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ORIGINAL ARTICLES
Quantitative EEG in autistic children
Hala Elhabashy, Omnia Raafat, Lamia Afifi, Hebatallah Raafat, Khaled Abdullah
July-September 2015, 52(3):176-182
DOI
:10.4103/1110-1083.162031
Background
Autism spectrum disorder is a neurodevelopmental disorder that is characterized mainly by difficulties in social interaction and communication. Studies have suggested abnormal neural connectivity patterns in the brains of patients with autism.
Objective
The current work aimed to study the quantitative electroencephalography (EEG) findings in autistic children and compare it with those of normal controls.
Methods
The EEG recordings of 21 autistic children between 4 and 12 years of age were compared with those of 21 age-matched and sex-matched controls under an eyes-opened condition. Differences in cerebral functioning were examined using measurements of absolute and relative power and intrahemispheric and interhemispheric coherence.
Results
There were statistically significant differences in EEG power between the autistic and control groups, with greater absolute of delta and theta power especially at the frontal region in autistic children. There was also global reduction in relative alpha and beta power especially in the frontal, central, and posterior regions in autistic children. In addition, there was a pattern of underconnectivity and overconnectivity when measuring the intrahemispheric and interhemispheric coherence in the autistic compared with the control group.
Conclusion
These results suggested regional dysfunction of the brain in autistic children, along with a pattern of abnormal neural connectivity, which could explain the autistic symptomatology.
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Assessment of precipitating factors of breakthrough seizures in epileptic patients
Manal Al-Kattan, Lamia Afifi, Reham Shamloul, Emad El Din Mostafa
July-September 2015, 52(3):165-171
DOI
:10.4103/1110-1083.162002
Background
The prevalence of breakthrough seizures is estimated to occur in 39-75.3% of epileptic patients in developing countries. Patients and physicians should be aware of the possible precipitating factors of breakthrough seizures to prevent their occurrence.
Objective
The aim of this study was to determine the precipitating factors for breakthrough seizures in patients attending Cairo University Hospital.
Methods
This cross-sectional study included 90 epileptic patients with idiopathic epilepsy receiving antiepileptic drugs (AEDs). They were divided into two groups. Group I included 55 epileptic patients with a history of recent breakthrough seizures. Group II included 35 epileptic patients who had not experienced any recent breakthrough seizures. Patients with breakthrough seizures were subjected to a thorough questionnaire addressing precipitating factors. All participants were subjected to an electroencephalogram (EEG) and the Morisky Medication Adherence Scale.
Results
Missed doses (56.4%) represented the most frequent reported precipitating factor, followed by sleep deprivation (36.4%) and psychological stress (34.5%). The patients in group I were found to have lower durations of seizure control, adherence to AEDs, and were more frequently on AED polytherapy than the participants in group II. In terms of the EEG, group I showed a higher percentage of abnormal EEGs and more frequent focal epileptiform discharges. No significant difference was found in age or sex, age at onset of epilepsy, duration of disease, and type of seizures between both groups.
Conclusion
Patients and their caregivers should be educated about these possible precipitating factors to achieve better control of epilepsy.
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593
Primary fatigue contributes to cognitive dysfunction in patients with multiple sclerosis
Mohamed S El-Tamawy, Moshera H Darwish, Sandra M Ahmed, Ahmed M Abdelalim, Engy B. S. Moustafa
April-June 2016, 53(2):74-78
DOI
:10.4103/1110-1083.183406
Background
A rising concern about quality of life of multiple sclerosis (MS) patients has emerged. Cognitive dysfunction and primary fatigue have been largely related to each other.
Objective
The aim of the present study was to examine the relationship between primary fatigue, cognitive dysfunction, and inflammatory biomarkers for patients with MS.
Patients and methods
A total of 40 Egyptian MS patients (Expanded Disability Status Scale<5) were divided into two groups according to the Fatigue Severity Scale (FSS), into patients with fatigue (G1; FSS>36) and those without fatigue (G2; FSS<36). Patients with depression and sleep problems were excluded from the study. Cognitive functions were assessed for both groups using the computer-based 'RehaCom' software, using which the following tests were carried out: (a) attention/concentration tests and (b) reaction behavior tests. The serum levels of tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) were analyzed for all MS patients.
Results
A statistically significant decrease in cognitive functions was found in G1 compared with G2 (
P
< 0.001), as well as a statistically significant higher level of TNF-α and IFN-γ in G1 compared with G2. FSS was positively correlated with the attention/concentration test. Correlative study also indicated a strong relation between the level of cytokines and FSS but not cognitive dysfunction.
Conclusion
Primary fatigue contributes to cognitive dysfunction in patients with MS and is associated with elevated serum level of TNF-α and IFN-γ
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Attitude of medical students toward mentally ill patients: impact of a clinical psychiatric round
MA Alaa El-Din, Ghada R Amen, Reem H ElGhamry, Dalia A.M. Mahmoud, Hagar H.A.H. Kandel
January-March 2016, 53(1):6-11
DOI
:10.4103/1110-1083.176321
Background
Stereotyped cognitive schemes are the main cause of casting out patients with mental illness. Educational psychiatry programs have to be re-evaluated as medical students often have misconceptions about psychiatry.
