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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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Background Migraine headache is a common feature in multiple sclerosis (MS) patients, with variable prevalence among studies. It can influence the diagnosis, radiological evaluation, treatment, and quality of life of these patients. Objective The aim of the study was to assess the frequency and severity of migraine in a sample of Egyptian patients with MS and to study the clinical and radiological characteristics in those patients. Patients and methods We studied 55 patients with MS. They were subjected to full clinical and neurological assessment, including the diagnosis of migraine. Migraine diagnosis was made using a questionnaire based on criteria proposed by the International Classification of Headache Disorders, 2nd ed. Neurological impairment was evaluated with the Multiple Sclerosis Severity Scale; migraine severity evaluation was made using the Migraine Disability Assessment Scale. MRI of the brain and spinal cord was also performed. Results Migraine headache was present in 19 (34.5%) patients. Our results indicate that the majority of patients with coexisting migraine and MS develop migraine years earlier. There was no statistically significant difference between patients with migraine and those without with respect to the age at onset of MS, duration of illness, annual relapse rate, Expanded Disability Status Scale, and Multiple Sclerosis Severity Scale. However, midbrain periaqueductal affection in MRI was more prevalent among MS patients with migraine. Conclusion Migraine is comorbid in patients with MS. The exact etiology and pathogenesis of these two seemingly disparate disorders has not been completely understood.

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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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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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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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Background Diabetes mellitus (DM) is a well-known risk factor of ischemic stroke. However, the effect of glycemic control regardless of the presence of DM on the clinical picture of stroke and its impact on the severity and outcome of stroke is not fully investigated. Objective The aim of this study was to assess the impact of prestroke glycemic control regardless of the presence of past history of DM on the size of infarction, stroke severity, and functional outcome in patients with acute ischemic stroke. Patients and methods We measured glycosylated hemoglobin (HbA1c) level as an indicator for glycemic control in the last 3 months before stroke in 56 patients with the diagnosis of the first attack of acute ischemic stroke. There were 26 female and 30 male patients between 45 and 94 years of age. After history taking and full clinical examination, the size of infarction was measured using computed tomography scan of the brain. Stroke severity within 72 h from onset of symptoms was assessed using the National Institute of Health Stroke Scale and outcome of stroke after 2 months was assessed using the modified Barthel Index, both of which were assessed for each stroke patient. Results There was a significant positive correlation between the value of HbA1c and both the size of infarction and National Institute of Health Stroke Scale score assessed within 72 h from symptom onset (P < 0.01). In contrast, increased HbA1c value was significantly associated with a decrease in the modified Barthel Index score assessed after 2 months (P < 0.001). Conclusion Glycemic control has a significant effect on ischemic stroke severity and outcome.

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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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Background Poor behavioural inhibition is the central impairment in attention deficit hyperactivity disorder (ADHD). At present, there is no reliable objective measure to detect ADHD. A proper pinpointing evaluation for ADHD depends mainly on the history from parents, family members as well as teachers and schoolmates, by means of questionnaires and conduct rating scales. Objective The aim of this study was to detect continuous performance task (CPT) (test of variants of attention) changes in children suffering from ADHD compared with normal children. Patients and methods CPT, Conners' parent rating scale and Wechsler intelligence scale were done for two groups of children each containing 39 children, a group of ADHD children and the other a normal control group. Results We found a significant difference between the mean total IQ score among the ADHD patients group compared with control group. Comparing both groups revealed statistically significant increase in omission, commission and reaction time among patients. A significant negative correlation was found between age on one side and IQ, hyperactivity and psychosomatic subscales, hyperactivity and total DSM-IV scores on the other hand and between commission and opposition, restlessness subscales and ADHD index and also between reaction time and restlessness and emotional index. There was a significant positive correlation between omission and hyperactivity and anxiety subscales, restlessness and emotional indices and DSM-IV hyperactive and total scores. In addition, there was a significant positive correlation between perfectionism and commission and also between reaction time and inattention and social problems subscales. Conclusion CPT can have a substantial role in objective identification of ADHD.

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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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Aim The aim of this study was to measure retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) complex thickness with Cirrus optical coherence tomography (OCT) in Egyptian multiple sclerosis (MS) patients, and to correlate the OCT findings with the visual functions and neurological conditions. Patients and methods This study design was a cross-sectional one. A total of 40 eyes of 22 MS patients diagnosed according to the McDonald criteria were included in this study. Exclusion criteria were as follows: optic neuritis less than 6 months ago; best-corrected visual acuity (BCVA) less than 0.5; intraocular pressure more than 21 mmHg; cup-to-disc ratio more than 0.5; myopia more than 5 D; and eyes with other ocular or central nervous system diseases. All patients were subjected to the following: full history taking; complete ophthalmic examination, including visual functions (BCVA, color vision, and contrast sensitivity), intraocular pressure, and anterior and posterior segment examination; ophthalmic investigations using the Cirrus OCT (peripapillary RNFL thickness and macular GCL complex thickness); and complete neurological examination containing Expanded Disability Status Scale (EDSS). Results There were statistically significant negative correlations (which is mostly still thickened or biased with BCVA selection) between BCVA and the GCL complex of the superior areas among the studied patients. There were statistically significant negative correlations between color total errors and the GCL complex of the inferior temporal areas among the studied patients. No statistically significant correlations between contrast or EDSS and the GCL complex of any area were found among the studied patients. Conclusion GCL complex thickness is correlated better compared with RNFL thickness in MS patients with their visual functions (mainly color vision with the inferior temporal area of the GCL complex), and visual function is better correlated with them than with neurological disability measured using EDSS.

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