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  Most popular articles (Since August 11, 2015)

 
 
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ORIGINAL ARTICLES
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.
  3,433 224 1
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.
  2,019 537 -
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.
  1,811 277 1
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.
  1,766 240 3
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.
  1,611 223 2
Effects of vitamin D deficiency on the relapse, severity, and disability of multiple sclerosis
Ahmed Esmael, Mohammed El-Sherif, Ayman A Elazzouny
July-September 2016, 53(3):174-178
Background Multiple sclerosis (MS) is a long-standing inflammatory disease of the white matter and affects more than two million people worldwide. Upcoming evidence proposed that 25-hydroxy-vitamin D3 (25HVD3) deficiency could be one of the most crucial environmental elements for the pathogenesis of MS. Objective The aim of this study was to compare 25HVD3 levels in MS patients and controls and to detect the association with relapse, severity, and disability in MS patients. Patients and methods Mansoura Neurology Department data sheet was collected and all patients were assessed using the Expanded Disability Status Scale (EDSS) at the onset. 25HVD3 levels in the blood were evaluated for all patients and controls using the chemiluminescent immunoassay test. Results A total of 50 MS patients were included in this work and matched with 25 controls. There was a statistically significantly lower mean serum 25HVD3 level in MS patients in comparison with the controls (20.5 ± 16.8 and 42.9 ± 17.9 ng/ml, respectively; P = 0.002). In addition, there was a statistically significantly lower level of 25HVD3 (18.4 ± 17.7) in severe cases of MS (EDSS ≥ 6; P < 0.05) with certain significant clinical features such as older age (P < 0.001) and longer disease duration (P < 0.001). The incidence of 25HVD3 deficiency (<20 ng/ml) in MS patients was 60%. Conclusion Our results showed that there is an inverse correlation between 25HVD3 level and EDSS score. In addition, lower 25HVD3 levels are associated with increased relapse risk in MS.
  1,555 267 -
Visual dysfunction and neurological disability in multiple sclerosis patients in correlation with the retinal nerve fiber layer and the ganglion cell layer using optical coherence tomography
Said A Gomaa, Mohamed B Badawy, Amr M Elfatatry, Amr A Elhennawy
October-December 2016, 53(4):200-205
DOI:10.4103/1110-1083.202376  
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.
  1,534 258 -
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.
  1,307 230 4
Importance of early recognition of amyotrophic lateral sclerosis-like disorders in the Egyptian population
Heba Raafat, Radwa M Azmy, Reham Shamloul, Amr El Deeb
October-December 2016, 53(4):219-224
DOI:10.4103/1110-1083.202381  
Background Early stages of amyotrophic lateral sclerosis (ALS)-like syndrome when only one limb is affected can be missed by physicians suggesting other unrelated disorders especially with evidenced concomitant pathology of the same limb, leading to diagnostic pitfalls and unnecessary procedures. Objective The aim of this study was to support the diagnosis of early stages of ALS-like disorders in clinically suspected patients by electrophysiological studies (EDX) including segments that may be clinically unaffected, and searching for the possible etiology. Patients and methods This study was conducted on 120 adult patients with unilateral limb symptoms associated with irrelevant imaging abnormalities. Diagnostic workup included history taking, general and neurological examination, and EDX using the El Escorial diagnostic criteria. Further investigations included laboratory studies and paraneoplastic and hormonal assays. Results Motor nerve conduction studies revealed reduced amplitude of compound muscle action potential in 62.5% of patients, borderline conduction velocities, normal distal latencies, conduction block in one case, and normal sensory nerve conduction studies. Electromyography of the cranial, cervical, lumbosacral, and dorsal segments showed acute denervation in 80% of patients and chronic denervation in all segments in 35% and in three body segments in 65% of patients. Laboratory investigations revealed 50.83% of patients with chronic hepatitis C, with significant statistical association between EDX and laboratory results, 30.83% with hyperthyroidism, 8.33% with paraneoplastic syndrome, one case with multifocal motor neuropathy with conduction block, one case with myasthenia gravis, and 8.3% with negative results. Conclusion ALS-like disorder should be investigated whenever ALS is suspected, and further laboratory workup might unveil a coexisting ‘possibly causative’ pathological condition.
