Analysis of compound muscle action potential of median and ulnar nerves: possible anatomical correlation

To analyze the shape of CMAP of both median and ulnar nerves in apparently healthy individuals, and the anatomical innervations of small muscles of hand in cadavers. Motor conduction studies of both median and ulnar nerves for 300 apparently healthy adults were performed. The nerve supply of both thenar and hypothenar muscles were dissected in 10 adult cadavers. The mean amplitude and the mean distal latency [MDL] of the median nerve were significantly higher than that of the ulnar nerve [11.785 +/- 5.0, 10.45 +/- 2.96 mV respectively, and 3.38 +/- 0.41 and 2.698 +/- 0.40 ms respectively]. The median nerve had mostly dome shaped rather than double peaked CMAP [p=0.0001], while in the ulnar nerve it was more frequently double peaked [p=0.0001]. The MDL of the median nerve was significantly longer in those with dome shaped CMAP, while in the ulnar nerve it was significantly longer in those with dome shaped [p=.0001]. There were no statistical significant differences between the amplitude of dome and double peaked CMAP in either median or ulnar nerve.. The anatomical results showed that abductor pollicis brevis is supplied by the median nerve in 90% of specimens, and by both nerves in 10%. The abductor digiti minimi brevis is supplied by the deep branch of the ulnar nerve in 90% and by superficial branch of the ulnar nerve in 10%. There was a connection between the median and ulnar nerves in 50% of specimens. Variability in the pattern of innervations of the small muscle of the hand could be a possible etiological factor for the difference in the CMAP configuration of the median and ulnar nerves

Impact of the combined low dose prednisolone regimen on liver fibrosis in children with autoimmune hepatitis who responded to treatment

Autoimmune hepatitis [AIH] is a chronic liver disease characterized histologically by interface hepatitis. Hepatic fibrosis and cirrhosis can occur in many types of chronic liver injury including AIH. Recent studies have reported that hepatic fibrosis and cirrhosis may be reversible in some patients with AIH who respond to treatment. To assess the effects of treatment on fibrosis in liver biopsies of children with AIH who responded to the combined low dose prednisolone and azathioprine regimen. Twenty children with median age 8 +/- 3.5 yrs [9 girls, 11 boys], 18 AIH type I and two AIH type II, who were in clinical and biochemical remission for at least 6 months, and who had a diagnostic and a follow-up liver biopsy were included in this study. Different histological stains were used for assessing the grade of necroinflammatory activity [HAI] and for evaluating the stage of fibrosis according to Ishak scoring system. Morphometric analysis using LeicaQ500IS image analyzer was applied on Peri's stained liver sections to assess the percentage of liver fibrosis. Data revealed significant decrease in the median HAI from 8.85 to 3.6 [p=0.001]. The median fibrosis score showed significant reduction from 3.9 to 2.4 [p=0.001] and the median fibrosis percentage decreased from 28.7 to 12.8 [p=0.001]. These data provide evidence for regression of fibrosis in AIH in children who responded to the combined low dose immunosuppressive prednisolone and azothioprine regimen. Fibrosis control is associated with regression of necroinflammatory activity, which is the main treatment component in AIH

Retrospective study of infections in Egyptian patients with systemic lupus erythematosus [SLE]

Infections are one of the leading causes of morbidity and mortality in patients with systemic lupus erythematosus [SLE], therapeutic, dose-related and genetic factors all contribute to a lupus patient's increased susceptibility to infections. Although bacterial pathogens are the most common cause of infections, a wide variety of pathogens have been reported. Multiple risk factors for infection in SLE have been reported. These include disease activity, renal disease, gluco-corticoid use and cytotoxic therapies. The objective was to analyze infection risk factors in Egyptian lupus patients; the influence of these factors on disease activity, organ damage, disease development and the type of micro-organisms involved. The study included forty patients with SLE [37 females and 3 males] They were selected from those attending the SLE clinic in Ain Shams University hospital outpatient. Lupus disease activity had been established according to SLAM score. They were subjected to a retrospective study to : Complete medical history with special interest on duration of the disease, current treatment for lupus and dosage of prednisone, antimalarial drugs and immunosuppressive agents, number of infections whatever the cause during One year and number of admission due to episodes of infection whatever the cause. It included also symptoms of urinary tract infection [UTI] upper respiratory tract infection [URTT] as well as any complaint of the patient proved to be due to infection Laboratory assays included: CBC, ESR, serum creatinine, urine analysis, 24 hours protein in urine and culture when necessary. Increased incidence of infection in lupus patients which was 83 infections during the one year study. the incidence of Upper Respiratory Tract Infections was 8 infections [9.64%], Urinary Tract Infections 70 infections [84.34%], and Skin Infections 5 infections [6.02%] 83% of the cultures had had obtained from lupus patients. 83% of the urine were G- ve organisms. E. coli was the most common uropathogen encountered in this study [47%] which was resistant to most antibiotics but was sensitive to aminoglycosides. Skin infections were presented by abscesses 4 times [80%] -with predominance of staphylococci- and Herpes Zoster once [20%] There was a significant increase in the number of infection in relation to corticosteroids dose. There was a statistical significance between incidence of infection and addition of immunosupressive drugs to corticosteroids. There was a strong relation between incidence of infection and disease activity. SLE itself, increased dose of corticosteroids, use of immunosuppressive drugs and activity of the disease all are risk factors in incidence of infection in patients with SLE. UTI followed by URTI and skin infections including HZ were the most frequent infections in Egyptian SLE patients