Objective
The aim of the present study was to examine the attitude of fifth-year medical students toward psychiatric patients and disorders, and to reveal the influence of psychiatric study experience on their attitudes.
Participants and methods
In this interventional study, 300 fifth-year students from Ain Shams University Medical School were enrolled. Sociodemographic data sheet, Fahmy and El Sherbiny's Social Classification Scale, and the Mental Illness Clinician Attitude Scale-2 were used on the first and last day of a 3-week clinical psychiatric round.
Results
Data before and after the round were compared and showed no significant change in Mental Illness Clinician Attitude Scale-2 scores among the studied sample after the psychiatric round. Only 4% of the students chose psychiatry as a future career with neutral attitude and had worse attitude after rotation. Students who had significant positive attitude at the beginning of the round ended up with a significantly more negative attitude, whereas those with significantly negative attitudes improved at the end of the round.
Conclusion
Three weeks may not be sufficient time to allow students to follow up the patients to notice their improvement as regards treatment and return to their functional baseline. Thus, students perceived mentally ill patients being untreatable. Greater emphasis on doctor-patient relationship and exposure to patients with psychiatric illness, which responds rapidly to treatment and students taking direct patient responsibility, may lead to the production of more favorable attitudes.
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Efficacy of transcutaneous electrical nerve stimulation versus biofeedback training on bladder and erectile dysfunction in patients with spinal cord injury
Wael S Shendy, Moataz M El Semary, Kadrya H Battecha, Mohamed S Abdel-Azim, Husam S Mourad, Amira M El Gohary
July-September 2015, 52(3):194-200
DOI
:10.4103/1110-1083.162044
Background
Spinal cord injury is associated with urinary and erectile dysfunction.
Objective
This study compared the efficacy of transcutaneous electrical nerve stimulation (TENS) with pelvic floor biofeedback (PFBFB) training in the treatment of bladder and erectile dysfunction for male patients with traumatic partial spinal cord injury.
Methods
The study included 30 male patients with bladder and erectile dysfunction (precipitancy overactive bladder) after traumatic partial spinal cord injury above the level of T12 within 6-18 months after injury. Patients were randomly divided into two equal groups: the study group was subjected to TENS and pelvic floor exercises and the control group was subjected to PFBFB training in addition the exercises. Patients were assessed before and after treatment by means of cystometric measurements, electromyography activity of pelvic-floor muscles, and International Index of Erectile Function (IIEF-5) Questionnaire.
Results
Before treatment, there was no significant difference in cystometric measurements, pelvic-floor muscle strength, and IIEF-5 score. In the TENS group, the treatment produced significant improvement in bladder volume at first desire to void (
P
= 0.001), maximum bladder capacity (
P
= 0.001) and maximum flow rate (
P
= 0.001), detrusor pressure at maximum flow (
P
= 0.002), strength of pelvic floor muscles (
P
= 0.001), and IIEF-5 score (
P
= 0.001). PFBFB training resulted in significant improvement only in the maximum flow rate (
P
= 0.042).
Conclusion
TENS of pelvic floor muscles is a promising, safe, effective, and inexpensive physical therapy technique to improve urinary and erectile dysfunction in patients with partial suprasacral spinal cord injuries.
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The influence of physical therapy on oropharyngeal dysphagia in acute stroke patients
Mohamed S El-Tamawy, Moshera H Darwish, Hatem S El-Azizi, Ahmed M Abdelalim, Shereen I Taha
July-September 2015, 52(3):201-205
DOI
:10.4103/1110-1083.162046
Background
Dysphagia occurs in 65% of acute stroke patients, resulting in airway obstruction, malnutrition, and chest infection.
Objective
The aim of this study was to evaluate the effect of a designed physical therapy program that consists of therapeutic physical exercises in addition to neuromuscular electrical stimulation on severe swallowing disorders (oropharyngeal dysphagia) in acute ischemic cerebrovascular stroke patients.
Methods
Thirty stroke patients suffering from severe dysphagia were assigned randomly to two equal groups: the study group (G1) and the control group (G2). The patients in the study group (G1) received medical treatment in addition to a designed physical therapy program mainly directed at strengthening and stimulating the elevator muscles of the larynx above and below the hyoid bone, whereas the patients in the control group (G2) were under medical treatment only. Digital fluoroscopy was used to assess the following variables: oral transit time, laryngeal elevation, hyoid elevation, esophageal sphincter opening, and aspiration or penetration. Assessment was carried out before and at the end of treatment after 6 weeks.
Results
Before treatment, there were no significant differences in different variables between G1 and G2. After treatment there was significant improvement in all variables in G1 compared with G2, as measured by digital fluoroscopy.
Conclusion
The suggested physical therapy program could be an effective and safe method for improving and restoring the normal swallowing mechanism in ischemic stroke patients suffering from severe dysphagia.
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772
Serum matrix metalloproteinase-9 in acute ischemic stroke and its relation to stroke severity
Maged Abdelnaseer, Nervana Elfayomi, Eman Hassan, Manal Kamal, Ahmed Hamdy, Enji Elsawy
October-December 2015, 52(4):274-278
DOI
:10.4103/1110-1083.170661
Background
Thrombolytic therapy is currently the only FDA-approved treatment for acute ischemic stroke. Hence, early diagnosis and risk stratification is of great importance in management.
