 to October 09, 2019. A multistage sampling technique was employed. First, the setting stratification done in urban and rural settings. Second, ten kebeles selected from both strata. The study participants identified by systematic random sampling technique using kebele log-books registration list as a scheme. The collected data were entered into Epi Info version 7.1.5.0 and exported to SPSS version 21.0.0.0 to analyze. Bivariate and multivariate logistic regression used to determine relations between independent factors and early initiation of breastfeeding. Nine variables became eligible for multivariate analysis at a p - value less than 0.05 in bivariate. The final analyses done the significance of association decided using AOR with its 95% CI, and p - value at less than 0.05. Results: A 97% response rate achieved in this study. The prevalence of early breastfeeding initiation was 74.5%. In multivariate analysis variables namely, mothers whose age category was 35 years and above (AOR = 2.34, 95% CI: (1.07, 5.11)), Pre-lacteal feeding (AOR = 0.37 95% CI (0.17, 0.79)), postpartum advice (AOR = 1.72, 95% CI (1.01, 2.95)) had a significant association. Conclusion and recommendations: The prevalence of early breastfeeding initiation was (74.5%). The finding was low compared to the world health organization recommendation. A working towards discouraging pre-lacteal feeding and strengthening postnatal advice and focusing on ways to better reach young mothers were the recommendations to bring the prevalence in the study area to the recommended level.