Association between helicobacter pylori infection and autoimmune hypothyroidism in Egyptian population

Autoimmune hypothyroidism commonly affecting females is one of the commonest causes of thyroid disease in adults. Among the various autoantibody tests applied in research and clinical practice, the determination of thyroid microsomal antibodies [TPO] and thyroglobulin antibodies [TG Ab] still retains its strong value in the screening for thyroid autoimmunity. Helicobacter pylori [H. pylori] infection plays an important role in the pathogenesis of chronic gastritis, peptic ulcer disease, MALT [Mucosa Associated lymphocyte T] Lymphoma and gastric cancer. The aim of this work was to study the relationship between H.pylori infection and autoimmune hypothyroidism in Egyptian population. This study was carried out on 147 Egyptian persons divided into 3 groups: Hypothyroid Group: Included 49 patients with autoimmune hypothyroidsm and positive antithyroid antibodies with no history of dyspeptic symptoms or peptic ulcer. H.pylori positive Group: Included 50 patients with dyspeptic symptoms or peptic ulcer with H.pylori positive antibodies with no history of any thyroid disease. Control Group: Included 48 apparently healthy persons serving as control. Serum Free T3, Free T4 and TSH were done for all subjects together with Antimicrosomal antibodies [TPO-Ab], Antithyroglobulin antibodies [TG-Ab] and Helicobacter Pylori antibodies [H. pylori Ab]. There was no significant difference between all groups as regards age. Also there was significant difference between Hypothyroid and H.pylori positive groups as regarding TSH and Free T3, TG-Ab, TPO-Ab and H. pylori Ab. There is also significant difference between Hypothyroid and control groups regarding TSH, free T3, TG-Ab, TPO-Ab, and H. pylori Ab. There is significant difference between H.pylori positive and control groups regarding FT3 and H. pylori AB. Hypothyroid Group was divided according to the presence of H. pylori Ab into ve and +ve H. pylori Ab subgroups. There was significant difference between the ve and +ve subgroups as regard TSH, free T4 and TG-Ab. H.pylori positive Group was divided according to the presence of TG Ab and TPO Ab into-ve and +ve subgroups. There was significant difference between the -ve and +ve cases in TSH, free T45 Free T3, and H.Pylori Antibody. Positive correlation was found between H pylori Ab titer and age, TSH, TG-Ab and TPO-Ab titers. There was also negative correlation between H. pylori Ab titer and free T4. There is no correlation between H. pylori Ab titer and free T3. [Correlation is referred to all subjects of the study = 147]. This study revealed that patients with positive TG and TPO antibodies, showed [+ve] H. pylori Ab, with significant high titer in their sera, The patients with positive H. Pylori Ab showed high serum titer of TG-Ab. In our study H. pylori-Ab correlates to thyroid function tests and thyroid antibodies

Role of dexamethasone iontophoresis in treatment of epicondylitis as evaluated with quantitative high resolution ultrasonography

To evaluate the effect of dexamethasone iontophoresis in treatment of epicondylitis based on high resolution ultrasonography. This study included 25 patients with epicondylitis and 14 healthy controls. Pain intensity was assessed by visual analogue score [VAS] and by patient global assessment [PGA]. Measuring the maximum grip force of the sound side, maximum grip force [MGF] and pain-free grip force [PFGF] of the affected side, using the hand grip dynamometer, were also assessed. Ultrasonographic assessment was performed for the site of complaint either the common extensor origin [CEO] or the common flexor origin [CFO]. Patients received 6 sessions of 4 mg/ml dexamethasone [DXM] iontophoresis on alternating days over a period of two weeks. After the treatment program, the patients were re-assessed both clinically and by ultrasonography. After treatment with dexamethasone iontophoresis, the decrease in the VAS, PGA as well as the changes in MGF and PFGF of the affected side was statistically significant. Regarding diagnostic US, abnormal findings were detected in 11 patients [44%] at the beginning of the study with no abnormal findings in the control group. High resolution ultrasonography proved to be of 48.5% sensitivity. and 65.7% specificity in diagnosing epicondylitis. The improvement of epicondylitis after iontophoresis treatment, though well evident and proved on clinical reassessment, couldn't be detected except in 3 patients out of the 6 patients reassessed by ultrasonography. Dexamethasone iontophoresis could be considered a simple, easy, safe, effective and non-invasive therapeutic option for epicondylitis. High resolution ultrasonography has a role in diagnosing epicondylitis but has no role in follow up

Electromyographic assessment of spinal stabilizing muscles activity in degenerative spondylolisthesis before and after a specific spinal stabilization rehabilitation program