Objective
The aim of this work was to study serum level of matrix metalloproteinase-9 (MMP-9) within 24 h of acute ischemic stroke onset and its relation with clinical severity.
Patients and methods
Thirty patients with acute ischemic stroke were subjected to measurement of serum MMP-9 within 24 h of stroke onset and clinical assessment of stroke severity. Thirty healthy volunteers of matched age and sex were included as controls.
Results
Fifteen male and 15 female patients with a mean age of 61 ± 7.11 years were studied. The mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 11.17 ± 4.76. The mean serum level of MMP-9 in patients was 998.8 ± 154.72 ng/ml, which was significantly higher compared with the serum level of MMP-9 in controls (
P
= 0.003). The mean NIHSS of patients with normal serum level of MMP-9 was less than the mean NIHSS in patients with high MMP-9 serum levels (
P
= 0.003). There was a significant positive correlation between serum level of MMP-9 and NIHSS score (
r
= 0.5;
P
= 0.005) even after adjustment of other variables )age, sex, diabetes, hypertension, fasting blood sugar, uric acid, serum triglycerides, serum cholesterol, and right and left carotid intima media thickness( (
r
= 0.48;
P
= 0.032).
Conclusion
Serum MMP-9 level was found to be high in acute ischemic stroke patients and correlated with clinical stroke severity.
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Transcutaneous nerve stimulation versus aerobic exercise in diabetic neuropathy
Zahra M. H. Serry, Gehan Mossa, Hala Elhabashy, Soad Elsayed, Reem Elhadidy, Radwa M Azmy, Ahmed Mokhtar
April-June 2016, 53(2):124-129
DOI
:10.4103/1110-1083.183449
Background
Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, which is frequently associated with pain. Studies targeting the painful DPN are necessary to support clinical decision-making.
Objective
The aim of the present study was to investigate the efficacy of transcutaneous electric nerve stimulation (TENS) versus aerobic exercise, and to compare them with regular pharmacological therapy in patients with DPN, using sensory nerve conduction study and the visual analogue scale (VAS).
Patients and methods
This study included 60 diabetic patients with a history of DPN for 5 years. Patients were divided into three equal groups, all receiving regular pharmacological therapy. Group A received TENS of both lower limbs, three times per week. Group B received aerobic exercise. Group C received only pharmacological therapy. Patients were assessed before and 8 weeks after treatment. The VAS was used to measure the pain intensity before and after treatment, and the medial plantar nerve conduction velocity (NCV) to assess nerve function.
Results
Group A and B only showed a significant statistical difference between pretreatment and post-treatment pain intensity on VAS, with 41.67 and 16.67% improvement on the VAS, respectively. There was no statistically significant difference in pretreatment and post-treatment as regards the medial plantar NCV in any of the groups.
Conclusion
TENS, of moderate intensity, carried out at 14 Hz, with a pulse width of 250 ms, for 30 min and three times a week is more efficient than aerobic exercise training program in relieving pain in patients with DPN, whereas neither TENS nor exercise showed any significant effect on medial plantar conduction velocity (CV) in patients with DPN.
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Cortisol level in depressed patients and its relation with suicidal risk and anhedonia
Samia Ahmed, Fatma Moussa, Akmal Moustafa, Doaa R Ayoub
October-December 2016, 53(4):193-199
DOI
:10.4103/1110-1083.202375
Context
In recent times, there has been an increased interest in research related to anhedonia. Nevertheless, its linkage to major depressive disorders and underlying neurobiology are still not well understood. High levels of cortisol are associated with an increased risk for suicide as evidenced by several studies; however, others have not found this association between cortisol levels and suicidality.
Aim
The aim of this work was to examine whether there is an increased activity of the hypothalamic–pituitary–adrenal axis in major depressive disorder patients and to detect the presence of an association between the level of cortisol and thoughts of death and anhedonia in at-risk patients with major depressive disorder.
Settings and design
This case–control study that was conducted on 20 patients with major depressive disorder, diagnosed according to the
Diagnostic and Statistical Manual of Mental Disorders
, 4th ed., text revision, in comparison with 20 controls.
Patients and methods
All patients were assessed using the Present State Examination 10th revision of the Schedules of Clinical Assessment in Neuropsychiatry, Snaith Hamilton Pleasure Scale, Beck’s Suicidal Ideation Scale, and Beck’s Depressive Inventory. Blood samples were collected to assess plasma cortisol level in the morning and evening.
Statistical analysis
Statistical calculations were carried out using SPSS, version 15.
Results
There were increased levels of morning and evening cortisol in major depressive disorder patients. Thoughts of death were positively associated with elevated morning cortisol in depression. Anhedonia was associated with higher evening cortisol level in depressed patients in the studied sample.
Conclusion
There are relatively increased levels of morning and evening cortisol in major depressive disorder patients in comparison with controls; thoughts of death are positively associated with elevated morning and evening cortisol level.