  1,327 208 -
Migraine comorbidity in patients with multiple sclerosis
Lobna M El-Nabil, Ghada Ashraf, Khaled O Abdulghani, Ayman Nasef, Mohammad Ossama Abdulghani
October-December 2015, 52(4):264-269
DOI:10.4103/1110-1083.170659  
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.
  1,324 139 -
Correlation between median nerve conduction studies and ultrasonography in cases of carpal tunnel syndrome
Hala R El-Habashy, Reem A El-Hadidy, Sandra M Ahmed, Basma B El Sayed, Aya S Ahmed
October-December 2016, 53(4):206-210
DOI:10.4103/1110-1083.202378  
Background Nerve conduction studies (NCS) have long been the only objective measure used to confirm the diagnosis of carpal tunnel syndrome (CTS), localize median nerve abnormalities, and exclude alternative diagnosis. Ultrasonography (US) can give information about the contents of carpal tunnel (CT) as well as aid in assessing the size of the median nerve (MN). Aim The aim of this study was to detect the relation between median NCS and cross-sectional area (CSA) of the MN measured using US in different grades of CTS. Patients and methods This study was a case–control, age-group matched, cross-sectional one. It included 60 wrists of 30 patients diagnosed with CTS and 60 wrists from 30 controls. Candidates were subjected to clinical assessment, median NCS, and measurement of CSA using US. Results There was a significant positive correlation between CSA of the MN at CT inlet and both motor and sensory responses latencies (r=0.638, P<0.001 and r=0.629, P<0.001, respectively). There was a significant negative correlation of CSA of the MN with sensory and motor amplitudes (r=−0.656, P<0.001 and r=−0.657, P<0.001, respectively). Median nerve CSA at CT inlet in the patients’ group was significantly higher than that in the control group (P<0.0001). CSA at CT inlet in early CTS was 13.27±1.56 mm2; 15.13±1.97 mm2 in mild, 16.47±4.16 mm2 in moderate, and 21.43±3.96 mm2 in severe CTS. Conclusion US is highly correlated to NCS results in CTS. CSA of the MN at CT inlet measured using ultrasonography can be used as a screening tool for detection as well as discrimination of severe cases of CTS.
  1,202 244 -
Postaneurysmal subarachnoid hemorrhage vasospasm: a review of the incidence of radiographic and clinical vasospasm
Ahmed M Ali Mahmoud
July-September 2015, 52(3):172-175
DOI:10.4103/1110-1083.162024  
Background Vasospasm following ruptured intracranial aneurysms has always been a challenging condition to treat. Objective The aim of this study was to correlate between clinical and radiographic vasospasms after aneurysmal subarachnoid hemorrhage (SAH) and to point out the other important causes of neurological deterioration. Methods This is a retrospective study conducted on 25 consecutive patients between June 2013 and February 2014 who presented with SAH. Altogether there were 18 male and seven female patients with ages ranging from 42 to 65 years. All patients underwent initial four-vessel or computed tomography (CT) angiography. All patients were treated by direct surgical clipping and all of them were operated upon 48-72 h from admission. All patients were assessed clinically and radiologically by CT scan and conventional angiography or CT angiography at day 10 of postbleeding. Results Out of 25 cases with aneurysmal SAH, 20 developed radiographic vasospasm, with only 11 cases developing clinical vasospasm. Conclusion The incidence of radiographic (angiographic) vasospasm was 80%, with only 55% of cases developing clinical vasospasm. Proper evaluation with laboratory tests and neuroimaging should be carried out in all cases to detect the actual cause of neurological deterioration and to start the proper treatment.
  1,246 161 -
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.
