Study of neuropathic pain among patients with chronic low back pain

Chronic low back pain refers to pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal fold [with or without leg pain] of 3 months or more in duration. Identify the neuropathic pain among patients with chronic low back pain through application of LANSS scale, identify the different aetiogenesis, study the associated medical conditions and socio-demographic features of neuropathic pain among patients with chronic low back pain. The study was carried out at Neurology department of AL Azhar University Hospitals, between Nov., 2006 and Dec., 2008. Sixty consecutive patients were included in the study. All of them suffered from chronic low back pain of 3 months or more in duration. They were subjected to the following: Complete history taking, full general and neurological examination with application of LANSS scale for detection of the neuropathic group. Routine laboratory investigation. Lumbosacral Plain x-ray anteroposterior, lateral and oblique views. Neurophysiological examination [NCS, EMG, SSEP] for the neuropathic group. Lumbosacral MRI for the neuropathic group. Ten normal controls were selected to match patient of neuropathic group in age, height and sex, they were subjected only for neurophysiologic examination [NCS and EMG]. The most prominent clinical features of neuropathic pain among patients presented mainly with neuropathic LBP where paroxysmal pain, dysesthesia, allodynia and altered pin prick threshold. The MRI has highly sensitivity for identification of disc prolapse. The needle electrode examination [NEE] has highly specificity for identification of radicuolopathy. The neuropathic pain is a contributing factor among patients presented with chronic low back pain and was attributed to many factors in our study like compressive radiculopathy, radiculopathy, nonspecific and discogenic cause. LANSS Scale is good bedside diagnostic tool that evaluate the presence of a neuropathic component of the low back pain

Proteinuria as a risk factor for stroke in type 2 diabetes mellitus

The study was designed to assess the relation between proteinuria and stroke in patients with type 2 diabetes mellitus. The study was conducted on two groups; Group I included 60 patients with type 2 DM with ischemic stroke, group II included 60 patients with type 2 DM without stroke. Both groups were matched by age, sex, body mass index and duration of diabetes. The study was performed at Al-Azhar University Hospitals from May 2005 to January 2006. The patients were evaluated clinically using Glasgow Coma Scale [GCS] for comatose patients and Canadian Neurological Scale [CNS] for conscious patients. Routine laboratory investigations as well as 24 hours urine protein were measured for both groups. CT scans were performed to all patients of group I within two days and after one week from the onset of stroke to determined site, depth and size of infarction. Systolic and diastolic blood pressures, prevalence of smoking and 24 hours proteinuria were significantly higher in group I than group II. On the other hand no significant changes were found on duration of DM, fasting and postprandial blood sugar, total cholesterol, LDL cholesterol, triglycerides, HbAlc, age and gender between two groups. In group I 38 patients were found to have proteinuria 38/60 [63%] versus 16 patients 16/60 [26.7%] had proteinuria in-group II, which was statistically significant. HDL-cholesterol only was significantly lower in-patients with proteinuria than those without proteinuria in-group I [p<0.01]. On the other hand no significant correlations were found between proteinuria and severity of strokes and CT findings. In multivariate logistic regression analysis, the ORs and 95% CLs for the variables identified as risk factors for stroke were as follow; SBP [OR 14.5, 95% CL 2.5-13.9], DBP [OR 13.1, 95% CL 2.4-15.9], proteinuria [OR 7.6, 95% CL 2.5-22.9], HDL cholesterol [OR 5.5,95% CL 2.1-23.5] and smoking [OR 4.89, 95% CL 1. 7-22.3]. Our results give evidence that proteinuria is an independent risk factor for ischemic stroke in patients with type 2 DM. Further support from additional prospective studies is recommended to confirm these findings

Pulmonary function tests in Parkinson's disease

The study was a cross-sectional and patient-control study. The study was performed at Al-Azhar university Hospitals from May 2005 to January 2006. The study was performed to document changes in respiratory pump and ventilatory function in idiopathic Parkinson's disease [PD] patients and its relationship with the main clinical presentation and the specific daily living activities [DLA] inthose patients. The study was conducted on 30 patients with PD and 10 healthy control volunteers. Patients were subjected to clinical evaluation by Unified Parkinson Disease Rating Scale [UPDRS] and respiratory pump function evaluation was done for patients and controls. Among patients group, 3 patients had normal pulmonary function [PF], 15 had obstructive PF pattern, 2 had restrictive PF pattern and 17 had upper airway obstruction. A significant disturbance in respiratory neuromuscular drive represent by the tracheal occlusion pressure after 100 m / sec from the start of quit inspiration [PO.l], decrease in respiratory muscle strength evaluated by maximum inspiratory pressure [PImax], marked respiratory muscle fatigue evaluated by [PO.l / PO.lmax]. A significant decrease in partial arterial oxygen pressure [PaO[2]] and increase in PaCO2 was found in patients group when compared to control group. Rigid / hypokinetic group patients 16/30 [53.3%] had significant [p<0.05] respiratory dysfunction rather than tremulous 14/30 [46.7%] group of patients. A significant negative correlation between the duration of disease, severity of illness, total daily living activity [DLA] and the severity of pulmonary dysfunction was found. Among the specific DLA, salivation and severe axial involvement was negatively correlated with maximum voluntary ventilation [MVV], PImax and PaO[2] Patients with Parkinsonis disease have impaired pulmonary function showing both obstructive and restrictive pattern, also abnormalities in mouth occlusion pressure and maximum inspiratory pressure were evident