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Frequency and determinants of subclinical neuropathy in type 1 diabetes mellitus
Yosria A Al-Taweel, Rasha M Fahmi, Nahed Shehta, Tamer S Elserafy, Hala M Allam, Ahmed F Elsaid
October-December 2016, 53(4):232-237
DOI
:10.4103/1110-1083.202383
Background
Diabetic neuropathy is the most common complication of diabetes. We hypothesized that uncontrolled diabetes is associated with subclinical diabetic neuropathy that is influenced by duration of disease. Assessment of the prevalence and associated determining factors will be important for the prevention and treatment of neuropathy.
Objective
This aim of this study was to assess the frequency and determining factors of subclinical peripheral neuropathy in type 1 diabetic (T1DM) patients.
Patients and methods
The current hospital-based, case–control study was conducted at Zagazig University Hospitals. It included three age-matched and sex-matched groups. Each group comprised 30 participants: group A included diabetic patients with a duration of T1DM of 5 years or less; group B included patients with a duration of T1DM of more than 5 years; and the control group included normal healthy individuals. Clinical assessment was carried out to exclude symptoms and signs of neuropathy. Laboratory investigations including fasting and 2-h postprandial blood glucose level, glycosylated hemoglobin (HbA1c), lipid profile, liver function, kidney function, and nerve conduction studies were carried out for every participant.
Results
The frequency of subclinical neuropathy in group A and group B was 46.6 and 76.6%, respectively, and this difference was statistically significant (
P
=0.03). Univariate analysis revealed significantly higher levels of HbA1c, dyslipidemia, and nerve conduction parameters in group B compared with group A and the control group. Multivariate logistic regression analysis showed that duration of diabetes (
P
=0.02) and HbA1c (
P
=0.02) were the only independent factors associated with subclinical neuropathy.
Conclusion
The high frequency of subclinical neuropathy in diabetic patients highlights the importance of nerve conduction studies for the early detection of neuropathy in T1DM.
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A study on serum levels of testosterone and prolactin hormones in male epileptic adolescents
Mohamed Osman Rabie, El-Sayed Ali Tag El-din, Khaled H Rashed, Wafik S Bahnasy, Hesham A El-Serogy
April-June 2016, 53(2):79-83
DOI
:10.4103/1110-1083.183407
Background
Testosterone and prolactin hormone abnormalities have been noticed in some epileptic patients and were attributed to either the direct effect of the disease or the effect of antiepileptic drug therapy.
Objective
The aim of this study was to evaluate the potential endocrinal dysfunction in nonmedicated male adolescents with idiopathic generalized epilepsy as well as those on valproate treatment.
Patients and methods
This study was performed on 40 epileptic patients, 20 newly diagnosed nonmedicated and 20 treated with valproate, who attended the epilepsy clinic in the Department of Neuropsychiatry, Tanta University Hospital. Twenty age-matched male healthy controls were also included. Patients were subjected to full history taking, neurological examination, evaluation of testosterone and prolactin blood levels, and electroencephalography.
Results
The serum levels of both free and total testosterone were higher in valproate-treated patients compared with nonmedicated patients and healthy controls. The levels were significantly lower in the nonmedicated group compared with the control group. The serum level of prolactin in both patient groups was significantly higher when compared with the healthy control group, with no statistically significant difference between the two patient groups.
Conclusion
The exact etiology of hormonal abnormalities in men with epilepsy appears to be multifactorial, including the disease and antiepileptic drug effects. Neuroendocrine regulation in men with epilepsy may be important not only for reproductive function but also for optimal management of seizure disorders.
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5,403
293
Vitamin D levels in a sample of Egyptian patients with multiple sclerosis
Dina A Zamzam, Mohamed M Fouad, Doaa A Elaidy, Doaa M Abd-Elaziz, Azza A Abd-Elaziz
April-June 2016, 53(2):107-110
DOI
:10.4103/1110-1083.183437
Background
Environmental factors such as vitamin D deficiency have been linked to the etiology of multiple sclerosis (MS) through interaction with genetic factors. Researches must be carried out to answer the question whether the relationship between vitamin D and MS is consistent and reproducible.
Objective
The aim of the present study was to assess the level of vitamin D in Egyptian MS patients.
Subjects and methods
In total, 111 patients with MS and 33 normal subjects were included in this study. Vitamin D level was estimated for each participant using the enzyme linked immunosorbent assay technique.
Results
Vitamin D levels were significantly lower among MS patients (ranging from 5 to 75 ng/ml with a mean ± SD of 26.4 ± 18.5) when compared with controls [ranging from 25 to 80 ng/ml with a mean of 51.2 ± 19.6 (
P
< 0.001)]. High expanded disability status scale scores were found to be related to low vitamin D levels.
Conclusion
Patients with MS tended to have lower vitamin D levels, and those with higher (expanded disability status scale) scores were more likely to have lower levels of vitamin D.
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300
Polysomnography and antidiuretic hormone secretion pattern in children with primary nocturnal enuresis
Hanan M Hamed, Amany M Abd Al-Aziz, Ayat A Motawie, Amany A. A. Fatouh, Mona A. M. Awad, Lamia Afifi
October-December 2015, 52(4):258-263
DOI
:10.4103/1110-1083.170658
Background
Nocturnal enuresis (NE) is one of the most common pediatric sleep-related problems. Data on sleep patterns in children with NE are conflicting.