  1,105 295 2
Correlation between clinical neuropathy scores and nerve conduction studies in patients with diabetic peripheral neuropathy
Lamia Afifi, Ahmed M Abdelalim, Amal S Ashour, Aussan Al-Athwari
October-December 2016, 53(4):248-252
DOI:10.4103/1110-1083.202386  
Background Diabetic peripheral neuropathy (DPN) represents one of the most common complications of diabetes mellitus. Objective The aim of this study was to assess the correlation between clinical neuropathy scores and nerve conduction studies (NCS). Patients and methods This study included 30 (12 men and 18 women) Egyptian patients with type 2 diabetes mellitus complaining of symptoms suggestive of DPN. All patients underwent a clinical evaluation using three clinical scores: the Neuropathy Disability Score (NDS), the Neuropathy Impairment Score in the Lower Limbs (NIS-LLs), and the Diabetic Neuropathy Examination (DNE) score. Neurophysiological studies using NCS as well as measurement of glycated hemoglobin (HbA1C) were carried out. Results HbA1C was significantly correlated with NDS, NIS-LL, and DNE. The NDS was statistically correlated to median nerve sensory amplitude, sensory conduction velocity; ulnar nerve sensory amplitude, sensory conduction, motor amplitude, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. NIS-LL was significantly correlated with median nerve sensory amplitude, sensory conduction velocity; motor amplitude, motor conduction velocity; ulnar nerve sensory amplitude, sensory conduction velocity, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. DNE was significantly correlated with median nerve sensory amplitude, sensory conduction velocity, motor amplitude, motor conduction velocity; ulnar nerve sensory amplitude, sensory conduction velocity, motor amplitude, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. Conclusion Clinical neuropathy scores represent a simple tool for evaluation and follow-up of patients with DPN in comparison with NCS, and we recommend the use of these scores in clinical practice on a routine basis.
  1,181 214 -
Carpal tunnel syndrome among other referral diagnoses in the Egyptian Clinical Neurophysiology Unit
Ann A Abdel Kader, Mye A Basheer, Eman A Maher, Saly H Elkholy
July-September 2015, 52(3):183-187
DOI:10.4103/1110-1083.162035  
Background Nerve conduction (NC) studies and electromyography (EMG) are invaluable tools in the diagnosis of neuromuscular disorders. Databases with plenty of observations are useful in better assessment and safe and effective decision making. Objective The aim of this study was to analyze data provided by the EMG and NC records and to correlate referral diagnoses, especially carpal tunnel syndrome, with the final electrodiagnostic ones. This will offer strategic clues to minimize time, cost, and human errors. Methods The study was carried out in the Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University. Tabulation of EMG/NC details for the cases examined during the study period (first half of the year 2014), followed by extensive analysis of the data provided, was carried out. Results Most of the referral clinical diagnoses were of carpal tunnel syndrome (44%) and the least were of ulnar entrapment (1.3%). Concordance between referrals and final diagnoses was found only in 59.2% of patients. The most concordant referral was facial palsy and the most nonconcordant referral diagnosis was anal dysfunction. Conclusion Because of the occurrence of the referral diagnoses and the percentage of concordance between provisional and electrodiagnostic diagnoses, the unit is launching a local project for standardized guidelines for every provisional diagnosis.
  1,178 162 1
Carotid artery stenting in high-risk patients: a single-center experience
Mohamed K Elewa
October-December 2016, 53(4):211-218
DOI:10.4103/1110-1083.202380  
Background Carotid artery stenting (CAS) is a valid alternative to carotid endarterectomy in selected patients. Periprocedural risk of complications is the main determinant for CAS validity. Certain patients’ features may increase the risk of complication. Purpose To assess the management and outcome of the CAS in high-risk patient population. Patients and methods Clinical, treatment, and outcome variables of consecutive high-risk CAS candidates between January 2011 and June 2016 in one center were analyzed. Results Among 29 patients, 21 patients had successful CAS, and only one (3.45%) patient had minor periprocedural stroke. In total, six (20.69%) patients were shifted to carotid endarterectomy, and two (6.90%) patients were managed with medical treatment. Regression analysis showed that bovine arch was independent predictor of CAS infeasibility (P=0.006). The mean follow-up duration was 21.38±15 months. Follow-up duration passed uneventfully. Conclusion CAS in high-risk patients appears to be technically safe. The adverse outcome in high-risk patients is low and accepted. The morbidity and mortality is avoidable with better patient selection and the avoidance of aggressive manipulation whenever possible. CAS should be avoided in patients with certain anatomic risk factors such as type III arch and bovine arch.
