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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.
  2,015 140 -
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.
  1,182 157 1
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.
  1,077 162 -
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.
  1,037 191 -
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.
  986 143 -
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.
  905 152 2
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.
  854 118 1
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.
  823 104 -
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.
  840 79 -
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.
  748 101 1
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.
  714 93 1
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.
  708 82 -
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.
  656 76 -
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.
  618 112 -
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.
  568 128 -
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.
  598 81 -
Sleep-related breathing disorders in stage II essential hypertension
Amira Labib, Lamia Afifi, Reham Shamlool, Mona M Nada, Hanan A Amer, Saly H ElKholy
October-December 2015, 52(4):232-237
DOI:10.4103/1110-1083.170653  
Background Sleep-related breathing disorders (SRBDs) are reported to be common among patients with hypertension (HTN). Objective Our aim was to use polysomnography (PSG) to objectively study the frequency and types of SRBDs in essential stage II HTN. Patients and methods We used an attended full PSG recording in a group of 20 patients suffering from stage II HTN and in a group of 20 age-matched and sex-matched controls. The Berlin Questionnaire was also administered to the patients. The patients were assessed for a history of smoking, fasting blood sugar, and BMI. Results We found that 70% of HTN patients had SRBDs: 15% had mild, 30% had moderate, and 25% had severe SRBDs. As for the controls, we found that 40% of controls had SRBDs: 20% had mild, 15% had moderate, and 5% had severe SRBDs. The overweight patients with HTN had a significantly higher hypopnea index compared with normal weight patients. The diabetic hypertensive group showed a lower sleep efficiency. In addition, all the high-risk patients identified by the Berlin Questionnaire showed evidence of SRBDs, but not all SRBD patients were identified as high-risk patients by the Berlin Questionnaire. Conclusion SRBD is very common in stage II HTN. Clinicians should be aware of this high prevalence and make use of the Berlin Questionnaire and PSG, as treatment for SRBDs can have a profound impact on these patients.
  574 89 -
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.
  550 94 -
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.
  527 110 -
Impact of early stages of (mild) hepatitis C viral infection on neurocognitive functions in otherwise healthy patients: an Egyptian magnetic resonance spectroscopy study
Hatem Anwar ElMassry, Nahla Elsayed Nagy, Walaa Mohamed Sabry, Reem Hassan El-Ghamry
October-December 2015, 52(4):238-242
DOI:10.4103/1110-1083.170654  
Background The alterations in cerebral function in patients with chronic hepatitis C virus (HCV) infection may be due to a direct effect of HCV on the brain, or due to neurotoxic-related systemic inflammation. Objective This study aimed to assess central nervous system involvement through brain magnetic resonance spectroscopy (MRS) as well as cognitive functions in HCV-infected patients with mild liver disease. Patients and methods Twenty-eight HCV-infected patients with slightly elevated liver enzymes were recruited from the outpatient Hepatology Clinic, Beni Sweif University Hospitals and Ain Shams University Hospitals. They underwent cognitive examination by means of the Wechsler attention, concentration, and memory subscales, as well as cerebral MRS. The results of all investigations were compared with corresponding results of 15 matched normal controls. Results The results showed mild but significant elevation of liver enzymes in the patient group compared with the control group with impaired levels of attention, concentration, and memory determined by the subscales. MRS findings showed elevated choline and myoinositol in the basal ganglia, decreased N-acetyl aspartate, and abnormal N-acetyl aspartate/creatine ratio. Conclusion Treatment plans for HCV should consider neuropsychological complications.
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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.
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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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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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Quantitative electroencephalographic changes in attention deficit hyperactivity disorder children
Ann A Abdel Kader, Nagwa A Mohamed, Omnia R Amin, Basma B El Sayed, Islam F Halawa
October-December 2015, 52(4):270-273
DOI:10.4103/1110-1083.170660  
Background The electroencephalogram (EEG) has long been used to pick up and analyze the electrical activity of the outermost layer of the brain. Attention deficit hyperactivity disorder (ADHD) patients revealed increased power in the lower frequency bands (δ and θ power) and a raised θ/β ratio. Objective The aim of this study was to detect the quantitative EEG changes in children with ADHD compared with normal children. Patients and methods The sampled group consisted of 45 children suffering from ADHD and represented the patient group, and 45 normal children represented the control group. EEG was recorded under resting conditions for all participants. Data from frontal areas were digitally processed and analyzed to calculate the four frequency bands' power (β, α, θ, and δ) and then θ/β ratio was computed. For the patient group, the Wechsler Intelligence Scale for Children was applied and parents of these patients filled out the Arabic version of Conners' Parent Rating Scale-revised-long version. Results The patient group showed significantly higher θ/β ratio in frontal areas compared with the control group (P < 0.05). There was a significant negative relation between age and θ/β ratios and a significant negative relation between age and Conners' hyperactivity subscale (P < 0.05). There was a significant positive relation between Conners' hyperactivity subscale and mean θ/β ratio (P < 0.05). Conclusion Quantitative EEG markers - namely, the θ/β ratio - could play a role in the understanding and identification of ADHD.
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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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