Objective
We aimed at studying the sleep architecture, associated breathing problems, and its relation to antidiuretic hormone (ADH) in children with primary NE.
Patients and methods
This study included 31 children aged 6-18 years with primary monosymptomatic NE and 16 healthy matched controls. They were subjected to a single overnight polysomnography and assessment of ADH levels at 9-11 a.m. and 9-11 p.m.
Results
Enuretic children had significantly prolonged sleep latency and higher stage N1 percentage, less total sleep time, lower sleep efficiency, and lower rapid eye movement sleep percentage compared with the control group. Ten (32.2%) NE children had nocturnal arrhythmia, whereas six (19.35%) had a respiratory distress index more than 5. Reversed ADH secretion pattern was present in 82% of the NE children. Children with reversed ADH secretion had lower stage N1 and respiratory distress index, and higher sleep efficiency, compared with NE children with normal ADH rhythm.
Conclusion
Primary NE is associated with disturbed sleep architecture. NE could be a presenting symptom for hidden sleep disordered breathing. The association of NE with cardiac arrhythmia is an interesting finding that requires further research. Most NE children have a reversed pattern of ADH secretion.
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310
Lumbar puncture as a single modality for treatment of idiopathic intracranial hypertension during pregnancy
Ehab Mohamed Eissa, Lamiaa Ibrahim Daker, Mona Mohamed Shaban, Mohamed I Hegazy
January-March 2016, 53(1):33-36
DOI
:10.4103/1110-1083.176367
Background
Idiopathic intracranial hypertension (IIH) is seen typically in obese women in their child-bearing age, management of patients with IIH during pregnancy can be problematic.
Objective
The purpose of this study is to assess spinal tapping as a single modality for treatment of IIH during pregnancy.
Patients and methods
This was a prospective case series of seven pregnant women with IIH who underwent full neurological and ophthalmological evaluation including perimetry and neuroimaging studies. They were followed up and treated using only spinal tapping.
Results
Spinal tapping either single or multiple sessions can control IIH safely during pregnancy with a success rate of 86%.
Conclusion
Spinal tapping is recommended as a single treatment modality in pregnant women with IIH.
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321
Admission leukocytosis, C-reactive protein and erythrocyte sedimentation rate in acute noncardioembolic cerebral ischemia: influence on early outcome
Magdy A Mostafa, Mohamed K Elewa, Nevine Ahmed Mohamed
October-December 2015, 52(4):223-227
DOI
:10.4103/1110-1083.170651
Background
There is growing evidence regarding the role of inflammation in the pathogenesis of ischemic stroke, especially nonembolic types of ischemic stroke. Despite this, there is a need to investigate the direct impact of inflammatory markers on the early outcome in nonembolic ischemic stroke.
Objective
The aim of the present study was to determine whether positive inflammatory markers such as raised erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and leukocytosis could be used as biochemical predictors for poor early outcome in patients with acute noncardioembolic ischemic stroke.
Patients and methods
A total of 60 patients(40 men and 20 women; median age: 64.5 years) with first attack of noncardioembolic ischemic stroke were included in the study. Full clinical assessment and routine laboratory investigation were conducted for all patients. MRI of brain, ECG, and cardiac echo were carried out to confirm the diagnosis and exclude cases with embolic stroke. Blood samples for all patients within the first 24 h of onset of symptoms were taken for assessment of ESR, qualitative CRP, and leukocyte count on admission. National Institute of Health Stroke Scale was used for all patients after 7 days. On the basis of their scores patients were divided into two groups: 40 patients with favorable outcome were included in the first group and 20 patients with bad outcome in the second group.
Results
There was significant difference between the two groups regarding ESR value, and the leukocyte count was higher in the group with bad prognosis. In addition, positive CRP was associated more with the same group in statistically significant way.
Conclusion
Inflammatory markers play an important role in detecting the early outcome of noncardioembolic stroke.
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Diagnostic value of optical coherence tomography in patients with idiopathic intracranial hypertension
Dalia M Labib, Dalia H Abdel Raouf
October-December 2015, 52(4):249-253
DOI
:10.4103/1110-1083.170656
Background
Idiopathic intracranial hypertension (IIH) is characterized by raised intracranial pressure in the absence of space-occupying lesions or other known etiology. It mainly affects young obese women, and may cause visual loss due to secondary optic atrophy.
Objective
The aim of the study was to investigate optical coherence tomography (OCT) and perimetry changes in patients with IIH at admission and 6 months later and highlight the relationship between OCT changes and severity of visual dysfunction measured by automated perimetry.
Patients and methods
This study included 30 female patients with IIH. Cerebrospinal fluid opening pressure was recorded. Complete ophthalmic evaluation included assessment of best-corrected visual acuity, perimetry, and retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness within 3-4 days of performing the lumbar puncture. Thirty age-matched healthy women underwent a similar ophthalmological evaluation.