Apoptosis and arterial thrombosis: expression of CD31 and CD146 in recent and old thrombotic disorders

Apoptosis [programmed cell death] of vascular lining endothelium is one of the causes of increased thrombogenicity. The Luminal release of apoptotic endothelium-derived microparticles can cause activation of tissue factor [TF], the most potent known inhibitor of the blood clotting system. The study was carried out at Al-Azhar University Hospitals on 70 cases of arterial thrombosis above the age of 25 years: Group 1: consisted of 15 apparently healthy subjects as a control group. Group 11: including 32 patients of recent thrombosis; 13 with cerebral infarction, 12 with acute myocardial in farction [MI] and 7 patients with peripheral arterial thrombosis. Group 111: including 38 patients with old thrombosis; 12 with cerebral infarction, 18 with MI and 8 patients with old peripheral arterial thrombosis. Endothelial-derived CD31 and CD146 were statistically higher in patients with recent and old arterial thrombosis than controls [p<0.005, p< 0.01] respectively and statistically higher in old than in recent arterial thrombosis [p<0.05]. Hypertension DM, smoking and lipid profile have no significant effect on CD31 and CD146. Finally, endothelial microparticle detection among cases of arterial thrombosis may indicate the persistence of the danger of re-thrombosis. Patients with acute and chronic ischemia have altered response of endothelial cells. It remains to be determined whether the reduction of the increased activity of CD31 and CD146 could provide an effective rationale for acute arterial thrombosis therapy

Correlation between transcranial doppler and magnetic resonance imaging of the brain in cerebral palsy

Cerebral palsy [CP] is a static encephalopathy that may be defined as non progressive disorder of posture and movement often associated with epilepsy and abnormalities of speech, vision and intelligence. The aim of our study was to assess haemodynamic alterations that might take place in children with CP using Transcranial Doppler [TCD] and to find out the correlation between Haemodynamic and structural abnormalities of the brain in CP. 40 patients with CP [age 1-10 years] were subjected to history, clinical examination and MRI brain and TCD was done for all patients and 20 children as control group to assess thmiddle cerebral artery [MCA] on both sides under sedation by chloral hydrate. Abnormal MRI findings were present in 92.5% of cases and normal MRI was found in 7.5% of cases. A significant correlation between MRI finding and clinical types was observed; atrophy was present in 50% of cases with spastic quadriplegia and periventricular leukomalacia diplegia. No significant difference between right and left side in both cases and control group in all parameters. A high statistical significant difference in the mean of flow velocities and indices was present between cases and control, the cases showed marked lowering of velocity in comparison to the control. No significant difference between different age groups of cases in TCD readings .No relation between clinical picture of CP and TCD readings. No relation between different MRI findings and TCD readings. All the hemiplegic cases showed reduction in the velocities at the affected side

Plasma adrenomedullin levels in patients with non-insulin dependent diabetes mellitus with and without complications

The present study was undertaken to determine plasma adrenomedullin [ADM] levels in patients with non-insulin dependent diabetes mellitus [NIDDM] to elucidate the potential involvement in the pathogenesis of diabetic complications. The patients were 31 males and 29 females with age ranging from 46-72 years [M +/- SD 57 +/- 12], the study were done at Al-Azhar University Hospitals and National Institute of Diabetes and Endocrinology between March 2000 and August 2000. Plasma ADM levels were 49.3 +/- 5.7 pg/ml in control subjects, 54.3 +/- 7.5 pg/ml in NIDDM patients without complications and 65.5 +/- 7.1 pg/ml in NIDDM with complications. Plasma ADM levels were significantly higher in NIDDM patients without complications than controls and in complicated vs non-complicated patients and their levels were not affected by plasma glucose concentrations. Plasma ADM levels increased dependently on the severity of diabetic complications and positively correlated with systolic blood pressure, serum creatinine, urinary excretion of albumin and fall in systolic blood pressure on standing up [sympathetic function]. In contrast, plasma ADM levels were reversely correlated with R-R interval on standing up 30:15 ratio [parasympathetic function] and conduction velocities of left ulnar nerves [peripheral neuropathy]. The results indicated that the increase in plasma ADM levels were closely related to diabetic complications, which may depend on the development of microangiopathy and play a certain role in protection against microvascular disturbance in diabetic patients