  1,088 231 -
Value of seizure semiology and ictal source analysis in lateralizing and localizing the epileptic zone
Khaled O Abdulghani, Ahmad A Gaber, Azza A Abdulaziz, Heba H Afeefy, Taha K Alloush, Amira A Zaki, Mohammad Ossama Abdulghani
October-December 2015, 52(4):243-248
DOI:10.4103/1110-1083.170655  
Background Sophisticated analysis of seizure semiology and electroencephalography (EEG) has a significant role in lateralizing and localizing the epileptogenic zone. Hence, understanding the pathophysiology of epileptogenic dysrhythmia requires thorough knowledge of how to put the very different pieces of the puzzle together. Objective The aim of the study was to investigate the concordance between seizure semiology, electrophysiological generator, anatomical lesions, and neuropsychological evaluation in patients with partial epilepsy, and to identify the importance of ictal EEG recording and the diagnostic yield of other electrophysiological techniques. Patients and methods Thirty patients with a diagnosis of intractable partial epilepsy and lesional MRI were prospectively included. All of them were clinically evaluated and identified according to semiological seizure classification. Long-term video digital EEG with ictal recording was done, along with a source analysis (SA) study. Results Clinical evaluation by seizure semiology lateralized 73% of the cases and localized 80%. Ictal EEG lateralized 80% of cases and localized 66.9%. SA revealed a much superior power to lateralize and localize (96.7%) the epileptogenic zone, but what is more important is the added value of SA, as it lateralized and localized 96-100% of the cases that failed on semiology. SA has the highest expected value for additional lateralizing and localizing information ( ±7.73 and ±7.30, respectively). Conclusion Seizure semiology and ictal EEG recording with SA are the most accurate ways to lateralize and localize the epileptogenic zone in intractable partial epileptic cases, giving the patient a respectable chance to avoid other invasive diagnostic techniques.
  1,089 173 -
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.
  1,025 196 -
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.
  997 205 2
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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Retinal nerve fiber layer thickness in multiple sclerosis subtypes
Dina A Zamzam, Ayman A Gaafar, Ahmed T Ismail, Ahmed Elbassiouny, Mohamed A Tork, Haytham Hamdy
July-September 2015, 52(3):216-221
DOI:10.4103/1110-1083.162052  
Background Optical coherence tomography (OCT) is a promising tool for detecting subclinical changes in retinal nerve fiber layer (RNFL) and macular volume in multiple sclerosis (MS). Objectives The aim of the study was to assess the relationship of retinal changes in different MS subtypes with and without optic neuritis (ON) with clinical disability, duration of illness, and MRI results. Methods Twenty-four patients with relapsing-remitting subtype and 12 patients with secondary progressive subtype, of age range 16-55 years, with and without ON, and 16 age-matched and sex-matched healthy controls were enrolled in this study; in total, there were 15 male and 37 female participants. Patients were subjected to history, clinical evaluation, Extended Disability Status Score for disease severity, MRI brain with contrast, and OCT to assess the RNFL and macular volume of the optic nerve. The control group underwent OCT. Results RNFL thinning was highly correlated in both subtypes with and without ON in all field quadrants compared with the healthy controls. In addition, retinal and macular thickness inversely correlated with Extended Disability Status Score and disease duration in the progressive group than in the relapsing-remitting type. MRI with contrast inversely correlated with both macular and RNFL thickness in the progressive type. Conclusion Retinal axonal loss is more prominent in advanced stages of disease with proportionally greater thinning in eyes previously affected by clinically evident ON. In the absence of clinically evident ON, OCT is a promising potential biomarker of retinal pathology in MS subtypes.