Results
In IIH patients the initial RNFL thickness was significantly higher, whereas GCC was significantly lower than that of controls (
P
= 0.045 and 0.004, respectively). The value of intracranial pressure measured was found to be positively correlated with the stage of papilledema (
r
= 0.494,
P
= 0.000). The final recordings showed significant decrease in GCC and RNFL values (
P
= 0.000 and 0.002, respectively) and improvement in mean deviation (
P
= 0.003).
Conclusion
GCC and RNFL thickness abnormalities in IIH patients were quantitatively correlated with visual field sensitivity losses. OCT is an effective tool for quantifying parameters of optic nerve damage.
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270
Monitoring occlusion therapy in amblyopic children using pattern visual evoked potential
Radwa M Azmy, Rasha H Zedan
January-March 2016, 53(1):1-5
DOI
:10.4103/1110-1083.176316
Background
Amblyopia is a unilateral or bilateral reduction of best-corrected vision that cannot be attributed only to a structural abnormality of the eye. It is a common childhood problem, and can be reversed if treated while the visual system is still maturing.
Objective
The aim of the present study was to investigate the role of pattern visual evoked potential (PVEP) in the assessment of visual function after occlusion therapy for children with unilateral strabismic amblyopia.
Patients and methods
Visual function was assessed clinically and using monocular PVEP, elicited by high-contrast checkerboard-patterned stimuli, before and after occlusion of the healthy eye for 1 week for every year of life in 20 children presenting with unilateral strabismic amblyopia.
Results
PVEP responses were significantly prolonged in latency in amblyopic eyes after the first assessment compared with nonamblyopic eyes. There was no significant difference in the interside amplitude. Assessment after occlusion showed a statistically significant reduction in the latency of the amblyopic eye and statistically significant improvement in the visual acuity.
Conclusion
PVEP can be used as a method of assessment of visual function after the occlusion therapy for children with unilateral strabismic amblyopia.
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330
Is peripheral arterial disease associated with carotid artery disease in Egyptians? A pilot study
Ahmed Sayed, Sandra M Ahmed, Ahmed M Abdelalim, Martin Nagah, Hussein Khairy
January-March 2016, 53(1):12-18
DOI
:10.4103/1110-1083.176324
Background
Atherosclerosis involves various vascular segments. The association of carotid artery disease (CAD) to peripheral arterial disease (PAD) is not well investigated in Egyptian patients.
Objective
In this pilot study, our aim was to examine the relationship between PAD and CAD in an Egyptian population.
Patients and methods
We examined 37 consecutive patients with PAD for the presence of CAD. Vascular and neurologic examination and duplex assessment of extracranial and intracranial carotid system and ankle-brachial index measurement were carried out to determine whether CAD is symptomatic or not.
Results
CAD was found in 20 (54.1%) patients. Eight (21.6%) patients had significant extracranial internal carotid stenosis and 13(37%) had intracranial stenosis and were more significantly above the age of 60 years. All patients with intracranial stenosis were men. PAD with RC6 was significantly associated with cerebrovascular events (
P
= 0.001) and significant extracranial stenosis (
P
= 0.013) and intracranial internal carotid stenosis (
P
= 0.001).
Conclusion
Intracranial and extracranial carotid stenoses are commonly present in patients with critical PAD. Duplex ultrasound screening for CAD presence and severity may be of great benefit, especially in the elderly and patients with critical limb ischemia. These findings need to be further confirmed in a study on larger population of Egyptians.
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Incidence and clinical predictors of outcome of Bell's palsy, Al-Quseir City, Red Sea Governorate, Egypt
Hamdy N El-Tallawy, Wafaa MA Farghaly, Ghaydaa A Shehata, Reda Badry, Mahmoud Hassan, Mohamed A Hamed, Mohamed A. M. Sayed, Khaled O Abdulghani, Sayed S Sayed, Tarek A Rageh, Nabil A Metwally, Khaled O Mohamed, Amal M Tohamy
April-June 2016, 53(2):70-73
DOI
:10.4103/1110-1083.183405
Background
Bell's palsy (BP) is one of the most common causes of acute-onset unilateral facial weakness. Through this study we aimed to estimate the incidence of BP in Al-Quseir City, Red Sea Governorate, Egypt.
Patients and methods
A project was undertaken to assess the epidemiology of major neurological disorders. A total of 33 285 eligible patients were screened through a door-to-door survey (every door) by three specialists in neurology and 15 social workers. All patients were subjected to detailed history taking and a meticulous neurological examination by means of a specific questionnaire designed for this study.
Results
Within 1 year, 27 patients were diagnosed with BP. This yielded an incidence rate of 98.9/100 000 population (aged 9 years and older). The incidence was higher in the male population than in the female population (116.4 and 81.2/100 000, respectively). Age-specific incidence of BP showed that its peak was between the ages of 18 and 60 years. About 78% of patients with BP recovered completely within 6 months after onset. There was no significant difference between male and female patients.
Conclusion
The incidence rate for BP was 98.9/100 000 among those aged 9 years and older. Most affected cases were older than 18 and less than 60 years.
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312
Helicobacter pylori
infection in Egyptians with Parkinson's disease: incidence and the effect on motor fluctuation and response to levodopa
Ahmed Esmael, Mohammed El-Sherif, Hany R Shabana, Ayman A Elazzouny
April-June 2016, 53(2):84-88
DOI
:10.4103/1110-1083.183408
Background
Gastrointestinal tract infection with
Helicobacter pylori
(HP) can inhibit levodopa (LD) in Parkinson's disease (PD) patients, leading to motor fluctuation.