To assess the electrical activity of local spinal stabilizing muscles in chronic low back pain [CLBP] diagnosed radiologically as degenerative spondylolisthesis, before and after a specific spinal stabilization program. Twenty patients complaining of CLBP longer than 3 months with or without radiation to the lower limbs diagnosed radiologically as degenerative spondylolisthesis were studied and compared to matched 10 controls. Patients underwent medical history, and thorough clinical and neurological examinations. Pain was assessed with McGill pain questionnaire, functional disabilities with Oswestry functional disability questionnaire. Flexion/extension plain x-rays were taken for spinal instability. Electrical activity [mean number of turns per second [T/s] and mean amplitude per turn [A/T]] of both lumbar multifidi [LM] and internal oblique [IO] was examined using surface electrodes. Group [I] of 10 patients received a specific spinal stabilization program and [II] received ordinary one. Reassessment was done after 10 weeks. Group [1] showed a significant improvement [p<0.05] in local spinal tenderness, lumbar paraspinal muscles spasm, painful back movements and overall electrical activity after than before rehabilitation program. The difference was highly statistically significant [p<0.001] for overall pain intensity, pain descriptor scores and functional disability scores. Group [2] showed a significant improvement [p<0.05] in spasm of lumbar paraspinal muscles, pain descriptor scores and functional disability scores. The difference was highly significant [p<0.001] for overall pain intensity, but not significant [p>0.05] for electrical activity of both LM and IO. After rehabilitation, group [1] had a significant improvement [p<0.05] in local tenderness and painful back movements as compared to group [II]. Group [1] had a highly significant improvement [p<0.001] in overall pain intensity, pain descriptor scores and functional disability scores. Group [1] had a significant improvement of overall electrical activity of the LM and IO [p<0.05] compared to group [II]. Group [1] had a highly significant improvement in [A/T] of IO [p<0.001]. Specific spinal stabilizing exercises are essential in any therapeutic exercise program advocated for treatment of CLBP patients

Neurodevelopmental assessment of children with idiopathic generalized tonic-clonic epilepsy: a short-term prospective study

The respective role of seizures, cerebral lesion, and antiepileptic drugs [AED] on development, cognition and behavior is difficult to identify and despite numerous clinical investigations, this remains questionable. The aim of this research was to assess neurodevelopment in children with newly diagnosed idiopathic generalized tonic-clonic epilepsy before and 6 months after treatment using the most commonly used AED in pediatric population as monotherapy [sodium valproate and carbamazepine] to determine the possibility of cognitive and behavioral effects of these AED. A randomized parallel group study design has been conducted on 40 children with newly diagnosed generalized tonic clonic epilepsy. Their age ranged from 4 to 9 years. All the included children received baseline neurodevelopmental assessment before administration of any AED. Then they were randomly assigned to two groups [20 patients each]. The first group received sodium valproate and the second group received carbamazepine as monotherapy, with follow-up and re-evaluation 6-month after initiation of treatment. Neurodevelopmental assessment of studied children included global developmental assessment using Denver II test, cognitive assessment using Wechsler Intelligence Scales, visual motor assessment using Bender-Gestalt test and behavior assessment using the Pediatric Symptom Checklist. The results showed that there were no significant differences between the valproate and carbamazepine groups on any neurodevelopmental measures neither prior to administration of the study drug nor at 6- month reassessment, except for picture completion score of performance IQ. Within group comparisons, using t-test for related samples determined that valproate group had a significant lowering of full scale IQ on reassessment. Performance IQ scores decreased significantly in both groups at the 6-month reassessment compared to pre-treatment scores in spite of complete control of seizures within the therapeutic dose. The same was observed with Denver I1 test, as the proportion of suspect cases to normal were significantly higher in both groups at 6-month reassessment. Analysis of Pediatric Symptom Checklist results showed that 35% of all patients [5 patients in valproate group and 9 patients in carbamazepine group] had score 2 [problems] before start of any treatment and this was significantly different after 6 months in valproate group only. There was no significant change in Bender-Gestalt score in both groups at 6-month reassessment. Significant relation was observed between lowering in IQ score after treatment and frequent seizures, cases with slow wave and spikes, and generalized epileptiform activity in EEG

Conclusions and Recommendations: the two studied drugs were associated with absolute cognitive and behavioral side effects, although these effects are significantly evident in valproate group. Therefore, the cognitive and behavioral effects of therapies for epilepsy must be an important consideration in the evaluation of risk/benefit ratios directing treatment decisions. Physicians prescribing anticonvulsants should monitor the child behavior, academic progress, cognitive function, and mood, during follow-up visits. Diagnosis of such selective changes early in life is of critical importance, both to provide the affected children with appropriate remedial help in school and in daily life and to protect against the adverse socio-emotional consequences that can impose on the developing child

Biochemical study of children with grand mal epilepsy treated with either carbamazepine or valproate sodium

The present study was conducted on 40 children with grand mal epilepsy attending the Pediatric Neurology Clinic of El-Shatby Children's Hospital [Alexandria]. They were divided into two groups Group [A]: those patients receiving valproate sodium as the sole drug therapy and Group [B]: those patients receiving carbamazepine as the sole drug therapy. Twenty patients from each group were investigated at three stages: Before starting treatment, after four weeks of treatment and after control of the attacks. Twenty healthy, age-matched children were studied as controls. Serum and CSF electrolytes,liver transaminases, alkaline phosphatase and lactic dehydrogenase were studied

study on the significance of postmortem serum electrolytes in diagnosis of drowning

Estimation of blood electrolhytes [Na, K, Ca, Mg and Cl]. Was useful to differentiate rabbits died by drowing in waters of different nature [Sea, Nile, Drainage and tap] from those of undrowned reference group. The most reliable index for differentiating sea water drowning from those drowned in fresh water was chloride followed by sodium. On the other hand, there was no mineral estimate that successfully differentiate between river, drainage and tap waters drownings