Biochemical markers of fibrogenesis in pediatric chronic liver diseases

Objectives: Non-invasive diagnosis of hepatic fibrosis has become the focus, especially in the surveillance of treatment and in screening hepatic fibrosis. To investigate the clinical usefulness of fibrogenesis markers in evaluating liver fibrosis, we determined serum levels of TGF-beta1, collagen IV, and laminin., and their relationships with frequently used liver function tests, and findings of liver ultrasonography and liver biopsy were investigated

Methods: 50 patients with chronic liver diseases were enrolled from the National Liver Institute, Menoufiya University. Serum markers of fibrosis, liver function indices [for the patients and 30 controls], and ultrasonography for all patients were performed and compared with histologic fibrotic changes

Results: Serum levels of TGF-beta1, collagen IV. and laminin were significantly higher in patients than those in control [P<0.000]. The levels of serum fibrosis markers were not correlated with fibrotic scores [P>0.05], but laminin was positively correlated to histologic activity index. There were no significant changes in the level of serum fibrosis markers related to ultrasonographic findings. Their levels were also not correlated to ALT or AST. The cut-off values, specificity and sensitivity were determined for all markers, among which collagen IV was the marker with the highest sensitivity and specificity

Conclusion: Serum level of TGF-beta1, collagen IV, and laminin can be used as indices for the diagnosis of hepatic fibrosis. Among them, collagen IV is more sensitive. Biochemical markers of fibrogenesis might be useful in regular monitoring of disease development and treatment effectiveness and should be inseparable part of progression assessment in all chronic hepatopathies

Plasma endothesin-1 and renin as predictor factors in schistosomal liver disease of children

Endotheh-1 [ET-1] is a mitogenic and a potent vasoconstrictor peptide. It affects the hemodynamics of the liver and plays a role in fibro genesis through activation of stellate cells. Also renin-angiotensin system, which is activated in liver cirrhosis, may play a role in the pathogenesis of portal hypertension associated with schistosomal liver disease. The role of plasma ET-1 and renin in schistosomal liver disease and their clinical significance remain largely under investigated particularly in children. This study included 20 patients attending Pediatric Department of National Liver Institute, Menoufyia University, or Pediatric Department of Tanta University Hospital. Their mean age was 10.2 +/- 2.1 years. A control group of 20 healthy children of matched age and sex was included in the study. For all study children, history, physical examination, urine and stool analysis, CBC, kidney function tests and liver function tests were undertaken. Rectal snip biopsy, abdominal ultrasound examination and liver biopsy were utilized to diagnose our patients. Plasma ET-4 and renin were measured by radioimmunoassay. The mean level of ET-1 in the control group was 0.83 +/- 0.20 pg/ml with a range of 0.49 to 0.99 pg/ml, In contrast, the mean ET-1 level in the patients group was 1,37 +/- 0.6 pg/ml with a range of 0.49 to 2.24 pg/ml. The difference was statistically significant [p=0.001]. ET-1 was found to be elevated [2 SD above the mean control value] in 9 of 20 patients [45 %] with mean of 7.8 +/- 0.37 pg/ml and a range of 1.49 to 2.24 pg/ml. ET-1 was elevated in 2/11 [19%] of patients with hepatomegaly, in 2/3 [67%] of patients with hepatosplenomegaly, in the only case with shrunken liver 1/1 [100%] and in 4/5[80%] of patients with ascites. The relation of ET-1 elevation to the stage of disease was statistically significant [p=0.026]. Elevated ET-1 was found in 6/1 [86%] of patients with elevated ALT, compared with 3/13 [23%] of patients with normal ALT. This relation was statistically significant [p=0.017]. Plasma ET-1 levels appeared to correlate with duration and severity of the disease. Unlike in cirrhotic patients previously reported, renin was normal in all studied cases with no significant difference between patients of all disease stages versus controls. in the control group the mean plasma renin level was 2.52 +/- 1.23 ng/L and ranged from 1.23 to 3.81 ng/L while in the patients group it was 2.09 +/- 1.06 ng/L and ranged from 0.72 to 3.45 ng/L. This might be attributed to the stable hemodynamics and normal renal function of our study cases

Conclusions: the present study suggests that ET-7 level might be elevated in cases of schistosomal liver disease of Egyptian children particularly advanced cases. Elevated ET-1 might be involved in the aggravation of the disease or development of complications like portal hypertension 3rd ascites. So, monitoring ET-1 level along the course of the disease may be useful as a predictor for the development of these complications and may be helpful in the prevention planning. Plasma renin measurement probably has no important role in following up schistosomal liver disease during childhood

Open versus arthroscopic partial meniscectomy in pure meniscal tears

This study is a review of 115 cases of Knee injuries with pure meniscal tears that had been subjected to partial meniscectomy; 67 cases were done through an arthrotomy and 48 cases by using arthroscopy. The results of both open and closed techniques were compared. It was found that the arthroscopic partial meniscectomy is superior to open partial excision