Objectives
The aim of this study was to identify the incidence of HP in PD patients compared with healthy controls and its effect on motor fluctuation, response to treatment, and quality of life.
Patients and methods
Serum IgG Abs against HP urease were detected using enzyme-linked immunosorbent assay. We compared the incidence of HP infection in PD patients and controls. We compared PD patients with positive HP (PD positive) and PD patients with negative HP infection (PD negative) with regard to clinical features, the Unified PD Rating Scale (UPDRS) scores, Hoehn and Yahr (H and Y) stages, PD Questionnaire for the quality of life (PD-Q39), and PD Nonmotor Symptoms Questionnaire (PD NMSQ).
Results
Fifty Egyptians with PD were included. Forty-six percent of patients were HP positive compared with 20% in the control group; the difference was statistically significant (
P
= 0.043). In PD-positive patients, the total UPDRS and PD-Q39 scores were significantly higher in comparison with PD-negative patients (
P
< 0.005 and
P
< 0.001, respectively). The differences were not significant with regard to the total PD NMSQ score and H and Y stages between the two groups of patients. The LD onset period was significantly greater in PD-positive patients by nearly 14 min in comparison with PD-negative patients. There was a significantly prolonged on-duration time in PD-positive patients in comparison with PD-negative patients.
Conclusion
There is a high incidence of HP infection in PD. HP affects the response to LD and can deteriorate motor manifestations and the quality of life.
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301
Barriers for acute ischemic stroke treatment using recombinant tissue plasminogen activator in Mansoura Emergency Hospital: prehospital and inhospital delay factors
Mohammad Abu-Hegazy, Ibrahim Elmenshawi, Mohamed Saad
October-December 2016, 53(4):263-267
DOI
:10.4103/1110-1083.202377
Introduction
Effective treatment must start as early as possible as brain cells die rapidly after stroke. To increase the number of patients who are eligible to receive tissue plasminogen activator, measures are needed to reduce the prehospital and inhospital delay time. The study aimed to evaluate the possibility of thrombolytic therapy in acute ischemic stroke patients in Mansoura Emergency Hospital (MEH) by studying the effect of prehospital and inhospital delay factors.
Patients and methods
A standardized, structured questionnaire was completed for every stroke suspect; in it we documented the exact time of stroke onset, the way of referral and transport to hospital, and their demographic data. The exact time of patient arrival, time to neurology consultation, and detailed time delay inside MEH was marked on the forms of the hospital as well.
Results
In total, 435 patients had arrived MEH in less than 24 h, their mean age being 61.7 years. The median prehospital time was 2.7 h. Patients with younger age, locals, those who reached by private vehicle, or reached directly without any medical reference were significantly associated with early hospital admission. Sex, time of arrival, or severity of stroke had no influence on reaching hospital early. The median times to computed tomography request and acquisition were 20 and 35 min versus 25 and 45 min, respectively, National Institute of Neurological Disorders and Stroke recommendations.
Conclusion
Hyperacute treatment of ischemic stroke is possible in MEH. Methods to improve the emergency medical services and reduction of the patient circulation system in MEH will give more chance for these therapies by reducing prehospital and inhospital delay times.
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3,491
320
The effect of hypovitaminosis D normalization on diabetic neuropathy
Mohamad Saad, Wael M Gabr, Enaase Barakat, Asmaa F Enein
April-June 2016, 53(2):102-106
DOI
:10.4103/1110-1083.183436
Background
Few data on the association between vitamin D levels and peripheral nerve function are available from human studies, although diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus. Unfortunately, pharmacological treatment is often partially effective or accompanied by unacceptable side effects, and a new concept for the management of DPN is imperative. The purpose of this study was to clarify the impact of hypovitaminosis D correction on DPN in type 2 diabetic (DM2) patients.
Materials and methods
Fifty patients with a mean age of 54.72 ± 9.00 years with DM2 (disease duration 14.62 ± 5.95 years) were recruited. They were assessed clinically for neuropathy using the Michigan Neuropathy Screening Instrument, the Toronto Clinical Score System, and nerve conduction study (NCS) of the sural, popliteal, and ulnar nerves. At same sitting, vitamin D was assessed by measuring 25-dihydroxy, and then repeat Toronto Clinical Score System and NCS were carried out after vitamin D correction.
Results
Neuropathy severity was significantly improved after vitamin D supplementation. The mean ± SD neuropathy severity was 11.60 ± 2.90 before treatment and 10.82 ± 3.31 after treatment. Moreover, there was improvement of NCS in mild DPN after vitamin D correction but failed to show the same effect in moderate and severe cases.
Conclusion
Normalization of low vitamin D level has a potential beneficial effect in reducing neuropathy severity in DM2, and hence serum 25-hydroxyvitamin D level should be tested and low levels should be corrected to improve neuropathy symptoms. Further studies in a larger scale are required to confirm these results and re-evaluate patients with severe and moderate DPN.
