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https://www.selleckchem.com/products/motolimod-vtx-2337.html 4%) teachers. At least one aspect of toilet requests was a frequent or intense hassle in 43 (39.8%) and 29 (28.7%) teachers, respectively. CONCLUSION Toilet requests are misunderstood by and present a stressor to a sizeable minority of teachers.OBJECTIVE To study the etiological profile and patterns of clinical presentation of nephrocalcinosis. METHODS In this observational study, patients 18 years or younger, referred to the pediatric nephrology clinic with nephrocalcinosis were evaluated for etiology. Symptoms/signs at presentation, estimated glomerular filtration rate (eGFR) at presentation and follow-up, and growth parameters were recorded. RESULTS The etiology of nephrocalcinosis (n=54) included distal renal tubular acidosis (n=18; 33.3%), primary hyperoxaluria (n=9; 16.7%), Bartter syndrome (n=7; 13%), Dent disease n=4; 7.4%), cystinosis, familial hypomagnesemia with hypercalciuria and idiopathic hypercalcemia of infancy (2 each). Idiopathic nephrocalcinosis was seen in 5 (9.3%) children. Clinical features included failure to thrive (53.7%), polyuria (44.4%), bony deformities (31.5%) and hypokalemic paralysis (11.1%). At a median (IQR) follow-up of 24 (8, 56) months, the mean (SD) eGFR had improved from 59 (25.5) to 77 (31.48) mL/min/1.73m2 (P less then 0.01). Consanguinity was present in 50% (27/54). Genetic analysis in 5 primary hyperoxaluria cases confirmed AGXT mutations in 4; and GRHPR mutation in 1 child. CONCLUSION Distal RTA, primary hyperoxaluria and Bartter syndrome were the common etiologies of nephrocalcinosis in our patient population.Since the introduction of cognitive theory of multimedia learning more than a decade back much empirical evidence has substantiated the theoretical rationale of multimedia instructional design principles. Medical educators use multimedia mostly for delivering lectures in the form of power-point presentations. Abundant literature is available giving instruct

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