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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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Effect of glycemic control on the severity and outcome of stroke in Saudi Arabia
Magdy A Mostafa, Nevine A Mohamed
October-December 2015, 52(4):228-231
DOI:10.4103/1110-1083.170652  
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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Neurophysiological and psychometric evaluation of cognition in the normal aging population
Ann A Abdel Kader, Ebtesam M Fahmy, Ayatallah F Ahmed, Omneya R Ameen, Amira A Labib, Alshaimaa S Khalil
July-September 2015, 52(3):188-193
DOI:10.4103/1110-1083.162041  
Background Assessment of cognitive function in normal aging has been considered as an important issue nowadays. There is a generalized proportional decline in mental processing speed among elderly adults that affects all elements of mentation equally. Objective The aim of this study was to assess cognitive functions in normal elderly individuals using psychometric cognitive assessment scales and electrophysiological studies including late cortical responses, P300 and contingent negative variation (CNV). Methods Thirty-five healthy elderly individuals of both sexes were included. Their ages ranged from 60 to 75 years. The participants were subjected to thorough clinical assessment, cognitive evaluation using psychometric scales and neurophysiological tests in the form of P300 and CNV. Results The results of P300 showed a significant positive correlation between reaction time and age. A significant negative correlation was found between reaction time and performance on the Wechsler Intelligence Scale (WIS) (P = 0.03). The mean amplitude of P300 wave recorded from the parietal region was significantly greater in male participants than in female participants. As regards the results of CNV, a significant negative correlation was noted between N2 latency and the verbal scale of WIS. Comparison of the mean CNV parameters between male and female participants showed that the mean latency of P2 wave was significantly higher in the male population compared with the female population. No significant correlation was revealed between P300 and CNV parameters and scores of Wechsler Memory Scale subtests and parameters of Wisconsin Card Sorting Test. Conclusion Results suggest that the psychiatric scales do not provide a substitute for electrophysiological tests in evaluating the cognitive changes that occur with normal aging. However, there was a limitation for the study in detecting changes because of the narrow age range of the cases.
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Muscle response of anticholinesterase-intoxicated rats to different therapeutic modalities
Abd-Elrahman M Elnaggar, Omayma A Khorshid, Amira A Labib, Inas A Harb
July-September 2015, 52(3):206-211
DOI:10.4103/1110-1083.162047  
Background Organophosphorus (OP) compound poisoning is a common, serious health problem that results in more than 250 000 deaths yearly worldwide, according to WHO estimates. Traditional use of atropine and oxime has failed to reduce the attendant morbidity and mortality. Objective The aim of the study was to evaluate the effects of magnesium sulfate and intravenous lipid emulsions versus the traditional standard of care - atropine and oxime - on butyrylcholineesterase enzyme (BuChE) activity and find whether there is a correlation between the enzyme level and muscle activity. Methods Adult female rats were used to study intermediate syndrome and a sublethal toxic dose of dimethoate (60 mg/kg) was used for induction of OP toxicity. Assessment of BuChE level, evaluation of De Bleecker score for muscle activity, and repetitive nerve stimulation test were carried out in all groups. Results The mean BuChE serum level was significantly reduced in the OP-intoxicated group compared with the normal control group. Significant improvement was recorded in the groups treated with oxime and intralipid emulsion. The De Bleecker scale showed elevated scores in all treated groups, and the best result was with oxime and magnesium sulfate. Regarding electrophysiological findings, the most frequently found were repetitive firing after single nerve stimulation and decrement response after repetitive nerve stimulation. Conclusion This study highlighted possible new trends that could prove beneficial in the management of OP poisoning and in improving the degree of muscle weakness and its impact on respiratory muscles.
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