Effect of therapeutic electrical stimulation on spasticity, gait pattern and ankle range of motion in spastic cerebral palsied children

This study aimed to evaluate the effect of therapeutic electrical stimulation [TES] of the anterior tibial group of muscles on spasticity, range of motion [ROM] of the ankle joint and gait patterns in children with spastic CP. The study was carried out at neurology outpatient clink of Alexandria University Children's Hospital [El-Shatby]. Sixty spastic cerebral palsied children were randomly selected. They were divided into three groups I, II, and III. Group [I] comprised 34 children with spastic hemiplegia. Group [II] comprised 19 children with spastic diplegia. Group [III] comprised 7 children with spastic quadriplegia. Patients of the three groups were treated by electrical stimulation of the anterior tibial group of muscles at a frequency of 30 Hz with pulse width of 100ns for 7 seconds contraction and 15 seconds relaxation for one hour every other day for 3 months. Re-assessment was done using the following parameters: self-concept assessment, spasticity assessment of the ankle joint, goniometry of the ankle joint and gait pattern assessment [step length and step width] was done at the end of the study period. The study showed that TES had a significant positive effect on spasticity reduction in all types of spastic CP. Also, TES had a significant positive effect on ankle joint angle where it increased the passive ROM in all types of spastic CP. Furthermore, TES had a significant positive effect on gait patterns in the form of an increase in step length and decrease in step width in all types of spastic CP. Also, it had a significant positive effect on self-concept score in all types of spastic CP. Therapeutic electrical stimulation [TES] of the anterior tibial group of muscles in children with spastic cerebral palsy is an effective modality in decreasing spasticity of the extensor group of muscles of lower limb and increasing ability of dorsiflexion of the foot which will increase joint range of motion, improve gait patterns. All these will raise the patients' self concept with better quality of life despite cerebral palsy

Serological status of mumps in non-immunized Egyptian infants

The present study was conducted on 2114 infants divided into different age groups ranging from 6-18 months. All studied infants were subjected to full history taking, thorough clinical examination and laboratory investigation for semiquantitative measurement of mumps IgG by ELISA technique. The study revealed that maternally acquired mumps seropositivity wanes out gradually reaching its nadir level at the age of 12-13 months. Therefore, infants in this age period have a greater risk to develop mumps infection with either higher morbidity or mortality. Hence, the study recommended that MMR vaccination should be adopted at 12-13 months of age in the expanded program of immunization in Egypt as being the time of waning out of passively acquired mumps IgG

Cytomegalovirus load among Egyptian newborn infants admitted to the neonatal intensive care unit: new perspective

CMV transmission is very hazardous to neonates whether due to its severe congenital form or the latent effects of this virus. The aim of the study was to assess CMV load among Egyptian newborn infants admitted to the NICU, to clarify the risk factors for CMV transmission and to set clinical criteria for suspicion of this viral infection among such neonates. This cross-sectional prospective study included 260 neonates admitted to the NICU of the Gynecology and Obstetric hospital, Ain Shams University. Each enrolled case was subjected to detailed history taking laying stress on the socioeconomic st and ard, maternal diseases such as infection, fever, premature - rupture of membranes and past history of any abortion, neonatal deaths or affected newborns. APGAR score at 1 and 5 minutes, their birth weights and skull circumferences were assessed. Thorough clinical examination including assessment of gestational age was done together with regular follow up of the clinical course of the neonates during their NICU admission for a mean postnatal age of 12.35 +/- 10.34 days. In addition to the routine laboratory investigations and the sepsis screen, peripheral blood samples and nasopharyngeal secretions were taken from all the studied neonates on their first and fifth day of life for viral isolation using human fibroblasts cell line culture. Indirect Fluorescent Antibody [IFA] test was carried out for the identification of isolated CMV virus. The present study revealed positive viral culture in 49 cases, 13 of which were confirmed CMV by IFA. Ten of the CMV positive cases were detected in the first day sample [prenatally acquired] and the other three were detected in the fifth day sample which denotes either perinatal or community acquired infection. In all, 84.6% of the CMV positive cases were delivered prematurelv and 61.5% were IDM. Clinical examination showed that 53.9% of them had MCA, 53.9% had jaundice, 46.2% had rash and 38.5% had enlarged lymph nodes, 30.8% were hypothermic, 23.1% had poor peripheral perfusion, 7.7% were pale and 7.7% were cyanosed. Systemic examination revealed that 46.2% had HSM and 23.1% had abdominal distension. As regards the neurological manifestations, 30.8% had hyporeflexia while 15.4% had hyperreflexia, 38.5% were hypotonic while 15.4% were hypertonic and 15.4% suffered from tonic convulsions. A cardiac murmur was heard in 15.4% and inguinal hernia was detected in 7.7%. In conclusion, CMV acquisition especially the congenital form represent a significant problem among newborn Egyptian infants who may be asymptomatic or present with various manifestations ranging from mild to fetal illness. Thus increasing awareness of this viral infection, its ways of transmission, risk factors for neonatal acquisition and its mode of presentation are m and atory to prevent its neonatal as well as the delayed hazards

Thiamine status in protein energy malnutrition

Serum thiamine was studied in 51 malnourished infants and children and in the sera of 17 apparently healthy infants and children serving as a control group for a possible role of thiamine deficiency in nutritional edemagenesis. Patients were categoirzed according to Wellcome's classification into kwashiorkor, marasmus and marasmic kwashiorkor groups. The mean serum thiamine levels of patient groups were significantly lower than that of the control group with lower values in kwashiorkor gropus than in the marasmic group. The mean serum pyruvic acid levels, a substrate for thiamine pyrophosphate coenzyme, were significantly higher in the patient groups than in the control group. There was a significant positive correaltion between serum thiamine and albumin levels among the malnourished gropus. We concluded that serum thiamine deficiency and consequently the accumulation of pruvic acid besides hypoalbuminemia may play a role in the pathogenesis of edema in protein energy malnutrition

Neonatal retinal hemorrhage and neurobehaviour related to the mode of delivery

The frequency and severity of neonatal retinal haemorrhages was evaluated in 200 neonates. The influence of the mode of delivery was obvious as retinal haemorrhage was commonest in infants delivered by vacuum extraction [52 percent] and in infants delivered by caesarean section after being in labour [44 percent] while the incidence for those delivered normally was [31 percent] and for those delivered by forceps it was [24 percent]. No infant had evidence of retinal haemorrhage in the group delivered by elective caesarean section. The initial grading of retinal haemorrhage was positively correlated with its frequency in each group as well as the rate of disappearance. It disappeared in all infants delivered normally within the fifth day and in most cases within one week postnatally. All infants had normal ophthalmologic findings after the third month. The neurological assessment showed no relationship between the grade of haemorrhage and the neurological score. Behavioral assessment showed initial lower records for infants delivered by vacuum extraction or by caesarean section in labour. However, the predominant state after the 5[th] day postnatally showed normal records for all cases. It is emphasized that neonatal retinal haemorrhage is a common transient condition. Its incidence and severity are related to the mode of delivery. It is not related to abnormal neurological signs