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2,569
289
Sleep disorders in chronic kidney disease patients
Mohamed Eltawdy, Amany Rabah, Mona Nada, Rasha Refaat, Lamia Afifi
January-March 2016, 53(1):48-53
DOI
:10.4103/1110-1083.176372
Background
Sleep complaints are frequent among chronic kidney disease (CKD) patients.
Objective
We aimed to subjectively and objectively assess sleep disturbances in CKD patients and compare them between those who undergo hemodialysis (HD) and those who do not.
Patients and methods
The study was conducted on 40 CKD patients who were subdivided into two groups; group I included patients not undergoing HD (
n
= 20), and group II included patients on regular HD (
n
= 20). A total of 20 matched healthy volunteers participated as controls. Patients completed Epworth Sleepiness Scale, a sleep questionnaire, and underwent an attended polysomnography.
Results
All patients had sleep complaints in the form of excessive daytime sleepiness, difficulty falling asleep, early morning awakening, jerking leg movements, and fragmented sleep. CKD patients had lower total sleep time, sleep efficiency, slow wave sleep (SWS) percentage, oxygen desaturation, and higher respiratory distress and periodic limb movement (PLM) indices compared with controls. Group II patients showed a higher Epworth Sleepiness Scale and more frequent complaints of leg jerks. Furthermore, group II patients showed higher sleep efficiency and PLM compared with group I. Patients' age positively correlated with respiratory distress index and negatively correlated with total sleep time and oxygen saturation. The duration of illness and duration of dialysis positively correlated with the number of awakenings.
Conclusion
There is a high prevalence of sleep disorders in CKD patients whether they were on regular PLMs. Achieving a more complete understanding of sleep problems experienced by these patients can improve quality of life and patient survival.
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2,948
297
Knowledge and attitude towards stroke among workers in Cairo University Hospitals
Hatem S Shehata, Sandra M Ahmed, Ahmed M Abdelalim, Naglaa El Sherbiny
January-March 2016, 53(1):54-59
DOI
:10.4103/1110-1083.176374
Background
Stroke is a major cause of mortality and morbidity worldwide. Poor knowledge of stroke risk factors, symptoms and appropriate response to stroke are possible causes of poor outcome.
Objective
The aim of this study was to evaluate the knowledge and attitude towards different aspects of stroke in a sample of Cairo University Hospitals' workers.
Patients and methods
A structured self-administered questionnaire was administered by 111 workers who were classified into clinical workers (physicians, house officers, nurses, laboratory technician and pharmacists) and nonclinical workers (administrative, sanitary and security workers).
Results
Out of 111 participants, 92 completed the questionnaire. Most participants had heard of stroke (91.3%), mostly through encountering a family member with a stroke rather than through mass media (10.9%). Hypertension was the most common identified stroke risk factor (66.3%). Clinical workers were more likely to identify risk factors. The most common identified stroke symptoms were slurring of speech (38.5%) and elevated blood pressure (38.5%). Clinical workers were more likely to identify symptoms such as slurring of speech (
P
= 0.042) and altered state of consciousness (
P
< 0.001). The most frequent response to an attack of stroke was transferring the patients to a hospital (59.8%).
Conclusion
Knowledge and perception of stroke in Cairo University Hospitals' workers appear to be poor, especially among nonclinical workers. Planning educational programs for raising the level of knowledge and awareness of stroke, both on the level of hospital workers and on the public level, is important to improve stroke management and outcome.
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5,016
588
Multifocal electroretinogram in insulin dependent diabetes mellitus type I
Saly H Elkholy, Zeinab El-Sanabary, Mona M Nada, Neveen M El-Fayoumy, Amira Gohary, Elham N Fayed, Mohamed M Al-Kanishy, Hossam Mohammed
January-March 2016, 53(1):28-32
DOI
:10.4103/1110-1083.176350
Background
Diabetic retinopathy (DR) is one of the leading causes of new blindness. The multifocal electroretinogram (mfERG) has been demonstrated to be useful in objective assessment of various retinal disorders.
Objective
To evaluate the retinal function by mfERG in adolescents with insulin dependent diabetes mellitus type 1 (IDDMT-1) without clinically evident DR.
Patients and methods
A case/control study carried out on 30 adolescents (30 eyes) with IDDMT-1 for 5 years' duration or more in comparison with 20 healthy adolescents (40 eyes). Cases with DR were excluded based on ophthalmological examination, slit-lamp biomicroscopy and fluorescein angiography. mfERG-P1 wave-peak time and amplitude were measured and expressed in the form of four quadrants and fovea.
Results
In diabetic adolescents, mfERG-P1 wave had small amplitude in the four examined quadrants. The foveal response was small in amplitude and delayed in time as well. There is a significant negative linear correlation between the ages of the diabetic adolescents, the duration of illness, the glycosylated hemoglobin level and the amplitude of mfERG-P1 wave in the upper nasal quadrant only.
Conclusion
Homogeneous reduction of the amplitude of the mfERG test in IDDMT-1 goes with the diffuse nature of the microvascular affection of the retina even before the retinopathy becomes clinically evident.
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© The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Published by Wolters Kluwer -
Medknow
Online since 11
th
August, 2015